Rheumatology

Discussion in 'Other Subspecialties' started by bigfrank, Nov 3, 2002.

  1. bigfrank

    bigfrank SDN Donor

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    Hi,

    Could someone comment on this subspecialty of IM, specifically as far as patients/diseases encountered, lifestyle, salary, etc.? I'd appreciate it.

    What types of injections/interventions are possible?

    Thanks,

    Frank
     
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  3. yukdog

    yukdog New Member

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    Sort of sad to see “all” of this activity on this topic.

    I’ve been doing adult rheumatology at a tertiary referral center, not a medical school, but a private hospital where med students rotate and we do have internal medicine and other residents at our hospital. I have been doing this for about 25 years.

    I picked rheum because as an intern I was going into radiology, and then I got drafted into the Navy and I spent 2 years as a GMO (general medical officer). I found out that once you got away from “academics” medicine and taking care of patients was fun! I than was an ER doc (in the old days, before you needed a residency for 3 more years trying to figure out what to do with the rest of my life.

    I picked rheum for a couple of reasons. First of all, everywhere I went there were good cardiologists, GI docs, etc. who could help me with tough cases, but I had NEVER had a rheumatologist help me with patient care! Given the competition, I figured I could be a good cardiologist, etc., but even as dumb as I was, I could probably be a GREAT rheumatologist. I’m not that bright, but I was right.

    Also, as one of the medial residents we had rotating with us once said “you are the back of the book doctors”. When I asked her what she meant, she pointed out that we were seeing all the stuff (Behçet’s, vasculitis, sarcoid, etc.) that was in the “back of all the textbooks” and that no one reads about or understood. We are the last of the true “diagnosticians”. When Everone else is stumped on a case, they call us. That can be a lot of fun!

    Lastly the life style isn’t bad. I have been on call for our 9 rheumatologist group for 5 days, and I have had two calls. One for a med refill, one for a headache. Not bad. As you get older you will find call is less and less fun, and even with hospitalists, you are going to be a lot busier working in other areas.

    You will also make an “OK” living. (I should tell you that my kid is a first year ortho resident.)

    I hate to tell you all this, but in the future docs are almost certainly going to make less and less money, and the only way you are going to really get ahead is going to be to save and invest wisely! I don’t care if you do intevential radiology; this is going to be true. I hate investing, I have had help, I should have started earlier, but I’m still better off than most surgeons at this point. YOU ARE NOT GOING TO GET RICH BEING A DOCTOR. You will make a good living, but when you went to your interview and told the guy/girl “I want to be a doctor because I like science and I like to help people”, heaven help you if you were lying!

    Time to get back to work. I have to see what you do with a 40 year old lady with radiation necrosis of the pubis and an unstable pelvis (yes she will need surgery, but the guy “at the school” who sent her to me may not be smart enough to know what kind), and to see what experimental programs may help PSS lung involvement. (Endo-1 Inhibitors? Rituxan? If you have an hour, I can show you from the literature how Cytoxan may be of statistical value but clinically it doesn’t help, prednisone just makes this disease mad, and to do a marrow transplant in someone who almost certainly already has graft vs. host disease is just plain dumb.) (The best theory concerning the etiology of PSS is that we are all “chimerics”, either our mother’s cells or our kid’s if we have had babies, circulate in us all the time. PSS is probably GVH disease due to this. Find me a better theory!)

    ANYWAY, if I had it to do over again I would do rheum again, and NOW I can treat patients with some drugs that really work!

    (PS Fibro is NOT a disease, it is a very real stereotyped set of symptoms, it is treated by practicing office psychiatry, or referral, it is NOT a rheumatology problem, it is a psych problem, and as soon as people figure this out, these poor people who are really suffering MAY get better.

    I do not see or follow fibro. When you are grown up, you too can pick and chose just what you do if you go into private practice!)

    Good luck!
     
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  4. chemamr

    chemamr PGY2

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  5. fantasty

    Physician

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    Mostly geared toward yukdog but please feel free to chime in...

    I recently talked to my advisor about my career plans, and he said that rheum is a dying field. Of course, he and others have also suggested this about epi (he's an epidemiologist and MD in an internal med dept although he doesn't practice anymore). For many of the reasons that yukdog mentioned, I think I'd really enjoy rheum. (And money aside - I'm planning on going into academics anyhow). But, it seems to me that the new therapies coming down the pike would be rejuvenating the field.

    What is your take on the trajectory and long-term potential of the field?
     
  6. ResidentMD

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    Super 5 year bump.

    Mainly also to laugh at the fact that someone said epi is a dying field :laugh:
     
  7. lipstikisntfood

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    #6 lipstikisntfood, Oct 27, 2010
    Last edited: Jan 18, 2011
  8. london12

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    I will apply to rheum this year. Apart from that I really like rheum let's see the prons
    1. Not competitive, you will get a spot, and probably to the city/town/area you like. (Who wants to have to explain yourself AGAIN, and maybe not getting a position)
    2. The training is 3 half days of clinic/week for the fellows+ administrative, research, teaching stuff. (Who wants to be q3 call like cardio or GI fellows, and everybody calling you for chest pain in the middle of the night?)
    3. You can moonlight as much as you want, so money during fellowship is not an issue
    4. Clinic is by referrals only, so you do not have to deal with pain seekers and weird people as in general medicine clinics
    5. After the training u can find a job easily (only 179 spots of rheumatology fellows every year across the country!)
    6. Your life it is not going to be as a hospitalist (7am-7pm with a census of 20 patients daily)
    7. You can be certified densitometrist, do musculosceletal ultrasound, have an infusion center and make a lot of money if you want to
    8. You are the smart person to know relapsing polychondritis and meralgia paresthetica

    Overall is a great career choice.

    Cons
    1. Two extra years of "training" (3 half days of clinic/week)
    2. People do not really know what you do, they may not know you are a doctor even
    3.Two extra years of "training"
     
  9. LunaMD

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    Hi rheum lovers!
    I am a 4th year med student applying to residencies, and I'm not 100% set on rheum, but I would say its a very very probable option for me when the time comes. At this point in my career, I'm wondering if I should be looking for a residency program that has a strong rheum program (like cornell and the hss) or if I should cast out a broader net and try for one of the top tier programs. Will going to a fantastic program, that has very few ppl going into rheum, hurt or help my chances later on if I decide to pursue the field? Should I be more rheum focused, even if I'm not 100% sure?

    Thanks for any advice
     
  10. Rheumor

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    Man I just spent like 20 minutes typing this long elaborate response and then I was logged out. Have been writing notes all day long so I will go ahead and just give you my "clinical bottom line (thanks EMB)": Apply to where you will be happy (right fit and acceptable level of prestige), decide what you want to do with your life, and then apply. I am assuming that if you don't think Cornell is "top tier" then you must have some baller programs under your belt that are top tier in your mind, in which case you will match in whatever specialty you want. Most top tier programs are top tier because of its subspecialties so its a win win if you can go to a top program. Be glad if you go to a program where not many graduates go into rheum because then you will have less competition to fill internal spots (most programs prefer their own anyway). Good luck and peace!:)
     

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