Why choose rheumatology

Explore the various rheumatology career opportunities. Do you need help? Call Help Get more information. Choose Rheumatology! A 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 , 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 themselves as the Rodney Dangerfields of medical specialists. Ever try to explain to your high school friends what exactly a rheumatologist is or does? No, we are not interior decorators or purveyors of 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?

Rahbar et al presented their survey of nearly trainees at the ACR annual meeting. They found three 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. More than half were inspired by 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, fewer surgeries, less X-ray damage and more remissions than decades ago. 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. Promoting the role of rheumatology within medicine and also promotion of ground-breaking advances were felt to be a key. One respondent suggested a rheumatology article in BMJ Careers.

Finally, it was suggested that we take a more pro-active local position through targeting of individual trainees and active recruitment by both SpRs and consultants.

It was also suggested that SpRs talk to SHOs about working in rheumatology, not just teach rheumatology as a subject.

Many suggested that academic career pathways be promoted. Increasing research fellow posts was felt to be an option, as well as providing research projects that trainees could slot into. However, we believe that we have demonstrated some important factors which the speciality can now utilize for future recruitment strategies. The four critical factors influencing the choice of rheumatology were experience as an SHO, love of the subject matter, meeting inspirational consultants and lifestyle factors.

The consistent nomination of lifestyle as a third placed influence suggests that an intellectually stimulating hospital speciality which does not place the same demands on personal life as GIM-based specialities is highly attractive to potential trainees. On the other hand, it is important to note that the complete loss of on-call programmes and linked income may influence trainees, particularly male respondents in this survey, to avoid the speciality in future.

The vast majority of current trainees had rheumatology experience as an SHO, and this was the time that they made their career decision. If as feared with the advent of MMC, exposure to the speciality at early postgraduate level is diminished [ 3 ], the consequences for recruitment could be severe.

It has already been suggested that as a speciality we maximize locally the number of posts provided within foundation programmes, and that if this is not possible we offer outpatient experience in designated clinics for trainees [ 1 ].

This is echoed strongly in the survey responses, and should be the primary target of any activity aimed at recruiting trainees. This also corresponds with findings of the recent Tooke report, published in the wake of the failure of MTAS, which explicitly states that ST1 is too early to decide on a speciality for the majority of doctors. Tooke's recommendations are that FY2, ST1 and ST2 with their imposed rigidity should be abandoned in favour of more flexible core specialist rotations with generic, transferable elements and some hybrid rotations.

This system would be more likely to offer experience of rheumatology to a broader range of trainees [ 4 ]. It could be argued that some of the critical factors influencing choice of rheumatology are mutually inclusive; that during SHO experience a love of the subject develops, fostered by the inspirational supervising consultant. Thus, loss of SHO level posts could sound a death knell for speciality recruitment. Extrapolation from other survey answers, however, would suggest that although SHO experience is a key, earlier undergraduate teaching builds the foundation upon which the decision to apply for an SHO post is based.

Concern has already been expressed elsewhere that musculoskeletal medicine is poorly represented in the undergraduate curriculum [ 10 ]. Interventions in the US to enhance the profile of radiology suggest that increasing early exposure leads to greater awareness and may lead to increased subsequent recruitment [ 11 ]. A study in Canada suggested that early positive clinical experiences as medical students were highly influential amongst factors which governed changes of career choice [ 12 ].

Our data would therefore support measures to increase the exposure to, quality and structure of rheumatology undergraduate teaching as a means to enhance recruitment. Strategies to enhance rheumatology recruitment should begin in medical school. The ARC has long donated an annual prize to each medical school, awarded to students excelling in rheumatology.

New medical student bursaries have been established which allow prize winners to attend the annual scientific meeting, present their prize winning poster and be mentored at the meeting by SpRs.

In addition, a rheumatology trainee profile has recently been published in a well-established medical student careers magazine, Target Medicine [ 13 ]. This is not just an issue for the BSR. These data clearly indicate that as individuals we have a powerful sphere of influence on our local trainees. We need to raise our own local profiles. The national profile of rheumatology is a more complex problem. While a few respondents made positive comments about the image of rheumatology as a speciality, the majority of comments about rheumatology's profile were damning.

If our own trainees think we have a serious image problem, then it is tempting to speculate that the image perceived by juniors who do not become enthused during an SHO job is even worse. In the US, anxiety over the future of the speciality prompted the commissioning of a survey by the ACR to understand the factors that will affect the future supply of and demand for rheumatologists.

While the outlook for the clinical speciality is optimistic based on demographic trends, concern has focused more specifically on the loss of academic rheumatologists to industry, resulting in the potential loss of mentors and inspirational educators for the next generation of rheumatologists [ 14 ]. This echoes concerns about the future of clinical academics in the UK.

