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#BlackCardioInHistory: Daniel Hale Williams – Pioneer in open-heart surgery in the United States

This is part of the #BlackCardioInHistory series.  #AHAEarlyCareerVoice is partnering with #BlackInCardio to feature a series of profiles of black/African American Cardiologists for #BlackInCardioWeek2020.  For more information: blackincardio.com


Daniel Hale Williams III was born to a family that owned a barber business and worked in the Equal Rights League in Hollidaysburg, Pennsylvania, in 1856 (1). Young Daniel moved to Baltimore as a young boy to become a shoemaker’s apprentice when his father died but did not like the work (1). His family had moved to Illinois, so he moved back with them and began barbering with the long-term goal of pursuing his education (1).

Daniel Hale Williams III apprenticed with Dr. Henry Palmer, who was an accomplished surgeon. From there, Daniel attended the Chicago Medical College (1).

(2) Daniel Hale Williams (Pre 1923 photograph, public domain). https://en.wikipedia.org/wiki/File:Daniel_Hale_Williams.jpg From Wikipedia page: Daniel Hale Williams.

After completing medical school, Dr. Williams began to practice on Chicago’s south side while teaching anatomy at the Chicago Medical College (1). He was an early adopter of Louis Pasteur’s sterilization to prevent transmission of infection (1).

In the late 1880s in America, Black Americans were prevented from being admitted to hospitals and could not be hired at hospitals (1). While Black women had a long history of working as nurses, they were often denied opportunities for formal training (3). Dr. Daniel Hale Williams III disagreed with this practice and opened the Provident Hospital and Training School for Nurses which was the first hospital in the United States that was racially integrated (1).

(3) Provident Hospital and Training School for Nurses (36th and Dearborn Streets, Chicago). Chicago History Museum (ICHi-040212). https://www.chicagohistory.org/provident-hospital/. Brittany Hutchinson.

A few years later, in 1893, Dr. Williams treated a man with a significant stab wound to the chest, named James Cornish (1). Dr. Williams successfully sutured the man’s pericardium allowing Cornish to live for many years. Only 3 other surgeons, Dr. Francisco Romero, Dr. Henry Dalton, and Dr. Dominique Jean Larrey, have been credited as performing open-heart surgery previously (1,4). One year later, in 1894, Dr. Williams was appointed as Chief Surgeon of the Freedmen’s Hospital, which has seen a high relative mortality rate. He moved back to Chicago upon marrying Alice Johnson, where he continued working for Provident Hospital (1).

(2) Daniel Hale Williams (National Library of Medicine believes this to be public domain). https://commons.wikimedia.org/wiki/File:Daniel_H._Williams.jpg From Wikipedia page: Daniel Hale Williams.

In 1897 Dr. Williams was appointed to the Illinois Department of Public Health to increase medical standards in hospitals (2). In 1913, Dr. Williams was the only Black American member of the American College of Surgeons (5). Dr. Williams died in 1931 in Idlewild, Michigan from a stroke (2). Some of Dr. Williams’s honors include membership in the Chicago Surgical Society and American College of Surgeons, which were both uncommon for Black Americans at the time (2). Dr. Williams also received honorary degrees from Howard University in Washington DC and Wilberforce University in Wilberforce, Ohio (2).

 

Reference

  1. Biograhy.com Daniel Hale Williams Biography. 6/5/2020. https://www.biography.com/scientist/daniel-hale-williams. Accessed 10-19-2020.
  2. Daniel Hale Williams (Pre 1923 photograph, public domain). https://en.wikipedia.org/wiki/Daniel_Hale_Williams#cite_note-EB-6 From Wikipedia page: Daniel Hale Williams
  3. Provident Hospital and Training School for Nurses (36th and Dearborn Streets, Chicago). Chicago History Museum (ICHi-040212). https://www.chicagohistory.org/provident-hospital/. Brittany Hutchinson.
  4. Wikipedia.com Henry Dalton. 4/4/2020. https://en.wikipedia.org/wiki/Henry_Dalton. Accessed 10-19-20
  5. Daniel Hale Williams American Physician. Encyclopedia Britannica. 2018.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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#BlackCardioInHistory: Dr. Edward William Hawthorne

This is part of the #BlackCardioInHistory series.  #AHAEarlyCareerVoice is partnering with #BlackInCardio to feature a series of profiles of black/African American Cardiologists for #BlackInCardioWeek2020.  For more information: blackincardio.com


Edward William Hawthorne was born near Port Gibson, Mississippi as the son of a minister and teacher. He suffered from polio at the age of 7 (1). He graduated high school in Washington DC and began his undergraduate study at Fisk University but later transferred to Howard University (1). It was at Howard University where Hawthorne spent most of the rest of his life.

(2) https://www.acc.org/latest-in-cardiology/articles/2018/02/13/14/42/harold-on-history-black-history-month-and-pioneering-african-american-physicians. Photo Credit: Howard University.

