How I reimagined my career in rheumatology
Editor’s note: In part 2 of “Doctoring Differently,” the author addresses how her career has changed. Read part 1 of her journey.
‘Shoot, No Parachute’
Well, let me revisit my last statement. Although resigning from my job without a back-up plan was the best thing I ever did, it was not exactly awesome at first. Jumping without a parachute was terrifying. I felt angry, lost and scared. I questioned whether I even wanted to be a doctor anymore. I cried—a lot. But I had a mortgage to pay, and I needed to figure something out.
When word got out that I was leaving the University of Texas, I was offered a few jobs in private practices around the city. But the thought of seeing more patients in less time made me nauseous. There had to be a better way.
So for the first time in my life, at age 35, I asked myself a few simple questions:
- What do I want?
- What do I need? and
- What are my values?
I realized that I love being a rheumatologist, and I love being a clinical educator. I just needed to find a way to do those differently.
How?
I started by calling any doctor I knew with an alternative career path, such as concierge medicine, management consulting or pharmaceuticals. Within a few weeks, I talked to more than 50 physicians who’d all found a niche for themselves outside the box of a hospital or clinic.
Some avenues sounded interesting, but many did not. Whatever the outcome, I thanked them for their time and asked if they knew someone I should speak with next. I was amazed to discover just how many opportunities existed for people with medical degrees that nobody had told me about in medical school.
Clinical Practice, But Different
I knew I wanted to practice rheumatology, and I knew I could not go back to the travesty that is the American healthcare system. I wanted time to spend with patients and their records. I wanted to help my patients feel seen and heard.
Enter second opinion consulting.
I found a company that connects me to patients in need of a second opinion—or sometimes, simply a doctor who listens to them and answers their questions. Some patients are undiagnosed while others have a diagnosis but want a second, expert opinion. Some patients just want to understand more about their conditions and medications. This work allows me to be the doctor I want to be: A doctor who has the time, space and energy to take care of patients the way she was trained.
Also, I knew I wanted to improve access to care.
During my time in academics, I had become an accidental rheumatology advocate, caring for a primarily uninsured and non-English speaking population. The waitlist to see me was over a year long. However, not all those referrals needed to be seen in person. Also, the patients who did need an in-person visit could have started treatment with disease-modifying anti-rheumatic drugs (DMARDs) prior to their appointments with great benefit—if only their primary care providers (PCPs) had had a little guidance from a rheumatologist.
Enter e-consults.
I found companies that connect me to PCPs in rural and/or underserved areas who are concerned about possible rheumatic disease in their patients. Via simple HIPAA-protected electronic platforms, PCPs can submit a consult question, clinical notes and labs for their patient. Within 24 hours, I review the information and send them advice. In three to five minutes, I get to change a patient’s life and make a PCP’s life much easier.
Clinical Education, But Different
Little in life gives me as much of a rush as teaching a room full of people about rheumatology—especially if you give me a microphone. I have found a handful of opportunities to lecture since leaving academics. I once taught doctors in Mongolia about rheumatology labs, and my talk was subtitled in the Mongolian Cyrillic alphabet. This moment was a peak for me as an educator.
These days, my primary outlet for teaching is right here, writing for The Rheumatologist and its audience. Believe it or not, I actually get paid to interview experts and write articles that translate the latest and greatest in clinical research for practicing rheumatologists. It’s the coolest.
Consulting, But Different
Rheumatologists are uncommon, and our knowledge is valuable. No one communicated this idea better to me than my business-savvy little brother, Jon, who helped me set up a LinkedIn profile for self-promotion.
Shortly thereafter, some unusual projects surfaced for me. I taught an advertising agency tasked with designing a website for a new biologic treatment about psoriatic arthritis. I also helped a company developing an app for people with autoimmune disease tailor its product to better target its users: rheumatologists and their patients. It was rewarding to ensure the medical information and messages being disseminated were accurate and evidence based.
That One Time I Was an Island Doctor
One summer, I spent a month in Guam, working as the only rheumatologist on the island. The patients were incredibly grateful, the people were kind, and the sunsets were epic. I even learned how to scuba dive.
That One Time I Was a Medical Publisher
At one point, I became the executive editor of Harrison’s Principles of Internal Medicine. McGraw Hill hired me to dream up what this iconic medical reference textbook may look like as a digital education product and flew me to India and across the U.S. to vet my ideas. I spent a week in Bermuda with the book’s physician editors, discussing updates to the new edition.
These editors include, but aren’t limited to, such greats as Anthony Fauci, MD, former director of the U.S. National Institute of Allergy and Infectious Diseases, and Carol Langford, MD, MHS, the current president of the ACR. It was truly a dream to sit beside them and learn from them.
What’s Next?
It has been three-and-a-half years since I left academia and conventional clinical practice, and life has been creative to say the least. I never thought this is where I would end up, and I would absolutely never go back.
I’m not sure what’s next, and I adore that. Whatever it is, I know it will make a difference—just differently.
Samantha C. Shapiro, MD, is a clinician educator who is passionate about the care and education of rheumatology patients. She writes for both medical and lay audiences and practices telerheumatology.
