Brief Report
Private Rheumatology in Catalonia, Spain
La Reumatología privada en Cataluña
Cayetano Alegre
Hospital Universitario Dexeus-Quirón, Barcelona, Spain
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"aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La Reumatología privada en Cataluña" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 885 "Ancho" => 1708 "Tamanyo" => 103110 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Median of the ranking of the most frequent diseases attended.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">Reumatología Clínica</span> published a study by Yoldi Muñoz et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> on the status of private rheumatology (PR) in Spain, and demonstrated that PR is most prevalent in Catalonia. The Catalan Rheumatology Society (SCR) commissioned us to undertake a study on this subject.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to define and create an appropriate framework for our study objective, we must clarify that we understand private medicine as being directly user or company financed with no support from the public administrations; in other words, the doctors’ income is directly related to the care activity they undertake.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of this study might be relevant in several respects:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0020" class="elsevierStylePara elsevierViewall">To work out the number of rheumatologists that need to be trained to cover these little-known areas of work in the future.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0025" class="elsevierStylePara elsevierViewall">They might also help us to establish the differences between the training that our junior doctors receive, currently in state hospitals, and the care differences that might be found if their work were in private centres.</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">We set out to discover the percentage of rheumatologists in Catalonia attending private patients, the most common rheumatological conditions encountered in private practice, to determine the rheumatologists’ dedication to each of the 2 large areas that we will consider in this study, the care and activities necessary to ensure appropriate care, continuous training, practice management, and to find out the routine techniques used in the practices.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">An individual survey was given to all the rheumatologists whose emails were available to us, created by the author, and unanimously agreed with 8 rheumatologists from the author's environment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We obtained the email addresses of the SCR members who gave their authorization to receive communications, performed a search of the websites of health insurance companies, and asked colleagues who received the survey to forward the email to their colleagues.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We obtained a list of 231, 147 from the area of Catalonia: 123 from Barcelona, 9 from Girona, 4 from Lleida, and 11 from Tarragona. We received 63 responses, 52 of which were valid for analysis, one was eliminated because all the responses were left blank, and 10 because the respondents did not practice PR.</p><p id="par0050" class="elsevierStylePara elsevierViewall">There were 27 (52%) men and 25 (48%) women; 9 were aged from 30 to 40 (17%), 21 from 41 to 50 (40%), 17 from 51 to 65 (33%), and 5 were aged over 65 (9%). In the under-forty age group, the male to female ratio was 9:1, from 41 to 50 it was 8:11, and in the older age group the ratio changed to 14:4. The average age was 49, similar to other countries such as Canada.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">With regard to years in PR practice, 13 (26%) had fewer than 5 years, 4 (8%) between 6 and 10 years, and 33 (66%) more than 10 years, a third of those who started PR practice had not continued with it.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Only 13 (26%) of the respondents worked exclusively in the private sector, 37 (74%) worked in both private and public medicine.</p><p id="par0065" class="elsevierStylePara elsevierViewall">There were 17 (33%) rheumatologists working exclusively in the private sector. Most, 20 (39%), worked in multidisciplinary teams or in a team with several rheumatologists, 14 (27%). Twenty-seven (53%) worked in private hospitals, 18 (35%) worked in shared practices, and 6 (11%) had their own practice.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In terms of place of work, 14 (27%) worked for themselves, 8 (15%) were members of a society of doctors, 8 had an employment contract, and 22 (42%) worked for another person in professional collaboration.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Practically all of them, 48 (94%), had staff in their practice, 3 had neither administrative nor nursing staff, 41% had only administrative staff, and 53% had both administrative and nursing staff.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The hours devoted to their practice were very variable, most, 19 (37%), devoted less than 5<span class="elsevierStyleHsp" style=""></span>h/week, 20% between 5 and 10<span class="elsevierStyleHsp" style=""></span>h, 14% from 11 to 16<span class="elsevierStyleHsp" style=""></span>h, 6% from 26 to 32<span class="elsevierStyleHsp" style=""></span>h, 8% from 33 to 40<span class="elsevierStyleHsp" style=""></span>h, and 2% devoted more than 40<span class="elsevierStyleHsp" style=""></span>h/week.