Job File: Rheumatologist

In this age of office work and sedentary lifestyles, our bodies are suffering. An aging population, malnutrition and even climate change can lead to joint, tendon, ligament and bone disease. This is where the profession of rheumatologist comes into its own. This specialist in the musculoskeletal system intervenes as soon as the patient experiences pain likely to belong to the various fields mentioned. In this article, we attempt to explore all the facets of this medical specialty, from the studies needed to practise to the qualities required.

The skills needed to practise rheumatology

Specialized medical knowledge

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

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

Technical skills: clinical examinations and interpretation of results

The rheumatologist's technical expertise lies in his or her ability to perform precise, meticulous clinical examinations. He or she must be fully conversant with :

• Performing and interpreting joint ultrasound scans.
• Joint punctures to relieve pain or analyze synovial fluid.
• Intra-articular injections (corticoids, hyaluronic acid).
• Prescription and monitoring of complex drug treatments.
• Analysis and interpretation of medical images (X-rays, MRIs, scans).
• Development of rehabilitation plans in collaboration with physiotherapists.
• Management of specific medical devices (orthoses, splints).
• Multidisciplinary approach to the management of systemic diseases.
• Use of databases and clinical research tools to monitor medical advances.

Human and interpersonal skills

The practice of rheumatology requires exceptional human qualities, common to all medical specialties (see our general practitioner job description). These include the ability to listen and empathize with patients who often suffer from chronic pain that impacts on their daily lives. The rheumatologist must also be able to explain complex pathologies and treatments that can be restrictive, as well as being patient, as some diseases evolve slowly and require gradual therapeutic adjustments. Finally, the ability to establish a relationship of trust over the long term is crucial to treatment compliance and success.

Training to become a rheumatologist

General medical studies

After high school

Before entering higher education, students wishing to become rheumatologists must obtain a scientific baccalaureate. Once this diploma is in their pocket, they can choose between two options for pursuing health studies:

• Parcours Accès Santé Spécifique (PASS)

• Introduced in 2020 to replace the First Common Year of Health Studies (PACES), the PASS offers a year of study combining a health major with a minor in another discipline. This system encourages the diversification of skills while offering opportunities for reorientation.

• Assessment is based on continuous assessment and final exams.

• Those who pass gain access to the health professions

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

This formula reduces the pressure associated with the former PACES competitive entrance examination, and encourages multidisciplinary learning.

• License with Health Access (L.AS)

• Launched in 2020 to diversify career paths in health studies, the L.AS combines a major in any field (law, literature, 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 school, or fail the exams.

• The L.AS offers a diversified pathway, valorizing both specific skills and opportunities for reorientation.

General medical studies

On completion of the PASS or L.AS (see above), general medical studies are structured into two degree-granting phases:

• The Diplôme de Formation Générale en Sciences Médicales (DFGSM): a three-year course (including the first year validated via the PASS or L.AS) integrating theoretical teaching in medical sciences and clinical internships in hospitals.
• The 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.

Exam Classant National (ECN)

At the end of six years of medical studies, students take part in a national competitive examination for all students in the field. The ranking obtained determines the order of priority in the choice of specialties.

Specialization in rheumatology

On completion of general medical studies, students specializing in rheumatology enter a five-year internship, alternating between theoretical and practical training:

• Theoretical training: interns attend courses covering all 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.

Interns must also write and defend a thesis to earn their doctorate. At the end of this rheumatology training, they receive the Diplôme d'Études Spécialisées en Rhumatologie (DES).

Further training

After obtaining the DES and registering with the Ordre des Médecins, rheumatologists can further specialize in areas such as pediatric rheumatology, immuno-rheumatology, tropical rheumatology, psychorheumatology, dermato-allergology, photo-rheumatology, and other fields related to joint, bone and connective tissue diseases. This super-specialization will enable him to apply for better rheumatology job offers.

The main tasks of a rheumatologist

Diagnosis of joint and musculoskeletal diseases

Diagnosis is an essential part of the rheumatologist's work, requiring a methodical and rigorous approach. Detailed questioning of the patient is fundamental in tracing the history of the disease and identifying triggering or aggravating factors. A meticulous clinical examination then assesses joint mobility and muscle strength, and pinpoints the precise location of pain. The specialist draws on his expertise to prescribe the relevant complementary tests: medical imaging, biological analyses, even biopsies in certain cases. Interpretation of all these elements enables a precise diagnosis to be made and appropriate treatment to be initiated.

Patient treatment and follow-up

Treatment is tailored to the diagnosis, the severity of the disease and the patient's profile. The rheumatologist has a varied therapeutic arsenal at his or her disposal: anti-inflammatory drugs, analgesics, disease-modifying treatments for chronic conditions, and biotherapies for the most severe cases. Local infiltrations are also a valuable therapeutic tool for rapid pain relief. Physiotherapy sessions or orthopedic devices are sometimes prescribed to complete the treatment. Regular follow-up enables us to adapt the treatment to the evolution of the disease and prevent potential complications.

Prevention and patient education

The rheumatologist plays a major role in the prevention of rheumatic pathologies and the therapeutic education of patients. He or she advises on lifestyle measures, work ergonomics and adapted physical activity. Education on pain management and specific exercises is essential to improve patients' quality of life. The rheumatologist also educates patients about modifiable risk factors and the behaviors they should adopt to preserve their joint capital.

Working conditions and career prospects

Private practice, hospital or clinic

Rheumatologists can choose from a wide range of practice options, each with its own particularities:

• Private practice: a high degree of autonomy in the organization of activities, and the development of a special relationship with patients.
• Hospital: multidisciplinary teamwork, management of complex cases, possible involvement in clinical research and teaching.
• Mixed practice: a combination of hospital and private practice, enabling you to diversify your practice.
• Private clinics: access to high-performance technical facilities and close collaboration with other specialists.
• Rehabilitation centers: specialization in specific pathologies and close collaboration with rehabilitation teams.

Working hours and schedule of a rheumatologist

A rheumatologist's working hours vary according to the type of practice chosen (see above). In private practice, the rheumatologist organizes his or her working hours to suit the needs of his or her patient base, with days often 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 little on-call duty and few emergencies, enabling a better quality of life. In a hospital setting, working hours are more structured, but may include on-call duty. Administrative management, updating medical records and coordination with other healthcare professionals also take up a significant proportion of working time.

Career development and possible specializations

Career prospects in rheumatology are many and varied. Some rheumatologists choose to develop particular expertise in specific fields, such as pediatric rheumatology, interventional rheumatology or the management of sports pathologies. An academic career is possible for those wishing to combine clinical practice, teaching and research. In addition, hospital practitioner positions offer the opportunity to progress to head of service or department. 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 drawing up professional recommendations or take on expert missions for health organizations. In all cases, ongoing training and scientific monitoring are essential to keep skills up to date and incorporate therapeutic innovations into practice.

As you can see, the career of a rheumatologist is as complex as it is rich. It enables doctors wishing to specialize to devote themselves to an exciting medical discipline, which is so important at a time when musculoskeletal problems are on the increase.

Find out more on our rheumatologist salary page!