January 25, 2017 | Purav Mody, MD
Education

Mark Drazner, MD, FACC, is the clinical chief of cardiology, medical director of the Heart Failure, LVAD and Heart Transplantation Program and a professor of medicine at UT Southwestern Texas. Purav Mody, MD, a Fellow in Training (FIT) at University of Texas Southwestern Medical Center, recently sat down with Drazner to discuss his career trajectory, his mentors and how he balances his time.  

What inspired you to pursue cardiology and heart failure (HF)?

MD: Sometimes in life you make a decision that isn’t entirely well informed and yet it works out great –  that was the case with my decision to go into HF. I was finishing my general cardiology fellowship at Duke University where I had the incredible privilege of working in Robert Lefkowitz, MD’s laboratory on gene therapy to potentiate beta-adrenergic signaling as a means to treat HF. I recognized that I wanted to specialize further beyond general cardiology, to focus on a narrower area and become a true expert. Since the basic research I was doing was related to HF, that seemed like an attractive field to me. I had actually considered other options including further noninvasive imaging training and even peripheral vascular disease.

Around that time, however, I heard an interview with Lynne Warner Stevenson, MD, FACC, from Brigham and Women’s Hospital, on an ACCEL tape – yes, that was how they were done back then! She described her approach to characterizing and treating patients with decompensated HF based on a clinical assessment of their hemodynamics. I remember thinking to myself that it would be fantastic to have the opportunity to train with her. Shortly thereafter, Brigham posted an advertisement for an advanced HF/transplant fellow position. I applied, was fortunate to get accepted, and off to Boston I went. I never would have anticipated that I would love the field of advanced HF so much. HF has it all: utilizing the clinical examination and an emphasis on hemodynamics (both of which I have always enjoyed), caring for critically ill patients such that your decision-making is truly important, being able to offer an effective therapy to restore patients to a high quality of life (transplant), exciting and emerging technologies (VADs), and a lot of ethical questions to ponder (as we decide whom to transplant). To this day I still don’t understand why all trainees don’t go into HF!

You have been recognized as a great teacher with the ability to breakdown complex clinical scenarios into simple, easy to grasp teaching points. What is your advice to junior faculty, in terms of achieving similar levels of efficiency when they are start their teaching careers?

MD: Thank you for those kind words. I have been fortunate to have some incredible role models who influenced my teaching style. In particular, when I was an internal medicine resident at UT Southwestern, David Hillis, MD, gave the very best medical lectures I have ever heard in my life. What always struck me was the clarity of his thoughts, and how he could break down complex conditions such as mechanical complications following myocardial infarction into easily understandable concepts. And, he would do that on a chalk board, with no fancy Powerpoint slides that had moving objects!

My advice to trainees would be that when they are listening to a lecture or talk, they should not only listen to the content but also assess the effectiveness of the teacher. Then, when you identify teachers you believe are effective, think about what exactly made them effective; you can then incorporate those techniques into your own presentations. Your goal is not to become a carbon copy of any one person, but rather pick the very best techniques from a group of people. Equally important, you should avoid doing those things that you see in presenters you believe are suboptimal.

Once when we had a terminally ill patient, you stopped clinical rounds and spent the last remaining time by the patient’s bedside. How important is it to balance the constant challenges of administrative duties, documentation and duty hours and our duty towards our patient?

MD: This is a very important question. I worry about this – we all are under increasing pressure to see more patients, fulfill increasingly complex documentation requirements, generate more RVUs, and overall be more “productive.” It is easy to lose sight of the awesome responsibility and privilege we have daily when caring for patients. Literally, our patients are entrusting their lives to us. In fact, how we treat our patients is the crux of being a doctor, of being a professional. In terms of balance, an important rule I have is that patient care can never be sacrificed: if you have to choose, then you must cut corners in one of your other obligations.

In your role as the clinical chief of the cardiology service at UT Southwestern, what is your advice to FITs interested in pursuing academic careers to be competitive for academic positions?

