Perspectives

Clinical Academia: Challenging But Possible in Private Practice

Kusum Lata, MD, FACC, FSCAI

Interventional Cardiology, Early Career Physician Chair ACC-CA; Cardiology & Vascular Disease, Sutter Health, California

Kusum Lata, MD, FACC, FSCAI

Interventional Cardiology, Early Career Physician Chair ACC-CA; Cardiology & Vascular Disease, Sutter Health, California

The selection of a career pathway in interventional cardiology after fellowship is quite challenging. Both academic and private practice have their own pros and cons. A paucity of academic positions, shortage of research funds, lack of mentorship, and significant salary discrepancies are major limitations to entering true academic positions. Prolonged training leads to debt burden, and the better salary and easy availability of private positions in desired geographic areas are a major draw for fellows to enter into private practice. These limitations are true across the spectrum of medicine and more so in cardiovascular medicine. Vision is imperative. The time has come to think out of the box in terms of career selection after fellowship in order to satisfy personal, professional, and ethical aspects of cardiovascular medicine. We are privileged to be taking care of older populations with a complex disease burden. To satisfy the needs of our various patient populations, we need to constantly strive for evolution in basic, clinical, epidemiological, and translational research in all aspects of cardiology.

Research and clinical care are equally important for the best patient care. Involvement in academics requires participation in epidemiological or clinical research, which further requires infrastructure such as grants, mentorship(s), and strong support systems. I had always dreamt of having a dynamic career consisting of a strong clinical practice combined with an involvement in active clinical research. Clinical care is important to me to satisfy my desire to engage with patients. Yet to maintain an up-to-date treatment practice, it is of the utmost importance to be involved on regular basis in didactics, society actions, presentations, research, and current innovations. 

As I graduated from my interventional cardiology fellowship and was ready to embark upon an independent career, I faced some limiting factors while looking for a job in the private or academic sector. Due to family reasons, I was restricted to a particular geographic location and there were limited academic positions in my desired area. I could not find a place with good blend of academic work and clinical care, and so I had to decide between a career in either academics or the private sector. I found myself in the real world with a real choice to make. Bounded by geographic territory and the paucity of academic positions in my preferred area, I ultimately decided to start a new journey, combining private practice with clinical excellence/academic research. There was no preexisting pathway, so I decided to pave my own non-traditional path.  I had ideas and plans for clinical academics, but I was unsure about my success.

I joined a large group in a well-established private practice. My practice consists of 100% clinical care. At first, I focused on clinical excellence, which I defined as a practice of outstanding up-to-date clinical care and related research. I practiced a wide range of general cardiology and performed a variety of procedures. Apart from regular interventional cardiology work, I performed high-risk coronary interventions, managed acute and critical limb ischemia, and developed awareness regarding limb salvage. My heart failure training was extremely useful in serving advanced heart failure patients and for the utilization of hemodynamic support devices in heart failure. Advanced radial artery intervention skills helped me spread the awareness about radial-first intervention and radial access in ST-elevation myocardial infarction. Extensive training and comfort with a wide range of procedures helped me take care of patients as a whole. Referring physicians valued cardiac, vascular, and heart failure care collectively. Private practice is not about keeping a solitary corner of a selective clinical niche and forgetting the rest of the medicine. Versatility and comprehensive knowledge help you establish your practice. We do not have thousands of resources and people backing us up, allowing us to become multitaskers. 

Soon my clinical practice was blooming in leaps and bounds, but is this sustainable in a field where we are evolving every second? New medicines, new techniques, and new recommendations are emerging on regular basis. If I am not updating my knowledge and skills, how can I serve my patients best in the future? I found that in my current practice, a clinical research/academics track was not available, but could be implemented, if there was the desire to do so. It was not the career I dreamt of, but I was doing things in a strategic way to accomplish my dream. While I didn’t have a structured clinical research program, I decided to keep active with societies and meetings such as the Society for Cardiovascular Angiography and Interventions (SCAI), Cardiovascular Research Therapeutics (CRT), Transcatheter Cardiovascular Therapeutics (TCT), the American College of Cardiology (ACC), and various other organizations. I had good ground relations with these societies and their leadership from my fellowships, being fortunate to have had great mentors. I always kept in touch with my mentors and kept on making new ones. I continued to update mentors about my clinical work and they helped me evolve clinically all through the years of my early career. I attended most of the national conferences in person, continued meeting with their leadership, and discussed my willingness to be involved in their work, writing, committees, and presentations. My constant presence, commitment to my work, and clinical presentations were well paid and I was recognized as many of these leaders became my regular day-to-day mentors. I started getting opportunities to work with societies at a national level. I reviewed abstracts for various societies, worked on updating their apps, mentored, fostered careers of fellows, and involved myself in many committees and leadership meetings. I connected myself to several journals and reviewed papers on a regular basis. Eventually my hard work was acknowledged, and I received excellent opportunities from SCAI to serve on a few writing committees. I also participated in various leadership trainings that further nurtured my career. I was amazed to see that it was not very difficult to get mentors and many of the leaders at these societies encouraged me to pursue my work, amend it in positive directions, and made themselves available to guide me throughout. 

Working in private practice requires a lot of time. Simultaneous involvement in additional work, whether academics, research, writing, and/or presentations is challenging, especially from a time perspective. At work, I made myself available for my colleagues if they needed me to cover the practice on weekdays, weekends, or during vacations. I offered my peers attentive coverage on regular days, and so did not get pushback from my colleagues when I attended conferences. Most of the time, I utilized my weekends and vacations to attend conferences. I put my hard work and time into the practice, so that during my off days, my practice did not suffer economically. Strong support at home gave me extra time to work on my projects, and my economic support was solid enough that the days off did not affect me economically or personally.

It has not been an easy journey to combine both private and academic work. I faced hurdles, but never gave up and kept working without worrying about success. I never let my challenges dictate my life. Despite limited resources, I continued working with the belief that dedicated and committed work is the only way to achieve your goals. 

Even in the darkest and toughest time, a thoughtful person with a plan will find their way. It is important to pursue your dreams. Even if you don’t achieve them, the journey itself teaches a lot.

Conclusion: Consider “Clinical Academia”

Private practice is not an isolated field. A global perspective is essential to ensure that every physician participates in the advancement of medical therapy and technology. A dynamic balance between clinical work and research is beneficial to treat patients. Durable innovation has led us all, from the era of the Framingham Heart Study to advanced structural heart disease and endovascular and electrophysiological treatment. Our clinical acumen will remain static if we don’t update. Academia in private practice is possible, it is a requirement of the current era, and I would argue it is the ethical responsibility of the cardiologist to our patients and future generations. Pathways to involve yourself with academics while in private practice include initiating regular local educational conferences, maintaining active involvement with societies and journals, seeking national presentations of your clinical work, and keeping in touch with leaders/mentors for their guidance and opportunities. 

Acknowledgments. I would like to offer sincere acknowledgment to my mentors from the Society for Cardiovascular Angiography and Interventions (SCAI), Cardiovascular Research Therapeutics (CRT), Transcatheter Cardiovascular Therapeutics (TCT), the American College of Cardiology (ACC), the Journal of Interventional Cardiology, the Sutter Health System, and my family and friends.

Dr. Lata can be contacted at lata.drkusum@gmail.com.