What is our future?
What is our future?
Reflecting upon my career in pediatric cardiology, its dawn was
filled with excitement, learning a new language and gaining skills. We
spent a great amount of time in the cardiac pathology lab learning
lesions and correlating them with angiograms. Left heart catheteriza-
tion and open heart surgery were fairly new concepts. All evaluations
available to us were a careful history, physical examination, electrocar-
diogram (sometimes vectorcardiogram—they existed; look it up) and
thoracic roentgenogram. Any “blue baby” emergently underwent car-
diac catheterization. There was no echo, prostaglandin E1, ECMO, real
intensive care or interventional cath beyond balloon atrial septostomy.
Pacemakers were just on the horizon. The term “house officer” had a
During the daytime of my career, new discoveries such as echo,
MRI, CT, interventional cath, refined operative techniques/care/anes-
thesia, lipidology, prevention of rheumatic fever and adult coronary
artery disease, insights into pulmonary hypertension and cardiomyopa-
thies and refinements in electrophysiology opened possibilities previ-
ously considered impossible. Cardiac pathology continued to be
clarified as it was necessary to present the surgeon with accurate diag-
noses, including subtelities of cardiac conduction tissue passage in vari-
ous lesions. Along with the good came the electronic medical record
which has slowed me down a measurable 1/3. Fortunately, the
younger generation is much more facile with it. It certainly has poten-
tial advantages, but has a long way to go to reach them. Note Dr. Red-
ington’s comments regarding its present state.
Iamatmycareer’s eventide and shadows and colors in the setting
sun allow a colorful and richer view of things. We are on the exciting
crest of applying genetic discoveries beyond diagnosis to possible
treatment. We can now offer therapy to fetuses. Newer technologies
offer amazing insights into imaging, analysis of function and greater
understanding of cell biology. Such have brought amazing never before
considered hope to, for example, boys with Duchenne muscular dystro-
We are discovering new morbidities in an emerging young (and
not so young) adult population that has treated, mistreated and non-
treated congenital heart disease. All of the above stated improvements
are being refined.
We should consider who will be our future. Today’s fellows come
from the millennial generation that is very different from that of my
time. They are smarter and are better scientists. They face terrible
financial pressures from student loans, board examination fees, and
MOC fees. They have greater issues balancing work and home life than
we did. They have partners who are professionals with their own
expectations and time demands. They face incredible scheduling issues
related to co-parenting and job location. They are facile with and
dependent upon social media.
Cardiology fellows are facing increasing difficulty getting the ideal
postfellowship appointment, as discussed in the latest workforce
as well as proven by my own experiences in helping them
gain employment. The most difficult areas for our fellows to find a job
seem to follow those noted in the workforce assessment; catheteriza-
tion, general cardiology, imaging and electrophysiology. Positions that
seem to readily fill (for now) include cardiac ICU, myopathy/heart fail-
ure, and young adult cardiology. Nobody seems to mention cardiac
pathology, a still badly needed discipline that has already lost Drs.
Edwards and Lev, and Drs. VanPraagh and Anderson are senior. Sadly,
RVUs are few in this area.
I offer a few truisms for today’sfellows.
Whatever facts you are learning today will be outdated
Do an extra year in a subdiscipline. Prepare yourselves
by fulfilling the fire in your belly. Your perfect job may
not be available tomorrow, but when it does come up,
you will be ready.
If you work in an academic institution, it is less likely
that you will fall behind.
Spend time in the continuity clinic. If your program
does not have such, demand it or move. When all is
said and done, every cardiologist works in the clinic. It is
the core of your experience and is where you really
learn to be a cardiologist.
Do not accept “in my opinion” or “we do it this way
here.” Be driven by data. If none exist, pursue the ques-
tion until there are data.
As surgery goes, so goes your program. Many fellows
who train in excellent programs discover a different
level of quality when they move to a new, often smaller
program. The frustrations and ethical considerations
that this disparity creates cannot be underestimated.
Solid buildings are built one brick at a time. Don’tbein
such a hurry. It will happen. Your reputation will not be
made in one day (but it can be lost in one). Don’texpect
sudden notoriety, national reputation, or a gush of
referrals on your first day.
Congenital Heart Disease. 2018;13:347–348. wileyonlinelibrary.com/journal/chd
2018 Wiley Periodicals, Inc.
Received: 23 March 2018