1. Please describe your educational and training background.

I completed my medical school at Seth G.S. Medical College and K.E.M. Hospital in Mumbai, India  in 2011. I completed my Internal Medicine residency at the Mayo Clinic in Rochester, MN; and then stayed on for cardiology fellowship, followed by cardiac electrophysiology fellowship at Mayo Clinic Rochester.

2. What are your future career plans and/or goals?

I just graduated fellowship in 2020 and am currently in my first job post-fellowship. I am an electrophysiologist at the Mayo Clinic Health System in Eau Claire, Wisconsin. The cardiology division has 12 cardiologists, 1 electrophysiologist (that's me) and 3 cardiac surgeons. I continue to spend some clinical time at Mayo Clinic Rochester. My clinical goals are to continue to grow our clinical practice here in Eau Claire, and increase the scope of the procedures being performed here. For example, we are in the process of building a VT ablation practice and expanding our lead extraction program here. We are planning to start hybrid convergent ablation procedures and a Watchman device program soon. My research goals are to continue studying non-compaction cardiomyopathy and outcomes in arrhythmias and devices in that patient population. I did focus on innovation in cardiac EP during my fellowship; at some point I may head to the large animal lab to continue that line of research.

3. Please describe a typical day in your cardiology subspecialty.

Although each program is a little different in terms of how you spend your time, there are basically three aspects to a cardiac EP fellowship. The most important aspect is the time you spend in the EP lab learning how to perform extremely complex EP procedures – and that should be the bulk of your fellowship. The second part is doing EP consults on inpatients, and third is EP clinic. Most programs also have built-in research time. I'll spend a little more time describing the EP lab, since that is the crux of the fellowship. There are two main kinds of procedures: devices and ablations. In the EP device lab, you will learn how to implant various devices: pacemakers, ICDs and CRT devices. Depending on the program, you may also learn how to perform lead extractions and implant Watchman devices. As to the ablation practice, it ranges from simple ablations like AV node ablations and SVT ablations to complex ablations using 3D mapping, which includes AFib ablations, VT ablations and PVC ablations. In most programs, you will start out with easier procedures that you may have even already done in cardiology fellowship, and then work towards the more complex procedures.

A typical day for me at the Mayo Clinic EP lab would start pretty early. It would start with a morning conference, typically at 6:30-7 am. I would then round on patients we had done procedures on the previous day. At around 8:15 or so, our first patient would be ready for their procedure. Procedures typically last all day, however the time taken by cases is variable: I have reached home as early as 5 pm, but there have been times where I have even had to stay till midnight if we have had a very complex case! The cases also tend to be much longer than other cardiology procedures; sometimes a complex VT or congenital flutter ablation can take all day. Consults and clinic are pretty standard, similar to all subspecialities. Mayo was a very procedure heavy fellowship, where we spend 4 days in the lab, and 1 day on consults/clinic. At Mayo, the general cardiology fellows do the EP consults and staff with the EP attendings. However, different programs have different schedules- some programs may have up to 6-8 months consult time. Consults are very important to gain expertise in clinical decision making and learn to take care of complex EP patients. Clinic is usually a half-day continuity clinic, which is standard across most programs. We get patients for procedures from both the hospital and the clinic. For example, patients with complete heart block or pacemaker requirement are usually inpatient consults; whereas patients with afib or SVT requiring ablations or patients with HFrEF requiring CRT come for procedures from clinic. So you can see that there is a mix of some urgent, even emergent EP procedures, as well as elective procedures (which are the majority).

4. What were you looking for in an EP fellowship, were you looking more at the disease spectrum or were you looking purely at lab vs consult time?

That's a great question. Everything has to be based in clinical medicine first, and assessing patients is key. Hence, you may be looking for a program with a lot of consult exposure. For me personally, I did over 3 months of EP consults as a general cardiology fellow- hence, I was looking for fellowships with robust lab exposure. Most cardiology fellows do look at EP fellowships that have more time in the lab. I was also looking for a diverse and balanced lab experience, with the full range of procedures being performed there. However, if you know ahead of time what you are interested in or what you think your career trajectory is going to be like, you can think about programs that are well-known in one specific kind of procedure. For example, there are programs focused on VT ablations and programs focused on extractions. In general though, I do think it is a good idea to go to a more balanced program.

