Interview With Neil J. Weissman, MD, FACC

Neil J. Weissman, MD, FACC

Neil J. Weissman, MD, FACC, is the chief scientific officer for MedStar Health and president of MedStar Health Research Institute. As chief scientific officer, he provides leadership for the development and implementation of specific scientific priorities, with a commitment to further advancing MedStar Health as an academic health care system. As president of the Research Institute, he is responsible for the overall strategic and operational direction of the research arm of MedStar Health.

Weissman is also a professor of medicine at Georgetown University School of Medicine and an internationally recognized expert in cardiovascular imaging in clinical trials. He founded the Cardiovascular Core Laboratories at MedStar Washington Hospital that has provided services for hundreds of multi-center trials, including multiple studies on the effects of medications on valvular and ventricular function, novel prosthetic and percutaneous valve devices, and intracoronary therapies.

Weissman received his medical degree from Cornell University Medical College in New York. He completed his internship, residency and chief residency in Internal Medicine at New York Hospital. He followed his residency training with a clinical and research fellowship in cardiology and a fellowship in Cardiac Ultrasound at Massachusetts General Hospital in Boston.

In the following interview, Weissman reflects on his training, career arc and field of cardiovascular medicine.

Who, what or where in your training inspired your interest in cardiology?

My interest in cardiology started in college well before medical school. I took a physiology course at the veterinary school at Cornell University when I was an undergraduate student. There was a very dynamic lecture by a cardiologist that I loved. To me, cardiac physiology made sense and I enjoyed learning about cardiodynamics. It was then a dormant few years until my first and second years of medical school when I was looking for a research opportunity.

I started working with Richard (Dick) B. Devereux, MD, FACC, at Cornell Medical Center. I spent the summer with him doing research on mitral valve prolapse and the use of echocardiography. From then on, I was passionate about cardiology and particularly the use of cardiac ultrasound. I continued to work with Devereux throughout my four years of medical school. I stayed at Cornell and New York Hospital for my internship and residency, so I worked with him for about seven years in total. We were very productive on the research front using echocardiography to look at mitral valve prolapse and other cardiac diseases, and I left my residency with several publications.

I then applied to cardiology fellowship knowing that I wanted to be a cardiac echocardiographer. I was very pleased to have been selected to train at Massachusetts General Hospital, which has an extremely strong echocardiography lab and a rich history of producing leaders in echocardiography.

What type of professional goals did you develop as a medical student, resident and Fellow in Training?

As a medical school student and resident, I was focused on learning as much as I could about medicine and being as good a doctor as I possibly could. I continued performing research in my elective time, and quite frankly, any other time I could find, including nights and weekends. I always had a "home" in the echo lab, even as I was going through medical school and residency. This activity satisfied my cardiology desire, which meant that when I was not doing research, I was able to concentrate on general medicine.

When I started cardiology fellowship, I dedicated my first two years to becoming a great clinical cardiologist. At the same time, I started to bring in my prior experience in cardiac ultrasound to other rotations that I was doing. For example, when I was in my cath lab rotation, the director knew that I had done work in ultrasound and he immediately introduced me to intravascular ultrasound. This technology was brand new and just going through the U.S. Food and Drug Administration approval process. So, while I was learning how to do routine interventions, I was also fortunate to start an intravascular ultrasound program at Massachusetts General Hospital (MGH).

This experience showed me that even at an early stage of my career, I could apply my experiences in different settings to advance the use of technology in clinical care and emerge as a leader in a specific area despite my junior status. Even though I was a "lowly first-year fellow," I very quickly became the expert in intravascular ultrasound in a premier hospital. I worked with leaders at MGH and we wrote several papers as we figured it out together. The entire cardiology community was figuring out what these images meant and how they could be used. It felt great to become an expert in a technology, but it was even more satisfying to be able to figure out how the technology can help patients, share that information and help assimilate it within the broader national cardiology community.

How did you build relationships with your mentors in medicine?

