Follow the Money (4.23.2026)

Rheumatologists are facing a paradox: while they're among the most intellectually fulfilled physicians, they rank in the bottom four for annual salaries in the U.S., earning an average of $284,000—well below other specialties. In this episode, Dr. Jack Cush unpacks the disconnect between professional satisfaction and financial compensation, urging rheumatologists to rethink their career strategies. He highlights a striking contradiction: despite the field’s growing complexity and demand, most rheumatologists expect no salary increase, even as other specialties report double-digit growth expectations. Yet, he argues that the solution isn’t resignation—it’s entrepreneurship. From launching blogs and podcasts to building digital platforms, rheumatologists can leverage their expertise to generate meaningful side income. The episode also dives into key clinical updates: citrullinated histone 3 as a promising biomarker in ANCA-associated vasculitis, the safety of continuing biologics during surgery, and the potential of JAK inhibitors in treating severe dermatomyositis with interstitial lung disease. These advances underscore the field’s evolving science—yet the financial reality remains stubbornly stagnant. The episode closes with a call to action: rheumatologists must stop treating their expertise as a public good and start monetizing it.