Name: 想成為風濕免疫科醫師？[EP. 42] 讓你一次搞懂！ (So You Want to Be a RHEUMATOLOGIST [Ep. 42])
Uploaded: 2026-03-09T17:48:26.000Z
Duration: 10 min 21 s

所以你想成為一名風濕病科醫師。

You like to solve complex puzzles and go through a lot of trial and error with your patients.

你喜歡解決複雜的難題，並且在病患身上經歷許多嘗試與錯誤。

Let's debunk the public perception myths and give it to you straight.

我們要來破解大眾的迷思，直接告訴你真實情況。

Dr. Jubbal medschoolinsiders.com welcome to our next installment in so youo Want to Be.

來自 Dr. Jubbal medschoolinsiders.com，歡迎來到我們的「所以你想成為」系列的下一集。

In this series, we highlight a specific specialty within medicine, such as rheumatology, and

在這個系列裡，我們會介紹醫學中的特定專科，像是風濕病學，

help you decide if it's a good fit for you.

You can find the other specialties on our so youo Want to Be playlist.

你可以在我們的「所以你想成為」播放清單裡找到其他專科。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure you are subscribed.

如果你想投票決定未來要介紹哪些專科，記得訂閱喔。

If you' see what being a rheumatologist looks like, check out my second channel, Kevin Jubbal, M.D.

如果你想看看風濕病科醫師的日常，可以看看我的第二個頻道 Kevin Jubbal, M.D.。

where we'll cover A Day in the Life of a Rheumatologist Rheumatology is the specialty of medicine focused on musculoskeletal problems and autoimmune diseases where the body's immune system is dysfunctional and the body basically attacks itself.

在這裡，我們會介紹「風濕病科醫師的一天」，風濕病學是專門研究肌肉骨骼問題和自體免疫疾病的醫學專科，也就是身體的免疫系統功能失調，身體基本上會攻擊自己。

Rheumatology can often be described as internal medicine plus because autoimmune diseases are often systemic and they can affect any part of the body.

風濕病學常被形容為內科醫學的延伸，因為自體免疫疾病通常是全身性的，會影響身體的任何部位。

So you need to maintain all of your internal medicine knowledge and then some Rheumatologists treat a Wide Variety of Conditions the complex conditions students and trainees encounter in the hospital may not be the conditions you most commonly see, but

所以你需要維持所有內科醫學的知識，還要學更多。風濕病科醫師會治療各種病症，學生和受訓者在醫院遇到的複雜病症，不一定是你們最常看到的，但

they're the ones people are drawn to, like lupus vasculitis, rheumatoid arthritis, and

這些是大家會被吸引的病症，像是狼瘡、血管炎、類風濕性關節炎等等。

話雖如此，風濕病學的核心業務會因執業、地點和執業類型而異。

That said, the bread and butter of rheumatology can vary based on practice, location and type of practice.

這就帶我們來探討一個重要的區分方法：學術、社區或私人執業。

This brings us to an important method of differentiation, academic versus Community versus Private practice.

在學術環境中，風濕病科醫師會將時間分配在臨床教學和研究職責之間。

In the academic setting, rheumatologists will divide their time between clinical teaching and research responsibilities.

學術界的風濕病科醫師比私人執業的同行更專注於研究，而且

Academic rheumatologists are much more research focused than their private practice counterparts, and

你會經常發現風濕病科醫師遵循醫師科學家軌道，投入更多時間在實驗室研究或轉譯研究。

you'll often find rheumatologists who follow the physician scientist track to dedicate more time to lab research or translational research.

Academic rheumatologists are also more likely to see rare, complicated patients in the hospital.

學術界的風濕病科醫師也比較有可能在醫院看到罕見、複雜的病患。

As a private practice or community based rheumatologist, the most common conditions you will encounter include osteoarthritis, osteoporosis, rheumatoid arthritis, lupus pain syndromes like fibromyalgia, and

身為在社區或私人執業的風濕病科醫師，你最常遇到的病症包括骨關節炎、骨質疏鬆症、類風濕性關節炎、狼瘡疼痛症候群，例如纖維肌痛症，以及

Many of the conditions you see in the clinic will be much more straightforward than in academia.

在診間看到的許多病症，會比在學術界遇到的情況單純許多。

While not not as much of a focus, you can still spend time in private practice teaching students and residents or being involved in research.

