OK I felt bad letting this linger here. As I'm about 50% of the practicing allergists on this board...
- What is unique or special about this specialty?
- One of the few, maybe only, medical specialties that sees patients of all ages. You can come from a peds or IM background but your fellowship will train you in both and your practice will generally be with both, unless you're in an academic setting where you may be able to focus on just kids or just adults. I see CVID patients in their 90's and eczematous babies in the first months of life, and everything in between.
- Someone in Rheumatology did a cons list, so here's A/I cons, at least in my view: Testing and management of food allergy, specifically in kids, can be very imprecise and open to interpretation, and often there isn't one right answer about what to do next. This can be disorienting for families. Same goes for some of the, let's say, "undifferentiated" immunodeficiencies that don't quite check all the boxes for the known immunodeficiencies we know more clearly how to treat. Chronic urticaria is a very frustrating diagnosis to make and treat, since standard treatments often work great for some patients but not others, or work for a year and then stop working, and these patients suffer. PCPs unfortunately don't know much about conditions in our field, and pre-order testing that often provides more questions than answers (food specific serum IgE panels for chronic rhinitis or urticaria - please STOP doing that), or they make promises on our behalf that we can't keep, like telling people with chronic hives why they have chronic hives. Or they refer patients to us for autoimmunity because they see the "immune" thing and think it's us. If someone has a weird rash and you don't know what it is, dermatology is a better first stop than allergy, since I don't consider myself a dermatologist outside of the few skin conditions that are safely under our umbrella. OK that's enough, really this is a good field.
- What other specialties did you consider and why did you pick this one?
- I came from Peds, I considered Peds ID and endocrine, I also did primary care for several years before specializing. This is a 2-year fellowship compared to 3 for the others (and I was already old), I thought I'd see more interesting and diverse stuff, I did want to see adults, and definitely more earning potential in A/I than those others. In my primary care career I also got an intro to A/I through a program where I was doing allergy testing and administering immunotherapy when I was practicing in the military, so it was a good intro and I knew I liked it.
- What challenges will this specialty face in the next 10 years?
- Not sure, I don't think anything that doesn't also apply to other medical specialties.
- What are common practice settings for this specialty?
- Almost entirely outpatient, maybe some inpatient consults depending on where you are, private practice vs employed vs academic.
- How challenging or easy is it to match in this specialty?
- I think it is very challenging. There aren't many programs and they are small, usually just 1-3 slots per year in most of them. I think as a result, luck probably plays more of a role in this specialty compared to some of the bigger ones.
- What excites you most about your specialty in the next 5, 10, 15 years from now?
- Even now, the therapeutics. I prescribe meds these days that didn't exist 15 years ago and the effects are often very dramatic. I'm talking mostly about biologics for asthma, chronic rhinosinusitis with nasal polyps, hives, eczema, EOE. Allergy immunotherapy also still works and that is a very old concept, we've been doing that in basically the same way for 100+ years.
- Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
- I think I'd see a role for AI in scribing, I think lots of places are already doing that. I haven't yet but we'll see.
- What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
- Have to be OK with uncertainty - see discussion of food allergy and immunodeficiency above.
- What does a typical workday consist of in your specialty?
- I'm in the office 7:30 - 5:30, 4 days a week. I see 8 new patients, 10 follow-ups, and I do 2 procedures (cluster immunotherapy, food or drug challenges). I supervise a shot room doing 50-100 shots per day. I don't take work home (except in my mind).
- What is the career progression for your specialty?
- I just work. I guess you could be an academic and progress through that career but that's not me.
- How has your work impacted your life dynamics? What is your work-life balance?
- Work-life balance is great. I could work 5 days a week if I wanted to, and I'd make more money, but I'm happy where I am.
- How does healthcare policy impact your specialty?
- Nothing unique compared to others, I think.
