When thinking about the business of healthcare, what are 2-3 concepts that you wish you knew coming out of your fellowship?

It’s important to know how your family and spouse feel about that geography you are looking at and how happy you will be. This is one of the major reasons that physicians leave their practice. So make sure that everybody’s happy and that it’s a reasonable area that you can have a family and live within.  

You have friends and colleagues across multiple healthcare disciplines. For a young clinician, how important is networking? Are there 2-3 tips that you can pass along on collaborating more effectively?

Training at a good institution is important because you can network. From a business perspective, it’s always nice to be able to reach out to colleagues across the country to make sure that what you are doing (and receiving) is fair. This is also great from a clinical standpoint as well.

Before the pandemic, I would call some of my close friends and colleagues and I would tell them about our regional meeting, or a national meeting, and plan to attend as a group. This is a great way to maintain a solid clinical relationship and have some fun as well. National conferences are great because you can meet a lot of people through your colleagues that you’ve trained with in the past.

Physician-industry relationships can be very valuable, but they are sometimes perceived in a negative light. Dr. Germanwala, how do you effectively work with industry partners?

I can honestly say that all of my industry relationships are valuable, but it’s because I already use the drug, device, or equipment. I don’t side with anybody just to get a paycheck. I think physicians that do tend to lose their credibility.

My recommendation would be to firmly stand your ground, look at the data, and ask yourself if it makes sense for your clinical practice. If you happen to be doing something and are asked to partner with an industry manufacturer, go ahead and do it because you believe in the platform or technology. For example, I won’t name the company, but I do not use their product because I just don’t believe in it. And when they come to my hospital, I don’t even walk back to the break room to grab a cup of coffee that they provide.

You speak on podium at many conferences and do a fair amount of physician training. What are some of the important skill sets needed to be an effective leader in these types of initiatives?

I have spoken on the podium at many conferences. This is definitely some training that most fellows should have the skillset for, particularly in the interventional world. Most fellowships require you to present cases at a board meeting several times a week, and at the bedside discussing things with families, residents, and interns. This is definitely something that comes with experience; you can teach intelligence, but wisdom comes with time. Within the first few years, you will have enough practice to be an expert. If you have problems, you can certainly reach out to some multidisciplinary speaker training programs online.

COVID-19 has sped up the process (and technology adoption) where virtual learning and remote case observation are becoming much more prevalent. How do you see this playing out for residents and fellows?

I think virtual learning is not as good as being in the operating room with an individual. However, it is still so much better than nothing at all. I have walked physicians through tough cases recently during the pandemic, and I’ve also had to do some mitral clip cases on my own that were very tough with the help of FaceTime. So it definitely works, and as I said earlier, it’s better than nothing.

Dr. Germanwala, who were your biggest mentors throughout your medical training and what key insights did you gain from them? How should residents and fellows go about finding (and keeping) a mentor?

My biggest mentors were cardiologists since I spent of my most time with them. The best mentors for me were those that I got to follow not only in the operating room, but also through their office, and sometimes through glimpses of their personal life, including things they taught me outside of cardiology. They really demonstrated what work-life balance looks like, including family time, learning financial skills, and the importance of having fun.

I also thought that my senior fellows were great mentors because they showed me a lot of skill sets and spent more time with me than my attending physicians. I think it’s very important to respect your senior fellows and remember they have a great deal of knowledge to share.

When it comes to personal finance, what do you wish you knew coming out of your fellowship?

To be honest, I did not know that cardiologists can make this level of income when I came out of my fellowship. I was just not aware of it. Everybody chooses things for different reasons, but I had a very humble beginning and came from a very middle-class family, so I was extremely thrilled when I found out that we could make this sort of money. I would say trying to stay humble and frugal is really important. I was able to pay off my loans quickly by living modestly.

Also, make an effort to understand how you are paid and really try to spend time with the administration and financial officers to learn more about your fee and bonus structures. Most cardiologists are great at knowing how to do procedures, but lousy at knowing where their money comes from and making sure they are fairly paid. I would spend some time learning Excel spreadsheets and really try to understand a profit and loss statement that’s typically provided every month by hospital or clinical administrators.  

I did go on and buy the cars (and watches) of my dreams later on, but not until I had my nest egg for my children’s education and finances set up.  

Okay, let’s transition to some fun, rapid-fire questions. When operating, if you had to choose 3 songs to play on repeat, what would they be?

• Hello by Lionel Richie

• Every Breath You Take by The Police

• We Are the Champions by Queen

Which mobile app are you addicted to -- personally and professionally?

Professionally, I use Epocrates and a kidney calculator because I’m always checking someone’s creatine clearance.

Starting over in your late 20’s or early 30’s, knowing everything you know now, what would you do differently?

If I was starting over, I probably would have gone to the Ivy League school that I got into, but I was so worried about money and ended up going to the University of Pittsburgh. In the end, it has not made any difference. Other than that, I would not have changed anything else. I am extremely happy with being a physician and I continue to recommend kids pursue a career in medicine. In my opinion, I think it’s the best field, and you will always be busy and make a comfortable living.

I chose my location in eastern Texas because I knew that nobody in the area worked on aneurysms, peripheral vascular disease, carotids, nuclear cardiology, and structural heart disease. This was important for me because my skillsets and treatment toolbox are really broad and I wanted to go to a place where I was not restricted. If that is a concern, the individual needs to look at the internal politics of that particular area.

For example, if you wanted to do all the aneurysms in San Diego, good luck! That’s just not going to happen. So you need to decide what’s important to you. The odds are you’re not going to be able to do everything unless you move to a rural area like East Texas or somewhere comparable.

Do you have any conferences, symposia, or other resources that you’re trying to raise awareness for?

The only conferences I’m currently doing now are transcatheter aortic valve replacement (TAVR) courses here at my institution in Texas one or two times a month. I tend to only go to regional conferences within Texas on very specific areas in peripheral vascular, aneurysms, or structural heart disease. I have found that the national and larger conferences are a little intimidating, and I just don’t seem to get as much out of them.

Thanks for doing this interview, Dr. Germanwala! Where’s the best place fellows and residents can connect with you online?

The best places to connect with me are on LinkedIn or just email me directly at germanwala@gmail.com.