As a result, Dr. Despotovic chose a fellowship in rheumatology but also retained and continued to nurture his interest in critical care. Shortly after completing his two-year rheumatology fellowship in 1999 at Washington University, he decided to do a critical care fellowship. Combining the two was, at the time, an unusual step. “To most people, this [choice] did not look like straightforward career decision making,” he says. After completing his second fellowship, he realized that he wanted to combine both skillsets in his clinical practice. “The pace of work in the inpatient hospital environment fits me better than the outpatient environment,” he states.
Dr. Despotovic maintains that his biggest challenge was establishing his legitimacy in both fields. His immediate mentors, among them John Atkinson, MD, head of the rheumatology division, and Richard D. Brasington, MD, professor of medicine in the division of rheumatology, were “exceptional role models,” he says.
In the beginning, he perceived “an extra layer of questioning” from colleagues because the rheumatology/critical care specialist was not a defined niche. “Once people realize you can do both things with the same amount of passion, that doubt goes away.”
His current interests in the ICU environment encompass vasculitis and connective tissue disease-associated interstitial lung disease (CTD-ILD). He often interacts with his pulmonary colleagues at his institution’s ILD clinic. He finds these collaborations “a productive relationship. I think the collaboration makes us all better doctors,” he says. He also attends at his institution’s medical critical care unit in Barnes-Jewish Hospital for two-week-long blocks. If there were enough patients to warrant the volume, Dr. Despotovic quips, “the perfect position for me would be as a rheumatology intensivist.” (Indeed, in practice both he and Dr. Dellaripa do function in that role, he notes.)
The Synergy of 2 Fields
Will obtaining credentials as rheumatologists/critical care specialists become a trend? Both Drs. Despotovic and Dellaripa say it’s too early to tell. Dr. Despotovic reports that some of his trainees have inquired about following his path. “I try not to talk them into it just because I have done this,” he says. “I mention the challenges I have encountered and advise that they must have persistence. I want to make sure they are choosing the right career path for themselves.”
Dr. Dellaripa is enthusiastic about the additional synergy that has been created through the collaborations in the ILD clinic. He has also collaborated with pulmonary colleagues Aryeh Fischer, MD, and Kevin R. Flaherty, MD, to edit a new text: Pulmonary Manifestations of Rheumatic Disease, A Comprehensive Guide.
