The Happiest Specialty: Rheumatology Is #1!

9. We see and care for patients of all ages.

8. We take care of the whole patient, not just an organ.

7. We practice the art as well as the science of medicine.

6. We get lots of hugs from our patients—both literally and figuratively.

5. Rheumatology self-selects happy people.

4. We have excellent therapies and get to see excellent results.

3. We are diagnosticians—the Sherlock Holmes of the clinic—often the court of last resort.

2. We get to take care of, and form long-term relationships with, our patients.

1. We are in control of our lives, practice, and time. Therefore, most of us know our children’s names.

Numbers one through four on the list were a consistent theme across many dinners. Having control of one’s time, establishing long-term patient–physician relationships, being called on to solve complex diagnostic puzzles, and having the ability to change lives with our skills and therapies were highly rated by all. Many appreciated the balanced life they had been able to lead compared with their colleagues in more acute care specialties. Some highly valued the relationships they had formed with their patients who have become a big part of their lives through the years. Many shared anecdotes about not only caring for their patients but their patients providing inspiration and care to them. Others took great pride in their evaluation and management skills and being the court of last resort—the specialty that others turned to when no one else knew what the heck was going on. The diagnosis of complex conditions, often not even rheumatological, is a source of great satisfaction. Still others—particularly those of my generation—marveled at the wonderful treatment responses we can now expect compared with what we were accustomed to only several decades ago. Who wouldn’t be happy about changing lives in such a positive way?

For all of the above reasons and many more, rheumatologists are useful, and what we do makes a difference in patients’ lives on a daily basis. It is easy to get caught up in the daily hassles of clinic or academic life, documentation, prior authorizations, insurance denials, demands from Chairs and Deans, and grant rejections, to name just a few. Believe me, I know about hassles—we recently went live with EPIC at the university! Even with all that, writing this column made me appreciate what I get to do on a daily basis. EPIC aside, my last clinic is a great example. I got to see eight rheumatoid arthritis (RA) patients (five are in remission, two have low disease activity, and the other is starting on combination disease-modifying antirheumatic drugs), two systemic lupus erythematosus patients (both doing well), and a couple of new patients (one who has been an enigma and we think has lymphoma and, to top it off, a male fibromyalgia patient who comes in to tell me his sleep apnea is being treated and his fibromyalgia is “cured”!). Then I got to go to a postclinic conference lunch and discuss with the students and residents all of the above cases. We really do have a great life!