Hawthorne earned his bachelor’s in science degree in 1941 and completed his medical degree in 1946 (1). Hawthorne was an intern at Freedmen’s Hospital from 1946-1947 and developed an interest in research, especially in the cardiovascular field (1). Dr. Hawthorne completed a Masters in Science in physiology in 1949, and then a Ph.D. in physiology in 1951, both from the University of Illinois in Chicago (1). This would be Hawthorne’s only stint away from Washington DC.

In 1951 Dr. Hawthorne moved back to Washington DC as he was appointed to faculty at Howard University(1). Dr. Howard helped organize masters and doctoral graduate programs in physiology at Howard and a laboratory focusing on cardiovascular research(1). Dr. Hawthorne was the head of the physiology department until 1969(1). All the while Dr. Hawthorne was moving ranks of the administration. He was assistant Dean of the College of Medicine from 1962-1967, associate Dean of the College of Medicine until 1970, and Dean of the Graduate School of Arts and Sciences in 1974. During these appointments, he was also Chairmen of the department of physiology and biophysics in 1969-1974(1).

Hawthorne referred to his research as “a personal vendetta against ignorance”(1). Dr. Hawthorne was a leader in Renal physiology research and utilized animal models ranging from rats, rabbits, dogs, and horses(1). Dr. Hawthorne was a pioneer in using techniques to measure heart function and size in conscious animals(1). In 3 papers from 1959 and 1962, both published in Circulation Research, Hawthorne examines hypertension and left ventricle size in dogs (3, 4, 5). Dr. Hawthorne pioneered an experimental hypertension model in dogs consisting of constricting the brachiocephalic and left subclavian arteries surgically(5).

Figure 1 from Chronic experimental hypertension in dogs after constriction of brachiocephalic and left subclavian arteries. HAWTHORNE EW, et al. Circ Res. 1962. PMID: 13905535.

Dr. Hawthorne would go on to publish many papers on cardiovascular physiology, which ultimately led to his election as a fellow of the American College of Cardiology in 1969 and vice president of the American Heart Association from 1969-1972(1). He was also active in predominantly Black associations, including the John A. Andrew Clinical Society, Alpha Omega Alpha, Alpha Phi Alpha, and Association of Former Interns and Residents of Freedmen’s Hospital. In 1980 he was elected to the prestigious Institute of Medicine of the National Academy of Sciences(1). Dr. Hawthorne died in October 1986, only 4 months after his final manuscript was published(6). Dr. Hawthorne is remembered as a pioneer for cardiovascular physiology research and education and a pioneer in the field of hypertension.

 

Reference

  1. Hawthorne, Edward William. https://doi-org. /10.1093/anb/9780198606697.article.1201084 American National Biography. Accessed 10-19-2020
  2. https://www.acc.org/latest-in-cardiology/articles/2018/02/13/14/42/harold-on-history-black-history-month-and-pioneering-african-american-physicians. Photo Credit: Howard University.
  3. Instantaneous dimensional changes of the left ventricle in dogs. HAWTHORNE EW. Circ Res. 1961. PMID: 13712425.
  4. Telemetering of ventricular circumference in dogs. HAWTHORNE EW, et al. J Appl Physiol. 1961. PMID: 13905534.
  5. Chronic experimental hypertension in dogs after constriction of brachicephalic and left subclavian arteries. HAWTHORNE EW, et al. Circ Res. 1962. PMID: 13905535.
  6. Estimation of left ventricular mass in conscious dogs. B Coleman, L N Cothran, E L Ison-Franklin, E W Hawthorne. Among authors: hawthorne ew. Am J Physiol. 1986. PMID: 3789168

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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#BlackCardioInHistory: Dr. Marie Maynard Daly

This is part of the #BlackCardioInHistory series.  #AHAEarlyCareerVoice is partnering with #BlackInCardio to feature a series of profiles of black/African American Cardiologists for #BlackInCardioWeek2020.  For more information: blackincardio.com


Photo credit: Ted Burrows, Archives of the Albert Einstein College of Medicine (https://www.sciencehistory.org/historical-profile/marie-maynard-daly)

Dr. Marie Maynard Daly (1921-2003) became the first African American woman to receive a PhD in Chemistry. Dr. Daly was born in Queens, New York. She had the ambition to become a chemist through the influences of her father, who was on track to graduate from Cornell with an undergraduate degree in Chemistry when he was forced to drop out because of financial circumstances. Dr. Daly graduated magna cum laude from Queens College in New York with a bachelor’s degree in Chemistry. She then enrolled in a Master’s program in Chemistry at New York University and graduated in 1 year while working at Queens College as a part-time laboratory assistant.

