Cool Careers & How You Got Them
A conversation with professionals who have cool and interesting jobs and a description of their career path, targeted at high schoolers, hosted by Zain Raza, a current high schooler.
Cool Careers & How You Got Them
1.8 - Sports Cardiologist Ankit Shah
In today's episode, Ankit Shah takes us through the ins and outs of his career as a sports cardiologist.
Hello everyone, welcome back to another episode of Cool Careers and how you Got them. I'm your host, zain Raza. I'm sure lots of adults ask you what you want to be when you grow up and if you're anything like me, you don't have an answer for them. Hopefully, my podcast can give you some inspiration. I'm very excited and lucky to be joined today by Dr Ankit Shah, who has a very cool and interesting career. He's dedicated his career to sports cardiology and, without further delay, let's get into it. Dr Shah, how are you? Very well, good morning, all right.
Speaker 2:So let's start out, how we always do, with what is your official title. So I'm founder and president of sports and performance cardiology.
Speaker 1:Okay, awesome. So, founder and founder and president, you said Okay, so does that? What kind of implications come with starting your own practice? Or can you explain what starting your own practice would be like first of all?
Speaker 2:this day and age, very few people are doing this. Most people are going the other direction and being employed by big health systems. So it's a big undertaking. So the first thing is making sure your spouse, if you're married, your children and your family are fully on board and supportive of taking this type of leap. It's not an easy task to do. It's a lot of risk financially and both time-wise. But yeah, I mean, I think you need to know one, that you have a specific niche or expertise where you can. You know there's a market for what you want to do. And then, second, make sure you have the right location, staff and then you know again the support to sort of say this is going to take time to build and grow.
Speaker 1:And, in your opinion, what are the advantages of owning your own practice versus working for somebody else?
Speaker 2:The autonomy. Autonomy is really important. No-transcript. Athletes and teams don't want to wait weeks or months which is not, you know, pretty common in big health systems to wait um, and so we can do testing and see athletes on weekends nights. I have that flexibility just opening up my office, calling in my staff and we can do what we need to do. So, uh, for this field that works out really well okay, awesome.
Speaker 1:So when you were a teenager, what were you like? Let's see, I enjoyed my life. I worked hard, but I socialized a lot and I played a ton of sports. Awesome, did you?
Speaker 2:know what you wanted to be when you grew up. I grew up with medicine in my family, so that was sort of always there. But I wanted to test out something else, and so I studied economics in college while I was doing pre-med and then going through the economics. I actually loved it, but didn't know if I wanted to do that for a full career, so I ended up going into medical school afterwards.
Speaker 1:Okay, and speaking of school, can you take us through the education process to lead you to where you are now?
Speaker 2:Yeah, absolutely. So I went to Boston College for undergrad and you know, I think one of the things when you're thinking about careers, you have to make sacrifices to end up where you want to go and what you want to do. You can't have everything. And so certainly in that first two years of college I was a road crew and I was doing an econ major and pre-med as well. So there was very little socialization in those first two years of college and then hung out with my roommates, but I wasn't going out, I was dedicated to what I wanted to do and so I had that vision and I pursued it.
Speaker 2:I got into Tulsa University Medical School to do an early program and that allowed me to study abroad. So I studied abroad in Italy and studied economics at a really great institution called Bocconi University in Milan. From there I went to Tufts University School of Medicine in Boston and I did a Master of Public Health as well. I did a joint four-year program, which is pretty unique. Most schools have it as a five-year program. So again, summers were taken up doing public health courses when you had some free time. From there, I did internal medicine residency at Cedars-Sinai in LA for three years and then I went to New York where I worked with your father at Lenox Hill Hospital as a cardiology fellow, and then I pursued a year of sports cardiology fellowship in Boston at Massachusetts General Hospital, and then from there it's when I actually started my career. So, as you know, medicine is a very long path, and so after you finish college, you're starting years and years of training and work.
Speaker 1:Right, right, I know my dad always complains. He's like well, I know, if you think you want to be a doctor, go through the first four years of school and still, if you really want to. But speaking of your background in economics, can you touch on really quickly how that kind of plays in with running your own practice?
Speaker 2:Yeah, I mean I think part of it is just again, not being one-dimensional. I think it's really important to have different experiences, different exposures. You know, I'm good at finances, I'm good at math, I understand some of the bigger concepts A lot of. I mean I don't have an MBA, I've never run a business before, so I'm learning a lot as I go, but sort of a sound thought process and you know, a lot of this is, I think, part of the reason medical practices don't survive is they have really high overhead and they don't keep track of their sort of ins and outs and their balances, and so you really need to get on top of that.
