Yesterday morning I got to sleep in an extra hour. My young son, running in from his room, was all smiles as it was sure to be a snow day. Outside, I could hear the snow blowers going full throttle as I rolled out of bed. A quick shower, breakfast, and I was off. My car, a four-wheel drive sedan, took to the road well, as I knew it would. I had done this before. Once again, I was one of the few cars on the road. Police cars outnumbered regular cars two to one, signaling that only those who acted in service to our community dared brave the weather. It took a good hour to get in, during which time I found myself reflecting on why I chose interventional cardiology, whether I am happy, and whether I’d do it again.
To be sure, there are many other careers for intelligent and driven individuals – finance, law, or business come to mind. And many of my friends had done just that, balancing financial reward and lifestyle in a way that oftentimes seemed elusive to me. Interventional cardiology, in particular, is a tough life. Not only do we have to wait until age 34 to start working, but our jobs are stressful technically and emotionally, mandates force us to work speedily yet with high quality, reimbursement has declined, and we have been forced to work longer hours and see more patients. The inevitable result? Less financial security despite more time spent at work – a recipe for disaster, both personally and professionally.
Indeed, it is easy to get bitter. We provide a great service to society, yet seem to be less respected than we once were, have fewer allies professionally, get less financial remuneration than in years past, work our bodies under heavy lead for decades, have to roll out of bed at all hours and race to the hospital, routinely log 12-14 hour days and weekends, and sacrifice quality family time. We also run busy practices, and have to deal with increasing bureaucracy – scrutiny over appropriateness, authorizations, and physician autonomy is at every turn. Ours is a physically and emotionally demanding path, one that remains so until we retire.
As I reflect back on the first 10 years of my career, though, I have been happy. First, there is the technical aspect of the job – I love using my hands and my eyes to achieve a technical goal. Be it complex angioplasty with stent placement using a ventricular assist device, performing an alcohol septal ablation, or implanting a mitraclip, the calm interventional suite environment where I can orchestrate success is pure bliss. Second, there are the patient relationships. When you save a person’s life or improve their breathing so they can do the things they love, you have made a real difference to a real person. Nothing fills you with more sense of purpose than these types of human connection, and we are right smack in the middle of them.
Next, there is the intellectual stimulation of academics. Our field has pioneered such amazing innovation, and we can both educate others and perform purposeful research toward further progress. And the future holds such promise in terms of new devices and therapies for some of our most challenging diseases. Writing, teaching, enrolling patients in trials, and using new techniques keep the job both fresh and exciting. Further, there is much to do on the national level, and working with our professional societies or industry on political advocacy, national education, or the technology pipeline provides a strong sense of service to our field and society. And, finally, despite the reduction in reimbursement, we remain relatively well paid.
I can’t imagine doing anything else. It is true that we will face more challenges in the years ahead, and likely less pay and autonomy, and this will be demoralizing given the heavy toll the job takes. But we each have to decide if the confluence and proportion of positives outweigh the depths of the negatives. And it will take a conscious effort to maintain those positives as our landscape changes. For me, the diversity inherent to my job, and the ability to separate work from life, has made it rewarding, while for others one or two other factors may dominate. My advice? Find what aspects are most satisfying to you and maximize those while maintaining a proper balance. That way, if you find yourself at 3 am rolling out of bed for a STEMI, or even on the road in a blizzard trying to safely get in to take care of patients as I was, you too may take a moment to reflect on how you’ve constructed your career and balanced your life. And hopefully you’ll be smiling by the time you arrive.
Dr Naidu is Director of the Cardiac Catheterization Laboratory, Interventional Cardiology Fellowship Program and Hypertrophic Cardiomyopathy Treatment Center at Winthrop University Hospital, and Associate Professor of Medicine at SUNY – Stony Brook School of Medicine. He is a Past Trustee of SCAI, and a current Trustee of Brown University.
Address for correspondence: Srihari S. Naidu, MD, FACC, FSCAI, FAHA, 120 Mineola Blvd, Suite 500, Mineola, NY 11501. Email: SSNaidu@winthrop.org