Winter 2016 (Volume 26, Number 4)

My Decision to Pursue Rheumatology

By Natalia Pittman

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My decision to enter rheumatology happened unexpectedly. My line of sight had always, even before entering medical school, been on medical oncology. I had many inadvertent opportunities in rheumatology prior to choosing my specialty that eventually led me to change my career focus.

During the completion of my undergraduate degree at Memorial University, I was involved in exciting research in the areas of ankylosing spondylitis and psoriatic arthritis. While in medical school, I tried to secure a rotation in general internal medicine (GIM) or medical oncology for an upcoming elective at Queen’s University in Kingston, Ontario; however, I was unable to secure placement in one of these areas. They were able to accommodate me for an elective in rheumatology, which I begrudgingly accepted.

My experiences during this elective made me question my decision to pursue medical oncology. I quickly realized that there were many facets to rheumatology that I enjoyed and that I could relate to. I was, and still am, fascinated with the complex and often unusual presentations of the diseases. I enjoy the challenge of arriving at a diagnosis and the subsequent management strategies given the new advances in biologic medications. I was able to quickly recognize the strong and ongoing doctor-patient relationships that existed in this specialty and was pleased to see how the addition of the appropriate treatment plan could ensure a quality of life to those patients impacted by rheumatologic conditions.

Skipping ahead several years, it has been six months since my transition from an internal medicine resident at Queen’s University to a rheumatology fellow at McMaster University, and with that came many challenges. In pursuit of rheumatology training, my family and I made the decision to move from a city that we called home to a city that was unknown to us. Not only did I have to acquaint myself with a new area, I also had to familiarize myself with a new work environment: four hospitals, new staff and colleagues, and new electronic medical record systems. This was all very overwhelming. A welcome change was home call, which is certainly a nice break from the in-house call that I was accustomed to as a GIM resident and allowed me to spend more time with my husband and two children.

Despite the excitement of starting this new chapter in my personal and professional life, I also felt some anxiety. I had significantly increased responsibility and accountabilities as a perceived ‘expert’. I was no longer a resident, but rather became junior attending for my patients, and a teacher and resource for medical students and residents. My confidence grew during my first few weeks as a rheumatology fellow because of supportive staff and an environment that fostered learning. I also had the opportunity to attend the Basic Skills Course for the Rheumatology Fellow in Vancouver, B.C., which was a week-long course that helped prepare me for fellowship.

Right now, my challenge lies with balancing the need to learn rheumatology whilst studying for the Internal Medicine Royal College exam. My work-life balance has shifted more to just work. It has proven to be the most challenging time of my life given the time commitments of studying on top of work demands and personal life. Thankfully the support of my family has allowed me to focus on these multiple competing priorities. Through it all, there is one thing that I am sure of; I chose to enter a specialty in which I can see myself having a long and rewarding career and one I can say I truly enjoy.

Natalia Pittman. MD, FRCPC, MSc, BSc
Rheumatology Fellow
McMaster University
Hamilton, Ontario