Carol A. Langford, M.D., MHS

Director, Center for Vasculitis Care and Research

Cleveland Clinic

I am pleased to introduce Dr. Eamonn Molloy who has been with us at the Cleveland Clinic since August, 2005 and who formally began his vasculitis fellowship in July, 2006. Thanks to the leadership of Dr. Gary Hoffman, the training of physicians interested in vasculitis has had a long history in the Cleveland Clinic Center for Vasculitis Care and Research. During their training, these physicians have contributed meaningful scientific work that has enhanced our understanding of vasculitis. After completing their fellowships, our graduates have provided expert care to vasculitis patients in Mexico, Asia, South America, Canada and the USA.

Even though our own Institution's enthusiasm and resources have been very important to our fellowship program, the training of a vasculitis expert is not possible without funding. The Vasculitis Clinical Research Consortium (VCRC) Fellowship that was discussed in an earlier Vasculitis Foundation newsletter is an important landmark in funding vasculitis education. However, it will be a long time before we have adequate numbers of vasculitis experts. Patient needs are often unmet and we lack a critical number of talented physician investigators who can lead future research directed towards finding cures. It is for this reason that we are so deeply appreciative of the Vasculitis Foundation's support of fellowship training.

Dr. Molloy is an excellent example of the promise of such training. As seen in his comments, Dr. Molloy is engaging and sincere in his commitment to vasculitis. His excellent education to date earned him funding from the R.J. Fasenmyer Center for Clinical Immunology to partially support his quest to acquire advanced knowledge and skills. However, if it was not for the generous support of the Vasculitis Foundation, completion of his vasculitis fellowship and Masters Degree studies would not be possible. It has been a great pleasure for all of us in Cleveland to work with Dr. Molloy and we are tremendously grateful for the support of the Vasculitis Foundation which has invested in our common goal to help people with vasculitis. 

By Eamonn Molloy, M.D., September 2006Dr. Eamonn Molloy 

I was born and raised in the western part of Ireland. As a family we were heavily involved with Irish culture – language, music and sports. There is no medical background in my family; my boyhood dreams focused more on winning the All-Ireland Gaelic Football championship with my county team, but the likelihood of those dreams coming to fruition was critically undermined by a lack of sporting prowess!

I first considered a career in medicine at age 17. The Irish system of medical training differs substantially from that in the United States, requiring the completion of a six year course, which is generally pursued directly after finishing secondary school (the equivalent of high school). The system for college entry is based on the ‘Leaving Certificate’, an examination taken at the end of secondary school. This is the most onerous examination that Irish students face at any time during their academic career, with approximately 10 days of examinations, typically consisting of 6 hours of written/essay papers per day across at least 6-7 subjects.

My decision to apply for medical school was a late one, coming after completion of the Leaving Certificate, just before the deadline for revised submission of college course choices. I had not been sure as to what I wanted to do in college because I enjoyed studying a broad range of subjects at secondary level. I had not really considered medicine until my mother suggested it while I was discussing with her some of the latest medical news from Time magazine. The more I thought about it the more it appealed to me so I applied about one week later, started medical school at University College Dublin in October 1991 and I have not regretted it since.

The six year medicine course is followed by a one year internship (six months of internal medicine and six months of surgery). At this point, doctors are fully registered practitioners. Subsequent to this, I entered a senior house officer scheme (analogous to a residency scheme) in internal medicine at the Mater Misericordiae University Hospital (MMUH) in Dublin. This provided a number of key experiences that influenced my subsequent career choices. A 3-month rotation on the Rheumatology service convinced me that my future lay within this specialty. The patient-centered approach and the potential to build a rapport with patients over the course of their chronic illness was an important factor in this decision. Many of the rheumatic conditions are multi-system diseases that provide a diagnostic and therapeutic challenge for the clinician. Even at that early stage, I was particularly stimulated by the challenge provided by the vasculitis patients that I cared for during this rotation.

As part of the MMUH Senior House Officer scheme, I then spent a six month period as an internal medicine resident at the Mayo Clinic, Rochester, Minnesota, USA. This was another important experience, as it emphasized the potential benefits to my career of seeking specialty training in a top-level academic center in the USA.

I commenced the Specialist Registrar (SpR) program in Rheumatology and Internal Medicine in July 2000. This is a 5-year program, overseen by the Royal College of Physicians in Ireland, which ultimately leads to Certification of Satisfactory Completion of Specialist Training (CSCST; analogous to specialty board certification in the USA). The first three years of my SpR program were spent in internal medicine and rheumatology at three different teaching hospitals in Ireland, including one year at MMUH, where one of my mentors was Dr. Geraldine McCarthy. I subsequently began a two-year research experience under the supervision of Dr. McCarthy. This was undertaken at the Department of Molecular and Cellular Therapeutics at the Royal College of Surgeons of Ireland Medical School in Dublin and MMUH. This laboratory-based research explored the role of prostaglandins in calcium crystal-associated osteoarthritis. Based on this work I submitted a thesis for a Doctorate of Medicine degree through the National University of Ireland, which was accepted in January 2006.

Health care in Ireland is provided mainly by a public health care system, supplemented by a number of private hospitals. The government-funded public health care system provides acute and elective care for the entire population. The private hospitals mainly engage in elective clinic services and non-acute inpatient care. Because of the shortcomings in the public system, approximately half of the population purchase private health insurance so that they can access these services in the private sector in a more timely fashion.

Rheumatology has historically been underserved in Ireland, with long waiting times for clinic appointments in many centers. Vasculitis has a relatively low profile in Ireland, with no established vasculitis center. Because of the shortage of rheumatology posts, demand for positions and quality of applicants has been high. Therefore, virtually all rheumatologists have trained both in Ireland and in international academic centers, mainly in the United Kingdom and North America, and have thereby gained significant experience in management of patients with complex rheumatic diseases. However, this scarce resource is further diminished by the fact that the vast majority practice as dual internists-rheumatologists. A new strategy aims to considerably increase the number of rheumatologists, and critically, also the number of appointments in the allied health professions. Hopefully, if implemented, this strategy will significantly increase the resources available to Irish patients with vasculitis and other rheumatic diseases.

As mentioned above, I have had a specific interest in vasculitis from an early point in my career. To further my goal of sub-specialty training in vasculitis, I sought out the opportunity to participate in the Vasculitis Fellowship Program at the Center for Vasculitis Care and Research at the Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation. This commenced in August 2005. Since then I have gained invaluable experience in the care of vasculitis patients under the supervision of Dr. Carol Langford (Program Director), Dr. Gary Hoffman (Department Chairman) and Dr. Leonard Calabrese.  I am planning to spend a further two years as a vasculitis fellow at the Cleveland Clinic Foundation, to gain further experience in the care of patients with these complex diseases. In addition, I have enrolled in the two-year Clinical Research Scholars Program at Case Western Reserve University. This program is specifically aimed at teaching clinical investigative skills, culminating in the award of a Master of Science in Clinical Research degree.

The support provided by the Vasculitis Foundation Fellowship will enable me to achieve these goals. My ultimate objective is to develop the skills necessary to provide expert care to vasculitis patients and to become an effective vasculitis investigator, preferably in Ireland. The potential exists for participation in international vasculitis collaborative research networks, which could benefit vasculitis patients in Ireland and elsewhere.

Francisco Silva, M.D. - Involved...

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