In 2008, the American College of Rheumatology Workforce Study Advisory Group published a comprehensive rheumatology workforce analysis.1 It concluded: Based on assessment of supply and demand under current scenarios, the demand for rheumatologists is expected to exceed supply in the coming decades. Strategies for the profession to adapt to this changing health care landscape include…
Medicare and other third-party payers have started predicating reimbursement on adherence to standards of care. Post hoc chart reviews have resulted in substantial take-backs for failure to adhere to those values in cardiology, pulmonology and expanding to other areas. Outpatient medicine is also being subjected to such scrutiny. The question of standards and who sets…
Associate Editor of The Rheumatologist on Working Sabbatical Maura Daly Iversen, PT, DPT, SD, MPH, professor and chair of the Department of Physical Therapy, Movement, and Rehabilitation Sciences at Northeastern University, a behavioral scientist in the Division of Rheumatology, Immunology, and Allergy at Brigham and Women’s Hospital, a lecturer at Harvard Medical School, Boston, and…
The human intestinal microbiota is home to more than 1,000 bacterial species, containing approximately 3 million genes, many of which code for functions that have the potential to affect human physiology.1 Smaller numbers of organisms are also present in the skin, upper gastrointestinal tract, female reproductive tract and the oro- and nasopharynx. As tools have…
There is no denying that the past few years have been a time of immense change in healthcare. Sweeping pieces of legislation have fundamentally altered the way we practice medicine. This is absolutely the case when it comes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, for short). MACRA is an enormous…
The microbiome comprises diverse microbial flora, including bacteria, viruses and fungi, that live on mucosal surfaces, predominantly the skin and digestive tract. Microbes evolved billions of years prior to the development of modern Homo sapiens 200,000 years ago; we have always existed with their ubiquitous presence. Despite this, the first microbe was not visualized until…
I tell my patients there are three types of science: 1) investigative science, which sometimes gets it right; 2) science in the courtroom, which is junk science; and 3) science in Washington, D.C., which is political science. Our decisions are based on art and science; our patients’ medications are brought to market based on science….
As much as 80% of employee turnover can be attributed to bad hiring decisions, the Harvard Business Review reported.1 And turnover costs are high—one report estimated them to be 100–300% of the base salary of a replaced employee (with 150% commonly cited).2 Given this, the importance of hiring the right employees can’t be underestimated. So…
SAN FRANCISCO—To unravel how out-of-control inflammation begins in rheumatoid arthritis and other diseases, one target for immunologists is the macrophage. Researchers discussed macrophage activation and other key drivers of inflammation at the 2015 ACR/ARHP Annual Meeting on Nov. 7. How macrophages behave when recognizing damage-associated molecular pathways (DAMPs) tells us more about why some inflammation doesn’t…
Robert Thoburn, MD, finds discipline and the opportunity for continual learning in both rheumatology and karate, an activity he has pursued for decades. Karate Lessons “I was fortunate to have had the opportunity to learn karate and achieve a black belt,” Dr. Thoburn says. “I used my training journal and [did] extensive research to write a…