Musculoskeletal complaints are a common reason for outpatient visits to internists, and little training time is devoted to this in the majority of internal medicine residency programs. The objectives of this study were to determine whether rheumatology training improves accuracy in diagnosing common musculoskeletal syndromes and whether this results in decreased cost of diagnosis.Internal medicine residents (n = 43), staff internists (n = 27), and rheumatologists (n = 8) were given 15 written vignettes of common musculoskeletal syndromes. Participants' choices of laboratory tests, radiographs, and consultations were used to calculate cost of evaluation. Diagnostic accuracy for each physician group was compared with the physicians' rheumatology and orthopedic training and with their clinical experience. Cost for evaluation was also compared with diagnostic accuracy and physician experience.Rheumatologists accurately diagnosed 91% of the vignettes, staff internists 75%, and residents 68%. Rheumatologists tended to spend less for evaluation. Those who made correct diagnoses incurred significantly less cost for several vignettes. Rheumatology training for greater than 14 days correlated with improved diagnostic accuracy (p = 0.0001), whereas orthopedic training did not. Staff internists with greater than 6 years of experience had at least 80% diagnostic accuracy (p = 0.02). Internists trained in rheumatology had improved accuracy in diagnosing common musculoskeletal syndromes and tended to incur fewer costs.