Marc D. Thames, MD, is Assistant Professor of Medicine at Emory University and former Chief of Cardiology, University Hospitals of Cleveland and the Joseph T. Wearn University Professor in Medicine at Case Western Reserve University; and Chief of Cardiology, Temple University Hospitals and the Florence P. Bernheimer Professor of Medicine, Temple University School of Medicine. He recently discussed his experiences and thoughts about a career in academic cardiology with Lakshmi S. Tummala, MD, Assistant Professor of Medicine at Emory University.

Highlights

One scenario for medical students, residents, and fellows, is that you find a research mentor, you're working on a project, and then you realize that it doesn't really light the fire in your belly. Any tips for successfully navigating the transition out of that and finding something that's a better fit?

Do not feel intimidated by having to do this. I mean people make decisions. They're not always the right decisions and you need to pay attention and really ask yourself, "Am I involving myself in something that really excites me?" That's very important. If it really excites you, you'll work hard, you'll be successful, you'll be thinking about things that are relevant to your research direction. That kind of enthusiasm and commitment is extremely important.

I had an opportunity like that in my career. When I went to the NIH in 1971, I worked on the physiology of skeletal muscle because I thought I might be interested in studying cardiac muscle, and this would be a great background for that. I went there, I had a good experience, I published an important paper, and then I went back to the Brigham to finish my residency. During that time, it made me think about what is it that I'm really interested in? I had a pivotal conversation with someone who was working in the area of cardiac muscle, and we talked about what I could do to continue my training and he asked, "But are you really interested in this?" And I said, "Not really; I'm really interested in how the autonomic nervous system regulates the heart and circulation."  And he said "Well, then you should go someplace else because there's nobody here for that."  And so that's how I happened to go to the Mayo Clinic, because I identified people who were doing exactly what I was interested in.

You could argue that some of this was just luck. But some of it was very intentional. It's good to be good; it's better to be lucky. But having said that, I've had a lot of good advice along the way which has been very helpful. Don't be afraid to sit down with people who are experienced and who can help you to identify your direction and what you need to do to succeed. These people aren't always necessarily the ones who are in your area of interest, but the ones who can listen and help you understand who you are and what you want to do.

What is your perspective, thinking specifically about fellows who are at a crossroads trying to figure out if they should pursue an academic job?

For someone who's trying to decide what direction to take, they have to first understand themselves and what really excites them. They have to be honest with themselves. So, if there's an area of inquiry that really interests them and that drives, they should absolutely pursue that. If really their interest is overwhelmingly clinical, then they should do that. The key is to be honest with yourself and to understand who you are. If you can do that, then I think you'll make the right decision.

What do you think about transitioning in and out of academic medicine? When I was in training there was always this idea that once you leave [academia] you can never come back.  I found that to be less true as I go through my career. What is your perspective?

There's no reason that you can't transition in either direction. I spent 27 years in an academic career, and then I went into private practice for 13 years, and then I came back to academic medicine sort of by accident. But I've enjoyed everything I've done, and I do have the perspective of having done both private practice and academic medicine. For young people who have left the academic environment but want to come back, there's always opportunity. But for them to succeed, they need the same thing that other young people do - they need mentoring, guidance, and direction. The provision of guidance and direction for young people—during what I would call the developmental phase of their careers—is critical to their long-term success. To just hire somebody into an academic job and not provide them with that kind of mentoring, guidance, and direction would be unfortunate.

Could you provide some general guidance for research for early career faculty?

One of my key pieces of advice to young people is, number one, to be patient. It takes time to develop academically. It's not going to happen overnight, and everybody's in a big hurry right now. That's just the way medicine is. Number two, you're better off developing some sort of a long-term area of research interest, meaning something that will provide you with opportunities over time to test hypotheses and to build a body of publications that will make the academic world recognize who you are and what you're contributing in that area. This is very important for a young person. There are a lot of young people who tend to be clinically focused but also interested in doing research, and they wind up doing a lot of different things, often unrelated to each other. That's not a recipe for success. So, if you're interested in obesity for example, then think about areas where you can marry that to relevant cardiovascular problems. Think about who you need to collaborate with to succeed. Focus on the important questions in that area.

The early period is a time to try to understand what the important questions are in the area that need to be answered, and then to develop plan to answer them. Then it's a question of how you structure all that, and how you get what you need to succeed. That includes things like identifying the key questions, which will then lead to the development of a series of specific aims, if you think about how you write a grant. Then those specific aims, in turn, lead to the experiments for the research questions you're going to answer. Ideally, that can happen early because if you wait too long, it gets harder and harder to do that as you become more committed to patient care and teaching, and then there's more resistance to doing this because you're already committed to those other areas.

