A day in the life of a Rheumatology Registrar

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A Rheumatologist is a specialist physician who investigates, diagnoses and treats diseases, injuries and deficiencies of human joints, muscles and soft tissue. Common rheumatic diseases include arthritis, tendonitis and osteoporosis. Rarer diseases include lupus, myositis and scleroderma.

A rheumatologist uses advanced medical knowledge to diagnose and treat musculoskeletal and autoimmune disorders. Rheumatologists assist patients by evaluating their symptoms and ordering diagnostic imaging. They might also make recommendations to improve symptoms or prevent the progression of a rheumatic disease.

Common diseases treated by rheumatologists include Lupus, Fibromyalgia, Gout, Osteoporosis and various forms of Arthritis.

Rheumatologists often work in outpatient clinics with patients directed to them by referral, either from a hospital or a GP. Many rheumatologists also work in research settings to further knowledge of disease and the creation of new treatments.

Once a diagnosis is established, a rheumatologist will prescribe a course of treatment which may include pharmaceuticals (NSAIDs, steroids, anti-rheumatic drugs), physiotherapy and/or occupational therapy. Rheumatologists often work in multidisciplinary teams with other health practitioners to manage and treat diseases.

There are over 100 types of rheumatic diseases, some of these are very serious and can be difficult to diagnose and treat.

ANZSCO ID: 253323

Knowledge, skills and attributes

To become a rheumatologist, you would need:

• good diagnostic skills
• a broad knowledge of general medicine
• an empathetic approach to managing patients with long-term conditions
• good management skills within the multidisciplinary team

(Source: RAP-eL)

Duties and Tasks

• Examines patients to determine the nature and extent of problems after referral from general medical practitioners and other medical specialists, and undertakes laboratory tests and diagnostic procedures.
• Analyses test results and other medical information to make diagnoses.
• Prescribes and administers drugs, as well as remedial and therapeutic treatment and procedures.
• Records medical information and data.
• Order diagnostic imaging to identify signs of a systemic or autoimmune disorder
• Monitor the progress of an existing rheumatic disorder
• Prescribe medications to improve symptoms or slow the progression of the disorder
• Perform a physical assessment to better understand the symptoms
• Educate the patient on the autoimmune disorder and discuss a treatment plan
• Reports specified contagious and notifiable diseases to government health and immigration authorities.
• May admit or refer patients to hospitals.
• May consult other medical specialists.

Working conditions

Rheumatologists usually work regular office hours with occasional longer hours including evening and weekend work. A typical day involves seeing outpatients and spending time doing paperwork. The role can be emotionally demanding yet rewarding.

Rheumatology is an opportunity to practise clinical medicine in its broadest sense however it can sometimes be regarded as having a low profile compared to cardiology and oncology.

Tools and technologies

Rheumatologists should be competent in the use of a number of tools and technologies including:

• radiographs

• nuclear medicine

• ultrasound

• CT scanning

• MRI

• biopsy

• electrophysiological testing

Education and training/entrance requirements

To become a rheumatologist, you need to first become a qualified medical practitioner and then specialise in rheumatology.

To become a Rheumatologist in Australia you must first complete either a 5 year Bachelor of Medicine/Bachelor of Surgery (MBBS) or a 4 year graduate medical degree.

Upon completion of a medical degree, applicants can register for provisional accreditation and undertake a minimum 12 month internship as a junior doctor, usually within the public system.

Full medical registration is awarded after completion of an internship. Doctors must then spend years completing their ‘pre-vocational’ residency as an RMO (Registered Medical Officer). Doctors may spend 5-10 years working as an RMO, Registrar or Physician before they are eligible to apply for advanced training with the Royal Australian College of Physicians.

Advanced training in Rheumatology is an additional 3 years in a training position at an approved site (refer to RACP for more information). Once advanced training is complete, trainees will be awarded Fellowship with the Royal Australian College of Physicians (FRACP).

Did You Know? Rheumatologists are experts in treating the many different types of arthritis and other musculoskeletal conditions including: Osteoarthritis, which most commonly occurs in the hands, hips, knees or feet    Gout ,which most commonly affects the big toe but can also affect other joints such as knees and hands Gout in elderly man (Source: eMedicine) Osteoporosis,which increases the risk of broken bones Pain that affects one or more specific parts of the body, most commonly the low back, neck, shoulder, hip, and foot    Generalised pain conditions (e.g. fibromyalgia) They also diagnose and treat autoimmune diseases including: Rheumatoid arthritis    Psoriatic arthritis, a type of arthritis that occurs in people with psoriasis    Ankylosing Spondylitis, which most commonly affects the back    Reactive Arthritis, which most commonly occurs in young adults after an infection    Lupus (Systemic Lupus Erythematosus, SLE)    Scleroderma, which affects the skin, blood vessels (Raynaud’s phenomenon) and may affect the kidneys, lungs and other organs    Sjogren’s syndrome which commonly causes dry eyes and dry mouth    Myositis, which involves inflammation in the muscles Some rheumatologists will also have interests or specific experience in certain areas. In particular there are also paediatric rheumatologists who see patients younger than 18 years of age. Conditions in children and adolescents are often quite different from adult conditions and require particular expertise.