Speaker 1:Yeah, got it. So obviously I think you have a very cool career because you're on the show. But in your opinion, what makes your career cool or unique?
Speaker 2:Yeah, I mean I get to do, I get to combine what I love in my sort of free time, which is sports and athletes and all that excitement, with what I do on a day-to-day basis.
Speaker 2:And so I am a cardiologist who specializes in active people and athletes with potential cardiovascular problems, and so you know I work with the whole spectrum. So most cardiologists typically see older patients. My age range is sort of 16 to, you know, over a hundred. So I have a lot of competitive high school, collegiate athletes, professional athletes, Olympic athletes, which is a really fun group to work with, obviously because they're you know, if, for whatever reason, they do have a cardiac issue, we'll try to work with them to keep them safe and let them do what they want to do. And then also work with a really engaged sort of master's athlete population, which we define as anyone over 35, who have heart disease and want to stay active. And so I've got some really impressive athletes with pretty significant heart disease who are Ironman triathletes, get on podiums doing marathons. So it's a really fun group to work with, Keeps me interested, keeps me active and motivated myself.
Speaker 1:Okay, so is your work more preventative, you would say, or is it after something has already happened? Then you come into the picture.
Speaker 2:Both, both, really both. So you know, for all the not all, but a lot of the younger athletes, they were required to do some sort of screening before they can participate in sport. Whether it be a history and exam, some places will do some cardiac testing. So if there's abnormalities or initial concerns from there, then I'll do testing to sort of work with them to make sure they're okay. But in a small subset of those people they are found to have heart disease and so I'm working with them to allow them to play. I do see a lot of patients sort of who aren't through uh teams or organizations but come in on their own because a strong family history of heart disease or they're worried about their risk factors, and so in that sense it's preventive cardiology. But there's a you know, I don't know, it's probably split 50, 50,. Then you know real cardiac patients with bypass surgery or stents or heart attacks or valve problems, um, and they want to stay active, and so it's a perfect mix to sort of everything.
Speaker 1:Okay. So when it's a situation where you already have an athlete and then they have some kind of issue, what is the return rate like for that person returning to sports afterwards?
Speaker 2:Yeah, so part of this is where we've come from and where we're going um. And so traditionally I don't know 10, 15, 20 years ago it was a very conservative approach and a very paternalistic approach which meant I know what's best for you, and so you have some heart problems and I'll say you can or cannot play sport, and so it was a decision pretty much, uh, on the shoulders of the physician, um, but we've come a long way and we've realized that we probably don't know what's necessarily best and we don't know the values, the wishes and goals of the athlete and families. And so what we do now is we sort of provide the risk stratification. We make a diagnosis, we say this is what we think your risk is, and we engage typically what's called a shared decision-making process where we really engage the athlete and families and say how much risk are you willing to take, how much risk you take in your day-to-day lives, what are your wishes and goals and how much does this mean to you? And then we come to sort of an agreement on saying you think this is reasonable or not.
Speaker 2:Um, and so these days a lot more athletes are returning to play with cardiovascular disease, um, who wish to now, certain athletes and families say I don't want to take any added risk and they won't, and sort of self-disqualify. But there's been a big shift in the last again 5, 10, 15 years of saying let's work together and partner together. I think one of the big things when you think about it also is that there's athletes without cardiovascular disease who take risks every day with extreme sports and whatever it may be, and so sport is not risk-free. And so if we, if we can work with the athlete, provide sort of an appropriate plan obviously it's been all over the news over the last year or so, a year and a half but creating what's called an emergency action plan, with providing CPR, aeds, all of that, we can sort of keep the athletes as safe as we can.
Speaker 1:Okay, got it. So you know, while I was preparing for this interview, I could not get Damar Hamlin out of my mind. I was thinking about him the entire time, so I didn't fully understand the process that he went through. So when that initially happened, he went to the emergency room, I'm assuming, and then afterwards, when everything is okay, then he comes to you.
Speaker 2:Yeah, so, um, so I can't speak to his case specifically, but what happens is yeah, so I mean, obviously he had a critic arrest on the field. He's resuscitated by the initial team, physicians, athletic trainers and staff, ems. He gets taken to the emergency room, icu in the hospital, he gets treated medically and then at some point he gets discharged home and then an athlete like that would typically seek exactly second opinions, and they would go usually in this scenario it'd be more than one or two people typically to do a full workup, you know, evaluate the stuff as a sort of a separate set of eyes and then again make a decision on what was the cause of the cardiac arrest. Does anything specific need to be um, and then can you return to play okay, got it.
