Rheumatology as US IMG

[messengers]

I'm a US IMG (England) about to take my Step 1 this spring. I'm expecting roughly 230 though higher would be fantastic, I'm also being realistic. My expectation is I'll match into a community IM program more than likely without university affiliation.

My primary interest in the field is for the immunology aspect and I know I am not A/I candidate. Of all the basic sciences the immunology part of microbio was the most interesting. During my clinicals rheum and pulmonary were the most enjoyable.

My questions
-how competitive is the fellowship these days for an IMG from a community hospital?
-staying in academic medicine how much immunology aspects to the research is there?
-what sort of opportunities are there after fellowship for further specialization fellowships?

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[rheumatology]

#1. It's not difficult to get in at all.

 

[messengers]

What about points two and three? Thanks.

 

[gutonc]

If you stay in academics and do immunology based research, you can have all of it that you want.

Rheum doesn't really have sub-specialties, but that doesn't mean you can't have a specific focus to your practice.

 

[messengers]

A few more questions if you guys don't mind. I've done several searches and most of my questions were answered.

I've rotated through rheum clinics in England. The average appointment is about 15-20 minutes and a full H&P isn't done, just a focused exam of the joints (maybe quick cardio or lung). I'm not sure if this is because of the NHS system with far fewer physicians/specialists. ie in a weekly clinic that runs 9-1 there would be roughly 100 patients waiting to see a team of 4-6 rheumatology SHO/registrar/consultants (residents, senior residents, attendings respectively)

Is it similar in the US or are rheumatologists spending much more time in a clinic appointment with full H&P, etc? (re-reading this I know it sounds a bit naive)

I will do a rheum elective during residency, but thought I'd ask this...

 

[Rheumination]

It really depends if it's an initial visit or a follow-up visit. An initial visit at an academic center can be quite long depending on the patient's history. For example, a patient coming in to one of the academic centers where I have worked has generally seen a rheumatologist previously and is referred for a second opinion or help with management. There is a lot of history and background to get through and usually some coordination of needing more outside records, plus an extensive history and physical both by the resident and fellow and then by the attending. This can be longer than an hour. Sometimes patients stay for post-clini conference as well if they are interesting or have diagnostic or management dilemmas. However, we do get new diagnoses of rheumatic diseases in patients who have little past medical history, which can generally be very quick, or a patient who has a solid diagnosis of rheumatoid arthritis and is transferring care, which can be very quick.

A follow-up appointment for an established patient who is stable can be much more brief and focused and is likely what you've experienced. This can be longer for a patient with a lot of other subspecialists or other issues or very brief for a patient who is a well controlled spondyloarthritis or RA patient.

Also, the volume of patients is usually much higher in private practice (without trainees) and the appointment times shorter. Hope this helps!

 

[messengers]

Thank you very much Rheumination!

 

[danvasta]

Hey guys I too am an IMG (non citizen) that matched at a mid-low tier university program.. I'm interested in Rheum and was wondering about the path for IMGs. I saw in nrmp charting outcomes that non US citizens have an average of 4 pubs/posters/presentations.
Do these HAVE to be in Rheum or potentially any research experience would do? I plan to dive into these during intern year so I'll have a good amount published by the time I apply for fellowships.
Also I did pretty well for my steps - 230's late 240's , so what are my chances being a non US citizen?
My 2nd route is to work in primary care, get my green card and then apply.

 

[drfunktacular]

Rheum is not hard to get into. If you performed competently in a US IM residency program and expressed interest in rheum you can probably match into a fellowship somewhere. Obviously several high quality publications in Arthritis & Rheumatology or Annals of Rheumatic Disease would be great, but any demonstrated experience or interest in research would benefit your application. Research as a resident might be necessary if your clinical performance wasn't great but otherwise isn't critical

There's lots of immunology-based research to be done in rheumatology, both in academia and industry. In clinical rheum there are no "subsubspecialties" per se but in academia many people develop a particular focus of research and practice, for example scleroderma, myositis, RA, AS, etc

Day to day practice varies widely. In academics you might see 6 very complicated patients in a half-day in a disease-focused specialty clinic, or you might supervise trainees seeing 100 patients in a county hospital clinic. In an efficient, business-focused private practice you might see 20-25 straightforward patients in a half-day. Most people will be somewhere in between

 

[Rheumination1]

20-25 patients in HALF a day? Wow.


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[drfunktacular]

It's extreme, but I've seen it done. Most rheumatologists I know who are more than a year or two out of training see 10-15 established patients per half day

 

[Successor12]

you have any idea about average rheumatologist salaries? how much they can make two to three years into practice? an asking about private practice
Also does a good training in.MSK US makes a difference in.terms of supplementing your income as a rheumatologist?