Early Career Focus | Moving from fellowship training to early career is an exhilarating time. For me, it meant moving to a new city, buying a real house, and starting a family in addition to my career. Having been well trained in a broad array of cardiovascular diseases and procedural techniques, the world was my oyster.

As I quickly found out, everyone else was equally well-trained, and most of the folks that started before me were even more seasoned and better than me at some things. As such, carving a niche as a clinician educator in an academic institution took some trial and error, as well as strategy.

First, how does one figure out what they enjoy and what they’re good at? How does one develop a style that is both unique and true to his or herself? These are, of course, not easy answers. For me, I quickly jumped into everything. I was performing transesophageal echoes, reading nucs, doing some prevention, seeing patients with pulmonary hypertension, and, of course, treating coronary disease. I worked hard to build relationships in the community and with my colleagues and was willing to see any patient if needed—even at a moment’s notice.

As such, I became known as a “go-to” person for difficult cases that might need to be seen urgently. For me though, this was not enough. My colleagues were well known for very specific things, and I too wanted to develop a niche of my own.

My “aha” moment came when I realized that I wanted to do more than treat people after a cardiovascular event – I wanted to prevent and even help reverse disease, often with less medications. This idea came from numerous patient interactions where I would hear, “Doctor, isn’t there some way I can get better or reverse this without medications for the rest of my life?” I asked myself this question regularly and never came up with the right answer entirely.

While reflecting on what this answer could be, I recalled reading an article about a doctor who was walking with his patients [Dr. David Sabgir of Walk With a Doc (walkwithadoc.org)]. It was then that the proverbial light bulb went off. I knew I needed to walk with my patients and really “walk the walk.” Then, as I saw patients actually want to join me, including many who literally turned their lives around through lifestyle, I wanted more. I soaked up every nutrition documentary, book, article, website, and meeting I could handle. I too went through my own transformations in lifestyle and soon became knowledgeable in this area. I tried all sorts of techniques to encourage my patients to make changes – many were met with resistance and futility. As I refined my techniques and learned more about motivational interviewing and the amazing impact I could achieve with this approach, I worked harder and finally had a few success stories. Patients actually wanted to walk with me and hear the results of my own deep dive into nutrition research.

The rest is history. I was hooked. From that point forward, I decided I wasn’t doing my full duty as a cardiologist without a little lifestyle discussion centered around diet, exercise, and stress relief. I did my own research, presented at grand rounds, gave talks to students, and soon had unknowingly carved a niche I never would have imagined that I would. I was that “walking doctor” who treated cardiovascular disease with lifestyle modification, in addition to the usual techniques I was trained with.

My lessons learned in this process were several: First, see what comes: that is, see what comes your way and file it away – you never know when you will need it. Listen to your colleagues and your patients – there are many gems in these discussions you may not be aware of. Be true to yourself: carve a niche in a place that fits and allows you to be who you are. Work hard to literally practice what you preach and walk the walk. Your career depends on it.

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Andrew M. Freeman, MD, FACC, is the former chair of the ACC Early Career Section Leadership Council.

Keywords: CardioSource WorldNews, Life Style

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