Marie M. Daly Biography. Biography.com/scientist/marie-m-daly 08/26/2020

From NYU, soon to be Dr. Daly enrolled in a doctoral program at Columbia. Her dissertation was titled A Study of the Products Formed by Action of Pancreatic Amylase on Corn Starch. Dr. Daly received her PhD in Chemistry in 1947 and was the first African American woman to receive a PhD in chemistry in the United States. Dr. Daly went on to teach at Howard University and then began researching at the Rockefeller Institute in New York as a post-doctoral fellow. After 7 years at the Rockefeller Institute, Dr. Daly started to teach at the College of Physicians and Surgeons at Columbia University in New York in 1955. She continued her research while at Columbia studying arterial metabolism.

Dr. Daly made seminal findings in arterial metabolism. In particular, she published findings of how respiration and cytochrome oxidase activity are altered in rat aortas during hypertension which was published in the Journal of Experimental Medicine in 1958. In 1960 Dr. Daly moved to Albert Einstein College of Medicine at Yeshiva University and from 1958 to 1963, Dr. Daly was an investigator for the American Heart Association.

M.M. DALY, E.G. GURPIDE. J Exp Med. 1959 Feb 1;109(2):187-95. doi: 10.1084/jem.109.2.187. PMID: 13620848

In 1963 Dr. Daly published another paper, this time examining the concentration of cholesterol and cholesterol synthesis in hypertensive rats, which she published in the Journal of Clinical Investigation. In 1970 Dr. Daly published a methods paper on how to isolate intimal-medial tissues in arteries from rabbits. Dr. Daly was an integral part of the early molecular study using small mammal models to examine atherosclerosis and hypertension and was a pioneer in cardiovascular research.

M.M. DALY, Q.B. DEMING, V.M. RAEFF, L.M. BRUN. J Clin Invest. 1963 Oct;42(10):1606-12. doi: 10.1172/JCI104845. PMID: 14074354

H. WOLINSKY, M.M. DALY. Proc Soc Exp Biol Med. 1970 Nov;135(2):364-8. doi: 10.3181/00379727-135-35052. PMID: 4921030

WOLINSKY, M.M. DALY. Proc Soc Exp Biol Med. 1970 Nov;135(2):364-8. doi: 10.3181/00379727-135-35052. PMID: 4921030

Thus, it is not surprising that Dr. Daly was a member of the board of governors of the New York Academy of Sciences along with being a fellow of the American Cancer Society, American Association for the Advancement of Science, New York Academy of Sciences, and Council of the American Heart Association. In 1999, just 4 years before her death, the National Technical Association recognized Dr. Daly as one of the top 50 women in Science, Engineering, and Technology. Finally, in 2016, a new elementary school was named The Dr. Marie M. Daly Academy of Excellence after Dr. Daly and her many achievements.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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R.E.D. C.U.P.: FROM BURNOUT TO WELLNESS

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA, Krishna Doshi BS

We cannot ignore what a recent president of the World Medical Association describes as the “physician burnout pandemic”. We must find ways to transform our professional lives from a state of burnout to a state of wellness. A study from the American College of Cardiology reported that 27% of cardiologists experience burnout (compared to 43% from Medscape), while 49.5% reported being under stress with limited energy (1). In another study, approximately 15% of cardiologists reported experiencing depression, and among these 33% easily became exasperated by patients and 32% felt less engaged with patients (2). Similarly, burned-out physicians noted an effect on their professional activities with both patients and colleagues (1).

Neither subspecialty nor practice setting appears to have an impact on burnout (1). Contributors to burnout among cardiologists have been listed as excessive workloads, large bureaucratic loads, balancing work and life, and after work emergencies impacting lifestyle (1)(2). The constantly evolving technology was also identified as a culprit, with 57% of cardiologists reportedly accessing the electronic medical record at home (1)(4). I think we may all be guilty of some of this. Further, in the era of COVID-19, most of our professional and social interactions have been transferred to virtual interfaces. The absence of physical togetherness can take its toll on our emotional or mental wellness, coupled with decreased social support for many in the pandemic (5).

One cardiologist wrote in a survey that our profession is the ‘most unhappy’ specialty, but also the least likely to seek professional help. Thus, to cope many physicians turn to food, alcohol, drugs, or smoking (2). The struggle is real across our professions, and we must as a society pursue recommendations for burnout mitigation strategies (4). These initiatives must be conducted in shared responsibility for physician wellness (4). Resilience-based interventions should consider job design, leadership, and management training (4), and must be endorsed by the C-suite, with commitment to broad-sweeping implantation across the institution. Reduction in administrative tasks for physicians, increasing non-physician support staff, and emphasizing teamwork can make a world of difference, as can fostering self-awareness, life-work balance or more aptly integration, and regular check-ins for mental health (4).

 R.E.D. C.U.P.

To avoid or overcome being in a state of burnout, there are key components of the journey to wellness that should also be embraced.

 Relationships

When we informally survey individuals in person or on social media, undoubtedly the number one catalyst for wellness is noted as relationships. Frequent personal interactions with others who know and understand us can help relieve some of the altruistic burdens we carry in our daily professional lives.