MD: My advice would be to be the best you can at what you do. If you are a clinician/ educator, then become the very best clinician and teacher you can; if your passion is research, then knock it out of the park in your research efforts. Our center, I’m sure like all centers, is looking to recruit “stars,” and it helps tremendously if you have “wowed” the faculty during your fellowship. I would say that if you are interested in clinical medicine, you should still add more to your portfolio – whether it be contribute to the medical literature during your fellowship, develop expertise in quality improvement, or take the lead on some educational initiatives. In our UT Southwestern cardiology fellowship, we talk about developing “leaders” in cardiology, in whatever focus you choose to pursue. Such efforts will help you as you move to secure a position at an academic medical center, in particular, so those hiring can envision how your subsequent career path will be successful.

Who has helped shape your career?

Wow – there are so many. I have to first recognize Daniel Foster, MD. He was the chair of Internal Medicine when I came to UT Southwestern as an intern, and I had the privilege of learning from him through my chief residency. Before I met Dr. Foster, I had liked what I was doing, but it was through his influence that I came to love the practice of medicine. He taught me what it meant to be a doctor. I’ve already mentioned Dr. Hillis’ influence on my teaching style. Sandy Williams, MD, who was the chief of cardiology when I came to UT Southwestern, also had a huge influence on me. After I spoke with him when I was an assistant professor, he was supportive of sending me to the program in Clinical Effectiveness at the Harvard School of Public Health to get formal training in epidemiology and biostatistics. His decision to let me get that training had a huge impact on my research career. There are too many others from my time as faculty at UT Southwestern to mention but I do want to publicly acknowledge Clyde Yancy, MD, MACC; James de Lemos, MD, FACC; and Colby Ayers for their contributions to my career.

At Duke, during cardiology fellowship, Tom Bashore, MD, FACC, and Kevin Harrison, MD, were huge role models for me as master clinicians, and of course, Dr. Lefkowitz on how to approach research questions. Also, the whole culture at Duke promoted the importance of evidence-based medicine and that became deeply ingrained in me. Dr. Stevenson has been a very important mentor for me, both when I was an advanced HF fellow and subsequently as a junior faculty member. She introduced me to the amazing field of advanced HF, showed me how to look for interesting questions during clinical care, and how to treat patients even during the final phases of their journey with HF. I feel like I owe her the most for any success I have had in this field.

The field of HF has gone through different phases. There was the phase of newer drugs starting in the late 80s and early 90s to the phase of devices in the 2000s. What is going to be next phase of innovation and breakthroughs in the field of HF?

MD: There are four areas that excite me the most. First, left ventricular assist devices are improving at a breath-taking speed, and I have great hope that ultimately they will solve the problem of HF for many patients. Second, the field of myocardial regeneration, while still early, seems to still hold incredible potential. Third, technologies have the potential for us to offer personalized therapies; here, I am thinking of implantable monitoring. Finally, I remain very excited about our ability to understand the underlying genetic causes of patients with “idiopathic” cardiomyopathy. I suspect such efforts ultimately will yield targeted therapeutics as in the field of oncology.

Finally, what are the tips you would want to share with current FITs to balance family time with ever-increasing clinical and research responsibilities?

MD: Ah, the holy grail – how to balance it all. I wish I had the magic answer. I do suggest that FITs think about time management skills. I had little exposure to those skills during my medical training, but quickly realized how vital they were once I became a faculty member. Subsequently, I sought out the business literature where a lot has been written about time management and have found useful tips available. For example, try to get the maximum bang for your efforts. If you present a lecture, try to turn that into a review paper, or at least, use that lecture to develop an area of expertise and give that lecture to multiple groups, rather than just one time. Efficiency at work is key to freeing up more time at home. Also, I found it very helpful to be vigilant with my schedule: if there was an important family event like a parent-teacher conference, athletic event, or performance, I put those on my calendar as soon as I knew about them. I then respected those commitments as I would work-related items. 

This article was authored by Purav Mody, MD, a Fellow in Training (FIT) at University of Texas Southwestern Medical Center.