Official 2016-2017 Rheumatology Fellowship Application Cycle

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I wonder if we can attend SOTA 2017 prior to Rheumatology fellowship.
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I totally agree with Successor12 post. Lets discuss the resources and tips for fellowship. I heard rheumatology secrets plus is better than rheumatology secrets 3 ed. SOTA 2017 will be a 2 day event in Chicago and will be really helpful in my views.
 
Hi all - I heard the same thing about rheum secrets. I'm planning to work through 30 pages a week for the next few months and am making flash cards along the way. Feel free to follow / join and use them if you want:

https://quizlet.com/class/3897596/
 
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Hi Guys
What is the difference between Rheumatology secrets and secrets Plus? Where can I get it from?
Thanks


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Hey sorry my last post was confusing. I actually just have the normal rheum secrets. Not sure what the difference is but the normal one seems good


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the only difference is that rheum secrets plus has more questions, more images and more coverage according to the title.
 
For you baby fellows I would keep Rheumatology Secrets close at hand throughout your first year. I don't know what Rheumatology Secrets Plus is, or if there is such a thing, but the regular one (3rd Ed) is hard to beat as your main (although obviously not the only) learning source.

I think the Hochberg Rheumatology textbook is the best reference text, but it is not as reader-friendly in terms of just reading it straight through as Rheumatology Secrets is.

I would try to read once through the Primer on Rheumatic Diseases prior to starting fellowship. It is not very down and dirty in terms of details but gives a good overview of the field and is reasonably quick reading.

UpToDate is pretty good on rheum topics for looking things up on a day to day basis in clinic and on consults--at least starting out I would advise you to read the UTD topic article on every case you see.

The CARE questions are great study material, especially if someone at your program keeps an archive of previous years' questions and answers. The answers are extremely detailed in terms of why each answer is either correct or incorrect and typically have very useful references as well.

As far as getting the most out of fellowship, I would do the things above, and try to take every patient and consult seriously and try to learn something unique from each one. Pretty quickly you will get tired of seeing what feels like the millionth fibromyalgia or OA patient but you can learn something about how to manage those conditions from each encounter. The positive ANA referrals will get old quickly, but you'll be surprised how many positive ANA consults turn out to actually be polymyalgia rheumatica or some other significant rheumatic condition that the PCP missed. Having been in practice for a few years now, my experience has been that if you come out of a good training program you will be perfectly capable of managing "serious" diseases like lupus, vasculitis, RA, etc; the things that are really hard are the people who have complaints that are difficult to explain but can't be ignored entirely. To be a good rheumatologist you really have to become comfortable with uncertainty, and communicating that to patients in a way that doesn't make them feel like you don't know what you're doing (even though sometimes you don't :scared:). Rheumatology programs just don't teach this very well, so you have to learn it on your own.
 
Agreed - thanks for the advice. Does anyone have an archive of the prior CARE questions?
 
Congratulations to all who matched to Rheumatology this year, i did not even after getting quite a bit of interviews. i feel devastated. I am not sure what went wrong, where i should blame myself for failure. Can you guys please give me some guidance for next year.
 
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So sorry to hear that - it was a rough year, so don't be too hard on yourself. If you got a large number of interviews, that means you must have a decent application. Hard to say exactly, but a few ideas:

1. Cast a wider net next year to boost your chances, and look outside the programs you applied to this year.
2. Practice interviewing with some people you trust to give you honest feedback. If there's a bad vibe or something that you're giving, be receptive to feedback from them and see what you can do to address it.
3. Keep your chin up! Its a long process and you have a long career ahead of you - a year off may be a good time to reflect and gather yourself.

Best of luck going forward!


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doctorbeastmode said:
So sorry to hear that - it was a rough year, so don't be too hard on yourself. If you got a large number of interviews, that means you must have a decent application. Hard to say exactly, but a few ideas:

1. Cast a wider net next year to boost your chances, and look outside the programs you applied to this year.
2. Practice interviewing with some people you trust to give you honest feedback. If there's a bad vibe or something that you're giving, be receptive to feedback from them and see what you can do to address it.
3. Keep your chin up! Its a long process and you have a long career ahead of you - a year off may be a good time to reflect and gather yourself.

Best of luck going forward!


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Thanks for your valuable input. I appreciate it.
 