The relationship between rheumatology and GIM is contradictory. Another point to consider with reference to rheumatology recruitment following recent MMC changes is the influence of geographical location. The data presented here clearly indicate that for the vast majority of trainees The relevance of this for smaller specialities such as rheumatology is that once appointed to a run-through training programme after foundation posts, trainees will no longer be able to move deaneries.

In smaller deaneries, where there may not be a rheumatology higher specialist training HST post available every year, trainees will have to choose another speciality. It is possible that trainees wishing to train in rheumatology will migrate to larger deaneries at core medical training CMT level, or within smaller deaneries actively pursue alternative specialities where there is a greater chance of available posts year on year.

It is still not clear whether the deaneries should be encouraged to allow cross-deanery applications at HST level for smaller specialities, where posts are not available every year [ 16 ]. It is to be hoped that wide ranging changes to deaneries proposed by the Tooke report, which cited a lack of encouragement for career flexibility and unequal access to specialist expertise across the country, will result in improved opportunities for trainees [ 4 ]. Flexible training has changed.

Supernumerary posts are no longer available. The only way to train flexibly is to slot share, job share or for permanent LTFT positions to be created locally.

Slot and job shares require more than one LTFT trainee within a region, usually at a similar stage in training, for the posts to work. Most of our rheumatology training regions are simply not large enough to accommodate this.

Across the board, women trainees are shunning hospital specialities in favour of general practice due to concern about availability of LTFT training [ 5 ]. Furthermore, our data suggest that the current trend towards loss of rheumatology on call and its associated income may discourage male applicants to the speciality, leading to a greater proportion of female trainees.

Add to this the state of adolescence, which is normally associated with a thought disorder, and is best characterized as a developmental psychosis. We always had five or so terribly ill, difficult, noncompliant SLE patients on the adolescent floor. As an intern, pediatric rheumatology was the last thing on my mind.

During my second year of residency, I had to choose a two-week elective. I found that the great majority of the specialty was outpatient care of ill children. I even saw adolescents with SLE as outpatients and found them to be wonderful pleasant kids who had been understandably scared and difficult during their hospitalization.

I came to be fascinated by the effect of autoimmune disease on patients. As a result, I chose pediatric rheumatology as my life career choice. I was, and still am, attracted to the pathophysiology and abundance of clinical findings. I enjoy the challenge of diagnostic dilemmas and trying to understand the pathophysiology of autoimmune and inflammatory diseases.

I like that there are so many therapeutic things I can do to make these children and teenagers feel better and function to the best of their ability. I especially enjoy taking care of children and adolescents with chronic disease, working with them and their families over many years. I find teaching young pediatricians and budding pediatric rheumatologists about pediatric rheumatology very rewarding, and I love taking what I learn in the clinic and applying it to research and laboratory studies and vice-versa—bedside to bench and bench to bedside.

I have never regretted my choice. I am amazed daily how the breakthroughs in our understanding of these diseases have led to amazingly improved outcomes for patients. And the future continues to be bright for all patients with these diseases—I want to do my part to bring the advances in therapy and diagnosis and prevention to my patients.

Years ago, in preparation for giving a lecture on "Careers in Rheumatology," I asked a group of rheumatologists and rheumatologists-to-be why they had chosen this field, whether their expectations had been fulfilled, and what rewards had come as a surprise. Three answers stood out among all others. They crossed generations, and seemed to apply at all stages of a career in rheumatology. First, there was a fascination with the mystery and clinical challenge of the diseases we treat.

Second, there was a sense of excitement about the pace of scientific progress in this field and the likelihood that this progress would translate into practical new therapies for people with rheumatic diseases.

Third, there was a strong belief that a career in rheumatology - in academic life or in community practice - could be balanced with a full personal life without having to sacrifice one for the other.

Each of these concepts has held true throughout my career in rheumatology. The intellectual challenge is exciting, sustaining and dynamic; the growing number of new therapies, both those currently at our disposal and those on the horizon, adds enormously to the satisfaction of patient care; and this fulfilling career has allowed me to "have a life.

I admire colleagues whose career choices place them in the hospital at all hours of day and night, but I do not envy them.

In making these frank comments, I do not mean to imply that rheumatologists do not deal in long hours and unexpected emergencies. We do, and like everyone in medicine, we enjoy the special reward that comes from the most serious challenges - but this can be done in a manner that is compatible with a balanced life.

For me, the unexpected surprise of a career in rheumatology has been the enjoyment of caring for people with chronic illness. Frankly, I had expected not to enjoy treating chronic illness as much as treating acute illness.

However, the satisfaction of helping people control serious health problems over a long period of time and the reward of developing genuine long-term friendships with patients in the process has been an unanticipated bonus. In the final analysis, this may be the best part of a career in rheumatology. Do you need help? Call Help Get more information.