Rheum vs Primary Care !!!! HELP PLEASE

[RHEUM2020]

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similarities/differences between rheum and primary care. are you better off applying for rheum in residency or doing primary care for a few years followed by fellowship? what would help to make you a better rheumatologist

 

[jhamaican]

rheum is getting more and more competitive. Recommend just go straight into rheum fellowship. It is a good field: expanding and sky is the future with all the new biologics. Fibromyalgia patients are a pain but every specialty has their difficult population.

 

[bronx43]

rheum is getting more and more competitive. Recommend just go straight into rheum fellowship. It is a good field: expanding and sky is the future with all the new biologics. Fibromyalgia patients are a pain but every specialty has their difficult population.

Lol, what does “sky is the future” even mean? You do realize that it’s basically 4-5 pharmaceutical companies making near identical drugs for the same few indications right? We haven’t had any meaningful new indications for awhile now. If anything small molecules are probably going to take over the field in the next 10 years, which means you won’t sound as cool to your friends when you say you are just prescribing a pill as opposed to a “biologic.”

The problem with rheum is that our diseases are simply too rare. That means you don’t need many docs to treat all the TRUE autoimmune disease. Unless you’re in a very underserved area, you’re prob gonna fill half your clinic with fake lupus/ra and fibro. That is the reality of rheum.

The ACR is trying to make everyone believe that there’s a huge shortage of rheumatologists. I beg to differ. There’s only a shortage if you include fibro and osteoarthritis.

 

[DrMetal]

The ACR is trying to make everyone believe that there’s a huge shortage of rheumatologists. I beg to differ. There’s only a shortage if you include fibro and osteoarthritis.

Quite true. Most of which can be managed by a good general internist who isn't afraid to keep some things, vice consulting off.

 

[bronx43]

Quite true. Most of which can be managed by a good general internist who isn't afraid to keep some things, vice consulting off.

With the increasing burden of healthcare costs onto patients, I’m seeing fewer and fewer fibro patients wanting to follow with rheumatologists... except Medicaid patients who barely pay a dime.

This along with an influx of midlevels into the field may wreak havoc on the job market in no time. Unlike fields like dermatology where there’s a good amount of elasticity in the demand, rheumatology can become saturated rapidly if fibro gets phased out. Either that or rheumatologists will come up with fake diagnoses. Joint pain with positive RF and you get put on methotrexate...

 

[DrMetal]

At least rheum is still a sub-specialty of internal medicine. I take some comfort knowing that the rheumatologist is a trained internist. Neurology on the other hand....

 

[Animalcules]

I work in a state with the highest density of rheumatologist and our wait times are 2-3 months. We rarely see fibromyalgia without another rheumatic disease, unless billed incorrectly at referral. I disagree that management through primary care is a good option, unless we are talking about fibromyalgia, OA, and gout. That said, especially gout is often horribly mismanaged.

 

[bronx43]

I work in a state with the highest density of rheumatologist and our wait times are 2-3 months. We rarely see fibromyalgia without another rheumatic disease, unless billed incorrectly at referral. I disagree that management through primary care is a good option, unless we are talking about fibromyalgia, OA, and gout. That said, especially gout is often horribly mismanaged.

Are you a fellow?

If not, how many ra patients do you have in your panel?

 

[Postictal Raiden]

Neurology on the other hand....

Lol. Don’t worry about us.