What did you do to start your path to a career in Allergy and Immunology?
In high school, realizing the study of medicine was for me, I studied Animal Physiology and human Anatomy and Physiology. In class we pricked our fingers and performed complete blood cell counts. While I was dissecting animals, measuring their intestines and weighing their organs, my high school teachers made these discoveries fun. Because I felt sure of my path, I applied to the University of Louisville as well as the GEMS (Guaranteed Entrance into Medical School) program. GEMS promised if one completed undergraduate training, maintained or exceeded a specific GPA, scored at or above the national average on the MCAT, participated in the GEMS programming and “had proper and ethical conduct,” he or she would be reserved a spot in medical school upon completion of his or her undergraduate degree. The combination of that award, U of L’s educational value and reputation and the scholarship money I received made choosing U of L a “no-brainer” for me.
How did you prepare for medical school while you were an undergraduate?
While in college I majored in Biology and minored in Psychology, taking all of the usual pre-med courses and then some… I worked to get a head start by enrolling in Animal Physiology, Histology and Biochemistry during my undergraduate tenure. With the GEMS program I was able to observe surgery and rotate through physicians’ offices to reinforce my choice of pursuing medicine as a career.
What was your medical school experience like?
In the late 1990s the University of Louisville School of Medicine was divided as such: the first two years included an overwhelming amount of book study, and the final two years were saturated with clinical rotations. It is my understanding the clinical exposure is now more integrated throughout the entire four-year curriculum. Like most students, I found a core group of study partners and together we lived and breathed medicine for four years.
I, along with many of my classmates, wanted to be an orthopedic surgeon, spending half of my senior year completing rotations in orthopedics: one month of joint replacement; one month of orthopedic trauma; one month of rural medicine specializing in orthopedic surgery in Owensboro, Kentucky; and one month externship at the University of Cincinnati performing hand surgery and orthopedic trauma.
Tell us about your match experience.
The competition was fierce, and when on “Scramble Day” I received word that I did not match, I was devastated. On that day my world was turned upside down, and I had to quickly figure out a plan B. I did not feel led to scramble into one of the few open orthopedic spots in New York or California; therefore, I decided to pursue a Categorical Internal Medicine slot at the University of Kentucky. A year of internal medicine would provide some versatility if I wanted to jump to Radiology or another specialty. Looking back, it was one of the best things that could have happened to me, since I found my true calling allowing me to stay in Kentucky and near my soon-to-be wife. She would eventually follow me to Lexington, Nashville and back to Louisville.
What was your experience during residency after “scrambling” to find your IM position?
When I reflect on residency, I begin to feel old and say things that sound like my parents, such as “Back when I was resident, we didn’t take days off, and we worked 36 hours at a time (insert in the snow, barefoot and uphill both ways).” No work hour caps were in place, and every-other-night or every-third-night call was standard. I found I excelled in medicine both in the hospital and also in the outpatient clinic. My initial plans of one year in Internal Medicine and redirect became three years.
I knew I wanted to sub-specialize and my top choices were Allergy and Immunology and Pulmonary and Critical Care. I enjoyed the adrenaline rush that came with Pulmonary and Critical Care Medicine–running a code and having a very hands-on approach in various procedures. I would drop by the Medicine ICU to see if any lines needed to be done just for the added practice. On the other hand, I thoroughly enjoyed outpatient medicine, and having childhood allergies gave me a head start in the subject. I liked talking with patients and decided to create an allergy rotation at UK. No one had gone into Allergy and Immunology from UK in almost a decade. Rotating through the allergy clinic and spending time in the Immunology rodent lab at the VA, my decision became clear.
Please describe your training in Allergy and Immunology.
At the time, Allergy and Immunology was “outside the match,” meaning one applied by paper and scheduled interviews throughout the year on no particular schedule. I interviewed at some of the top Allergy programs at the time, including the Mayo Clinic, the University of Wisconsin and Vanderbilt. When Vanderbilt offered me a position, I still had several interviews scheduled. It was an easy choice given Vanderbilt’s reputation and its proximity to our families. I completed a two-year Allergy and Immunology fellowship. (Most programs have since moved to a three-year fellowship.) Vanderbilt was a hybrid of unique cases and “bread and butter” allergy. Not only was it a great springboard to becoming a clinical allergist in private practice because of the volume and variety of patients we saw, but it could also prove to be a solid launch pad for going into academics because of the research opportunities. I knew I wanted to practice clinical allergy.
What did you do after you graduated from your fellowship?
I joined a group allergy practice in Louisville, KY that I had rotated through as a medical student, and it had ties to the allergist who prescribed my allergy shots back in the 1970s. It was time to put all of that training into practice as well as start to learn the business of medicine.
Can you provide an overview of Allergy and Immunology?
With the exception of a few hybrid programs, most allergists must complete the following:
• a four-year undergraduate degree,
• a four-year medical degree,
• a three-year residency in Internal Medicine or Pediatrics (no other fields will allow entry into an Allergy and Immunology Fellowship), and finally
• a two-three year Allergy and Immunology Fellowship
If one completed all of these steps directly from high school without taking a break or changing course, private practice would begin in one’s early 30s.
Allergists see many patients with rhinitis, asthma, food allergies and skin issues such as eczema and hives. On the immunology side, many patients with immune deficiencies are treated. Most allergists are trained to see patients of all ages, cultivating long-term relationships while caring for entire families and multiple generations.
What do you like best about Allergy and Immunology
Without a doubt, lifestyle is one of the reasons Allergy and Immunology programs are so competitive. When it comes to practicing in this field, there are many options. Being an allergist can be a 9-5 job Monday through Friday, although many allergists begin their day earlier and end their day later as well as having Saturday hours to accommodate patients’ schedules. Some allergists perform hospital consults; many do not. Other options include solo versus group practice, or university versus private practice. Call is generally light, mostly via the telephone unless the physician elects to perform consults in the hospital. Malpractice insurance is affordable, if not the most affordable, compared to other specialties. In Louisville, most patients are covered by private insurance, Medicare or Medicaid. Compensation structures can be based on a straight salary or productivity.
What do you like least about Allergy and Immunology?
Like most doctors, allergists are also subject to declining reimbursements and changes in health care policy. Life after fellowship is another learning experience, and I would recommend anyone going into private practice to study and learn the business side of practicing medicine.
What advice would you give medical students interested in Allergy and Immunology?
If you are in medical school and interested in Allergy and Immunology, first decide if Internal Medicine or Pediatrics (or Med/Peds) is in your wheelhouse, then seek an allergy rotation during residency. It is important to ask a lot of questions each step of the way to find out if the field of Allergy and Immunology is right for you and your future.