Does anyone include rheumatology in their practice, specifically injections. It seems to take quite a bit of skill. I did a rotation and very much enjoyed it (was able to ease a lot of pain) but I would blow my brains out if this is all I did every day, please take no offense just my feelings. (this is why I picked family med over Internal med). Guess my question is can I keep this skill set on the back burner and feel competent to pull it out when I need it, or could I even have a subset patient base? Do you all just refer it off? Oh, and did you just do electives in Rheum or would a sports medicine fellowship be something I should be gunning for (I did not get to do any rotation time in this)?
Thanks again,
Disco
Every FP will have rheumatology in their practice, like it or not, because we don't know it's a rheumatologic problem until we diagnose it as a rheumatologic problem. It's then up to the FP to decide if the patient stays or goes. It's extremely hard to get patients into see a rheumatologist, even with insurance; and when you do, they don't see the patients with enough frequency for patients to go to a rheumatologist every time the patient has a problem (related to or not related to their rheum problems), so the onus falls on us to "co-manage" them with the consultant. And, if you do underserved or take public health insurance (like Medicaid), you will have many very interesting rheum patients come see you because you are the safety net.
That being said, you can't diagnose what you don't know; so you definitely should have exposure to rheumatology as a med student and resident. The RRC requires a certain number of required internal medicine rotations of which rheumatology may count towards that requirement, but that is program specific. Individually, you can arrange for your own rheumatology rotation with your own electives and attend rheumatology lectures/conferences on your own. The best place to experience rheumatology is your continuity clinic. That's the best place to get your own cases and procedures.
As far as learning the procedures, most of the injections rheumatologists may be done in primary care. Most primary care residencies will teach knees and shoulders and if you have an interest, you can learn small-medium joint and peritendonous injections. Again, best place to find them are in your own clinic but you need to know what you're looking for in order to find them.
Sports medicine rotation/fellowship can get you exposure to the injections. MSK complaints are top 10 (I believe #3) in why patients come to the doctor, so you have many chances to learn. If you join a primary care group, and you're the one in the office that does them while your partners don't, they can deliver patients to you so that you'll end up doing more and more injcection.
During sports medicine fellowship, you'll learn more than joint injections. And like you said, if all that you are interested is in rheumatology, then be a rheumatologist. But, rheumatologic patients will fall in your hands, so take of them accordingly.
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