雖然不是主要重點，你還是可以在私人執業中花時間教導學生和住院醫師，或參與研究。

In terms of compensation, academic rheumatologists typically make less than their private practice counterparts, but

在薪酬方面，學術界的風濕病科醫師通常比私人執業的同行收入少，但

this can often depend on other factors as well, such as location and research funding from grants.

這也常常取決於其他因素，像是地點和來自補助金的研究經費。

Let's clear up some of the misconceptions about rheumatology.

讓我們來釐清一些對風濕病學的誤解。

One big misconception is that all rheumatologists do is give steroids.

一個很大的誤解是，所有風濕病科醫師只會開類固醇。

While they do give corticosteroids frequently, it's not the only medication they use.

雖然他們確實常開類固醇，但那並非他們使用的唯一藥物。

In the past 30 years, new biologic medications completely changed the game for both doctors and patients.

過去三十年來，新的生物製劑徹底改變了醫師和病患的遊戲規則。

This actually leads us to our next misconception, which is that rheumatology patients are always in pain and don't get better.

這其實帶我們進入下一個迷思，也就是風濕病患總是處於疼痛且無法好轉。

With these biologic medications, patient outcomes are greatly improving to the point where new rheumatology trainees aren't seeing late complications of rheumatoid arthritis anymore.

有了這些生物製劑，病患的預後大幅改善，甚至新的風濕病科受訓者已經看不到類風濕性關節炎的晚期併發症了。

Diseases like RA are no longer considered a sentence of disability for patients.

像類風濕性關節炎這樣的病症，對病患來說已不再是殘疾的判決。

In addition, many people perceive rheumatologists as nerdy or slow to act.

此外，許多人認為風濕病科醫師很死板或行動遲緩。

Rheumatologic diseases are often very complex and physicians need to go through a lot of documentation and labs when working up their patients.

風濕性疾病通常非常複雜，醫師在診斷病患時需要查閱大量文件和實驗室報告。

Even in rheumatologic emergencies, it's usually not the rheumatologist that's coming in to save the day.

即使是風濕性急症，通常也不是由風濕病科醫師來搶救。

At first, the emergency itself is usually managed by another team, whether it's cardiology, critical care or surgery, and

起初，急症本身通常由其他團隊處理，像是心臟科、重症照護或外科，

then rheumatology will come in afterward to treat the underlying condition.

然後風濕病科才會進來處理潛在的病症。

Rheumatologists are often called in when no one knows what's going on.

風濕病科醫師常在大家一籌莫展時被請來。

Stepping into the role of the doctor's doctor and with the constantly evolving medications, rheumatologists have to stay up to date with the latest research.

身為醫師的醫師，加上不斷進步的藥物，風濕病科醫師必須跟上最新的研究。

To become a rheumatologist, you must first complete physical four years of medical school, followed by three years of internal medicine residency and usually two years of rheumatology fellowship.

想成為風濕病科醫師，你得先完成四年的醫學院學業，接著是三年的內科醫學住院醫師訓練，通常還要有兩年的風濕病科進修。

Some programs offer a three year fellowship to make time for more research, while other programs offer combined training that includes allergy and immunology.

有些計畫提供為期三年的進修，讓受訓者有更多時間投入研究；有些計畫則提供結合過敏學與免疫學的綜合訓練。

If you're interested in becoming a physician scientist, a three year fellowship can set you up for success.

如果你對醫師科學家軌道感興趣，為期三年的進修能讓你奠定成功的基礎。

For those interested in going into pediatric rheumatology, the pathway is slightly different.

對於有興趣投入兒童風濕病學的人來說，這條路徑會稍微不同。

After medical school, you must complete three years of pediatric residency followed by three years of pediatric rheumatology instead of two years.

醫學院畢業後，你必須完成三年的兒童內科住院醫師訓練，接著是三年的兒童風濕病學進修，而不是兩年。

The reason it's three years is pediatric rheumatology is mostly academic and the fellowship requires more dedicated research time.

之所以是三年，是因為兒童風濕病學大多是學術性質的，進修期間需要更多專注的研究時間。

In terms of competitiveness, internal medicine and pediatrics are among the 10 most attainable medical specialties.

在競爭激烈程度上，內科醫學和兒科是排名前十容易進入的醫學專科。

According to our analysis, internal medicine is the ninth least competitive specialty and pediatrics is the second least competitive specialty, only behind family medicine.

