When [my] fellowship was ending, one of my rheumatology attendings and role models asked if I’d ever considered applying for a dual faculty position in both hospital medicine and rheumatology. Up to that point, I had never heard of such a thing. But I could not unhear it. This sounded like my dream job. So I went for it.
TR: Can you describe the ins and outs of your split role?
Dr. Murthy: My time is distributed as 0.6175 FTE hospital medicine, 0.1825 rheumatology clinic, and 0.20 as a longitudinal coach for medical students. This is my dream job. Every week is different. I’m constantly on my toes.
TR: Tell us about your research into how expert physicians learn and problem solve. How has this research influenced your career trajectory?
Dr. Murthy: My research centers on peer-defined experts in clinical medicine to explore their formative learning and clinical activities and generate insights to guide medical trainees who view clinical excellence as an important career goal.
Our first study in this area identified 14 specific behaviors of master clinicians that trainees can consider adopting early in their careers.1
Thereafter, collaborating with a team of clinicians across the country and with senior author Dr. Gurpreet Dhaliwal, I was principal investigator for a multi-center study of the learning habits and clinical activities of 150 peer-defined master clinicians across seven U.S. academic centers and 40 specialties. Our findings were published in 2023.2
These studies have cast light on specific and actionable behaviors that I continue to practice regularly. I also rely on them to frame my feedback for trainees I work with and coach.
TR: How does the split role contribute to patient care? Do you find that your skills in rheumatology complement your hospital medicine practice and vice versa?
Dr. Murthy: Any attempts of mine to compartmentalize rheumatology and internal medicine into separate folders in my mind have been foiled repeatedly. I now see them as two ingredients that are baked into the same cake.
As a hospitalist, I often see patients with crystalline arthritis flares, antinuclear antibody-related conditions or complications of immunosuppression. As a rheumatologist, I regularly find myself working through the differential diagnosis of multifocal pulmonary nodules and fever of unknown origin. It’s less a bifurcation of knowledge and more of a continuum. Practicing rheumatology has expanded my knowledge as a hospitalist, and I think practicing hospital medicine has improved my skills as a rheumatologist.
