Hi, everybody. Welcome to the Sky Webinar, Transforming into a Leader in the Cat Lab, the Art, and the Strategy. I'll take a minute to introduce our program faculty. We have Nadia Sutton. She is my amazing co-chair. Nadia is Assistant Professor in the Division of Cardiovascular Medicine, Section of Interventional Cardiology at the University of Michigan. I'm board-certified in interventional cardiology and serve as the Medical Director of the Women Heart Center at Ascension Providence. We have Benita Shah and Alison Dupont who are our moderators for today. Benita is Assistant Professor of Medicine, Director of Internal Medicine Residency Research, and Associate Director of Research in the Cardiac Cat Lab at NYU. Alison Dupont is a board-certified cardiologist in interventional cardiology and cardiovascular diseases at Northside Hospital Cardiovascular Institute. Our panelists are Rania Swaiss, Megan Quailwright, and Hoeda El-Sayed. Rania Swaiss is an Attending Interventional Cardiologist at Northwestern Memorial Hospital, Clinical Practice Director at Northwestern Medicine Cardiology Outpatient Clinic, and an Associate Professor of Medicine at the Feinberg School of Medicine. Megan Quailwright is a funded research scientist, mentor, and leader in interventional cardiology, serving as Director of Structural Heart Program at the Erlanger's Heart and Lung Institute. Hoeda El-Sayed is the Director of Cardiac Catheterization Laboratory at Rady Children's Hospital San Diego, and a Clinical Professor of Pediatrics at UC San Diego. This is the agenda, which has been emailed to everybody and will be starting momentarily. Well, thank you Nishtha and Nadia for planning these webinars. I think they sound so fantastic. Looking at the questions and the panelists, we've been so excited. We even said in the green room that we're not sure how this can ever be done in one hour, but we will try and hopefully the discussion will just keep going. I would have put in a little bit more thought into my intro. It took me five years, but I did finally put in my promotion paperwork, and that could be a whole other topic in and of itself, especially for those who are in academics. But I say we just dive right in. No one needs to hear more about us and just our titles and whatnot, but let's just get right into it because I think the discussion is good. The first question was, what are the differences between academic, private, hospital-employed, and hybrid career models? There's a diversity here on the panel, even diversity within academics. There's diversity in private practice, a lot of diversity in hybrid models. I do find that even amongst hybrid models and that a lot of the private practices, you're now shifting a little bit more towards the hybrid model, but not all of them. Maybe we can just go around the panel and talk about what practice model you're in. Rania, you want to start? Absolutely. I'm at Northwestern University in Chicago, and I would say that it's a completely academic model. The majority of my time is interventional, so in the cath lab, and I have interventional fellows and general cardiology fellows that work with us in the lab. Our model actually doesn't include many texts, so we don't really have a text scrubbing with us in our cases because we've got our fellows. Then I round in the CCU between six to eight weeks, and so that's my exposure to other trainees, and so we round with medicine residents, a fellow, and sometimes we have some medical students. My work in the academic setting is primarily teaching and administration, although I do have some research work as well. Most everybody here is in academics to some degree, so I'm curious as to how you chose to do academics. If one of you wants to comment on that, I'd be curious to know. Well, my answer to this is always you have to figure out what you love to do. If you don't love whatever it is you want to be doing, you will not get far. For me, the harder part is figuring out what you want to do and then figuring, and then you put those pieces of the puzzle together and find the job that has the right balance that gives you what it is you're looking for. When I started 11 years ago, and I said I'm looking to do research and like an academic interventionalist at the time, I was told there's no such thing. That does not exist. Very few role models were out there, and if they were, they were just so big. They just seemed so unreachable, but my answer is first figure out what it is you want to do and then find the job that fits that because that job doesn't have to be academics. That fits all of it, right? A hybrid practice model can fit all of the things that you love doing without some of the hassle of the overhead academics, but Megan, what about you? I mean, you just moved. Institutions and geography, those were big changes. Any differences between the two, what you like, what you didn't like? Most of the time when I share my experience, I like to try to be really controversial, so let me try to do that just to provide food for thought. I just made a move from Dartmouth down to Erlanger. I moved down to Chattanooga, Tennessee, and the hospital where I am was traditionally a private practice model, and five years ago, they started a cardiology fellowship. It is primarily still, for most of my colleagues, more of a private practice model, but they're really excited about the research that we're bringing, which is fun, but one of the aha moments I had in this job search when I was looking at very traditional, prestigious positions is that I think that there may be a connection between some of the sexism and harassment that we face as