Summer 2021 (Volume 31, Number 2)
The CRA's 2021 Distinguished
Rheumatologist:
Dr. Rachel Shupak
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Why did you become a rheumatologist?
What or who influenced you along the
way to do so?
My decision to become a rheumatologist
occurred in my PGY2 year when I looked
after a young woman who presented
with an acute and severe polyarticular
inflammatory arthritis that totally
disabled her. Under the supervision
of Drs. Gladman and Lynn Russell, we
were able to treat her effectively and she
walked out of the hospital. The ability
to treat and control inflammation both
articular and systemic and at the same
time minimize or prevent damage was a
powerful influence on my decision. As a
rheumatologist, I believe that we make a big difference in
the quality of our patients’ lives.
Since 1995, you’ve been Associate Professor in the
Department of Medicine at the University of Toronto (UofT).
Over the past 40 years, you’ve taught and mentored many
undergraduate students, postgraduate residents and
rheumatology residents. In your role as Clinician Educator,
you’ve had the opportunity to develop, operationalize and
evaluate innovative educational programs for primary care
clinicians, patients and allied health professionals.
(a) From where do you think your passion for education
stemmed?
At an early stage in my career, I recognized the importance
of training our young students, both undergraduate and
postgraduate, to recognize, diagnose and manage patients
with rheumatic diseases. For my first five years on staff at
St. Michael’s Hospital (SMH), I ran a general internal medicine
team for three months a year, which gave me the opportunity
to interact with many students and residents on
a regular basis. I was rewarded with a number of teaching
awards at the postgraduate and undergraduate level which
made me recognize that I was probably doing a good job.
Over many years, I strengthened my teaching skills and
eventually cultivated the ability to develop educational
programs and thus evolved into the clinician-educator role.
(b) As a respected clinician-educator, what would your
advice be to a prospective rheumatologist?
I would advise them that to be a good rheumatologist,
you have to first be a good internist. Rheumatology deals
with systemic diseases in patients who
are often quite ill and requiring extensive
treatment and monitoring. A detailed
comprehensive history and physical
exam is the foundation of our specialty
which remains very much hands-on. The
breadth and depth of knowledge in this
specialty is growing at a rapid rate and
ongoing learning is an essential part of
training and clinical practice.
I was grand-mothered as a clinician-educator but today formal training
and a Master’s degree is required to assume
this role in academic practice. All
academic rheumatologists are required
to teach, whereas clinician-educators’
role is to develop innovative programs, evaluate these programs
and publish the results.
The “jewel in your crown” is the Advanced Clinician
Practitioner in Arthritis Care or ACPAC program, which you
co-developed with your esteemed colleague, Dr. Katie
Lundon. This academic/residency program has created a
new cadre of clinician practitioners to address the current
and growing gap in access to care for patients with arthritis
and musculoskeletal (MSK) conditions. One hundred highly
knowledgeable and skilled practitioners, graduates of this
rigorous program, are poised to work in a model of shared
care delivery. Why did you create this program and how has
it impacted the Canadian rheumatology landscape?
Recognizing that there will never be enough rheumatologists
to provide equitable access to care, Katie and I
hoped to change the way care is delivered for patients
with arthritis and MSK diseases. We developed a formal
rigorous program for existing allied health care professionals
that was competency based and which we prospectively
evaluated at the program and trainee level. The gap
in access to and quality of care for patients with arthritis
and MSK conditions is in large part due to a well-documented
inadequate number and unequal distribution of
rheumatologists practicing in Canada. Our goal was to
increase knowledge (academic program) and hands-on
training (residency program) for existing heath care providers
to enable them to work in a model of shared care,
thus improving access to and continuity of arthritis and
MSK care in rural/remote, community and urban centers.
Last year, Amanda Steiman kindly took over my role as the
medical director of the ACPAC program.
Can you tell us about your involvement with The Annual
Arthritis Day for Primary Care Clinicians, which has
continued into its 14th year and addresses relevant MSK
gaps in the knowledge of family doctors and ACPAC
practitioners?
I started this program approximately 15 years ago to provide
continuing medical education to primary care physicians
and practitioners. Although MSK/arthritis represents
about 15% of all patients seen in primary care, it is
well recognized that knowledge and skills in assessment,
diagnosis and management of these conditions needs to be
enhanced at the primary care level. My colleague Dr. Ophir
Vinik took over the role of Medical Director of this continuing
professional development (CPD) program about five
years ago and continues to provide an outstanding annual
CPD course.
What is the greatest professional and organizational
challenge you have faced, and how did you address/overcome this challenge?
We embarked on ACPAC, a very ambitious project and were
determined to create a rigorous program, episodically delivered
and competency based. We had a large faculty (>90),
largely volunteers, that made the program the success it
has become. However, finding a sustainable home and
funding for the ACPAC program proved to be a huge challenge,
despite our heroic efforts. We were making substantial
gains with the Ministry of Health (MOH) prior to
the change in government, which unfortunately then never
moved forward. This is an ongoing bureaucratic process
that continues and will in my opinion be successful, due to
the recognized incredible added value of the ACPAC graduates
on the delivery of care to our patients.
What major changes to the landscape of rheumatology
have you witnessed over the course of your career?
Mostly, we have all seen an explosion in biologic therapies
for rheumatic diseases, benefitting our patients
tremendously.
What do you foresee as challenges to Canadian
rheumatologists in the future and what can individual
rheumatologists and the CRA do to meet these challenges?
I believe that we need to remain patient-focused in all
we do. The challenge is to provide equitable (newer models
of care), affordable (provincially supported) care. We
need to double down on our effort to develop one of the
Chronic Disease Management Portfolios that will provide
the resources required to effectively manage our patients’
care. Recruitment and retention of rheumatologists has
been an issue dating back to when I first started in practice.
This has been a priority for the CRA and needs to
continue. However, attention is also needed to foster the
development of newer models of care, utilizing knowledgeable,
well-trained and highly skilled allied health professionals
to decrease the gap in access to and quality of care.
This would require new provincial funding models, referral
patterns and adoption of medical directives recently provided
to nurse practitioners in Ontario. Cancer and diabetes
are examples where this can work effectively to the
satisfaction of the physicians, allied health care providers
and patients.
What is your favourite book of all time?
I like historical fiction best as it takes me to different places
and times in history. I thoroughly enjoyed “A Gentleman in
Moscow” by Amor Towles.
If you had an extra hour in the day, how would you spend it?
Gardening.
If you could eat one food for the rest of your life, what would
it be?
Bread.
If you had a “theme song” that played whenever you enter a
room full of people, what song would it be?
“What the world needs now is love sweet love.” There is too
much anger and hatred in the world today.
How many cups of coffee does it take to make a productive
day?
Two at breakfast (to get me going in the morning) and one
at 4 pm (to allow me to finish my day).
Dr. Shupak receiving the CRA Distinguished Rheumatologist
Award during the virtual gala in February.
Rachel Shupak, MD, FRCPC
Associate Professor,
Department of Medicine
University of Toronto
Physician,
St. Michael’s Hospital,
Toronto, Ontario
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