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The number of annual medical visits ranged from 63% arranging fewer than 1000 to 9% arranging more than 4000 visits, there being 2 extremes: one of 3 visits per year, and the other 5000 visits per year.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Fourteen (27%) were in training, the majority through clinical sessions with other specialties, 2 had training of junior doctors (MIR), and 2 undergraduate sessions; 73% undertook took no training of any type.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Osteoarthritis was the disease most commonly treated in PR, according to 37%. The median frequency of the various entities is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The medical activities performed in practice specific to rheumatology were not routine in all of the PR centres, as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Seventeen (51%) were involved in studies: 47% clinical trials, 58% clinical studies, 29% epidemiological studies, and 18% basic studies.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Of those surveyed 100% belonged to a medical society: 88% to the SCR and the Spanish Rheumatology Society (SER), 25% to international societies, and 12% to the Spanish Society for Bone and Mineral Metabolism Research.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Two scientific societies, the SER and the SCR, have commissioned two simultaneous studies on PR in their catchment areas; this is a reflection of the importance that out specialism's activity is acquiring outside the single-payer regulated framework.</p><p id="par0120" class="elsevierStylePara elsevierViewall">According to the publication by the private practice commission of the SER,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> 52% of Catalan rheumatologists work in PR from the responses received; in our survey it was 42% from 123 emails sent.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Eleven percent of Spanish rheumatologists who are members of the SER practice PR exclusively, compared to 26% in our survey.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The average age in the survey conducted by Yoldi Muñoz et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> was 49, which is similar to the mean. In terms of age group, 71% in the SER were under 50, who comprised 57% of our population, although there was a measurement difference of 5 years in each group. Those over the age of 55 constituted 29% in Spain, and 42% in Catalonia. In other words, our private rheumatologists were older.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The profile of the rheumatologists was similar: the male:female ratio was 53:47, and 52:48 in our survey. In terms of years of service in the specialty: for the SER it was an average of 19 years, and in our survey 84% had been practising for more than 15 years; the number of hours devoted to their practice varies greatly: in the SER it was 42<span class="elsevierStyleHsp" style=""></span>h per week, and in our population the majority, more than 70%, devoted less than 30<span class="elsevierStyleHsp" style=""></span>h per week.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Grados et al. published a study in 2013 on rheumatology care in the public health sector in Catalonia; from a sample of 38 rheumatologists they report that 4% were in private practice exclusively, which contrasts with the 13% of the current SER survey, and the 26% of our survey.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The sex ratio was equivalent in the 3 surveys: in public rheumatology, Grados 48:52, Yoldi et al. 53:47, and in this survey 52:48, although with some trend towards males predominating in the private sector.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Most of the public-sector rheumatologists (96%) worked full or part-time in a hospital, and only 35% of those working in the private sector did so in a hospital.</p><p id="par0155" class="elsevierStylePara elsevierViewall">In their private practice, 53% had nursing help, when only 33% in the public sector had nursing help in 2013.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Of the private rheumatologists, 88% practised in the province of Barcelona compared to 78% of those in the public sector.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The results show that a major percentage of Catalan rheumatologists, 35% according to Grados et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> work in PR, with a level of care activities that we believe is similar to that undertaken in the public hospitals, although this data has not been compared, and 51% undertake research of some type, however only 27% are in training.</p><p id="par0170" class="elsevierStylePara elsevierViewall">All of the above indicates that the concept of PR as a private business is changing and being transformed into units with a similar working structure to public hospitals with formal training.