Quick question guys, Currently I am PGY4 doing Geraitrics Fellowship, I matched into Rheumatology this year. My Rheum coordinator said that I will only get PGY4 salary/stipend not PGY5 scale when I start my Rheum fellowship. GME office was not sure about this issue. Is anyone in the same situation? Appreciate any input. Thanks much!
 
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deadpool2016 said:
Quick question guys, Currently I am PGY4 doing Geraitrics Fellowship, I matched into Rheumatology this year. My Rheum coordinator said that I will only get PGY4 salary/stipend not PGY5 scale when I start my Rheum fellowship. GME office was not sure about this issue. Is anyone in the same situation? Appreciate any input. Thanks much!
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Seems petty of them.

Similarly petty of you to make a huge stink about it though. Definitely not the sword I'd be willing to fall on.
 
gutonc said:
Seems petty of them.

Similarly petty of you to make a huge stink about it though. Definitely not the sword I'd be willing to fall on.
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Your answer din't help. If you don't have anything productive to say, keep your ****ty opinions to yourself!
 
It's actually a very helpful answer.

It's petty of them not to pay you the extra 3-5K for your PGY year. But your options are either take it or violate your Match agreement. If the GME office was useless (which is pretty much par for the course), I'm not sure what recourse you have.

Your call hoss.
 
gutonc said:
It's actually a very helpful answer.

It's petty of them not to pay you the extra 3-5K for your PGY year. But your options are either take it or violate your Match agreement. If the GME office was useless (which is pretty much par for the course), I'm not sure what recourse you have.

Your call hoss.
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Thanks! I am not gonna violate the match agreement over this issue. I was just curious if anyone else had the same situation.
 
deadpool2016 said:
Thanks! I am not gonna violate the match agreement over this issue. I was just curious if anyone else had the same situation.
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I could be wrong but since geriatrics is not a prerequisite for rheumatology, it does not count as you becoming a PGY-5 instead of PGY-4.
I found this on one of the program's sites:
The Post Graduate year is the one appropriate for the program in which the housestaff is currently enrolled and is determined by the number of years remaining before successful completion of the program. Only pre-requisite years are included in the Post Graduate year determination. Example: An individual has completed 5 years of previous GME and enters the first year of a Cardiology program. The training year level would be PG IV if the individual successfully completed 3 years training in an Internal Medicine program as the pre-requisite for Cardiology.
 
GQMO16 said:
I could be wrong but since geriatrics is not a prerequisite for rheumatology, it does not count as you becoming a PGY-5 instead of PGY-4.
I found this on one of the program's sites:
The Post Graduate year is the one appropriate for the program in which the housestaff is currently enrolled and is determined by the number of years remaining before successful completion of the program. Only pre-requisite years are included in the Post Graduate year determination. Example: An individual has completed 5 years of previous GME and enters the first year of a Cardiology program. The training year level would be PG IV if the individual successfully completed 3 years training in an Internal Medicine program as the pre-requisite for Cardiology.
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Thanks much for the reply! Looks like it depends up on the program too. For a similar situation some of the programs are considering them as PGY5. Appreciate your reply!
 
For all who are wondering why Rheum is getting much more competitive now, it's because of the increased use of infusions which bring more money into the specialty. Rheumatology salaries are going up which drives more people to be interested in the field. Increased demand, basically. Another specialty that utilizes infusions a lot is Heme/Onc and Rheum salaries will be rising to close to what Heme/Onc docs make in the future.
 
SeaSalt said:
For all who are wondering why Rheum is getting much more competitive now, it's because of the increased use of infusions which bring more money into the specialty. Rheumatology salaries are going up which drives more people to be interested in the field. Increased demand, basically. Another specialty that utilizes infusions a lot is Heme/Onc and Rheum salaries will be rising to close to what Heme/Onc docs make in the future.
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This may not be correct. If anything infusions as a source of revenue are increasingly endangered. The recently proposed Medicare Part B demonstration project would have all but destroyed infusions as a source of revenue for all but the largest practices. That was defeated last month but this is a very large piñata that deficit hawks will almost certainly keep swinging at.

