Rheumatology: Lifestyle, Salary, and Future

[Carbocation1]

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Been digging up a lot of info about Rheum, and I'm wondering why this is not a more desirable IM fellowship. It seems to have a lot of pros: Great lifestyle, outpatient, not a top earner but still brings in more $$$ than primary care, ability to perform procedures and use cutting edge meds, and of course, there is the potential to greatly improve QOL in many suffering patients/make a difference in the lives of the chronically ill.

It also seems to have a great future: huge 15% increase in salary according to the most recent Medscape report, increasing aging population with pain (increased demand), huge research effort towards immunotherapy/inflammation (topics which I am interested in). I also don't see mid-level encroachment being a problem due to the fuzzy diagnostic nature of the field. The future strikes of Rheum strikes me as much better than Allergy/Immunology (sublingual therapy at home will eventually replace their cash cow procedure?)

-2014 NRMP data suggests it is not competitive at all: 230 apps for 206 spots, with a whopping 68% of spots going to FMGs.

-2013 MGMA report gives a 236K avg. salary for Rheum. Not bad, but I think it's skewed by the large number of Rheumatologists who go into academics for lower pay (as opposed to specialty like gas, for example). I'd be content with a stable 250K w/ good lifestyle.

-In 2013, there were only 1.69 Rheumatologists per 100,000 people. The majority of currently practicing Rheumatologists are between 55-64 in age.

I can see how having long term relationships with chronic pain patients can be annoying, but I think I can handle, or even appreciate that. Any thoughts? Many thanks.

 

[Psai]

not sure but i spent some time in a rheum clinic and those patients are very difficult to manage. chronic pain is a huge issue and you are dealing with insurance companies all the time, trying to get them to cover the meds that people need. i would never do it, it's too difficult to do well

 

[PL198]

just seems like there aren't that many and it's pretty morbid stuff

 

[notbobtrustme]

Spend 10 minutes with a patient who has bad fibromyalgia begging for IV narcs.

**** that. Would rather disimpact bowels all night. At least half the patients will thank you for flushing their system out.

 

[Carbocation1]

not sure but i spent some time in a rheum clinic and those patients are very difficult to manage. chronic pain is a huge issue and you are dealing with insurance companies all the time, trying to get them to cover the meds that people need. i would never do it, it's too difficult to do well

Don't you have to deal with insurance companies in any specialty that isn't cash only though?

 

[Carbocation1]

Spend 10 minutes with a patient who has bad fibromyalgia begging for IV narcs.

**** that. Would rather disimpact bowels all night. At least half the patients will thank you for flushing their system out.

Isn't it better than waking up at 2 am every night for an MI or perforated bowel?

 

[darklabel]

Because there are other fellowship options that appeal to most people. I also think it just breaks down to salary compared to other fellowships. 236k is the average but according to CiM, the median starting salary is 199k, same as internal medicine. Also the average salary of an internist is 229k. To go through a fellowship for 2 years to earn just ~6-8k more a year isn't really worthwhile to most people.

GI is 510k, Cards is 441k and even Nephrology (which is also noncompetitive) makes 323k on average (according to CiM)

 

[Carbocation1]

Because there are other fellowship options that appeal to most people. I also think it just breaks down to salary compared to other fellowships. 236k is the average but according to CiM, the median starting salary is 199k, same as internal medicine. Also the average salary of an internist is 229k. To go through a fellowship for 2 years to earn just ~6-8k more a year isn't really worthwhile to most people.

GI is 510k, Cards is 441k and even Nephrology (which is also noncompetitive) makes 323k on average (according to CiM)

But isn't Rheum's lifestyle >>> Cards, GI, Nephro, or IM? The two years fellowship would be more for lifestyle, and just a little extra salary.

 

[Slack3r]

Don't you have to deal with insurance companies in any specialty that isn't cash only though?

Yes, but arguing with insurance companies to pay for incredibly expensive biological agents and infusions is an entirely different hassle. It's amazing the reasons they can come up with to deny those medications.

And if you seem to think rheumatology is great, then go for it. But there are reasons it's not competitive, as outlined above. There are no "secret" specialties in medicine.

 

[darklabel]

But isn't Rheum's lifestyle >>> Cards, GI, Nephro, or IM? The two years fellowship would be more for lifestyle, and just a little extra salary.

I can't comment except the averages I see. Even personal anecdotes can be useless since some people choose to work less and thus have a great lifestyle while others choose to work more for $$$ or because they enjoy it. The CiM we're given is a great tool to compare the averages and according to that, they all work pretty similar number of hours. I don't know personal details like call schedules, etc.

I personally liked rheum as well when I went to some of their talks, but living like a fellow for 2 years and making the same as an IM doc coming out of it seems like a bit of a turn off.

 

[W19]

Yes, but arguing with insurance companies to pay for incredibly expensive biological agents and infusions is an entirely different hassle. It's amazing the reasons they can come up with to deny those medications.

And if you seem to think rheumatology is great, then go for it. But there are reasons it's not competitive, as outlined above. There are no "secret" specialties in medicine.