</p><p id="par0175" class="elsevierStylePara elsevierViewall">All the epidemiological data reported by Yoldi et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and which are very similar to those of our study, indicate a natural generational renewal and inclusion of new specialists.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4,5</span></a> Therefore, MIR training could include learning about the differences between the care given in university hospitals, and that given in private practice.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The time devoted to consultation differs between the SER committee and our study. They state 40<span class="elsevierStyleHsp" style=""></span>h/week and we found it to be very diverse: most did not devote 20<span class="elsevierStyleHsp" style=""></span>h weekly, and this influences admissions, since these take place per action undertaken.</p><p id="par0185" class="elsevierStylePara elsevierViewall">This paper is complementary to the 2 cited in the references on public rheumatology in Catalonia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and PR is Spain,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> and provides new data on the activity undertaken and the features of the group.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical Disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of people and animals</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data confidentiality</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">Grant from the <span class="elsevierStyleGrantSponsor" id="gs1">Catalan Rheumatology Society</span>, not available until publication of the article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of Interests</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1184370" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1104690" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1184371" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1104689" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of Interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-10" "fechaAceptado" => "2017-07-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1104690" "palabras" => array:2 [ 0 => "Patient care" 1 => "Private practice" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1104689" "palabras" => array:2 [ 0 => "Actividad asistencial" 1 => "Práctica privada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To establish the percentage of Catalonian rheumatologists who attended to private patients, to understand the most common processes in private practice, to determine the dedication to patient care and the necessary activities to guarantee proper care, such as continuing education and office management, and to know what techniques were most widely used.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A personalized survey of Catalonian rheumatologists whose e-mail addresses were made available to us. Fifty-two responses were analyzed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The percentage of men (52%) and women (48%) was similar; 33% worked exclusively in private rheumatology (PR), most of them in hospitals or medical teams; 11% worked alone; 27% were in training. The disease most frequently treated was osteoarthritis; 51% were involved in studies or clinical trials in the field of RP.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The concept of RP as a private business is changing and is progressively being transformed into working units with a structure similar to public hospitals with formal training.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This report provides new data on the activities and characteristics of private rheumatologists.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Conocer el porcentaje de reumatólogos de Cataluña que atienden a pacientes privados, los procesos reumatológicos más comunes en la consulta privada, determinar la dedicación a la asistencia y las actividades necesarias para garantizar una correcta asistencia: formación continuada, gestión de la consulta y conocer que técnicas son usuales.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mediante encuesta personalizada a los reumatólogos de los que pudimos conseguir sus datos de correo electrónico. Se sometió a análisis 52 respuestas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El porcentaje de varones (52%) y mujeres (48%) es similar, un 33% trabaja exclusivamente en reumatología privada (RP), la mayoría en hospitales o equipos médicos y un 11% trabaja solos. El 27% realiza formación; la enfermedad más frecuentemente atendida es la artrosis, el 51% realiza estudios o ensayos clínicos en el ámbito de la RP.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El concepto de RP como un negocio particular va cambiando y se está convirtiendo en unidades con una estructura de trabajo similar a los hospitales públicos con formación reglada.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este trabajo aporta nuevos datos sobre la actividad que se realiza y características del grupo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alegre C. La Reumatología privada en Cataluña. Reumatol Clin. 2019;15:170–172.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 885 "Ancho" => 1708 "Tamanyo" => 103110 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Median of the ranking of the most frequent diseases attended.