Dr. Califf: So Colorado was a good choice for you then, but then you moved on.
Dr. Smith: It was a great choice because we loved to ski. You play tennis at altitude with low-altitude balls. Your serve goes like you have never seen it. All you have to do is bring a few balls from sea level, and they don't believe you. You have to serve first.
The Move to San Diego
Dr. Smith: So I went to San Diego, which was a big move.
Dr. Califf: What was the attraction there?
Dr. Smith: Do you remember in the early 1970s, when cardiovascular disease was the exclusive domain of academic centers? There was not a lot of bypass surgery going on out in the community. So I was invited to go out and head up the program at Sharp. Pat Daily, who had been a superb cardiac surgeon, left the University of California, San Diego (UCSD), and we started that program. We did the first heart transplants and left-ventricular assist devices going back in the late 1980s/early 1990s. The idea that I had was that if this makes sense, it has to be done outside of academic centers.
So I was in that early wave of people who were involved clinically in academic centers. I didn't have what I needed to do research out in the community. But I never could have done it without John Ross. When I went out there, I said, "John, I feel very uncomfortable about this and I'm not sure I want to leave completely." He said, "We'll bring you on the clinical faculty." He got me into the Ischemic Heart Disease SCOR (Specialized Centers of Research). K Kirk Peterson was a phenomenal partner, and the people at UCSD were very good to me.
Dr. Califf: That doesn't happen so often now, does it?
Dr. Smith: No. We had fellows who rotated with us, such as Howard Rockman and Kirk Knowlton, who are now heading programs. They were great fellows. So I got into an Ischemic Heart Disease SCOR and was able to write papers, and I kept it alive.
But that was a difficult domestic decision, because when we were married I asked Lucy where she wanted to live. She said, "I will follow you everywhere you go, and that includes Texas and Alaska, but I never want to live in southern California."
I said, "Don't worry. I'm from Delaware, you're from Minnesota; trust me, it's just not going to happen." So she was not enthusiastic about that move to San Diego, but it turned out that San Diego was wonderful. Charles Manson was up in Los Angeles, and we didn't know what it would be like to raise a family out there. It's a crazy place. It turned out that San Diego was really a fantastic place to raise a family.
Dr. Califf: Yes, from my experience in San Diego, I don't know how you possibly left it, because almost every day is a perfect day.
Dr. Smith: I agree, and when we got out there, we ended up recruiting a lot of people. The program took off and really, at one point, it was the third largest in California. It was a very busy program.
I told my partners -- we ended up recruiting 3 or 4 people from the Brigham calling it "Brigham West" -- I told them that if the first thing someone says when you ask him, "Why are you looking at the job?" is "I want to live in San Diego," then don't take him, because he's never going to be at work; he' s going to be on the beach. On your weekends off, you are able to be outside. We played tennis, which is what I really enjoyed doing then. It was a great group of people; they accept you for what you are, what your ideas are, without an extensive background check of where you came from.
Another Move, to UNC
Dr. Califf: So why did you go to UNC of all places?
Dr. Smith: I had never been at UNC. Throughout my time in Virginia, every summer I had 1 or 2 students who would come and work with me. They were usually merit scholars; they were highly motivated, and every one of them has gone on to Sarnoff Fellowships; Stanford; University of California, San Francisco; University of California, Berkeley; MD programs; PhD programs; or to Duke, and then out to the West Coast.
They were good people. The fellows coming over from UCSD -- they have written about 75 papers out there with Ross and did some of the first angioplasties with acute myocardial infarction in 86 patients back in the late 1980s.
I always had an interest in doing a little bit more, although I love taking care of patients. People said, "If you leave, you are never coming back. It just doesn't happen." Then I had the opportunity to come back, to go to Chapel Hill. I had never been to UNC. Most of the people I knew were from Duke. I was impressed at the balance that they have in terms of basic research, the School of Public Health, and a solid clinical program that is maybe one half or one third the size of Duke's, but a good program.
I felt that this was an opportunity, and so it has worked out that I have had about 17 years in what would be termed "private practice" and maybe 22 now in academics, if you count Colorado as academic. I feel lucky to have had that combination.
Dr. Califf: Yes, UNC is a great university. Looking at it from 8 miles away, it is full of amazing opportunities, but it is also big and there are a lot of things to navigate. The balance is good, but then the balance requires a lot of trade-offs.
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Cite this: Life and Times of Leading Cardiologists With Rob Califf. Guest: Sidney Smith - Medscape - Dec 11, 2013.