A Rheumatology State of Mind

In 2013 study reported that people from Denmark were the happiest.  Reasons were postulated, but it was suggested it was because their expectations were so low.   In 2012 a Medscape survey of US physicians revealed rheumatology as the most satisfying of medical specialties.  This came as a surprise to many as rheumatologists see rheumatology as the Rodney Dangerfield of specialties. 

I’m sure it irks the rheumatologists out there when they fill out career/job forms only to find rheumatology and obstetric paleontology as the only “unlisted” medical specialties.   Ever try to explain to your high school friends what exactly a rheumatologist is or does?  No, we are not interior decorators or purveyors rumors.  A Rheumatologist is an internist or pediatrician who is qualified by training and experience in the diagnosis and treatment of arthritis, musculoskeletal disorders and disease of immune dysregulation.  The reasons why many choose or are so passionate about this specialty is easily evident.  Ask any rheumatologist – do you enjoy your job?  You’ll be surprised by their responses.

In 2006 a UK survey of 165 UK Rheumatologists, 89% said they would choose rheumatology again if they had to do it all over again. Most went into rheumatology because of an influential training experience or influential teacher or consultant.  Love of the subject matter, lifestyle and the opportunity to do research ranked high with respondents.   These same features were represented by Rahbar et al when presenting a survey of nearly 180 trainees at the 2009 ACR annual meeting. They found 3 factors that strongly influenced a rheumatology career choice: 1) Time (work hours, call, control); 2) Money (salary, opportunities, prestige, less litigation); and 3) Personal fit and intellectual interest. They claimed the ACR recruiting efforts that emphasize “bench to bedside” correctly targeted those intellectually interested enough to be drawn into rheumatology.

I surveyed 449 US and Canadian rheumatologists, about why they went into rheumatology.  Nearly 36% made the decision to go into rheumatology during medical school and 48% decided during their 2nd or 3rd year of residency.  More than half were inspired a mentor or teacher and one-third by their rheumatology rotation.  Compared to when they started rheumatology, most Rheums are proud that they now have fewer disabled patients, less surgeries, less x-ray damage and more remissions than decades ago.  Although some lament the low income compared to other specialites, only 24% are disatified with their incomes.

There was uniform consensus that rheumatology was a perfect blend of internal medicine and immunology. As practicing rheumatologists they claimed job satisfaction because of challenging patients, the right mix of patients (young and old) and physician quality of life.  Problem solving, quality patient interactions and the potential to improve patient quality of life with advances in therapeutics stood out as reasons for their job satisfaction.  Like the earlier UK survey, 87% would again choose rheumatology as a career. Past ACR president Jim O’Dell said Rheums are happy because “we are in control of our lives, practice, and time. Therefore, most of us know our children’s names”.

Surveyed rheumatologists offered the following advice to those who may be considering rheumatology as a career.  Many stating, “do what you love; rheumatology is a wonderful life”.

“This may be the most exciting era of rheumatology ever with rapid advances in basic, translational and clinical research.”

“Rheumatologists are the true "sleuths" of medicine. We deal with diseases that often have very subtle findings, may be extremely uncommon and are often the ones that could be considered diagnostic challenges that "stump" the other specialties. We have the most appreciative patients and the chronicity of the diseases results in us truly becoming a part of the patient's family. Our new therapies really make a difference in the lives of people who, in the past, have told "you have an incurable disease; sell everything and get a nursing home bed, because that is where you will be in two years.”

“A wonderful mix of the art and science of medicine.”

“Rheumatology is the most cognitive of all specialties. I like the complex interactions between patients, family, disease, new science, common sense, ethical purity, the satisfaction of solving difficult problems wisely.”

“I have never had a boring day. I learn something new every day. No two patients are the same.”

“The practice of pediatric rheumatology is very broad and consequently I have many interactions with colleagues in other subspecialties. Pediatric rheumatologists are a collegial group. Having the opportunity to know patients and families over years is very rewarding. The rapid rate of change in the therapeutic armamentarium is exciting... the potential of curing patients now exists. Be a pediatric rheumatologist. It is the best job in all of medicine.”

“The practice of rheumatology is a wonderful blend of internal medicine, musculoskeletal medicine, and clinical immunology. Our diagnoses are often established with a good history and physical examination coupled with serologic tests and various imaging modalities. Biologic therapy has dramatically affected rheumatology patient's treatment and quality of life as well as rheumatologist's practice satisfaction. The practice of rheumatology is always intellectually challenging, enables physician-patient relationships, and allows for a predominantly outpatient practice. This career can be satisfying in a full-time or part-time practice. There are many opportunities for rheumatologists in private practice, clinical trials practice, academic medicine and research.”

“If you have chosen medicine, rheumatology is the most satisfying integration of all you have learned. I consider my specialty the "super-internist" where the buck stops when diagnosis has not been found. Take good care of your patients and your nights and week-ends are mostly free.”

“Rheumatology is a perfect field for someone who enjoys both intellectual stimulation and quality long-term relationships with patients.  The advances in therapy and diagnostic modalities in the past several years also make this specialty very satisfying.”

“You will stay busy in a rheum practice and enjoy what you do.”

“Fascinating patients with the opportunity to be a detective and make a difference.”

“Great specialty for thinkers.”

“Two of my 3 sons are rheumatologists.”

Rheumatology is a truly unique field that draws a special kind of thinker.  I find it interesting that rheumatologists have great clarity and optimism about what most practitioners view as voodoo puzzles of aches, pains and complex systemic problems with abnormal serologies.

Rheumatology is looking for future leaders and problem-solving practitioners who enjoy quality patient relationships and who wish to be lifetime learners, teachers and researchers.  Our diseases are highly prevalent and there are many great achievements and discoveries that have yet to occur.  If you like challenge, patient care and rapidly evolving science that benefits patients you should be a rheumatologist. 

Cole Porter once wrote, ”do that voodoo that you do so well. For you do something to me that nobody else can do” – this seems to define the rheumatologist.