Subspecialty Careers: Rheumatology
The Discipline
From the Greek word rheuma, "that which flows as a river or stream." In ancient medical writings, "rheuma" was used to describe any thin discharge from a body surface or orifice. This term was eventually applied to an infection of the joints, presumably because an effusion of the joint space marks the various forms of arthritis.
Rheumatology deals with the prevention, diagnosis, and management of crystalline diseases, systemic rheumatic diseases, spondyloarthropathies, vasculitis, inflammatory muscle disease, osteoporosis, osteoarthritis, recreational sports injury, soft-tissue diseases and trauma. The goal of the rheumatologist is the early diagnosis and treatment of these conditions to prevent disability and death.
Procedures
Important procedural skills include diagnostic and therapeutic joint aspiration, and joint and soft tissue injection of corticosteroids. Rheumatologists are expert in the interpretation of joint fluid analysis, including crystal identification, and the interpretation of serology associated with rheumatological disorders.
Training
Rheumatology fellowship training requires two years of accredited training beyond general internal medicine residency. Of the two years, a minimum of 12 months must include clinical training in the diagnosis and management of a broad spectrum of medical diseases. Dual certification in Rheumatology and Allergy and Immunology requires a minimum of three years of training which must include (a) at least 12 months full-time clinical rheumatology, (b) weekly attendance for 18 consecutive months in a rheumatology ambulatory care program which must include continuity of patient care, and (c) at least 18 months of full-time allergy and immunology.
Certification
The American Board of Internal Medicine offers certification in Rheumatology. Dual certification in Rheumatology and Allergy and Immunology requires completion of the entire three-year program.
Training Positions
For the 2012-2013 academic year, there are 111 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in Rheumatology with 436 active training positions.