Rheumatology outside of academia

[skeptical1]

Hey SDN!

I'm an IM resident choosing a subspecialty to apply to. At my institution, the rheumatologists absolutely amazing. They see sick as all heck patients with SLE nephritis and alveolitis, ANCA positive vasculitis, and all sorts of bizarre immune-mediated diseases that I learned about med school but never expected to see on the wards. Even in clinic, patients are generally pretty sick, with a lot of first-presentation RA or PsA patients with very active disease. I understand that in a typical private practice, there's a huge amount of outpatient work and that the patients aren't quite so sick. Still though, as a private rheumatologist, are people seeing good amounts of RA/PsA/SLE with complications/vasculitis/weird autoimmune stuff, or does that get drowned out in all of the OA, gout, and osteoporosis?

Thanks!

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[bronx43]

Hey SDN!

I'm an IM resident choosing a subspecialty to apply to. At my institution, the rheumatologists absolutely amazing. They see sick as all heck patients with SLE nephritis and alveolitis, ANCA positive vasculitis, and all sorts of bizarre immune-mediated diseases that I learned about med school but never expected to see on the wards. Even in clinic, patients are generally pretty sick, with a lot of first-presentation RA or PsA patients with very active disease. I understand that in a typical private practice, there's a huge amount of outpatient work and that the patients aren't quite so sick. Still though, as a private rheumatologist, are people seeing good amounts of RA/PsA/SLE with complications/vasculitis/weird autoimmune stuff, or does that get drowned out in all of the OA, gout, and osteoporosis?

Thanks!

Mostly RA, PsA, AS, OA, crystals, metabolic bone, mild lupus. Trust me - you don't want to be seeing the sick vasculitis or lupus patients in private practice. Those patients deserve the multidisciplinary approach from a tertiary care center.

 

[Raryn]

Mostly RA, PsA, AS, OA, crystals, metabolic bone, mild lupus. Trust me - you don't want to be seeing the sick vasculitis or lupus patients in private practice. Those patients deserve the multidisciplinary approach from a tertiary care center.

You forgot Fibromyalgia

 

[bronx43]

You forgot Fibromyalgia

Unless you're in a saturated market like tier 1 cities, you really don't have to see fibro, lol.

 

[Kakoy]

Unless you're in a saturated market like tier 1 cities, you really don't have to see fibro, lol.

this is so true, especially if you are willing to take medicare/medicaid. Everyone outside of rheum always think our clinics are FILLED with fibros but it's actually mostly autoimmune and gout/pseudogout. There is such a shortage of rheumatologist right now that OA and fibro get seen twice and back to PCP. PCP freakout way more with the actual SLE/RA/Seroneg spondyl/myositis/vasculitis than the OA or fibro.

 

[Aspyn]

I'm trying to decide my specialty and I shadowed a private practice rheum! You do have to be sympathetic for patients with pain, because most of these patients are in chronic pain (from OA, RA, spondyl dx). The rheum meds are amazing and help with this, but still.. pain is part of these patients lives unfortunately and you have to be willing to talk about it.

 

[FohBay]

I'm trying to decide my specialty and I shadowed a private practice rheum! You do have to be sympathetic for patients with pain, because most of these patients are in chronic pain (from OA, RA, spondyl dx). The rheum meds are amazing and help with this, but still.. pain is part of these patients lives unfortunately and you have to be willing to talk about it.

You recognize that the patients do have a disease process that is making them miserable and affecting their daily functions. It is quite different from trying to get your patient to take a statin to prevent CAD 10 years from now. The bright side also is that rheum is a chronic disease specialty and no chronic diseases should be treated with opioids (at least that’s my philosophy).

 

[Kakoy]

I'm trying to decide my specialty and I shadowed a private practice rheum! You do have to be sympathetic for patients with pain, because most of these patients are in chronic pain (from OA, RA, spondyl dx). The rheum meds are amazing and help with this, but still.. pain is part of these patients lives unfortunately and you have to be willing to talk about it.

I think we are absolutely willing to talk about it. However, if it's not inflammatory pain, we refer to pain management. Our clinic does not prescribe opiates or any controlled substance. In general, rheumatologist seem to be very empathic (I am obviously bias) but that doesn't mean we handle chronic nonautoimmune pain. Honestly, we don't have appointments to accommodate patients who doesn't necessarily need our expertise and that can get treatment from pcp/chronic pain specialists. I rather make sure patients who REALLY NEED rheumatology have appointments and followups than have fibromyalgia pts needing to go to an extra appt when I have nothing new to offer them that they can't get from their pcp.

The pain meds (NSAIDs, Tylenol) that rheum prescribes works just as well when the pcp and pain management orders them. Honestly, rheum prescription doesn't work better just because we wrote it! Promise!