Conversations With Cardiologists: Deepak L. Bhatt, MD, MPH, FACC
Deepak L. Bhatt, MD, MPH, FACC, executive director of Interventional Cardiovascular Programs at Brigham and Women's Hospital and professor at Harvard Medical School, shares his advice with ACC Fellows in Training (FITs).
What are your best memories from your cardiology fellowship training?
My best memory of cardiology fellowship was hanging out in the cardiology fellows' room. It was a fun place, and there was always a lot of activity, excitement and learning. This helped foster a terrific sense of camaraderie. There's a good number of my co-fellows that I'm still in regular contact with.
Who were your mentors during training, and how did they influence your career?
I was fortunate to work with a lot of great people who influenced my career. First, my undergraduate advisor, Robert Weinberg, MD, who played a central role in discovering the first human oncogene. I recall having an interesting conversation with him. I was trying to explore his motivations for the world-class science that he did. He said it was the beauty of science. I thought it was an elegant answer in itself; however, it made me realize that my motivation was a bit different. I was more about curing cancer or doing something that would affect human health directly in my lifetime. I thought to myself that it would have been such a great experience to have a career in science doing very elegant work that was intellectually satisfying. However, for me, that wouldn't have been fulfilling if there wasn't a tangible effect and benefit on broader human health. That was when I pivoted from basic research at MIT to more clinical research. My clinical research experience started with great faculty like Richard Devereaux, MD, and the late Thomas Pickering, MD ,at the Cornell Hypertension Center. We looked at different blood pressure patterns and left ventricular remodeling on echocardiography. I loved the clinical research, and in hindsight, I realize how much time and effort Dr. Devereux put into overseeing me. It taught me a lot about writing and doing clinical research as I had to gather the data and do the statistics myself.
What are your thoughts on the current landscape of interventional training?
The current landscape has an embarrassment of riches. In coronary intervention, there are all sorts of new things going on with drug-coated balloons and intravascular lithotripsy. Peripheral interventions are really growing, and cerebral vascular interventions are continuing to evolve. Finally, structural heart interventions are in a rapid phase of evolution. So, I think interventional training and interventional cardiology as a field, for that matter, are really booming with good times ahead.
What advice would you give current cardiology fellows interested in an interventional career?
For current cardiology fellows interested in an interventional career, I say make sure you get a really good general cardiology background training. Sometimes people make the mistake of just thinking about their next stage of training instead of focusing on what they could be learning and should be doing now. Even if you love interventions, I think it's really important to get a solid foundation in general cardiology that includes outpatient and inpatient settings, including critical care. Then make sure you understand imaging really well, as that's a big part of intervention today. These are important points as many of you might be thinking of doing interventions 100% of the time down the road, but that's rarely the case. At academic places and in most private practices, you end up doing a fair amount of general cardiology. Also, there might come a time where you have to hang up your lead and focus only on cognitive medicine, so you want to make sure to keep up those general cardiology clinical skills because those are always in demand at any time or place.
Some specific advice for those already in interventional cardiology try to maintain an exercise regimen, especially workouts involving strengthening your core. It can be tough in interventional cardiology, as it can be very busy. This helps you avoid getting long-term back and neck problems that are common among interventionalists.
How has the practice changed since you finished fellowship?
A lot has changed. The shift to the radial artery is pretty big. There are still places in the U.S. that are lagging, so I'd say if you're at one of those places, just do what you can to push radial over femoral and make sure you learn it yourself. At the same time, don't abandon femoral. Mastering vascular access is always important for any proceduralist. The other change is the improvement in outcomes for some of the sick patients we treat, and for one, codes in the catheterization lab have become much less common than I used to remember. Other things that have changed aren't specific to just interventional cardiology, such as work hour restrictions for trainees.
How do you maintain your work-life balance?
I don't know that I'm a good role model for this, but I think it's really something that people must decide for themselves as it's a very personal decision. I don't think it's possible for any human being to have everything in life all at once. You have to know what's important to you as an individual. I think that requires some self-reflection, but it also does involve sacrifice.
How would you advise cardiology fellows to navigate their careers?
I'd say work hard. That always helps in every field of life, but also pursue what excites you. I think that's important. I remember when I was in medical training in internal medicine, a lot of faculty were saying, don't go into cardiology when they knew I was interested. And when I said I might even be interested in interventional cardiology specifically, they said that's crazy; there aren't going to be any jobs. Jump ahead now, and the demand for cardiologists and interventional cardiologists is high. I think that you should always follow your passion. And if you're working hard at it and are good at it, you can be sure success will follow. My former chief of cardiology at UPenn once told me, "There's always room at the top." Even if a field seems crowded, if you're really good, there's always room.
This post was co-authored by Zaid I. Almarzooq, MBBCh.