Conversations With Cardiologists: Robert H. Beekman III, MD, FACC

June 22, 2016 | Tarek Alsaied, MD

Robert H. Beekman III, MD, FACC, is an interventional pediatric cardiologist and professor of pediatric cardiology at Cincinnati Children’s Hospital. He is currently the chair of ACC’s Adult Congenital and Pediatric Cardiology Section and also is the chair of the National Pediatric Cardiology Quality Improvement Collaborative.

Tarek Alsaied, MD recently sat down with Beekman to learn more about his advice for Fellows in Training (FIT) and Early Career professionals.

Why did you choose a career in interventional pediatric cardiology?

My path to cardiology was not planned, like some people who know their intended subspecialty from the moment they enter medical school. During medical school I learned to love caring for children and thought I wanted to be a primary care pediatrician working with underprivileged children. During my pediatric residency, Arthur Moss, MD, FACC, talked to me several times about giving pediatric cardiology a chance and he convinced me that if I tried it I would never regret it. He was correct. Children with congenital heart disease present complex physiology that fascinated me. It was clear that I would not be a surgeon (I hated those early rounds) so I chose interventional pediatric cardiology as a career. One of the most attractive aspects of interventional pediatric cardiology is the nature of the job. It is one of the rare situations where the cardiologist needs to understand the patient’s clinical situation, know the natural history of the disease, obtain the pertinent diagnostic data, weigh the risks and benefits of intervention, and then perform the intervention all in the moment.

How did you get involved with the industry for the new devices early in your career?

One of the fascinating aspects of interventional cardiology in the 1980s-1990s was working to develop new innovative technologies in cardiology. The technology was rapidly growing during those years, and changed paradigms of treatment and natural history of many congenial heart defects. It was interesting how each new catheter procedure was disruptive and generated new debate about the value and the ethical use of this technology versus the standard surgical option. I still vividly remember being asked in the early 1990s whether using a device to close a PDA or ASD was the right course of action (or even ethical) given the low risk of surgical closure.  

It was exciting to be active in pediatric interventional cardiology during these years, and to help move the field forward – mindful of the need to have appropriate IRB approval and careful informed consent.  The field has evolved tremendously since that time and it is hard to predict what it will be like 10 years from now. The people who can figure that out will be the current FITs and early career cardiologists, the future leaders of the field.

Working with industry in pediatric cardiology has presented many challenges. Pediatric cardiology is a small market with limited opportunities for marketing and investment. Our field suffered for that reason and a lot of the devices we use were designed for other purposes. We use them off label in creative ways and have continued to try to engage the U.S. Food and Drug Administration to help facilitate the development of targeted pediatric devices. A few years ago, we reviewed our experience at Cincinnati Children’s with all devices used in the cath lab and found that approximately 65 percent were used off label, which is an alarmingly high number.

What do you see as your biggest impact on the field of pediatric cardiology?

I am humbled by this question. Currently I am very proud of the role I have played with many other colleagues in helping to develop the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). I think its most important impact on the field has been to demonstrate that pediatric cardiology programs can in fact work together to share their best practices to improve care. They actually can collaborate instead of competing.

I feel that the NPC-QIC and other collaboratives can benefit fellows and there is plenty of opportunity. Fellows are the future of the field and we are working on engaging those in training and early career cardiologists. We need to do a better job of this.

What career accomplishment are you most proud of?

I am really proud of my work with the NPC-QIC. We showed that the programs can work together in a great collaborative. In addition we engaged families and patients as partners in improving care. I think partnerships with families provide amazing insights that makes us better physicians and will be an important paradigm for future efforts to optimize individualized patient care.

What is the most satisfying part of your career?  

It changes from day to day and over the years. One of the things which always provided great satisfaction has been the opportunity to work with children with challenging health problems and to develop long-term relationships with these children and their families. The other great satisfaction for me comes from working with young physicians and helping train the next generation of pediatric cardiologists. Watching them learn and improve their skills, and prepare to lead the field forward, is a priceless experience.

What advice would you give to current fellows?

There are many ways to answer that. Right now that there is a palpable concern among many fellows that they will not get jobs in the future. This is a superficial current that, in my opinion, does not really run very deep. I have never encountered an excellent cardiologist who did not get a good job. Fellows need to identify what their passion is, work hard to do their best so that programs will be compelled to hire them. If you are excellent and you are doing what you are passionate about, you will have a great career. Your first job may not be your dream job but with hard work and excellence you will have a very rewarding career.  

What is your take on academic vs. private practice for pediatric cardiologists?

There are many private practice and academic opportunities. Different people have different goals and interests. An academic career is not a single career pathway. There are amazing rewards from a career that involves clinical or translational research, and these opportunities are available in academic centers. People who are interested in teaching and clinical research will certainly thrive in academic environment. Many of the most satisfying achievements in my career would not have happened outside of an academic environment.

On the other hand if your strongest desire and interest lies in patient care, private practice can be a wonderful opportunity for you. The private practice environment provides fewer research and teaching opportunities, but certainly some can be found there. 

As a chair of the ACPC Section, what do you think of pediatric cardiology fellows’ involvement with the ACC and how can the ACC help fellows?

I think the ACPC Section needs to do a better a job of providing opportunities for the fellows and early career cardiologists. Fellows are very welcome to participate on our work groups and there is a fellow position on the ACPC Leadership Council. We need to promote that and engage fellows more in the work of the ACC. Fellows are the future. 

How did you manage to find work-life balance in your career and what do you recommend for fellows in training?

Finding proper work-life balance is really important. You will not have a successful career if you are not achieving success in your personal life. I think fellows need to figure out a way to balance career with what is important for them in their personal lives. This proper balance is different in each family and every person, and shifts with time.  

My wife was a very important part of my career and helped us find that balance. Nancy met me during medical school, was with me as a resident and fellow, and she knew how important my career was to me. As my career evolved and became more intense, she would never let me stray too far from the family. I remember she would sit me down for a serious talk every six months or so about the importance of having quality time with our daughters. I would improve for a while, she kept an eye on our family dynamics, and then when necessary she would reel me in again. A supportive spouse who advocates for your work-life balance and understands your career demands can be an extremely important partner.

This article was authored by Tarek Alsaied, MD, a pediatric cardiology fellow in the Heart Institute at the Cincinnati Children's Hospital Medical Center.