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Why Pediatric Rheumatology?

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. Esteban chose the field of Pediatric Rheumatology and why Pediatric Rheumatology is a great field.

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As a Med Student, I Never Knew This Field Existed (Yet Here I Am!)—5 Reasons Why You Should Choose Pediatric Rheumatology

Pediatric rheumatology is a small field, with only about 300 of us in the United States. It can be challenging at times for patients to get access to care because of this. It is also probably why the first time I even knew that pediatric rheumatology was a subspecialty was during my pediatric clerkship in third year of med school.

We also tend to deal with the rarest of the rare diseases. Because of this, within the field you can develop a deeply meaningful and impactful medical career–whether you are a physician scientist or strive to be a clinician educator, here are the top 5 reasons to choose a career in pediatric rheumatology.

1. Do you find detective work exhilarating? Yes? Welcome!

We are oftentimes the specialty consulted when there are diagnostic conundrums. In rheumatology, all body systems are fair game, which quickly turns into us trying to put together many pieces of a diagnostic puzzle. We are mostly tied to academic centers, so what we see can be quite varied, to say the least!

I will say, you need to be comfortable with not knowing everything–and that’s okay. Whether it’s waiting for a test to come back (no matter where you practice, some results take a long time to return), needing to look up an obscure disease process you may have heard of that one time in medical school, or facing a brand-new etiology.

Remember Multisystem Inflammatory Syndrome in Children, or MIS-C? The new syndrome described in the height of the COVID-19 pandemic? Depending on your institution, you may have been reaching out to a pediatric rheumatologist to help with diagnosis, management, or both. There are other new rheumatologic entities being described in children–our autoinflammatory syndromes chart is frequently being updated (and is by no means comprehensive).

As a pediatric rheumatologist, you are able to synthesize seemingly disjointed clinical findings and find a unifying diagnosis, and that makes our work so satisfying. If you find detective work exhilarating, and enjoy working with kids, then welcome to pediatric rheumatology!

2. Do you enjoy developing long-term relationships with your patients? Come join us.

It may sound strange, but oftentimes we end up seeing our patients more often than their primary care providers. Whether it’s for a new diagnosis of a childhood rheumatic disease, evaluating disease activity, or medication monitoring, we’ll end up seeing our patients every few months or so.

We’ll see them even more frequently if we are still doing the initial work-up. That’s right–many of our diseases can be diagnosed on the outpatient side!

3. How do you feel about bedside procedures? You have options…

If you’re thinking, “the fewer, the better!” Then this may be the field for you.

In pediatric rheumatology, we have the option to do our own joint injections (mostly of the knee, ankle, or wrist). This can either be ultrasound-guided or unguided, depending on your training and comfort level. But if you feel uncomfortable doing your own injections, many institutions have alternative resources for you to refer your patients to.

Speaking of ultrasound, this is another bedside procedure you could do, if you’re interested! Ironically, kids seem to love it. I think it’s the ooey-gooey-ness of the gel.

Musculoskeletal ultrasound has been gaining traction in pediatric rheumatology. Some fellowship programs even have formalized curricula. If you want more in-depth training as well, there is the program offered through the Ultrasound School of North American Rheumatologists, which can be done either in fellowship or as an attending.

4. Are you excited by constantly evolving therapies and patient care? Us, too.

It’s crazy how fast our field is evolving. In my time during fellowship alone, there were FDA approvals for at least three different biologic or small molecule inhibitor (affectionately called, “jakinibs”) therapies for pediatric rheumatic diseases. These included canakinumab, tofacitinib, and secukinumab. Oh! Also belimumab for pediatric lupus. And there’s other medication approvals coming down the pipeline, but these things take time.

Also, as a pediatric rheumatologist, you get to learn about the latest biomarkers for your diseases and get to apply them in clinical practice. You can also get your fair share of genetic testing (for autoinflammatory and some autoimmune diseases), if that’s your interest. There are many different genetic panels to choose from nowadays, and it’s crazy how fast the turnaround time can be for these.

5. Is work-life balance important to you? Because it is for me.

Again, our field is mostly outpatient based. We do have some inpatient consultation or service time, but how often (or even at all) depends on the institution. Regardless, you can be sure to make it to dinner on time, or to that evening concert, or even that after work yoga class you’ve been eyeing.

In addition, there are very few pediatric rheumatologic emergencies. Most of us can count on one hand the number of times we’ve had to go into the hospital in the middle of the night.

6. Bonus reason! We are generally quite happy, all things considered!

No, you will never escape prior authorizations. This is sadly a part of medicine here in the U.S.

And yes, as it is a pediatric subspecialty, our compensation is unfortunately not as robust as others.

However, you get the chance to work with families whose children have rare rheumatic diseases and can reassure those that don’t–which can be just as rewarding.

In addition, as there are so few of us, you’d be joining a tight-knit community who are always willing to help each other. Whether you end up joining a larger practice or are going solo, your pediatric rheumatology global community is just an email away with the Dr. Peter Dent Pediatric Rheumatology Bulletin Board. This is a resource where you can post de-identified difficult diagnostic cases to see if anyone else in the world has seen or managed something similar. (And trust me, you will see strange cases…it’s the norm here.)

Also, if you’re interested in research, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) is a great resource to tap into. They provide networking, mentorship, and several different grants which you can apply to! Some of which help jump start the career of early investigators.

CARRA also has an annual meeting in the Spring, and there is a resident program during the meeting for those interested in learning more about our field. I did it as a resident back in the day, and it was a ton of fun. (But maybe I am bias?) There is also a resident program offered through the American College of Rheumatology (ACR) annual meeting, which usually takes place in the fall. Both usually have some funding for applicants, so if you’re interested, I’d recommend checking the sites for updates.

All in all, pediatric rheumatology is a fun, challenging field with areas of constant growth and potential. If any of the above reasons to explore our field speaks to you, check out either theAmerican College of Rheumatology or CARRA websites for more information. Or, feel free to reach out to me! Always happy to chat.

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