Well, I'm actually going to skip forward to our next panelist. And the reason being is that, Tacey, I'm not sure if you can see this question, but Pratt asked, I was hoping to get your thoughts on building a career as an ACHD interventional cardiologist. It sounds like he's predominantly ACHD trained. So with that, I'm going to introduce you because I know that's a part of your lecture that you're going to cover, so I didn't want to steal your thunder. So this is Dr. Tacey Downing. She's an interventional cardiologist at Children's Nastaral Hospital, also very involved in the adult congenital heart disease realm as well. She's assistant professor of prebiatrics at the George Washington University. And as mentioned, she's going to talk to us about career path options and pursuits. Take it away. All right, thanks, Alan. Yeah, that was a great question. I was trying to type an answer to it in the chat, but I ran out of time before it was my time to talk here. We'll touch briefly on that in this talk. I didn't focus on it in depth because it was so specific, but I'm more than happy to answer that question a little bit more if we have some time at the end and very happy to talk to anybody individually who has questions about that. So thanks all for the great talks so far. So we've talked about finding that first job and Alan and I are going to follow a little bit on some thoughts with what comes next. Now, my part of this is the bird's eye view. So we're going to talk about a variety of career options and pathways and kind of what the mental process is for finding your professional niche. So it's important to recognize that there is no one size fits all career that works for everyone. So my goal is not to give you answers here on which path to take, but rather to help you raise the right questions. You know, what are the questions you can ask yourself to figure out what it is that you want? You know, keeping in mind that what works for me, what I want is probably not going to be the same thing as what you want and what works for you. You'll probably begin to define your path during your fellowship, but it's important to recognize that you're not locked in. So as others have mentioned, you know, your interests may really evolve at any point in your career based on a number of factors. You may encounter new opportunities, new resources, you know, new exposures, different colleagues who bring different skills or ideas to the table. And it's important to keep in mind that jobs are a lot more diverse than fellowships. So because we almost always train at larger academic programs with similar models, I think it's very easy to be biased into believing that this is the only job pathway. You know, we see what our mentors do and think, okay, I have to do that. That's the only thing I've ever seen. All the way through my training, I've been to big academic medical centers. You know, this is what it means to be a doctor. But in truth, most of us lack meaningful exposure to alternatives like private practice, industry jobs. And so it's important to recognize that familiarity bias and seek out alternative exposures if you're interested. A good place to start is to think about kind of what is my perfect job? Now Arash already touched on some issues like location, work-life balance, you know, practice type in the context of securing that first job. But once you're in the job, I think there's value in exploring it again in kind of the new context of where you are. Even if there are some constraints that make some of your goals not attainable in the moment, it can still give you something to aim for. And you know, as a spoiler, for those of you guys who are not there yet, even the best job is not perfect. So we should not, you know, use that word. It might be better to use the word ideal. If you're spending your time shopping for the perfect job, you are gonna be moving around an awful lot. So I kind of think of defining your ideal job in two buckets, they overlap. But perhaps the easier part for us of defining our ideal job is thinking about the time in the Cath lab. Now, I mean, hopefully we all love to Cath if we're on this webinar and we've made it this far and we're thinking about this career pathway. But optimizing the lab experience will go a long way towards your overall satisfaction with your path. Ellen's gonna talk more about logistics and team building in the next talk. So I'm not gonna duplicate those topics, but you do have an opportunity to define your personal practice a little bit. So do you see yourself as a generalist or a specialist? Is there a particular procedure or population that excites you? You know, there are numerous examples in our field where a young interventionalist develop expertise in a particular procedure and use that to really launch a career and national notoriety. You know, some of you may have met Sham Sathanandam who pioneered a lot of the preemie PDA work or Yoav Dori who developed a lot of the lymphatic work. And both of those guys did that, started all that stuff within the first five years out of their fellowship. If not a procedure, you know, is there a particular population that you love? Like ACHD patients. We were just discussing that. And one thing I've observed is that some of these, sometimes these opportunities or these directions are born out of local need. And so maybe you don't think of yourself as loving the preemie PDA procedure, but your heart center really needs to develop that program. And I think being open-minded towards opportunities that present themselves can open doors for you. It can also establish your reputation as a team player and kind of a doer, you know, somebody who takes on what the team needs at that time. Where there is probably a bit more variability between all of us as interventionalists is in what we do outside of the cath lab. There is a pretty broad opportunity here to define your niche, your interests. Sometimes those are driven by necessity, you know, as I alluded to in the last slide. But since we're talking about what is our ideal job, let's say that it's gonna be driven by your passion. Because I think that's what really, you know, that's what really drives you and gets you going if what you're doing is your passion. Now, it can be a little bit hard to find that. A lot of us in medicine are interested in a lot of things. And so if you say, well, how do I find my passion? I haven't gotten that yet. I don't have a magic answer, but I would suggest asking yourself, you know, what am I doing when I hit that state of kind of flow where four hours go by and I don't even realize it's not, you know, I suddenly look down at the clock and it's 8 p.m., what was I doing for the last four hours? You know, when I get in trouble for not finishing my cath reports on time, you know, what was I doing? Was I doing my research? Was I, you know, thinking about inventing better equipment? Was I teaching? You know, am I doing things like this, involved in society's leadership? I'm interested in advocacy. And a final thought on this, and this is, I think, a mistake that I struggled with a little bit mentally early on in my career, is that your niche doesn't have to be unique to be important. I think it's easy as a trainee or an early career person to say, well, all the good ideas are already taken. You know, I don't have a new idea, but maybe they aren't in your