Exercise/Hobbies

Quite often exercise and hobbies are listed as mediators of wellness. Exercise can relieve stress and release endorphins that help improve mood. Hobbies can give an object of focus that takes our minds away from what troubles us, or perhaps what might otherwise consume or overwhelm us. Hobbies can also help us share our inner selves, interests, and creative skills with others.

Diversity/Delegate

Welcoming a diversity of perspectives and selectively delegating to individuals with the appropriate level of training and preparation can offload some of the pressure on our generally full plates. Surrounding yourselves with individuals who enjoy taking initiative and being resourceful can be mutually beneficial.

Compassion for self

Giving yourself permission to have compassion for yourself is tremendously underrated, especially by women. We are so used to caring for everyone else around us and sharing our compassion selflessly that we often forget to do so for ourselves. To bring our best selves to the table and to truly give our best to others, we need to first invest in our own selves in ways that matter most to each of us.

Unplug

The ability to intermittently unplug from sources of time-consuming or draining asks can free up incredible amounts of time and mental space that can be used on more enriching and life-affirming activities.

Purpose

A sense of purpose can give clear direction and allow us to prioritize opportunities more effectively.

Pursuing R.E.D. C.U.P. may help us collectively and collaboratively as we grow together on our journey from burnout to wellness.

 

 

References:

  1. Mehta LS, Lewis SJ, Duvernoy CS, Rzeszut AK, Walsh MN, Harrington RA, et al. Burnout and Career Satisfaction Among U.S. Cardiologists. J Am Coll Cardiol. 2019;73(25):3345-8.
  2. Nicholls M. Cardiologists and the Burnout scenario. Eur Heart J. 2019;40(1):5-6.
  3. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA. 2018;320(11):1131-50.
  4. Panagioti M, Geraghty K, Johnson J. How to prevent burnout in cardiologists? A review of the current evidence, gaps, and future directions. Trends Cardiovasc Med. 2018;28(1):1-7.
  5. Graham MM, Higginson L, Brindley PG, Jetly R. Feel Better, Work Better: The COVID-19 Perspective. Can J Cardiol. 2020;36(6):789-91.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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HOW TO SAY NO: R5

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA, Mehnaz Rahman MD

For many of us, to nurture our continuous and whole sense of well-being, we are in a constant process of learning to say “no”. Here is one scenario that can help provide an effective framework for saying “no”.

Consider a new junior attending faculty member at the same academic institution where she trained as a Cardiology fellow. Her pursuit of wellness in this new role has fallen to the sidelines, as she first tries to establish a sense of authority within a society that has only ever known her as a trainee. While navigating this unfamiliar territory, a surprising source of anxiety has come from responding to requests to collaborate on projects. She consistently accepted almost every single one. The fellow in her aimed to please.

Although she approached each with the same work ethic, her interest in them was not as equitably distributed. At the end of her first year, her cup had “runneth over” – she was overworked and overcommitted admittedly she felt by her own doing.

She then realized that she had agreed to those undertakings because she did not quite have the words ready at the tip of her tongue to say “no”.  When respectfully declining a specific ask, she determined that it can help to have a practiced approach to the conversation, one that can produce a beneficial result for both parties.

As we discuss this scenario, we can recognize that in general, people appreciate ideas and potential solutions. Accordingly, we may not be able to fulfill every request, yet we can still be a resource and offer alternatives.

One framework for saying “no” is grounded in R5: Reframe, Refer, Reduce, Reorient, and Recommend. Saying “no” can be challenging. Sometimes we need to say “no” to the way the ask is presented or the specific focus of the ask.

If we can perceive benefit from modifying the ask so that it actually fits with our career goals and specialty interests, then we can say “no” to the original ask while reframing it to a more fitting ask for us.

If we choose not to reframe the ask, we can refer the asker to someone else who we feel could be interested in working on such a task.

Alternatively, we could reduce the original ask to limit the portion for which we would be responsible.

Further, often those asking do not know how full our plates are and may need to be kindly informed or reoriented, so that they can better understand your perspective as you say “no”; you can even solicit their input as you think about how to prioritize your time on pre-existing projects.

Finally, recommend a new deadline or seeking out more resources if you would find working on the opportunity valuable but time-consuming or limited in available resources.

Remember, those asking for your involvement are genuinely interested in working with you, recognize you as an asset, and will more often than not be receptive to your counteroffer. Saying “no” the right way will leave the door open to future opportunities that you may be waiting or looking for.

We can continue to recalibrate our expectations of ourselves, as we engage in projects that keep us passionate and hope that our journeys to wellness become smoother with time and practice.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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How to Engage with Content & Colleagues at a Virtual Meeting (And Like It!)

Now that AHA20 is going virtual, you might have some questions: Is it worth it? How can I connect with my council? Will the valuable networking still happen? Will I actually learn anything? So many of our regular touchstones have been canceled in 2020, but you don’t have to give up Scientific Sessions. It won’t be the same, but with a little planning, it will be great in different ways.

