Dr. Hursh Naik, MD, FSCAI, is the Chief of Cardiology at Dignity Health St. Joseph's Hospital and Medical Center and the Director of Structural Heart Interventions. He also serves as a Clinical Professor at Creighton University School of Medicine in Phoenix, AZ. Specializing in structural heart disease and complex coronary interventions, Dr. Naik has extensive expertise in transcatheter aortic, mitral, and tricuspid therapies.
Looking back, either during fellowship or after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
That's a good question. Here’s the thing about fellowship: you should maximize what you learn at the time because the field changes so rapidly. The techniques I use now weren’t even taught during my fellowship. For instance—intravascular lithotripsy—I didn't even think of something like that back in the day, it only came into existence recently. I'm never upset about not learning something specific; I focused on maximizing what was available. At Cedar Sinai, we didn’t do many peripheral procedures, but I wouldn’t say it was lacking. You learn the most when you start practicing. I think fellowship is more of a foundation, and mine was sufficient because, as I said, the field changes quite rapidly and you’re likely going to be doing something entirely different in five years.
The way the question was phrased, about what I wish I had learned, carries a negative connotation. I wouldn’t want fellows to think like that. Every fellowship is different. Just push yourself and learn as much as you can. Then, you develop the tools you need. For example, I didn’t perform peripherals during my fellowship, but I acquired enough skills to do so, if my interests led me there. If you do that, you'll learn and become good at it over time.
You're well-published and an investigator in some high-profile trials. For residents and fellows inspired by your work, either from seeing you on podium or reading your papers, what advice would you give to those who want to get involved in similar initiatives?
An easy way would be to simply approach mentors. When I was a fellow, I felt like a kid – everyone on the podium seemed unapproachable. Now that I’m part of that group, I can tell you most of us really appreciate being approached.
Most clinical trialists and speakers are generally busy. But teaching is part of our ethical duty as physicians, and mentorship is highly valued across fields. Having the confidence to reach out is important – we all love it.
I have worked with residents who have started out by asking, “Can I write a case report for you?” This approach is especially useful for those who lack publication or significant writing experience. Many researchers, myself included, have numerous cases that could be written up – and I think this is a great start.
Here's another good approach: I had a resident who was good at statistical analysis, something I’m not great at, approach me with the idea of creating a database for MitraClip patients and cardiogenic shock. He put all that data into a database, and now we can mine that data statistically.
Meta-analysis is another option, especially if you're comfortable with statistics or know someone who is. The data is already out there, waiting to be collated.
These are all good starting points to build your experience until you're ready to design and lead your own investigative projects.
When you think about dealing with calcific plaque, whether it’s for a structural heart case, PCI, or in the periphery, do you have a default algorithm?
I love talking about this because I'm known for being practical, and that applies to how I handle calcific plaque. Some might also call it lazy, but I don’t like to overthink stuff.
I have some very smart colleagues who take a more nuanced approach. They're experts in calcium and use different devices like orbital atherectomy or rotational atherectomy based on the specific type of calcification.
For me, things are simpler. IVL has made it even easier.
If there's a large amount of calcium that you can see fluoroscopically, I go straight to either IVL or a combination of rotational atherectomy (ROTA) and IVL. I don't do orbital atherectomy anymore because the pragmatic side tells me to master one device. And, arguably, ROTA can handle a wider range of calcium than orbital. So, I'm a "ROTA-shock" interventionalist. If a balloon won't pass, it's rotational atherectomy first. Then comes intravascular ultrasound (IVUS) followed by IVL.
I don’t perform rotational atherectomy without IVL. Data shows that IVL allows for better stent expansion. I keep things manageable for myself by focusing on these two, ROTA and IVL.
After you move past the ROTA-shock part of a case, do you always go back in with a non-compliant balloon?
Not necessarily. I might after the stent. But I think that's a factor of how I was trained, as 10 years ago, putting a non-compliant balloon in an unstented artery was considered dangerous. Now that we can modify calcium, things are different. Now, I might use a non-compliant balloon after IVL if the IVUS shows it's safe.
Let's move on to some more professional-related questions. Thinking about healthcare in general or your practice specifically, are there a couple of concepts you wish you better understood when you first started after fellowship?
