JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 64, NO. 23, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jacc.2014.10.022
FELLOWS-IN-TRAINING & EARLY CAREER PAGE
Why Early Career Cardiologists Should Establish a Professional Home Sarosh P. Batlivala, MD
“A man’s home may seem to be his castle on the
may place ECPs at higher risk for developing burnout.
outside; inside, it is more often his nursery.”
Additional studies have shown that even residents
E
—Clare Boothe Luce (1) arly career cardiologists are faced with many challenges as they begin practice. As Tong et al. (2) noted, a “perfect storm” has come
together in the form of recent research funding cuts, a decline in reimbursement for clinical activities, and impending cuts in graduate medical education; this storm threatens the success of early career cardiologists at a vulnerable transition. In fact, the number of physician scientists receiving post-doctoral research training and career development awards is at an all-time low (3). With all of these challenges, early career cardiologists would benefit from establishing a professional home soon after completing training. McKevitt et al. (4) highlighted an important aspect of many a physician’s psyche: “Illness doesn’t belong
to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman” (4). Common sense may suggest that a physician’s sense of well-being relates to his or her ability to care for patients. Unfortunately, some physicians have suboptimal personal insight into this matter (5). Furthermore, recent evidence has shown that early career physicians (ECPs), as compared with their midand late-career counterparts, have the lowest satisfaction with overall career choice, highest frequency of work-life conflicts, and the highest rates of depersonalization (6,7). Tijdink et al. (8) demonstrated similar findings, with ECPs scoring higher on an emotional exhaustion scale, which they postulated
are developing burnout at relatively high rates (9,10). In medicine, health is defined as the absence of disease (11). Physicians may transpose this disease model to their personal well-being and define wellness as the absence of burnout or distress (12). Physician engagement has been described as the corollary of burnout. Engagement has been defined as “a positive, fulfilling, work-related state of mind, characterized by vigor, dedication and absorption” (13). In fact, Schaufeli et al. (14) suggest that strong professional engagement may be protective again physician burnout. Given these data and observations, establishing a professional home is a critical task. Tuedio (15) describes home as “a place to preserve connections between our past and present, but also the place where we must continually reconstruct these connections.” Gadamer (16) notes that when we are at home and functioning in our element, “we are open to new things, ready to embark on new enterprises.” He further describes that this may allow us to forget ourselves and our existential pains, so we may “scarcely notice the demands and strains which are put on us.. This is what health is” (16). These descriptions of home embody the professional aspirations of many physicians. Having a professional home where you are a member of a group can provide a sense of community, of belonging, and of unified purpose. The particularly niche field of pediatric interventional cardiology raises some important issues in terms of where to establish a professional home. As opposed to the adult cardiac population, few children suffer significant heart disease—and fewer still suffer hemodynamically
From the Blair E. Batson Hospital for Children, Jackson, Mississippi; and
significant heart disease that requires transcatheter
the Department of Pediatrics, University of Mississippi Medical Center,
assessment and intervention. Given that, my practice
Jackson, Mississippi.
includes both pediatric and adult cardiology patients,
Batlivala
JACC VOL. 64, NO. 23, 2014 DECEMBER 16, 2014:2554–6
Fellows-in-Training & Early Career Page
and I serve at multiple organizations, which could
Sections. One goal is to foster collaboration between
serve as a professional home. The American Academy
both organizations to better advocate for common
of Pediatrics (AAP) is 1 option, striving to “improve
issues. Such collaboration has led to important rec-
the health of children everywhere.” Similarly, the
ommendations, including the recent assessment of
American College of Cardiology is another, with the
electrocardiography as a screening tool as well as
mission to “transform cardiovascular care and improve
neonatal screening programs for critical congenital
heart health.” Importantly, both groups encourage
heart disease, among others (17). ECPs can take
collaboration, so I chose both. I have found tremen-
advantage of similar opportunities to establish a
dous professional satisfaction by becoming involved
professional home within their local ACC chapter,
with both organizations.
other professional societies, or at their home institu-
My involvement with the AAP began in residency,
tion, among others. The first step is as simple as
through a combination of good timing, luck, and hard
reaching out and volunteering to help. Creating a
work. I attended a national conference and took a leap
professional home with both the ACC and AAP has
when a position on the resident executive committee
allowed me to not only advance my career, but to also
was vacated without a candidate. I immersed myself
improve my personal satisfaction and health, which
in the tasks and networking, and ran for additional
could potentially be transferred to the health of my
positions, culminating in being elected as chairperson
patients.
of the National Section on Medical Students, Residents, and Fellowship Trainees. Having completed
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
training, I now hold an office on the AAP’s equivalent
Sarosh P. Batlivala, Pediatric Cardiology, Blair E.
of the Early Career Section. In a complementary
Batson Hospital for Children, University of Mississippi
effort, I have become involved in the ACC’s Early
Medical Center, 2500 North State Street, Jackson,
Career and Adult Congenital and Pediatric Cardiology
Mississippi 39216. E-mail: [email protected].
