July 19, 2017 | Georges Ephrem, MD, MSc
Career Development

Each month, the Fellows in Training (FIT) Section newsletter, ACC On-Call, highlights the achievements of one FIT. The Section would like to recognize Georges Ephrem, MD, MSc, an adult congenital heart disease (ACHD) FIT at Emory University School of Medicine in Atlanta, GA. Dr. Ephrem describes his involvement with the ACC, career goals, research interests and advice for new cardiovascular FITs in the interview below.

What roles do you have within the ACC and how did you become involved with the College?

I became involved with the ACC as an FIT at the beginning of my cardiology fellowship. I enjoyed the access to educational resources and then presented my research at many of ACC's Annual Scientific Session conferences and recently chaired my first session. I decided to take on an active role by joining the Adult Congenital and Pediatric Cardiology (ACPC) Section and helped create the ACHD FIT Work Group, which I have the privilege of chairing.

What are your plans after ACHD fellowship?

I am looking forward to a career as an interventional ACHD cardiologist. The ideal setting would be an academic institution where I can thrive as a physician scientist, with clinical responsibilities involving ACHD and interventional/structural cardiology, and pursue my work in interventional innovation and outcomes-based research.

Why did you choose this field?

I honestly believe the field chose me. From early on in my medical training, I was drawn to cardiovascular disease and later to interventional cardiology. The inherent ability to make an immediate difference in a patient's status was extremely appealing and rewarding. Along the way, during my cardiology fellowship, I got acquainted with the field of ACHD. I was immediately under the charm of the challenging pathology at hand, as well as the complexity of the patients' care and their need for qualified, knowledgeable physicians in their particular situation. The opportunity of a lifelong rapport with people who have faced adversity, sometimes from as early as day one of life, and being there for them as they strive to achieve their role and potential in life was not one to miss. This coincided with a burgeoning interest in structural interventions, which ACHD patients benefit from immensely. Next thing you know, I am on a path to become an interventional ACHD physician.

What are your research interests?

Being both a clinician and an interventional operator, my research interests have been in the realms of improving patient care and operator wellbeing. This interest is the rationale behind my work in concepts of fluoro-less and contrast-less interventions, as well as exploring innovative ways to "motorize" Fontan patients in order to delay or even prevent the late complications of such repair. Besides innovation, I am really interested in outcomes-based clinical research, especially in valvular heart disease and interventions. Currently, my focus is on transcatheter pulmonary valve replacement.

What are your hobbies?

As you can imagine, pursuing all these endeavors does not leave much free time for hobbies. However, I am an aficionado of fine cuisine and I enjoy watching a good soccer game whenever I can.

How do you balance life and work?

To say that balance is challenging would be an understatement. Keeping up with a healthy personal/social life while meeting the requirements of clinical education and meaningful research contribution is difficult. Invariably, one must compromise. Patient care always takes precedence. Nights and weekends are allotted for research and very little time is left for hobbies and outings. Thankfully, I am blessed to have a significant other in the medical field, so she shows great degrees of understanding and support. I also have a fantastic group of friends who manage to plan events around my hectic schedule. Finally, family is an unconditional pillar of support that is always a phone call or video chat away.

Who are some of your inspirations and mentors?

I would not be where I am today and where I hope to be in the future without the influential people who have helped shape my career path: Daniel Steinberg, MD, my medicine program director at Beth Israel, especially with his precious advice during my chief resident year; Donna Marchant, MD, FACC, my cardiology program director at Northwell Health in New York, who fostered my path towards interventional cardiology and supported my efforts to break into the ACHD field; Robert Safian, MD, FACC, and George Hanzel, MD, FACC, the interventional and structural program directors (respectively) at Beaumont Health in Michigan, for their great training and vision; and, finally, the amazing leadership at the Emory ACHD program, namely Wendy Book, MD, FACC, and Michael McConnell, MD, medical directors of the ACHD program, Maan Jokhadar, MD, FACC, and Fred Rodriguez III, MD, program director and associate PD of the ACHD fellowship, respectively, Anurag Sahu, MD, FACC, and Camden Hebson, MD, for the path they are carving out before me.

What are the developments in the field of cardiology you are most excited about?

Cardiology is an exciting field par excellence. However, I am mostly amazed by the big bang in the field of interventional and structural procedures, and the thriving technological advances being translated into patient care. We have seen the impact of TAVR on patient mortality and wellbeing. Today, more devices with smaller profiles and better durability are becoming available to deal with all aspects of the cardiovascular system. They represent not only a less invasive alternative for patients in general but also the only prospect for sicker and more complex patients, such as our ACHD population.

What advice do you have for new FITs starting their fellowships?

Keep your priorities straight and be proactive. Remember, patient care always comes first. Focus on your clinical education, sharpen your procedural skills and master the tasks at hand so you can help your patient to the best of your capabilities. By all means, do not be passive: seek every opportunity to learn; draw upon the knowledge and experience of your attendings and your seniors; and get involved with the ACC at all levels (local, regional and national). ACC's Annual Scientific Session is an invaluable asset for FITs. The best way to set yourself up for success is by putting your future in the best hands: yours.

What advice do you have for FITs interested in ACHD?

Become familiar with the field early on. ACHD is an intricate maelstrom of pediatrics, adult, surgical and structural components. It takes a particular breed of people to navigate through it. Know the people in the field, get their impressions and perspectives, and reach out to your peers who have gone or are going through the ACHD FIT experience. Your best asset is the ACHD FIT Work Group. We are always around and are more than happy to be of service (email us at acpcsection@acc.org!).