Rheumatoid and Residencies

[AtomKr]

I've have rheumatoid arthritis since I was 13-14, no joint damage or loss of mobility thus far, just occassionaly pain/fatigue/depression, especially after prolonged activity or little sleep (less than 7 hrs/night)

I'm a first year now and interested in getting information about specialities that may be more accomodating to someone with RA, and why.

Which residencies would be the toughest/easiest for a person with RA? Which fields would probably allow me to work until retirement even if my RA got significantly worse? Also, if I were to go into a residency/career and find that my RA prevented me from doing a good job, how difficult is it to switch residencies or fields? Is this common?

Please respond constructively and don't just tell me I'm "doomed" if I pursue a particular field- motivation goes a long way! Thanks in advance for any advice

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[DadofDr2B]

My daughter is starting med school this fall and has Type 1 diabetes. Her choice was to fight the disease that is trying to kill her. She wants to be an endocrinologist. Maybe you should choose to fight RA. You would serve as an example of what you can do with the disease and you would certainly understand your patients point of view. Just a suggestion.

 

[AtomKr]

Thanks for the advice... While I'm amazed with the advancements that have been made for RA already, I think I'm just too frustrated with not being able to "Cure" it to go into the field. It's always been a toss up between "how much pain can you handle" vs. "how many serious side effects are you willing to risk?" and the never-ending battle can be very hard to deal with.

However, if I went into rheumatology I could perhaps do research to help the problem. That would definately be worth looking into!

 

[Samoa]

I am in a similar situation, and I also find rheumatology too frustrating and not at all suited to my personality and interests. In addition, there are any number of other reasons why I think it would be an inappropriate choice for me. Plus, as a patient, I'm not sure I'd want to go to someone who has RA. What you gain in empathy is lost in objectivity, and in reality every person's disease manifests differently enough that I don't want someone telling me what problems I *ought* to be having based on their own experience with the disease. Likewise, I think I would do my patients a similar disservice.

So here's the advice that I was given, which I found to be remarkably insightful and practical: for now pursue what you think you would like to do, because if you let it limit you in your own mind, you might as well be limited physically. If later your situation changes, you can alter your path at that point. From what I understand, that's not too difficult.

 

[AtomKr]

Thanks for the advice! I was starting to think maybe I was just scared and weak for being somewhat afraid to go into rheumatology, but now at least I have another reason- You're right, objectivity would be very, very hard for me....

 

[Samoa]

Thanks for the advice! I was starting to think maybe I was just scared and weak for being somewhat afraid to go into rheumatology, but now at least I have another reason- You're right, objectivity would be very, very hard for me....

Definitely don't do it just because you think you "ought" to, or out of any sense that you owe it to society as repayment or whatever. You'll be best at the field you love, not the one toward which you feel obligated.

 

[kchan99]

I imagine that ortho and maybe any surgical subspecialty would be difficult for someone with RA, esp. with increasing incidence of obesity. Please tell me if I'm wrong. I want to know about it because I have some kind of autoimmune arthritis.

 

[AtomKr]

I think ortho residency is going to be a big obstacle, as you said. But if I were a practicing joint replacement surgeon, I could SCHEDULE surgeries to accomodate my arthritis, and I *think* that surgeons of this type do about two-three days of surgery a week and spend the rest of the time doing consult and follow-up stuff. Please correct me if I'm wrong, but I'm thinking two-three days of surgery and a REAL sleep schedule (who needs an emergency joint replacement?) will equal a really great career for a person with arthritis. I just don't want to keel over and die or develop addictions to painkillers during the residency

As you mentioned, weight is definately the thing to control. I finally inched up towards the "overweight" category and my feet feel every extra pound :-( I'm swimming like mad during med school to fix this.

If you're interested, I *may* be keeping a diary on student doctor network (if they let me!) I'm sure I'll be documenting all the aspects of medical school that are difficult with rheumatoid, and most of what I say probably applies to your condition as well. Best of luck to you and thanks so much for posting!

