Sort of sad to see all of this activity on this topic.
Ive 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. Im 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 (Behçets, 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 isnt 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 dont 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 Im 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 doesnt 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 mothers cells or our kids 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!
