71: An Academic Pediatric Cardiologist Shares Her Specialty

Session 71

Dr. Serena Sah is an academic Pediatric Cardiologist in the California area. We talk about what drew her to the specialty, what she likes about it, and more. Serena has been out of training now for three years.

By the way, do you know of someone whom you think would make a great guest on this show? Email me at ryan@medicalschoolhq.net.

[01:25] Her Interest in Pediatric Cardiology

Serena enjoys working with kids so she knew she wanted to do Pediatrics. She had a six-month-old cardiac patient that had an interesting physiology. Knowing nothing about cardiac disease, she was freaking out and that encounter with the patient was what really got her intrigued by the physiology of the heart. Additionally, pathophysiology made sense to her. She likes being able to figure out the causes of the disease. Going through medical school, she initially didn't have that interest in Cardiology as much as when she encountered that experience. She thought she would do general pediatrics at first but she already had the mindset of going into cardiology.

She admits her intern year was rough and thought of not going any further. But that rotation in cardiology and her interest just peaked again. She also considered neonatology which had intensive care to it. Still, she was interested in the cardiac patients.

[07:11] Traits that Lead to Being a Good Pediatric Cardiologist

Serena says you have to enjoy working with kids and being around kids a lot. Understand that pathophysiology is interesting to you. Some of these kids can get pretty sick so just having a sense of calm under stressful situations.

"You have to be able to know that you'll see kids of both spectrums of severity of illness. You have to be comfortable in that kind of environment."

[08:25] Types of Patients and Her Typical Week

A lot of the patients that get referred into their clinic are teenagers with chest pains, fainting spells, arrhythmia, or minor heart diseases. She would also have a portion of patients where she does neonatal surgery or infant surgery where patients are born with a single ventricle. They would need to have a series of operations and you need to follow them throughout their life. Basically, it's a good mixture of people who have cardiac-related symptoms, heart murmurs, and those diagnosed during their neonatal period and she just follows them through.

Of her patients who come in already diagnoses, Serena calculates it's about quarter to a third of them and she's just following them up. The next quarter to half of them are people that come in with symptoms and they diagnose it. Also, a quarter of them get screened but get discharged without any cardia diagnosis.

Serena works at an academic institution with a large group of cardiologists or pediatric cardiologists so majority of their time is spent on outpatient. Then they do a rotation of inpatient service a week at a time and it happens less frequently. Her typical week would be one to two days of outpatient clinic. She reads heart ultrasounds for 2 to 2 1/2 days of the week. She also does a couple of half day sessions of administrative time or research time.

[12:37] Academics vs. Community

Serena chose academics over community for convenience. She felt she could go either way. But she enjoys teaching trainees. In fact, she looked to both places but it just worked out that her home institution had a position that opened up so she grabbed it. And it worked geographically.

"It wasn't the only thing I was looking at, but it ended up being where I was at."

[13:40] Doing Procedures, Work-Life Balance, and Taking Calls

As a pediatric cardiologist, cardiology is one specialty in pediatrics that is a medical specialty but provides a way for you to do hands-on things. They have a specialty in catheterization and put on cats and heart stents. You can also go into cardiac ICU as a subspecialty which is a third level of training. Then you can do a lot of procedures. Doing ultrasounds is not invasive but these are two subspecialties within pediatric cardiology where you get to work with your hands.

Serena says she has a very demanding position from a clinical standpoint so there's a lot of clinical work involved. Being in a larger group, their call schedule is more spread out. So she's not on call as much versus as she were in a smaller private practice group. That being said, she still wishes she had more time for family and things outside of work.

They usually handle home calls. They do have fellows that do first call where they're screened and their just escalated to them. So they rarely go to the hospital when they're home at night. But during service, they would also cover the weekend which means going to the hospital to round and be there if there are emergency situations. Their fellows also take phone calls so they go in if they need to.

[17:07] The Training Path to Pediatric Cardiology

After four years of medical school, you match into residency for Pediatrics. Then the application cycle has changed since she applied. You have to apply in your second year so you know where you're going by the end of your third year as you graduate from residency. But they've just changed the fellowship application cycle. You apply on your second year and then match in the fall of your third year. Pediatrics is three years and Cardiology is another three years. If you want to do the subspecialty within Cardiology, the trend is to have another year or two of training. Then there's five to six different subspecialties within Cardiology - Heart Failure, Transplant, Imaging, Electrophysiology, Catheterization, and ICU.

Some are also doing a fellow, fourth year, in Hypertension so it makes six years all in all. Others do Preventive Cardiology since there's growing obesity in the younger population. There's Cardiac Genetics.

"There's seven or eight subspecialties that you can potentially train for as an extra year of training if there's something specific in Cardiology that you want to do."

Serena says the more competitive fields are neonatology, critical care, or PICU within pediatrics to match into since a lot of people want go into it. But generally, all are pretty competitive although she doesn't really have the numbers of it.

[21:50] Bias Towards DOs and Working with Primary Care and Other Specialties

Serena doesn't see any negative bias towards DO in general. As with working with primary care, she feels for the pediatricians seeing a lot of patients. When they see referrals from pediatricians, it's difficult for them. So if there's something they're uncomfortable with, then pass them onto them. But they don't mind seeing patients that need to be seen to help the general practitioners figure out who needs further care.

Other specialties she works the closest with are the ICU people, neonatology, pediatric ICU, general pediatrics, hematology-oncology, nephrology, and GI.

As with special opportunities outside of medicine, she knows of several pediatric cardiologists who have gone medical mission trips to help different places and countries. They also have people who work with developing technologies and devices. Research is also one since genetics is becoming a big field that people are interested in that relates to both bench research and genetics research.

"Genetics is becoming a big field that people are interested in." 

For nonclinical things, there are opportunities for teaching. For Serena, her job is more clinical so it's most of what her know. That said, there are people that do AI type of technology that incorporates cardiac information.

[30:57] What She Knows Now that She Wished She Knew

Serena says she has a conflicting view of things. She loves the action of intensive care but she dreads it at the same time being a stressful situation since patients have various outcomes. So she loves and dreads it at the same time. She finds herself gravitating more towards the outpatient stuff where she can be involved in the action but not as directly.

All this being said, she wished she knew more about call in general in that it can be pretty rough during residency and training.

What she likes most about her specialty is thinking through the heart diseases and diagnosing them. She likes being able to educate the family about it which she finds fascinating and rewarding. She likes being able to work the families and helping them through the process.

What she likes the least on the flip side is handling difficult cases and if there's nothing they can do for tough conditions as well as that feeling of being responsible even though you're not if the outcome isn't good.

[35:27] Major Changes in Pediatric Cardiology in the Future

Serena says there's a lot of new technology being developed within interventional cardiology and imaging. They're working a lot with 3D stuff, printing or imaging modalities. They also work very closely with bioengineers. So if you're thinking about going to medical school, Serena says having this background helps. And if you're already in medical school, just be aware of all the technologies up and coming that are potential things to explore going into it.

"There's a lot of emerging technology that will come into play very prominently in the field."

Although she loves medicine and the intellectual stimulus of it, but if she were to go into medicine again, she would still be in pediatric cardiology. If she didn't go into medicine, she would probably be into graphics design or any design-related field.

Finally, her advice to those who are considering this specialty is to be persistent as cardiology training is difficult. Persevere and maintain your motivation and persistence, Have an attitude of learning everything as much as possible within your training time. It's a great field and a very interesting and fulfilling and rewarding field. The process is long but there's a lot of rewards that come out at the other end.

Links:

ryan@medicalschoolhq.net