Fellows Course: Overcoming Challenges as an Early Career Physician

Rajan Patel, MD, FACC, FAHA, FSCAI, shares insights and advice to help early career interventional cardiologists overcome challenges. Dr. Patel is an interventional cardiologist and interventional cardiology fellowship program director and CTO PCI program director at Ochsner Medical Center in New Orleans. This discussion was part of Abiomed’s MCS & Complex Coronary Intervention virtual fellows course held on September 26, 2020.

Dr. Patel opens by discussing best practices and techniques for complex high-risk indicated PCI (CHIP) and chronic total occlusion (CTO) PCI, illustrated with several case examples. He also discusses the importance of understanding the indications and contraindications for procedures as well as post-procedure care for patients. 

“You really have to understand the data to support the procedures that you’re doing,” Dr. Patel states. He reviews key findings demonstrating the benefits of PCI and complete revascularization, reduction in MACCE associated with Impella® heart pump support, and data comparing stenting techniques.

Next, Dr. Patel discusses the career advantages associated with being affable and available, emphasizing the importance of engaging with referring cardiologists, cardiac surgeons, physicians in competing groups, internists/hospitalists, ED physicians, nurses, and janitors. 

Dr. Patel also explains how having a mentor, building a team, and discussing cases with partners can help junior faculty navigate challenges. “Here at Ochsner,” Dr. Patel explains, “every Monday morning at 7am we discuss all the PCIs from the previous week with regard to the technical aspects, so we all get better. For example: Where was the distal wire placed? Why was a certain bifurcation stent technique used? Why did we use an Impella versus something else?” Dr. Patel also describes the importance of engaging in a heart team approach with cardiothoracic surgeons, heart failure cardiologists, and non-invasive cardiologists.

Other topics Dr. Patel discusses include interactions with senior staff, nurses, and techs as well as achieving consensus on the use of Impella for Protected PCI and cardiogenic shock. Once again, Dr. Patel emphasizes the importance of knowing and sharing outcomes data and engaging with colleagues to build protocols. Dr. Patel relates an “epiphany case” highlighting interactions and teaching moments with his cath lab team.

Dr. Patel concludes by sharing his mentor’s advice regarding being a good doctor, which is defined by the 5 Cs of commitment, courage, compassion, character, and competence.