根據我們的分析，內科醫學是第九競爭力較低的專科，而兒科則是第二競爭力較低的專科，僅次於家庭醫學。

If your goal is to match into a top tier internal medicine or pediatrics residency, you will still need to do well on your step exams and and obtain ample research experience.

如果你想進入頂尖的內科或兒科住院醫師訓練，你還是得在考試中表現優異，並累積足夠的研究經驗。

That said, rheumatology is one of the more attainable internal medicine fellowships.

話雖如此，風濕病學是內科醫學中比較容易進入的進修科別之一。

According to the 2019 Fellowship Competitiveness Index proposed by Trant et al, Rheumatology was the fifth most competitive IM fellowship, trailed only by endocrinology, infectious disease and nephrology.

根據 Trant 等人在 2019 年提出的 Fellowship Competitiveness Index，風濕病學是內科醫學中第五具競爭力的進修科別，僅次於內分泌學、傳染病學和腎臟學。

Competitiveness is increasing for multiple reasons.

競爭激烈程度正因為多種原因而逐漸升高。

First of all, the introduction of biologics, which has led to improved patient outcomes, has attracted many trainees.

首先，生物製劑的問世，改善了病患的預後，吸引了許多受訓者。

Secondly, the importance of work life balance has increased for many people and rheumatology is traditionally considered a specialty with a better work life balance and very rare emergencies.

其次，對許多人來說，工作與生活平衡的重要性日益增加，而風濕病學傳統上被認為是一個工作與生活平衡較佳且極少出現緊急狀況的專科。

In fact, in 2022 there were approximately 1.3 applicants per position.

事實上，2022 年大約有 1.3 位申請者爭取一個職位。

Most positions filled up with a fill rate of 97.8%.

大多數職位都已填補，填補率高達 97.8%。

As for the type of medical student who typically goes for rheumatology, they're usually more laid back students who prefer spending their time thinking rather than doing.

至於通常選擇風濕病學的醫學院學生的類型，他們通常是比較隨和的學生，喜歡花時間思考而不是動手。

Students who enjoy the art of piecing together different components of medical context to come to a conclusion generally enjoy rheumatology.

喜歡將醫學情境的不同組成部分拼湊起來得出結論的學生，通常會喜歡風濕病學。

Unlike many specialties, most rheumatologists don't pursue additional training after fellowship.

和許多專科不同，大多數風濕病科醫師在進修結束後不會再接受額外的訓練。

However, for those who want to focus on a specific disease or area within rheumatology, that path is typically straightforward.

不過，對那些想在風濕病學中專注於特定疾病或領域的人來說，這條路通常很直接。

The solution is usually to stay in academia and focus on your interests by doing more research in that field and learning from mentors.

解決方法通常是留在學術界，透過在該領域進行更多研究並向導師學習來專注於你的興趣。

For example, you can become the lupus specialist or scleroderma specialist at your institute.

例如，你可以在你的機構裡成為狼瘡專家或硬皮症專家。

If you're interested in med peds, you can specialize in transition care.

如果你對內兒科有興趣，你可以專攻轉銜照護。

Helping adolescents with rheumatologic diseases transition between adolescence and adulthood.

協助患有風濕性疾病的青少年從青少年時期順利過渡到成年。

There's a lot to love about rheumatology to start if you love the patient care aspects of being a physician, few specialties allow you as much time with patients as rheumatology.

如果你熱愛醫師的病患照護面向，風濕病學有很多值得喜愛之處，很少有專科能讓你像風濕病學一樣花這麼多時間與病患相處。

As a rheumatologist, you get to build long term relationships with most of your patients.

身為風濕病科醫師，你得以與大多數病患建立長期的關係。

When patients start to suffer from autoimmune diseases, they often feel like they are losing control of their life and body, which can be scary for them.

當病患開始罹患自體免疫疾病時，他們常會覺得自己失去對生活和身體的掌控，這對他們來說可能很可怕。

You'll be able to help them regain a sense of autonomy and navigate a very vulnerable point in their life through treatment and education.

你可以透過治療和衛教，幫助他們重拾自主感，度過生命中非常脆弱的時期。

Furthermore, rheumatology is a much more creative specialty than other internal medicine specialties.

