Conversations With Cardiologists: Mehdi H. Shishehbor, DO, MPH, FACC

August 25, 2016 | Rayji Tsutsui, MBChB

Mehdi H. Shishehbor, DO, MPH, FACC, is the director of endovascular services in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic, Ohio. His interests include coronary and peripheral vascular interventions. He completed his internal medicine, general cardiology and interventional cardiology fellowship at Cleveland Clinic. Dr. Shishehbor is married and has two daughters. In his spare time, he enjoys playing soccer, reading Persian poetry and watching basketball.

What is your advice to a general fellow in preparing to become an interventional fellow?

A lot of folks think that to become an interventional fellow, you need to do a lot of procedures in your general cardiology fellowship, which personally I do not think is true. I think you need to be a good general cardiologist first. As we move on through our careers from an internist, to a general cardiologist and an interventional cardiologist, the most important thing is the foundation that we build.

I would not focus so much during your general fellowship on learning techniques and doing a large number of cardiac caths since you will get that opportunity throughout your career as an interventionalist.

When you do move on to your interventional fellowship, you should do it in a program that has a high volume. There should be folks that are willing to teach and mentor you. You should be exposed to a different flavor of procedures. Easy ones, complex ones, structural, peripheral and so on, in order to get a nice comprehensive education during your training.

Why did you decide to pursue intervention cardiology?

For me, I always wanted to do interventional cardiology because I enjoyed working with my hands and was more technically minded. When I was undergoing my general cardiology fellowship at Cleveland Clinic, I was fortunate to receive a K grant and I was doing a lot of research. When time came for me to apply for interventional cardiology, honestly, I had a lot of doubts. On one hand I wanted to be a scientist focusing more on research, and on the other hand, I knew my passion was performing procedures and the dream was to do interventional cardiology. Additionally, my admiration towards my mentors also influenced my decision.

I think it is rewarding in the sense that you can have immediate impact on people’s lives but also it gives me a lot of variability in my work – I can be in the cath lab, attending in the ICU, in the outpatient clinic, performing and evaluating ultrasounds, etc. I never have a boring work day.

For a fellow who is trying to decide between structural and peripheral, what you would you advise?

Unfortunately, we have a couple of issues in our field. It does not surprise me that more fellows are interested in structural than peripheral, because you get a lot more exposure to structural heart disease than peripheral vascular disease during your training.

Here at the clinic, we are fortunate because fellows get a lot of exposure to peripheral procedures. But as you know at most academic centers, the majority of peripheral vascular work is done by vascular surgery. Most of the cardiology trainees have little exposure to vascular diseases and it is not really embedded in the curriculum of cardiovascular medicine, whereas in structural heart disease, you are dealing with aortic and mitral valve diseases on a daily basis which is one of the key foundations of general cardiology fellowship.

I would advise those interested to find some exposure to vascular disease so that you realize the impact you can have to the patient. Once you get that exposure, whether you rotate though vascular medicine or vascular surgery, you will be fully informed of what the field is all about.

I think that for a fellow to decide to go to peripheral training, it will require some kind of experience with vascular disease that gives that fellow a chance to recognize and appreciate vascular disease.

This field is ready for young people to navigate it, to do cutting edge research and innovate.  There is a lot room in the field of peripheral vascular disease for sophisticated, young, motivated individuals that want to engage it.

What is your experience in being successful as a researcher and an interventionalist? What were the difficulties you faced?

I think that this is just like anything else in life. If you are passionate, if you enjoy what you are doing, you will be able to get there. If you approach it like business, it will be very hard for you to take it to the next level. Additionally, you need to know the disease inside and out. With this, you will be able to formulate innovative questions for research.

I do research only if it impacts patient care. At this stage in my career, I am not required to do research just to publish. I care about research that will move the field forward and impact patient care.

Whenever a fellow comes to me, I emphasize that a good research question will have a clinical impact. This way you have the chance to feel very good about the research and its answers.

Next is how do you balance research and work. It is tough. In clinical practice, taking time out for research will take a major toll on you. It is already a huge burden to build a successful clinical practice and not forget time to educate for your junior colleagues.

You will have to find the right balance that fits your interests. You cannot do everything in one day. Things will have to be spread out and you need to have a strategy about where you want to take those things and overtime accomplish those goals you set for yourselves.

Lastly, it is important to be in an environment that this kind of thought process is cherished and supported, meaning that you are in an environment that your colleagues also believe in advancing the field.

What would you advise regarding work-life balance?

That is a big challenge. I have two young children, 8 and 5 years old. The volume of work that I have and the research that I try to do along with teaching fellows, it can be a major challenge to balance personal life with work. You need to learn how to say no, to prioritize what is important to you and to be able to look at the big picture.  

A lot of times we do sacrifice our family. I can tell you that I have done this throughout my career several times, both as a trainee and as a staff. I am blessed to have supportive wife and family. But again prioritizing what it most important in your life is the advice I can give you. As you become more experienced and older, you will be able to say no to the things that are not on your priority list.

You held the Masters Approach to Critical Limb Ischemia (MAC) Symposium recently. What is this symposium about?

This is a dedicated, academic symposium where discussions are held about critical limb ischemia (CLI) and any interventions that involve anywhere from the aorta down to the feet. We designed this meeting to meet the need for dedicated sessions on CLI. Without dedicated sessions/symposium, the importance can get diluted amongst venous disease and other peripheral vascular diseases.

The goals are to give folks hands-on experience, live case experience, one-to-one teaching experience in a smaller setting, and more importantly, really focus on case-based teaching. We had about 40-50 cases with discussions as to how we would approach those cases. We felt this approach made the meeting unique. When we go to larger meetings such as TCT, it is a great meeting and very educational, but you are talking about 12,000 attendees or so. We wanted to have a multidisciplinary approach. Therefore, we had podiatrists, plastic surgeons, wound care specialists, hyperbaric specialists, vascular surgeons, radiologists, and interventional cardiologists.

This year we had the meeting for two and a half days, but next year we decided to expand to three and a half. We hope to keep it in the 600 attendee scale or so to enable smaller group teaching and discussions specifically about CLI.

Where do you see yourself in five years? 10 years?

Great question. As we grow in our careers, I hope to provide impact in a larger scale beyond just having my own practice. I would like to be able to help junior faculty build their careers. I would like to have an opportunity to run a catheterization laboratory and also expand my research. To be more innovative and create startup companies that will help bring new technologies to fruition, and expand to a point that I can bring better health care to larger number of patients.  All those things take time and as we move on, hopefully I can reach those goals.

This article was authored by Rayji Tsutsui, MBChB, a Fellow in Training (FIT) at Cleveland Clinic in Ohio.

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