program. You know, okay, so you didn't invent lymphatic interventions but if you've been trained in them and you love them, you're gonna be hugely valuable to an awful lot of programs out there. So it doesn't have to be novel to be important. Maybe you already have a unique skillset or additional training that points you in a certain direction. You know, are you med-peds or adult cardiology trained? For the folks in our chat, are you one of those, a couple of people who might be insane and did combination training in EP? If you haven't, but these populations are interesting to you, is there a benefit to pursuing extra training? And you know, what are the trade-offs there, both personal and professional? You know, can I subject myself and my family to more training years if that's necessary? And does that skill make me more marketable? And this is one where you may have to survey your colleagues a bit because there's definitely a sweet spot in specialization. So I would say that certainly being qualified to see ACHD patients in clinic right now almost certainly makes you more marketable almost anywhere you would go. However, doing adult and ACHD interventional cardiology, you know, where you've defined your niche so narrowly that you need 1.3 clinic days a week in the adult hospital, adult cath lab time, but you know, only for PFOs and pediatric cath lab time, but only for ACHD patients because you don't know how to do neonates. And you know, that's not going to work out because nobody needs that skillset. So it is possible to over-specialize. And you want to reach out to your mentors to kind of, to talk about that if you're considering kind of a choose your own adventure type of career that's, you know, pretty non-standard. We've talked about, you know, defining your goals is great, but flexibility is also really key. The best path at a given moment may be shaped by where you are, what are the needs of the program, especially in the first job, not all your goals may be attainable. And that kind of gets, I think, a little bit to the question that we were just discussing. It doesn't mean that you give up on your goals, but you may need to revise them or table them and set a concrete time for re-evaluation of when and how you're going to achieve those. And then ultimately, how do we pivot from defining our goals to executing them? And this could be a whole talk in and of itself. So just, you know, briefly, I think that early in the career, the challenges are often about negotiating and securing basic resources, things like, do you actually have time for your non-Cath lab pursuits? How do you justify that to your boss? You know, what additional skills help with that? Things like Arash was just alluding to, many academic institutions offer, you know, free or reduced tuition at affiliated universities to pursue things like master's degree or biostatistics courses. Would that help improve your case for more research time or more funding? What concrete resources do you need to achieve that? And if you can identify some of these upfront, the best time to get some of these things is when you negotiate your original sign-on package. I do personally think that's a little bit harder in your first job, maybe than it is in your second job, but we can talk about a little bit of that more in the discussion if we have time. And importantly, who's going to mentor you through the formative years, especially if you've left the nest of your original training institution? I can't stress enough how key mentorship is in guiding you through this early career discernment process. Ask yourself who your role models, they can be within your institution or more broadly. Very importantly, you almost certainly need more than one mentor. This is another mistake that I think I personally made, sort of expecting one person who I sort of, you know, idolized to be everything. And I think it's unrealistic to expect one person to guide you in your cath lab, your research, your leadership, you know, no one is perfect. Everyone has different strengths and weaknesses and expecting everything out of one relationship can set you up for disappointment kind of on both sides. Another thing that's important is looking outside your institution. You know, you may find people who are, can offer you a very valuable alternate perspective. Your best mentor may not even be a cath doctor, a couple of people have noted that so far. But however you go, I'm a big fan of formalizing the mentoring relationship. I'm actually asking your target senior faculty will you mentor me? And setting up regular meetings to kind of ask that person to hold you accountable for your goals and your decisions. Last thing I'll just mention briefly, because in full disclosure, this is an area that I don't have really personal expertise in, is thinking farther outside the box in terms of non-traditional job options like industry, regulatory agencies, essentially kind of non-clinical medicine jobs. These are out there. My observation is that they may be less common in our field because once you leave the cath lab, just because of the procedural nature of things, it can be a little bit hard to go back. You know, procedural competency fades quickly without practice. So if you're gonna make that kind of a decision, I think it's something that you need to think hard about because it may be more difficult to undo, especially as time goes by. But putting this all together into a career path playbook, you know, we want to explore these questions, identify our passions, define the large goals, define then the incremental steps that you need to get there. People talk about having a five-year and a 10-year plan. Sometimes I find that a little bit overwhelming, so I at least maybe say, plan a finite time for reevaluation for where you are, maybe like three to five years into your first job. Is everything great? Okay, but you need to make some adjustments? Or is this completely not working out and it's time to see what's out there? What if things completely go off the rails? You get to a position and you discover it's not what you expected. It doesn't meet your needs, but you just can't move for whatever reason. I would say, take a deep breath and remember there's always something valuable to be learned from your current situation. Is your job not academic enough? You can learn skills like from private practice, like billing. You know, do you not have a good CAF mentor? Okay, you'll learn to run elaborately in your career. So there's always, you know, it's sort of a trope, but there's always a silver lining, I think. Some of you who are involved in Pisces, which is our early career group, may have filled out our recent job survey. And we're going to talk a lot more about this at the SAI meeting in May. So a plug for our session, but I'm going to share this one teaser slide that I think is telling. And we asked early career interventionalists whether their first job was a type of position they had hoped for. And the answer is a straight 50-50. And I think this is really important. The job market can be tough. It's not surprising if your first position isn't your ideal, you're not alone and you can still learn and grow. Remember, your first job isn't your only job. You're smart, you're successful. You're going to help a lot of people. Thanks.

cardiology

career options

career pursuits

flexibility

mentorship