Are You a Super Rheum? Save

Jack Cush, MD

Mar 18, 2021 4:05 pm

Several weeks ago, at the Rheumatology Winter Clinical Symposia (RWCS), an interesting debate between Drs. Orrin Troum and Marty Bergman hashed over the concept of whether rheumatologists should sub-specialize with a practice, research or career devoted to one disease ("Super Rheum"), or be "selective" about what disorders and diseases they would treat or just be a generalist.

The views were either: A) rheumatologists would be more efficient, fulfilled and happier by being a "Super Rheum" (devoted to just one disorder) or a "Selective Rheum"; versus B) Rheumatologists are expert in their diversity and the large public need for rheumatologic services mandate that we be dedicated to general rheumatology. Of course the obvious exception and example would be pediatric rheumatologists who prefer to only manage those patients with pediatric rheumatologic disorders, not taller than their Pediatric Rheumatologist and not yet pregnant, smoking or jailed.

With the debate still undecided (read more here), we asked the RheumNow readership to answer the question - how common or rare are Super Rheums or Selective Rheums?

An electronic email survey was sent to verified rheumatologists 3000 verified rheumatologists and a week later, a social media (Twitter) invitation encouraged rheums (only) to participate in the same online survey. A total of 449 responses were received from 46 countries, with 330 of these being US rheumatologists. While the rest of this report will detail the answers for the US market place, comparison of US and non-US rheumatologists largely revealed no significant differences, other than the 1st question which shows that more non-US rheums are practicing as "specialized rheums" (21% vs 6.5%).

Key takeaways from this survey:

In the US - very few rheums are "Super Rheums" (seeing only one disease) - 1.2%
There are more Super and Selective rheums amongst international rheum (21%) compared to the US (6.5%).
The most common Super (specialized) Rheums in the US are pediatric rheumatologists
Most rheums are content to practice general rheumatology now and in the future
Selective Rheums are more apt to divert care of fibromyalgia, chronic pain and pediatric rheumatology - problems most rheums are not particularly masterful at.
Respondents had little future interest in hiring NP or PA's, going telemedicine or expanding services
There are many retired rheums and many more to follow in the next few years.

Below are the responses received from US rheumatologists, along with commentary.

Question 1. What Kind of Rheumatologist are You?
Response		Rheums	Commentary
a	Typical/General Rheum	77.8%	These data represent respondents from the RheumNow audience and suggest that of the practicing Rheums, 90% consider themselves to be "Typical or General Rheumatologists". Thus only 6.4% of rheums have "specialized" or could call themselves Super Rheums. Amongst the international Rheum responders, specialized rheums increased to 20.7%.
b	Specialized Rheum (1 Dz)	1.2%
c	Selective Rheum	5.8%
d	Pediatric Rheum	1.5%
e	Not Practicing	13.5%

Question 2. What is your Clinic focus?

General rheumatology - 87%
Inflammatory arthritis - 4%
RA only - 3%
SLE only - 3%
Myositis, Scleroderma, PsA/SpA, Vasculitis

Question 4. If you are a Selective Rheum what Dz do you defer (not want to see)?
Response option		Rheums	Commentary
a	Fibromyaliga	35%	For those who wish to restrict their clinics (be more selective), Fibromyalgia, Pediatric rheumatology and chronic pain management lead the list of "dislikes". I might suggest that these topics of disinterest are also topics the respondents are not particulary masterful at managing.
b	Pediatric rheumatology	18%
c	Chronic pain	16%
d	Osteoarthritis	11%
e	Inflammatory arthritis	6%
f	Low back pain	5%
g	Second opinions	5%
h	Autoimmune disease	4%

Question 5. In the next 2 years, what do you intend to transition your practice to?
Response option		Rheums	Commentary
a	None; fine as is	56%	More than half of those in general practice, intend to stay the same.One in five intend to be more selective in the future and 14% intend to retire Very few intend to hire an NP or PA, expand their services or convert to mostly telemedicine. Very very few intend to be a specialized "Super Rheum"
b	Be more selective/restrictive	20%
c	Intend to retire	14%
d	Expand practice/services	4%
e	Hire an NP or PA	3%
f	Convert to Telemedicine	1%
g	Be a Super Rheum - 1 Dz only	1%