With more opportunities available than ever before, today’s cardiologists are faced with critical decisions as they make the transition from a Fellow in Training (FIT) to early career. Options range from joining a group practice to doing clinical research; from teaching to administrative work, and more. It used to be that an FIT had to choose just one of those paths and stick with it. But as cardiovascular medicine has evolved and become more diverse, expansive and innovative, career options have multiplied. While the myriad choices present a wider range of opportunities, they also can make it more difficult for a cardiologist to decide on which path to take – and where.
The cardiologists featured here have faced that challenge – often more than once. Their approaches are as unique as their careers, but three beacons shine through each doctor’s counsel: know yourself, be ready to seize opportunities and listen to that inner voice.
Too Much Planning Can Lead to Missed Opportunities
John Rumsfeld, MD, PhD, FACC
 I’ve never liked the question, “What is your five-year plan?” My own career happens to have shifted about every five years, but at no point did I have or follow a ‘five-year plan,’ which implies a specific set of steps toward a specific endpoint. I think such planning can actually inhibit career growth from unanticipated opportunities that arise. Instead, I think the career development focus is best placed on being ready to evaluate and seize opportunities. There is no single way to do this, of course, but I think the following tenets are helpful: start with “why,” pursue rigor, be enthusiastic, collaborate (and mentor) and listen to your “self.” Lastly, fiercely defend time away from work and away from thinking about work. You will not miss opportunities doing this – if anything, it enables your enthusiasm and other traits that will open doors.
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Be the Academic You Want to Be
Jeffrey B. Geske, MD, FACC
 Beginning an academic career can be a challenging task, and “academia” can mean different things to different people. A key to early success is developing a niche; an academic focus that you develop and grow. When looking for the “right job,” write down your ideal scenario – a task harder than it sounds. What is your ideal mix of outpatient/inpatient/laboratory time? Clinical/research/education/administrative time? Does the patient mix match your niche? Combining research and clinical interests is a rewarding process and can facilitate success; generally it is easiest to focus on a disease as opposed to a particular testing modality. Throughout each step, mentoring is critical. Identify and meet regularly with a mentor to facilitate your academic growth and establish career goals and milestones. While the process of beginning an academic career can seem intimidating, engaged mentorship and an organized approach are tools to ensure success.
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Go Full Force: Hard Work is the Thing
Andrew M. Freeman, MD, FACC
 The transition from FIT to early career is daunting. Along with trying to understand how to do the work you need to do – from electronic health records to billing to office politics – these are the pivotal years to really establish yourself and your niche. Leaving fellowship, you come out like a Swiss army knife with the ability to do almost anything. The goal is to end up with a few well-honed and well-wielded tools. The key is to develop your interest area and go full force at becoming the most knowledgeable and skilled in this area, all while being incredibly hard working. Your goal should be to establish yourself as one of the hardest working individuals in your group. In addition, be sure to give back to your group, institution or community with meaningful approaches like free clinics, "walk with a doc" programs or others. The extra miles you go initially will pay you back handsomely.
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You Can Have it All – Even in a Group Practice
C. Michael Valentine, MD, FACC
 It used to be that early career cardiologists had to choose either academics or private practice. Now, you can choose from academic practice, private practice, small and large practices, private or integrated practices, research and clinical. And you can do clinical work and research while you’re in a practice. The lines have blurred. So how do you decide where to focus your career? First, determine the things you really want to do. Next, decide where you want to live. See what opportunities are available there. Third, be flexible in your interviews so you can be open to different opportunities. Last, examine the culture and atmosphere of the practice or center and make sure you’re a good match. Today’s academic centers are demanding a lot of the same things that practices are demanding. They both want candidates who are involved in clinical and quality processes. You can be in an integrated practice and still do clinical research and teach.
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The ACC Opens Doors
Antonio Bacelar, MD
 The ACC opens doors for early career cardiologists. It has been a privilege for me to get to work with the College on several different projects as an early career cardiologist from Brazil. One of my first experiences with the ACC was an opportunity to participate in an FIT meeting in Mexico City. During the meeting we learned about different areas of clinical cardiology and held a very exciting FIT case competition that was facilitated by our training directors. My hospital – Hospital Israelita Albert Einstein in São Paulo – is pleased to be one of the pioneer institutions in ACC’s International Centers of Excellence (ICOE) program and has even received the Platinum Performance Achievement Award. As an ICOE participant, my colleagues and I have had access to a suite of tools that help us maintain a high level of patient care. Most notably, we have been participating in the ACTION Registry-GWTG and the CathPCI Registry, both of which allow us to measure, benchmark and improve our performance. I look forward to continuing my quality improvement journey with the ACC.
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Interventional Cardiology: Calling All Adventurous Spirits and Creative Minds
Deepak L. Bhatt, MD, MPH, FACC
 There remains intense interest in interventional cardiology – understandably so. The field remains dynamic and vibrant, with ongoing advances on several fronts. A challenge is that this explosion of knowledge and procedures requires extending the already long duration of training. Additional challenges include making sure the interventional workforce is the correct size. For those interested in this space, it is a great time to get on board, but only if one has a certain degree of tolerance to uncertainty and change. It will be important to be trained broadly with a diverse clinical skill set, spanning an understanding of echocardiography and computed tomography in assessment of valvular heart disease as well as of the impact of novel lipid modifying agents in prevention of coronary artery disease. At least a basic appreciation of clinical research will be a necessary foundation to keep up with the rapid knowledge shifts that are likely to occur in the next two decades. I predict it will be a fun ride for those with an adventurous spirit and a curious mind.
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Learn more about the Early Career Section at ACC.org/EarlyCareer.
Keywords: Cardiology Magazine, ACC Publications, Atmosphere, Awards and Prizes, Benchmarking, Brazil, Cardiology, Clinical Competence, Coronary Artery Disease, Echocardiography, Electronic Health Records, Explosions, Fellowships and Scholarships, Goals, Group Practice, Heart Valve Diseases, Inpatients, Learning, Lipids, Mentors, Outpatients, Patient Care, Platinum, Politics, Private Practice, Quality Improvement, Registries, Research, Social Planning, Tomography, Uncertainty
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