Early career is a crucial time in the life of a cardiologist. When I became an attending physician 3 years ago, I had many doubts about my capabilities as a cardiologist. As the time went by, I realized the transition from fellowship to early career is actually smoother than we think it will be. My role of an attending physician came "naturally" to me. However, once the early career phase settles in, it's the perfect time for professional evolution by carving a niche into a specific area of interest. Carving a niche evolves from the blend and balance of an unmet area of interest with an unmet area of need. While looking for the area you want to develop the subspecialty niche in, following these steps can be helpful:

1. Follow your passion and develop expertise

Knowing what excites you on a daily basis is the key determinant to sustaining and innovating in the field and doing well. Your passion will define you eventually. Realizing your passion may take time. It's okay to take the first few years out of fellowship to transition and get comfortable with your new role. Sometimes the clinical experience in the first few years may help carve your interest in an area. For others, the initial spark during fellowship in a particular area may define their long-term passion. For some fields like women's heart health or cardio-obstetrics there is no formal training or recommendations. Educating yourself about the subject through ongoing research and attending educational opportunities available through organizations like ACC may help further your interests. Think of how to get clinical experience in the field before you start a new program at your institute. It may require more specific course training, an externship at a tertiary care center with high volume, or extra months in a specific area during training. Such experience may help establish competency and proficiency.

The niches one should avoid include the ones in which there is limited opportunity to grow volume due to regional threats, no institutional support or infrastructure, few resources and inconsistent referral pattern.

2. Know your organization

Recognizing the gaps in the services at your organization may help you find your own niche. If you identify an interest during fellowship, look for a job that may help you develop it further. Developing a niche in a specialized area out of training without any previous experience can be challenging and the success of the program may remain contingent on your hard work and sacrifices. This may mean being available for consults in your area 24/7. On the contrary, if the institution you are at, already has expertise built in the area of your interest, you may have to carve out your role in the program and think about your specific contribution. It's important to know what patient clientele you will be catering to, what is the regional dominance in the area and who you will be competing against. If there is regional competition, how will you set your program different from other programs. If someone else had been recruited before to develop a similar area of expertise at your institute, identify the barriers to their success. If the environment is threatening for your own growth, think of collaborative strategy and exercise it.

3. Always think of the budget of the proposed program vs. the revenue generation

In an ideal situation, before starting a new program or new service line, you will have to get strong commitment from your department chair, department and hospital. You will have to convince all the parties involved, that your expertise in any particular area is everyone's priority. A successful program requires investment in personnel and additional financial resources. A useful exercise is to put together a business proposal that includes a budget, key personnel, short- and long-term goals, "deliverables," as well as a cost-benefit analysis to ensure a clear goal and destination.

4. Research, training and education

If you are at an academic institute, starting a program will definitely provide opportunities to develop a patient cohort with a specific cardiovascular condition. Another option is to participate in national as well as international registries for any particular disease state or cardiovascular field. Developing a training module, disease algorithm and curriculum for the trainees will help further the educational and research goals of the program.

5. Support

The transition from residency to practice, and the selection of an appropriate niche, are not easy tasks. Even if everything falls into place and you have the perfect setting at a perfect program, input and guidance from mentors will have critical impact on your professional growth. In the era of social media, we now have abundant networking opportunities which certainly helps with connecting us to like minded individuals with similar areas of interest and finding distant mentors.

Developing a niche in your area of interest is a complex but fulfilling task in one's professional ladder. It will definitely take significant time commitment but considering the impact a successful novel cardiovascular service line may have, it is our chance to make a difference. Early career is the perfect time to embark on this journey and to consider your professional evolution.

This article was authored by Purvi Parwani, MD, FACC, cardiologist at Loma Linda University Health in Loma Linda, CA.