A day in the life of a Rheumatology Registrar Taken directly from On the Wards (now only in WebArchive) Dr Katrina Pavic is now a Specialist Rheumatologist     "I chose to work in Rheumatology as it encompasses a wide spectrum of conditions of varying complexity, ensuring that each day is not only interesting, but challenging." Posted by Katrina Pavic | Nov 26, 2017 My Monday starts at 8am. I make my way to the ward to meet with my Resident. We work our way through the inpatient notes to update ourselves on what has happened over the weekend, before proceeding to discuss each case in the multi-disciplinary team meeting. Once this is finished, I make my way to the Rheumatology Clinic, where I will be seeing patients for the next few hours. During this time, I will see both new and follow-up patients, with a multitude of issues. I chose to work in Rheumatology as it encompasses a wide spectrum of conditions of varying complexity, ensuring that each day is not only interesting, but challenging. The first patient I see is a young woman who has recently moved to Australia from India. She tells me that she was diagnosed with some form of arthritis in India, and that she had previously managed her condition with herbal supplements. Whilst taking a detailed history, I start to think that she probably has rheumatoid arthritis. I tell her that I suspect she has an inflammatory arthritis and that we will have to do more investigations as soon as possible, before likely commencing her on disease-modifying therapy. Fortunately, she is very receptive to this advice and overall appears quite relieved that someone is willing to follow through with her case. The best aspect of working in Rheumatology is positively impacting the lives of patients, particularly when it comes to managing conditions such as inflammatory arthritis, which can be quite debilitating. In these situations, it is gratifying to watch patients so drastically improve with the treatments we offer. Another patient I see is a middle-aged woman who has had a recently confirmed diagnosis of rheumatoid arthritis. She reports that she is feeling relatively well and as such is very anxious about commencing on any disease-modifying therapy. I explain that her symptoms may progress in the near future, in which case a more aggressive approach to her management may be warranted, so as to avoid any long-term complications. She seems understanding of this, but remains quite anxious. I give her some information on Methotrexate to read prior to her next appointment. Whilst seeing patients in the Rheumatology Clinic, I receive multiple calls from the Emergency Department and ward teams requesting advice. In the Emergency Department, three patients are waiting to be seen. The first is a patient with a presumed flare of ankylosing spondylitis. The second is a patient with a presumed flare of reactive arthritis. The third is a patient who is unable to mobilise due to severe pain in both of her hips. I mentally schedule the rest of my day, realising that I still need to round on the inpatients. Before I set out to complete my various tasks, I grab a quick lunch and liaise with my Resident, who updates me on the status of the inpatients. Ankylosing spondylitis (Source: The Conversation) I make my way to the Emergency Department. The first patient I see is an elderly woman with a history of ankylosing spondylitis. She tells me that she has had terrible pain for multiple days, with widespread stiffness and swelling in both of her knees. She is unable to look after herself at home in her current state. I admit her for further investigation and management, and plan to aspirate both of her knees later in the day. The next patient I see is a young man who has had a recent admission with reactive arthritis. He tells me that he stopped taking his medications after his initial supplies ran out, as he didn’t realise how important they were. His ankles are swollen and he is unable to bear any weight on his feet. I admit him, recommence him on his previous medication regime and emphasise the importance of adhering to the prescribed management plan. He seems understanding of this. The final patient I see is a middle-aged woman who has no known history of any rheumatological issues. She tells me that she recently travelled to Fiji. Since returning to Australia, she has been feeling unwell with flu-like symptoms. In the past few days, she has developed severe pain in both of her hips and is unable to mobilise. I admit her for further investigation and management. (Source: The Conversation) I make my way to the ward to commence rounding on the inpatients, who have an array of issues. I see a young woman who is recovering from severe lupus with cerebral vasculitis, an elderly man who is being worked-up for suspected giant cell arteritis, a young woman with severe lupus and immune thrombocytopaenia whose platelet count drops to critically low levels on a regular basis, a young man with severe and disabling tophaceous gout who has lost his independence to carry out activities of daily living, a middle-aged woman with diffuse scleroderma and ischaemic toes requiring an Iloprost infusion and an angiogram, and an elderly woman with a flare of oligoarticular pseudogout who is unable to look after herself at home in her current state. Whilst rounding on the inpatients, I receive further calls for consults. There are two patients waiting to be reviewed with suspected giant cell arteritis – one in the Eye Clinic and the other in the Emergency Department. It’s late in the afternoon, I still have two knees to aspirate, and I need to be at a Department Meeting by 5:30pm! I make my way to see the newly admitted patient with a presumed flare of ankylosing spondylitis. I aspirate a reasonable volume of synovial fluid from both of her knees and in turn provide her with some symptomatic relief. Fortunately, the synovial fluid doesn’t look too sinister. Once I have finished, I make my way to the Eye Clinic to review the first patient with suspected giant cell arteritis, an elderly gentleman. He tells me that he has had generalised headaches with some associated visual blurring of a few days duration. The Ophthalmologists are quite suspicious of underlying giant cell arteritis. We admit him for further investigation and management. Next, I make my way to the Emergency Department to see the final patient of the day, another elderly gentleman. He tells me that he has had a right temporal region headache with associated diplopia. We admit him for further investigation and management. Finally, I head to the Department Meeting. The meeting centres on a case presentation, where the patient himself has arrived to be part of the discussion. He has a longstanding history of deforming rheumatoid arthritis with a relatively recent diagnosis of interstitial lung disease. We discuss in detail his management to date and the various challenges going forward, in view of his various comorbidities. My Monday ends at 7pm. I leave work and prepare to do it all again tomorrow!

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Material sourced from
Jobs & Skills WA [Rheumatologist; ]
Health Careers UK [Rheumatology;]
Indeed Career Advice [Rheumatologist; ]
Health Times [What is a Rheumatologist;]
Your Career [Rheumatologist; ]