Sometimes the mid-career stretch is where academic faculty tend to struggle. There's a lot of support for early career, and by the time you've gotten to a senior level, you sort of figured it out. The mid-career period often coincides with personal and family demands as well. Do you have any specific advice or experience that you can share for that group?

Mid-career people need the same kind of guidance and advice that early career people do. As you become more established and you feel more secure about who you are, what your area of research is, and the directions you want to take, it requires less of that, but it's still very helpful to have senior people around you who can help you stay focused, and who can listen to what you want to do and provide some critical feedback. It's very hard to do these things by yourself. Even the most senior people need feedback. They may get it from different people. They may get it from their department chair, or they may get it from the Dean. But this idea that guidance and direction just stops in the early portion of your career is just not realistic. It has to continue throughout. It's just that different people are involved in providing you with that kind of guidance and direction.

What if there's no one at your own institution who fits the bill as an ideal mentor?

You can Interact with people at other institutions who work in your selected area and who can provide you with guidance and direction. The simple fact that we're having this conversation over WebEx is proof of that. One of the things the pandemic should have done for everyone is to make them recognize how much easier it is than we had thought to interact with people at other institutions. It's very helpful to be able to identify people at other institutions who can also contribute to the guidance and direction that you need, and I wholeheartedly support that. Sometimes that means that your home institution may need to support you to go visit that person and spend a week or 10 days or a couple of weeks working with their team. That accomplishes a number of things. It gives you a sense of the direction in terms of what's going on in a very established program. Secondly, it allows you to think about what you're interested in within that context. You could say it's like a mini- or micro-sabbatical. I honestly think that can be very helpful. I don't know if we do enough of that.

What's the most valuable lesson you've learned about academic productivity?

As you probably know, people feel a lot of pressure to publish. What's important is to publish quality – to publish things that are important contributions to the area that you're interested in. In the long run, that will serve you better than publishing a lot of small contributions that, in the aggregate, don't add up to that much. So be patient and recognize that it's important to work on important questions and get important answers.

Thinking about the future of academic cardiology, what do you think the biggest challenge or expected shift is going to be for fellows and early career attendings?

I've lived through the evolution of what Cardiology is today over a period of a long time—I mean, I started my academic career in 1977—that was a long time ago. Academic medicine has changed a lot in many ways, but the fundamental issues have not changed. Whether you're talking about education, practice, or research, I think the challenges are basically very similar to what they've always been. What has made it more challenging is the environment in which we do this. So for example, in many respects, although NIH funding is much harder to come by than when I started, other sources of funding are proliferating, and I'm actually surprised at how much research support is available, particularly to young people in clinical divisions. So that's a start. Secondly, I think that clinical medicine has changed enormously, and the clinical demands have, of course, increased over time which can make it more challenging to carve out time. The educational mission is also very important. So it's important, to the degree that we can, to be involved in all these areas, but if you really want to succeed in a research area, you really have to be willing to commit the time to it. These are our challenges; things change in terms of the environment, but I think the fundamental principles of how to succeed have not changed at all.

Tell us a little bit about what you do in your free time? Looking back over your career, any thoughts on maintaining a good work-life balance?

I like to exercise a fair amount when the weather is nice. I like to be out on my road bike, and I like to walk. In terms of work-life balance, I'm probably as guilty as many in terms of not doing a good job with that. That's not always the fault of medicine though. We all have choices and we need to decide what the balance of these things ought to be. There have been times in my life where I feel like I didn't make good choices in that regard, and there are times when I think I did. So, to be completely open and honest, I think this is an area that everyone faces as a challenge, but we have to be mindful to commit the time and thought about what the best fit for you is. We sometimes, for example, get involved in research and we get very excited about it, and it sort of sucks all the energy out of us because we're so focused on that. And then we leave behind some of these other areas that are still an important part of who we are.

Are there any career goals that you still feel like you're looking to accomplish?

I'm pretty much at the sunset of my career if you want to think about it that way. I find myself in a very fortunate position to finish my career in a place where I can be involved in publication and education, interacting with young people like you. For me, it's a privilege to do this. Having spent 13 years in a private practice and then come back full circle to academic medicine, it's an environment in which I feel very comfortable. On the other hand, the transition from academic medicine to private practice—I found that very challenging.  I look at where I've come from over these last 40 some years. I think this is a great place to finish and I am having a great time. I enjoy what I do and, in particular, I like to interact with young people and to provide them with what I consider the important guidance and direction that they need.  So, for me, it couldn't be better.