Rheuminations: A Long Journey Brings Unexpected Insights

Gridlock. Congestion. Stuck in Chicago’s rush hour at its worst. My poor car could barely advance a few blocks over the course of an hour, jostling with much more aggressive local drivers who could put their tires first into valuable street space. It was frustrating to say the least. I was eager to return home and spend time with my family to discuss all the fun adventures and misadventures I’d experienced during a very successful, but very hectic, ACR Convergence 2025. Instead, cramped in the driver’s seat with my foot firmly on the brake pedal and eyes darting to find a spot to move ahead, I felt as if I was in some sort of limbo within the confines of downtown Chicago.

Once my impatience eventually gave way to the more serene realization that I would slowly but surely return home, the more I realized how appropriate it was to make my exit from Chicago and ACR Convergence in such a way. It was only natural that such an exhilarating five days should be followed by an incredibly boring conclusion. In fact, and I say this without any sense of irony or sarcasm, I started to enjoy having this time alone. Why? Let’s rheuminate!

Traffic

As I sat in my car, barely creeping forward between red lights, I began to think about gridlock as more than just a physical inconvenience. It felt like a metaphor for the state of our world. Our society is overwhelmed by competing priorities, noise and the relentless jostling for perceived progress. Many people with good intentions and pressing goals end up stuck because the system itself no longer accommodates fluidity and flexibility. Just like on the road, there is tension, competition and, at times, a simmering despair when every lane seems occupied or otherwise blocked. And yet everyone remains in their car, inching forward, hoping to get to their destination.

In rheumatology, we experience this too, and I observed a lot of it at ACR Convergence 2025. Our healthcare systems seem to be constructed around artificial bottlenecks, such as limited funding for training spots, unnecessarily rigid schedules and fragmented care among specialists, to name a few. We find ourselves competing for space, literally. My colleagues detailed the fierce zero-sum games in their workspaces with clinic slots, lab space, infusion chairs and basic offices. Even time with patients, the most fundamental input necessary to being a clinician, is increasingly becoming a luxury. Quite honestly, it is not that we lack purpose or effort. It’s that the infrastructure itself sometimes pits us against each other, even when we share the same mission. The result? Intellectual and emotional gridlock that feels inescapable.