Conversations with Cardiologists: C. Noel Bairey Merz, MD, FACC

C. Noel Bairey Merz, MD, FACC, is Director of the Barbra Streisand Women's Heart Center at the Smidt Heart Institute of Cedars-Sinai, where she is also the Irwin and Sheila Allen Chair in Women's Heart Research. In addition to her roles as a leading physician scientist and clinical cardiologist, she is also Director of the Clinical Scholars Program at Cedars-Sinai, a program offering formal research training to fellows. This piece focuses on Bairey Merz's path toward a successful career in clinical research, and her advice to fellows interested in a career in clinical research.

How did you get started in your research career studying the impact of heart disease in women?

The start of my research career is one of those stories that I can look back and rationalize a process, though in truth it was driven at least as much by emotion. I had always thought that I would like research because I am easily bored. I found that I loved working with patients in my internal medicine and cardiology care, though it had the tendency to fall into routines. I hoped research would add another element to spark my interest.

I started by getting involved with a highly productive, highly published group, and hoped to get pulled into their jet stream. For me, this was the Cardiac Imaging group at Cedars-Sinai led by Daniel S. Berman, MD, FACC. I came onto the scene when SPECT imaging was taking off, and we were investigating tissue-attenuation software. There, I saw an early example of sex-specific medicine. It was a simple example where an obvious sex difference – women, in general, have breast tissue – had a huge impact on data interpretation. I learned the skills of cardiac imaging and launched my own work using imaging as a tool to study sex differences in heart disease.

How do you balance clinical time with research?

This has evolved over the course of my career. I started off working in the CCU, on the consult service and in the clinic, though my clinical time is now all in the clinic. I strongly feel that to compete for extramural funding, you really need to have more than 50% of your time carved out for research and not committed to clinical or administrative work.

With respect to work/life balance, despite its bad reputation, academics can allow a family-friendly lifestyle. I found that a career in academics gave me the flexibility that I needed to have the family life that my husband (also a cardiologist) and I wanted. While you need to get the grants and there is a lot of work, you can often work on your own time. I had three children while building my research career and was able to be there and raise them in a way that I enjoyed.

You direct the Clinical Scholars Program at Cedars-Sinai, where many recent cardiology fellows have gotten formal training in clinical research. What does this kind of program offer for fellows?

I think back on my own beginnings in research. I was self-taught, but I was coming up in a time where H. J. C. Swan, MD, PhD, MACC; William Ganz, MD; George A. Diamond, MD; and James S. Forrester, MD, FACC, were all here at Cedars-Sinai. I had these mentors that I felt truly understood relevant bedside clinical research, and I could walk into Swan's office and get help with a question I was working on. Also, the environment in medicine and in academics felt less corporate. As an early faculty member, I was given research time to pursue my projects without having to buy that time back off the bat.

There are a lot of challenges today that young faculty face, and this is the impetus for the Clinical Scholars program. We give fellows the tools and the mentoring that I feel I got when I was starting out. We require that faculty mentors ensure that fellows will have time carved out for research, and we hold a grant-writing workshop to build the skills needed to obtain competitive funding. Fellows in the program learn these skills just like they learn clinical skills in fellowship such as doing an angiogram or reading an echo, and they improve by doing a lot of writing and getting feedback during the course.

What advice to do you have for FITs hoping to embark on a career in clinical research?

You need to have passion and curiosity for what you are doing, because there is a lot of rejection along the path of a clinical investigator. Put on your seatbelt, and keep testing yourself along the way – ask yourself, "Do I like this? Am I having fun yet?"

Take my lead and find a productive group and mentor that is working on something that you are interested in, and dive into it, work hard and burn the midnight oil. Over time, you'll carve out your path.

This article was authored by Paul Marano, MD, a third-year fellow at Cedars-Sinai Medical Center, interested in critical care cardiology and clinical research. Twitter: @pjmarano1.

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