Life and Times of Leading Cardiologists With Rob Califf. Guest: Sidney Smith

Robert M. Califf, MD; Sidney C. Smith, Jr., MD


December 11, 2013

In This Article

Still Seeing Patients

Dr. Califf: In the midst of all of this, you are still seeing patients.

Dr. Smith: Yes.

Dr. Califf: Would you recommend that people continue to do that even when they have big administrative loads?

Dr. Smith: No; I think it's a personal decision, particularly if you are heading a large operation or if you are the chief of cardiology. The role of mentoring the young faculty is very important, and I don't know how well that is done. It takes a lot of time, and now there are many responsibilities involved with hospitals. There are arguments about how much you are getting paid for EKGs, who is billing for this, who did this plan. There are a lot of very important administrative duties that keep you from being just a regular professor of medicine in cardiology who gets to ask questions and write about them, and also see patients.

I also feel a responsibility. There is nothing like picking up a guideline when you are seeing a patient and saying, who wrote this? You are living with what you write, and that is an important experience in life.

Advice for the Next Generation

Dr. Califf: As you look back, speaking to the younger people who may be reading this, what is your advice? If you were going to become a cardiologist today, what would you focus on and what do people need to be thinking about?

Dr. Smith: First of all, I still see cardiology as a great field, a great career, for patients of both sexes and all ages, you can make a difference. If somebody has something wrong with their heart, you get to know them in a manner that is really different (highly personal and complex). I had patients in San Diego for 18 years, and now some in Chapel Hill for 15-17 years. You really get to know those folks. That is a special relationship. It is very fulfilling, and very rewarding.

I would advise them to take care of the whole patient. It bothers me to see an interventionalist who says, "I don't do prevention, I don't think about the medical therapy" or somebody who is involved in prevention who doesn't understand that there are times when revascularization can make a difference. We are also looking at patients who are becoming older, so you really need to think about them, about how many other things are going on. It's a more complex decision.

Dr. Califf: If someone was pursuing academics now, what would you say? It's a complex world, isn't it?

Dr. Smith: Yes, it is. Bob Levy said that if you go into academics, you have to have a gimmick. He was saying that you have to have something that is a little special that you need to do. I would say, what's not special about taking care of patients? There is nothing quite like having a faculty of good doctors, and you are teaching the students to be good doctors. Isn't that what these medical schools are at least in part about?

But in academics, you have to make some sacrifices. You have to be willing to live a life that is slightly different economically, and you need to be willing to spend weekends and nights writing and working on papers because the time to do that is not always, as they say, protected or set aside.

It is an incredibly rewarding career. If I had continued doing only patient care, I'm not sure that I would feel as happy or as fulfilled as I do now with the international and the national work. Academic medicine is still a great career, but I think medicine in general is great. There is absolutely nothing wrong with going into a community and doing a good job of taking care of patients.

Being a Good Leader

Dr. Califf: Sid, I really appreciate you spending the time. I have to make one other comment. You have had these amazing accomplishments and you are a real leader, but sitting here talking with you, you are like the most humble guy I have ever met. A lot of people would say you can't be a leader unless you are a jerk and have a huge ego. Any last comments about how to be a leader without that?

Dr. Smith: Certainly, charisma is an important factor in leadership. But good leaders are good listeners, and good leaders understand their people. Good leaders need to communicate well. There are times when you do have to come in, assess the situation, and make a change. But a lot of good leadership is like a good football team. You need to know who is on the team, what they do well, and figure out what the best strategy is for that team and encourage people and let them do what they can do well.

Dr. Califf: That's great advice. We'll stop there, and thanks so much for spending the time.

Dr. Smith: Thanks, Rob. It's been fun.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.