UCSF and the Future of Rheumatology

A conversation with Dr. David Daikh, director of the nationally recognized UCSF Rheumatology Fellowship Program

Health policy experts predict this country will soon begin to have a shortage of rheumatologists as the U.S. continues to experience the highest population growth rate in the industrialized world as well as the aging of the large "baby boomer" generation. Given these realities, it has never been more imperative to ensure funding is available to train talented young physicians as specialists in the field.

Over the years, the Rosalind Russell Medical Research Center for Arthritis has provided vital financial support for the UCSF Rheumatology Fellowship Program, helping launch the careers of what are today many of the country's leading clinicians, research scientists and educators, as well as top policy-making officials within governmental agencies. Widely considered one of the finest — if not the best — in the country, the UCSF Rheumatology Fellowship Program is headed by Dr. David Daikh, himself a 1997 graduate.

The following interview with Dr. Daikh highlights the critical importance of programs like this to the future of arthritis treatment.

Q: "What would you say are the key goals for this fellowship program?"
Dr. Daikh: We certainly view our mission as the same as any other rheumatology training program — to train rheumatologists to care for patients with arthritis and related conditions. But I would say, above and beyond that, we view our mission as training leaders in academic rheumatology, people who are going to be training the rheumatologists of the future — here and in other universities around the country. And we have a very long, very strong track record in doing just that. We also have a strong track record in training top arthritis researchers, based on the fundamental premise that better understanding of the origins of disease leads to better understanding of disease causation and therefore better treatments. We were one of the first rheumatology divisions formed in the country, so there is quite a pedigree here to draw upon.

Q: "I understand that the vast majority of rheumatology fellowship programs provide financial support to their Fellows for only two years, all that is required for board certification. But the UCSF program provides a full three years of financial support. Why is that important to do?"
Dr. Daikh: Because our emphasis is on producing academic rheumatologists. In the first two years, you need to develop your clinical skills and you need to start in a research area in which you not only learn how to do the research but you have to produce adequate results to convince a granting agency that you merit funding. That is very, very hard to do in two years. It is actually hard to do in three years. But the extra time allows our Fellows to advance their research to the point that they become very competitive in receiving what are known as career development awards from such major funders as the National Institutes of Health.

Q: "How important a role does the Rosalind Russell Center play in funding the third fellowship training year?"
Dr. Daikh: It wouldn't be possible without the Center's support. We put together funding for the fellowship program from a variety of sources, including the National Institutes of Health, but we could not run a three-year program without the Center's ongoing commitment.

Q: "What are some of the reasons young internists decide to specialize in rheumatology?"
Dr. Daikh: First of all, people who love internal medicine are drawn to rheumatology. In rheumatology, you have to maintain your diagnostic skills in internal medicine because rheumatic diseases commonly affect many organ systems, as opposed to other subspecialties like cardiology or gastroenterology. Secondly, rheumatologists typically especially enjoy the patient interaction. With a chronic disease, you see people throughout their lives and that's tremendously rewarding to be able to provide that kind of supportive care. And then, of course, for those who also do research, many of the arthritic diseases are not adequately understood, so there is the challenge and promise of discovering something that will make a real difference.

(Published June 2006 in Arthritis Progress Report, the newsletter of the Rosalind Russell Medical Research Center for Arthritis. To be added to our mailing list, please send us a note with your name and address to rrac@medicine.ucsf.edu. Your information will not be shared with any other organizations.)

It has never been more imperative to ensure funding is available to train talented young physicians as specialists in the field.

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