Testimonials from Rheumatology Professionals

I decided to become a rheumatologist the beginning of my fourth year of medical school. I had just completed my cardiology rotation and every patient had chest pain. Cardiologists were most excited by the unusual patient with rheumatic fever or systemic lupus erythematosus. I realized that the interesting patients for the other internal medicine subspecialties were those with rheumatic diseases. My rheumatology professors were great teachers, but they were honest. They were willing to admit that a host of questions remained to be answered. I was intrigued by a subspecialty that did not have all the answers, where a young investigator could make a contribution. While a number of major advances have been made in rheumatology over the last five years, a number of questions remain unanswered. Thus, the possibilities for a young physician to make a major advance in the field are as great now as they were then.

I became an academic rheumatologist at the George Washington University Medical Center. I wanted to teach young physicians how to care for rheumatic disease patients. Over that period of time, I taught more than 20 rheumatology fellows. These fellows are now caring for patients in locations all over the country. In this way, I've had an opportunity to influence the way individuals receive care far beyond my own office. In addition, the academic setting allows the opportunity to investigate both basic and clinical research interests. My basic research interest was the susceptibility of joints to infections. In the clinical arena, I investigated therapies for low back pain.

After 18 years, I decided I wanted to write more extensively while continuing my clinical practice, so I joined a practice with five other rheumatologists. I was able to complete a book for the public on low back pain and a third edition of my spine book for physicians. I was also able to continue my clinical research efforts which help to design and implement clinical trials, all while seeing rheumatic disease patients five days a week. I have the opportunity to enjoy non-medical aspects of life. I play squash three times a week, enjoy ski vacations, and my family and I relish the cultural aspects of Washington, DC.

I am pleased to have chosen rheumatology as my life's work. I have been honored to provide care to patients, some for more than 20 years, and I continue to enjoy going to work each day. That is my reason for becoming a rheumatologist.

The decision to pursue a career in rheumatology was made in my third year of medical school. Initially attracted to surgery, a rotation in rheumatology as part of my third year medicine clerkship convinced me that rheumatology would provide me greater personal and professional satisfaction than a career in surgery. At the time, the practice of rheumatology was a wonderful blend of the basic clinical skill of physical examination and the rapidly expanding science of immunology. Through immunology, the mysterious shrouds were lifted off many strange diseases and a greater understanding of these diseases unfolded before my eyes. The patient-doctor relationship I witnessed between my role model and his patients were solid, long-term ones with a level of mutual respect seen in very few other clinical specialties. Finally, the ability to make such a tremendous positive impact in the lives of so many people devastated by their disabling, deforming diseases was probably the most appealing aspect of the specialty.

More than 25 years have passed since my introduction to rheumatology, and it has remained a career choice that I've never regretted. The intellectual stimulation created by scientific advances has remained exciting and continues at a breathtaking pace. Today's therapeutic options, based on our new scientific understanding, have taken my ability to help people with arthritis to a level only imagined when I was a third-year medical student. Today, I feel fortunate to work at a medical school as an academic rheumatologist and as a medical school administrator. Although I have administrative responsibilities as a senior associate dean for medical education, my first professional identity is as a clinical rheumatologist, as it is the professional accomplishment of which I am most proud.

My daily professional activities include a blend of administrative duties, teaching responsibilities and clinical patient care responsibilities. Each activity is a chance for me to satisfy the primary reason I sought entry into medical school, as each is a chance to help someone and make a difference in the world. Whether improving our school's curriculum to provide the world with better doctors, using rheumatology as a platform to "turn on light bulbs" in our students' or residents' heads, or seeing my own patients in my clinic, each activity provides me the professional satisfaction I desired in medicine - to make a difference in the world.

During my third year of medical school it became clear to me how I would contribute to mankind as a physician. Having been involved in team sports and because of my excellent hand-eye coordination, I decided that surgery was a natural fit.

During the first few months of my internal medicine internship, I began to reconsider. I was having fun in this discipline, so I decided to complete the full three years of internal medicine training. There were three events that occurred over that third year that clenched my choice in becoming a rheumatologist.

The first occurred while I was rotating on the cardiology service. A patient was admitted for consideration of ischemic heart disease, but her only complaints were related to her arthritis and musculoskeletal problems. Each day on morning rounds, I would convey this information to my senior resident - whose opinion I valued - and each day he would say that we should only be "concerned about her heart." My resident had no idea what her arthritic condition was, and after three days and a negative cardiac workup, we discharged a markedly dissatisfied patient.

The second event occurred during elective rotations in my second year of residency. The Chair of the Department of Internal Medicine recommended I do a rotation in rheumatology. I learned more about medicine that month than I had learned at any other time during my residency, and I was truly beginning to understand the diseases that had previously seemed like a black hole in my education.

