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!
But traffic, like healthcare systems, is not destiny. We have the tools to redesign flow. ACR Convergence 2025 redemonstrated the vital importance of organization, collaboration and, most of all, advocacy during trying times. Collaboration among far flung rheumatologists across the globe, investment in promising technology to advance humanism and team-based care were major themes of this year’s Convergence. To extend the metaphor, these are akin to roundabouts and express lanes for congested, outdated systems. Gridlock may be common, but it is not inevitable.
Back in my car, as I was thinking about these heady concepts, I encountered a rare opportunity. A kind gentleman, likely seeing my Iowa license plate, gestured me forward with a brief wave. That small act of generosity reminded me that even in the most gridlocked systems, small human gestures can generate movement.
Tollways
Eventually, I found the on-ramp for the highway, and like magic, the traffic dissolved. The city fell behind me, replaced by the humming momentum of suburban sprawl. It felt like freedom, for a price of the toll, of course. I gladly pressed the accelerator and finally felt like I was making tangible progress. It was a minor miracle, and I didn’t take it for granted.
At the same time, that tollway reminded me of my privilege. Indeed, some paths to efficiency and ease come at a cost that not everyone can pay. I was incredibly fortunate. I didn’t have to detour through side roads or local routes to avoid tolls. I could afford the faster way, but I recognized that not everyone can. Some people get stuck in inefficient systems not because of poor planning, but because of structural limitations.
As I drove, I thought to myself: What if we made the tollway free for everyone? What if we invested in infrastructure that enabled all patients to move smoothly through the healthcare system, regardless of their background, experiences or income level? We could rethink access, minimize bureaucratic friction and create fast lanes not just for those with means, but for everyone. Fairness, to my perhaps naive mind, should not be controversial. On second thought though, removing the tolls would also mean more congestion, which only means that we would trade one set of problems for another. In short, the real question is what dilemmas we should prioritize to resolve.
Regardless, after an hour or so, as I left that tollway behind and entered a realm of chain restaurants, outlet malls, corporate offices and enormous warehouses, I felt both a sense of momentum and a sharp tinge of discomfort. Suburbia was sprawling in all directions, yet it felt oddly placeless. I was finally moving quickly, but where exactly was I going?
Flanked by Malls
Mile after mile of big box stores, chain restaurants and indistinguishable strip malls flanked the highway. It felt like the geography of consumption had swallowed the uniqueness of place. From the seat of my modest car, I felt oddly diminished by the towering signs and parking lots. I couldn’t help but be enveloped by a sense of insignificance. With every passing mile, there was a reminder that, despite my role and my thoughts, I was just another driver passing through the machinery of modern commerce.
This landscape mirrored a tension I heard from rheumatologists at ACR Convergence. We want to be individuals and to bring our unique perspectives and humanity to the bedside. Yet we are increasingly at the mercy of massive systems—hospital networks and insurance companies. Both patients and clinicians seem anonymous to those who seem solidly and firmly in place while we scurry around them toward where we want to go.
Still, just as my car must traverse these zones to reach home, we too must navigate corporatized medicine without losing our identities. We can’t pretend the strip malls aren’t there or that the billboards aren’t distracting, but we have to keep our eyes on the road. We must keep moving, discerning what to engage with and what to resist. Progress doesn’t mean assimilation. Rather, it means movement with intention.
And so I moved with great intention. I drove past the shopping centers and the outlet villages, and slowly, the buildings thinned out. Ahead, I saw the familiar rolling hills of the Midwest. Fields and silos and wide, open sky greeted me. I was nearing the heartland.
Into the Heartland
At some point, I snapped out of my highway hypnosis. Gone were the brake lights and exits, and instead, there was now open highway and horizon. With so few cars around, I set the cruise control and relaxed my right foot. To my left and right were rows upon rows of freshly harvested corn fields. I passed dilapidated red barns with faded paint and machinery resting from the fall harvest. This was a different world from the gleaming towers of Chicago. But it was no less significant. It was quieter, more rustic and somehow more enduring.