There are a few things. Number one is, understanding your self-worth. As physicians, we tend to be selfless – we choose medicine over, say, investment banking because of certain personality traits. We find reward in putting others first and are ostracized if we don’t put the patients first. Part of this is also why when applying for residency or fellowships, we feel lucky to be accepted, rather than acknowledging that we deserve it. It’s important to strike a balance—acknowledging your value without crossing into arrogance.
Secondly, institutions – I’m not saying this in a bad way – prioritize their interests. We usually wrap our brains around this dynamic after 5 or 6 years, after we’ve done a lot for the institution. However, once you see that, your relationship with the institution improves. Then you can say, “I'm going to do this to help my career. Hopefully, that benefits you guys. But if you want to go in a different direction, I understand. We're not married.” I wish I understood this sooner because going through it, there were times I was emotionally traumatized. I worked hard, trying to build a program for patients, but didn’t get any reward or support whatsoever. Now, I see that institutions just don’t think that way.
The other thing is navigating workplace politics. My mentors always told me to be affable, available, and able – the three A’s. But sometimes that's not enough, especially when there are political minefields to deal with. There can be a lot of institutional infighting once you get to the real world.
Finally, contract negotiation. Early in my career, I was just happy to get a job with a lot of volume. I didn't even look at my contract. Now I’d say that having a lawyer, even for a simple consultation, should almost be mandatory. For a lot of folks, this is our first real job – before becoming an attending in medicine. I was a waiter at Olive Garden, so the transition was remarkable. We don't have a step-by-step process to learn about contracts and the legal aspects of things. Looking back, I’d tell my younger self, "Hey, you need to get a lawyer." But I know I would’ve probably replied, "No, I want this job. I don’t want them to rescind the offer."
Dr. Hursh Naik, MD, FSCAI, is the Chief of Cardiology at Dignity Health St. Joseph's Hospital and Medical Center and the Director of Structural Heart Interventions. He also serves as a Clinical Professor at Creighton University School of Medicine in Phoenix, AZ. Specializing in structural heart disease and complex coronary interventions, Dr. Naik has extensive expertise in transcatheter aortic, mitral, and tricuspid therapies.
Looking back, either during fellowship or after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
That's a good question. Here’s the thing about fellowship: you should maximize what you learn at the time because the field changes so rapidly. The techniques I use now weren’t even taught during my fellowship. For instance—intravascular lithotripsy—I didn't even think of something like that back in the day, it only came into existence recently. I'm never upset about not learning something specific; I focused on maximizing what was available. At Cedar Sinai, we didn’t do many peripheral procedures, but I wouldn’t say it was lacking. You learn the most when you start practicing. I think fellowship is more of a foundation, and mine was sufficient because, as I said, the field changes quite rapidly and you’re likely going to be doing something entirely different in five years.
The way the question was phrased, about what I wish I had learned, carries a negative connotation. I wouldn’t want fellows to think like that. Every fellowship is different. Just push yourself and learn as much as you can. Then, you develop the tools you need. For example, I didn’t perform peripherals during my fellowship, but I acquired enough skills to do so, if my interests led me there. If you do that, you'll learn and become good at it over time.
You're well-published and an investigator in some high-profile trials. For residents and fellows inspired by your work, either from seeing you on podium or reading your papers, what advice would you give to those who want to get involved in similar initiatives?
An easy way would be to simply approach mentors. When I was a fellow, I felt like a kid – everyone on the podium seemed unapproachable. Now that I’m part of that group, I can tell you most of us really appreciate being approached.
Most clinical trialists and speakers are generally busy. But teaching is part of our ethical duty as physicians, and mentorship is highly valued across fields. Having the confidence to reach out is important – we all love it.
I have worked with residents who have started out by asking, “Can I write a case report for you?” This approach is especially useful for those who lack publication or significant writing experience. Many researchers, myself included, have numerous cases that could be written up – and I think this is a great start.
Here's another good approach: I had a resident who was good at statistical analysis, something I’m not great at, approach me with the idea of creating a database for MitraClip patients and cardiogenic shock. He put all that data into a database, and now we can mine that data statistically.
Meta-analysis is another option, especially if you're comfortable with statistics or know someone who is. The data is already out there, waiting to be collated.
These are all good starting points to build your experience until you're ready to design and lead your own investigative projects.
