Job File: Rheumatologist

À l’ère of office work and sédentarité à excess, bodies are suffering. An aging population, malnutrition and even climate change can lead to joint, tendon, ligament and bone disease. It's in this context that the rheumatologist's roleis of the utmost importance. This specialist in the musculoskeletal system is involved whenever a patient experiences pain that may fall into any of the above-mentioned fields. In this article, we will attempt to explore all facets of this medical specialty, from the studies required to practise it to the qualities required.

Les compétences nécessaires pour exercer la rhumatologie

Specialized medical knowledge

To carry out their missions successfully, rheumatologists must possess a wide range of medical knowledge, such as:

• Anatomy and physiology of the musculoskeletal system.
• Inflammatory, dénérative, métabolic and autoimmune pathologies.
• Immunology and autoimmune disease mechanisms.
• Bone biology, calcium and mineral metabolism.
• Pharmacology of rheumatological treatments (anti-inflammatories, immunosuppressants, biothérapies).
• Interpretation of biological tests (inflammatory markers, autoantibodies).
• Radiology and medical imaging (MRI, CT, joint imaging).
• Complications and comorbidities of rheumatological pathologies.
• Épidémiology and risk factors of joint diseases.

Technical skills: clinical examinations and interpretation of results

The technical expertise of the rheumatologist lies on his ability to carry out precise and meticulous clinical examinations. He must have a perfect command of: 

• Réalization and interpretation of articular échographs.
• Articular punctures to relieve pain or analyze synovial fluid.
• Intra-articular injections (corticoïdes, hyaluronic acid).
• Prescription and monitoring of complex drug treatments.
• Analysis and interpretation of medical imaging (X-rays, MRIs, scans).
• Development of réducation plans in collaboration with kinésithérapeutes.
• Management of specific medical devices (orthotics, splints).
• Multidisciplinary approach to the management of systemic diseases.
• Using databases and clinical research tools to monitor medical advances.

Human and relational qualities

The practice of rheumatologyrequires exceptional human qualities, common to all medical specialties (see our fiche métier médecin généraliste). These include listening and empathy for patients who often suffer from chronic pain that impacts their daily lives. The rheumatologist also needs to be able to explain complex pathologies and treatments that can be restrictive, and to be patient, as some diseases evolve slowly and require gradual therapeutic adjustments. Finally, the ability to establish a long-term relationship based on trust is crucial to treatment compliance and success.

The training path to becoming a rheumatologist

Études générales de médecine

Before entering higher education, students wishing tobecome rheumatologistsmust obtain a scientific baccalaureate. Once this diploma is in his pocket, he can choose between two options to pursue health studies:

• Le Parcours Accès Santé Spécifique (PASS)

• Initiated in 2020 to replace the Premiée Année Commune aux Études de Santé (PACES), the PASS offers a year of study combining a health major and a minor in another discipline. This system encourages the diversification of skills while offering opportunities for reorientation.

• Assessments are based on continuous assessment and final exams.

• Those who succeed will have access to the health care system.

• Those who are unsuccessful can reorient themselves towards the stream corresponding to their minor before, if they wish, trying their luck again.

This formula relieves the pressure associated with the former PACES single entrance exam and encourages multidisciplinary learning.

• La Licence avec Accès Santé (L.AS)

• Launched in 2020 to diversify career paths in health studies, the L.AS combines a major in any field (law, humanities, economics, etc.) with a specific health minor (biology, physiology, etc.).

• After the first, second or third year, students who have met the minimum requirements can apply for health studies and take specific exams. Depending on their results, they are either admitted to the second year of medical studies, or fail.

• The L.AS offers a diversified pathway, valuing both specific skills and re-orientation possibilities.

Études générales médicales

À l’issue of the PASS or the L.AS (see above), the générales de médecine are structured in two graduating phases:

• Le Diplôme de Formation Générale en Sciences Médicales (DFGSM): a three-year curriculum (including the first year validated via the PASS or L.AS) integrates theoretical teaching in the medical sciences and clinical internships in hospitals.
• Le Diplôme de Formation Approfondie en Sciences Médicales (DFASM): a three-year course directly following the DFGSM. It combines specialized courses and advanced internships in various hospital departments.

Examen Classant National (ECN)

At the end of six years of médecine study, the student passes a national competition bringing together all the élèves in the field. The ranking obtained determines the order of priority in the choice of specialties.