Also the majority of infusions in rheum are for RA and with more JAK inhibitors coming to market soon I would not be surprised if there is a paradigm shift away from biologics altogether over the next decade, facilitated by competition for pharmacy benefit managers among JAK manufacturers, along with the relatively lower cost to manufacture small molecules
 
Is that actually true that salaries are going up? I don't honestly know either way.

Even if it is, are they going up more than other specialties? If rheum salaries went up by 5% and other specialties went up by 8%, then the increase in salaries still wouldn't explain it.

It's also not clear that rheum will ever be the same as heme onc. The sheer volume of infusions would be hard to match. Moreover, I think their volume of patients is higher as well.

Finally, even if salaries are going up at a faster pace than other specialties, it's not clear to me that it's sufficient to drive the markedly increased competitiveness of rheum.


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deadpool2016 said:
Quick question guys, Currently I am PGY4 doing Geraitrics Fellowship, I matched into Rheumatology this year. My Rheum coordinator said that I will only get PGY4 salary/stipend not PGY5 scale when I start my Rheum fellowship. GME office was not sure about this issue. Is anyone in the same situation? Appreciate any input. Thanks much!
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This is pretty standard. You get paid based on your required year of training.

You could complete a full neurosurgery residency and then decide to go back and do internal medicine, and they'll start you off as a PGY1, not a PGY9.

No clue how it works for fast-track people where their years of training are all screwed up.
 
Raryn said:
This is pretty standard. You get paid based on your required year of training.

You could complete a full neurosurgery residency and then decide to go back and do internal medicine, and they'll start you off as a PGY1, not a PGY9.

No clue how it works for fast-track people where their years of training are all screwed up.
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The same. As a first year fellow (but PGY3), I got paid the PGY3 salary I would have been paid as an IM R3.

Some surgical programs will pay you completely off of grants/T32s during your research years and will then re-start you at the (usually) PGY4 level when you go back to the OR, despite the fact that you're a PGY6-7 at that point.
 
I'm excited to start the rheumatology fellowship! I bought Rheumatology Secrets and started reading it. I finished residency last year (I'm working as a hospitalist in the meantime) and I have extra time to study. Any other other recommendations before starting fellowship next July?
 
The reason why rheumatology is getting more competitive continues to puzzle me! I think pay did not change that much. Is that residents now are more aware of it as a life style friendly specialty? The other factor I think is that the limited fellowship spots do not accommodate much increased applicants number meaning more applicants will be just be competing for not so many spots and I was amazed at how few these rheumatology spots are during interviews with most programs taking two at the most if not just one fellow per year!! Only one program I been to actually it's leadership realized that demand for training now is higher and they talked about funding a third spot this year!

I think pay is very much comparable to internal medicine of course without the primary care daily hassles and I would take that lifestyle friendliness that rheum offers over 50K more a year to be honest!
If you need more money you can always just moonlight ! Or work more in rheum because remember most of these salaries are based on 4-5 /week working days schedule most of the time.
 
drfunktacular said:
Just based on this reply it sounds like they might have been better off with a different fellow
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excuse me???? remember I can insult you the same way in the group, but I wouldn't fall to your level! read the conversation before you judge my comment.
 
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Raryn said:
This is pretty standard. You get paid based on your required year of training.

You could complete a full neurosurgery residency and then decide to go back and do internal medicine, and they'll start you off as a PGY1, not a PGY9.

No clue how it works for fast-track people where their years of training are all screwed up.
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Thanks for the reply buddy!
 
Raryn said:
This is pretty standard. You get paid based on your required year of training.

You could complete a full neurosurgery residency and then decide to go back and do internal medicine, and they'll start you off as a PGY1, not a PGY9.

No clue how it works for fast-track people where their years of training are all screwed up.
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After discussing with GME offices at different programs, couple of my friends who are in the same situation concluded that they will count your previous training (PGY years) if they were ACGME accredited
 
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Does anyone have advice on what variables to look for in a rheum program to do an away at? Should I really just try to find a program that I would like to basically do an audition and hope to match PGY3, or are there other variables I should be considering? This will probably be for the end of my PGY2, and might try for another early PGY3. One of our rheum graduates suggested trying to do an ultrasound course to have for my CV but wasn't sure of the utility of that given I'm seeing a lot of programs that will do this training during fellowship.
 