When you think about dealing with calcific plaque, whether it’s for a structural heart case, PCI, or in the periphery, do you have a default algorithm?
I love talking about this because I'm known for being practical, and that applies to how I handle calcific plaque. Some might also call it lazy, but I don’t like to overthink stuff.
I have some very smart colleagues who take a more nuanced approach. They're experts in calcium and use different devices like orbital atherectomy or rotational atherectomy based on the specific type of calcification.
For me, things are simpler. IVL has made it even easier.
If there's a large amount of calcium that you can see fluoroscopically, I go straight to either IVL or a combination of rotational atherectomy (ROTA) and IVL. I don't do orbital atherectomy anymore because the pragmatic side tells me to master one device. And, arguably, ROTA can handle a wider range of calcium than orbital. So, I'm a "ROTA-shock" interventionalist. If a balloon won't pass, it's rotational atherectomy first. Then comes intravascular ultrasound (IVUS) followed by IVL.
I don’t perform rotational atherectomy without IVL. Data shows that IVL allows for better stent expansion. I keep things manageable for myself by focusing on these two, ROTA and IVL.
After you move past the ROTA-shock part of a case, do you always go back in with a non-compliant balloon?
Not necessarily. I might after the stent. But I think that's a factor of how I was trained, as 10 years ago, putting a non-compliant balloon in an unstented artery was considered dangerous. Now that we can modify calcium, things are different. Now, I might use a non-compliant balloon after IVL if the IVUS shows it's safe.
Let's move on to some more professional-related questions. Thinking about healthcare in general or your practice specifically, are there a couple of concepts you wish you better understood when you first started after fellowship?
There are a few things. Number one is, understanding your self-worth. As physicians, we tend to be selfless – we choose medicine over, say, investment banking because of certain personality traits. We find reward in putting others first and are ostracized if we don’t put the patients first. Part of this is also why when applying for residency or fellowships, we feel lucky to be accepted, rather than acknowledging that we deserve it. It’s important to strike a balance—acknowledging your value without crossing into arrogance.
Secondly, institutions – I’m not saying this in a bad way – prioritize their interests. We usually wrap our brains around this dynamic after 5 or 6 years, after we’ve done a lot for the institution. However, once you see that, your relationship with the institution improves. Then you can say, “I'm going to do this to help my career. Hopefully, that benefits you guys. But if you want to go in a different direction, I understand. We're not married.” I wish I understood this sooner because going through it, there were times I was emotionally traumatized. I worked hard, trying to build a program for patients, but didn’t get any reward or support whatsoever. Now, I see that institutions just don’t think that way.
The other thing is navigating workplace politics. My mentors always told me to be affable, available, and able – the three A’s. But sometimes that's not enough, especially when there are political minefields to deal with. There can be a lot of institutional infighting once you get to the real world.
Finally, contract negotiation. Early in my career, I was just happy to get a job with a lot of volume. I didn't even look at my contract. Now I’d say that having a lawyer, even for a simple consultation, should almost be mandatory. For a lot of folks, this is our first real job – before becoming an attending in medicine. I was a waiter at Olive Garden, so the transition was remarkable. We don't have a step-by-step process to learn about contracts and the legal aspects of things. Looking back, I’d tell my younger self, "Hey, you need to get a lawyer." But I know I would’ve probably replied, "No, I want this job. I don’t want them to rescind the offer."
Dr. Hursh Naik, MD, FSCAI, is the Chief of Cardiology at Dignity Health St. Joseph's Hospital and Medical Center and the Director of Structural Heart Interventions. He also serves as a Clinical Professor at Creighton University School of Medicine in Phoenix, AZ. Specializing in structural heart disease and complex coronary interventions, Dr. Naik has extensive expertise in transcatheter aortic, mitral, and tricuspid therapies.
Looking back, either during fellowship or after, was there a clinical subject matter or therapy area that you wish you were taught or had more experience in?
That's a good question. Here’s the thing about fellowship: you should maximize what you learn at the time because the field changes so rapidly. The techniques I use now weren’t even taught during my fellowship. For instance—intravascular lithotripsy—I didn't even think of something like that back in the day, it only came into existence recently. I'm never upset about not learning something specific; I focused on maximizing what was available. At Cedar Sinai, we didn’t do many peripheral procedures, but I wouldn’t say it was lacking. You learn the most when you start practicing. I think fellowship is more of a foundation, and mine was sufficient because, as I said, the field changes quite rapidly and you’re likely going to be doing something entirely different in five years.
