Doreen DeFaria Yeh, MD, FACC, is an Adult Congenital Heart Disease (ACHD) Cardiologist at Massachusetts General Hospital (MGH). She currently serves as associate director of the MGH ACHD Program and co-director of the MGH Cardiovascular Disease and Pregnancy Program. She also serves as the director of the MGH Cardiovascular Disease Fellowship. Her clinical focus is on ACHD and Pregnancy & Cardiovascular Disease, particularly high-risk cardiac conditions in pregnancy and ACHD echocardiography.

How did you start considering a career in cardiology? What inspired your interest in the field?
I wish I could say I knew from the moment I started college, but I definitely did not. I came into medical school very undifferentiated in terms of my interests. Initially, I considered surgery pretty strongly. Interestingly, at the time I had gotten some advice that it might not be a great career path for women. Unfortunately, I was a little bit deterred because I had done a number of surgery electives and cardiac surgery rotations and loved it but just seemed to think that wasn't going to be the best career path moving forward. I applied to internal medicine in the primary care track. The medical school I went to had a really terrific primary care and community-based focus which I just loved. I was a primary care resident at MGH. During my intern year and early during my junior year, I realized that the rotations that I just couldn't wait for, that I loved, were more acute care, the cardiac ICU, and seeing cardiac patients. I thought, what am I feeling, could things be going in a different direction? I really spent a long time suppressing that, but it became hard to ignore after a while, and I sought some advice from faculty mentors. They made it very clear that most people don't know what they're going into when they come into internal medicine residency, and you have to really follow the field that you feel passionate about. It made me feel less bad about changing my career path, and I applied to cardiology at that point, thinking that I'd probably work in the intersection of primary care and cardiology. When I came into my cardiology fellowship at the University of California San Francisco and I did my congenital heart rotation, I saw lots of pregnant patients with cardiac disease. I thought, oh my gosh, this is amazing, this is what I love. I took yet another 90-degree turn within cardiology. Most people don't know what they plan to do, and you have to be honest with yourself about what you love doing in the moment and allow yourself the permission to move with that as your interests change. I took a little bit of a roundabout course, but here we are.

What are your clinical and research interests in cardiology? How did you develop these areas of interest?
My clinical interests are in congenital heart disease. When I was on rotation in fellowship, I had never seen patients like that before. It was a whole new cohort of patients, types of diseases, and way of thinking, and I just really loved it. I loved taking care of young patients. We saw a lot of congenital patients who were going through pregnancy and getting to know their families and seeing them bring their babies in after they delivered. That was a big part of my congenital training when I was a senior fellow. It was the patient population, the physiology, the anatomy. Part of it was maybe the rarity of the condition, I loved learning about something that was unusual and unique. Many of our patients came to the congenital clinic saying, I've seen a lot of doctors but nobody really knows a lot about what things will look like for me 20 years from now. It's true, there's not many cardiologists that focus in this area, so I also loved acquiring this unique skill set that was a little bit off the beaten path. I did a focused year of training on heart ultrasound echocardiography and congenital heart disease. At that time, there weren't as many focused fellowships, there weren't actually any in congenital heart disease outside of children's hospitals, so it was a little bit "flying by the seat of my pants" type of training at that point. Now, there are much more structured processes for people interested in congenital heart disease and pregnancy to go through training programs after they finish their general cardiology training.

I direct our fellowship program at MGH, which is a true joy. It's wonderful to participate in the career development of amazing fellows and people I know are going to do great things in the field and to be a small part of that. That's a big part of my job right now. Some of the research I've worked on over time has been looking at different aspects of how ventricular function changes in congenital heart patients over time and how their reserve function may change before their resting function. We translated that into a project around peripartum cardiomyopathy and looking at variability in exercise ventricular reserve in women who've had cardiomyopathies during pregnancy. All of this comes back to hope that we better understand how to risk-stratify patients sooner in their disease trajectory to help prevent problems and to identify problems that are developing sub-clinically so we can more closely monitor and manage them over time. That's a clinical observation I had that turned into research projects. I participated in research that really comes from questions that have come up in my clinical life in the patients that I see. Having that diversity in what I do on a daily basis, with clinical work and echoes and the fellowship, it's very busy but also a lot of fun. I love writing and participating in projects as they come and lending a clinical perspective to help advance research efforts.

How do you balance your roles as a clinician, educator and researcher?
I think one has to be really careful because many of us have a lot of interests and there's a lot of passion around many things. It's important to identify the things you really care about and love and focus your energy and do them well, rather than being involved in a million things and not doing them well, because that could be a big disservice in your career moving forward. You don't necessarily need to do all things all the time in your career. Unlike medical school and residency training, which is a discrete few years in your career, your career as a cardiologist is decades-long, so not everything has to happen all at the same time. I moved into the fellowship director role more recently and now I really focus my energy and efforts there. You have to be careful in how you divide your time so that you're not overcommitting to things and importantly, you're not underdelivering. Just recognize that there's lots of time in your career to get things done, and they don't all need to happen at the same time.

How has the role of a cardiologist changed in the last 10 years and how might it change in the next 10 years?
I really hope we do a much better job at educating all general cardiologists in our training programs about congenital heart disease! It was an area some years ago, even when I was a general fellow, that was still managed by pediatric cardiologists because they have expertise, and they see very unique anatomy and unusual physiology. These patients were growing up and they were adults, but they were being managed by their pediatricians. Certainly, things change as you become an adult. We want to be thinking over decades of their lifetime. I want them to be healthy when they're 80 years old, how do we get them to be healthy without heart failure at 80?! There's a little bit of a difference in objectives and skill set there. It's critically important for adult cardiologists to feel comfortable with congenital heart disease, it's not something that was traditionally part of the foundation of what we taught general cardiologists for a long time. I work with a lot of colleagues who say, "I wish we learned about this as a fellow," but it just wasn't part of what we did. Now we have a better understanding that all cardiologists need experience taking care of these patients and learning the anatomy and physiology because there are far more adult patients with congenital heart disease now who need specialized care than there are kids with congenital heart disease. What happens when they get diabetes or coronary atherosclerosis or arrhythmias or heart failure? We have to manage all of that superimposed on their congenital anatomy. We have a long way to go on better educating adult cardiologists around congenital heart disease. This has been a big focus of mine from an education perspective. We've had CME courses on congenital heart disease for adult cardiologists and nurse practitioners who work in cardiology so that people feel like they have access to learning about these conditions and so it doesn't feel like such a black box. We really are moving along that trajectory and have made enormous strides in the past 10 years to embed this education for all fellows.

What barriers do you see that need to be eliminated to encourage more female medical students and residents to pursue cardiology?
They need to know that it is such a terrific field for a woman! I can't imagine doing anything else. The diversity in what you can do as a cardiologist is enormous. There are so many areas within cardiology that are super sub-specialty niches that remind us that there are so many career paths. We need women in our field. I think it's been a tragedy that we have not seen higher numbers of students and residents considering this field and that it's been slower to see a rise in the proportion of women applicants than other procedural fields like surgery. We have to recognize that, address it, and support our students and residents if they have any inkling of an interest in cardiology. Go for it! You can be a cardiologist and you will be a cardiologist! It's such a great field, I just love it!

This article was authored by Anusha Gandhi, a medical student at Baylor College of Medicine in Houston, TX, and member leader of the ACC Medical Student Leadership Group.