Abstract
As I reflect on my circuitous path, there is no career I would have rather had than to practice medicine. I was recently reflecting on the highlights of my career with my nonmedical friends, and every story was around a patient I’ll never forget: the medical malpractice plaintiff’s attorney who was postop day 1 from a lobectomy for lung cancer when he collapsed and was dying with a massive pulmonary embolus (this was when systemic thrombolytic therapy or open surgical pulmonary thromboembolectomy were the only heroic options available); the 29-year-old patient with severe lupus and recurrent venous thromboembolism (VTE) whose obstetrician told her she could never get pregnant; a 31-year-old high school teacher with a massive pulmonary embolus and iliac artery aneurysm ultimately diagnosed with Behcet’s syndrome; and the 60-year-old man with severe intermittent claudication who felt life wasn’t worth living if he couldn’t walk the golf course.
It’s not to say that I haven’t had other rewarding moments in my career, but centering on patients and what the vascular medicine specialist brings to the table, which no other specialist has the knowledge or experience to manage, is so fulfilling.
To those who are early in your career, you believe you know what you want to do, in what type of environment you want to practice, and your goals for the future. These are all important aspects of career planning. However, there is also a risk that you will limit yourself and miss opportunities if you are unwilling to keep looking around corners, take risks, and raise your hand.
After my internal medicine residency and vascular medicine fellowship at the Cleveland Clinic, I was certain I would stay on staff there for my career. Unfortunately, the Clinic had a different plan, and I was not offered a position. I received several opportunities to begin a vascular medicine and vascular laboratory program in private practice environments across the Central and Eastern regions of the United States. After four failed experiences in four different cities, my self-confidence was shaken. A giant in the field (Thomas Rooke, MD, MSVM) pulled me aside at an SVM board meeting and said that he was worried about me and wondered if I were someone who just couldn’t hold down a job.
During this tumultuous time for me (and my family), I established VasCore, the first-ever vascular device ultrasound core laboratory, which would ultimately become the largest of its kind in the world. That was based on a crazy thought and a series of lucky breaks. Never did I envision the success VasCore would have. It gave me the platforms I have used to build my career, both in the academic environment and in leadership. This was the first ‘aha moment’ in my career. I had an idea that was founded in how medicine was shifting, and without having any concept of what a core lab meant, I went for it.
With the strong support of a friend and colleague (Kenneth Rosenfield, MD), I was offered the opportunity to move to Boston and become the medical director of the Massachusetts General Hospital (MGH) Vascular Diagnostic Laboratory. This position had never been held by any specialist other than a vascular surgeon. I thought this was a crazy idea and in fact, when first approached by this, I immediately discounted it off-hand. This was my second aha moment—if Mass General wants me to do this, and the physicians who oversee the vascular program have confidence in me, why wouldn’t I have the self-confidence to proceed? So, I raised my hand, went for it, and moved to Boston.
VasCore went with me, and the productivity of the lab exploded based on the rapid rise of minimally invasive devices to treat vascular disease without surgery. Today, endovascular therapy is the first-line strategy for most vascular conditions that the vascular medicine specialist manages. However, in 1997, there was no peripheral vascular implantable device anywhere in the world. I hit it at the right time with courage, conviction, and a ton of luck. As a result of the success of VasCore and the confidence of my clinical partners at MGH (it took me 5 years to get anyone to send me any patients), I became academically productive and achieved Professor of Medicine at Harvard Medical School.
In parallel, each time a tough administrative task app-eared, and no one wanted to attempt to solve it, I raised my hand yet again. Quite honestly, I knew nothing about administrative responsibilities in a massive academic medical center. However, I became curious about what was required to be a successful physician leader. With multiple small (and relatively insignificant) projects under my belt, I was given more meaningful challenges to attack. This ultimately led to me running the first multispecialty, horizontally integrated program at MGH: the Institute for Heart, Vascular, and Stroke Care. Working with leaders across cardiology, surgery, radiology, vascular medicine, and neurology, we set out to define what true collaborative care meant. It was a failed experiment for a multitude of reasons (politics, specialty battles, finances, and I’m sure weaknesses in my leadership). However, I learned so much about what it takes to lead physicians in a new way of thinking.
I also talked my way into matriculating at Harvard Business School in the General Management Program. This was the highlight of my learning career. I was energized hanging around people 10–20 years younger than me in business with so many unique perspectives: the CEO of a copper mine company in sub-Saharan Africa, the CFO of Audi worldwide, the President of the Visa credit card company in Spain, the general manager of a chemical company in Germany, and others. I discovered a new way to learn, think, and problem solve. I made relationships with classmates and faculty alike that last today.
Ultimately, I was selected to be President of Newton-Wellesley Hospital, a large community hospital in the near Western suburbs of Boston. Initially I was asked to apply but was told it was unlikely that I would be selected given my lack of prior hospital leadership experience. I loved working at MGH and VasCore was thriving, so I ‘put on the coat’ of the hospital President role during the interview process. I kind of liked how it fit. I was nervous and excited when selected, and in short order, this was clearly my most challenging and emotionally draining job. No one was happy . . . not the physicians, not the nurses, not the support staff (the unsung heroes who are the true engine of any hospital). To fix all the ills within a community hospital is an overwhelming task, and although we did have some success (the first time the hospital was ever recognized by U.S. News & World Report as the top community hospital in the Commonwealth of Massachusetts), I really wasn’t cut out for the multiple emergencies (hospital units flooding, air conditioning systems failing, antiquated electrical grids for a decaying infrastructure) and dissatisfaction of my colleagues with issues that I was unable fix.
However, I was committed to the role and the workforce and pushed forward with several initiatives. Because of the many clinical trials I ran at VasCore, I was ultimately offered the role I have now: Chief Medical Officer of Peripheral Interventions at Boston Scientific. Imagine a medical device company selecting a noninvasive vascular medicine physician to lead the medical aspects of a device division! I had tremendous trepidation about going to ‘the dark side’ of industry. However, the confidence that Boston Scientific leadership had in me as someone who truly understood clinical care, physicians, healthcare administration, and clinical trials led to my third aha moment. This is an energizing, impactful, and fruitful role, which is a delicious capstone to a wild career ride.
As I reflect on the multiple turning points in my career, a few themes emerge that seem to hold true even today:
Have confidence in your clinical capabilities
You are unique in the breadth and depth of knowledge in vascular conditions that no other single specialist possesses. Be bold in letting those around you know how you can help their patients and, in turn, help them.
Take risks
Admittedly, where you are in your career and personal life will dictate the extent of risk you can take. However, if you stop looking for opportunities around every corner in order to grow clinically, academically, and with leadership, you will shortchange yourself.
Raise your hand
Try to take on small projects in your practice, in your hospital, in the SVM. They do not have to be groundbreaking, but the more you volunteer to take on tasks, the more people around you will consider you for bigger and even better opportunities. One caveat—you must be successful in these tasks. So, focus, build a team around you who possess skills and knowledge that complement you, and go for it.
It is and always will be about the patients
As a physician leader, if patient care remains your true North, then you will succeed. The attorney with lung cancer and a chest tube, one day postop from a thoracotomy, did not bleed a drop with systemic lytics. He sent me annual holiday cards for years. I receive annual birthday photos of the daughter of my patient with lupus. The schoolteacher with Behcet’s syndrome, with the help of rheumatology, is leading a productive life now with children of his own. Oh, and the patient who wanted to walk the golf course? He still does.
