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Fellowship in rheumatology

 Director Research [Emeritus], P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
VR Joshi,
503, Om-Shiv Co-op Hsg. Soc., Mogul Lane, Mahim, Mumbai - 400 016, Maharashtra
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Source of Support: None, Conflict of Interest: None

How to cite this URL:
Joshi V R. Fellowship in rheumatology. Indian J Rheumatol [Epub ahead of print] [cited 2019 Sep 22]. Available from:

Dear Editor,

IRA is to be congratulated for the fellowship initiative. I have for a long time felt and expressed the need to train medicine practitioners to augment our numbers and improve our accessibility to patients and provide better care.[1]

At present, the population of India is nearly 1.37 billion,[2] of this 68% is rural. It means that 2/3 of our patients reside in rural India. There are 40 cities with a population of more than 1 million, 396 with 1 lakh to 1 million population, 2500 with 10,000–100,000 population,[3] 725 districts with populations ranging from >1.1 crore (Thane) to <10,000 (Dibang Valley),[4] and 649,481 villages, of these 236,004 are with <500 population and 3976 with >10,000 population.[2]

As per the 2014 IRA directory of members, there were 1066 life members, including 32 overseas members, effectively meaning 1034 members, plus 80 additional associate members. Over time, some of the members are no more, some have migrated, and some do not practice rheumatology, further reducing effective numbers. Majority of the rheumatologists are located in bigger cities. To illustrate, Kolkata, Delhi (New and Old), Mumbai, Bengaluru, Chennai, Hyderabad, and Lucknow together account for 476 (47%) members. In all 6 states, 4 union territories and 77% of the districts did not have a single rheumatologist. Although the number of members has increased (1295 in June 2018), it is unlikely that the overall picture would have changed significantly.

At present, for the patients from villages and small towns, it is difficult, if not almost impossible to consult a rheumatologist, because of the distances involved, logistics of travel, and the expenses. The ground reality is that today most of the patients are being treated by general practitioners, physicians, and orthopedic surgeons with little if any exposure to rheumatology,[5] practitioners of other pathies, and nondoctors. To improve this situation, we need to think of alternate solutions and approaches. Fellowship is one of them. It will improve the scenario albeit to some extent.

All in all, fellowship is a welcome step in the right direction.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Joshi VR, Poojari VP. Cost-effective management of rheumatoid arthritis in India. Indian J Rheumatol 2013;8:179-82.  Back to cited text no. 1
  [Full text]  
India Population; 2019. Available from: [Last accessed on 2019 Jul 24].  Back to cited text no. 2
Cities of India. Available from: . [Last accessed on 2019 Jul 24].  Back to cited text no. 3
Districts and Villages of India. Census of India; 2011. Available from: [Last accessed on 2019 Jul 24].  Back to cited text no. 4
Misra DP, Ravindran V, Sharma A, Wakhlu A, Negi VS, Chaturvedi V, et al. Rheumatology practice and training in India. J Assoc Phys India 2019;67:38-43.  Back to cited text no. 5


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