Derm...

 

[W19]

I can't comment except the averages I see. Even personal anecdotes can be useless since some people choose to work less and thus have a great lifestyle while others choose to work more for $$$ or because they enjoy it. The CiM we're given is a great tool to compare the averages and according to that, they all work pretty similar number of hours. I don't know personal details like call schedules, etc.

I personally liked rheum as well when I went to some of their talks, but living like a fellow for 2 years and making the same as an IM doc coming out of it seems like a bit of a turn off.

That is what turn me off about ID as well, which is a specialty that I can see myself into... But after talking to some ID docs, almost all of them told me there were able to moonlight and supplement their fellowship salary...

 

[WhippleWhileWeWork]

Derm...

Ha, pretty sure that "secret" has been out for quite a while.

 

[DermViser]

just seems like there aren't that many and it's pretty morbid stuff

How is Rheumatology morbid?

 

[PatsyStone]

I was interested in rheumatology, but I ultimately decided on derm

Dermatologist see--and depending on how comfortable you are--can be the primary provider for discoid lupus, psoriatic arthritis, systemic sclerosis, and Bechet's patients. Again, depending on how comfortable you are, dermatologists prescribe as much--or sometimes even more--biologics than rheumatologists. The pay is better, the hours are better, you don't have to manage fibromyalgia patients, and you don't have to do a full medicine residency. While connective tissue disorder patients are interesting, they are also exhausting, which is why it is also nice to have acne and rosacea patients in your schedule, too

 

[DermViser]

I was interested in rheumatology, but I ultimately decided on derm

Dermatologist see--and depending on how comfortable you are--can be the primary provider for discoid lupus, psoriatic arthritis, systemic sclerosis, and Bechet's patients. Again, depending on how comfortable you are, dermatologists prescribe as much--or sometimes even more--biologics than rheumatologists. The pay is better, the hours are better, you don't have to manage fibromyalgia patients, and you don't have to do a full medicine residency. While connective tissue disorder patients are interesting, they are also exhausting, which is why it is also nice to have acne and rosacea patients in your schedule, too

The rheumatologists I know have a large hospital component mainly thru Rheumatology consults from inpatient teams. I guess one could do an outpatient only Rheum practice, but I don't many who are able to do that - they are still connected to the hospital although much better hours than Cardiology, GI, etc. I think Rheum is also more fun in theory --- synovial fluid analysis and looking at crystals under a microscope, but I don't know how often this really happens. I'm ok with treating CTD patients in pain for some reason.

 

[Nasrudin]

I think it's a good option for somebody who, for reasons I can't imagine, chose general medicine, got some sense and decided to specialize in something and missed the boat for or wasn't interested in the more lucrative fellowships.

I would specialize from general medicine even for no monetary gain. Like ID or something. Anything. Not to be a social working pan consulter on the admit/dispo merry-go-round of inpatient internal medicine.

 

[Successor12]

You can not beat the lifestyle.

 

[ooh a bean]

You can not beat the lifestyle.

Current M1 here....could you further explain?

 

[Successor12]

You have to enjoy Rheumatology or any specialty you choose and then the ride would be awesome! That being said Rheumatology is intellectually stimulating, mostly outpatient based speciality. Its common to take a job (full time job) only 4.5 days with none to minimal call responsibilities! And you can find a job where you wont have to do hospital consults! Income is decent but not a super pay or anything! And you have to like clinics! And working in the office with a slower pace than seeing hospital patients. But honestly as an IM specialty I say the lifestyle is GREAT and your chances of being happy as a physician are much higher and likely in Rheumatology! Again all depends and some people are just incapable of being happy and your work environment can also play a role

 

[scrublyfe21]

I can say that if you want to avoid the hospital after finishing an IM residency and weren't competitive for one of the other 100% outpatient specialties, and want to see all the autoimmune diseases you wrote off during the preclinical years (if you're like me and thought "I'll never see that in real life"), then go for it.

What I can tell you is that I haven't seen a single rheumatologist in the hospital since I've been on rotations. Rumor is that our local rheumatologist rounds at the hospital for all their consults once a week.

 

[Successor12]

FYI Rheumatology is getting competitive. The trend is changing!

 

[Treebeard]

Rheum strikes me as a specialty where we don't really understand most of the diseases and there isn't a ton we can do for the patients besides give them immunosuppression and hope for the best. That would bother me.

If you are very interested in research I could see it being a good field.

 

[Successor12]

Rheum strikes me as a specialty where we don't really understand most of the diseases and there isn't a ton we can do for the patients besides give them immunosuppression and hope for the best. That would bother me.

If you are very interested in research I could see it being a good field.

Are you a Rheumatologist?

 

[Slack3r]

Are you a Rheumatologist?

By the reply you should assume he is not.

 

[sella.turcica]

By the reply you should assume he is not.

Yet he is right.

 

[Treebeard]

Are you a Rheumatologist?

No, just my impression from class and the patients I have seen. Am I wrong? Please tell me why.