What You’ll Learn

Why do medical students choose cardiology as a specialty? Learn from an early-career cardiologist in a major urban hospitals why, after earning a degree in engineering, he was drawn to return to medical school and the appeal of cardiology: technological innovation, immediate impact, and a choice of subspecialties. Then explore the perspective of a senior cardiologist >>here<< to see how age and experience can evolve those perspectives. 

Interviewee: I graduated three months ago from medical school, and have been a intern at a major hospital in Philadelphia since. .

VIVO: When were you most recently inspired in healthcare?

Interviewee: My background is engineering and I decided I did not want to work sitting in an office by myself. I wanted to work with people, having connection. Not that in the office you don’t have connection, but I felt like I was a computer engineer working in front of a computer and it was not the kind of work that I wanted. I decided to make a major career change and went into medicine and I’m very happy with my decision. People say how did you decide to be a physician? I say I think the question is how did I decide to be an engineer? I don’t know, because as a kid I always wanted to be a physician and then right at the time of college applications I changed and I regret it. Now I’m here.

VIVO: What is it about being a physician that inspires you?

Interviewee: I feel like working with people and making a difference in their lives. I think especially cardiology, especially procedural cardiology, you make immediate impacts in their life. Not that other professions don’t make impacts. Everyone makes impacts on people’s lives like lawyers or engineers. But I feel like in medicine you’re there and you make an immediate impact. You can see the before and after and that’s one of the reasons I chose cardiology. Some professions, it takes months for you to see the results of treatments. Cardiology, I feel like a lot of times, especially if you’re in procedures, is immediate. You fix the problem right away.

VIVO: When is the last time that something tangible inspired your work? 

Interviewee: I feel like one of the other reasons I chose cardiology is the constant innovation. Something that was completely unfixable or untreatable a few years ago can be treated right now. And that’s a reality for many things. If you go back 15, 20 years ago, if you wanted to replace a cardiac valve, you needed to open the chest. You can do it now with catheters. Those things inspire me a lot and make me wonder what’s going to happen in 20 years. What else can we do in 20 years? That’s the real question.

VIVO: What do you think cardiology will look like in 10 years?

Interviewee: It’s hard to say. I feel like AI is going to have a major impact in cardiology and I think in everything else, helping with decision-making. I think also, I’m not sure if it will happen, but I would love to see augmented reality incorporated in cardiology, especially in procedures. So you can see real-time improvement and real-time information about patient condition. I think that’ll be a very relevant tool for cardiology.

VIVO: You may say it’s only been three months, but what wisdom would you say in those three months you’ve gained from being a cardiologist and gaining that working experience?

Interviewee: It’s a very different perspective. Once you finish, there’s a lot of… I feel like it’s a weird feeling. People expect you to know everything when you don’t. And there’s a lot of responsibility and people trust you a lot and sometimes it’s scary.

VIVO: What would you say is not being said in the field of cardiology that should be spoken about?

Interviewee: I think people expect that we can deliver results. When we cannot deliver results, we can deliver treatments and hopeful results, so setting the expectation. A lot of patients, people have a completely different understanding of what getting a treatment means, like a cardiac stent or even a cardiac transplant. People think their life is going to be completely back to normal when it will not go back to normal. Once the problem is there, you cannot completely fix it. That’s something that I feel needs more education. I think people need to be better educated about the fact that the better way to have your normal life is avoiding having a problem. It’s not always possible, but once you have a problem it’s going to be very hard to go back to normal. We can try to make you have a good life, a quality of life, but going back to life as it was before is going to be very hard. Especially if we’re talking about major things, like a cardiac transplant or a cardiac valve replacement.

VIVO: So, managing what that expectation is once you have some level of diagnosis.

Interviewee: Exactly. You can see even people from my immediate family, they don’t realize that we don’t fix things back to normal, we fix things back to something that you can live with. That’s the best we can try.

VIVO: You shared why you made the transition from engineering into cardiology and why cardiology because of the ability to make immediate change. Has it been what you expected so far?

Interviewee: Yes, and I feel like cardiology is a very flexible field, work-wise. You can work in an outpatient environment, you can work in an inpatient environment, you can work in a critical care environment, you can do procedures, you can deal with medical images. You can have everything possible. You can be as close to a radiologist, as close to a surgeon, as close to a primary care physician as you want. I think that’s an important decision that I made in my life. I love procedures, but I feel like I’m not going to… I’m 37 now, I probably won’t be doing procedures when I’m 57, 20 years from now. I’m probably going to move to something a little more chill that doesn’t require as much. I think cardiology will allow me to transition through different phases of my life and help transition my work style, my work life.

