Congratulations! You’ve decided to become a rheumatologist and, in so doing, join the ranks of some of the most intelligent, empathic and dynamic physicians out there. But between your decision today and where you see yourself in three, five or 10 years, many more decisions must be made. Arguably, the most important is the decision of where to go for your fellowship training.
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Explore This IssueAugust 2019
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Your fellowship provides the tenor for your career ahead. Although each individual’s circumstances are unique and many factors are beyond your control, the answers to some general questions will help you navigate the process of selecting programs.
Here are five critical questions I ask aspiring rheumatologists at my own institution and from others.
1. What does your family want?
The most important decision you can make is actually not your own. It’s your loved ones who make this decision. Therefore, it can’t be understated that their involvement early in the process is absolutely critical to your success. Assuming your family members and friends are already okay with your decision to pursue two to three years of fellowship, you really have to listen carefully to what they would like in the coming years.
Actively listen to and solicit their opinions. Are they willing to, or have you, move across the country? What will happen to their jobs and career plans? Are they willing to endure long, hard days, as well as weekend calls at some of the busier programs? Do they enjoy cold weather as much as you do?
These important considerations may not necessarily be at the forefront of your mind, but if you fail to consider them now, they will reappear in one form or another in the future.
2. Do you want to customize your training?
Most rheumatology fellows pursue two- or three-year fellowships leading to board eligibility in rheumatology. But this is not strictly the rule. Many fellows have completed fellowships in more unorthodox fashions. For example, I completed a dual-certification pathway in allergy/immunology and rheumatology. It took an extra year, and it was a lot more work, but before I started, I envisioned myself as a clinical immunologist at the intersection of autoimmunity and immunodeficiency. Having two certifications has been an essential step toward realizing my vision.
That’s not the only combination possible. Depending on the training program and Accreditation Council for Graduate Medical Education (ACGME) requirements, some flexibility exists in incorporating other specialty training into your rheumatology fellowship. Infectious disease, nephrology, pulmonology and pediatric rheumatology are just some viable options. Because rheumatologists don’t own an organ, rheumatology trainees can be much more creative than their peers in other specialties.
This customization can extend to other facets of fellowship as well. Masters degrees in public health, business administration, clinical research or medical education can be incorporated, if acceptable to you and your program director. With some effort, doctorate programs and extended research through such mechanisms as the National Institutes of Health T32 funding program can also be accommodated. These represent hard lifts, but if that is your desired career path, then finding programs that afford flexibility should be a priority.
On the other hand, these are significant commitments that can place you in a niche you may not necessarily want to be in. Moreover, important aspects on the back end of programs, such as the bureaucratic burden of crafting conjoined curricula, communicating with specialty boards and assuaging ACGME concerns, may hamper the ability to customize your training.
That shouldn’t stop you from investigating the options, especially in programs that have proven records of training dual-certified fellows.