Great post Jack, you summarized what many of us feel. When you suggest a full time hospitalist covering Rheumatology, do you mean a dedicated inpatient Rheumatologist? Or rather a hospitalized that is trained in MSK procedures with access to practicing rheumatologist? Also, several hospitals offer Arthocentesis via IR, 7 days a week. This eliminates burden from rheums for going in just for a 90 min inpatient procedure (that only takes 10 min in the office).