November 30, 2016 | Michael Goldfarb, MD
International

Lawrence Rudski, MD, FACC, FASE, is the Quebec-ACC governor and president of the Canadian Society of Echocardiography. He is a professor of medicine at McGill University, Montreal Quebec; Director, Division of Cardiology and Director, Integrated Cardiovascular Center, Jewish General Hospital, Montreal Quebec Canada.

Can you tell us about your career journey?

My career choice in cardiology was made during my second year medical school at McGill University. I was influenced by my mentor, David Langleben, MD, who ultimately hired me after my core cardiology training at McGill University and became my Chief. My clinical and research specialty training in echocardiography was completed at the Massachusetts General Hospital under the mentorship of Michael Picard, MD, FACC, and Robert Levine, MD, FACC. I was hired as a full time cardiologist and associate professor of medicine at the Jewish General Hospital at McGill University, and after periods as director of non-invasive cardiology and associate divisional director, I assumed the position as divisional director three years ago and professor of medicine two years ago.

Outside of my own institution, I developed a very involved relationship with the American Society of Echocardiography (ASE). I served on many ASE committees, including co-chairing the ASE Guidelines and Standards Committee, and serving on their Board of Directors until 2014. I also had the privilege of chairing their writing group on the echocardiographic assessment of the right heart. Much of my academic career has focused around this field and the use of echocardiography in pulmonary hypertension, working with my mentor and friend, Dr. Langleben. In October 2016, I assumed the role of president of the Canadian Society of Echocardiography, allowing me to give back more to the Canadian echocardiography community.

Can you tell us about challenges you faced on the way and how you overcame them?

Careers, and academic careers in particular, are more and more scarce. When I was seeking a position, criteria were presented that required significant sacrifice. As someone who grew up in Montreal and trained at the same institution that he was born in, leaving Montreal for a fellowship was daunting – particularly since I already had two children. Even prior to that, getting a funded fellowship was not easy. I sent out applications and either had the door shut on me, or received no reply. One prominent program director interviewed me at  ACC’s Annual Scientific Sessions in New Orleans and it did not go well. The opening lines were, “Dr X, I apologize, I am a few minutes late” - there had been an accident on the highway. The response that I received was “Yes. You certainly are”. Like many challenges, the solution came through a seemingly random act of kindness by Dr. Levine, described below.

Did you have any mentors along the way? Can you tell us about them and how they impacted who you are as a professional?

I strongly believe that mentorship forms one of the most important components of education, together with career planning and development. While I did not take the Hippocratic Oath (choosing Maimonides’ Oath), there is a clear sense of family between the mentor and mentee. I was privileged to have a few major mentors that have influenced my career choice, and have nurtured it well beyond the termination of my training. As I discussed above, Dr. Langleben, one of the leading international experts in pulmonary hypertension, helped me establish my career choice. My first exposure to him was in my second year of medicine - he saved me from a life as a respirologist. He became my program director in cardiology and hired me. He practices medicine and has a lifelong career research track with the singular aim of curing a patient with pulmonary arterial hypertension. He works harder than anyone I know, is always available and treats his patients as his family. He protected me when I was first hired, and enabled me develop the qualities that ultimately gave me the honor to succeed him as director. 

My second and third mentors were Drs. Robert Levine and Michael Picard at the MGH. When I was despairing that I had yet to find a fellowship, I received a call out-of-the-blue from Bob – not his secretary! Never having spoken before, we had an hour-long chat about echocardiography and interests, and this call parlayed itself into my fellowship at the General. Bob taught me how to stretch my mind – to see possibilities that others could not. Bob would say (paraphrased) that if you really understand how things work, you need to design an experiment to demonstrate to others what you already know.

Finally, Mike became, to a great degree, my career mentor. He gave me the opportunities to put my skills “out there”, getting me on scientific programs such as co-chairing an oral abstract session at an ACC Scientific Sessions during my first year on staff. His faith in me allowed me to believe more in myself.  Mike, during his term as president of the ASE, also appointed me to my first committee – the Guidelines and Standards Committee, where I got to serve with  Neil Weissman, MD, who then recommended me to co-chair the committee the next year.     

Can you describe an experience or experiences that shaped the cardiologist you are today?