 

[Fermata]

I think ortho residency is going to be a big obstacle, as you said. But if I were a practicing joint replacement surgeon, I could SCHEDULE surgeries to accomodate my arthritis, and I *think* that surgeons of this type do about two-three days of surgery a week and spend the rest of the time doing consult and follow-up stuff. Please correct me if I'm wrong, but I'm thinking two-three days of surgery and a REAL sleep schedule (who needs an emergency joint replacement?) will equal a really great career for a person with arthritis. I just don't want to keel over and die or develop addictions to painkillers during the residency

As you mentioned, weight is definately the thing to control. I finally inched up towards the "overweight" category and my feet feel every extra pound :-( I'm swimming like mad during med school to fix this.

If you're interested, I *may* be keeping a diary on student doctor network (if they let me!) I'm sure I'll be documenting all the aspects of medical school that are difficult with rheumatoid, and most of what I say probably applies to your condition as well. Best of luck to you and thanks so much for posting!

I suppose you could do this....but.....all of the orthopods I've met work like dogs. Joint replacements also seem to be longer in hours.

Joint replacement surgery is really cool though.

 

[Samoa]

Well, ortho was never on my list to begin with. I pretty much don't want to be any kind of doctor that I might go see, myself. Although it's really because none of those fields interest me, and not out of avoidance.

All I have to say is, surgical outcomes are not a function of pretty hands, but rather fine motor skills and the ability to provide good post-op care, and someone with arthritis may very well have both. Don't get me wrong, to the extent that a skill involves muscular strength, I will always have more difficulty than other people. Which is one reason ortho simply doesn't appeal to me. But maybe someday I'll make enough money to hire Mr. Universe to do all my heavy lifting, and it won't matter. I think that's a reasonable accommodation, don't you?

 

[Twitch]

TNF alpha inhibitors like Infliximab (Remicade) and others have been doing wonders for RA patients. From what I've heard, you get to live a literally symptom free life and thus are free to choose to do what you desire.

RA can't hold one back anymore with the advancements with these new protiens (mouse derived not chemically syntesized) though common sense would dictate steering away from anything that constantly challenges this freedom.

Good Luck,
-Y_Marker

 

[Twitch]

Forgot to ask you - did you mention your RA in your med school application. Clearly it didn't hinder it since you're in med school, but just wondering if it could hurt mentioning the RA condition in the app.

Thoughts anyone?

 

[OldWest]

If you're interested, I *may* be keeping a diary on student doctor network (if they let me!) I'm sure I'll be documenting all the aspects of medical school that are difficult with rheumatoid, and most of what I say probably applies to your condition as well. Best of luck to you and thanks so much for posting!

Definitely interested! When will you know?

 

[Samoa]

I wrote about it on my app. But I don't recommend doing so unless you need to explain something that would otherwise appear much more damaging to your app. If you have an application that can stand on its own, adding that information will only raise questions where otherwise there would be none. They're not allowed to consider it as an adverse factor, and in general I try to avoid giving people the opportunity to do the wrong thing. Having said that, though, it did my heart good to have gotten in the first time I applied to this particular school (meaning, I finally bit the bullet and paid their secondary fee, which I couldn't bring myself to do in a previous cycle), and utterly without a fight.

Yes, it's great that there are all these new drugs. But the real problem is that the overall approach to treatment has been all wrong until very recently. I can still remember when the recommendation was to rest your joints, avoid strenuous exercise, particularly activities involving the inflamed joints. Treatment started with a few months of rest and ice/heat, to see if it would go away on its own. Then if it didn't, you were started on an NSAID. That's it. Then when it became clear the NSAID wasn't enough, they started a DMARD--one at a time, usually for six months. If it didn't work well enough, it was stopped and another one started.

The only reason I'm in any kind of decent shape is because I had a top-notch internal medicine guy as my family doctor (who is so good, he STILL doesn't take insurance and manages to do quite well), who sent me to a top-notch rheumatologist, who started me on a DMARD from day 1. That, and the fact that I ignored their advice to rest, and continued my exercise routine (weights and cycling/swimming) on the sly. I think it was a good five years or so before I came clean on the fact that I was still working out regularly, even during flares.

