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How to Become a Rheumatologist
Overview
Achy conditions that attack the joints, muscles, and bones are an issue that affects individuals of all ages and can lead to issues that have the potential to incorporate internal organs. The complexity of these ailments calls for the expertise of a specialist trained to identify and treat such concerns. According to the American College of Rheumatology (ACR), there are over 100 complex and intriguing diseases that fall under the internal medicine specialty of rheumatology with more than 50 million Americans in need of the specialized care of a rheumatologist.
What is a Rheumatologist?
A rheumatologist is a doctor that specializes in treating patients with diseases affecting their joints. The primary role of this type of physician is to detect, identify, treat, and medically manage individuals who have arthritis and other rheumatic diseases that can cause issues with a patient's joints, muscles, bones, and even internal organs, such as the kidneys, lungs, and the brain. While the majority of patients that a rheumatologist sees typically have a condition associated with arthritis, other cases may also involve autoimmune diseases such as lupus, Sjögren's syndrome, scleroderma, and fibromyalgia.
Rheumatologists are primarily trained to:
- Conduct and/or order tests to diagnose the patient, determine the cause of their issues associated with the joints through physical examination, identifying symptoms, and evaluating the whole body.
- Choose the proper medications, coping mechanisms, infusions, and management of diet and exercise regimens for a patient.
- Assess the physical and mental well-being, as well as the level of independence of a patient.
- Educate patients, their family, and the community about health information, such as how to live with a chronic (long-term) rheumatic disease.
- Implement techniques to prevent disability or help patients regain function, including measures that improve quality of life.
Rheumatologists care for a wide array of patients—from young children to senior citizens – with a goal to eradicate, treat, and/or maintain quality of life as it pertains to an individual case. In addition to battling arthritic conditions (from osteoarthritis to infectious arthritis), the typical patient that a rheumatologist sees may also suffer from bursitis, gout, Lyme disease, osteoporosis, tendonitis, and vasculitis.
Educational Track
A doctorate degree is the entry-level educational requirement for rheumatologists.
Step by Step Educational Path of How to Become a Rheumatologist
- Earn a bachelor's degree. Although the minimum requirement for a student to gain acceptance into medical school is three years of education at the college or university level, the majority of medical students tend to possess an undergraduate or advanced degree. Although not a requirement, undergraduates may pursue a pre-med program which consists of a curriculum that is heavier on the sciences, like physics, biology, and inorganic and organic chemistry.
- Apply to medical school. Students with an interest in becoming a rheumatologist must apply to an accredited medical school to obtain a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) degree. The admissions process is competitive and takes into account a variety of factors during their evaluation of applicants. The majority of medical schools require the submission of Medical College Admissions Test (MCAT) scores with an application. This test is typically taken during an undergrad's junior or senior year, and assesses a student's aptitude as it relates to science, critical thinking, problem-solving skills, and the ability to reason.
- Complete a four-year medical school program. During the first two years of medical school, aspiring rheumatologists take courses such as anatomy, biochemistry, physiology, pharmacology, and pathology. From psychiatry to internal medicine, the remaining two years of medical school are spent experiencing multiple specialties through clinical experiences. During this time, students learn how to care for patients within real medical settings (like hospitals and clinics) while under the supervision of seasoned medical staff. Throughout their time at medical school, clinical rotations and exposure to mentors help students decide on which area of medicine he or she would like to concentrate on.
- Complete a residency in general internal medicine or pediatrics. Since rheumatology is a sub-specialty of internal medicine, medical school graduates must fulfill all of the requirements to become an internist. An internal medicine residency takes at least three years to complete, and consists of the specialized education and training necessary for a physician to move forward towards becoming a rheumatologist.
According to a questionnaire administered by the American College of Rheumatology Training and Workforce Committee, the majority of rheumatology fellows had their initial exposure to rheumatology as second-year and third-year medical students; and more than 75 percent surveyed said they solidified their decision to pursue the field during their internship and residency program.
- Obtain a license. Upon completion of residency training, the physicians are now referred to as internal medicine doctors or a pediatrician. In the United States, it is a requirement for all doctors to obtain a license in order to practice medicine in a specific state.
- Complete fellowship training in rheumatology. To become a rheumatologist, physicians must pursue an additional 2-3 years of training related to rheumatology.
- Become board certified. To further enhance his or her credibility and commitment to excellence, most rheumatologists become board certified following their rheumatology fellowship training. Rheumatologists treating adults pass the exam administered by the American Board of Internal Medicine, while pediatric rheumatologists take an exam given by the American Board of Pediatrics.
The primary work environments of a rheumatologist are found within a medical office or clinic, but these specialists also provide care in many different healthcare settings – from a private physician-owned practice to outpatient clinics. Rheumatologists may also work out of inpatient units that provide medical, surgical, rehabilitation, and transitional care. Universities, colleges, and pharmaceutical companies also hire rheumatologists to conduct research regarding the causes of rheumatic diseases and the development of alternative treatments.
