The Role Of A Rheumatologist
Rheumatologists diagnose, treat and rehabilitate persons of all ages with disorders of the musculoskeletal system.1 This includes inflammatory disorders, systemic autoimmune diseases, degenerative diseases, soft tissue disorders, sports injuries, chronic pain syndromes and metabolic bone diseases.
Examples of pathologies managed by rheumatologists are rheumatoid arthritis, systemic lupus erythematosus and osteoporosis. A large proportion of the caseload comprises chronic illnesses. Consequently, rheumatology allows doctors to have prolonged involvement in patient care.
Rheumatologists apply an array of approaches in clinical medicine. Imaging and pharmacological modalities and joint and soft tissue injections are commonly utilised.1 Rheumatologists employ a multidisciplinary working model.
Care is typically delivered in outpatient settings in coordination with primary care practitioners, other medical and surgical specialists and allied health professionals, for example, physiotherapists and occupational therapists. Personal skills requisite for rheumatologists are teamwork, cohesiveness and empathy.
Most rheumatologists jobs are exclusively in the specialty. However, they are accredited dually in general internal medicine (GIM). GIM physicians are trained to diagnose and manage a broad array of acute and chronic medical conditions in persons that present to emergency departments and acute medical units, to inpatients of other specialties – for example, surgery and obstetrics and gynaecology – and to attendants of medical outpatient clinics.2
They also engage in the management of inpatients and outpatients with co-morbidities. Consequently, rheumatologists may assume additional roles, for example, contributing to the acute on-call rota and leading a medical ward.
In the UK, high levels of job satisfaction are reported by rheumatologists. Recently, the specialty has benefitted from pioneering treatment methods that have resulted in improved patient outcomes and there persists scope for further advancements. In 2017, 51% of rheumatologists were women.3
A Typical Week
Most of the activities performed by a rheumatologist in a standard week comprise patient consultations in outpatient clinics or day assessment and treatment centres. The number of cases managed per day is variable. For example, three new patients and ten follow-up patients may be seen.4
Registrars are given the opportunity to work in different subspecialty clinics every week to facilitate the development of special interests. Other responsibilities are teaching, clinical governance and research. On-call work is very infrequent – approximately 25% of consultants conduct routine on-call work at weekends.4
The Route To Rheumatology
The route to rheumatology is via general medical training. This can be Internal Medicine Training (IMT) stage 1 or Acute Care Common Stem (ACCS), which are three-year programmes. Both programmes feature several rotations across a variety of medical specialties; ACCS facilitates increased focus on acute medicine, emergency medicine, anaesthetics and critical care medicine in the initial two years.
Application to these is through a form examining entry requirements, for example, core competence, clinical reference, and details of achievement in various areas – and an interview. Trainees must then pass the Membership of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination.
Specialty training in rheumatology has a duration of five years and results in dual accreditation in GIM.5 Entrance to this is very competitive – in 2018, the competition ration for rheumatology ST3 was 2.40.6 Trainees are assessed for appointment to rheumatology ST3 by an application form and an interview.
Many rheumatology trainees conduct research towards attainment of an MD or PhD qualification. The Specialty Certificate Examination (SCE) in Rheumatology must be successfully completed prior to being awarded a certificate of completion of training (CCT) by the General Medical Council.
Application for consultant posts can be made six months prior to attainment of a CCT. There is a good balance between the number of trainees and the availability of consultant jobs in rheumatology, unlike in many other specialties.5
Strong competition for rheumatology ST3 means that it is important to demonstrate commitment to the specialty. Medical students interested to pursue a career in rheumatology can attend conferences, join student societies and choose student selected components with a focus on rheumatology.
The British Society for Rheumatology (BSR) can also be joined by students. An early decision on specialty choice may be of use and can be aided by careful observation and enquiries on clinical placements.
Foundation trainees should attempt to secure full placements in rheumatology or, if unfeasible, full placements in a related discipline. Alternatively, taster experiences can be attained. It may also be useful to enter essay competitions and construct case reports or presentations relevant to rheumatology.
An extensive CV, featuring, for example, audit, teaching and research experiences, including publications and postgraduate degrees, is requisite for entrance to specialty training.
It is possible to undertake specialist fellowships in an area of personal interest in the final years of specialty training or subsequent to the attainment of a CCT.7 This is typically completed in one year at national or international centres of excellence, for example, the Faculty of Life Sciences and Medicine at King’s College London, the Centre for Musculoskeletal Research at the University of Manchester and The Birmingham Rheumatology Research Group. Subspecialty interests include paediatric rheumatology, metabolic bone disease, neurophysiology, sports medicine and autoimmune multisystem connective tissue disease.1
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849.6 Salaries can be further enhanced with NHS excellence awards.
Rheumatology is a specialty with modest potential for private practice. JRSM reported in 2008 that private income for rheumatologists was 0.33x their NHS income.
The recommended starting salary of accredited consultants in the British Army is similar to that in the NHS. In 2017, this was £80,527.8
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The primary society for rheumatology and musculoskeletal care professionals in the UK is the BSR. Additionally, the European League Against Rheumatism (EULAR) is the representative of people with rheumatic diseases, health professionals and scientific societies of rheumatology of the European countries. BSR organises an annual conference and EULAR hosts an annual congress.
Key journals in the discipline are Nature Reviews Rheumatology, Annals of the Rheumatic Diseases and Rheumatology.
Related Job Sources With BMJ Careers
More Complete Guides By BMJ Careers
Rheumatology [Internet]. Health Careers. [cited 19 June 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/rheumatology
General internal medicine [Internet]. Health Careers. [cited 19 June 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/general-internal-medicine
NHS Digital. Analysis of the representation of women across the hospital and community health services workforce [Internet]. NHS Digital; 2018 [cited 19 June 2020]. Available from: https://digital.nhs.uk/data-and-information/find-data-and-publications/supplementary-information/2018-supplementary-information-files/analysis-of-the-representation-of-women-across-the-hospital-and-community-health-services-workforce
Working life (rheumatology) [Internet]. Health Careers. [cited 19 June 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/rheumatology/working-life
Rheumatology [Internet]. Physician ST3 Recruitment. [cited 19 June 2020]. Available from: https://www.st3recruitment.org.uk/about-st3/overview-st3-recruitment
Specialty Recruitment Competition Ratios 2019 [Internet]. Health Education England; 2019 [cited 19 June 2020]. Available from: https://specialtytraining.hee.nhs.uk/portals/1/Content/Resource%20Bank/Competition%20Ratio's/Competition%20Ratios%202018.pdf
Akram Qasim, Hughes Michael. A career in rheumatology BMJ 2016; 352: i1367
Pay [Internet]. British Medical Association. [cited 19 June 2020]. Available from: https://www.bma.org.uk/advice/employment/pay