Why Rheumatology Needs a Direct Care Model: Dr. Abhijeet Danve’s Perspective on Access, Time, and Outcomes
The practice of Rheumatology depends heavily on time, pattern recognition, and longitudinal observation. Unlike many acute medical conditions, inflammatory and autoimmune rheumatic diseases often evolve gradually, with symptoms that fluctuate and overlap across diagnoses. According to Dr. Abhijeet Danve MD MHS, a board-certified rheumatologist, CEO and founder of Axis Rheum, this inherent complexity is precisely why the traditional insurance-based care model often falls short for rheumatology patients.
Rheumatology is not built for rushed care
Most rheumatologic conditions do not present with a single defining clinical, test or imaging finding. Diagnosis frequently relies on:
- Detailed symptom history
- Understanding how the symptoms behave over time
- Evaluating different organ based symptoms and family history
- Interpreting laboratory and imaging results in the correct clinical context
- Monitoring disease activity and progression across multiple visits
Dr. Danve notes that this process is difficult to execute within short, highly constrained appointment slots. When visit time is limited, important clinical details may be missed, and follow-up becomes fragmented.
The problem of lack of access to care in rheumatology
Across the United States, access to rheumatology care remains a growing challenge. The ACR’s 2015 workforce analysis estimated about 5,595 adult rheumatologists in 2015 and projected a decline to ~4,246 by 2030, while projected need rises to ~8,184—worsening the national shortage. This shortage (plus geographic maldistribution) translates into reduced access to timely specialty care and new-patient rheumatology wait times being longest among the other specialties. Many patients report waiting several weeks or even months for an initial appointment. During this time:
- Symptoms may worsen or evolve
- Diagnostic uncertainty increases
- Patients often cycle through urgent care or primary care visits
- Treatment decisions may be delayed
- Patients may undergo unnecessary testing and treatments for unrelated conditions
Dr. Danve emphasizes that these delays are not simply inconvenient. For inflammatory and autoimmune conditions, delayed evaluation can affect symptom control, functional outcomes, and long-term disease management.
Insurance-driven care does not always align with clinical needs
In traditional insurance-based systems, care delivery is often shaped by administrative requirements over the clinical priorities. This can affect rheumatology care in several ways:
- Limited appointment durations
- Restrictions on visit frequency
- Delays related to authorizations
- Fragmented communication across providers
While insurance plays an important role in healthcare financing, Dr. Danve points out that it does not always guarantee timely or comprehensive access to specialty care. In rheumatology, where continuity and clinical reasoning are central, these constraints can limit effectiveness.
Why time matters in inflammatory and autoimmune diseases
Inflammatory arthritis and autoimmune diseases often follow unpredictable courses. According to Dr. Danve, effective care requires:
- Time to listen and clarify symptom patterns
- Structured follow-up to observe progression
- Flexibility to adjust plans as disease activity changes
- Patient understanding of their condition and options – this is the most critical part
Without adequate time, care risks becoming reactive rather than thoughtful and anticipatory.
The rationale for a direct care rheumatology model
The direct care model removes insurance billing for visits, allowing the physician–patient relationship to function without administrative intermediaries. In a rheumatology context, this model supports:
- More predictable access to appointments
- Longer and more focused clinical discussions
- Continuity with the same specialist
- Clearer expectations around care and costs
Dr. Danve explains that direct care is not about replacing insurance altogether. Rather, it allows insurance to be used where it is most appropriate, such as for labs, imaging, medications, or hospital services, while preserving clinical time for evaluation and decision-making.
How direct care influences outcomes
While outcomes in rheumatology depend on many factors, Dr. Danve highlights several areas where direct care may support better long-term management:
- Earlier clarification of symptoms and diagnoses
- Reduced delays in initiating appropriate treatment
- Improved patient understanding and engagement
- More consistent monitoring of disease activity
These elements are particularly relevant for conditions such as axial spondyloarthritis, psoriatic arthritis, gout, and rheumatoid arthritis, where early recognition and structured follow-up can influence disease trajectory.
A model designed around the realities of rheumatology
Axis Rheum was developed with these principles in mind. The practice is structured to provide direct access to rheumatology care, including a free 10-minute introductory video call that allows patients to understand the model before committing to care.
Dr. Danve emphasizes that this approach is not necessary for every patient or every condition. However, for individuals navigating chronic inflammatory or autoimmune disease, the ability to access timely, focused, and continuous specialty care can be meaningful.
The takeaway
Rheumatology is a specialty defined by complexity, nuance, and time. Dr. Abhijeet Danve’s perspective reflects a growing recognition that traditional care models are not always well aligned with these realities.
By prioritizing access, continuity, and clinical time, the direct care rheumatology model seeks to address long-standing gaps in specialty care delivery. For many patients, this approach offers an alternative pathway toward clearer understanding and more structured long-term management.