TR: What evolution have you seen in training over the course of your career?
PE: I have seen only improvement in education. It is much more organized, and the CME is now very good. We have large numbers of trainees with educational training sessions every week. The one downside for trainees, educationally speaking, is that they spend far less time on call and therefore see less clinical material than in the past, but the education is much more structured. We learned on our feet, but these days there is much more to learn and it is organized much better.
TR: The work-hours issue looms large in the U.S. Is that as big an issue in the U.K.? What’s your view on the situation?
PE: Longer hours are very good for learning medicine, especially acutely, but not so good at a personal level. I think you learn a huge amount by doing it, which shapes your career. Inevitably it is a compromise, and some people in the past were not able to cope with that level of sustained work.
From a U.K. perspective, there is the choice of training in either monospecialty rheumatology or dual-specialty training in internal medicine and rheumatology. To do internal medicine well in addition to rheumatology, you do really need to do more on call than it is currently possible to do with the European Directive, which limits your hours officially to 48.
TR: Physicians get into medicine to help people. How satisfying is a specialty where you can, as you say, cure and be able to see that this actually worked, as opposed to others where more positive lifelong outcomes aren’t always obtainable?
PE: It is one of the reasons—it was the main reason—I did rheumatology, because I experienced it very early in my career and then went back to rheumatology and saw the same patients. It’s enormously satisfying to look after patients whom you know well. This is very different from the surgeons who perhaps see their patients once or twice, or even cardiologists who see them fairly rarely. Rheumatologists actually get to know their patients well.
Richard Quinn is a freelance writer based in New Jersey.
