Jack I agree with most of your top and bottom tools, but i STRONGLY disagree with exam table. There are a flat tables that are perfect for injections, and can be electronically controlled for height. (Even the flat tables with no electronic up and down, work OK too) Your message is strongly advocating (perhaps not intentionally) that physical exam is not useful. I know of colleagues that don't do a joint exam /any PE and just rely on labs to determine disease activity. In addition some Rheum practices include some " office orthopedics" with injections as a significant component of their practice. Agree that they are not the most efficient at making money, but are very important for giving non operative candidates some relief and improved function. Compassion and excellence should still be rheumatologist's primary tools.