I would not spend your time on an ultrasound course as a resident. You should spend your time learning as much internal medicine as you can prior to fellowship; even more than in many other subspecialties, a good rheumatologist needs to be a good internist. You'll have time to learn US as a fellow. Although it is a "hot topic" now, I remain unsure what the long-term viability of US in rheumatology practice will be. Payors are cutting back on reimbursements for US-guided procedures and I would not be surprised if a lot of practices that currently incorporate US start giving it up, the way they gave up on MRI 10 years before.
 
It is great that rheumatology is gaining in popularity.

I think new fellows should be proactive and pursue new technology such as ultrasound. This will open the door to interventions including PRP, tenotomies etc.

You should also gain expertise in osteoporosis as this will be helpful in practice.

There are many rheumatologists who have figured how to make infusions work for them, so yes infusion is a source of income.

Do not follow the footsteps of loser attendings in the academic institutions, who get kicked around by other specialties. They are not respected because they do it to themselves-including being skeptical of ultrasound.

You can make as much money as other specialties.

Believe in yourself and you will make rheumatology great!
 
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rheumatology81 said:
It is great that rheumatology is gaining in popularity.

I think new fellows should be proactive and pursue new technology such as ultrasound. This will open the door to interventions including PRP, tenotomies etc.

You should also gain expertise in osteoporosis as this will be helpful in practice.

There are many rheumatologists who have figured how to make infusions work for them, so yes infusion is a source of income.

Do not follow the footsteps of loser attendings in the academic institutions, who get kicked around by other specialties. They are not respected because they do it to themselves-including being sceptical of ultrasound.

You can make as much money as other specialties.

Believe in yourself and you will make rheumatology great!
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Love the positive attitude!
 
The positive attitude is great but in rheumatology you simply will not make as much money as a gastroenterologist or cardiologist without resorting to business practices that are questionable at best...
 
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http://www.medscape.com/slideshow/compensation-2017-overview-6008547

The new medscape compensation report is out. I know its not a very accurate representarion, but how did Rheum go from one of the happiest specialties w/ high satisfaction to one of the lowest? Also any comment on the salary stagnation? Not surprised of the total compensation, but shouldnt it be at ne going up on pace w/other specialties??
 
drfunktacular said:
The positive attitude is great but in rheumatology you simply will not make as much money as a gastroenterologist or cardiologist without resorting to business practices that are questionable at best...
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As if high income cardiologists and gastroenterologists don't also take many liberties with "indications" for their procedures.
 
bronx43 said:
As if high income cardiologists and gastroenterologists don't also take many liberties with "indications" for their procedures.
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They most definitely do, but those excesses are encouraged by the structure of our healthcare system and expectations of healthcare consumers:

"Boy that cardiologist works hard. He did an echo, exercise stress test, nuclear stress test, cardiac MRI, diagnostic right and left heart cath, and preventive PCI on me; I wasn't even having any symptoms yet! What a great doctor. I know my insurance paid $8000 for all that but it's worth it for the peace of mind."

"Why did my insurance pay that rheumatologist $120?? He just talked to me for an hour about why that blood test didn't mean I have lupus! He didn't even do anything!! What a waste of money!"
 
drfunktacular said:
They most definitely do, but those excesses are encouraged by the structure of our healthcare system and expectations of healthcare consumers:

"Boy that cardiologist works hard. He did an echo, exercise stress test, nuclear stress test, cardiac MRI, diagnostic right and left heart cath, and preventive PCI on me; I wasn't even having any symptoms yet! What a great doctor. I know my insurance paid $8000 for all that but it's worth it for the peace of mind."

"Why did my insurance pay that rheumatologist $120?? He just talked to me for an hour about why that blood test didn't mean I have lupus! He didn't even do anything!! What a waste of money!"
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I think consumers will know why they paid $120 for the rheumatologist after they had to wait 6 months to see one. That's probably the biggest thing going for us right now. Cardiologists are dime a dozen, while rheumatologists are dwindling by the day as the older generation retires.
 
bronx43 said:
I think consumers will know why they paid $120 for the rheumatologist after they had to wait 6 months to see one. That's probably the biggest thing going for us right now. Cardiologists are dime a dozen, while rheumatologists are dwindling by the day as the older generation retires.
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Yes but supply and demand has very little impact on valuation of or reimbursement for services since our healthcare system is not actually driven by markets (rhetoric otherwise notwithstanding).