women in interventional cardiology and academic institutions that traditionally have a high profile. We know that throughout the country, when there are harassers that are in academics who either bring the institution and a reputation through their research funding or through their productivity and national reputation, that it is harder to address that behavior, and what I found is at the institution where I am, an incredibly supportive and collaborative group of individuals that have the patient's needs right at the forefront and has allowed my own research and academic career to expand at a completely different rate than where I was before, so I think one of the reasons why we choose academics is because that's what we were told equaled success all the way through our training, and boy, if you didn't get into that model, then somehow you were failing, not only failing yourself, but your mentors and what they expect of you, so I do think it's important to, as we expand diversity in interventional cardiology, to really blow up that idea of what is the right place to be or the right model to be in. As women, there's little that'll hold us back, so you put us in an environment where you've got friends around you and success follows, so sometimes that might be in a center that you had not envisioned yourself based on the models that were placed in front of you during your training, just a little controversy there, not saying it's always right, but a recent experience of mine. Great. I think that comes down to what we say about you have to figure out what you love, and then I'm gonna add to it, you have to figure out what your ethos is, what culture fits you, what personalities fit you, so it's not just what you love to do and then figuring out the job, but also what the ethos of the practice is, because I'm in an academic institution, but I'm also, so it's NYU, we're affiliated with Bellevue and the VA, and I would say the culture may be slightly different across both the main campus and the two affiliates, and my partners are different across the three campuses, and I found my home, I found what fit me, but honestly, it took me 11 years at my institution to try to navigate different areas to figure out what it is that made me happy, what it is that allowed me to thrive, what is it or what was it that allowed me to want to continue to support my colleagues and support them thriving, allowing that whole group dynamic to be great, because it's not just about you, it's really about that group dynamic, and that only comes from different people. Sorry. No, please. I'm the only pediatric intervention cardiologist here, I'm the director of the Cath Lab, I think I echo both what Benita and Megan say, you have to find what makes you wanna go to work, what makes you tick, what makes you happy? It doesn't have to be academic, it doesn't have to be private, I've done both, and I've been very productive research-wise in both places, but as Megan was saying, initially, it was like, oh my God, you have to be in academics, but you don't, and then also there's the phases of your lives, right? Because you're at different phases, like when your kids are young versus when your kids are older, there's different things that affect you and your choices and your time management, and so there's no reason you can't go from one to the other or change paths based on where you're at and where your family is, because at the end of the day, you want to have a balanced life, you want to have a successful career, but at the same time, you wanna have a family that your kids know you and know who you are and you feel like you've contributed to their lives, and so I think it's a balancing act and you can do it either in academic or in private, but you have to find that harmony and that comfortable environment where people around you are understanding of your situation, your family, you're productive, and they understand your productivity is gonna differ depending on where you're at in the stage of your life and they understand that and appreciate it and work with you. I think those are fantastic points. Megan, how would you, I know that there's probably some people thinking, well, how do I find a practice that isn't malignant? Is that something that I can avoid right off the bat coming out of training or with my first job? How would you say that that's something that you can investigate before? Or is it, is it something you just have to experience? Well, I know Allison, so I know that she's gonna have some knowledge around this as well, and guess what? We all do. So I think that, I will say this, sometimes when I tell that story, I do feel inside like, why can't those other spaces be mine? Why can't they be a place where I feel respected and honored and work in collaboration? They will be someday, I don't doubt that. But it's true that currently there are many, many, many cath labs where it is going to be a challenge to find a group that is not just so scared by your excitement and your energy and your brilliance and your innovation and everything that you bring to the lab, that you just, you're raising the bar the minute you walk in there from fellowship and they're like, whoa, whoa, whoa, we had it fine before you came. And so I think I would just suggest and answer your question for new fellows that are looking for jobs that just give yourself a break. Like it is a tough field that we've chosen and you have friends around you at other institutions to help support you. And if you're in a tough environment and that first job will certainly not be your last. And we all have drawn strength from one another. And that I