VIVO: Tell me about how many patients do you see on a day? I know there’s no such thing as an average day, but roughly how many patients do you see?

Interviewee: It can be anywhere from five to 15.

VIVO: And if you had to take a stab at how many of those patients that you’re seeing fall within a low risk category, moderate risk or high risk?

Interviewee: I would say 25% low, about 40% moderate, and 35% high risk.

VIVO: Walk me through a little bit of your decision-making process for patients and outside of the obvious medical need, how do you determine what treatment is right per patient?

Interviewee: I try to understand how big of an impact the medical problem is making in their life. Also weighing how much risk that condition has because some conditions don’t make you feel anything, but you have a high risk of having sudden death or something tragic. Other conditions, you don’t have a risk of having sudden death, but they’re very symptomatic to the point that they’re affecting your life and affecting things that you like to do. Those are different categories.

I try to inform the patient which situation their condition is in. If it’s something that is not life-threatening, I try to assess how much impact that has on their quality of life because there’s always an option of not treating something because treating is not risk-free. Everything we treat, whether it’s with medications, interventions, surgeries, or anything, has risks. Everything you do has risks and not doing anything also has risks. Everyone needs to be on the same page and understand what the consequences, risks and benefits are that we will potentially provide them. I tell my patients, “Right now you have this situation and once we start treating we don’t know where you can go.”

A lot of those evidence-based treatments, they improve your life but they improve on a population level. When you do a study with 10,000 people, most of those people, that’s when the treatment is beneficial, but the only thing that matters to you is what’s going to happen to you. It doesn’t help saying that 50% of people get better, if you’re not in the 50%. I try to show patients that we have an indication, we are doing something, but things might not go as we expect and we have to manage the expectations. What options do we have if we don’t start a treatment and what options do we have if we start a treatment and something happens? What are the consequences? I try to give them the big picture. I know I’m biased because I’m working in the hospital, so I see the patients that did not go well. That’s why they ended up here. I try to manage my expectations because I have a bias that things might go wrong when most of the patients are outside in the real world living their lives. Those are the things that I take into consideration when sitting with a patient and offering something. Some patients are pretty good at understanding that, some patients are a little more challenging.

VIVO: What differences do you notice in the way you approach your practice compared to maybe a cardiologist who’s got 15, 20, 25 years of experience?

Interviewee: You train with several cardiologists during your training and I think you get a little bit of each of them in your own style and then you decide to build your own style. I feel like being a recent graduate cardiologist, I’m more open to new ideas, more open to new technologies and more open to new things than I think people that have been doing that for 25 years. I get it, you’ve been doing that for 25 years, you probably have good success. It’s hard to change your mindset, to be accepting changes in the things you’re doing. Being successful for 25 years, it’s hard to convince you that you need to improve. I don’t want to be treated with a treatment that hasn’t changed for 25 years. Your patient also doesn’t want that. I think that’s going to be a balance and I’m not sure how we’re going to navigate that. I’m at one spectrum and the 25-year physician is at the other spectrum. I’m not sure how the transition is going to be.

VIVO: What unique challenges or advantages do you experience based on your location in an urban area?

Interviewee: The convenience, you’re in an urban area, you have everything that can be available. In the hospital, you have every resource that you might need available. It helps a lot when things go wrong, but it also makes you sometimes very spoiled by having everything at your disposal. You ask for help and people come to help. That’s good. But that’s not the reality everywhere. I’m not sure how it will be if I have to move my practice to a smaller location where I don’t have all the resources that I need. Those are the things that cross my mind. Being in a city you have all the convenience of life. That’s where I want to be. I don’t want to be anywhere else.

VIVOt: Do you think you have any unique challenges being in a big city?

Interviewee: You do. You have a very diverse population. It’s good. You have a lot of variety, but it’s also challenging when you have the same population, same patients, and same treatment. I feel like it’s easier when you have people, especially if you’re talking about a global city, people come from all around the world. We have all types of things happening and presenting, so that can be challenging. It’s a good challenge, but it is challenging.

VIVO: Can you provide any examples of how your regional setting influences patient interactions or clinical decisions?

Interviewee: That’s what I’m saying, people from different cultural backgrounds, you see people from different cultural backgrounds, very different socioeconomic levels, different educational levels. Sometimes it’s hard to communicate, sometimes it’s hard to break the culture barrier, the language barrier. Sometimes it’s hard to navigate through different educational levels, patient’s understanding of the problem and understanding what we are offering, understanding what the consequences are. I think that’s a major challenge of being in a major city. I feel like if you’re in a smaller city, in a smaller region, you probably don’t have as much variety as you have here.