The way the question was phrased, about what I wish I had learned, carries a negative connotation. I wouldn’t want fellows to think like that. Every fellowship is different. Just push yourself and learn as much as you can. Then, you develop the tools you need. For example, I didn’t perform peripherals during my fellowship, but I acquired enough skills to do so, if my interests led me there. If you do that, you'll learn and become good at it over time.
You're well-published and an investigator in some high-profile trials. For residents and fellows inspired by your work, either from seeing you on podium or reading your papers, what advice would you give to those who want to get involved in similar initiatives?
An easy way would be to simply approach mentors. When I was a fellow, I felt like a kid – everyone on the podium seemed unapproachable. Now that I’m part of that group, I can tell you most of us really appreciate being approached.
Most clinical trialists and speakers are generally busy. But teaching is part of our ethical duty as physicians, and mentorship is highly valued across fields. Having the confidence to reach out is important – we all love it.
I have worked with residents who have started out by asking, “Can I write a case report for you?” This approach is especially useful for those who lack publication or significant writing experience. Many researchers, myself included, have numerous cases that could be written up – and I think this is a great start.
Here's another good approach: I had a resident who was good at statistical analysis, something I’m not great at, approach me with the idea of creating a database for MitraClip patients and cardiogenic shock. He put all that data into a database, and now we can mine that data statistically.
Meta-analysis is another option, especially if you're comfortable with statistics or know someone who is. The data is already out there, waiting to be collated.
These are all good starting points to build your experience until you're ready to design and lead your own investigative projects.
When you think about dealing with calcific plaque, whether it’s for a structural heart case, PCI, or in the periphery, do you have a default algorithm?
I love talking about this because I'm known for being practical, and that applies to how I handle calcific plaque. Some might also call it lazy, but I don’t like to overthink stuff.
I have some very smart colleagues who take a more nuanced approach. They're experts in calcium and use different devices like orbital atherectomy or rotational atherectomy based on the specific type of calcification.
For me, things are simpler. IVL has made it even easier.
If there's a large amount of calcium that you can see fluoroscopically, I go straight to either IVL or a combination of rotational atherectomy (ROTA) and IVL. I don't do orbital atherectomy anymore because the pragmatic side tells me to master one device. And, arguably, ROTA can handle a wider range of calcium than orbital. So, I'm a "ROTA-shock" interventionalist. If a balloon won't pass, it's rotational atherectomy first. Then comes intravascular ultrasound (IVUS) followed by IVL.
I don’t perform rotational atherectomy without IVL. Data shows that IVL allows for better stent expansion. I keep things manageable for myself by focusing on these two, ROTA and IVL.
After you move past the ROTA-shock part of a case, do you always go back in with a non-compliant balloon?
Not necessarily. I might after the stent. But I think that's a factor of how I was trained, as 10 years ago, putting a non-compliant balloon in an unstented artery was considered dangerous. Now that we can modify calcium, things are different. Now, I might use a non-compliant balloon after IVL if the IVUS shows it's safe.
Let's move on to some more professional-related questions. Thinking about healthcare in general or your practice specifically, are there a couple of concepts you wish you better understood when you first started after fellowship?
There are a few things. Number one is, understanding your self-worth. As physicians, we tend to be selfless – we choose medicine over, say, investment banking because of certain personality traits. We find reward in putting others first and are ostracized if we don’t put the patients first. Part of this is also why when applying for residency or fellowships, we feel lucky to be accepted, rather than acknowledging that we deserve it. It’s important to strike a balance—acknowledging your value without crossing into arrogance.
Secondly, institutions – I’m not saying this in a bad way – prioritize their interests. We usually wrap our brains around this dynamic after 5 or 6 years, after we’ve done a lot for the institution. However, once you see that, your relationship with the institution improves. Then you can say, “I'm going to do this to help my career. Hopefully, that benefits you guys. But if you want to go in a different direction, I understand. We're not married.” I wish I understood this sooner because going through it, there were times I was emotionally traumatized. I worked hard, trying to build a program for patients, but didn’t get any reward or support whatsoever. Now, I see that institutions just don’t think that way.
