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Why Allergy/Immunology?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Relan chose the field of allergy/immunology and why it's a great field.

Growing up all I knew was that I wanted to be a doctor, librarian, or teacher. (What do all these have in common? Books!) In high school, after volunteering and taking a health science elective, I decided on being a doctor. Starting clinical rotations as a third year medical student was exciting since I had no idea what type of doctor I wanted to be. I liked every rotation. I would call my parents and tell them I was going to be an Ob-Gyn, then 2 months later, a general surgeon, then an internist, and so on.

One of the best pieces of advice I received in medical school was to pretend you were in a busy ER; who was the first person you would want to treat?

I had a hard time deciding between Ob-Gyn and pediatrics but ultimately decided on the latter due to medical training culture (at least at the time when I rotated it was rough) and lifestyle. In pediatrics I was extremely happy, but overwhelmed with having to know a little bit about so many things. It was a reflection of my personality: need to know everything and be a perfectionist. I missed treating pregnant women and looked forward to the NICU when I could be in the delivery room again. I enjoyed high energy fields and knew I had to sub-specialize. I was literally about to turn in my PICU application when I got sick. I spent one week in the hospital, going from taking care of patients to becoming a patient myself. And it changed my life. My Allergy/Immunology mentor was the only attending (aside from the one whose service I was admitted on) who came to see me. We had a lot of heart-to-heart conversations. She assured me immunology would be challenging and I could see the sickest patients. There would be lots of pathways and details to know. (complement, innate versus adaptive immunity, all the Th pathways - she wasn’t kidding!) She talked about how gratifying it is to treat Asthma patients, and improve their breathing. She relayed how humbling it is to live with fear when you have food allergies. She told me about use of biologic drugs for hereditary angioedema. In Allergy/Immunology, I could choose to practice inpatient or outpatient or both. I would have tons of options in making my job what I wanted it to be. And there would be lots of variety. In addition, Allergy/Immunology is one of the few fields where you get cross-trained. While completing pediatric or internal medicine residency, you apply for fellowship and spend part of your training years "on the other side" (peds or IM) with A/I attendings so you can see the whole spectrum of life!

All of these things contributed to my choice of Allergy/Immunology as a sub-specialty. Below, I've shared some of the positive and negative aspects of the field from my own experience. POSITIVES

▪️Work-Life Balance: you set your hours; most of us do not work weekends unless we are on call

▪️See All Ages: infancy through the end, pregnancy included

▪️Oral Challenges (food, medication) procedures in the clinical setting spice up the day

▪️Immunology affects every single body system, which results in cross-over with multiple specialties including cardiology, pulmonology, dermatology, ENT, GI, rheumatology, and ophthalmology especially

▪️Varied Practice Settings: Outpatient or Inpatient or both!

▪️Allergy/Immunology is a tight knit community

▪️Goal of keeping patients out of the hospital, giving them lots of anticipatory guidance and working on prevention strategies

▪️Teaching; so much teaching! Part of the job is to educate patients, parents, grandparents, nurses, and especially students

▪️Immunology: so much learning! The field is constantly changing as we are discovering newer mechanisms. NEGATIVES

▪️Allergy/Immunology does not get much exposure on rotations as med student or resident, either due to lack of fellowship in the learning center, or lack of exposure to A/I attendings on staff.

▪️Burn-out from clinic life and repetitive days (you have to take vacation days!)

▪️Competition from other specialties, for instance- ENT and Primary Care trying to take over testing and immunotherapy

▪️For many conditions specific to A/I, there are tons of non-evidence based medicine therapies online and on blogs. You will be fighting anti-science with patients and parents. For me, the positive aspects of this specialty completely outweigh the negatives. I hope you enjoyed this glimpse into Allergy/Immunology. For more information about A/I, follow me on instagram @pedsallergymd and feel free to DM with any questions!

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