What you are saying makes sense except here we run into the reality of rural GA (or AL or MS or AR or any other Southern state). There are literally no pediatric rheumatoligists outside of Atlanta, and no adult rheumatologist will see her until she's 18. We have a real problem with healthcare in rural GA in terms of how there isn't any. It's part of the public discourse of suckitude.

However, what you are saying about what to do about subsequent visits totally apply: how much can we phone this, email this, call this in, Skype, etc.