I cannot overstate the importance of personal relationships – with your mentors, peers and trainees. I was very fortunate to meet Devereux at Cornell, who was welcoming, nurturing, and would take time and effort to teach me – whether it was about mitral valve prolapse, echocardiography or just how to write a paper. At MGH, I had a group of mentors, including Dr. Arthur Weyman, director of the echo lab and chief of cardiology, and Dr. Michael Picard, who was a junior faculty when I was a fellow, who were both excellent. Weyman had a style that always challenged and motivated everyone to do their very best. He is known for producing more echo directors than anyone in the U.S. There were people from around the world who were coming to this lab to learn echocardiography. I was a beneficiary of that environment. Weyman's demanding style was complemented by Picard's mentorship, where we stood side-by-side in the animal lab or when doing the very first dobutamine stress echocardiograms at MGH. I was at the cutting edge of the first stress echocardiograms that were done at the hospital and across the U.S. I was very fortunate to have it all when it comes to mentorship.

What personal qualities or traits did you have that helped you develop successful relationships with your mentors?

I was very motivated to seek out mentorship. I also did my due diligence to make sure mentors that I sought out were experts in their area and had credibility not just in cardiology but also as someone who wanted to mentor. At the same time, I was humble. When I first met one of my mentors, he challenged me if I would be successful in my training and in this field. I reacted to that challenge in a positive way. I was not defensive and did not try to convince him of my conviction. I embraced the challenge as a personal one of what I needed to do to become successful. I let him know that by simply saying "you make a good point and if you give me the chance, I will show you my commitment and ability to succeed." So, I think there is a combination of ambition and humility that allows you to get the most out of your mentor.

Why did academic medicine appeal to you following your training?

I grew up with two parents who did not have the chance to go to college. They are both very smart but they had to work jobs that were not as intellectually stimulating as they would have liked. I made a promise to myself to go into a field that I found stimulating and challenging and intellectually satisfying. Academic medicine by definition does that. It is always something new, whether it is the creation of new knowledge through research or stimulation of intellectual questions through education. It brings me back to the idea of humility. The best educator is not someone who has all the answers but one who embraces curiosity and cultivates it among others. That is why I love academic medicine.

What are your clinical and research interests in cardiology?

My clinical research interests – which started with valvular heart disease and mitral valve prolapse – have evolved throughout my career. I consider myself an expert in cardiac ultrasound and its use in clinical trials. However, the application of echocardiography in clinical trials has become broad over the last 30 years since my first publication.

The MedStar Cardiovascular Core Labs serve as the core lab for numerous multicenter, international trials like TAVR and percutaneous mitral valve techniques. In addition, I have long been involved with intravascular ultrasound. Through that experience, I became particularly interested in intracoronary imaging and intracoronary therapeutics. Much of my work several years ago, in collaboration with another mentor, Gary S. Mintz, MD, FACC, focused on intracoronary disease. Perhaps the highest visibility I achieved was when I applied my expertise in echocardiography and valvular heart disease to understand how diet pills affected the heart and, specifically, the valves. The "Fen-Phen" era was a period of several high profiles and very large clinical trials that were surrounded by a lot of controversy. It was during this period that I also learned about media relations!

What has been your role with the American Society of Echocardiography (ASE)?

I have been very fortunate to ascend in ASE to become the president and be in several other positions of leadership. While I highly value my roles as a governor and chair of the ACC Imaging Council, the ASE provided a smaller venue which gave me a chance to ascend into more positions. Among other things, I chaired Guidelines and Standards for many years, served as the chair of the scientific sessions, was the treasurer of the organization, led a restructuring of the governance to meet future Society needs, and am now the founder of the ASE Leadership Academy.

I believe that medicine is changing so rapidly and dramatically that the only way we can make smart decisions about these changes is to have people in leadership positions that understand both clinical aspects of medical care and business aspects of clinical care. It is true that businessmen and businesswomen can learn about medical care, but they are not going to understand it to the depth that clinicians can. It is much more practical to let clinicians learn the fundamentals of business and apply both together. That is what I have embraced over the last 10 years of my career as the leader of a Research Institute with 300 employees embedded within a health care system.