REFERENCES 1. BrainyQuote. Clare Boothe Luce quotes. Available at: http://www.brainyquote.com/quotes/ authors/c/clare_boothe_luce.html. Accessed October 27, 2014. 2. Tong CW, Ahmad T, Brittain EL, et al. Chal-
burnout at different career stages. Mayo Clin Proc 2013;88:1358–67. 8. Tijdink JK, Vergouwen AC, Smulders YM. Emotional exhaustion and burnout among medical professors; a nationwide survey. BMC Med Educ
lenges facing early career academic cardiologists. J Am Coll Cardiol 2014;63:2199–208.
2014;14:183.
3. Garrison HH, Deschamps AM. NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J Off Publ Fed Am Soc Exp Biol 2014;28:1049–58.
Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–67.
4. McKevitt C, Morgan M. Illness doesn’t belong to us. J R Soc Med 1997;90:491–5. 5. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44:1017–22.
9. Shanafelt TD, Bradley KA, Wipf JE, Back AL.
10. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA 2002; 287:3143–6. 11. St Claire L, Watkins CJ, Billinghurst B. Differences in meanings of health: an exploratory study of general practitioners and their patients. Fam Pract 1996;13:511–6.
13. Schaufeli W, Bakker A. Utrechtse Bevlogenheidsschaal [UBES: Utrecht Work Engagement Scale]. Utrecht, the Netherlands: University of Utrecht, 2003. 14. Schaufeli W, Salanova M, Gonzalez-Roma V, Bakker A. The measurement of engagement and burnout: a two sample confirmatory factor analytic approach. J Happiness Stud 2002;3:71–92. 15. Tuedio J. Thinking about home: an opening for discovery in philosophical practice. Philos Soc 2002;201–15. 16. Gadamer H-G. The enigma of health: the art of healing in a scientific age. Stanford, CA: Stanford University Press, 1996.
7. Dyrbye LN, Varkey P, Boone SL, Satele DV,
12. Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellnesspromotion practices. West J Med 2001;174:
17. Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12– 25 years of age): a scientific statement from the American Heart Association and the American College
Sloan JA, Shanafelt TD. Physician satisfaction and
19–23.
of Cardiology. J Am Coll Cardiol 2014;64:1479–514.
6. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory. 3rd edition. Palo Alto, CA: Consulting Psychologists Press, 1996.
RESPONSE: Take a Look Around for Your Professional Home Mary Norine Walsh, MD From the St. Vincent Heart Center, Indianapolis, Indiana. E-mail: [email protected]. Dr. Batlivala brings forth a very important aspect of our
find a sense of belonging. As a pediatric interventional
professional satisfaction in writing about the need to
cardiologist, he has both a very small peer group of
2555
2556
Batlivala
JACC VOL. 64, NO. 23, 2014 DECEMBER 16, 2014:2554–6
Fellows-in-Training & Early Career Page
those who practice in his subspecialty and a very wide
senior adviser at the inception of the council, and since
variety of choices of professional organizations to make
its beginning, the council and section have flourished.
his home. Even for those adult early career cardiologists
Many ECPs have found a professional home there or in
with a fairly general practice focus, there are a plethora
other ACC sections that focus on subspecialty science
of places to call home. When I was an early career
and other interests.
cardiologist, there were far fewer choices to make. Cer-
Picking a professional home can be daunting. As in
tification in the subspecialties of cardiology did not yet
other areas of life, volunteering requires work, and
exist, and the multiple cardiology subspecialty organi-
getting involved in the ongoing efforts of a group or
zations had not yet formed.
organization can give a flavor of the group’s mission and
In 2011, the American College of Cardiology (ACC)
interests. Experiencing the energy and momentum of
recognized the need to provide the necessary support
people with similar interests and goals is very powerful,
and resources to cardiovascular specialists after they
and joining them can greatly enhance our professional
had completed their training program and initiated their
satisfaction. As Dr. Batlivala has done, I encourage all
careers. At that time, nearly 20% of the ACC’s members
ECPs to take a look around and find a professional
were in that stage of practice. In response to this need,
home. Our profession needs your energy, ideas,
the ACC established the Early Career Professionals (ECP)
commitment, and innovation to continue our efforts in
Council and Section. I had the pleasure of serving as
advancing science and excellence in patient care.
