Dr Derek Baxter, Consultant Rheumatologist
‘Definition’ of specialty

Rheumatology involves the assessment and multi-disciplinary management of joint disorders (from inflammatory and degenerative arthritis, spondyloarthritis and crystal arthritides), vasculitis, osteoporosis, connective tissue disorders and management of their related co-morbidity.

Overview of training 

Higher training is over five years (if dual accrediting with General Internal Medicine [GIM]).

Exam  and other requirements

Specialty Certificate Examination in Rheumatology required.

Expected competence in joint and soft tissue injections will be attained through training.  Skills in the use of ultrasound is also desirable.

Opportunities for research

A formal research period is desirable and many opportunities exist to do so, from clinical studies to scientific laboratory-based work (close ties with immunology-based topics and metabolic/osteoporosis research).

A day in the life of a Registrar/Consultant

Whereas inpatient ward work is forming less and less of daily practice, those requiring inpatient management represent the severe end of the spectrum, requiring close multi-disciplinary input and management of multi-system problems. Ad hoc urgent care takes place in day ward facilities for the management of acute symptom flares and joint injections. Outpatient (OP) work (clinics) is the mainstay of the specialty, often streamlined into disease specialty clinics. Administrative follow-up of OP work and communication with primary care of results and drug monitoring also form an important part of the day.

Pros and Cons of working in this specialty

Pros

  • Good work/life balance
  • Many and varied opportunities for research at clinical and basic science level
  • Continuing care of a multifaceted chronic disease. Opportunity for longer term follow-up and build relationships
  • Effective therapies - the opportunity to achieve disease remission and return patients to employment represent achievable and rewarding outcomes
  • Managing co-morbidity requires knowledge of and consideration of virtually every other medical specialty. Close ties with anaesthetic/pain management, surgical and orthopaedic colleagues
  • Counselling and communication skills are key when commencing therapy and explaining the nature of disease
  • A rapidly progressing specialty with the need for frequent updating of skills and awareness of recent publications to inform daily practice

Cons

  • Many diseases can’t be cured, and patients need a lifetime of therapy
  • There are limited options for non-inflammatory conditions
  • Expensive, potentially toxic therapies require considered judicious use and are subject to varying degrees of external regulation
  • Good deal of administrative work and OP clinic pressures
How this specialty differs to others and why I chose it

I enjoy working within a team and managing the acute aspects of rheumatology such as the acute joint flare treated rapidly and effectively with a joint injection. The management of early arthritis has been transformed and we are working towards effective disease remission and decline in disability, need for joint surgery and loss of employment. Following-up individuals and building a relationship over a long period is rewarding and sharing care in areas of their condition with primary care again fosters close links.

Tips for success in applying for this specialty

Year on year, there are very few ST posts and it is therefore highly competitive. Experience such as an audit in rheumatology is highly desirable, in addition to a period of previous experience in the specialty to draw on.

For more information

British Society for Rheumatology

Joint Royal College of Physicians d (JRCPTB) curriculum and specialty pages

The European League Against Rheumatism (EULAR)