 

[AtomKr]

Definitely interested! When will you know?

They sent me a confirmation link today! I'm moving and have very little internet access, but I'll be posting soon

 

[AtomKr]

Y_marker- thanks for the confidence in the new drugs...I'm so excited to be starting something that I called my rheumatologist yesterday and told him to squeeze me in anywhere! I can't believe I let it get so bad before I moved up to something stronger, but I have a sometimes irrational fear of side effects that make me stay with the status quo...

I mentioned my rheumatoid in my personal statement, but nowhere else. I tried to leave it out completely for the same concerns you brought up, but the PS asked me to trace my involvement in medicine, and going from near-bedridden state to a functioning person again as the result of a new medicine was honestly the jump-start of my interest. In the end, I had to leave it in for fear of sounding vague and generic without it.
Still, I was also careful to put a VERY positive spin on my RA and pretend like I was COMPLETELY free of symptoms. I dismissed any comments about "it must be difficult" and acted like it was never a problem anymore.

I did have two interviewers (out of six) examine my hands. I'm not sure if they were just curious, of if they were checking to see if I might be unsuitable for admission to medical school, but I THINK it was the former.

 

[Seyrbeyr]

Hi, I know it's a long shot since this post was from several years ago but I recently got diagnosed with Mixed Connective Tissue Disease, an autoimmune disease. I'm about to be a sophomore in college and I've been super down about hearing this and I keep wondering if I'm going to be able to bear my future. Is it really that hard? How are you all doing in medical school? I have Raynaud's so far and joint pain and I'll be starting Plaquenil soon. I'm just looking for inspiration and motivation in others. Not sure if you even see this post anymore but any help would be great! I want to be a doctor and I have the grades for it! I just want to know, how're you all doing?

 

[maxxor]

Considering how far treatment has come, I wouldn't limit yourself as other posters have said. Look for what you are interested in and let the logistics work themselves out later.

However, to answer the direct question posted in the thread, I would imagine surgical subspecialties would be "harder" for you, as you will sleep less and need to physically use your body to do procedures. Similarly, Diagnostic Radiology, Pathology, Radiation Oncology, and Derm would probably be "easier" for the reverse reasons. If your hands and fine motor skills aren't affected, maybe Ophthalmology.

 

[Chillbo Baggins]

Hi, I know it's a long shot since this post was from several years ago but I recently got diagnosed with Mixed Connective Tissue Disease, an autoimmune disease. I'm about to be a sophomore in college and I've been super down about hearing this and I keep wondering if I'm going to be able to bear my future. Is it really that hard? How are you all doing in medical school? I have Raynaud's so far and joint pain and I'll be starting Plaquenil soon. I'm just looking for inspiration and motivation in others. Not sure if you even see this post anymore but any help would be great! I want to be a doctor and I have the grades for it! I just want to know, how're you all doing?

I think you lucked out, @Samoa is still around and a successful attending!

 

[TNFR1]

(Throwaway for sensitive medical reasons; just finished M2 in the US.)

Hi, I know it's a long shot since this post was from several years ago but I recently got diagnosed with Mixed Connective Tissue Disease, an autoimmune disease. I'm about to be a sophomore in college and I've been super down about hearing this and I keep wondering if I'm going to be able to bear my future. Is it really that hard? How are you all doing in medical school? I have Raynaud's so far and joint pain and I'll be starting Plaquenil soon. I'm just looking for inspiration and motivation in others. Not sure if you even see this post anymore but any help would be great! I want to be a doctor and I have the grades for it! I just want to know, how're you all doing?

"That hard" is relative. I had new-onset, spondyloarthropathy (undifferentiated w/ lots of connective tissue/systemic issues) in M1 year and two surgeries, 8 scopes, lots of rehab, a couple liters of bloodwork, and countless doctors appointments later I passed M2 year and am doing relatively well. Some days I didn't want to keep on going, but I always bounced back. (But hey, that's life, right?) Taking a research year to try to get back pain under better control before clerkships (congrats to @A Nonie Meus for getting things under control!). It sucks pretty hard being sick while in med school, but I wouldn't change careers for anything at this point.