I polled the AHA early career bloggers for their best virtual meeting tips, and here’s their rundown on how to make virtual meetings work for you:

  • Use multiple channels. While the meeting may be streaming on a designated platform, you might also find engagement using outside tools or social media platforms.
    • Follow the official hashtag (#AHA20) on twitter. This is a great way to highlight key presentations, engage with other participants, and connect with experts and presenters. (If you haven’t used twitter professionally before, take the time to set up your bio, make sure your existing content is safe for work, and make your avatar a good picture of you. Or consider a dedicated profile for work. Do some legwork ahead of time to follow people and organizations you’re interested in connecting with during the conference).
    • You could create a Slack Channel with others in your institution or research area to share resources and have ongoing conversations.
    • You could make a Strava group to engage in a little healthy competition and give one another kudos— who got their workout in today?
  • Take breaks. At a face-to-face event, you spend time walking between sessions and break for meals. When everything is online, it’s easy to forget to get up, rest your eyes, and move around.  Hydrate. Take bio breaks. Bonus points if you go outside and don’t take your phone.
  • Consider using a standing desk, or even a makeshift setup, to help you be more mobile throughout the day. Changing position frequently is one of the keys to avoiding pain from being sedentary.
  • Take notes! Things start to run together and a good note-taking strategy will help you remember key information. Maybe you use a good, old-fashioned paper notebook, or maybe you prefer a tool like Evernote. Up to you.
  • Use the interactive tools to ask questions. Especially if you haven’t gotten up the gumption to stand up and ask questions at a live session, you might find the online format more accessible.
  • Connect with colleagues before the meeting starts, and schedule times to debrief and share key takeaways. This helps to keep momentum and excitement going.
  • Constant on-screen interaction can be very taxing. If available, try the on-demand option to give yourself more flexibility. Also consider taking a break from being on camera and just listen.
  • Let yourself be immersed. When you travel to a meeting or conference, you may arrange child care, get someone to cover your clinical or teaching duties, and put up your out-of-office message. While it might be tempting to squeeze conference sessions around your regular responsibilities, you’ll miss the value that the immersion experience provides.

And remember, the virtual conference is accessible to all– if you might ordinarily be limited by difficulty traveling or cost, this is could be your year.

Share other tips (@AHAmeetings and #AHAEarlyCareerBlogger on twitter), connect with the Early Career Community, and grow your network!

And register for sessions: https://professional.heart.org/en/meetings/scientific-sessions

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WELLNESS MATTERS

American Heart Association Early Career Guest Blog

Sherry-Ann Brown MD PhD FAHA

WELLNESS

The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. The terms in this definition inspire similar words such as continuous (state), whole (complete), tangible (physical) and intangible (mental), as well as togetherness or community (social).

 PANDEMIC WELLNESS

Indeed, during the pandemic, we often say or hear, “We are all in this together”. The global community has rallied around each other to get through the coronavirus disease of 2019 (COVID-19) well. In the midst of a nation in turmoil with pandemics juxtaposed (coronavirus and racial and ethnic inequities), we find ourselves in the middle of it all as physicians.

SAFETY & WELLNESS

Along with everyone else in medical authority, we encourage those around us and all we serve to distance physically more so than socially. We want people to remain social, to enhance wellness. Yet, we need that socialization to be safe and physically distant, to foster tangible wellness.

 WELLNESS NOT CANCELLED

We encourage everyone to recognize that conversations, relationships, love, songs, reading, hope, joy, getting outdoors, music, family, and self-care should not and will not be canceled. This is the good stuff. The intangible components of wellness.

WELLNESS HEROES

So many of us in health care are sacrificing this period of our lives or in fact our very lives so that our patients can be whole. This altruism that led us here is continuous and indestructible by the #rona. Many of us turn to visual wellness inspired by COVID-19 to help capture the essence and sentiments of these challenging times. Art and other forms of creative expression of what’s inside of us or in society can motivate us to see more, be more, and serve more.

These matters at hand are crucial to help maintain our state of complete physical, mental, and social well-being. If we are honest with ourselves, we recognize that most of us live at best in a state of incomplete well-being. Yet, we can stand together against cancellation of our will and empower each other on this journey to wellness. It’s never been a destination. It’s always been a process that we continue to learn daily.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Work life balance- Is This a Myth?

Work-life balance: for many in Cardiology it’s an elusive idea. Now, our worlds of work and “life outside of work” are even more blurred among Zoom meetings and facemasks.  However, over the years, I have learned 3 important concepts (Figure 1) that has made work-life balance POSSIBLE, not just a myth.

Figure 1. Outlining the three key concepts of work-life balance.

Concept #1: Who are you outside of work?