What struck me about this landscape was that it is fundamentally built by calloused hands. As a rheumatologist, I couldn’t help but imagine examining those hands and feeling for swelling and for bone spurs. Here, the musculoskeletal system felt highly tangible, even through the bug-splattered windshield. I felt convinced the presence of fully functioning joints is critical to the livelihood of the people whose houses I was passing by. It was a great reminder that our work is not merely clinical. Joint and bone health is tied to the infrastructure of the entire nation.
And yet so many of these areas are medically underserved. Rheumatology deserts dot the map, not just in rural regions but in urban centers as well. Disparities in access aren’t limited to geography. They intersect with ethnicity, income, disability and more. If we want to expand our impact and keep these communities connected, we must look beyond our own clinic schedules and begin advocating for system-level solutions. Not surprisingly, that was also a theme at this year’s ACR Convergence.
Looking back to the highway, the clouds were layered like curtains, rippling and gray. They moved quickly, pushed by fierce gusts that made my car shimmy from side to side. Thunder growled somewhere in the distance. It was beautiful and terrifying all at once. Nature was reminding all of us on the road who was truly in control. And it was warm. Too warm for late October in the Midwest. Only a decade ago, this same weekend would have likely seen frost on the ground and, potentially, snow. I remember first arriving in Iowa a decade ago and seeing children in heavy coats covering their costumes while trick-or-treating. Now that seems quaint in the midst of a late October rainstorm. I couldn’t help but wonder how these changes would affect our patients’ health and that we need new strategies to build our resilience.
Coming Home
Crossing the Mississippi River into Iowa, the storm still swirled around me, but seemed to ease. The bridge arched gently over the water, and a billboard welcomed me to my current home state. As clouds parted, the sun was directly ahead of me. The journey was nearing its inevitable end.
Eastern Iowa’s rolling hills greeted me with familiarity, even though, quite frankly, they don’t look very different from the ones in Illinois. My heart beat a little faster, not from caffeine, but from the anticipation of being reunited with my family. Work is clearly important, but it is never the whole of who we are. I was eager to share stories, laugh over spilled coffee and simply be present.
Still, I had to stop for gas. Even with momentum, we need moments to refuel. The pit stop was a great reminder that none of us can run on empty. As was mentioned in the opening session by Tait Shanafelt, MD, self-care isn’t an indulgence, but a necessity. As I filled up the tank, I thought about all I had seen and felt over the past few hours. From gridlock to tollways, from suburbia to silos, from storms to silence. There were certainly many things I learned at Convergence within the lecture halls and plenary sessions, but I would contend that I learned a lot in the otherwise idle moments in the car as well.
Conclusion
Finally, after almost four hours, I reached home. I pulled into the garage, stretched my legs and opened the door to the joyful clamor of my three daughters. They handed me a “Missed you, Daddy” card and pulled me into a group hug. Our 14-year-old puppy barked with joy and relief to see me again. Dinner was warm. Conversation with my wife and kids was lively. There is nothing like coming home.
The road from Chicago to Iowa was more than just a journey between two places. It became a meditation on how we individually and collectively move through the world. It reminded me that while progress can feel slow or uneven, we are always capable of finding new paths forward. When we recognize the privileges we carry, we also gain the power to extend access and ease to others. Even in the face of immense systems, we can preserve our identity and values. And along the way, I was reminded that rheumatologists, through the science, service and shared humanity we experienced at ACR Convergence, are essential stewards of health, connection and hope.
Rheumatology, like that road, is shaped by what we build together through patience, advocacy and reflection. And if we remain curious and open, even the most frustrating traffic jam can become a place of unexpected insight. I’ll see you next year in Orlando. As much as I enjoyed the trip, I assure you that I will be flying to Orlando next year.
Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X (formerly Twitter) @BharatKumarMD.