My point is that in medicine you get rewarded both financially and in terms of appreciation/prestige for doing things, not for thinking or not-doing things (even though that is often best for the patient and the system as a whole)
 
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drfunktacular said:
Yes but supply and demand has very little impact on valuation of or reimbursement for services since our healthcare system is not actually driven by markets (rhetoric otherwise notwithstanding).

My point is that in medicine you get rewarded both financially and in terms of appreciation/prestige for doing things, not for thinking or not-doing things (even though that is often best for the patient and the system as a whole)
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Not necessarily. Hematology/oncology is a thinking field. They technically don't "do" anything in the same way cardiologists or gastroenterologists do. Dermatology also don't do any more procedures than we do. Sure, they can do biopsies and freeze a few AKs here and there, but overall it's not a procedure driven field. They only make bank because they can see 50-70 patients per day given the fact that they don't have to take a history and their exam is looking at a skin lesion.

There is more to making money in medicine than reimbursement numbers. With high demand and low supply, you can capture more of the market share in your region and utilize midlevels to your advantage. Hell, you have the option of just running a cash only practice and significantly cut down your overhead since there's no one else within 200 miles who can see our diseases.
My point is that it's ALWAYS better to have supply and demand in your favor, and once the reimbursement system changes, it may be even more important. The status quo will inevitably change away from a fee for service model, and once that happens, would you rather be the guy who's competing with the others to fill up next week's schedule, or the guy with a 6 month wait list?
 
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I am aware of a rheumatologist who makes half a million
I have no way to verify this actual number and I have no idea what kind of unnecessary measures he might opt for to make this much money
I know however that he thinks more like a business man, utilizes midlevels and has strong connections and a huge network in the area where he practices and he sees many many patients!

I don't necessarily suggest that following his lead is a good/bad thing just sharing something I knew about
 
Successor12 said:
I am aware of a rheumatologist who makes half a million
I have no way to verify this actual number and I have no idea what kind of unnecessary measures he might opt for to make this much money
I know however that he thinks more like a business man, utilizes midlevels and has strong connections and a huge network in the area where he practices and he sees many many patients!

I don't necessarily suggest that following his lead is a good/bad thing just sharing something I knew about
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75th percentile for rheumatologists in this country is $301k. So to make 66% more than that? Shady business going on.
 
Raryn said:
75th percentile for rheumatologists in this country is $301k. So to make 66% more than that? Shady business going on.
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Just because you make a lot of money you are doing shady medicine? Come on now...

I know a rheumatologist making $750k. In fact, he used to clear over a $1 mil before reimbursement rates got cut. He did this by owning 3 ultrasound machines, and doing a ton of scans daily, as well as having midlevels augment his volume. There is nothing immoral about this business model. In fact, I would argue that doing ultrasound scans on people's joints to evaluate for synovitis can in fact save them money in other forms of diagnostics or therapeutics. This isn't even borderline shady like how some rheumatologists would prescribe infusions just to fill up their infusion center, instead of injectable biologics. While this usually isn't harmful to the patient, it does drain time and resources from the patient when a cheaper and more convenient alternative is available (assuming their insurance would pay for injections).

You just have to know how to run a good business, and this doesn't necessarily mean (and shouldn't mean) shady practice.
 
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bronx43 said:
Just because you make a lot of money you are doing shady medicine? Come on now...

I know a rheumatologist making $750k. In fact, he used to clear over a $1 mil before reimbursement rates got cut. He did this by owning 3 ultrasound machines, and doing a ton of scans daily, as well as having midlevels augment his volume. There is nothing immoral about this business model. In fact, I would argue that doing ultrasound scans on people's joints to evaluate for synovitis can in fact save them money in other forms of diagnostics or therapeutics. This isn't even borderline shady like how some rheumatologists would prescribe infusions just to fill up their infusion center, instead of injectable biologics. While this usually isn't harmful to the patient, it does drain time and resources from the patient when a cheaper and more convenient alternative is available (assuming their insurance would pay for injections).

You just have to know how to run a good business, and this doesn't necessarily mean (and shouldn't mean) shady practice.
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Whether such utilization of ultrasound is defensible or not is at least debatable. It is CERTAINLY done in that kind of volume at least in part to make money
 
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