Spécialisation in rheumatology

Once the general medical studies have been completed, the student will spécialize in rheumatology intègre a five-year internship, alternating between theoretical and practical teaching:

• Theoretical training: interns attend courses covering the various aspects of rheumatology. They also attend seminars and conferences to keep abreast of scientific advances.
• Practical training: interns immerse themselves in the day-to-day activities of various hospital departments.

The intern must also write and defend a thesis to earn a doctorate. À At the end of this training in rheumatology, he receives the Diplçome d’Études Spées en Rhumatologie (DES).

Complementary training

After obtaining the DES and registering with the Ordre des médecins, the rheumatologist can specialize further in fields such as pediatric rheumatology, immuno;diatrics, immuno-rheumatology, tropical rheumatology, psychorhumatology, dermato-allergology, photo-rheumatology, and other fields related to joint, bone and connective tissue diseases. This over-spécialisation will enable him to apply for better job offers rheumatologist.

The main tasks of a rheumatologist

Diagnosis of joint and musculoskeletal diseases

Diagnosis represents an essential part of the work of the rheumatologist, requiring a methodical and rigorous approach. Careful questioning of the patient is fundamental in tracing the history of the disease and identifying triggering or aggravating factors. A meticulous clinical examination is then carried out to assess joint mobility and muscle strength, and to pinpoint the precise location of pain. The specialist draws on his or her expertise to prescribe the relevant additional tests: medical imaging, biological analyses, even biopsies in certain cases. Interpretation of all these elements enables us to establish a precise diagnosis and initiate appropriate treatment.

Patient treatment and follow-up

Therapeutic management is personalized according to diagnosis, disease severity and patient profile. The rheumatologist has a varied therapeutic arsenal at his or her disposal: anti-inflammatory drugs, analgesics, disease-modifying treatments for chronic conditions, or biotherapies for the most severe cases. Local infiltrations are also a valuable therapeutic tool for rapid pain relief. Prescription of kinesthetic or orthopedic devices can sometimes complement treatment. Regular follow-up enables management to be adapted to the progression of the disease, and potential complications to be anticipated.

Patient prevention and education

The rheumatologist plays a major role in the prevention of rheumatic diseases and the therapeutic education of patients. He advises on lifestyle measures, work ergonomics and adapted physical activity. Pain management and exercise education are essential to improving patients' quality of life. The rheumatologist also raises patients' awareness of modifiable risk factors and the behaviors they can adopt to preserve their joint capital.

Working conditions and career prospects

Freelance, hospital or clinic practice

The rheumatologist has multiple practice options, each with its own particularities:

• Cabinet libéral: great autonomy in the organization of activities and development of a privileged relationship with the patient.
• Hôpital: multidisciplinary teamwork, management of complex cases, possible participation in clinical research and teaching.
• Mixed practice: combination of hospital and private practice, enabling diversification of practice.
• Private clinics: access to high-performance technical facilities and close collaboration with other specialists.
• Centre de rééducation : specialization in the management of specific pathologies and close collaboration with rééducation teams.

Rheumatologist's working hours and schedule

The work rhythm of a rheumatologistvaries according to the chosen mode of practice (see above). As a freelance rheumatologist, you'll be able to organize your working hours to suit your patients' needs, and your days will often be packed with consultations. Consultations last between 20 and 30 minutes, but can be longer for first appointments or complex cases. Unlike some specialties, rheumatology involves few on-calls and emergencies, enabling a better quality of life. In a hospital environment, working hours are more structured, but may include on-call duty. Administrative management, updating medical records and coordination with other healthcare professionals also occupy a significant proportion of working time.

Évolution de carrièreère et spécialisations possibles

The career prospects in rheumatologyare many and varied. Some rheumatologists choose to develop special expertise in specific fields, such as paediatric rheumatology, interventional rheumatology or the management of sports pathologies. For those wishing to combine clinical practice, teaching and research, an academic career is also possible. In addition, hospital practitioner positions offer the opportunity to move up to head of department or departmental responsibilities. Clinical research also offers the opportunity to participate in the development of new treatments and advance knowledge in the field. Finally, rheumatologists can also become involved in learned societies, participate in the development of professional recommendations or take on expert missions for health organizations. In all cases, ongoing training and scientific monitoring are essential to keep your skills up to date and integrate therapeutic innovations into your practice.

As you will have gathered, the carriage of a rheumatologistis as complex as it is rich. It enables doctors who wish to specialize in an exciting and very important medical discipline to devote themselves to a time when musculoskeletal problems are on the increase.

To learn more, find our rheumatologist salary sheet!