The other thing is navigating workplace politics. My mentors always told me to be affable, available, and able – the three A’s. But sometimes that's not enough, especially when there are political minefields to deal with. There can be a lot of institutional infighting once you get to the real world.
Finally, contract negotiation. Early in my career, I was just happy to get a job with a lot of volume. I didn't even look at my contract. Now I’d say that having a lawyer, even for a simple consultation, should almost be mandatory. For a lot of folks, this is our first real job – before becoming an attending in medicine. I was a waiter at Olive Garden, so the transition was remarkable. We don't have a step-by-step process to learn about contracts and the legal aspects of things. Looking back, I’d tell my younger self, "Hey, you need to get a lawyer." But I know I would’ve probably replied, "No, I want this job. I don’t want them to rescind the offer."
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Some data suggests a fair amount of turnover within the first handful of years in the healthcare field. If you were to coach a younger fellow on career sustainability and how to best set themselves up for a longer tenure in one particular geography, are there one or two things you'd recommend?
I happen to have stayed with my job since I started, and there were times I seriously considered leaving, but I worked through them. It's a common experience, I think, especially considering that for most of us, this is our first real job out of training.
The problem is, we don’t truly know ourselves as operators until we get out. So my advice would vary, depending on the person.
Let’s say they’re on the arrogant side, fresh out of fellowship and ready to take the world by storm. I would advise dialing it back a notch – calm down the arrogance, be humble, and show humility.
On the other hand, if someone is naturally humble, they might undervalue themselves and might not stay past five years. My advice would be to find trustworthy people – but that’s also hard to know when you’re green.
For example, although I trained in structural heart disease, I went to a rural area knowing I wouldn’t be doing TAVR in my first two or three years. The field was just beginning. But I hustled and tried to build a practice. Then, once you’re busy, your group or institution is usually okay with you moving into areas you’re passionate about.
If you ask me for advice on how to stay past five years, I'd say expect that you might not. If everyone's nice and trustworthy, stay and don't let roadblocks discourage you. If you're not working hard or trying to get along, you might need to change. But if you're doing all the right things and it's still not working, it might just not be the right fit, and that's okay.
When it comes to building relationships, are there any other strategies that have been successful for you? Whether it's within your geography, with other disciplines, or maybe within the broader interventional cardiology community, are there a few things that have worked well for you?
I didn't network as much as I should have when I first started. I was focused on building volume, but networking has proven to be invaluable. Sure, it helps you learn about clinical trials and opportunities for your hospital, but it goes much deeper than that. It’s important for your mental health.
As your career improves, interventional cardiology can feel isolated. People in this specialty can be competitive. Networking outside your immediate environment helps, for instance, to discuss cases with peers, vent about frustrations, or simply connect with someone who understands the unique pressures of your field.
I always think in blocks of five years. The first five years out, that group of people is going to grow up together until they retire. I have a group of colleagues outside my hospital who are in the same career block. We talk about cases, politics, etc. Your career will figure itself out—if you’re good, you’ll do well. But burnout, mental health, all that stuff is so important in our field, and we don’t address it enough. Networking can help with that.
I encourage people to network, especially with peers. At fellows' conferences, stay in touch with those you meet. We coordinate a conference called the Southwest Interventional Structural Heart Symposium (SWISH) every year. This year, we're starting a mentorship program. Participants will be grouped with a faculty member who's five to ten years ahead in their career. That group will grow together over a year, with regular meetings to discuss cases and other issues. It's important to have a friendly face to talk to, someone not in your immediate competitive environment.
Let’s transition to some fun, rapid-fire questions. When you're in a case, are there a couple of songs that are usually high on the playlist or maybe on repeat?
This might not sound very doctor-like, but I'm a big rap fan. I grew up with rap. Hail Mary by Tupac is one of my favorite songs. Then, The Next Episode by Dr. Dre, probably. And for a non-rap song, I'd pick Come Undone by Duran Duran.
Generally, I listen to a variety of music. You asked about songs on repeat, so I had to pick those. But if it wasn't on repeat, it would be whatever new rap I'm into at that time.
How about movies? Any top one or two movies of all time?
