Has Rheumatology Become a More Attractive Career?

Rheumatology is a unique and challenging internal medicine specialty, offering diverse career paths, investigative opportunities and long-term meaningful relationships with patients. In recent years, surveys have found rheumatologists to be among the happiest medical subspecialists and reported positive work–life balances.

Despite these positive aspects, rheumatology has been a less common career choice than other internal medicine subspecialties. The field offers lower compensation than procedural specialties, and disorders are typically incurable, creating a high-stress environment. However, these perceptions may be changing, according to new research from Huynh W. Tran, MD, and colleagues at the University of Southern California and Los Angeles County + University of Southern California Medical Center, published in the April 2019 issue of Arthritis Care & Research.

In a retrospective study, investigators evaluated the current attractiveness of rheumatology as a career choice and compared it with other medical subspecialties. Using data from the National Resident Matching Program (NRMP) from 2008 to 2017, the 2015 ACR workforce study and Medscape physician salary reports from 2010 to 2017, researchers determined the annual numbers of fellowship applicants, availability of positions and post-fellowship salary trends. Data from 2008 to 2013 were compared with those from 2014 to 2017, and rheumatology was compared with other subspecialties.

The Results
“Our findings suggest that since 2014 the number of applicants and the ratio of applicants to offered positions in rheumatology has increased in comparison with other medical subspecialties,” write the authors. “Furthermore, the percentage of U.S. medical graduates applying for careers in rheumatology has grown. Rheumatology seems to be becoming a more attractive and competitive subspecialty.”

From 2008 to 2013, the total number of annual rheumatology fellowship applicants decreased from 251 to 244 applicants, a 3% decrease. However, from 2014 to 2017, annual rheumatology applications increased from 230 to 332 applicants, a 44% increase. Other nonprocedural and procedural internal medicine subspecialties did not exhibit a similar increase.

Additionally, the post-fellowship average annual salary for rheumatologists increased 30%, from $180,000 in 2010 to $235,000 in 2017. The average salaries for nonprocedural subspecialists increased 25%, from $212,500 to $264,500, and the average salary for procedural subspecialists increased 32%, from $283,333 to $375,000. “Income disparities, compared with other subspecialties, decreased in 2016. For example, rheumatology tied with general internal medicine for the largest increase in [post-fellowship] salaries,” note the authors.

In the discussion, the researchers speculate why rheumatology is growing in popularity. They note the change is “multi-factorial, likely reflecting lifestyle, job satisfaction and availability, influence of mentors and other elements.” They also note “rheumatology has experienced notable scientific advances, which may make the discipline more appealing to potential applicants.”