Dr. Amir Lotfi is the chief of the cardiovascular division at Baystate Health and a professor of medicine at UMass Chan Medical School-Baystate. He’s also affiliated with multiple hospitals, including Baystate Franklin Medical Center and Baystate Medical Center. Dr. Lotfi specializes in research on acute myocardial infarction, stem cell therapy, and hypertensive emergencies. He’s published several articles in the Journal of Hypertension along with other reputable outlets and has authored numerous articles and book chapters on these topics.

Looking back to when you first completed your training, is there a specific clinical area you wish you had received more exposure to? Alternatively, for fellows and younger physicians, is there a topic you believe deserves more emphasis from a clinical perspective?

Well, thinking back to my own fellowship, I wish I had more experience in chronic total occlusion (CTO) interventions. However, the advanced technologies we have now weren't available 18 years ago, and they've significantly improved CTO tools. If I could go back, that's an area where I'd want more training.

For today's fellows, I'd say the biggest thing is understanding when not to do a case. Being a high-volume center, our lab is in the top 7% of interventions in the US. Our fellows gain a lot of hands-on experience, but it's crucial they learn to discern the appropriate times for intervention. 

Considering your extensive experience in publishing, do you have any advice for medical students, residents, or fellows who want to get more involved in collaborative research?

Absolutely. First, take some time to understand basic clinical statistics. Second, find something you're genuinely interested in and write a case report. It's the simplest way to start with an abstract in a small publication. Equally important, find a mentor who is invested in your growth. Schedule time with them, even if it's just half an hour, to discuss your interests and opportunities. Then, work closely with them.

You have deep domain expertise with CTOs, so what's your default algorithm for treating calcific disease? 

When possible, my first choice is intravascular lithotripsy, if I can pass the balloon. Before IVL, we used to do a lot of rotablation and orbital atherectomy, but IVL is much safer. So generally, the first thing that comes to mind is whether I can get a balloon through to treat the lesion with IVL. After imaging to see what we’re dealing with after IVL, I usually use a one-to-one non-compliant balloon to ensure the vessel expands. Once I know it expands, then I go ahead and stent. If it doesn’t expand after lithotripsy, then other interventions are needed.

Let's talk about the business of healthcare. What are some key areas you believe young physicians coming out of residency or fellowship should have a better understanding of?

During residency and fellowship, your life is highly structured. You know what to do and when to do it, and your primary job is to learn. Once you’re out of that environment, many residents and fellows struggle with negotiation. And by negotiation, I don’t just mean compensation. It’s about understanding expectations from both sides and what you want to offer. Additionally, they need a better grasp of financial management and the revenue cycle. Young physicians often get overwhelmed with RVUs, billing, and coding. These are crucial aspects of the U.S. healthcare system that aren’t covered in depth during residency or fellowship. So, understanding how to negotiate not just salary, but job expectations and the financial aspects of billing and coding are vital.

Many cardiologists see you as a mentor. When you think about training other physicians, especially those coming out of fellowship who look up to you, what are some important skill sets they should hone, whether it’s specific therapy training or podium presentations?

One of the most important things I try to convey is the value of active listening. Not just listening to respond but truly understanding what the other person is saying. This builds fundamental skills in empathy and mentorship. It’s how you grow. 

Another key aspect is balancing confidence with humility. In medicine, you need confidence in your abilities, but humility keeps you from becoming arrogant and helps you make better decisions. Maintaining a balance here makes you a better, more empathetic human being. Confidence also allows you to recognize what you don’t know, which drives continuous learning. This is essential in our field; whether you’re a month into your career or twenty years in, you’re always learning.