RHUEMATOLOGY Questions

i did a rheum elective. rheum is not that competitive right now but my attending had said that the field is getting more competitive as the years progress. research vs. clinical tracks are still separate. most people accept that there is a pay-cut when you subspecialize in rheum, but people can make it more lucrative if they focus on pain mgt (some rheum folks are getting trained in spinal analgesia). i am sure research experience will play a bigger role in securing loftier programs. some top programs include ucsf, mayo, michigan, and harvard, but i'm not sure of all of them.

i think rheum has great potential especially with the advances in immunotherapy that is being used for many types of autoimmune diseases. it's also a good IM subspecialty if you want to re-incorporate some of the basic sciences/pathophysiology

-s.

Gwen:

Correct me if I am wrong, but weren't your doing PM&R? If I may ask, why the rheum considerations? I'm matching in PM&R this year and was wondering if you were having second thoughts. Sorry to pry, just curious.

Sanfilipo hit the mark with his comments. Though any of the more cerebral subspecialties confront lesser reimbursements than those which are procedure oriented, the income is nevertheless more than sufficient for a nice lifestyle. Probably the biggest boon to Rheumatology incomes of late is the ability to do in-office infusion therapy (currently with infliximab, but newer drugs are in the pipeline). Many Rheumatologists, depending upon their location, also do Bone Densitometry in their offices as another source of added revenue. Still, this will never equal the dollars generated by invasive cardiology or gastroenterology.

There are terrific training programs in Rheumatology at all of the
top-notch academic centers. I do not believe that any one institution holds a monopoly on excellence. The programs to which Sanfilipo alluded are all leaders. From what i hear, UCLA and Hopkins also have great clinical people in addition to turning out top-notch research. Washington University also has a strong rheumatology program, although the full-time faculty may be more research than clinically driven.

I am not a rheumatology fellow but i have one friend currently going through his rheumatology fellowship and another one who just got done with it and is in practice. If you have any specific questions to ask them, i will be more than glad to forward your questions or concers to them.

Don't mean to hijack your thread but I have alot of questions about Rheumatology too. For instance what is the typical lifestyle of a Rheumatologist (hours per week/call)? Do most practice Rheum. only or combine int med? Do you really take a pay cut from int med or is it possible to earn ~200K/year? Is most of the work outpatient or inpatient? How is the job market in urban areas in NYC or Boston? Finally, how do see the future of Rheum in terms of medical advances and new procedures and technology (is it going to be a exciting and cutting edge field)

-thanks

bump

while i think rheum is a great field, don't expect the money to be rolling in.

infliximab is not better than enbrel or humira for rheumatoid arthritis. so i can't see infliximab infusion therapy really being justified as a treatment for ra.

Although Remicade is not more clinically efficacious than Enbrel or Humira in RA, it is an option for RA refractory to such treatments. However, I honestly don't think that we have seen the last of IV immunomodulatory therapy. Studies are currently underway evaluating the role of zolendronate, which is IV, in the treatment of both Paget's disease and osteoporosis, which some rheumatologists actively manage.

-s.