What competence does a rheumatologist need?: an international perspective.

OBJECTIVES: To forecast, on the basis of the past and present position of rheumatologists in Europe, the competence needed in the future to secure and promote the specialty within the healthcare network.
METHODS: Union Européenne des Médecins Spécialistes/European Board of Rheumatology (UEMS/EBR) questionnaire on (a) training centres in Europe, (b) rheumatologists' skills, (c) UEMS core curriculum.
RESULTS: 173 training centres in rheumatology were identified. Reponses to the questionnaire showed both harmony and diversity in the practice of rheumatology. Harmony arises from the need to (a) have an extensive and profound knowledge of, and clinical experience with, all the causes of painful or disabled locomotor apparatus; (b) manage such disorders in the most cost effective way; and (c) promote "shared clinical decision making". The diversity seen both among and within the European countries is due to the different activities of rheumatologists.
CONCLUSION: Rheumatological competence must be based on a common core, as described in the UEMS core curriculum, and on deeper and diverse clinical or scientific knowledge covering the entire field of the specialty, to secure its flexibility and resilience in the market place and to promote its scientific development.