Why I Chose a Career in Rheumatology

Editor’s Note: I’m grateful to Dr. Diana Girnita, M.D., Ph.D. for contributing this article about rheumatology!  If you would like to contribute an article to The Specialist Series for your specialty, simply send an email to editor@thescopeofpractice.com.  

Rheumatology or cardiology?

When you are a medical student, you think about the day when you will be able to step into a specialty that will offer you the reward of saving lives. This is why like many medical students, I initially chose to pursue a fellowship in cardiology.

After a few years in cardiology, I quickly realized that you can save some lives, but you will also lose many. At times, the only option for patients with severe heart failure remains a heart transplant. My dream came true when I earned an opportunity to pursue a heart failure postdoctoral fellowship at Harvard University.

One year later, the opportunity arrived. I went to work on a multinational research grant to deepen my understanding of the immune system and the genetics impacting the success of heart transplants.  That’s what initially drew me to rheumatology as a possible career.  Who could believe that saving patients’ lives is related to understanding the complexity of our immune system?

I had no idea that in a few more years, when I was redoing my clinical training in Cincinnati, I would discover that rheumatology is so profoundly connected with the transplant world. Understanding and managing the immune system was the foundation to develop targeted therapies that proved to change the prognosis of patients with autoimmune diseases.  Oncology is the only other specialty in medicine that has seen such a remarkable turnaround in the prognosis of their conditions.

Why rheumatology?

So, what’s the connection between being rheumatology and cardiology? Autoimmune diseases cause chronic inflammation, and in turn, uncontrolled inflammation leads to increased risk of developing premature atherosclerosis, increased cardiovascular risk (e.g. myocardial infarction, heart failure, and strokes). Sometimes, excessive use of NSAIDs and corticosteroids increase this risk. However, better management of inflammation translates into reducing cardiovascular risk.

Practicing rheumatology taught me that this specialty offers you a unique role in the patient’s life. What can be worse than being in severe pain and unable to move or take care of yourself? What can be worse than a diagnosis of lupus or vasculitis that can have life-threatening consequences? I had patients with severe lupus nephritis or cerebritis, or ANCA vasculitis. Their lives were in great danger, but I had the tools to save their lives with immune-modulating and targeted therapies. These patients remain forever grateful, and many times the patient-physician relationship will span over a lifetime.

Additional opportunities in rheumatology

I have always enjoyed teaching. Rheumatology allowed me to teach and inspire young residents in pursuing this specialty. Not many residents have the opportunity to rotate in this specialty as their residency programs concentrate on offering internal medicine, ICU, cardiology, or nephrology.

As the prevalence of arthritis and autoimmune disease is increasing, there is a significant shortage of rheumatology specialists in the U.S. and worldwide. This specialty became highly competitive, and only 1 out of 4 applicants will receive fellowship opportunities.

I created a course designed to address the steps to be successfully admitted into the rheumatology fellowship. I successfully put seven residents into fellowships in renowned programs across the U.S. from Dartmouth University to the University of Illinois to Case Western in less than five years.

Rheumatology is just part of the equation

Another aspect that I enjoy in rheumatology is that I can help patients understand that medical treatment is just one part of their solution. Integrative medicine became a big part of my practice when I understood that nutrition, sleep, exercise, and mindfulness could be instrumental in managing chronic diseases.

When I got educated and started incorporating these into my practice, it became clear to me that western medicine was trying to solve one problem at a time instead of addressing the whole person. Autoimmune diseases affect the entire body.

The biggest challenges that I encountered practicing rheumatology in the traditional healthcare system were the lack of time with my patient, little to no control over my schedule, and long waiting times for my patients. Many patients will also face a financial burden due to incredibly high costs for tests, imaging, or medication.

Two years ago, I decided to design my private practice to put the patient in the center and offer access, enough time, and transparent and affordable pricing. I like to think about the members of my practice as people that carry disease, not patients. My efforts to elevate and educate them are highly appreciated.

Final thoughts

Here’s a little piece of advice to young physicians who are considering a career in rheumatology. They will discover a very intellectually challenging specialty where every few years, new emerging therapies will bring outstanding results and change lives in a way that was not anticipated 30 years ago.

Rheumatology will captivate you and will never become a routine!