I was interested in some surgical subspecialties before but have totally ruled them out at this point as it is unclear what type of control I can expect. (I've also fell in love with a medical sub-specialty). As mentioned earlier in this thread, the surgical lifestyle and physical demands are grueling. Not just standing/gripping things for hours in the OR, but also shift schedules and overnight call that can really screw with your body. That is not to say that if you get well-controlled you guys can't follow your dreams. Conversely, if everything goes south physically there are some internal medicine fields as well as psych that involve very little physical demands and the MD degree can open doors outside of clinical practice.

FWIW there are several attendings in our rheum dept. with autoimmune diseases who do just fine and have colleagues cover if flaring occasionally. There are also several other well-performing attendings and residents in wheelchairs or with canes/clear physical handicaps succeeding.

I have lupus and have been on Plaquenil for 10 years. I just graduated from med school. Yes, it's hard, but it's doable. The main thing is to take care of yourself. Exercise, eat well, rest when you need to, and always, always, always stay on top of the work to have a cushion for the days when everything hurts and you can't get out of bed. Don't ever let anyone tell you that you can't do this. You can. You just have to know your disease and know your body. Read the signals and follow the cues. Work hard and you'll get through it.

This is very good advice. I am taking much better care of myself than I did in college/before my diagnosis and will need to continue to do so. Also get in touch with your student affairs office after acceptance to find out what kind of support your school offers you. You will need to recognize that you can't compete neck-to-neck with your healthier classmates all the time, but you should be OK as med school is more about personal growth.

The best advice I can give:
1) stay on your parents' insurance till 26 if possible (unless the school's is really a better deal)
2) go to a P/F med school (should be a no-brainer, but really helps during flares)
3) As @Mass Effect mentioned, take good care of yourself throughout. This includes an appropriate amount of exercise and not eating ramen/fast food every day.
4) As I previously mentioned, work with student affairs and a few other mentors to get a good support system. I have several physicians and mentors helping me through and it makes a world of difference. School near family/SO might also be a good idea.

This might be controversial, but 4) I would NOT mention your condition during the application process unless really necessary. Physicians unfortunately can be discriminatory against physical disabilities and you don't really know how this info will affect your application. I don't think you should be ashamed of your health, but you should also try to not shoot yourself in the foot along the way.

On the plus side:
A) you will rock the rheum/pain/anti-metabolite sections of M2 year out of personal experience
B) you will actually be able to empathize with some of your chronic patients (not that empathy is requisite over sympathy for physicians, but it really does help you connect with them in unexpected ways)

Feel free to post/PM other questions. Hopefully other students or residents/attendings with different rheum pathologies can contribute to the discussion.

 

[sazerac]

Hi, I know it's a long shot since this post was from several years ago but I recently got diagnosed with Mixed Connective Tissue Disease, an autoimmune disease. I'm about to be a sophomore in college and I've been super down about hearing this and I keep wondering if I'm going to be able to bear my future. Is it really that hard? How are you all doing in medical school? I have Raynaud's so far and joint pain and I'll be starting Plaquenil soon. I'm just looking for inspiration and motivation in others. Not sure if you even see this post anymore but any help would be great! I want to be a doctor and I have the grades for it! I just want to know, how're you all doing?

@cabinbuilder is another attending on these forums who practices in a variety of settings and has been public about her joint pain limitations (even as it concerns charting / EMR / dictation). Perhaps she will have something to contribute to the resurrected conversation.

 

[cabinbuilder]

Yes, I lost the use of my hands once for a few months due to typing chart notes for 30 hr/week. I am ok with the EMR systems where I only type in the HPI and the rest is mouse clicking boxes. Now, if the EMR is purely typing I either don't do that job or I insist on dictation. I have that luxury with locums and if I don't feel the charting is conducive to what my hands can handle then I just don't take that job but it is the first thing I ask when a job is presented to me.