“Hi, I’m Dr. Kumar, and I’m an allergist,” is something I sometimes fumble when I introduce myself to confused rheumatology patients, before I quickly correct myself with, “… well, I’m also a rheumatologist.” There’s a moment of slight embarrassment that I crossed my circuits, but otherwise I’m proud to say I’m certified in both.
Explore this issueMay 2019
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This dual certification makes me fairly unique—one of only about 70 people nationwide who are certified in allergy/immunology and rheumatology. But ask any of us and we’ll tell you this novelty comes not only with benefits but also considerable costs.1
For the record, I am a big proponent of combined training. I can’t imagine having a satisfying career as either exclusively an allergist or a rheumatologist. However, dual training is not for the faint of heart. Anyone who has done an MD/PhD, a med/peds residency, an allergy/immunology/rheum fellowship or any number of other combined training programs can attest to the long and arduous process. It seems wonderful on paper, but in practice it demands a peculiar combination of self-discipline and flexibility.
Although there is great variability in the types of programs and the certifications or degrees available, the fundamental considerations are the same. First, most combined programs require prior approval through institutional and accreditation bodies, which requires a lot of bureaucratic and administrative effort. Second, such programs also tend to reduce the total number of years of training compared to completing each program individually, but do not reduce the requirements needed for certification in both. Therefore, these programs are often very dense. Third, combined training programs usually weave two stand-alone programs together to promote continuity.
These three commonalities lead to certain generalizations regarding pros and cons.
Because there are so few of us, there is a sense of fraternity among dual-certified physicians.
Pro: Dual Certification Saves Time
Dual certification pathways are alluring because they save time in training. Indeed, completing two fellowships, residencies or dual programs sequentially would double the amount training time. By combining them, you may save a lot of years. When it comes to fellowship, dual-certified physicians typically shave off one year.
It’s not just the amount of time saved; it is also the quality of time. Dual-training pathways exist because there is overlap between specialties, and so there is synergy in teaching someone something once rather than over and over again. With allergy/immunology and rheumatology, learning the common core of basic science immunology only once meant I could focus on other topics with greater vigor. The same is true of administrative burdens, such as orientation or even documentation, in which combining programs may, in a relative sense, make training more efficient.
Moreover, that saved time allows future physicians to do amazing things with what they have learned. The path to becoming a doctor is long and zaps youth and vitality. Dual-certification programs hold the promise of cutting down on the time it takes to complete the journey. But, of course, it demands that you pick up the pace.