As Cardiologists, researchers, educators, and team members we know the day, night, and weekend hours that define our careers. However, how do you describe yourself outside of work? Who are “you” after shedding the scrubs and white coat, away from the office, hospital, and lab?   Beyond Cardiology, what are your interests?  The answers to these questions help to define you and an important part of your life. When we lose our work-life balance, we are losing a part of ourselves.

To begin recapturing your interests, look at your calendar over the next month, and schedule small increments of time (just 5-10 minutes!) to reconnect with your personal interests (of course staying safely physically distant for now).  These baby steps will move you closer to capturing the “life” in work-life balance.

Concept #2: “Balance” is dynamic.

How do you define “work-life balance”? Is it an equal distribution of time? Is it a certain quantity of time for specific activities?

Work-life balance is very similar to the field of Cardiology – it is constantly changing. For most people, work-life balance will not mean that there is “equal” or balanced time between work and personal life. Especially in Cardiology, our job usually engulfs the majority of hours in a week – clinical duties, grant deadlines, presentations, emails… and the list continues.  However, for work-life balance, one of the goals is to “balance” the transition from work to “life outside of work”. This means your presence, attention, and focus should completely shift from work to your personal interests and interactions. Work-life balance is beyond physically leaving the job, but balancing the mental transition to fully shift away from work.  It will take practice to avoid checking email or mulling over work.  The amount of time between work and your personal life will remain dynamic; but the “balance” is your ability to commit your focus and attention to those precious personal moments, just as you do for work.

Concept #3:   You are Responsible for You! 

Cardiology requires you to constantly learn and practice to achieve and maintain competency. You are upholding a professional commitment. The same commitment is required to grasp work-life balance.  You have to make a personal commitment to you!!  It is not sufficient to just “wish for it”.  We cannot expect anyone else to understand our needs or create our work-life balance.

To reframe this important concept, consider your self-care and work-life balance as critical as filling your car with gas (or charging your car):  you cannot function without it!  Your personal commitment has to be as strong as your professional commitment.   No, it’s not easy, but it is possible.  Some find it helpful to be accountable to a colleague or friend, check-in regularly (set a reminder) about small steps to promote work-life balance. We understand our responsibility to patients.  Now, it’s time understand your responsibility to you!

During these uncertain times of the COVID-19 pandemic, healthcare workers are working longer hours and under even greater stress. It is normal to feel overwhelmed. Now, more than ever, it is important to find creative ways to focus on precious moments and commit to your well-being!  Below are 5 tips to stay committed to yourself and safely connect with others:

  1. Take three minutes.  Listen to your favorite song, dance while nobody’s watching, or take a few extra minutes in a hot shower. You do not need a long time to be kind to yourself.
  2. Join a Virtual group or class.  Physical distancing and long work hours can be very isolating. Take advantage of the numerous virtual options to safely connect with others who have similar interests.
  3. Share and listen.  Try moving beyond texting and talk on the phone. Commit to that moment, engage in the conversation and focus on listening.  The human connection remains very powerful to strengthen our mind and body.
  4. Protect Your Time. I know it is easier said than done. However, learning to set boundaries is critical to sustain your commitment to work and participate in the joys of life.
  5. Be Kind to Your Body. Find time to sleep, eat healthy snacks, and participate in small amounts of physical activity. Mental health and physical health are equally important.

In summary, work-life balance is a journey, not a destination.  Remember, that “balance” in work-life balance is dynamic – the amount of personal time will change, but your commitment and focus to that time should only grow.

 

About the Author:

Heather M. Johnson, MD, MMM, FAHA, FACC is a Cardiologist & Preventive Cardiologist at the Christine E. Lynn Women’s Health & Wellness Institute at Boca Raton Regional Hospital/Baptist Health South Florida.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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NEGOTIATING YOUR FIRST CONTRACT

American Heart Association Women in Cardiology Blog Series

NEGOTIATING YOUR FIRST CONTRACT

Victoria Thomas MD, Simone Bailey MD, Sherry-Ann Brown MD PhD

Women are less likely to negotiate their contracts than men 1-3. Approximately 20% of women do not engage in contract negotiation 1. Despite improvements over time in the number of women negotiating their contracts, disparities persist in compensation and rank 4-5. Further, few resources exist to specifically guide women on how to negotiate salary and other beneficial components of the contract.

Optimal negotiation of your contract positions you well for future opportunities, promotion, visibility, and professional satisfaction. Know the process of negotiating your contract (Box 1, Image), know the perks or components of your contract (Box 2, Image), and know the resources available to you as you navigate and negotiate your contract (Box 3, Image). When reviewing contracts, consider the entire package, including malpractice insurance (with tail), paid time off, noncompete stipulations, salary, and incentives 6. Remember, time is money! Negotiate the allocation of your time: in/outpatient, research, medical education, and administration. If you are in academics, consider your incoming rank, clinical title, future promotion opportunities, and research funding if applicable. A clinical title may not cost the department and could set you up for deserved recognition and administrative time. Contracts should specify the requirements and duties of the physician and the employer explicitly, provide clear compensation models, and define term and termination protocols.