Employers hiring rheumatologists typically seek the following qualities in a job candidate:
- The ability to communicate information in layman's terms to patients and/or their families.
- Can subtly shift the decision-making role onto patients after providing the information necessary to make the best choice in treatment.
- Is compassionate and warm towards patients, who often suffer from painful and debilitating conditions.
- Possesses a 'good bedside manner' and has excellent listening skills.
- Offers helpful tips and knows when to refer patients to other medical professionals, such as a counselor or occupational therapist.
- Works well as part of a team, as rheumatologists often consult and collaborate with other health care providers associated with a patient.
To increase the chances of being hired and finding relevant job leads, joining a professional association or organization is highly recommended.
One of the leading resources and links to networking possibilities is the American College of Rheumatology (ACR), which focuses on education, treatment, and research related to the field. Representing more than 9,000 rheumatology health professionals, additional membership benefits include research opportunities, fellowships, educational discounts, and access to the latest information through rheumatology-related publications.
Additionally, keeping abreast of the current issues and trends related to the management and treatment of rheumatic diseases is important for shaping a well-informed job candidate. Subscribing to local publications, newsletters, and medical journals is highly recommended. The Rheumatologist is a newsmagazine that specifically caters to the field of rheumatology and serves more than 11,000 healthcare professionals.
The median salary for the occupation varies according to a handful of factors that include gender, workplace environment, self-employment, and geography. For example, the highest rheumatologist earners in the United States reside in the North Central and Southwest regions ($368,000 and $264,000, respectively), while the majority of the lowest-paid earners live in the South Central area ($166,000) and the Northwest ($167,000).
Interestingly, the Medscape Physician Compensation Report (2014) also states that the field of rheumatology has seen a significant increase of 15% in compensation, which contrasts greatly to the 6% increase of the closest highest-earning medical specialties. Although rheumatology showed this particular increase, Medscape also reports that salaries regarding this specialty have been more stable in prior years.
Nonetheless, the overall job outlook for rheumatologists is quite promising and will only continue to grow as arthritic conditions are a common ailment amongst the aging. An increased population in the U.S. (which on average is living longer) will create a higher demand for specialists of rheumatic conditions.
As a whole, rheumatologists make more money in private practice than in any other setting (with the exception of outpatient clinics), which is one benefit to establishing a solo medical business. Self-employed rheumatologists earn an average of $234,000, whereas those employed in other work environments (like hospitals, healthcare organizations, and the government) earned an average salary of $195,000. For physicians thinking about establishing their own medical practice, there are a few primary factors to note.
The start-up costs of a rheumatology private practice are one of the first things to evaluate; all of which involve a range of financial commitments that need to be covered before a practice can accept patients and really start to pull in a profit. A physician must create a budget that includes initial costs and ongoing expenses to determine whether a loan, savings account, or personal cash flow will fund his or her private practice. Common expenditures include renting office space, insurance, license and operation fees, office equipment, furnishings, and hiring staff, if necessary.
Building a reputation as a reliable rheumatologist helps grow a private practice, which means being available to patients – whether it's returning phone calls or accommodating scheduling changes. It is this type of customer service and attentiveness from a doctor that spreads like wildfire throughout a community. Word-of-mouth is one of the best ways to increase a patient roster as a self-employed rheumatologist. Additional advertising and marketing options may include newspaper ads, attending health fairs, organizing an open house, connecting with local support groups, and accepting speaking engagements.
Since the majority of patients that a rheumatologist sees originate from primary care physician referrals, it is highly recommended to network with area doctors, practices, and hospitals to establish connections throughout a local medical community.
Rheumatologists not only make more money than other physicians but are also noted to experience a lower level of career burnout than other specialty doctors. A common stressor amongst rheumatologists has nothing to do with the career field itself but centers on dealing with 'too many bureaucratic tasks' – something that can feel magnified when running a private practice. Keeping up with the paperwork of running a private practice plays an important role in the day-to-day tasks which can take away from the amount of time spent seeing patients.
According to Marcy B. Bolster, MD, director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital in Boston, rheumatologists spend an increasing amount of time in the current healthcare environment filling out pre-authorization forms for medications and diagnostic studies, as well as experience additional stressors centered on documentation associated with the electronic health record.
In conclusion, becoming a rheumatologist means entering a career field that places a physician in an important position to alleviate pain and enhance the quality of life for patients suffering from some of the most common ailments, such as arthritic conditions. With an aging Baby Boomer population across the U.S. leading to an increased need for the expertise and care of rheumatology specialists, plenty of employment opportunities await both salaried physicians and those who establish a private practice.
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