5. What is the most challenging aspect of your career path?

EP is definitely a challenging subspeciality. One of the most challenging aspects is the education and the steep learning curve: you need to put in a lot of time behind the scenes learning about it, since it is so very different from anything you have done before in IM or even cardiology.You have to pick up a lot of core EP concepts that are going to guide you for the rest of your career and learn how to perform procedures; at the same time you have to keep up with all the new developments. EP is growing tremendously, both in terms of technology and indications for procedures, and it can be challenging to stay abreast with the latest happenings.

Another challenging aspect is time. You have long days which can be physically and mentally draining. Academic practices generally have longer hours, because of additional academic responsibilities and having more complex cases referred to you. It may look long and boring on the outside, but I truly don't know where the time disappears when you are in the lab! It is definitely a good idea to get a taste for these procedures during your cardiology fellowship if you are interested in EP, by doing electives and going to the lab – this will help make sure that it is the right fit for you. Although you may enjoy the time you spend in the EP lab, there will be other people in your life who depend on your time. Your family needs to be supportive of this career choice and need to be OK with you being away for long days. That said, EP is an extremely rewarding field. You get to treat a diverse patient population ranging across all age groups, and can help many patients.

6. How did you identify your mentor(s) and develop a successful mentor/mentee relationship?

My mentor is Dr Sam Asirvatham at the Mayo Clinic. He has been my mentor since I was an intern at Mayo. At that time, I had an interest in cardiology but did not know much about EP. I was introduced to him by a peer who had done research with him, and highly recommended working in his lab. After our very first few meetings, I was convinced that EP is the right subspecialty for me.  He is an amazing doctor, an incredible teacher and truly a great person. He has contributed so much to resident and fellow education at Mayo and I would say he has greatly influenced my career.

While looking for a mentor, you need to ask other people and peers in your program who they have worked with. Secondly, look to see if the mentor has a good track record in presenting and publishing. Look at their publications and see how many of their articles had a fellow as the first/second author. Lastly, try to meet and see if you are getting along with them- sometimes things just click! Pay attention to your instincts.

The biggest tip I can give you in cultivating a mentor-mentee relationship is to ask for help when you need it, and be open to advice. Stay in touch: I have seen that sometimes residents  find a mentor, cannot fulfil their obligations for some reason and then break contact with the mentor, which results in the deterioration of the relationship. Be honest with your mentor, and tell them what challenges you're facing; you'll find that most times you can work through any difficulty together.

For residents that may not have many mentors at your institution, try to network and connect with people at attending meetings, away rotations at larger programs and using programs like the ACC mentorship site.

7. What advice would you give residents interested in pursuing cardiology?

You are considering a great field- cardiology is incredibly rewarding and a wonderful specialty to be working in. It is a field that is only going to get busier as the population ages, and as indications for procedures continue to expand.

Once you realize that you are interested in cardiology during residency, try to get as much clinical cardiology exposure as you can during your electives, over and above your scheduled cardiology rotations. Try to attend the cardiology conferences that are going on at your institution. Matching into a cardiology fellowship is definitely competitive, and your research background will play a big role in landing a fellowship position, definitely at an academic center. Try to get involved in projects early, and have some presentations/publications before you apply.

You don't have to decide your subspecialty early on- just keep an open mind to all the subspecialties cardiology has to offer. This is especially important when it comes to research- for example, if you have a great mentor in EP but later become more interested in interventional, don't give up! Fellowship directors are looking more at the fact that you are dedicated to this subject, and can carry out a project from start to finish. Finding mentors at your own institution is very important, too. Lastly, being involved with professional societies like ACC as well as attending meetings will help with networking and building contacts with faculty and peers. This will help not just with applying for fellowship, but also with research collaborations as well as applying for jobs in the future.