Pulp Fiction is probably number one for me. The Godfather is right up there as well. And then there's a movie that people might not know, but it's Drive with Ryan Gosling.
If you had to go back to your mid-to-late 20s, maybe just after you completed medical school, is there one thing that you'd tell your younger self from either a personal or professional standpoint?
Yes, I'd probably tell myself to have self-worth. The constant pressure to apply, compete, and get into the "top" programs can chip away at your confidence. You might start feeling like your success hinges on external validation. If you can get away from that mindset and know your self-worth, it makes a big difference. I'd tell myself, "It'll be okay, keep on doing what you're doing. You'll be good.”
Some data suggests a fair amount of turnover within the first handful of years in the healthcare field. If you were to coach a younger fellow on career sustainability and how to best set themselves up for a longer tenure in one particular geography, are there one or two things you'd recommend?
I happen to have stayed with my job since I started, and there were times I seriously considered leaving, but I worked through them. It's a common experience, I think, especially considering that for most of us, this is our first real job out of training.
The problem is, we don’t truly know ourselves as operators until we get out. So my advice would vary, depending on the person.
Let’s say they’re on the arrogant side, fresh out of fellowship and ready to take the world by storm. I would advise dialing it back a notch – calm down the arrogance, be humble, and show humility.
On the other hand, if someone is naturally humble, they might undervalue themselves and might not stay past five years. My advice would be to find trustworthy people – but that’s also hard to know when you’re green.
For example, although I trained in structural heart disease, I went to a rural area knowing I wouldn’t be doing TAVR in my first two or three years. The field was just beginning. But I hustled and tried to build a practice. Then, once you’re busy, your group or institution is usually okay with you moving into areas you’re passionate about.
If you ask me for advice on how to stay past five years, I'd say expect that you might not. If everyone's nice and trustworthy, stay and don't let roadblocks discourage you. If you're not working hard or trying to get along, you might need to change. But if you're doing all the right things and it's still not working, it might just not be the right fit, and that's okay.
When it comes to building relationships, are there any other strategies that have been successful for you? Whether it's within your geography, with other disciplines, or maybe within the broader interventional cardiology community, are there a few things that have worked well for you?
I didn't network as much as I should have when I first started. I was focused on building volume, but networking has proven to be invaluable. Sure, it helps you learn about clinical trials and opportunities for your hospital, but it goes much deeper than that. It’s important for your mental health.
As your career improves, interventional cardiology can feel isolated. People in this specialty can be competitive. Networking outside your immediate environment helps, for instance, to discuss cases with peers, vent about frustrations, or simply connect with someone who understands the unique pressures of your field.
I always think in blocks of five years. The first five years out, that group of people is going to grow up together until they retire. I have a group of colleagues outside my hospital who are in the same career block. We talk about cases, politics, etc. Your career will figure itself out—if you’re good, you’ll do well. But burnout, mental health, all that stuff is so important in our field, and we don’t address it enough. Networking can help with that.
I encourage people to network, especially with peers. At fellows' conferences, stay in touch with those you meet. We coordinate a conference called the Southwest Interventional Structural Heart Symposium (SWISH) every year. This year, we're starting a mentorship program. Participants will be grouped with a faculty member who's five to ten years ahead in their career. That group will grow together over a year, with regular meetings to discuss cases and other issues. It's important to have a friendly face to talk to, someone not in your immediate competitive environment.
Let’s transition to some fun, rapid-fire questions. When you're in a case, are there a couple of songs that are usually high on the playlist or maybe on repeat?
This might not sound very doctor-like, but I'm a big rap fan. I grew up with rap. Hail Mary by Tupac is one of my favorite songs. Then, The Next Episode by Dr. Dre, probably. And for a non-rap song, I'd pick Come Undone by Duran Duran.
Generally, I listen to a variety of music. You asked about songs on repeat, so I had to pick those. But if it wasn't on repeat, it would be whatever new rap I'm into at that time.
How about movies? Any top one or two movies of all time?
Pulp Fiction is probably number one for me. The Godfather is right up there as well. And then there's a movie that people might not know, but it's Drive with Ryan Gosling.
If you had to go back to your mid-to-late 20s, maybe just after you completed medical school, is there one thing that you'd tell your younger self from either a personal or professional standpoint?
