I’m also very doubtful that any artificial intelligence can truly emulate empathy and compassion as only a human being can. Therefore, during fellowship, I would strongly advise the newest rheumatologists to reflect on, and engage in, deliberate practice on softer skills, those involving strengthening the patient-physician relationship, especially non-verbal communication and rapport building. Those were important in 2014, are important in 2024 and will be of even more paramount importance in 2034.
Every Rheumatologist Will Be a Policy Expert
On similar lines, I envision that every rheumatologist will go to Washington, D.C., at least once in their career, and a large percentage will go there annually to advocate for their patients. Because much of the clinician work will be supported by clinical decision support tools, including artificial intelligence, rheumatologists will need to have a greater say in policy development at all levels. This includes rheumatologist input in determining reimbursement, regulations and recognition.
For rheumatology fellows entering in 2024, it should be a priority to understand these larger systems that impact their practices. Such opportunities as the ACR’s Advocacy 101 can be invaluable in imparting skills that create such awareness and lead fellows toward becoming experts in advocacy. Other events, at the local and the state levels, may also be helpful and may, in fact, be even more impactful for practice. Beyond the ACR, advocacy events from other professional and specialty associations may supplement efforts to achieve these educational ends.
Of course, this particular future depends on the idea that our sociopolitical systems are going to be largely intact over the next 10 years. Nobody knows if that will happen. But here, rheumatologists in 2024 can play a vital role. The more that we advocate in our everyday capacities, the more we can shore up the democratic norms of citizenry and advocacy—and, in the process, lead us to that future that we seek. In this case, we have enormous agency to mold the future as we wish it to become.
Better Treatments & Cures
My biggest hope for 2034 is that we’ll look back at 2024 and see how crude our tools were to help treat patients with rheumatic disorders. By 2034, thanks to massive investments in basic, clinical and translational research, I anticipate that we’ll have treatments (and cures!) for many of the chronic immune disorders we manage.
Currently, we are undergoing a renaissance in basic science knowledge of immunology. In 2014, innate-like lymphoid cells (ILCs) were barely characterized, having been identified only in 2008.2 Now, in 2024, we recognize the indispensable role they play in maintaining homeostasis of the immune system. Between now and 2034, there will undoubtedly be a proliferation of new science that helps uncover the hidden realms of the immune system. Instead of tenuously hypothesizing about links between cells, cytokines and end effects, I imagine there will be a larger, more tangible map outlining pathways that lead to immune regulation and immune dysfunction.