I have been involved in physician leadership programs within MedStar Health and ASE. As I mentioned above, I founded the ASE Leadership Academy, which selects high potential members who want to ascend into leadership positions. This means bringing in experts like professors from the Wharton Business School to talk about business acumen and what it takes to develop leadership skills in a clinical setting – to make smart decisions from a clinical sense and business sense. In this 19-month program, we use live sessions, virtual learning, experiential learning and peer-to-peer learning in a comprehensive program for a diverse group of select future leaders.

We all live in a clinical world that we think we understand. Quite frankly, there is a whole another world of business around us as physicians that affects our day-to-day life, our daily practice medicine. This idea of clinician leadership is crucially important to the future of medicine. For me, I love to learn about the world in which we live in. It has been eye-opening and, again, very satisfying to be a part of the business of medicine.

How do you view the leadership potential of a clinician?

Leadership potential among clinicians requires a number of traits that are different from those that make a great clinician. A great clinician is someone who is very smart at applying knowledge that they have learned. They are curious and they are trained not to miss things. As cardiologists, we need to quickly diagnose and treat, and that means we rely on our own inherent capabilities. Leadership requires a different skillset. There are a thousand definitions of leadership, but I like a very simple one: to become a leader means there are those that want to follow you. Leadership is recognizing that you cannot do it all yourself. It is having the vision, strategy, communication and interpersonal skills to show people how to get there. It is the ability to help everyone reach their fullest potential and be the very best they can be. In a way, being a leader is similar to being a mentor.

How has the role of a cardiologist changed in the last ten years and how might it change in the next ten years?

Cardiology is becoming more complex. There are more and more subspecialties and sub-subspecialties. It is more challenging to be a great general cardiologist without a level of knowledge of these different specialties. We have become more defined, unfortunately, given our specific areas of expertise, and it threatens "the house of cardiology: as a whole. I also think that when we look at the next 10 – 20 years, the use of different forms of artificial intelligence and machine learning are going to have a dramatic impact on our practice. Many routine things we do are going to be assisted with new technologies. I think that there will be a lot of non-cardiologists doing some of the things that we do routinely. For echocardiography, there are algorithms for interpretation and to assist with the acquisition of echocardiograms. Take point-of-care ultrasound, which is already prevalent in emergency departments and critical care centers in the U.S. As a field, we are going to see a big change in our work.

How would you define your career arc?

My career has transitioned from primarily a clinician with some educational and research work to a researcher and an educator who does some clinical work. I was initially doing research on heart disease and diet pills. That was also the time that I became the program director of the cardiology fellowship across Georgetown and MedStar's Washington Hospital Center. In the last ten years, I shifted again and became much more of an administrator. I oversee the research activity of the MedStar Health System, which includes 10 hospitals and 300 points of care with more than 1,000 clinical trials across a very broad domain, far beyond cardiology. This has been a great learning experience as I apply the concept of physician leadership to administrative activities.

Do you have any parting thoughts for students and trainees?

I would say to enjoy and get as much as you can from what you are doing at the time. We are all in a rush to get to some place while not appreciating what we are doing at the moment. So, get as much out of your medical school, internship and residency as you can. Once you start your cardiology fellowship, it is important understand what you like about cardiology, that way you can prioritize the things you like in your career. Lastly, from a personal perspective, if you enjoy learning and growing, this is the field for you. You will learn and grow. There are no boundaries. If you look at my career, I have been a clinician, educator, research, administrator and leader. I have loved each and every one of those roles and I still continue to grow and explore different areas every day.

Samip Sheth

This article was authored by Samip Sheth, medical student at Georgetown University in Washington, DC, and member of ACC's Student Leadership Group.

"I met Dr. Weissman during my first year of medical school.
He has provided excellent guidance, mentorship and perspective
to me about cardiovascular medicine."