92: A Community Allergist and Immunologist Shares Her Specialty

Session 92

Dr. Neeta Ogden is an allergist and immunologist. She has been out of training for about 13 years and she talks about her career as an allergist in a community setting. She shares some tips and tricks for you as you're going through the process to hopefully become an allergist if this is something you're interested in.

[01:16] An Interest in Allergy

There are two paths to Allergy fellowship – internal medicine residency and peds residency. Neeta took the internal medicine route. She remembers being in one rotation and the patient was very sick. He needed penicillin desensitization. And she found this very interesting that it was so specific. She describes the field as being precise, systematic, and specialized, which simply drew her to it. Then she did some HIV research at the hospital she was training at.

Although she comes from a family of doctors, she never really came across Allergy until her residency. She also liked Dermatology at that time because there was an overlap between the two, but she hasn't really thought about doing anything other than Allergy. Otherwise, she would have just really chosen internal medicine.

She thought Allergy was also a great lifestyle specialty. She didn't want to be taking crazy calls at the hospital so this was part of her thought process in choosing the specialty too.

[06:24] Types of Patients

With the huge rise of food and environmental allergies today, her day-to-day practice is mostly private practice. She sees a variety of both children and adult patients. She manages a lot of skin allergy. She also sees children with food allergies, allergic rhinitis, and asthma. She doesn't see a lot of complicated immunology although it could come up once in a while.

"There's a ton of rashes and hives and allergic skin reactions more than I probably would have thought I would see."

Allergy is driven by immunology and the immune system, the TH2 arm of our immune system specifically. But there's also a specific discipline of immunology like DBID. But she really doesn't see as much. That being said, immunology and allergy are both driven by the same pathophysiology.

Immunology is rare and is a discipline that highly evolves in academic centers. In fact, Neeta would 100% defer to academic medical centers for immunology or complicated immunology.

[10:16] Community vs. Academic

Although Neeta still sees patients at the hospital, it's not the same thing as being in an academic setting which she also misses. Nevertheless, this decision was driven by a lifestyle choice. She joined her family of doctors, a multispecialty private practice, which gave her incredible flexibility of time and overhead. Being a mother, she also thought she'd be more successful in treating patients if she had this level of flexibility.

[11:11] Diagnostics

Neeta does diagnostics for almost every single patient. Patients are referred to her to find out what they're allergic to. 95% of patients end up getting bloodwork or allergy test in her office.

[11:45] A Typical Day

A typical day for Neeta would be walking into the office, rotating between three exam rooms. She does a variety of procedures – skin testing, patch testing, pulmonary function testing. Patients end up staying in the exam room for a considerable length of time. So what she does is bringing them on different days for specific testing.

[13:05] Procedure Work

Procedures done may vary from doctor to doctor. Neeta says procedures can be delegated to staff provided they're trained well. She does scratch testing, pulmonary function testing, and patch testing, application, and removal. They could also do variations of nasal endoscopy.

[13:50] Taking Calls and LIfe Outside of Work

Neeta takes calls at the hospital but it's not that often. She can get called for desensitization for patients who need it. Other issues she would usually encounter include endroedema and complicated asthma. But then again, it's not that often.

"Internists, general doctors, and ER docs know how to get patients to a safe place and then discharge them with an instruction to see an allergist.

Neeta describes this specialty as being one of the nicest specialties. You can have a rigorous work life but you can still spend time with your family.

[15:50] The Training Path

You obviously go through medical school for four years and then followed by a residency either in pediatrics or internal medicine. Around 3rd to 4th year, you will be applying for an Allergy Fellowship. At her time, the specialty was pretty competitive. The fellowship is really for everybody including peds and adults. Then when you ultimately go out, you treat both.

To be competitive to match, try to find the chief of Allergy/Immunology at the hospital and get involved with research to show your interest.

"Show some sincere interest and truly research. Dedicated work never hurts."

[18:30] Subspecialty Opportunities and Bias Towards DOs

There are medial centers that have a Food Allergy fellowship as well as other subsets where you may be able to go deeper.

As for any negative biases towards DOs, Neeta hasn't really seen anything at all. There are just so many DOs everywhere and they're great doctors.

[19:50] Working with Primary Care and Other Specialties

Neeta wishes that primary care physicians wouldn't just test a battery food allergy test because people may leave the office thinking they're allergic to all these things and they need to stop. When in reality, we all have antibodies circulating in our bodies. So there isn't really any clinical relevance without a history of a reaction. So it's important for them to know how to interpret those tests or just leave it to the allergist.

She also hopes they don't lead people to believe it's an immunology when it's actually an intolerance. She has seen a lot of primary care physicians though that know the updated food guidelines in terms of allergy that all infants should be started on. Hopefully, this is going to turn around peanut allergy cases that have been rising in the last two decades.

Asthma is another one that she commonly hears where a primary care physician says they don't have asthma because they're not wheezing. But nocturnal hop especially in children is equivalent to wheezing. So she wishes she wouldn't hear as much of this as this makes the parents of patients doubt you.

Other specialties she works the closest with include Dermatology, GI, ENT, Pulmonology, etc. She says asthma is either taken care of by pulmonologist or an allergist. But an allergist can probably help more since much of asthma is driven by allergy.

"So much of asthma is driven by allergy and an allergist can do a bit more to help."

Neeta further shares an advice to aspiring primary care doctors who would be consideirng whether to send their patients to an allergist or a pulmonologist. If the asthma is triggered, pulmonary may be the better route. But the medications they're going to use are just the same anyway. That being said, you can't go wrong.

[24:50] Special Opportunities Outside of Clinical Medicine

A big part of her life is doing work in the media. Neeta has done a lot of TV and educational media around the issue of allergy, which has become a hot topic. You could also write or have a podcast.

[25:50] Most and Least Liked Things About Allergy

What she wished she knew that she knows now going into the field is that the field requires a bit of being business savvy. What she likes most about the field is the ability to make people feel better.

"Even though so many allergy medications are over the counter, I don't think people know how to use them efficiently."

What she likes the least, on the other hand, are chronic issues that can make people feel miserable. In many cases, they don't respond to therapies. Treating the chronic asthmatic isn't also fun.

[27:44] Major Changes in the Future

Neeta has read about allergists fighting against an FDA regulation that allergists can no longer make shots for their patients. This would be problematic since this is a huge source of income if you're administering shots.

Moreover, there's the automization of skin tests and the interpretation can take the allergists out of the picture. But that being said, you may think people may no longer need allergists. But people need that expertise.

[28:31] Final Words of Wisdom

If she had to do it all over again, Neeta would have chosen the same specialty. She simply loves it! She loves the "detective" aspect of it. One of the biggest medical mystery allergy-related cases she had seen was the drug reaction with eosinophilic systemic syndrome.

Finally, Neeta wishes to imparts to medical students and premeds that allergists are needed. You have to be willing to make time for people. Empathy is also needed. Keep in mind how valuable you are. Realize how much difference your words and your education can make in the lives of patients.

"It's a specialty that continues to be incredibly relevant because allergies are only going to get worse."

Links:

NeetaOgden.com

MedEd Media Network