Serving on the ACC Board of Governors has given me the opportunity to participate in many leadership fora. I recall one speaker talking about the “OSM” or “Oh Sh_t Moment”. Reflecting, I found that my OSM, that was truly career transforming, was when I was asked to chair ASE’s writing group on the right heart. It started very innocently. At my center, the Jewish General Hospital, we have a large Pulmonary Hypertension Center. In fact, when I did a quick search of our database, more than 20 percent of our patients had a systolic Pulmonary Artery Pressure (sPaP) of > 50 mm Hg. I was frustrated with the paucity of guidelines on how to assess the right heart, so I submitted an outline of what I thought such a document would involve. I received a letter from the ASE president asking me to chair the group.  At that point, I had never participated in a writing group – let alone chaired one. I consulted with trusted colleagues who advised me to run with it. As they say, the rest is history – a document that has been cited nearly 1500 times and helped put the RV on everyone’s radar.

If you could give advice to yourself at the beginning of your career, what would it be?

There are three pieces of advice that I usually give my fellows. First – the bank line of credit is your friend. While this seems somewhat glib, it tells them not to sweat too much over money issues. There’s the rest of your life to deal with that and it will be much easier then. Second  – things nearly always work out. There are a lot of uncertainties but if you do what you love doing - and not just what you perceive is the best (sub)specialty to get a job, then you are more likely to excel at it and become sought after. Third - there are always good people out there to give you opportunities (as you can see above). What you have to do is run with these opportunities and transform them into accomplishments.

You are an expert on echocardiographic assessment of the right heart. What fascinates you so much about the right side of the heart?

My interest in the right heart actually grew out of my interest in pulmonary hypertension and how and why it causes patients to deteriorate. Physiology has always fascinated me and I love simplifying things into basic physiologic principles. The simplest equation in cardiology has only two letters and one operator – R=L. This states that in the absence of a shunt, the right heart and left heart are equal in terms of their stroke volumes. In addition, the right heart has many complexities that the left heart does not. One of my great interests is taking something of seemingly infinite complexity and making it simple (though hopefully not too imperfect).

Can you tell us about your role as the ACC Governor of Quebec?

The ACC plays an interesting and complex role in Canada. With formal agreements between the ACC and our Canadian counterpart, the Canadian Cardiovascular Society (CCS), all official activities need to pass through the CCS. In Quebec, the vast majority of cardiologists see the ACC in the same way as their American counterparts (minus the advocacy piece) – one of the leading sources of cardiology know-how, science, education, guidelines, etc. Having just reviewed the membership list as I got ready to nominate my replacement, it struck me how senior the membership was. We clearly need to engage early career members and FITs for renewal.

How do you suggest to improve the engagement of Canadian FITs in the ACC?

The FIT leadership has made some great efforts in engaging Canadian trainees. We participated in this past year’s Jeopardy tournament (and the buzzer system cheated us out of advancing) and will be participating next year as well. Trainees are participating in an ACC-sponsored (by the Geriatric Cardiology Section) “Get Going” Trial using the Fit Bit in elderly post-MI patients. One great way to improve engagement would be more exchanges – both in terms of meetings and workshops at meetings, as well as facilitating cross-border elective rotations to see the strengths and weaknesses of both systems.

Where do you see your next career steps and what challenges do you foresee?

My next trajectory (for those of you who have never seen Pinky and the Brain) is to take over the world – of cardiovascular sciences. My institution has established a new vision of patient-centered care, using the care trajectory models and integrated practice units. I am in the process of fusing cardiology and cardiac surgery into a single entity, not only at an administrative level, but in a unique “on the ground” model. This takes up much of my time and brain power – trying to satisfy everyone, knowing that this is not possible, while maintain the focus on the patient.

With so many demands for your time, how do you maintain a work-life balance?

As I become more of an administrator, it is interesting how I cannot give up either my passion for echo, or my patients. As a director, it’s interesting how you end up with patients that no one else agrees to see (take one for the team) or the super high maintenance ones that are referred to you. So the answer is – you can’t. I described my former chief as 70 percent clinical, 70 percent research, and 70 percent administration. I don’t do the same research that he does, but we are otherwise similar.

In terms of escape from the hospital (other than being pestered by my iPhone), I have three children between 17 and 22 – the middle one hopes to follow in my path but finds cardiology too “boring”. They challenge me constantly. Even though my wonderful wife Marcy trained as a lawyer, she is my most trusted medical advisor – particularly dealing with my human relations challenges. Finally, vacationing to the point of exhaustion makes you forget about the hospital. I knew that when I had come back from my best vacation and had forgotten my log-in for my work computer.

Any parting words of wisdom for FITs?

Really, a summary of what I said before – Remember why you are in this. Do what you love. Run with the opportunities that you are given. And remember – things almost always work out for those for have done the leg work.

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This article was authored by Michael Goldfarb, MD, a Fellow in Training (FIT) at McGill University.