As cardiology fellows approach the end of their fellowship training and start looking for their first job, they face a critical decision regarding their future career: (1) location, (2) salary and (3) academic versus private practice setting. Most graduating fellows today are well-trained in echocardiography, nuclear cardiology, vascular and computed tomography imaging, and are able to manage complex patients. They have worked hard to get several board certifications, obtained excellent recommendation letters from top-notch cardiologists, participated in multi-center trials and published in the high-profile cardiology journals. They deserve an academic position in a world-renowned heart center, in a metropolitan area with a salary far above the Medical Group Management Association average. Soon though many will realize that such job may not exist.

Each young cardiologist should decide which of the three factors are most important, knowing that favoring one would adversely affect the other two. Moreover, it is important to realize that whatever decision they make, "the grass is always greener on the other side". Lifestyle mismatch, low salaries, restricted vacation flexibility or stressful productivity and financial expectations are the most common causes of an early move to another job. Approximately 70 percent of physicians across all specialties change jobs within their first two years.

Unless you end up at a major academic center, maintaining vigorous academic productivity may be challenging. Every cardiologist has an academic core inside of themselves; thus the following advice can be helpful in remaining academically active:

1. Find a Mentor: A good mentor should be a person who will take the time and effort to guide you through conducting research, career decision-making, leadership growth and development of potential in a specific clinical area of interest, scientific paper authoring and publishing. Such scientific leaders possess the patience to listen and consider novel ideas, walk mentees through difficult career decision or research processes and teach them how to optimize and submit their work for presentation or publication. The ACC offers a mentoring program, through which any Early Career cardiologist can find a mentor based on their clinical or research interests.
2. Get an Academic Affiliation: Even if a major teaching institution is not close to your practicing area, an academic affiliation and an adjunct professor position can be feasible, as long as you are willing to dedicate some time to research and/or teaching fellows, residents or medical students.
3. Get Involved With ACC Committees: The ACC provides an opportunity for Early Career cardiologists to participate in multiple committees. It may be time-consuming, but this is a unique opportunity to network with cardiologists from different institutions and backgrounds, exchange ideas and experiences, and develop a special interest or potential in a specific field. Furthermore, these committees through conference calls and newsletters provide an opportunity for continuous education and development of novel research ideas.
4. Attend Annual Cardiology Conferences: During cardiology training and after taking the cardiology boards, young cardiologists are up-to-date with the latest trials, devices and practice trends. Without morning reports, grand rounds and several super-specialists in your new job, you will soon realize the speed of cardiology knowledge expansion, something that was not apparent during the training years. Attending a conference or presenting your work in a major cardiology conference (e.g. ACC's Annual Scientific Session or, etc.) will allow you to realize your deficiencies and get exposed to the most recent evidence-based data.
5. Find Your Niche: Based on special interests and skills, Early Career cardiologists should find their niche. Diversification is important during the first years after training in order to keep skills fresh. However, a special area of focus should be chosen and developed, so that you can become the area "expert". A special imaging modality (i.e., perfusion stress echocardiography, positron emission tomography/cardiac magnetic resonance imaging), catheterization procedure (i.e., transradial/transpedal access, structural, endovascular interventions), a novel device (implantable loop recorder, implantable heart failure devices), or patient specialization in a specific population (women health, cancer patients, patients with kidney disease, etc.) are some of the fields that Early Career cardiologists can choose for their clinical and research focus.
6. Learn How to Perform Research and Publish (Write, Write, Write): Publishing a paper outside of a major institution is not easy. Most peer-reviewed journals accept well "polished" articles in a specific format. Unless you persistently write and get constant feedback by mentors, colleagues, peer-reviewers or editors, it will be difficult to get your work accepted in a major high-impact journal. Moreover, courses at academic institutions and several online courses may help you develop your knowledge on biostatistical analysis, grant submission and manuscript preparation. Global Clinical Scholars Research Training Program is an online program offered by the Harvard Medical School which provides clinicians and clinician-scientists advanced training in the methods and conduct of clinical research. Moreover, several webinars through the ACC Early Career Section serve the same purpose.

Remaining academically active after training may be challenging outside of a major teaching institution. Persistence, a good mentor, an academic affiliation and access to necessary resources are often sufficient to provide opportunities to succeed in an academic involvement. The ACC provides educational resources and opportunities to early career cardiologists and encourages such initiatives.

This article was authored by Konstantinos Marmagkiolis MD, MBA, FACC, from Citizens Memorial Heart and Vascular Institute, Bolivar, MO & University of Missouri, Columbia; and Mehmet Cilingiroglu, MD, FACC, from Arkansas Heart Hospital, Little Rock and Koc University School of Medicine, Istanbul, Turkey.