Speaker 1:So can you really quickly in your own words just explain why what you do is important?
Speaker 2:yeah, I mean I think you know, for again, I think traditionally most cardiologists are are not trained in the physiology of sport and understanding of sort of the normal changes of what happens with exercise to the body, which we think are physiologic and healthy, and how to differentiate health from disease. There's certain there's a lot of overlap with athletes, heart or what's called exercise inducedinduced cardiac remodeling, and then some forms of heart disease, and so making sure you can differentiate the two, and then you don't want to again unnecessarily disqualify people or say you can't do things, and so really working with people to keep them active and safe. I mean, I think, as we know, exercise is one of the best things you can do for your heart health and for many other chronic diseases, and so keeping people active is really important.
Speaker 1:Absolutely. Can you take us through a regular day at work?
Speaker 2:So get in 7.15, 7.30, prep for the day, see patients. For most of the day usually have one or two meetings I'm still involved in research and a lot of national committees and um programs and so a couple meetings by zoom a day. Typically, um, I'll finish anywhere from 4 30 to 6 pm here, um, go home, see family and then right now typically working from about 8 to 10 30 at night also.
Speaker 1:Wow, okay, and you're exclusively in person, other than the Zoom meetings that you have.
Speaker 2:No, I do virtual consultations and follow-ups as well. Yeah, telehealth.
Speaker 1:All right, nice, so you touched on this a little bit. But if you didn't run your own practice, what would be the difference in flexibility for your work schedule?
Speaker 2:Yeah.
Speaker 2:So I mean, I was employed for six years and there's there's obviously pros and cons to everything. You just have to figure out what works best for you. I mean, in that setting you have, you don't have to worry about staffing and other things. You sort of come into your patients to your job and then you can go home. You have allotted PTO time, other things. You sort of come into your patients to your job and then you can go home. You have a lot of PTO time, and so all that makes some of that very simple. You get your paycheck and this scenario.
Speaker 2:I mean, yeah, we work with some professional teams, we've had some trips, and so I just I'm able to close the office when I feel it is important for us and what I think is a bigger part of my strategy and my vision for this office, and so I can.
Speaker 2:Yeah, I can close down strategy and my vision for this office, and so I can. Yeah, I can close down, go to conferences when I want. If I'm invited to speak, I can shut down whenever I need to, and then again, I can come in whenever I need to. We've had some teams from the UK over here and we you know they had athletes flying in. We can open up for office on Saturday afternoon for an hour and a half, do what we need to close back up and then go back and see my family. So I think whatever I feel like is valuable for our growth and for what we want to do and how we want to help athletes, we can do, which is a lot harder when you have a bigger, bigger thing that needs a lot of approvals from different people.
Speaker 1:Okay, got it. And in running your own practice, what kind of managerial skills would you say you apply?
Speaker 2:I mean, part of it is you know. Again, it's just being on top of things. I think you need to make sure you understand the business of medicine, with how insurance works, how you keep your spreadsheets and your costs contained as much as you can, and then just make sure you have the right people around you Good accountants, good support staff, good billing department making sure that they all have you know they understand what you're looking for, when to reach out to you for help, and so there's definitely a balance of making sure you provide autonomy for those folks and not micromanage, but also stay on top of it Because, again, health care, medical practices these days aren't typically surviving. They're getting bought out, so you have to make sure you are financially sustainable okay, got it.
Speaker 1:So you know we talked a lot about work, but how do you use your free time?
Speaker 2:yeah, so, um, I've been all sort of exerciser. So I I played team sports growing up, I wrote school and college and then, depending on where I've lived, I've taken up different things. So I've done a lot of road, cycling, beach volleyball when I was in LA, same thing in New York, running and cycling. I've got a spouse and a child, and so these days, whatever is easiest I do, which is typically trying to jog or do some type of body weight exercises. I have a treadmill in my office so sometimes I'll run before I get home. So it's really working out and spending time with my family, nice.
Speaker 1:So how did your background in sports affect your choice in career? So how did your background in sports affect your choice in career.
