Lessons From Top Cardiologists

What Makes a Physician Leader?

Tricia Ward

Disclosures

March 06, 2017

What does it take to be a leader in medicine? More than 40 world-leading cardiologists have shared their insights in interviews with theheart.org | Medscape over the past several years. We collected their ideas to reveal the keys to their success.

Rocky Beginnings

If you didn't go to an Ivy League school or weren't top of the class, that doesn't mean that you have no hope of reaching the higher echelons of medicine. When the man who quite literally wrote the book on cardiology, Dr Eugene Braunwald, was asked about mentoring people to become leaders, he revealed that he is more impressed by "what knowledgeable people say about the candidate rather than [them] having gone to the best schools or having the highest grades."

Like so many medical students, Dr Richard Schatz was accustomed to being an A student, but he often found himself in the bottom half of his medical school class. He went to the dean in a panic, concerned that he might not be able to cut it. As he recalls, the dean told him, "It's real simple, Richard. You're really just not as smart as you think you are." The dean then advised him to "relax—we picked you for a reason." After his initial shock, Dr Schatz said that he felt relieved. He went on to develop the eponymous Palmaz-Schatz coronary stent.

Drs Julio Palmaz (L) and Richard Schatz (R). Courtesy of Dr Schatz.

Fellow cardiovascular innovator Dr John Simpson, who invented the first over-the-balloon catheter for use in coronary angioplasty, applied to several medical schools and was rejected by all of them. He worked as a bank teller until he was fired for losing golfer Jack Nicklaus' US Open winnings check. Yet Simpson didn't give up; he studied immunology and applied to medical school again, getting into Duke on his second try.

Mayo Clinic's Dr Bernard Gersh admits that he enjoyed the extracurricular aspects of medical school a bit too much and had to repeat his first year (something that wouldn't be allowed today, he noted). He was on the verge of flunking when a close friend was involved in a car accident after partying. "I got called in the early hours of the morning and had to go and identify him.... He died, and it was a wakeup call." Dr Gersh knuckled down to his studies and went from 121st in a class of 122 medical students to top of the class.

Determination

Regardless of class placement, all of these top docs showed grit and determination in their career pursuits.

In the 1970s, Dr Ray Gibbons remembers telling a Harvard admissions representative that he wanted to be a clinical investigator in cardiovascular diseases in a major academic center; the rep rebuffed that goal as a ridiculous idea. At that time, there was no clear career path in academic medicine, but Dr Gibbons got the last word. "I haven't ever followed up to see what became of him, but I know what became of me," he said, "and I ended up doing exactly what I said I would do." This former president of the American Heart Association (AHA) received its Distinguished Leadership award in 2007.

When I take risks, I want them to be big risks.

Tehran-born American Dr Roxana Mehran's medical school plans were upended by anti-Iranian sentiment during the hostage crisis that began in November, 1979. Ignoring her advisor's recommendation to wait it out, she applied to over 65 US medical schools. She didn't get an interview for a single one, despite excellent grades. Unbowed, she went abroad to St George's University in Grenada; even the US invasion of that island didn't deter her from completing her studies. "I just said... I need to proceed because this is what I want to do," explained Dr Mehran, who is now a leading researcher in the field of interventional cardiology.

Try Again, Fail Again, Fail Better

Exploring new areas of medical research will bring you up against the naysayers, so it helps to have a thick skin.

Professor Keith Fox learned this the hard way. When he gave a presentation at the AHA scientific sessions on the potential role of thrombolysis in myocardial infarction, he was mocked by a famous pathologist who called the blood clot a "post-mortem artifact."

At that time, medical students were taught that blood clots had no role in heart attacks. Prof Fox oversaw a reduction in heart attack deaths through the use of evidence-based care as co-chair of the Global Registry of Acute Coronary Events (GRACE) program.

Skeptics doubted the potential of balloon angioplasty in treating coronary artery disease: "Our colleagues laughed at it and said, 'You're wasting your time, this will never work.' But we pursued it," noted Dr Carl Pepine, who published one of the first studies suggesting that angioplasty could be a reasonable alternative to lytic therapy in patients with myocardial infarction.

