The future of rheumatology?

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ninin

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Hi, the last round of questions, b/c I can't decide on a specialty, and others are probably in the same boat.

1. Why are rheumatologists reimbursed so little? I would think joint injections are a cash cow and that the pain management aspects would be more lucrative than it is.

2. In the future, as the field advances, does anyone know if now is a great time to go into it? As my other posts indicate, I am deciding between rheumatology, endocrinology, and allergy. They're all more or less equally interesting to me, at least enough to pursue a fellowship. Allergy is financially good now, but if rheum and endocrinology will be more financially lucrative in the future and the job prospects only on the steady rise, then I'd do rheumatology or endocrinology now. I don't want to invest another 3 years if the salary doesn't increase much at all, b/c that's like a slap in the face to me.
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Joint injections are too easy and too routine to be a cash cow. Of course now that I write that I think of all the joints I'm not comfortable injecting (anything other than knee), so maybe I'm underestimating it.

Always think of the least enjoyable aspect of a subspecialty. For example, how do you feel about chronic pain and fibromyalgia? How do you feel about diabetes? And what about those wacko people who have "allergies" to everything under the sun? You could certainly become a fibromyalgia guru and rake in the bucks. Although you'd also be raking in the nuts.

If you can deal with the worst patients/complaints of a field, then that may be the field for you.

Just to put it all in perspective, you may not make a bizillion bucks in endocrine or rheum, but you're not going to be in the poor house either. Allergy can make you rich I hear, so if you like it equal to the other things, maybe you should go for it.
 
Infusion therapies such as with infliximab, etc. has given Rheumatology its cash cow, so to speak. These are reimbursed like a procedure, and you set them up to be done in your office, so multiple infusions at one time.

I'm not that knowledgeable about Rheum's market, etc., but I can say I think many private practice Rheums still do some IM as part of their practice. But with the advent of all these infusion therapies, who knows how much of that will be reality in the near future at least from a $$$ standpoint.
 
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Linie said:
Joint injections are too easy and too routine to be a cash cow. Of course now that I write that I think of all the joints I'm not comfortable injecting (anything other than knee), so maybe I'm underestimating it.

Always think of the least enjoyable aspect of a subspecialty. For example, how do you feel about chronic pain and fibromyalgia? How do you feel about diabetes? And what about those wacko people who have "allergies" to everything under the sun? You could certainly become a fibromyalgia guru and rake in the bucks. Although you'd also be raking in the nuts.

If you can deal with the worst patients/complaints of a field, then that may be the field for you.

Just to put it all in perspective, you may not make a bizillion bucks in endocrine or rheum, but you're not going to be in the poor house either. Allergy can make you rich I hear, so if you like it equal to the other things, maybe you should go for it.
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Linie & Task, thank you for your advice. It's down to endocrinology and allergy now. I had never thought about thinking about fellowship from the opposite end, i.e., which types of patients I'd dislike the most. Fibromyalgia, which I'm not even convinced is a real disease, and the chronic pain patients, would not be worth the money (even if it were there). And that makes rheumatology out.

Endocrine is possibly the easiest to match into, but diabetes galore and the minutiae of lipids probably will be my death knell. I'm afraid I don't have the biochem smarts for endocrine. Thumbing through endocrine journals showed me that.

Allergy runs the risk of being boring (without the immunology part), and it's super competitive.

I've decided that no one can predict the future, and what gets reimbursed well now may change by the time we're all 50 yrs old, and so you might as well do what you love.
 
I never understood what "bump" meant
 
Linie said:
Always think of the least enjoyable aspect of a subspecialty. For example, how do you feel about chronic pain and fibromyalgia? You could certainly become a fibromyalgia guru and rake in the bucks. Although you'd also be raking in the nuts.

If you can deal with the worst patients/complaints of a field, then that may be the field for you.
Click to expand...

ninin said:
Fibromyalgia, which I'm not even convinced is a real disease, and the chronic pain patients, would not be worth the money (even if it were there). And that makes rheumatology out.
Click to expand...

Wow, plenty of fibromyalgia and chronic pain hate here. Doesn't anyone actually like helping people who are in complete misery?
 
It is chic in medicine. When I was in a rheum clinic over the summer, the internal med residents called everything a psych complaint/fibromyalgia etc. However, then the lab results would come back and the patient's would be ANA + etc. The Attending's would always have a different perspective and were very professional. Lot of the folks ended up with serious rheum probs. There is alot of uncertainty in rheum until the disease starts moving so to speak. The physicians-in-training have a harder time with the uncertainty and call it a psych complaint. There are patients with psychosomatic problems coming through; however, the real experienced rheum attendings are good at managing the uncertainty and sorting out the data. Many are very sick. I think it is just something you learn and get good at. Plus, folks that go into rheum now tend to have heavy science backgrounds and are good at sorting through complex data.
Doctor said:
Wow, plenty of fibromyalgia and chronic pain hate here. Doesn't anyone actually like helping people who are in complete misery?
Click to expand...
 
Hi everyone,

I was wondering what is the outlook on rheumatology's future???
 
Doctor said:
Wow, plenty of fibromyalgia and chronic pain hate here. Doesn't anyone actually like helping people who are in complete misery?
Click to expand...
It's not just our patients who we don't take seriously. One of my friends (an internal medicine resident) would joke that she had fibromyalgia because of all her random joint pains. Then she was sure she had IBS because she started getting bloating and cramping. Then she got GI bleeding and discovered she had UC. :(
 
ninin said:
Linie & Task, thank you for your advice. It's down to endocrinology and allergy now. I had never thought about thinking about fellowship from the opposite end, i.e., which types of patients I'd dislike the most. Fibromyalgia, which I'm not even convinced is a real disease, and the chronic pain patients, would not be worth the money (even if it were there). And that makes rheumatology out.

Endocrine is possibly the easiest to match into, but diabetes galore and the minutiae of lipids probably will be my death knell. I'm afraid I don't have the biochem smarts for endocrine. Thumbing through endocrine journals showed me that.

Allergy runs the risk of being boring (without the immunology part), and it's super competitive.

I've decided that no one can predict the future, and what gets reimbursed well now may change by the time we're all 50 yrs old, and so you might as well do what you love.
Click to expand...

I highly recommend endocrinology. I am a double board certified/Diplomate in internal medicine and endocrinology myself for 25 plus years, and a Fellow in Endocrinology. I am an Attending in IM (training interns and residents) and in Endo (training Fellows).

I personally like dealing with diabetics and pancreas, pituitary issues, tumor-secreting hormones, adrenals, parathyroid, and thyroid patients: these are the scope of patients at my thriving outpatient practice (great referrals from GPs/PCPs). Reimbursements are respectable, with good outpatient load per 8 to 9 hour days (roughly 20 to 25 outpatients) Mon thru Fri.
 
Dr Hurly MD said:
I highly recommend endocrinology. I am a double board certified/Diplomate in internal medicine and endocrinology myself for 25 plus years, and a Fellow in Endocrinology. I am an Attending in IM (training interns and residents) and in Endo (training Fellows).

I personally like dealing with diabetics and pancreas, pituitary issues, tumor-secreting hormones, adrenals, parathyroid, and thyroid patients: these are the scope of patients at my thriving outpatient practice (great referrals from GPs/PCPs). Reimbursements are respectable, with good outpatient load per 8 to 9 hour days (roughly 20 to 25 outpatients) Mon thru Fri.
Click to expand...
Do you mind elaborating what respectable means?
 
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