Allen J. Taylor, MD, FACC, is chair of Cardiology at MedStar Heart and Vascular Institute, including Medstar Georgetown University Hospital and MedStar Washington Hospital Center in Washington, DC. He is also a professor of medicine at the Uniformed University of the Health Sciences in Bethesda, MD, and Georgetown University in Washington, DC. Dr. Taylor describes his journey into medicine and thoughts on cardiology and leadership in medicine.

How would you describe your pathway into medicine?
I was very committed to going into medicine while starting college. Everything I knew about it came through casual channels, people I knew, or even television. Practicing medicine had the mission I wanted to deliver in life, which was learning, helping, and discovering all together. I went to William and Mary as a chemistry major, which I felt would give me the math and science background to pursue a career in medicine.

In medical school, I wanted to learn and enjoy everything. For example, even if you may not have an interest in neurology because you really like cardiology, you learn from a neurologist how important a careful history is and how a physical exam is so critical. What I always tell medical students is the right field finds you as opposed to you finding it. If you stay engaged during medical school, you will find the field that feels right.

Whether that is the types of patients you take care of, the types of problems you confront, the types of solutions you can deliver, the type of joy that they bring, or the type of hope you give your patients – you will find it. Sometimes, it is a way of thinking. If you enjoy basic science, oncology may seem more appealing whereas if you like physics, orthopedics may seem more intuitive.

I always say pay attention to what is intuitive to you because you are going to want to learn about what comes naturally to you.

When did you find cardiology as a potential specialty?
Denton A. Cooley, MD, FACC, was a famous heart surgeon at Johns Hopkins while I was in medical school, and at the time, I remembered how I once read a book about his experience of becoming a physician and heart surgeon. And I thought that sounds very exciting to me. During my rotation on heart surgery, I found myself getting into it, but wondered why patients end up in the operating room and what would happen to them after recovering from surgery. That was my anchor into general cardiology and it opened my eyes to the specialty. Knowing all this, I would say follow your instincts and think about what is intuitive. You are going to learn your whole career, so think about what you would like to learn and the problems you want to solve.

How has cardiovascular prevention evolved since you first started training?
The journey in cardiovascular prevention has been an interesting one. Some would say that we have plateaued on risk factor assessment. However, phenotypic evaluation and characterization of atherosclerosis have improved. We are now in a phase of new drug discovery, which is driven by genetics and randomization studies. CRISPR is also going to be important and there are new biologics for cardiovascular disease, which is a huge change.

Preventive care has also traditionally been disaggregated. It was everyone's responsibility which means nobody had a dedicated role in preventive cardiology. As prevention gets more complex as therapeutic offerings expand and risk targets get reduced, we will begin to see more emphasis on it.

Similarly, as we accelerate the pace of innovation, we must be very clear about delivering value back to the patient and society. It is increasingly costly to develop and deliver new drugs and treatments. We still have to handle the basics without always having to jump into the complex and expensive. For example, we still have gaps in care with the under-use of statins and lack of blood pressure control.

Then, I think we have another challenge in prevention and medicine as a whole because there is so much information to speed up the time from clinical availability to proper utilization. We need to find ways to leverage machine learning and other approaches to identify the right patients, drive care into the right places, and provide real-time feedback that's helpful to clinicians. For instance, we are looking to improve the rate of adoption of new heart failure therapies by implementing  system-wide changes in our health care system. Faster implementation is truly an area of need.

How do you think medicine will change in the next decade?
I think that the quality and safety of health care will continue to improve. The demands, standards, requirements, and the complexity of medicine for quality and safety is an evolving, complex world. Cardiology is no exception. There has also been an explosion of extended providers, including advanced practice providers and PAs, and they will pay off hugely. We should be able to disseminate higher levels of care across the world more easily when right now we cannot reach everyone. However, one thing that will not change is that communication will be essential to providing good medicine. Listening and communicating are two fundamental skills that every trainee can benefit from practicing in all environments.

How did you pick an academic career in cardiology?
You should do what is important to you. Someone should never feel that the only thing that is valued is one type of career. Everything is valuable and is equally valuable. Clinical practice is not inferior to a research career or vice versa. I was attracted to the discovery process and intellectual appeal of trying to learn new knowledge in academic medicine. Frankly, in clinical practice, you also learn new things every day.

However, during training, I would encourage an academic experience even if academics are not in your future. Those are the things that are uniquely yours, you will remember those experiences, and they will give you life-long skills like how to complete and communicate a project. In fact, if you know that you will be returning to your hometown and starting or joining a practice, you should take advantage of research.

What advice would you give to trainees pursuing different types of careers in medicine?
It is important to brand yourself in clinical medicine and then seek out opportunities for growth. Sometimes trainees are too selective about pursuing opportunities when, in fact, you can learn something all the time if you are in a learning mode and you push yourself into areas that make you feel uncomfortable. So be good at saying yes and do not worry so much if something does not seem to go the way you wanted. Those efforts are always rewarded. You also want to grow as a trainee, as well as a colleague and as a person, so be attentive to all those things. With diligence and mentorship, you can do it.

What are some leadership skills to develop as a trainee?
Everyone who reads this article will have a component of leadership in their lives, whether they are expecting it or not. In a small group practice, for example, you will have 10 employees all coming to you every day for direction. Or you may lead a large health system and each has its own challenges. For trainees, it is imperative to develop good habits early on in one's career. Speaking well, communicating effectively, being able to take guidance, being able to express vision, and having the perspective of what is around you are all important things. There is no simple way, to sum up leadership other than a lifelong pursuit. Having those experiences builds successes and failures. Learn from your failures, do not forget your successes, and you will grow continuously.

This article was written by Samip Sheth, a medical student at Georgetown University in Washington, DC, and chair of the ACC Medical Student Leadership Group.