VIVO: I want to shift a little bit to learning about some of how your work impacts your personal habits and your personal life. Can you tell me just a little bit about what a typical day looks like for you and within that, how you manage stress?

Interviewee: A typical day we start probably at six, I wake up, I have my coffee and then go to work. I start at seven and I work until probably close to six, seven. It’s pretty much an 11 to 12 hour workday. It’s five days a week. That impacts my lifestyle and my life. It’s hard to make time for exercise because by the end of the day you’re tired or at the beginning of the day, you have to wake up earlier than six, so there’s not a good time. That impacts things. You don’t have a lot of time during the day, so it’s hard to eat healthy. I feel like I don’t do the things that I recommend my patients do. Managing stress, it’s not very stressful, it’s a long day. It’s not very stressful. I don’t feel like I have pressure from bosses or different level administration. I feel like it’s a pretty chill environment, but it’s a long day and the hours are brutal.

VIVO: Does the nature of the work itself stress you out ever?

Interviewee: Sometimes. Sometimes it stresses me in that second. I try not to carry that afterwards. Of course when you have a catastrophic situation, somebody’s dying, it’s very stressful. But that’s in that moment, that 30 minutes, that hour that you’re there. I try to focus on what I have to do to get out of that situation. After that I try to decompress a little bit. Be quiet, sit down, do something else for a while. Try to get out of that situation. The patient is already managed, he’s being seen by someone else. You did what you have to do and that’s it. You did your job. That’s it. That’s how I try to think. Because if I keep thinking what should I have done, what can I do, then that never ends.

VIVO: Can you tell me or can you describe any significant lifestyle changes you’ve made over the course of your career?

Interviewee: I think when you start training and you start working, that’s when you… First I had to move. I’m originally from Brazil, I’ve been in Miami, I’ve been in Texas, I’ve been in Philadelphia for training and working. I’ve been all around. That’s a major impact that had on my life. It’s a major change. Also the hours, I feel like I don’t have time to do the things that I like to be doing as much as I had before. That’s why I think at one point I will change my work setting. I like what I do. I’m happy now, but I’m not sure if in five, 10 years I want to be doing the same amount of hours, the same amount of work, the same type of work. That’s why I chose cardiology. I feel like I can transition to a different life, a different work style.

I tried to find a place where I can have a way out. If you’re a surgeon, you can only do surgery, you cannot do anything else. There’s no way you can get away from the OR without having a major career change. If you’re in dermatology, you’re working in the outpatient setting, there’s not a lot you can do. With cardiology, you can work anywhere from being like a radiologist reading echoes and CT scans and not seeing a single patient in your whole day, to something that you do like the job of a surgeon when you’re doing procedures the whole day.

VIVO: What misconceptions do people have about heart health?

Interviewee: There are a lot of misconceptions. One of the things I said is that the best way to have a normal life is preventing you from having a heart problem. Once you have it, it’s very hard to come back from that unpunished. You’re going to have some kind of price you’re going to have to pay. That’s a misconception. The other misconception is that we can fix everything. We can mostly prevent things. That’s what we do best. Once you have it, we do a lot, but the results are always suboptimal compared to not having the disease in the first place. The other misconception is about our lifestyle, about what we do, about what we eat, and that’s a major thing that’s important.

That’s not a misconception, but the thing is, the worst risk factors are your genes and those you can’t change. That’s still a major problem. We can change what we do and that’s probably why you have people eating soda and McDonald’s their whole life and doing fine. And people on the opposite spectrum, eating salad and having a heart attack. Your lifestyle postpones your problems, delays them, which is great. Delaying 15, 20 years is great. You’re living a good life for an extra 20 years, but you’re most likely not going to avoid it.

VIVO: Is there a single most important piece of advice that you give to patients or that you would want to share?

Interviewee: I feel like knowing your family history. Those are your genes. Knowing your risk factors, your diseases, your lifestyle, and knowing how you can improve those are the best way to avoid having a heart complication.

Participant Profile

• Male Cardiologist (recently graduated)
• Philadelphia, PA (urban setting)
• 3 months post-fellowship experience
• Hospital-based practice
• Procedural cardiology focus
• Patient volume: 5-15 patients daily
• Patient risk breakdown: 25% low risk, 40% moderate risk, 35% high risk
• Notable challenges: Managing patient expectations about treatment outcomes, balancing long work hours with personal health, navigating diverse patient populations with varying education/cultural backgrounds
• Unique perspective: Former computer engineer who made career change to medicine