Allergy and Immunology
A NextGen Pathways in Medicine Article
The practice of Allergy and Immunology dates back to Greek antiquity, when a man named Hippocrates, the "Founder of Medicine," dispelled the belief of his time that illnesses were caused by the supernatural–possession by evil spirits and the disfavor of the gods–and began advocating the notion of diseases as the results of natural causes. This fundamental theory, linking illnesses to a physical and rational explanation, proved to be the very root of modern medicine and gave impetus to the work of Edward Jenner, the "Founder of Immunology," in pioneering the first known vaccine in 1796 [1], the vaccine that subsequently led to the elimination of the small pox disease. Over the centuries, the field of allergy and immunology has expanded to encompass the prevention, diagnosis, and treatment of impairments to the immune system such as asthma, anaphylaxis, and acquired or hereditary immune deficiencies.
Allergy and immunology is unique not only in its subject, but also in its demand on physicians. It is "one of the few specialties where the physician is cross-trained in both pediatrics and adults," according to Dr. Anne Lent, Assistant Professor of Medicine at the National Jewish Medical and Research Center in Denver, Colorado. Medical students who choose to enter this dynamic field will be required to complete a three year residency in internal medicine or pediatrics, followed by a two year fellowship in allergy and immunology. The residency provides new physicians with the skills necessary to effectively treat patients and prepare for further specialization during their fellowship. Residents participate in rotations in various departments, clinics and wards; pursue academic endeavors such as publications, research, and departmental presentations; and are-on call approximately every fourth or fifth night. Dr. Lent describes her experience during her residency as a "labored, love-hate relationship; because while the work you are doing demands a lot from you, you're surrounded by other individuals going through the same experience and fittingly, you establish lasting bonds and friendships."
Upon completion of the residency and successful passing of the board exams, third year residents apply for a two-to-three-year allergy/immunology fellowship comprised of clinical experience, teaching responsibilities, and research. Although every fellowship program is unique, the programs share the common theme of integrating pediatric and adult care, requiring the fellow to carry an effort of twenty-five percent on an original research project, and upholding responsibilities in training new residents. The fellowship is academically centered and gives the physician the opportunity to pursue his or her specialty interests that he or she was unable to before or during their residency.
Dr. Henry Milgrom
Following their fellowship, an allergy-immunologist's time is divided between research and patient care; allergy-immunologists associated with a research hospital are more likely, though not required, to participate in research than those who are not. Many doctors who have chosen this career path have had previous experience in the laboratory, whether during their undergraduate, medical, or residency years. Dr. Henry Milgrom, Director of the Ambulatory Pediatric Allergy Program at the National Jewish Medical and Research Center, and Professor of Pediatrics at the University of Colorado Health Science Center, spent three years in a viral immunology laboratory and decided that a "specialization in allergy/immunology that would allow me to make use of [my] experience was a logical next step." He explains that "some days I see patients in the clinic or [in] the research unit. On other days I work at my desk; I evaluate data and write reports of completed studies, or plan future studies and apply for funds."
The process of acquiring funding for research is one of the more difficult aspects of the specialty and is primarily due to the limited funds available. According to Dr. Doug Graham, an MD/PhD and an Assistant Professor of Pediatrics and Immunology at the University of Colorado Health Science Center, "a few years ago, only the best 20% of research proposals were funded through the National Institutes of Health. Today, the number has dropped to 10% or less. These grants are vital for paying salaries of both the investigators and the lab employees and for supplies to carry out the projects." This challenge of grant funding is especially true of individuals, like Dr. Graham, who have both clinical and lab commitments as a physician scientist. He goes on to explain the added difficulty stems from the fact that "physician-scientist[s], who spends at most 80% of their time in the lab, must compete for grants with extremely bright and motivated scientists who spend 100% of their time in the lab."
What makes Allergy and Immunology an attractive specialty for those considering on entering this field are the vast types of clinical cases encountered, the integration of both patient and research responsibilities, and the lifestyle it allows. Allergy-immunologists are given the task of solving difficult diagnostic problems in patients with undefined immunodeficiency, or complex multi-system diseases; this responsibility is intellectually stimulating, and brings with it the excitement of working in a specialty that is always on the cutting-edge of science and new immunotherapy procedures. In addition, the lifestyle of the profession is quite relaxed and enjoyable: most allergy-immunologists do not take night call, and the median starting salary of around $150,000 one year after the fellowship [2]. Allergy and immunology is an excellent option for those who seek intellectual stimulation, research opportunities, a family life, and a good living, but without the hardship of many other specialties. 
Matthew Guidarelli is a writer for the Next Generation.
Anne M. Lent, MD, is an Assistant Professor of Medicine at National Jewish Medical and Research Center.
Henry Milgrom, MD, is Director of the Ambulatory Pediatric Allergy Program at National Jewish Medical and Research Center, and Professor of Pediatrics at the University of Colorado Health Sciences Center.
Doug Graham, MD/PhD, is an Assistant Professor of Pediatrics and Immunology at the University of Colorado Health Sciences Center.
Work Cited- British Broadcasting Company. Historic Figures: Edward Jenner, 2007. Accessed January 4, 2007 <http://www.bbc.co.uk/history/historic_figures/jenner_edward.shtml>
- MD Resources, Inc. American Medical Group Association Salary Survey, 2005. Accessed January 6, 2007. <http://www.mdr-inc.com/mdsalary.htm>