VOL. 64, NO. 23, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jacc.2014.10.022
FELLOWS-IN-TRAINING & EARLY CAREER PAGE
Why Early Career Cardiologists Should Establish a Professional Home Sarosh P. Batlivala, MD
“A man’s home may seem to be his castle on the
may place ECPs at higher risk for developing burnout.
outside; inside, it is more often his nursery.”
Additional studies have shown that even residents
E
—Clare Boothe Luce (1) arly career cardiologists are faced with many challenges as they begin practice. As Tong et al. (2) noted, a “perfect storm” has come
together in the form of recent research funding cuts, a decline in reimbursement for clinical activities, and impending cuts in graduate medical education; this storm threatens the success of early career cardiologists at a vulnerable transition. In fact, the number of physician scientists receiving post-doctoral research training and career development awards is at an all-time low (3). With all of these challenges, early career cardiologists would benefit from establishing a professional home soon after completing training. McKevitt et al. (4) highlighted an important aspect of many a physician’s psyche: “Illness doesn’t belong
to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman” (4). Common sense may suggest that a physician’s sense of well-being relates to his or her ability to care for patients. Unfortunately, some physicians have suboptimal personal insight into this matter (5). Furthermore, recent evidence has shown that early career physicians (ECPs), as compared with their midand late-career counterparts, have the lowest satisfaction with overall career choice, highest frequency of work-life conflicts, and the highest rates of depersonalization (6,7). Tijdink et al. (8) demonstrated similar findings, with ECPs scoring higher on an emotional exhaustion scale, which they postulated
are developing burnout at relatively high rates (9,10). In medicine, health is defined as the absence of disease (11). Physicians may transpose this disease model to their personal well-being and define wellness as the absence of burnout or distress (12). Physician engagement has been described as the corollary of burnout. Engagement has been defined as “a positive, fulfilling, work-related state of mind, characterized by vigor, dedication and absorption” (13). In fact, Schaufeli et al. (14) suggest that strong professional engagement may be protective again physician burnout. Given these data and observations, establishing a professional home is a critical task. Tuedio (15) describes home as “a place to preserve connections between our past and present, but also the place where we must continually reconstruct these connections.” Gadamer (16) notes that when we are at home and functioning in our element, “we are open to new things, ready to embark on new enterprises.” He further describes that this may allow us to forget ourselves and our existential pains, so we may “scarcely notice the demands and strains which are put on us.. This is what health is” (16). These descriptions of home embody the professional aspirations of many physicians. Having a professional home where you are a member of a group can provide a sense of community, of belonging, and of unified purpose. The particularly niche field of pediatric interventional cardiology raises some important issues in terms of where to establish a professional home. As opposed to the adult cardiac population, few children suffer significant heart disease—and fewer still suffer hemodynamically
From the Blair E. Batson Hospital for Children, Jackson, Mississippi; and
significant heart disease that requires transcatheter
the Department of Pediatrics, University of Mississippi Medical Center,
assessment and intervention. Given that, my practice
Jackson, Mississippi.
includes both pediatric and adult cardiology patients,
Batlivala
JACC VOL. 64, NO. 23, 2014 DECEMBER 16, 2014:2554–6
Fellows-in-Training & Early Career Page
and I serve at multiple organizations, which could
Sections. One goal is to foster collaboration between
serve as a professional home. The American Academy
both organizations to better advocate for common
of Pediatrics (AAP) is 1 option, striving to “improve
issues. Such collaboration has led to important rec-
the health of children everywhere.” Similarly, the
ommendations, including the recent assessment of
American College of Cardiology is another, with the
electrocardiography as a screening tool as well as
mission to “transform cardiovascular care and improve
neonatal screening programs for critical congenital
heart health.” Importantly, both groups encourage
heart disease, among others (17). ECPs can take
collaboration, so I chose both. I have found tremen-
advantage of similar opportunities to establish a
dous professional satisfaction by becoming involved
professional home within their local ACC chapter,
with both organizations.
other professional societies, or at their home institu-
My involvement with the AAP began in residency,
tion, among others. The first step is as simple as
through a combination of good timing, luck, and hard
reaching out and volunteering to help. Creating a
work. I attended a national conference and took a leap
professional home with both the ACC and AAP has
when a position on the resident executive committee
allowed me to not only advance my career, but to also
was vacated without a candidate. I immersed myself
improve my personal satisfaction and health, which
in the tasks and networking, and ran for additional
could potentially be transferred to the health of my
positions, culminating in being elected as chairperson
patients.
of the National Section on Medical Students, Residents, and Fellowship Trainees. Having completed
REPRINT REQUESTS AND CORRESPONDENCE: Dr.
training, I now hold an office on the AAP’s equivalent
Sarosh P. Batlivala, Pediatric Cardiology, Blair E.
of the Early Career Section. In a complementary
Batson Hospital for Children, University of Mississippi
effort, I have become involved in the ACC’s Early
Medical Center, 2500 North State Street, Jackson,
Career and Adult Congenital and Pediatric Cardiology
Mississippi 39216. E-mail: [email protected].
