Name: So You Want to Be a RHEUMATOLOGIST [Ep. 42]
Uploaded: 2026-03-09T17:48:26.000Z
Duration: 10 min 21 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

You like to solve complex puzzles and go through a lot of trial and error with your patients.

Let's debunk the public perception myths and give it to you straight.

Dr. Jubbal medschoolinsiders.com welcome to our next installment in so youo Want to Be.

In this series, we highlight a specific specialty within medicine, such as rheumatology, and

help you decide if it's a good fit for you.

You can find the other specialties on our so youo Want to Be playlist.

If you want to vote in upcoming polls to decide what future specialties we cover, make sure you are subscribed.

If you' see what being a rheumatologist looks like, check out my second channel, Kevin Jubbal, M.D.

where we'll cover A Day in the Life of a Rheumatologist Rheumatology is the specialty of medicine focused on musculoskeletal problems and autoimmune diseases where the body's immune system is dysfunctional and the body basically attacks itself.

Rheumatology can often be described as internal medicine plus because autoimmune diseases are often systemic and they can affect any part of the body.

So you need to maintain all of your internal medicine knowledge and then some Rheumatologists treat a Wide Variety of Conditions the complex conditions students and trainees encounter in the hospital may not be the conditions you most commonly see, but

they're the ones people are drawn to, like lupus vasculitis, rheumatoid arthritis, and

That said, the bread and butter of rheumatology can vary based on practice, location and type of practice.

This brings us to an important method of differentiation, academic versus Community versus Private practice.

In the academic setting, rheumatologists will divide their time between clinical teaching and research responsibilities.

Academic rheumatologists are much more research focused than their private practice counterparts, and

you'll often find rheumatologists who follow the physician scientist track to dedicate more time to lab research or translational research.

Academic rheumatologists are also more likely to see rare, complicated patients in the hospital.

As a private practice or community based rheumatologist, the most common conditions you will encounter include osteoarthritis, osteoporosis, rheumatoid arthritis, lupus pain syndromes like fibromyalgia, and

Many of the conditions you see in the clinic will be much more straightforward than in academia.

While not not as much of a focus, you can still spend time in private practice teaching students and residents or being involved in research.

In terms of compensation, academic rheumatologists typically make less than their private practice counterparts, but

this can often depend on other factors as well, such as location and research funding from grants.

Let's clear up some of the misconceptions about rheumatology.

One big misconception is that all rheumatologists do is give steroids.

While they do give corticosteroids frequently, it's not the only medication they use.

In the past 30 years, new biologic medications completely changed the game for both doctors and patients.

This actually leads us to our next misconception, which is that rheumatology patients are always in pain and don't get better.

With these biologic medications, patient outcomes are greatly improving to the point where new rheumatology trainees aren't seeing late complications of rheumatoid arthritis anymore.

Diseases like RA are no longer considered a sentence of disability for patients.

In addition, many people perceive rheumatologists as nerdy or slow to act.

Rheumatologic diseases are often very complex and physicians need to go through a lot of documentation and labs when working up their patients.

Even in rheumatologic emergencies, it's usually not the rheumatologist that's coming in to save the day.

At first, the emergency itself is usually managed by another team, whether it's cardiology, critical care or surgery, and

then rheumatology will come in afterward to treat the underlying condition.

Rheumatologists are often called in when no one knows what's going on.

Stepping into the role of the doctor's doctor and with the constantly evolving medications, rheumatologists have to stay up to date with the latest research.

To become a rheumatologist, you must first complete physical four years of medical school, followed by three years of internal medicine residency and usually two years of rheumatology fellowship.

Some programs offer a three year fellowship to make time for more research, while other programs offer combined training that includes allergy and immunology.

If you're interested in becoming a physician scientist, a three year fellowship can set you up for success.

For those interested in going into pediatric rheumatology, the pathway is slightly different.

After medical school, you must complete three years of pediatric residency followed by three years of pediatric rheumatology instead of two years.

The reason it's three years is pediatric rheumatology is mostly academic and the fellowship requires more dedicated research time.

In terms of competitiveness, internal medicine and pediatrics are among the 10 most attainable medical specialties.

