Fellows-Focused Session Emphasizes Best Practices for Building a Career in Cardiology

SAN DIEGO, CA—Networking with purpose, learning to say yes—and also no—and thinking creatively were the key messages presented to fellows and early career cardiologists attending the “Careers in Cardiology” special topics session on March 14, 2015, at the American College of Cardiology/i2 Scientific Session. 

Be Nice, Flexible

In his presentation on transitioning from fellow to faculty status, Andrew Freeman, MD, of National Jewish Health (Denver, CO), advocated beginning the job search process midway through the second year of fellowship. He emphasized the importance of networking within all possible avenues and the necessity of “being nice,” because everyone, including pharmaceutical representatives and office managers, will take note otherwise.

When it comes to recruiters, Dr. Freeman said to sign up with as many as possible and take their calls “with a sense of joy rather than anger and angst.”

But adding to that, Beverly H. Lorell, MD, of King & Spalding (Washington, DC), stressed the importance of a strong network, as the best new opportunities “will often not come from recruiters but from someone who knows you.”

Dr. Freeman also outlined the main perks and pitfalls of being employed by a hospital or hospital system—an increasingly common occurrence for new hires given the new medical reimbursement processes and health care climate. While a hospital job can come with better benefits, salary stability, less call, human resources support, and a more collegial structure, Dr. Freeman said these employees are subject to red tape, slower speeds, onerous processes, less schedule control, and less chance for significant salary increases.

His checklist for contract stipulations include the following:

• Clear specifications of call time, salary, CME requirements, work locations, and responsibilities
• Moving stipends
• Signing bonuses that will cover fees associated with becoming board certified
• Noncompete clauses that will not force an employee to move cities or even states to practice if they leave the job 

With regard to negotiating, Dr. Freeman said “the vast majority [of large hospitals] will put up some kind of wall, but actually everything is adjustable if you are a competitive candidate.” He suggested asking if someone else can weigh in to ensure a reasonable contract.

Once placed in a new practice, Dr. Freeman encouraged “being a Swiss Army knife,” and staying open to treating noninterventional cases. “It may not be a bad idea to see patients and start cathing your own, and then showing people how good the quality and outcomes are,” he said. “Then people will start sending you more. The people who are the most flexible are the people who they can insert into any practice.”

Academic Medicine is Not for Everyone

Speaking specifically to those interested in a career in academic medicine, Paulette S. Wehner, MD, of Marshall University School of Medicine (Huntington, WV), said, “If you’re the fellow who just cringes when you see the medical students standing at your door to see patients with you, [being a clinician educator] is probably not the best career path.”

Even though academics are core to being a clinician educator, she continued, the clinical aspect has to come first because “you have to be outstanding at your craft to do this and do it well.”

But on the other hand, “clinical work and teaching are not mutually exclusive,” Dr. Wehner said. “You can see a lot of patients and you can still teach very effectively because the patient is part of the education tool.”

One of the challenges of this career path is funding, she explained. The tides are turning, however, so that not every clinician educator is necessarily valued on the total amount of grant funding they bring in or papers they publish. “Almost every institution is developing a clinical education track, placing value on the true educators. So, if research isn’t your thing, don’t get stuck on that track,” Dr. Wehner said, suggesting running the clinical skills lab as an alternate responsibility.

After a show of hands revealed that the vast majority of the audience was interested in pursuing academic medicine, session moderator Sandra J. Lewis, MD, of Northwest Cardiovascular Institute (Portland, OR), said she was surprised. “All we've known through all our training [are] academicians, and there's always this pejorative of the ‘LMD,’ the local medical doctor,” she said. “How do you deal with your fellows letting them know that it's okay to look into their soul and not be an academician?”

Dr. Wehner responded that she has “never understood the program directors who took it as a personal assault if their trainees went into private practice.” The academic environment, she added, is “getting off its high horse a little bit” and becoming more welcoming to physicians who only want to see patients. These clinicians are necessary, she continued, because “it lets me go teach a 3-hour EKG course.”

Dr. Lewis added that interventional cardiology is a victim of its own success in terms of patient outcomes and decreases in overall procedural volume. Hence, “interventionalists who say ‘I’m glad to see patients part time’ have a huge advantage.”

Dr. Wehner also touched on the conundrum of overcommitting and saying “yes” too much. To create a balance, she advocated for saying yes to “what you really, really want to do and can do well. It’s okay to say an occasional no early on…. Pick what you love.”

Learn to Ask Good Questions

In a presentation on becoming a successful cardiovascular investigator, Lynne Warner Stevenson, MD, of Harvard Medical School (Boston, MA), said one must start by simply asking good questions, but then learning that the best answers come from a “[different] question that we weren’t smart enough to ask beforehand.”

Doing a controllable project early on is good practice for a new investigator, she said, and a yes/no hypothesis is not always necessary. Dr. Stevenson also stressed the importance of mentors who will “alert you to opportunities, point you to questions, and provide reality checks.”

She brought up the challenge of funding again, and—more importantly—the concept of protected time, which is “not free and not necessarily protected…. Time is money and if you don’t have money to buy that time, you don’t have that protected time.” When starting a new job especially, Dr. Stevenson said, “recognize that you have to know how to pay for the time you have.”

This resonated with Kaustubh Dabhadkar, MBBS, MPH, a first-year general cardiology fellow at Brown University (Providence, RI). “If you want to be successful, you have to work on your own time, see patients for most of your day, and then spend your weekends thinking about questions,” he said, adding that clinician educators must have passion—“not look at it as a job, but as a hobby or something you want to do as a lifestyle.”

When funding comes from industry, Louis A. Cannon, MD, of the Heart and Vascular Institute of McLaren Northern Michigan (Petoskey, MI), said, “We have to be very transparent [and] honest about who we are and what we’re doing…. I have seen [doctors] fall into the abyss and allurement of getting too close, and I would encourage you to keep a wall—have a relationship with everyone in industry, but don't pick one over the other. Be ‘Switzerland’ if you possibly can.”

Lastly, Dr. Stevenson suggested documenting “all tangible scholarly productivity, and [thinking] creatively about what scholarly work is. Hospitals want you to give them a reason to promote you.”

 

 

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Sources:
1. Freeman AM. Fellow to faculty: from negotiating a contract to becoming an FACC. Presented at: American College of Cardiology/i2 Scientific Session; March 14, 2015; San Diego, CA.

2. Wehner PS. Journey through academic cardiology: life as a clinician educator. Presented at: American College of Cardiology/i2 Scientific Session; March 14, 2015; San Diego, CA.

3. Cannon LA. Practice makes perfect: navigating an evolving practice landscape. Presented at: American College of Cardiology/i2 Scientific Session; March 14, 2015; San Diego, CA.

4. Lorell B. Academics to industry: making the transition. Presented at: American College of Cardiology/i2 Scientific Session; March 14, 2015; San Diego, CA.

5. Stevenson LW. How to Become a Successful Cardiovascular Investigator. Presented at: American College of Cardiology/i2 Scientific Session; March 14, 2015; San Diego, CA.

 

Disclosures:

• Dr. Freeman reports receiving consulting fees/honoraria from Gilead and serving on the speakers bureau for Medtronic.
• Dr. Lorell reports a conflict of interest related to her employment at King & Spalding.
• Dr. Lewis reports receiving consulting fees/honoraria from multiple pharmaceutical and device companies.
• Dr. Wehner reports no relevant conflicts of interest.
• Dr. Cannon reports conflicts of interest with multiple pharmaceutical and device companies.
• Dr. Stevenson reports receiving consulting fees/honoraria from St. Jude Medical.

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