Weigh all options, such as preferences for an academic or private practice setting. Be cognizant of important non-work factors: geographic location, significant others, children, and recreational activities, as these greatly affect working decisions. Be firm on your deal makers and breakers prior to contract negotiations 6. Ask for more than you really want. This will likely lead to compromise down to a mutually accepted agreement. Be sure to present special requests in a manner that creates shared interests, and have these written into the contract. It is acceptable to communicate your desires early on and your concerns as the process evolves and recommend modifications that you would like to implement. Remember, verbal promises or assurances are not contractually valid. It is also advised to seek legal counsel with expertise in physician contracts to help you identify loopholes, pitfalls, and modifiable terms.

When entering negotiations, remember to be respectful, humble, appreciative, and also know your worth. The 2020 Medscape Cardiology Compensation Report found that male cardiologists earn approximately 16% more than their female colleagues 7. The average salary for men was $449,000, while women averaged $386,000 7. A study has shown that women lose an average of $7,000  in their first-year salary and may lose up to $1,000,000 over the span of each of their careers 1. As a means to reduce the wage gap, women must increase their efficacy and advocacy through contract salary negotiations. Let the employer make the initial salary offer so that you do not ask for less than you may have been offered or lead them to think that salary is your top priority. Review national reports to determine average salaries for similar physicians in your state of interest and talk with trusted colleagues 8. Other factors such as call, relocation fees, sign-on bonus, student loan repayment, and continuing medical education time and expenses can be negotiated as part of your compensation packet.

In your negotiations, make your best pitch 9. Demonstrate your uniqueness as a candidate and show your creativity. Develop new strategies using your specific skillsets to benefit your employer in areas with knowledge or personnel gaps. Adequate preparation is the most emphasized skill in negotiating any contract. Look ahead of time at what your employer needs and listen well in conversations (in and out of the formal scheduled interview) and emails 9-10. Recognize that every conversation whether in-person, by phone, or through email is part of the negotiation process, and small talk is necessary (often sprinkled in fairy dust). Lead with confidence, and be open to concessions, to show your collaborative nature.

Align with the American Heart Association or American College of Cardiology Women in Cardiology Section, with an emphasis of early matriculation while in training. These organizations not only offer career development and networking opportunities, but they also offer sessions for contract negotiation. Contract negotiation preparation and practice will allow for greater success when navigating your first contract. This will help to overcome challenges related to compensation and promotion inequities, and better communicate career expectations prior to solidifying post-training employment.

BOX 1. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PROCESS

  • Consider life outside of work: social climate, recreation, partner, children
  • Discuss shared priorities and interests to support solutions with your employer
  • Ensure the contract clearly states non-clinical roles and other promises which may have been made to you during the interview process
  • Get in writing any specific unique requests that you may desire
  • Review national reports on average salaries in your specialty and state
  • Speak with trusted colleagues for an idea of fair wages for your specialty
  • Ask for a higher salary if what is offered does not meet your expectations

 

BOX 2. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON PERKS

  • Sign-on bonus
  • Relocation stipend
  • Non-compete stipulations
  • Malpractice insurance coverage with tail
  • Inpatient vs. outpatient service
  • Salary
  • Student Loan Repayment Plans
  • Dedicated Administrative or Research Time
  • Bonus/incentives
  • PTO (CME, Vacation, Sick days, etc)
  • Academic rank, promotion, and protected time for academic pursuits

 

BOX 3. NEGOTIATING YOUR FIRST CONTRACT: TIPS ON RESOURCES

  • PracticeLink (website); understanding the job search process
  • Getting to Yes (book); understanding negotiation
  • Good to Great (book); understanding the goals of your employer
  • ACC and AHA WIC Discussions; understanding strategies for women
  • Negotiation Skills: Negotiation Strategies and Negotiation Techniques
    to Help You Become a Better Negotiator; understanding power of negotiation
  • American Medical Group Association (AMGA) Compensation Survey;
    comparing compensation by specialty, region, and group size
  • Association of American Medical Colleges (AAMC) Faculty Salary Survey Results; comparing compensation within academia

 

REFERENCES:

