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The ONE Thing

Rheumatology is the perfect blend of opposites: art and science; technology and skills; young and old; novel and traditional. All of which, when exercised wisely lends to expert patient care and a fulfilling best career. Ask any rheumatologist, “Do you enjoy your job”? You’ll be surprised, encouraged, if not inspired, by their responses.

You became a rheumatologist because of the challenge, problem solving and interesting patients. Another day is a new opportunity to chalk up the victories of a new diagnosis, right drug choice or problem averted. Despite our Subaru salaries, rheumatologists are amongst the most satisfied with their career paths. Admit it; you’re very fortunate to be where you are and where you are going. 

But there are still major challenges ahead for you and rheumatology. It's time you took a bigger, wider view, because there’s a, sink hole in the future of rheumatology; and it’s up to you to change it.

Rheumatology needs more big thinkers and problem-solving practitioners who wish to be lifetime learners, teachers, researchers and leaders. Wwhat we really need are these and more disease specific mavens, more academics or game-changing futurists.

One analogy is that Rheumatologists are like baseball players who’ve made it to the big leagues. While we enjoy the hits, swinging for fence, throwing the knuckleball, and basking in our wins, none of us are changing the game and very few will be hall of famers. 

Sure there’s work to be done and bills to be paid but why can’t you have a bigger goal in mind?  Aim to change the game, redefine the paradigm, or at least break through the 60-40-20 ceiling? 

For some it is enough to be a rheumatologist. Yet if we all think like that, then who will lead? How will rheumatology advance?  (If you’re thinking drug development will lead the way, then you’re not in control, pharma and serendipity are)

Big thinkers and leaders early on figured out what their “ONE thing” is.  The ONE thing that drove them to success.

The “ONE thing” may be what defines you, launches your career or makes you a standout and leader where you work.

Aiming to be like every other rheumatologist should not be the goal. You are not equal to, nor the same as your fellow  rheumatologists. You’re either better or worse, leading or following, instigating or going along. My dad used to say there are those who give ulcers and the rest who get ulcers. Which you are, is up to you. Where you end up is contingent on your beginnings, your goals and who you work with or for.

Four fictional fellows (A, B, C, D) graduate from fellowship as card-carrying rheumatologists. "A" becomes an immunologist-scientist; "B" does clinical trials at a teaching hospital; "C" is the world’s expert on metatarsalgia; and "D" became an incredible businessman who owns a nationwide chain of “Jiffy-Joints”.  Another scenario might have all of them (A-D) going into private practice. Where's the inspiration and leadership in that?

I’m not disparaging private practice rheumatology, as I and many are just that.  I am stating that our obligations should go beyond being a squeeze and prescribe rheumatologist. 

Every trainee, rheumatology fellow, rheumatologist, or rheumatology faculty needs to have that “ONE thing” that sets them apart and establishes where they are going or what they will be known for.   Why not aspire to have a disease, drug, procedure, or skill named after you.  The ONE thing  will makes you valuable, credible and influential to your patients, peers and medicine.  Locally or nationally.

But, will we end up with thousands of experts in niche areas of rheumatology?   I believe that those who become leaders end up being known for more than just “ONE thing”. What they learned in their singular focus became a template for future career excellence.  A minority will remain “Mr. Metatarsalgia” and that’s a good thing too. Overall, we can’t keep up with the population demands for MSK care and we will benefit more from innovation and leadership than by putting everyone into general rheumatology practice. 

Recent ACR manpower studies  claim there are  4900 US rheumatologists and that this will decrease to 3,645 by 2025.  My study and current estimates are that there are only 3200 actively prescribing rheumatologists, who will experience the same decline in the next decade.  With either estimates, we do not have the collective manpower to care for 27 million OA, 8.3 million gout, 5 million fibromyalgia, 1.3 million RA, and 2.4 million spondyloarthritis patients. You, the individual rheumatologist, will make some, but relatively little difference in this gigantic MSK burden.  

Many say that work and other demands just won’t allow for the pursuit of a new goal or ONE (more) thing.  Lessons learned from the big achievers is that they find a way. Many succeed by time blocking for their ONE Thing and then protecting that time with a vengeance. 

Your career and training has prepared you to be the expert and future leader.  Isn’t it time you stood out, broke out or shout out what it is that you are passionate about? Clearly this is an option for those who are up to the challenge and those who wish to reinvent themselves.

With the right goals, passion, a smart mentor, a little luck and hard work - you may be the ONE who makes a difference.

“The goal isn't to clear the table (finish the fellowship); the goal is to set the table (develop excellence)”. – Seth Godin


For more on “The One Thing”  you can read The ONE Thing: The Surprisingly Simple Truth Behind Extraordinary Results by Gary Keller and Jay Papasa


Join The Discussion

Dr Arthur Weinstein

| Aug 10, 2017 4:38 pm

Thank you for that insight Jack. I would emphasize that success is dependent not only on one's inner desire and hard work but also having the right support systems around, especially mentors who can lead you along the right paths and open the doors to help you succeed. Also, the American College of Rheumatology has many committees which can facilitate the development of expertise in certain areas through knowledge acquisition and academic interactions. By volunteering you will get back much more than you put in. As you well know, it takes a Village to help the Village Chief. Best Art
Opportunities and mentors are key and greatly needed. Great suggestions about the ACR as another place to shine and advance! Insight from one who has been leading and mentoring for years! JC

Eric L. Matteson, MD, MPH

| Aug 11, 2017 9:51 am

Jack, I appreciated the passionate and sobering message. I feel very fortunate to have been steered toward rheumatology, for all of the reasons you state. All of us in the field need to continue to identify talented, motivated young people to come into this challenging and rewarding life. It certainly would be nice if the external challenges of insurance, bureaucracy and funding were fewer, but in the end, none one else has as much interest in our specialty, and the well-being of our patients as we. Eric
Eric, I concur. Yet the hassles and obstructions we deal with (insurance, bureaucracy, funding) are the price we pay to play - and all must endur these or retire. THe message is (primarily to fellows and young rheums) that KOLs, experts and leaders such as you find a way and find the time to do that ONE important thing - or in your case, NINE important things. My hope is that this gets ingrained early on in ones career or motivates the seasoned rheumatologist throughout her/his career. I appreciate what you've dedicated much of your professional life to such change. JC

James Smith

| Sep 03, 2017 8:54 pm

Great piece Jack. I am going back into private practice, but I do want to make a difference. I want to work with my new group on improving how primary care providers assess and advise patients with arthralgia and also improve on reducing infection and cardio-vascular events in our patients.
Just read this today. Good point Jack. Rheumatology is great, to me it offers best combination of humanistic and scientific dimensions to grow. Idealism is more in need these days, especially in medicine. Your input should be included in core rheumatology fellowship training.

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The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Executive Editor of and also Co-Edits the online textbook 
Dr. Cush's interests include medical education, novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow