COMMENTARY

Seth Bilazarian Signs off from Clinical Practice

Seth Bilazarian, MD

Disclosures

October 12, 2015

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Editor's Note:
After more than 20 years in clinical practice and 6-plus years with theheart.org | Medscape Cardiology, Dr Bilazarian has decided to leave clinical practice and take a job in industry. This will be the last post in the Practitioner's Corner series. All episodes will remain accessible here.

Seth Bilazarian, MD. Hi. Seth Bilazarian for Practitioner's Corner on theheart.org on Medscape.

Today is my last blog. I'm announcing my decision here on Medscape: I'm leaving the practice of clinical medicine, and therefore, the blog Practitioner's Corner will be ending. I'm here to sign off and say thanks to both Medscape and to the audience.

I've decided to move to an industry job. I'm not moving away from medicine, but am pursuing a new outlet for my experience and training. I'll be joining Abiomed (the maker of the Impella® mechanical circulatory support device) as vice president of interventional cardiology.

I've announced this in my clinical practice and my local hospital, and since my announcement, many colleagues have asked: How are you going to leave medicine? Won't you miss the patients and patient care? This led me to a lot of soul-searching. Soul-searching is appropriate because, like many physicians, my identity is wrapped up in taking care of patients—I've done it for more than two decades. I've done a fair amount of thinking about it. I thought I'd just share a few comments here on this last blog.

I was thinking about the adage that a successful practice is defined as a physician that is affable, available, and able. Although that's clearly true (I've certainly seen that for physicians who are successful practitioners), those are not really the elements that contribute to the many wonderful aspects of medicine that lead to the intellectual stimulation and the emotional reward that are the great parts of our profession.

The Best Parts of Medicine: The Four As

I thought about a different set of As that not just sustained me, but really invigorated me in the practice of medicine. I'll just mention those four.

The first one is probably the most important one, and that is an adoration of patients—to really love patients, to enjoy taking care of them, and to want the best for them. That drives a desire to be good at what we do—to be on top of the clinical literature and to think through adoption of new technologies. Many of the troubles that physicians have run into is from not loving their patients; I'm thinking of physicians who've been guilty of fraud and other kinds of issues. Adoration is number one.

The second is the assessment of new drugs and technologies, including research involvement. That's been another thing that's really invigorated me.

The third A is adoption. I've talked frequently about adoption on this blog, and early and late adoption. That's really an exciting part of our practice of medicine.

The fourth A is action—the actual diagnosis, prevention, and treatment of patients.

Those are the four As that have sustained me. I've been fortunate and blessed in my more than two decades of practice to have a practice and a local hospital who were phenomenally supportive of me pursuing those four As.

The best parts of medicine can't be beat in any other career. Our calling and the trust patients put in us, and the intimate relationships we have with patients, is not only unique, but it is sacred.

I've talked with many physicians (via the Web, on Twitter, personally), and many complain about the burdens of modern medicine. When I challenge them about the best parts of their careers, they all agree that the best parts have not really diminished at all in the past several decades—whether I've talked to an ophthalmologist who delights in cataract extraction, thereby restoring sight, or an orthopedist who delights in a patient's pain relief with joint replacement. It's a consistent theme that the burdens are rising, but the best part of our work has remained unchanged.

I will certainly miss the highs in cardiology. They're extraordinary, whether it's something complex but really important, such as successfully counseling patients on lifestyle changes. I take great pleasure when patients tell me that they listened and they adopted a change in diet or exercise.

I love treating acute heart failure. I love reviewing the risks and benefits of transcatheter aortic valves with patients and their families, especially very old patients—nonagenarians, octogenarians. It's really a delight. Treating a STEMI patient with shock is certainly a real high, as is seeing patients whom I've treated for a very long time. Many patients in the last several weeks have told me that they were one of the first patients that I took care of when I came into practice, so they've been with me for more than two decades.

Crushing Burdens

But the burdens are crushing good physicians. I won't rehash prior commentary, such as my blogs on review of systems and on the tenth edition of the International Classification of Diseases (ICD-10). Physicians, alone and collectively, bear some responsibility for the current healthcare system ills, but the current governmental and payer approach is burdensome, and I think it's putting patients at risk.

The move by physicians to become employed by larger health systems with resources and economic and political clout was thought by many to be a strategy that might create opportunities to improve care and efficiencies—but instead, it's resulted in a complete surrender and acceptance of these additional administrative loads. In many ways, these larger systems are worse than staying in smaller practices. The rise of billing coders and the expectation that coding be perfect or it's completely deficient is a standard not found in any other profession that I can think of, except maybe hostage negotiators and bomb defusers (which may be appropriate for this discussion).

I won't miss having to deal with poor-quality electronic medical records (EMRs) or the weekends I spent trying to fill in the useless phrases required by coders and auditors. I reviewed 10 review-of-system systems. Those are things that I won't miss, and they are just small examples of this rising and crushing burden.

My lament is that it will get a lot worse before it gets better. As a person leaving the practice of medicine, but someone who still identifies as a physician and as a future user of healthcare, I anticipate that because the government and payers have become so fully enmeshed in the physician/patient interaction that the system will need to break even further before there is a will to meaningfully change these inefficient, unproductive, and burdensome parts of the physician workload.

Advice From Industry Docs

Preparing for my move to industry, I talked to over a dozen physicians in industry and medical director roles, from doctors at the three big US drug-eluting stent manufacturers to directors of small startups with only a few dozen employees. I was served a hearty perspective on this career change. None of these directors I spoke with mentioned missing medicine. Most had left practice completely, but a few continued some small presence—once-a-day clinic, or once-a-weekend on call.

All found that the critical aspect of "being a physician"—ie, providing a physician perspective—was something that continued to satisfy them. The physicians in these corporations would provide projections on what would work and wouldn't work, which was critical to the company's success. I was told that industry physicians would be naysayers, but they provided reasoned, critical, and objective insights and felt highly valued by the company leaders. They were just speaking the truth. It was something that invigorated physicians in industry.

The best part of working in industry, according to these physicians, was the continuous learning. They felt that they were affecting healthcare delivery in a broad way with new treatments and research, and improving patient outcomes (actually saving lives), but in a different way than we do as practicing clinicians—with innovations that affected many patients, and therefore quantitatively larger but less directly than direct patient care. These were all things that were the best things that they did.

When I asked each of these physicians, the biggest problem they saw for physicians in industry—the one thing that I heard several times—was arrogance: a physician who might say, "I'm the only one in this room who's ever done such-and-such a procedure." It really shocked me that this was a significant problem that they cautioned me about.

Learning to have a boss was a concern. All of us, as independent physicians, even if we work for larger organizations, practice individually and don't have direct responsibility to a boss. Managing people as a leader was also something that some physicians struggled to become effective at. Adapting to a corporate culture and effectively communicating between silos, and up and down a corporate ladder, were all things that physicians didn't have any experience with. That was something that took them some time to get used to.

It has helped me to talk with these physicians, and their words of encouragement and caution have helped me embrace this new, exciting aspect of my career.

Medscape and theheart.org before gave me an awesome opportunity to communicate and collaborate with physicians around the world. I've had frequent and wonderful communication via comments on the blogs or through physicians emailing me. It's truly Web 2.0.

I thank the audience for listening as I learned how to blog on the job. I hope I have effectively communicated the clinical and practice challenges facing community-based practicing physicians.

I hope our paths will cross both virtually and in reality in the coming years. This is my final sign-off, Seth Bilazarian, on theheart.org on Medscape from Practitioner's Corner. Thanks.

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