Rheum

[Cranjis McBasketball]

Is it possible for family medicine docs to treat some of the more common rheumatologic disorders? I only ask because I have personal friends/family that have these issues but can never get into a rheumatologist (this could be geographical). So this is something I am interested in and hits close to home, but I am not sure if its feasible after a 3 year residency; I'm talking biologics and such

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[VA Hopeful Dr]

Is it possible for family medicine docs to treat some of the more common rheumatologic disorders? I only ask because I have personal friends/family that have these issues but can never get into a rheumatologist (this could be geographical). So this is something I am interested in and hits close to home, but I am not sure if its feasible after a 3 year residency; I'm talking biologics and such

Technically yes. Once you finish residency you have a full license to practice medicine and surgery. So you absolutely could.

The question then becomes should you? Rheumatology is a fellowship for a reason. I've had a few patients who had no insurance and the local rheumatology office refuses to accept cash pay patients, so I continued them on the current medication that they had been stable on for several years. But, had there been any worsening of their condition or weird side effects to the medication there's a fair chance I would not have caught it as quickly as a trained rheumatologist would.

 

[bronx43]

Is it possible for family medicine docs to treat some of the more common rheumatologic disorders? I only ask because I have personal friends/family that have these issues but can never get into a rheumatologist (this could be geographical). So this is something I am interested in and hits close to home, but I am not sure if its feasible after a 3 year residency; I'm talking biologics and such

Rheum here. You can do whatever you want, since all you need is a medical license to prescribe these drugs. However, the difficult parts are 1. making the right diagnosis (nothing in rheum is straight forward), 2. monitoring for clinical improvement/worsening (often non-linear), 3. monitoring for rare/severe adverse effects.

If you have family or patients who cannot get into a local rheumatologist, then i recommend referring further away. They can get a definitive diagnosis, and get started on a treatment plan. If distance is a problem, then they can try to space out their appointments, and you can monitor them in between.

 

[Cranjis McBasketball]

Technically yes. Once you finish residency you have a full license to practice medicine and surgery. So you absolutely could.

The question then becomes should you? Rheumatology is a fellowship for a reason. I've had a few patients who had no insurance and the local rheumatology office refuses to accept cash pay patients, so I continued them on the current medication that they had been stable on for several years. But, had there been any worsening of their condition or weird side effects to the medication there's a fair chance I would not have caught it as quickly as a trained rheumatologist would.

Rheum here. You can do whatever you want, since all you need is a medical license to prescribe these drugs. However, the difficult parts are 1. making the right diagnosis (nothing in rheum is straight forward), 2. monitoring for clinical improvement/worsening (often non-linear), 3. monitoring for rare/severe adverse effects.

If you have family or patients who cannot get into a local rheumatologist, then i recommend referring further away. They can get a definitive diagnosis, and get started on a treatment plan. If distance is a problem, then they can try to space out their appointments, and you can monitor them in between.

Thanks for your responses! That makes perfect sense. Definitely have to know your limits

 

[FrustratedFamDoc]

The other thing to consider is how many things do you want to have to juggle at a regular f/u? Most of us get 15 minutes for the entire encounter which includes triage, chart review, history, physical and time to complete your note. Is that enough time to do a very challenging illness plus other chronic issues and any acute complaints justice? Are 20 minute appointments even adequate?

 

[FamilymedMD]

I handle a lot of rheum at my DPC, either because patients have to wait months for a consult or because they have high deductibles or are uninsured and want me to work things up as much as possible before paying a consultant.

Like anything else, a lot can be done at primary care if you have the time to see the patient and figure out what to do. You also often eventually reach a point where it's cheaper or better for them to pay the consultant for their expertise and experience.

 

[AlbinoHawk DO]

Is it possible for family medicine docs to treat some of the more common rheumatologic disorders? I only ask because I have personal friends/family that have these issues but can never get into a rheumatologist (this could be geographical). So this is something I am interested in and hits close to home, but I am not sure if its feasible after a 3 year residency; I'm talking biologics and such

If your program has several elective months and strong rheumatology rotations, you can definitely become good at bread and butter cases. Just don't allow yourself to get cocky and know your limits