Dual Certification: Is 1 Head Better Than 2?

certified physicians become super-specialists—that is, institutionally, locally and nationally recognized experts in one of the intersections of the specialties. Others dissect the specialties in unexpected ways, such as going into education or administration to offer a global view of both specialties.

Alternatively, some tactically retreat from a specialty. I remember meeting a neonatologist who was trained in an internal medicine/pediatrics residency. Although she was grateful for the internal medicine background, she conceded she probably didn’t need an extra year of training. Many allergists and rheumatologists have embraced one field over the other for various reasons. However, they seldom leave all their attachments to the lesser practiced specialty. In the largest survey on dual-certified allergist/rheumatologists, nearly 100% expressed satisfaction in their decision to pursue dual certification.

Pro: Dual Certification Opens Career Opportunities

It seems like simple arithmetic: If you are trained in two distinct fields, you have access to jobs in two different fields. And that math is mostly true. If you are interested in any job, a greater breadth of training may open doors.

This is particularly true when dealing with multi-specialty clinics, in which there may not be sufficient demand for, say, both an allergist and rheumatologist, but enough for a single practitioner. Many clinics exclusively offer allergy/immunology and rheumatology services, and they would jump up at the chance to hire a dual-certified physician.

Even in academia, as mentioned earlier, dual-trained physicians may have a competitive advantage. A major focus within the academic world is to bridge specialties and create interdisciplinary services. Having dual-trained physicians is a great boon to divisions, so long as there is a niche to fill within the institution.

On a larger level, dual certification offers entry to an elite group of subspecialists. Because there are so few of us, there is a sense of fraternity among dual-certified physicians. At every opportunity and conference, we allergy/immunology/rheum physicians set aside time to meet, and we have robust and active communications through emails and text message chains. Some have even used these connections when looking for new jobs and career advice. This connectedness also improves the sense of purpose and belonging that drives well-being and inoculates us from burnout.

Con: Dual Certification May Lead to Pigeonholing

At the same time, dual training may inadvertently trap people into that niche. Although the twice-as-many-jobs math seems alluring, the fact is few job opportunities are specifically tailored for both specialties. Moreover, it is even more difficult to find jobs in which the split is roughly equal, which would be the ideal.

At its extreme, it’s possible dual training can actually ward off potential job prospects. Many employers simply want an employee who does one thing and one thing consistently. Varied experience may actually come across as a red flag to employers less interested in diversity and more interested in fulfilling a single desired goal. Other issues, including revenue sharing between two disparate divisions or groups, may also deter potential employers who would rather not deal with such administrative headaches.

So, to flip a common saying, is one head better than two? It depends on whose head and whose heart. Since graduation, I have never regretted dual certification, but I concede wholeheartedly that during the process there were a lot of times when I questioned what I was doing. Could I have figuratively been in a better place if I chose to stick with only one specialty? What would I do with all of my free time outside of clinic and consults? What was I going to do with two certifications after fellowship?

Toward the end of my fellowship, things seemed to conveniently fall into place, but the story continues to evolve because I’m still so early in my career. I’m sure that’s the same for most of us who have pursued dual training in one form or another.

Bharat Kumar, MD, MME, FACP, RhMSUS, is the associate program director of the rheumatology fellowship training program at the University of Iowa in Iowa City. Follow him on Twitter @BharatKumarMD.

References

1. Kumar B, Dolovcak S, Vogelgesang SA. Dual training in allergy/immunology and rheumatology: A viable and satisfying career path. Ann Allergy Asthma Immunol. 2017 May;118(5):634–636.