According to our analysis, internal medicine is the ninth least competitive specialty and pediatrics is the second least competitive specialty, only behind family medicine.

If your goal is to match into a top tier internal medicine or pediatrics residency, you will still need to do well on your step exams and and obtain ample research experience.

That said, rheumatology is one of the more attainable internal medicine fellowships.

According to the 2019 Fellowship Competitiveness Index proposed by Trant et al, Rheumatology was the fifth most competitive IM fellowship, trailed only by endocrinology, infectious disease and nephrology.

Competitiveness is increasing for multiple reasons.

First of all, the introduction of biologics, which has led to improved patient outcomes, has attracted many trainees.

Secondly, the importance of work life balance has increased for many people and rheumatology is traditionally considered a specialty with a better work life balance and very rare emergencies.

In fact, in 2022 there were approximately 1.3 applicants per position.

Most positions filled up with a fill rate of 97.8%.

As for the type of medical student who typically goes for rheumatology, they're usually more laid back students who prefer spending their time thinking rather than doing.

Students who enjoy the art of piecing together different components of medical context to come to a conclusion generally enjoy rheumatology.

Unlike many specialties, most rheumatologists don't pursue additional training after fellowship.

However, for those who want to focus on a specific disease or area within rheumatology, that path is typically straightforward.

The solution is usually to stay in academia and focus on your interests by doing more research in that field and learning from mentors.

For example, you can become the lupus specialist or scleroderma specialist at your institute.

If you're interested in med peds, you can specialize in transition care.

Helping adolescents with rheumatologic diseases transition between adolescence and adulthood.

There's a lot to love about rheumatology to start if you love the patient care aspects of being a physician, few specialties allow you as much time with patients as rheumatology.

As a rheumatologist, you get to build long term relationships with most of your patients.

When patients start to suffer from autoimmune diseases, they often feel like they are losing control of their life and body, which can be scary for them.

You'll be able to help them regain a sense of autonomy and navigate a very vulnerable point in their life through treatment and education.

Furthermore, rheumatology is a much more creative specialty than other internal medicine specialties.

While many specialties have much more straightforward diseases and algorithmic management plans, there's a lot more gray area in rheumatology.

Diagnostic biomarkers and classification criteria do exist for certain diseases, but the story is often vague.

Helping patients maneuver through this gray area by going through their documentation and lab findings is an art.

Since rheumatology is not as algorithmic, there's a lot more room for personalization and shared decision making with your patients.

In terms of lifestyle, rheumatologists have a good work life balance.

There are very few emergencies in rheumatology and even then, rheumatologists aren't called in during the middle of the night.

In fact, in 2019, rheumatology was the top ranked specialty in happiness outside of work according to Medscape's Physician Lifestyle and Happiness Report.

While rheumatology is an awesome specialty, it's not for everyone to start.

If you're not someone who can tolerate the day to day of clinic life, rheumatology may not be for you.

Additionally, the volume of patients in the clinic can wear you down for multiple reasons.

You need to figure out how to manage the high volume of patients without compromising their care.

A high volume of patients also means managing a lot of relationships which can weigh certain people down.

Like many specialties, and especially the internal medicine specialties, rheumatology has its fair share of administrative burden.

Rheumatologists have to do comprehensive chart reviews and extensively document everything they do with their patients.

There are also many hoops you need to jump through when it comes to insurance companies with new biologics.

You first need to find data supporting the use of these medications.

After that, you need to convince the insurance company to allow your patients to use these drugs.

You might spend hours curating a personalized management plan for your patient, only for them to have their request refused by their insurance company after they leave the clinic.

This leads to a great deal of frustration for all of the involved parties and results in a lot of extra paperwork.

If you're uncomfortable with gray areas, rheumatology may not be the field for you.

Since these diseases are multisystemic, each patient can present differently with different signs, symptoms and labs.

Patients won't respond to the same medications equally, and you have to keep experimenting occasionally.

Patients won't get that much better no matter how hard you try, which can be extremely frustrating and demoralizing.

Lastly, rheumatology is a specialty more suited to thinkers, not doers.

There aren't many procedures in rheumatology.