Rebecca M. Shepherd, M.D., serves as Chief of the LGH Division of Rheumatology. We asked Dr. Shepherd about her division’s priorities, what she loves about rheumatology and how she unwinds after work.
What is your background?
I was born in Scotland but moved to Texas when I was little. I spent summers in Scotland growing up and studied abroad there in college. I always enjoyed the arts, but I knew in the back of my mind that I wanted to be a physician. My dad and my grandfather were doctors. I earned my bachelor’s degree in art history and English from the University of Texas and went to medical school at Vanderbilt University. I did my internal medicine and rheumatology training at Washington University in St. Louis. My husband is from Delaware, and we wanted to settle in a place where we could easily travel to both Scotland and Texas. That’s how we chose Lancaster. I joined LGHP Arthritis & Rheumatology in 2006.
How did you choose rheumatology as a specialty?
During my first rotation in medical school, I met a young man who was very sick with severe lupus. Autoimmune diseases are so cruel and undeserved, and they have such a terrible impact on people’s lives. I decided then to specialize in rheumatology. I never wanted to do anything else. I still like taking care of really sick people, with conditions like systemic lupus or scleroderma. That’s what we train to do and where we can make the greatest impact.
How did you get into a leadership role?
I have a restless mind. I’m always looking for opportunities to educate and to learn, and I like to be involved in a lot of different things. When I first joined LG Health, I was part of the Institutional Review Board. Then I became a Senior Physician Leader for medical specialty for LGHP, and I completed my MBA at St. Joseph’s University. I have been Division Chief for Rheumatology for about three years. We’re a small division, with a half-dozen members.
Tell us about your division’s efforts to enhance osteoporosis awareness and care.
Osteoporosis has not been a well-understood diagnosis. Many patients and providers don’t recognize the symptoms, and that in many cases, having a fracture means osteoporosis. We are working closely with the musculoskeletal service line and our peers in other specialties on several efforts to change that. We now have a fracture liaison service in the hospital, which ensures that post-hip fracture patients are seen for their underlying osteoporosis diagnosis. We are working to raise awareness with our fellow providers so patients who receive outpatient fracture care are referred for bone density scans and possible treatment. We also recently opened an osteoporosis clinic. Thanks to these efforts, our bone density scanning rates have increased 14 percent in the last two years.
What are some of your other priorities?
We continue to work on improving access for our patients. We want to be sure that we see the sickest patients here in our office. We now have four satellite offices and offer e-consults to our colleagues. We are also working hard to manage costs, since the medications we regularly prescribe can be very expensive. Rheumatology can be like a little black box. A lot of people don’t understand what’s in there. We do a lot of education and outreach to our fellow providers and to patients, who have very real fears of pain and lack of mobility. We want to give our patients the confidence to help manage their conditions themselves.
What are some of the challenges you face?
The rheumatology work force is declining as the population expands, which creates longer wait times and potentially sicker patients upon presentation. The average age of a rheumatologist now is in the mid-50s, which means in one decade we could lose half of our work force. The national rheumatology organization is working hard to help support the small number of rheumatologists by training APCs; exploring novel visit modes, such as e-visits and round table discussions/case presentations for primary care providers; creating guidelines for referrals to ensure that the sickest patients are seen by rheumatology and encourage chronic pain conditions be assessed by other specialties; and preventing provider burnout.
What do you like most about your work?
I see 17-year-olds with juvenile rheumatoid arthritis all the way up to women in their 90s with osteoporosis and hip fracture. I like that variety. Sometimes clinical medicine can be very busy and stressful. Focusing on tasks related to my administrative role and to teaching our LGH family medicine residents can be a nice change of pace.
What do you like to do when you’re not at work?
My husband is a radiologist, and we have two children, ages 12 and 13. We live on a 10-acre farm in southern Lancaster County. We really like being outside. We rent out some land for soybeans but enjoy small holding farming, such as tomatoes, carrots and cut flowers for personal use. I like to run and hike, and we enjoy travel, which includes visiting family in Scotland. I’m the oldest of five sisters, and we go away together every year. I also really like working on our house. If I wasn’t a doctor, I would be an environmentalist or an interior designer.