Academic rheumatology has given Professor Les Schrieber a rich and fulfilling professional life. Here he reflects on his career choice
Imigrated to Australia from England in the late 1950s as a nine-year-old child with my family.
My mother was Romanian, but had left for England in 1938 to escape the impending Nazi invasion. There she married my father, an English cabinet maker. We migrated to Australia partly for better job prospects for my father but also to reunite with my mother’s family. She had a brother and sisters who survived the Holocaust who came as refugees to Australia.
In keeping with the classic immigrant dream, my mother was intensely proud when I enrolled in medicine. Her dream had a major influence on my career choice.
In 1966, I started medicine at the University of Sydney followed by an internship and basic physician training at Sydney’s Royal Prince Alfred Hospital.
Initially, I planned on becoming an academic psychiatrist. However, the College of Physicians and College of Psychiatrists could not agree on a combined training program, so that plan was abandoned.
Further to this, I decided to pursue advanced training in either rheumatology or clinical immunology.
At the time, academic rheumatology was in its infancy in Australia and I was hopeful there might be more job opportunities in this specialty. That took me to St Vincent’s Hospital, Sydney. Here I undertook a non-core year in clinical immunology under the supervision of Professor Ron Penny, an inspiring leader with a superior intellect who I am fortunate to be able to say, has remained a good friend, mentor and supporter throughout my career.
Then followed a year of core rheumatology with Dr David Champion, a remarkable rheumatologist who has combined private practice and clinical research in clinical pharmacology and pain for 40 years.
This experience led to an MD in immunopathology as an NHMRC scholar at the University of NSW.
While my mother might have been proud of her son’s choice of profession, she could never understand why I would waste my time doing low paid research rather than getting a job with a decent income!
TRAVEL AND WORK
During the late 1970s, the ARA invited a particular articulate and inspiring visitor named Tiny Maini who worked at the Kennedy Institute of Rheumatology, London to its national meeting.
Dr Maini was born in East Africa, of Indian heritage, and moved to the UK in the 1960s. He was charismatic, a bit like President Obama.
When the time came to look for a position to do an overseas post-doc (an unofficial requirement for an academic career in Australia in those days) I wasted no time in applying to work with Dr Maini. A productive period of research ensued (not to mention a productive period of European travel).
Over this time, Dr Maini became my mentor and friend, a relationship that has continued throughout my life. He was to become one of the world’s most famous rheumatologists for his seminal research on the treatment of RA with anti-TNF monoclonal antibodies.
Unfortunately for me, this work on TNF started shortly after I had left the Kennedy Institute.
In 1983, the first Professorial Department of Rheumatology was established at the University of Sydney, based at the Royal North Shore Hospital. Peter Brooks, then aged 39, was appointed the foundation professor.
I was fortunate to be appointed as his senior lecturer and was offered the freedom, support and protected time necessary to establish my research program. It was an exciting and productive time.
Nick Manolios, who subsequently became Professor of Rheumatology at Westmead Hospital in Sydney was my first PhD student. He was followed by scientists Tony To and Chris Jackson, who have each mapped out successful academic careers. More recently, Sean O’Neill completed his PhD working in London and at Royal North Shore.
Academic rheumatology has been a satisfying, diverse and stimulating career. However, it has not all been plain sailing.
There have been disappointments and periods of disillusionment with the academic process.
But even these times have had their benefits. I have come to a better appreciation of the importance of the support of my family, friends and colleagues. These down-times have helped shape my character and enhanced my compassion and empathy for colleagues and patients in distress.
MENTORING
Over the past two decades, I have turned my energies more to medical education than to research. The security of a university salary and the flexibility in the academic system has enabled me to do this without penalty.
It has offered the opportunity not only to teach, but to mentor medical students, junior medical officers and advanced trainees in rheumatology, which has been a source of great satisfaction.
I would recommend all junior doctors try to find a mentor.
Ideally this should be someone prepared to follow their careers and be available for support and advice through the inevitable ups and downs. These people are invaluable resources.
In addition, I’d suggest it is important to take a long-term view when deciding which job to apply for. Try to have a five-year plan, rather than just dealing with one year at a time. Where do you see yourself in five years? How do you plan to structure your career so that you can achieve your five-year goal?
Having said that a certain degree of flexibility is worth retaining. Sometimes an unexpected job opportunity arises. If it sounds good and you have done your homework, then be brave and go for it!
If you are academically inclined, consider a career as an academic rheumatologist. This will not appeal to everyone. However it is stimulating as it allows you to teach, do research as well as be a clinician … and to travel a lot!
It also offers an opportunity to see patients in both a public and private setting. I may have felt overwhelmed at times, but I have never been bored.
RURAL OUTREACH PROGRAMS
Over the last 15 years, I have also worked at rural rheumatology outreach clinics in Coffs Harbour, and more recently in Orange, in New South Wales. While I have never sought to live in the country or own a farm, this program has given me insight into the rural way of life and enabled me to provide a valuable service to an area of need.
The federal government provides funding for this program and offers a reasonable travel allowance. The main challenge has been the logistics of finding reliable transport. I regard these monthly rural two-day visits as an adventure and would commend the program to any specialist presented with this opportunity.
CHALLENGES FOR THE AGEING RHEUMATOLOGIST
I have discussed the importance of mentors in advising career development of junior doctors. But what happens to rheumatologists entering the twilight of their careers?
Where are the mentors? What is the exit plan? There isn’t one!
When it is time to retire? Who should you look to to provide sage advice? No one wants to be waiting till they receive a tap on the shoulder before deciding to retire.
There are no simple answers.
I would suggest even senior doctors would benefit from having a mentor. Perhaps a former trusted trainee could act as a mentor in a role reversal capacity.
Retirement is a tricky time for doctors in general, primarily because medicine tends to become an all-consuming profession. When one finally retires, as we all inevitably do, it is not uncommon to be left feeling empty, bored and without purpose.
The medical system could make the transition somewhat easier by considering utilising ageing rheumatologists, and other specialists as resources. It feels a waste not to pass on that wealth of life experience and knowledge to the next generation of medical practitioners. Having said that, it is also important to develop interests outside of medicine.
In conclusion, a career in academic rheumatology is not for everyone.
However, for those who are academically inclined, and prepared to accept a lower income than their private practice colleagues, this path offers many advantages including intellectual stimulation, freedom and time to pursue research, teach, do clinical work, as well as travel extensively.
Les Schrieber is Honorary Associate Professor, University of Sydney, Honorary Medical Officer, Royal North Shore Hospital and Consultant Rheumatologist, BJC Health and North Sydney Sports Medicine Centre St Leonards
