[The established rheumatologist in the tension field between health care deficits and cost control in public health].

The outpatient treatment of rheumatoid patients in Germany depends on certain conditions. Rheumatologists in Germany need to cooperate much more with hospitals specialized in this field than other subspecialties of Internal Medicine. Because of historical reasons many other physicians such as orthopedics, internists, general practitioners participate in this field in contrast to our neighbours in the western hemisphere, where rheumatology is solely covered by rheumatologists. It is therefore conceivable to calculate a rheumatologists/population relation of appr. 1:200,000 and not less than this figure. Starting a business as rheumatologist needs certain conditions, which are specified. One major challenge will be the new law directing out-patient treatment in Germany (Gesundheitskontrollgesetz). It forces the doctor to relate his work to a more financial background with various restrictions and regulations. In this context our goal(s) must be the institution of a specified position in the "Gebührenordnung", to pay for our intense and time consuming efforts to treat our patients.