  1. https://hbr.org/2018/06/research-women-ask-for-raises-as-often-as-men-but-are-less-likely-to-get-them
  2. Kugler, K. G., Reif, J. A. M., Kaschner, T., & Brodbeck, F. C. (2018). Gender differences in the initiation of negotiations: A meta-analysis. Psychological Bulletin, 144(2), 198–222
  3. Bowles  HR. Why women don’t negotiate their job offers.Harvard Business Review.https://hbr-org.proxy.library.vanderbilt.edu/2014/06/why-women-dont-negotiate-their-job-offers/. Published June 19, 2014. Accessed April 16, 2016.
  4. Jagsi  R, Biga  C, Poppas  A,  et al.  Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529-541.
  5. Mehta, L. S., Fisher, K., Rzeszut, A. K., Lipner, R., Mitchell, S., Dill, M., … & Douglas, P. S. (2019). Current demographic status of cardiologists in the United States. Jama Cardiology4(10), 1029-1033
  6. Fisher, Roger, William L. Ury, and Bruce Patton. Getting to yes: Negotiating agreement without giving in. Penguin, 2011.
  7. Lo Sasso  AT, Richards  MR, Chou  CF, Gerber  SE.  The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30(2):193-201.
  8. https://www.medscape.com/slideshow/2020-compensation-cardiologist-6012721
  9. Bowles, Hannah Riley, Bobbi Thomason, and Julia B. Bear. “Reconceptualizing what and how women negotiate for career advancement.” Academy of Management Journal62.6 (2019): 1645-1671.
  10. Fischer, Lauren H., and Anureet K. Bajaj. “Learning how to ask: women and negotiation.” Plastic and Reconstructive Surgery139.3 (2017): 753-758.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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How will COVID-19 Affect Return to High School Sports and ECG Screening?

August is traditionally very busy month in the pediatric cardiology office; visits for “sports clearance” flood the schedule due to something picked up on a high school sports physical such as chest pain. Most of these will be non-cardiac and receive reassurance; however, the cardiac causes in the pediatric population can be quite distressing. With the current COVID-19 pandemic we are seeing many cardiac effects of the virus— myocardial inflammation, dysfunction and coronary artery dilation or MIS-C (multisystem inflammatory syndrome in children). There has also been a reported increase in out of hospital cardiac arrest in the adult population, which could be attributed to those afraid to seek care, but none the less, a concern.

Cardiac effects play an important part in the recent discussions on return to school, as eventually return to school will mean return to school sports. Sports cardiologists have been following this closely and have been working to establish a safe way for return to sports in competitive athletes who have had COVID-191(click here for recommendations and see flowchart below), which may include extensive cardiac testing of those who had symptomatic COVID-19, most of which is based on the return to play myocarditis guidelines.2 These important decisions require individualization, knowledge of risk and what is happening in the community.

So what does this mean for the high school athletes? There is no doubt that exercise is great for everyone, especially with the rising obesity and the sedentary lifestyle. Organized sports participation has shown to have a positive impact on mental and physical health that extends beyond childhood.3 Many have raised concerns about the development and health of children by not attending school, along with decrease in social interaction and activity from organized sports during the stay-at-home orders and while we work to defeat COVID-19 spread.

Prior to the pandemic, the question of universal ECG testing for high school athletes always started a conversation, but could that change? Critics say that the false positives create distress and extra healthcare cost, that follow up is problematic and that it has not been shown to change outcomes. Others argue saving one child from the devastating event of collapsing and dying on the field is worth it, and a recent study showed ECG with H&P is more likely to detect a condition associated with sudden cardiac arrest (SCA) than H&P alone, and also improved cost efficiency when interpreted in the right hands.4 All agree it is important to have a good plan in place for SCA at all sporting events, including an emergency response plan in place specific to cardiac arrest.

With so many affected by the virus, at varying severity, I can’t help but wonder if this will change the way we assess our young athletes for participation in sports when it is safe to do so. While healthcare costs are always a problem, with a new virus and unclear long-term outcomes, we must be conservative. Perhaps this may provide an opportunity to learn more about ECG screening, as we will likely see a larger amount of patients who have had COVID-19 coming to our offices for clearance. This may provide an opportunity to gather evidence on the continued debate of whether ECG screening is effective.

Until we know more, what we do know is it is safer to be conservative, to assess benefit and risk and provide appropriate counseling to families on signs and symptoms of SCA. We also must continue to reassess and stay up-to-date on new knowledge and testing related to COVID-19 recovery and sports. Most importantly, it is important that we continue to advocate for heart safe schools which include having AEDs, training in CPR, and emergency response plans related to Sudden Cardiac Arrest. With more kids participating in school from home, this could be a great opportunity to engage the whole family in CPR and AED education to improve the safety and survival of our communities and at home.

 

References

  1. Phelan, Dermot, et al. “A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection.” JAMA Cardiology, 2020, doi:10.1001/jamacardio.2020.2136.
  2. Maron, Barry J., et al. “Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task  Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis.” Journal of the American College of Cardiology, vol. 66, no. 21, 2015, pp. 2362–2371., doi:10.1016/j.jacc.2015.09.035.
  3. Logan, Kelsey, and Steven Cuff. “Organized Sports for Children, Preadolescents, and Adolescents.” Pediatrics, vol. 143, no. 6, 2019, doi:10.1542/peds.2019-0997.
  4. Harmon, Kimberly G, and Jonathan A Drezner. “Comparison of Cardiovascular Screening in College Athletes” Heart Rhythm, 2020, www.heartrhythmjournal.com/article/S1547-5271(20)30406-9/pdf.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”