Dr Judith Hochman was principal investigator of a groundbreaking trial in patients with cardiogenic shock. But getting there wasn't all smooth sailing, and she emphasized the need to be tenacious: "The SHOCK trial took me three submissions to the National Institutes of Health to get funding. The first time it was reviewed, it was sent back 'NRFed'—not recommended for further consideration. That's how poor that one was."

 
Don't get discouraged by the different obstacles that fate puts in your way.
 

Dr Martin Leon explained that he believes in the "Teddy Roosevelt philosophy" to dare greatly. "When I take risks, I want them to be big risks, so if I succeed, I can succeed in an important way. If I fail, I fail." This approach served him well in helping to bring transcatheter aortic valve replacement (TAVR) into US practice in 2011. The AHA included TAVR on their list of top ten advances in cardiology that year.

Dr Simpson—the bungling bank teller—reflected that being an innovator is not for everyone. "Many would like to just keep doing it the way we've always done it. It's easier and simpler." He described himself as having a pretty high threshold for disappointment in his pursuit of novel coronary devices.

Fate and Resilience

Personal setbacks often pose even more challenges than professional ones. An "unexpected hard stop in our life," is how Dr Clyde Yancy described his wife's diagnosis of breast cancer. After she died, he had to face life as a single dad to two young daughters. "You can either look at these experiences and shrink away and just say, 'I don't want to re-engage,' or you can learn from those experiences... and keep trying to square your shoulders and move forward," he said in 2010.

Dr Salim Yusuf had similar advice: "Don't get discouraged by the different obstacles that fate puts in your way," he said in his 2009 interview. Dr Yusuf learned this after undergoing chemotherapy for testicular cancer while also running one of the first big clinical trials in cardiology. "I can't say it was particularly brave. I was frightened. I even broke down a couple of times. But something kept me going. Maybe it [the trial] was a distraction."

Fate can also bring opportunity.

Dr Kim Eagle has held numerous leadership positions within the American College of Cardiology (ACC), but it was his prowess at fly fishing that got him started. While working as a fly fishing guide, he met a philanthropic business man, Don Hopkins, who became his mentor. "He helped my parents pay for college, and then when I got into medical school..., this fellow decided that I was a good investment for him, and he funded my medical school." Coming from a family of four kids and one math teacher salary, Dr Eagle doubts that he would have become a physician without this support.

Dr Magnus Ohman credits pure chance for kick starting his career as a clinical trialist. "I was at a wedding with [investigator] Peter Sleight in Ireland, and he said they needed a man in Ireland—so I became the man in Ireland." That led to his involvement in the ISIS trial on lytic therapy in acute myocardial infarction.

The Pursuit of Knowledge

While he was undoubtedly lucky to have opportunity knock at his door, Dr Ohman could not have taken advantage of this chance encounter if he hadn't already taught himself about research—a subject that wasn't included in his medical training. "The first book on statistics that I read was Stuart Pocock's book [Clinical Trials: A Practical Approach]. I read that and started learning about research," he relayed in his 2014 interview.

This continual pursuit of knowledge is another hallmark of these leading docs.

All of us, at some stage in our career, are part of a social contract where we need to give back.

Adding more strings to your bow need not be limited to clinical information. Heart failure expert Dr Ileana Piña already has an MPH in addition to her medical degree and is now considering an MBA program. Her reasoning: "Physicians are terrible business people.... We're being faced with all these models of care: medical home, bundled payments, accountable care organizations. Do any of us really understand what they mean? I'd like to learn more."

Find a Mentor, Be a Mentor

A common theme among these profiled doctors is that they received guidance and support from those higher up the academic food chain.

"People don't realize the importance of a mentor. Somebody who really believes in you or somebody who is committed to you...these are critical people who really model your life," commented Journal of the American College of Cardiology editor in chief Dr Valentin Fuster.

Being a mentee is not just for the early career physician. "There is a chair of the Department of Medicine at a major university who is mentoring me as I learn this," noted Dr Anne Curtis in 2011, as she prepared to take on that job at the University at Buffalo.

As much as these leaders are grateful for their mentors' guidance as they scaled the heights of their careers, many are careful not to pull the ladder up behind them. "All of us, at some stage in our career, are part of a social contract where we need to give back," explained Dr Paul Armstrong, founding president of the Canadian Academy of Health Sciences.