A third event solidified my career choice. Because of my newfound interest in rheumatic disease, I decided to embark on a research study in patients with systemic lupus erythematosus. While conducting research, I had the opportunity to learn about the patients as well as the current research in the field. I realized that rheumatology was a field in which I could make tremendous contributions in terms of care for patients, while also being able to make academic contributions should I choose to pursue an academic career.

I took several of the rheumatology clinic patients to my internal medicine clinic to manage with periodic consultation by rheumatology. In so doing, I developed a burning desire to better understand the clinical immunology related to autoimmune diseases and the management of musculoskeletal diseases in general. With motivation and enthusiasm, I could easily envision myself embarking on a career in rheumatology and was excited by the possible contributions I could make. All I had to do was connect the dots.

My interest in rheumatology is largely due to having great mentors who have shared with me their enthusiasm and excitement about rheumatology. I began working with Drs. John Harley and Judith James through a medical research program when I was in high school. They taught me about the research they were doing, and allowed me to see patients with them. Through this experience, I grew to love both rheumatology medicine and research. Deciding to pursue a career in both, I am currently in the MD/PhD program at the University of Oklahoma.

When I first started seeing patients with Dr. Harley, the extent of my knowledge about rheumatic disease was the eleven criteria for lupus. After two years of medical school, it is even more interesting to study rheumatology because I am more aware of the complexity of the diseases and the potential for research. Being involved in the research aspect of rheumatology adds an even greater dimension to the diseases we study, and means my future career will be dynamic and exciting.

My second year as a medical student, my days were filled with studying pathology. During school, I tried to work in the lab and see patients with Dr. James as often as I could, which really made school more enjoyable and strengthened my decision to study rheumatology. I was also able to attend the ACR Annual Scientific Meeting to present an abstract. This experience showed me many new aspects of rheumatic disease; so much so that I couldn’t wait to get back into the laboratory and start my PhD!

My experience at the ACR Annual Scientific Meeting also reinforced what a dedicated group of colleagues I have in rheumatology. Everyone I met was friendly and incredibly passionate about his or her field. Rheumatology is an exciting field with huge advancements to be made, making it a researcher's dream. But most important, this is a field where you can make a tremendous difference in many people's lives.

I have practiced as a pediatric rheumatology nurse practitioner in an academic medical center for the past 15 years. I enjoy working as part of a multidisciplinary collaborative team in providing services to children with rheumatic diseases and their families. Working in pediatric rheumatology allows me to utilize all my skills as a nurse practitioner. I have found it to be intellectually stimulating and extremely rewarding.

I have worked in patient care as a physical therapist for over 28 years. I have remained in clinical practice because I enjoy the direct interaction with patients, especially those with rheumatic diseases. Treating rheumatology patients allows me to use all of my analytical and creative physical therapy skills.

With arthritis affecting one in three American adults, and with the tremendous advances in successfully treating these diseases, rheumatology has evolved not only as the leading specialty in the development of biologic therapies, but also as a gratifying specialty to care for patients.

I have a particular interest in immunology and the rapid pace that new discoveries move from the bench to bedside excites me. Pharmaceutical companies have succeeded in developing biological agents that target the immune system and consequently benefit rheumatological disorders. The near future is set for a rapid expansion of this novel therapeutic approach and rheumatologists are going to be the leaders in some of the most important cutting-edge advancements in medicine.

Clinically, the diverse nature of rheumatic diseases keeps me sharp as an internist and facilitates positive interactions with most internal medicine specialties. The fellowship track in rheumatology provides a good mixture of outpatient care and exciting inpatient consultations. In most cases it is rare to feel overworked as a rheumatology fellow, especially when compared to the all-too-recent memories of internship.

Finally, with a relative nationwide shortage of trained rheumatologists, an increasing burden of musculoskeletal diseases in our currently aging population, and improved reimbursement to practicing rheumatologists, this specialty provides a great opportunity to practice in a geographic locality of your choosing in a blossoming field that provides a comfortable lifestyle.

I have been a rheumatology nurse for over 20 years. My practice has included coordinating clinical research trials and supporting the clinical practice of a large scleroderma program. I am continually growing in my profession through the knowledge gained by each clinical trial and the experiences gained with each patient interaction. The scope of nursing practice, and potential for meaningful nursing intervention, in the rheumatology patient population is immeasurable. Working as a rheumatology nurse has been my most fulfilling professional experience in more than 30 years of nursing practice.

As a pediatric resident at Los Angeles Children's Hospital, I took care of many ill teenage lupus patients. In the late 70s, systemic lupus erythematosus (SLE) often led to renal failure, malignant hypertension and neuropsychiatric disease. 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 thought to myself, “I'll do pediatric rheumatology, because I would never want to do more than two weeks of that specialty.” However, during my elective, I recognized how the inpatient experience completely distorted my impression of this specialty. 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've never been hesitant to admit that I would prefer to limit the number of nights and weekends that emergencies take me from friends and family. 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.