I know what you’re thinking…we only spent one day in PA school learning rheumatology, and everybody dreaded it. So why would anyone willingly sign up to work in it? Well, would you believe me if I said I have found a deep love and respect for this specialty? Let me give you an idea of what it’s like to be a physician assistant in rheumatology, and how you too could get into this field! In this post, I’ll break down why I love my work and what an average day is like on the job.
Let’s get started!
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My Journey to Becoming a Rheumatology PA
How I Decided on Rheumatology
I didn’t go into rheumatology right out of school because I honestly never even considered the specialty. Like many of you, I considered a lot of specialties before, during, and after PA school. Going into school I always thought I would be a pediatrics PA. Then my first rotation was in pediatrics, and although I enjoyed it, I just couldn’t see myself working in that specialty long-term.
I also did rotations in emergency medicine, family medicine, neurosurgery, orthopedic surgery, OB/GYN delivery/surgery, behavioral health, cardiology, and outpatient OB/GYN. I really liked something about all of them, which made it hard to decide.
When it came time to pick my first job, I went with the specialty that came with a structured training program: emergency medicine. My first job offered a six-month “internship” where you got guaranteed training, education, and a structured onboarding process.
Transitioning from EM to Rheumatology
My first job in EM was everything you’d expect it to be. It was fast-paced, lots of procedures and skills, wild stories, and a horrible sleep schedule. Although I learned a lot and got a good foundation in medicine, the lifestyle just was not for me.
So I started looking into other jobs in my area, and came across a posting for a physician assistant in rheumatology that said you’d be trained on the job. I applied and the physician called me that day to see if I could meet with him in his clinic.
When I got there, I was brutally honest with him. I told him I didn’t know much about rheumatology but I was up for learning, if he was willing to teach. Thankfully he took a chance on me, and now two years later, I think we both feel we made the right choice!
My First Job as a Physician Assistant in Rheumatology
I prepared for my first day by hand writing 5-6 pages of everything I’d learned in PA school about rheumatology just to have some reference notes. (It wasn’t much, but it was a start!)
For the next three months, I worked part-time on an hourly basis to learn rheumatology while I finished up in the ED (my previous job required 90 days’ notice before I could leave). For two or three days a week, I’d take notes as my physician saw patients and ask lots of questions when it was appropriate to do so.
By month two, I would see a couple of the physician’s patients (easier ones like osteoporosis and RA) and then I’d present him with my treatment plan. Then, by month three, I’d see more difficult patients like those with lupus, psoriatic arthritis, ankylosing spondylitis, and vasculitis.
After three months, I was “on my own” but I’d still run any case I was unsure about by him. Thankfully, he was very approachable and easy to work with. After a year, I’d say I felt pretty independent, only going to him one or two times a week with a question on a lab or case.
A Day in the Life of a Physician Assistant in Rheumatology
Every day is different, which makes the work interesting and engaging. I see most of my patients every 3-4 months when they’re stable and every 3-4 weeks when they’re not.
On an average day, I see 15-17 patients. I have a lot of time to ask detailed questions, examine them, educate them, and develop a solid treatment plan. I see most of my patients every three to four months when they’re stable and every three to four weeks when they aren’t.
Procedures (primarily joint injections and the occasional aspiration) are an important part of my job. The most frequent joints/soft tissue injections are for the knees, shoulders, CMC joints, and bursitis. Another of my primary responsibilities is differentiating autoimmune disease from other conditions like osteoarthritis, structural injuries, fibromyalgia, etc.
For the most part, I see follow-up patients while the physicians do the consults. However, I have friends in rheumatology who do consults as well, so this depends on the location and practitioner’s comfortability level.
I’m paid hourly and work 8 a.m. to 5 p.m., but I often get off earlier, around 4-4:30 p.m. We’re closed weekends and holidays and I don’t take calls during the weekend. Some patients do have my email for emergencies (I know I shouldn’t, but I can’t help it).
Deciding Between Rheumatology vs EM? Here’s the Difference
For me, EM was a physical workout while rheumatology is often a mental workout. There are many more diseases, labs, and medications in rheumatology that have to be learned on the job. Also, in rheumatology I get to form solid relationships with my patients, which I love. I get to see the reward of my patient feeling better due to the changes I helped implement from the knowledge I worked hard to get.
We save lives in both specialties, it just looks a little different. I loved the procedures of EM and trust me, I miss the satisfaction of reducing a shoulder or repairing a laceration, but ultimately rheumatology is the better fit for my life right now. I get to enjoy a manageable caseload, make long-term connections with my patients, and have a work-life balance that’s sustainable.
Final Thoughts
I think rheumatology is an amazing specialty for advanced practice providers (APPs)! With dedication and the right attitude we can truly be instrumental in the well-being of our patients. I love what I do and every day I feel honored to be there for my patients during their health journey.
If you’re considering a career in rheumatology, I encourage you to do it! The rheumatology APP world is small and the friends I’ve made at conferences and rep dinners are forever friends in my book. It’s worth the steep learning curve as the other side is filled with the satisfaction of helping others feel better plus the personal benefit of a great work-life balance.
Best of luck on your journey choosing a PA specialty!
Up for exploring some more PA specialties? Check out these other blog posts from PAs who have been in your shoes!
😷 Cardiothoracic Surgery PA
👶 Family Medicine PA
🥼 Dermatology PA
🫀 Cardiology PA
🧬 Oncology PA