think is gonna be a theme as we go forward. And as we continue to train our colleagues on what it means to support someone in the cath lab, as I invited all of our colleagues, men and women to this session to learn more about it, we'll get to a point where we'll have safe environments in many places. But Alison, I'll turn it back to you. Very well said. You can develop safe environments like you said, by involving all of your colleagues as much as possible. A lot of questions come up that way on how do you transform that environment? And sometimes it's not transformable. Sometimes there's too many characters that just don't fit your, I don't know, whatever your persona. But there are other times where it is. And I mean, we've been in situations, all of us have been in situations where we've tried to change things. And the question comes up, how do you change those things? I'd love to hear what some tips or tricks other people have used. But for me, I think, I didn't necessarily go in saying, how could you not do this? Or how could you do this? Or I went in sort of saying, well, I'd like to do this. And I hope that's okay. And I'm just new to the group and whatnot, but this is what I'd like to do. And I would just sort of lay out my plan. And when you lay out the plan ahead of time, no one seemed off guard when we were in the lab. So we were switching from, essentially, I was the first radio operator and one of our affiliates. And I just laid it out and I said, listen, I'm just gonna need a little extra time in the beginning, but this is where I'd like to focus on right now. And then people hang out in the control room and they watch and they see you IVSing more and they see you using physiology more and they start seeing things. And then they're like, huh, maybe I'll do that. And some sort of like a very subtle pickup, per se, that happened to be just how things sort of went along for me. But I know everyone has a different experience here. So Rania, any thoughts? So interesting, I had a similar experience to you. So I ended up leaving where I trained for a year, not necessarily anticipating to come back, but then sort of life situations changed. And the place that I, this was 12 years ago when radio was just kind of taking off. The place that I went to was almost all radio. And I realized, like, it was one of these places where there were diagnostic proceduralists and then we would come in for a PCI. And that sort of totally took off with me because I realized, hey, there's no difference. I'm doing these PCIs the same. And I walk in and, oh, it's radial versus femoral. So for me, that transition kind of happened. And then when I came back to the institution that I trained at, I came back with a skill that allowed me to offer something that was different. So, because I think sometimes that transition is a little bit interesting if you stay at a place that you train. But I came with new knowledge and skill. And we had started that transition so it wasn't completely foreign to people at Northwestern, how to do radial and whatnot. But I said, this is what we're gonna do. We're gonna do all of it. And I think having a skill like that, something that you can offer that other people don't offer gives you some leverage or a place to start. Definitely. I wanna bring it back to Allison because I wanna hear her experiences here. But I just wanna mention that I think the statistic is something like 60 or 70% of graduating fellows will leave their first job within a few years. So I would say, do not feel bad about it. It's expected. I'm the oddball at that state. Meaning that, so that is very common. And one of the things I tell my fellows to do is that even if they're looking at a, wherever they're looking at the practice, talk to the neighboring centers, institutions. There may be a reputation that is known. And you have to take things with a grain of salt if there's some competition and things like that. But you wanna get a sense as to if you're hearing a common theme from different neighboring places or if it's just a one-off that someone just doesn't like someone. I think if there's other women at the institution already, then that kind of gives you a little bit of a advantage. You can speak with them. But not everybody has the same personality either. I mean, there's some women that just might not be bothered by an environment that bothers me. So one of the mistakes I made early on was that I had lots of ideas. I wanted to do things. I wanted to start the Left Atrial Appendage occluder program and things like that. And I felt that I almost had to make it seem like it was someone else's idea to make it a good idea. I don't know how better to describe that. But that I realized after a few years in practice that that's not the way to do it. I mean, that's really selling myself short and it doesn't have to be one of the guy's ideas. And you can be a leader. And even if you're not a leader, you can be an innovator. You can bring something new to the table. Everybody has different training. You're gonna probably be working with people from various training programs and everybody brings something different to the table. So I think you should feel valued. No matter where you are, you should feel valued. I think that's the bottom line. And if you don't, then you need to move on. And I think we all know people that haven't felt valued in their practice and have moved on. So if that happens to you, you're not alone. And people like us are always here to reach out to for support.

Transforming into a Leader in the Cat Lab

Art and Strategy

Interventional Cardiology

Career Models

Workplace Dynamics