此外，風濕病學比其他內科醫學專科更有創意。

While many specialties have much more straightforward diseases and algorithmic management plans, there's a lot more gray area in rheumatology.

許多專科的疾病和治療計畫都比較直接、有SOP，但風濕病學的灰色地帶就多很多。

Diagnostic biomarkers and classification criteria do exist for certain diseases, but the story is often vague.

雖然有些疾病有診斷生物標記和分類標準，但情況往往不明確。

Helping patients maneuver through this gray area by going through their documentation and lab findings is an art.

協助病患釐清這些灰色地帶，仔細審閱他們的病歷和實驗室報告，這本身就是一門藝術。

Since rheumatology is not as algorithmic, there's a lot more room for personalization and shared decision making with your patients.

由於風濕病學不像其他專科那樣有制式的治療流程，是以有更多空間能為病患量身打造個人化治療，並與他們共同做出決定。

In terms of lifestyle, rheumatologists have a good work life balance.

在生活方式方面，風濕病科醫師有很好的工作與生活平衡。

There are very few emergencies in rheumatology and even then, rheumatologists aren't called in during the middle of the night.

風濕病學很少有緊急狀況，即使有，風濕病科醫師也不會在半夜被叫去。

In fact, in 2019, rheumatology was the top ranked specialty in happiness outside of work according to Medscape's Physician Lifestyle and Happiness Report.

事實上，根據 Medscape 2019 年的醫師生活方式與幸福感報告，風濕病學在工作外的幸福感排名中位居第一。

While rheumatology is an awesome specialty, it's not for everyone to start.

雖然風濕病學是很棒的專科，但一開始並不是適合所有人。

If you're not someone who can tolerate the day to day of clinic life, rheumatology may not be for you.

如果你無法忍受日常門診生活，風濕病學可能就不適合你。

Additionally, the volume of patients in the clinic can wear you down for multiple reasons.

此外，門診病患的數量可能會因為多種原因讓你感到疲憊。

You need to figure out how to manage the high volume of patients without compromising their care.

你需要找出如何在高病患量下，同時不影響病患的照護品質。

A high volume of patients also means managing a lot of relationships which can weigh certain people down.

高病患量也意味著要處理很多關係，這可能會讓某些人感到壓力。

Like many specialties, and especially the internal medicine specialties, rheumatology has its fair share of administrative burden.

和許多專科一樣，尤其是內科專科，風濕病學也有不少行政上的負擔。

Rheumatologists have to do comprehensive chart reviews and extensively document everything they do with their patients.

風濕病科醫師必須進行全面的病歷審閱，並詳細記錄與病患互動的每一個細節。

There are also many hoops you need to jump through when it comes to insurance companies with new biologics.

對於新的生物製劑，你還需要通過許多保險公司的審核關卡。

You first need to find data supporting the use of these medications.

你首先需要找到支持使用這些藥物的數據。

After that, you need to convince the insurance company to allow your patients to use these drugs.

之後，你需要說服保險公司讓你的病患使用這些藥物。

You might spend hours curating a personalized management plan for your patient, only for them to have their request refused by their insurance company after they leave the clinic.

你可能會花好幾個小時為病患精心規劃個人化的治療計畫，結果他們離開診所後，保險公司卻拒絕了他們的申請。

This leads to a great deal of frustration for all of the involved parties and results in a lot of extra paperwork.

這會讓所有相關人員都感到非常沮喪，也產生了大量的額外文書工作。

If you're uncomfortable with gray areas, rheumatology may not be the field for you.

如果你對模糊不清的狀況感到不自在，風濕病學可能就不太適合你。

Since these diseases are multisystemic, each patient can present differently with different signs, symptoms and labs.

由於這些疾病是全身性的，每位病患可能都會出現不同的跡象、症狀和實驗室檢查結果。

Patients won't respond to the same medications equally, and you have to keep experimenting occasionally.

病患對相同的藥物反應不會完全一樣，你必須偶爾持續嘗試。

Patients won't get that much better no matter how hard you try, which can be extremely frustrating and demoralizing.

無論你多麼努力，病患的狀況可能都不會有太大的改善，這可能會讓人非常沮喪和灰心。

Lastly, rheumatology is a specialty more suited to thinkers, not doers.

最後，風濕病學是個更適合思考者，而非行動者的專科。

There aren't many procedures in rheumatology.

風濕病學中沒有太多侵入性的治療。