Turning Fellows to Flowers: John S. Douglas, Jr., Transforms Trainees at One of the Longest-Running Interventional Fellowship Programs

 
Looking back, John S. Douglas, Jr., MD, calls his career “a great ride.” One of the first physicians to travel to Zurich, Switzerland, to learn coronary angioplasty from Andreas Gruentzig, MD, in the late 1970s, he is currently director of the interventional cardiology fellowship program at Emory University School of Medicine (Atlanta, GA), and has helped train over 150 interventional fellows now stationed around the world. 

“I was so lucky when I started my career,” he told TCTMD in a telephone interview, noting that he has been a staff physician at Emory since 1974. “There was so much coronary work to do that I was in the lab from dawn to dusk every day.”

When balloon angioplasty was first introduced, Dr. Douglas spent most of his time in the cath lab “doing coronary angiograms and sending my patients to surgery.” Emory’s surgical program was “extremely active and extremely talented,” he said. “But the prospect of opening an artery and relieving a patient’s symptoms without an operation was so appealing that it had everybody’s interest back in those days.” The program accepted its first interventional cardiology fellow in 1981. 

Now, interventional cardiology is a changed field. While coronary intervention was the sole focus of Dr. Douglas’ work for decades, the current generation of fellows is entering a work environment in which they are also expected to have peripheral and structural skills. “The landscape is much broader and the possibilities are more varied than in the past,” he said, adding that this phenomenon makes the field more competitive.

Though he sees himself as a mentor, Dr. Douglas said his mentees do not need much reminding of the responsibility they have not only as physicians but as interventionalists. “They recognize that there’s a lot to learn…. But you learn progressively over time. My job is to expose these fellows to as much as I can and to teach them as much as I can during the brief time I have with them,” he said, stressing the importance of a strong foundation.

But building that foundation requires program directors to acknowledge the shortcomings of training programs in recent years. Dr. Douglas said fellows have been asking to learn more of the business of interventional cardiology—things like signing contracts and job searching—and “we haven’t really done that as well as I think we should.” Conferences have sessions on these topics, he acknowledged, but practicalities of life after fellowship should be addressed more within interventional fellowship programs.

An additional challenge for program directors, Dr. Douglas said, is determining which fellows will benefit from an extended program. “If I was going to start again, I would broaden my skill set to include both peripheral and structural because I think it broadens your horizons in terms of what you could do,” he reflected. On the other hand, “every interventional cardiologist needs to be a good coronary interventionalist, but the question is whether they need the other skills.”

Even with an extra year of training, everyone has only a “finite amount of time and so you do the best that you can. The learning process is for a lifetime,” Dr. Douglas observed, adding that “it’s very gratifying to have a former fellow call” to ask about a problem. Experiences like those “keep us invigorated and [are] the reason why we get up at 7 am and come [to work] every day.”

Ultimately, Dr. Douglas wants his trainees to come away from their fellowship with one priority—the patient. “We’re fortunate that we can take a patient who has a problem and is very symptomatic and give them some relief with a minimally invasive procedure,” he said. The ability to put the patient first by addressing their needs and concerns will help determine fellows’ success when they enter practice, Dr. Douglas said. “You can be a hero if things work out well but you need to also be a hero if things don’t turn out well,” he said.

Dr. Douglas is an avid gardener, especially of flowers like dahlias, which he said is surprising to the cath lab staff. But most cardiologists have a sense of delayed gratification, he said, so planting bulbs and waiting months for them to blossom is “very analogous to the fellowship program. When [the fellows] leave they are like beautiful flowers.”