Rheumatology Fellowship Columbia - Director's Welcome

We are extremely excited to have recently received official ACGME accreditation for our new rheumatology fellowship program at Prisma Health.

There is a tremendous need currently for rheumatology services locally and nationwide.

If the current trajectory continues unaltered, by 2030 the American College of Rheumatology (ACR) workforce study of 2015 projects that there will be a greater than 100% discrepancy between demand for rheumatology services and the rheumatology workforce available to meet that demand. New rheumatology training programs and internal medicine residents entering rheumatology fellowship slots are therefore urgently needed, and our new rheumatology fellowship program helps address this looming workforce crisis.

Our rheumatology division has grown rapidly in recent years, and we now have six board-certified rheumatologists and one nurse practitioner. All our providers love clinical rheumatology and have a genuine interest in teaching. We find rheumatology rewarding because the diseases are fascinating, there is nearly always treatment available to help preserve life and/or ease pain and suffering and because the chronicity of rheumatic diseases affords the opportunity to establish long-term relationships with patients.

We believe that we have a top-notch curriculum planned for our rheumatology fellowship. One distinctive feature of the training we offer is in the field of musculoskeletal ultrasound (MSKUS). We have five certified musculoskeletal ultrasonographers, a number few other rheumatology fellowship program in the country can match.

MSKUS has become an important modality in the diagnosis and management of rheumatic diseases. MSKUS with Power Doppler capability in our clinic facilitates the diagnosis of inflammatory arthritis such as rheumatoid arthritis or psoriatic arthritis by demonstrating even subtle, subclinical joint inflammation.

MSKUS may also help assess adequacy of response to treatment of inflammatory arthritis by showing either persistent or resolved joint inflammation. MSKUS has also become an important method of diagnosing giant cell arteritis, a notoriously difficult-to-prove diagnosis (sometimes even after biopsy), by demonstrating vessel “halos” in one or multiple vascular territories (e.g. temporal, carotid, and subclavian arteries bilaterally).

MSKUS can also allow diagnosis of gout by demonstrating the “double contour” sign and aid in identifying chondrocalcinosis in calcium pyrophosphate arthropathy (“pseudogout”). MSKUS also has numerous other applications in the realm of soft tissue rheumatology such as showing characteristic swelling of the median nerve in carpal tunnel syndrome, corroborating tendonitis, and importantly MSKUS aids in the corticosteroid injection of these various entities. MSKUS-coupled corticosteroid injections have been proven to be a quality enhancement over traditional landmark-based corticosteroid injections without ultrasound by means of more precise placement of the corticosteroid medication thereby yielding greater efficacy and resulting in less pain during the procedure.

Our goal during the rheumatology fellowship is to help fellows who are interested gain certification in MSKUS.

Our rheumatology fellowship features weekly two-hour “rheumatology grand rounds” which will be a rotating schedule of case presentations with group discussion, conferences on reviewing rheumatology tissue pathology with an expert pathologist, guest speaker presentations, metabolic bone disease, journal club, as well as conferences which feature rheumatology faculty lectures.

We will have a weekly radiology conference with a radiologist, a weekly board review conference to cover 104 different rheumatology topics over two years to help the rheumatology fellow prepare for a high level of success on the rheumatology board certification exam. Other conferences will include those on research (regular allotted time for planning research projects and scholarly activity with presentation of a poster at each of the two rheumatology national meetings over the two years), a quality improvement project, morbidity and mortality, and MSKUS didactics.

We have outside rotations planned which are designed to include two weeks of scrubbing in on operative orthopedics (joint replacements, upper extremity, lower extremity, spine, and sports surgeries), one week of physical therapy and occupational therapy, one week of EMG/NCVs, two weeks each of two years with our local pediatric rheumatologist. Fellows will have two weekly clinics seeing their own patients whom they will be responsible for over the entire two-year fellowship as well as working in faculty clinics 2-3 half days per week. A weekly half-day procedure clinic supervised by rheumatology faculty is built into the curriculum which will allow attainment of a high skill level in rheumatologic procedures. Rheumatology fellows will be in a two-way rotation for inpatient rheumatology consults and inpatient follow up cases supervised by second year fellows as well as faculty.

Based on the above design, we have every reason to think that fellows completing our program will become exceptionally well-trained clinical rheumatologists, who will have no difficulty achieving certification by the ABIM in Rheumatology, and be ready for a long and satisfying career in rheumatology. By completing our program, our fellows will help address the increasing local and national demands for rheumatology services.

Based on the ACR supply and demand projections it seems certain that the need for your expertise will be enduring for your entire rheumatologic career.

James W. Fant Jr., MD
Clinical Associate Professor of Medicine
University of South Carolina School of Medicine Columbia
Director, Division of Rheumatology
Prisma Health
Program Director, Prisma Rheumatology Fellowship