Specialty Profiles

What it's like to specialize in rheumatology: Shadowing Dr. Seo

As a medical student, do you ever wonder what it’s like to specialize in rheumatology? Meet Philip Seo, MD, a rheumatologist and featured physician in the AMA Wire® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in rheumatology might be a good fit for you.

“Shadowing” Dr. Seo

Specialty: Rheumatology

Practice setting: Academic

Employment type: University employee

Years in practice: 13

A typical day in my practice: Three days a week, I’m in the clinic seeing patients. I start around 8 a.m. and see my last patient around 4 p.m., sometimes with the help of a trainee. 

One of the advantages of working in a university setting is that it has allowed me to develop a narrow specialty.  Although I’m a rheumatologist, my area of expertise is systemic vasculitis, and patients will travel long distances so I can help them with microscopic polyangiitis, granulomatosis with polyangiitis, Takayasu’s arteritis and other diagnoses that might not walk into most clinics every day.

Philip Seo, MD

I am also the program director for the Division of Rheumatology at Johns Hopkins, so on the other days of the week, I run the fellowship programs and work on other projects.

Six weeks out of the year, I am assigned to supervise the inpatient consult service at one of our two hospitals. The disadvantage of this is that the workflow can be unpredictable. One day we may have five consults, and the next we may have zero consults. The advantage is that it forces me out of my comfort zone and makes me think about diagnoses and diseases that I might not typically see in my clinic. 

As a trainee, I think it’s hard to get a sense of what rheumatology is because we are often the service of last resort, the service that gets called when everyone else has seen a patient and no one can come up with a unifying diagnosis. My clinic is almost the exact opposite, and in my typical clinic day I will largely see patients who are doing well and are just coming in for a tune-up.

The most challenging and rewarding aspects of caring for rheumatology patients: Most rheumatic diseases are diagnosed clinically, meaning that there’s generally not one single test that can prove what diagnosis a patient has. As a practicing rheumatologist, this is endlessly gratifying because it never gets old. Generally, even within a given diagnosis, each patient will have his or her own unique set of symptoms, and an approach that worked for one patient may not work for another. 

Because so many diagnoses in my field rely on clinical assessment, they are generally not diseases that you can diagnose by reading about the criteria on UpToDate. It is incredibly rewarding to realize that I have picked up a skill set that allows me to help patients whom other doctors cannot.

Adjectives to describe the typical rheumatologist: Detail-oriented. Storytellers.

How my lifestyle matches or differs from what I had envisioned in medical school: Work-life balance is always a challenge, and I frankly try not to give a lot of thought to my college classmates who have already made more money than I will likely see during my lifetime. I also know that I’m making a bit of a trade-off: I work in an academic practice so I can see patients I find interesting and rewarding, and in exchange, I make somewhat less money than my trainees who went directly into private practice.

As an academic, I also do a reasonable amount of traveling to give lectures and meet people in other institutions, which is rewarding, but it also means that I spend fewer nights each month in my own bed. On the other hand, in my field, there aren’t that many reasons that I would have to go into the hospital urgently in the middle of the night, and it’s nice to have that level of predictability and stability in my life. In fact, there are a good number of people who choose rheumatology specifically because it allows them to work part-time.

Skills every physician in training should have for rheumatology but won’t be tested for on the board exam: E.Q.: emotional quotient. The ability to walk into a room and place a patient at ease is incredibly important, and it’s not a skill that is easily taught. I think that every patient needs a different type of doctor—say, a buddy, a father-figure or a confidant—and it is up to us to determine how to best respond to those needs.

The ability to communicate effectively is also incredibly important. Many diagnoses in rheumatology are complicated, with complex regimens, and learning how to explain everything in a comprehensible fashion is crucial. A good deal of my time in my clinic is spent explaining other doctors’ plans to my patients!

One question every physician in training should ask themselves before pursuing this specialty: How much do I enjoy the story? More than any other specialty, rheumatology is full of storytellers, people who enjoy listening to patients talk about how they were doing well until Memorial Day, when they looked down at their legs and realized that they were developing a rash that they had never seen before. In my field, it’s often the journey from health to illness that gives us the diagnosis, and listening to the patient tell his or her story is how we collect the pieces to the puzzle.

One book every medical student interested in rheumatology should read: When Breath Becomes Air, by Paul Kalanithi, MD

The online resources students interested in my specialty should follow: Johns Hopkins Rheumatology’s website, the American College of Rheumatology’s website and the American College of Rheumatology on Facebook and Twitter.

Quick insights I'd give students who are considering rheumatology: If you think you might be interested in rheumatology, go out and find a rheumatologist! I think that too many people are dissuaded from the field because of the one crazy case they had heard about without realizing the broad spectrum of patients rheumatologists see. The best way to figure out if the field is a good fit is to shadow a rheumatologist. 

Rheumatology is a good field for people who want to get to know their patients.  I’ve been in practice long enough that I have cared for some patients for over a decade, and not every field gives you the opportunity to become such an important part of your patients’ lives.