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Activities performed in private practice \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Injections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Capillaroscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Densitometries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blocks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Biopsies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arthroscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Complementary or alternative treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acupuncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2018995.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Techniques Used in Private Rheumatology With Reference to the Percentage of Rheumatologists Using Them.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:S1699-258X(16)30103-6" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado de la reumatología privada en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Yoldi Muñoz" 1 => "A. Gómez Centeno" 2 => "J.V. Moreno Muelas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2016.08.007" "Revista" => array:2 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asistencia reumatológica en el sector sanitario público de Cataluña: año 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Grados" 1 => "S. Marsal" 2 => "A. Olivé" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2013.05.012" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "85" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24252627" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stand up and be counted: measuring and mapping the Rheumatology Workforce in Canada" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.E. Barber" 1 => "L. Jewett" 2 => "E.M. Badley" 3 => "D. Lacaille" 4 => "A. Cividino" 5 => "V. Ahluwalia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3899/jrheum.160621" "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2017" "volumen" => "44" "paginaInicial" => "248" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27909087" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The United States rheumatology workforce: supply and demand, 2005–2025" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Deal C.L." 1 => "R. Hooker" 2 => "T. Harrington" 3 => "N. Birnbaum" 4 => "P. Hogan" 5 => """ E.\n <et al=""></et> Bouchery """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.22437" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2007" "volumen" => "56" "paginaInicial" => "722" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17328042" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rheumatology in the community of Madrid: current availability of rheumatologists and future needs using a predictive model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Lázaro y De Mercado" 1 => "A.J. Blasco Bravo" 2 => "I. Lázaro y de Mercado" 3 => "S. Castañeda" 4 => "J.C. López Robledillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2013" "volumen" => "9" "paginaInicial" => "353" "paginaFinal" => "358" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000003/v1_201904270657/S2173574319300279/v1_201904270657/en/main.assets" "Apartado" => array:4 [ "identificador" => "43294" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000003/v1_201904270657/S2173574319300279/v1_201904270657/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300279?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 16 | 21 |
| 2024 October | 28 | 21 | 49 |
| 2024 September | 31 | 11 | 42 |
| 2024 August | 49 | 25 | 74 |
| 2024 July | 33 | 21 | 54 |
| 2024 June | 37 | 26 | 63 |
| 2024 May | 48 | 26 | 74 |
| 2024 April | 35 | 20 | 55 |
| 2024 March | 33 | 27 | 60 |
| 2024 February | 36 | 30 | 66 |
| 2024 January | 27 | 23 | 50 |
| 2023 December | 27 | 27 | 54 |
| 2023 November | 40 | 28 | 68 |
| 2023 October | 36 | 24 | 60 |
| 2023 September | 88 | 37 | 125 |
| 2023 August | 41 | 20 | 61 |
| 2023 July | 28 | 25 | 53 |
| 2023 June | 33 | 25 | 58 |
| 2023 May | 27 | 20 | 47 |
| 2023 April | 16 | 8 | 24 |
| 2023 March | 33 | 21 | 54 |
| 2023 February | 26 | 21 | 47 |
| 2023 January | 32 | 6 | 38 |
| 2022 December | 39 | 29 | 68 |
| 2022 November | 40 | 27 | 67 |
| 2022 October | 35 | 32 | 67 |
| 2022 September | 29 | 24 | 53 |
| 2022 August | 37 | 32 | 69 |
| 2022 July | 29 | 37 | 66 |
| 2022 June | 28 | 23 | 51 |
| 2022 May | 26 | 40 | 66 |
| 2022 April | 28 | 30 | 58 |
| 2022 March | 32 | 48 | 80 |
| 2022 February | 30 | 35 | 65 |
| 2022 January | 29 | 31 | 60 |
| 2021 December | 36 | 36 | 72 |
| 2021 November | 25 | 36 | 61 |
| 2021 October | 38 | 53 | 91 |
| 2021 September | 31 | 38 | 69 |
| 2021 August | 18 | 30 | 48 |
| 2021 July | 25 | 22 | 47 |
| 2021 June | 31 | 23 | 54 |
| 2021 May | 35 | 43 | 78 |
| 2021 April | 102 | 99 | 201 |
| 2021 March | 45 | 22 | 67 |
| 2021 February | 38 | 10 | 48 |
| 2021 January | 35 | 18 | 53 |
| 2020 December | 24 | 19 | 43 |
| 2020 November | 26 | 19 | 45 |
| 2020 October | 21 | 19 | 40 |
| 2020 September | 25 | 17 | 42 |
| 2020 August | 38 | 16 | 54 |
| 2020 July | 41 | 21 | 62 |
| 2020 June | 21 | 14 | 35 |
| 2020 May | 41 | 8 | 49 |
| 2020 April | 39 | 11 | 50 |
| 2020 March | 8 | 1 | 9 |
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