Yes, I'd probably tell myself to have self-worth. The constant pressure to apply, compete, and get into the "top" programs can chip away at your confidence. You might start feeling like your success hinges on external validation. If you can get away from that mindset and know your self-worth, it makes a big difference. I'd tell myself, "It'll be okay, keep on doing what you're doing. You'll be good.”
Some data suggests a fair amount of turnover within the first handful of years in the healthcare field. If you were to coach a younger fellow on career sustainability and how to best set themselves up for a longer tenure in one particular geography, are there one or two things you'd recommend?
I happen to have stayed with my job since I started, and there were times I seriously considered leaving, but I worked through them. It's a common experience, I think, especially considering that for most of us, this is our first real job out of training.
The problem is, we don’t truly know ourselves as operators until we get out. So my advice would vary, depending on the person.
Let’s say they’re on the arrogant side, fresh out of fellowship and ready to take the world by storm. I would advise dialing it back a notch – calm down the arrogance, be humble, and show humility.
On the other hand, if someone is naturally humble, they might undervalue themselves and might not stay past five years. My advice would be to find trustworthy people – but that’s also hard to know when you’re green.
For example, although I trained in structural heart disease, I went to a rural area knowing I wouldn’t be doing TAVR in my first two or three years. The field was just beginning. But I hustled and tried to build a practice. Then, once you’re busy, your group or institution is usually okay with you moving into areas you’re passionate about.
If you ask me for advice on how to stay past five years, I'd say expect that you might not. If everyone's nice and trustworthy, stay and don't let roadblocks discourage you. If you're not working hard or trying to get along, you might need to change. But if you're doing all the right things and it's still not working, it might just not be the right fit, and that's okay.
When it comes to building relationships, are there any other strategies that have been successful for you? Whether it's within your geography, with other disciplines, or maybe within the broader interventional cardiology community, are there a few things that have worked well for you?
I didn't network as much as I should have when I first started. I was focused on building volume, but networking has proven to be invaluable. Sure, it helps you learn about clinical trials and opportunities for your hospital, but it goes much deeper than that. It’s important for your mental health.
As your career improves, interventional cardiology can feel isolated. People in this specialty can be competitive. Networking outside your immediate environment helps, for instance, to discuss cases with peers, vent about frustrations, or simply connect with someone who understands the unique pressures of your field.
I always think in blocks of five years. The first five years out, that group of people is going to grow up together until they retire. I have a group of colleagues outside my hospital who are in the same career block. We talk about cases, politics, etc. Your career will figure itself out—if you’re good, you’ll do well. But burnout, mental health, all that stuff is so important in our field, and we don’t address it enough. Networking can help with that.
I encourage people to network, especially with peers. At fellows' conferences, stay in touch with those you meet. We coordinate a conference called the Southwest Interventional Structural Heart Symposium (SWISH) every year. This year, we're starting a mentorship program. Participants will be grouped with a faculty member who's five to ten years ahead in their career. That group will grow together over a year, with regular meetings to discuss cases and other issues. It's important to have a friendly face to talk to, someone not in your immediate competitive environment.
Let’s transition to some fun, rapid-fire questions. When you're in a case, are there a couple of songs that are usually high on the playlist or maybe on repeat?
This might not sound very doctor-like, but I'm a big rap fan. I grew up with rap. Hail Mary by Tupac is one of my favorite songs. Then, The Next Episode by Dr. Dre, probably. And for a non-rap song, I'd pick Come Undone by Duran Duran.
Generally, I listen to a variety of music. You asked about songs on repeat, so I had to pick those. But if it wasn't on repeat, it would be whatever new rap I'm into at that time.
How about movies? Any top one or two movies of all time?
Pulp Fiction is probably number one for me. The Godfather is right up there as well. And then there's a movie that people might not know, but it's Drive with Ryan Gosling.
If you had to go back to your mid-to-late 20s, maybe just after you completed medical school, is there one thing that you'd tell your younger self from either a personal or professional standpoint?
Yes, I'd probably tell myself to have self-worth. The constant pressure to apply, compete, and get into the "top" programs can chip away at your confidence. You might start feeling like your success hinges on external validation. If you can get away from that mindset and know your self-worth, it makes a big difference. I'd tell myself, "It'll be okay, keep on doing what you're doing. You'll be good.”