REFERENCES 1. BrainyQuote. Clare Boothe Luce quotes. Available at: http://www.brainyquote.com/quotes/ authors/c/clare_boothe_luce.html. Accessed October 27, 2014. 2. Tong CW, Ahmad T, Brittain EL, et al. Chal-
burnout at different career stages. Mayo Clin Proc 2013;88:1358–67. 8. Tijdink JK, Vergouwen AC, Smulders YM. Emotional exhaustion and burnout among medical professors; a nationwide survey. BMC Med Educ
lenges facing early career academic cardiologists. J Am Coll Cardiol 2014;63:2199–208.
2014;14:183.
3. Garrison HH, Deschamps AM. NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J Off Publ Fed Am Soc Exp Biol 2014;28:1049–58.
Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–67.
4. McKevitt C, Morgan M. Illness doesn’t belong to us. J R Soc Med 1997;90:491–5. 5. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44:1017–22.
9. Shanafelt TD, Bradley KA, Wipf JE, Back AL.
10. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA 2002; 287:3143–6. 11. St Claire L, Watkins CJ, Billinghurst B. Differences in meanings of health: an exploratory study of general practitioners and their patients. Fam Pract 1996;13:511–6.
13. Schaufeli W, Bakker A. Utrechtse Bevlogenheidsschaal [UBES: Utrecht Work Engagement Scale]. Utrecht, the Netherlands: University of Utrecht, 2003. 14. Schaufeli W, Salanova M, Gonzalez-Roma V, Bakker A. The measurement of engagement and burnout: a two sample confirmatory factor analytic approach. J Happiness Stud 2002;3:71–92. 15. Tuedio J. Thinking about home: an opening for discovery in philosophical practice. Philos Soc 2002;201–15. 16. Gadamer H-G. The enigma of health: the art of healing in a scientific age. Stanford, CA: Stanford University Press, 1996.
7. Dyrbye LN, Varkey P, Boone SL, Satele DV,
12. Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellnesspromotion practices. West J Med 2001;174:
17. Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12– 25 years of age): a scientific statement from the American Heart Association and the American College
Sloan JA, Shanafelt TD. Physician satisfaction and
19–23.
of Cardiology. J Am Coll Cardiol 2014;64:1479–514.
6. Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory. 3rd edition. Palo Alto, CA: Consulting Psychologists Press, 1996.
RESPONSE: Take a Look Around for Your Professional Home Mary Norine Walsh, MD From the St. Vincent Heart Center, Indianapolis, Indiana. E-mail: [email protected]. Dr. Batlivala brings forth a very important aspect of our
find a sense of belonging. As a pediatric interventional
professional satisfaction in writing about the need to
cardiologist, he has both a very small peer group of
2555
2556
Batlivala
JACC VOL. 64, NO. 23, 2014 DECEMBER 16, 2014:2554–6
Fellows-in-Training & Early Career Page
those who practice in his subspecialty and a very wide
senior adviser at the inception of the council, and since
variety of choices of professional organizations to make
its beginning, the council and section have flourished.
his home. Even for those adult early career cardiologists
Many ECPs have found a professional home there or in
with a fairly general practice focus, there are a plethora
other ACC sections that focus on subspecialty science
of places to call home. When I was an early career
and other interests.
cardiologist, there were far fewer choices to make. Cer-
Picking a professional home can be daunting. As in
tification in the subspecialties of cardiology did not yet
other areas of life, volunteering requires work, and
exist, and the multiple cardiology subspecialty organi-
getting involved in the ongoing efforts of a group or
zations had not yet formed.
organization can give a flavor of the group’s mission and
In 2011, the American College of Cardiology (ACC)
interests. Experiencing the energy and momentum of
recognized the need to provide the necessary support
people with similar interests and goals is very powerful,
and resources to cardiovascular specialists after they
and joining them can greatly enhance our professional
had completed their training program and initiated their
satisfaction. As Dr. Batlivala has done, I encourage all
careers. At that time, nearly 20% of the ACC’s members
ECPs to take a look around and find a professional
were in that stage of practice. In response to this need,
home. Our profession needs your energy, ideas,
the ACC established the Early Career Professionals (ECP)
commitment, and innovation to continue our efforts in
Council and Section. I had the pleasure of serving as
advancing science and excellence in patient care.