Cardiovascular textbook author Dr Braunwald agrees, admonishing mentors not to compete with their mentees. "That comes up much more in the research world than in the clinical world."

An example of good practice is that of Philip Poole-Wilson, the late professor of cardiology from Imperial College in London, who was incredibly influential to Professor John McMurray during his training in Glasgow. "People could have seen Glasgow and London as rivals in the heart failure sphere, but Philip was absolutely not like that," recalled Prof McMurray. In that spirit, McMurray is happy to continue the tradition. "When I see all of these young people coming along below me, they are so much brighter, so much smarter, so much better than I was.... It is a privilege for me to try to help them."

I think clinicians as well as academicians can sort of run out of steam because they work too hard.

Stanford Chair of Medicine Dr Bob Harrington credits a fellow blue-collar premed student with getting him back on track when he "was adrift" after his mother's death. "Michael [Collins] took me under his wing.... He believed in this notion of pay it forward." Now that Dr Harrington is the experienced mentor, he suggests that "you have to guide people, but you can't tell them what to do. You have to let them find where they're going."

Mentoring is not the only way to give back. Dr Eagle, our fortuitous fly fisherman, started Project Healthy Schools after learning that his son's school had canceled recess in favor of "tater tot day." He embarked on many other philanthropic endeavors including a recycling program for pacemakers "fueled by my own experience where one person made a huge difference in my life," he explained in 2016.

Work Hard, But Not Too Hard

All of these consummate cardiologists may have been dedicated to their work, but not to the exclusion of extracurricular interests. Many of them had alternative passions, most often sports. "My other dream was to be a center fielder for the New York Yankees," noted Brooklynite Dr Leon, who ran the 100-meter dash in his youth.

Bostonian Dr Harrington's off-field sports dream is to be a radio commentator for the Boston Red Sox. "I tell people that the three things that are most important in my life are my family, my job, and the Boston Red Sox.... Some days my wife will ask if they really go in that order."

Former ACC President Dr Patrick O'Gara played baseball at Yale "when there were fewer people twice my size competing." Later, he was president of the local community little league team that his sons played on.

Before fleeing Austria in 1938, Dr Braunwald's parents took him to the Vienna Opera, instilling a lifelong love of music. The eminent cardiologist took an opera course at New York University with a professor who had a connection at the Met. "I made my debut carrying a spear in Aida. It was a dollar a night, which, with current rates of inflation, would be about $500."

Anne Curtis, MD, on the courts. Courtesy of Dr Curtis.

University of Buffalo Chair of Medicine Dr Curtis has been an avid tennis player over the years. "It is a great stress reliever, in a way, to just focus on something completely different," she said.

Horse riding and travel helped Dr Suzanne Oparil refuel during her time off. "I think clinicians as well as academicians can sort of run out of steam because they work too hard," warned the hypertension expert. Dr O'Gara echoed her concern. "We don't want a work force fatigued, narrowly focused, always thinking about career."

Their Advice

When former World Heart Foundation President Dr Sidney Smith was asked if you had to have a huge ego and/or be a jerk to be a good leader, he replied that, "Charisma is an important factor in leadership, but good leaders are good listeners, and good leaders understand their people."

A universal recommendation from these top docs for the next generation of medical leaders is to follow your passion. "I tell them to go where they think that they will have fun. Don't try to figure out where the money will be or where the success will be," said Dr Ohman in 2014.

SHOCK trialist Dr Hochman concurred. "Follow your passion. Work hard. Become part of a team." Dr Fuster tells fellows: "You have to work on a project that is risky and is going to make your life if you succeed."

Dr Nanette Wenger, who entered Harvard Medical School in 1954 when women doctors were a rarity, recommends stepping outside of your comfort zone to investigate unexplored areas in medicine. "If you believe in yourself and believe in what you're doing and begin the investigation, you then become the leader in the area—the go-to person," she advised.

Do you have advice for aspiring medical leaders? Please share it in the comments section.

Follow Tricia Ward on Twitter: @_triciaward

For more Cardiology follow us on Twitter: @theheartorg

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