Speaker 2:Yeah, I mean, once you get into medicine, I mean I think people typically change it a few times I was all over the board. I liked sport adventure medicine, so I thought about emergency medicine, doing wilderness medicine, I thought about orthopedic surgery, doing sports medicine, but ultimately I was most drawn to cardiology. I really liked the physiology of it. It makes a lot of sense once you learn it. It's not a lot of memorization. Like the physiology of it, it makes a lot of sense Once you learn it, it's not a lot of memorization.
Speaker 2:And then actually, unfortunately, one of my college roommates had cardiac arrest after winning a crew race and he was not resuscitated and so that had a big impact on me. And so when I was in cardiology, thinking about options if I wanted to be a proceduralist or if I wanted to do something else, I actually learned about sports cardiology. I think in my second year of cardiology fellowship and sort of putting all the pieces together, I went to a conference and I fell in love with it immediately after the first lecture or two and then since then I've been involved with it.
Speaker 1:Okay, nice, so your work. You're constantly interacting with other people, right? This is not the job for an introverted person.
Speaker 2:Yeah, no, I don't think you'd be a sustainable or an introverted person. I mean, you have to go out there and make contacts, especially again as an independent practice. You want to make sure you're having good relationships with all your inferring physicians, all your patients, and then again you can be doing research, you can be part of committees and, yeah, definitely, I guess you could be introverted socially. But as a business person, person you're going to want to definitely be actually absolutely so.
Speaker 1:How do you kind of balance the the day-to-day medical stuff and the running of the entire practice?
Speaker 2:yeah, that's something you have to learn with time. I mean up front. If you're going to start practice, it's the hours along, and this is where you know again, nothing comes easy. If you want to try something new or do something that's not or against the grain, I would say but if it's something that's part of your vision or something that makes you happy, the hours aren't as taxing. And there is a point where you have a vision, whatever it be one year, two years, three years from now that things will settle out and you're actually not going to work that much forever. But you have to put in your time to make it sustainable and make it make sense.
Speaker 1:But you have to put in your time to make it sustainable and make it make sense.
Speaker 2:And would there ever be a scenario where someone is running a practice without a background in medicine just from a managerial standpoint yeah, that happens a lot Private equities buying out practices. A lot of administrators don't typically have never practiced medicine, so it happens a lot.
Speaker 1:Yeah, and how would not having that background in medicine affect the way that they do their job?
Speaker 2:I think it's tough to run a practice when you don't know what the actual people do on a day-to-day basis, and so it sometimes can create some conflict or misunderstanding of what is actually being done, what's important, how your time's being used, and so those are some challenges definitely.
Speaker 1:Okay, got it. So what's the next step in this field for you?
Speaker 2:Well, I think, as field in general, I see us again, I think, pushing. We're just on the cusp of this whole shared decision-making part. We're doing a lot of more. I mean, we've been doing it as a cohort, but now there's a couple of big studies. I'm actually gathering data prospectively, meaning following these patients that we've had these conversations with and letting them participate in sport, and also the ones who decided not to participate in, following their outcomes and also the ones who decided not to participate in, following their outcomes. Are they, you know? Is the one group doing better than the other? Are we making mistakes? We need to learn from all of this, and so I think you know, these studies have just started in the last 12-ish months, and so we have a lot of really exciting things coming up for us in the next three to five years and as we go forward, yeah, Okay, got it.
Speaker 1:So in my conversations probably in the last month just reading I've been doing and talking with other people I keep hearing this recurring theme of longevity longevity in healthcare. So can you just touch on that a little bit, or can you explain it and then touch on it a little bit from your standpoint of sports cardiology?
Speaker 2:longevity meaning for the average person. You said longevity in health care. What is that?
Speaker 2:for the average person, sorry, oh yeah, so, um yeah, exactly so you're hearing all of this. From my perspective, there's the biggest thing is making sure that, um so risk is a cumulative impact. I think in the years prior we'd say in an arbitrary age would be 30, 40, 50, 60 you say, okay, now we've got to treat your blood pressure, cholesterol. I think what's intuitive, what becomes sort of an important push recently, is that you know these risk factors start early in life and if you don't treat them it's a cumulative impact. And so if you've got, if you're obese or overweight and you don't exercise in your 20s, you've got borderline blood pressures and high cholesterol. That's something we should attack when you're 20 and not wait until you're 40 or 45, because then you've given yourself 20 plus years of having those risk factors that are not treated.
Speaker 2:And so it doesn't always mean treated with medication, it just means hitting the lifestyle stuff big, so focusing on the diet and exercise.
Speaker 2:And that doesn't mean you can't eat whatever you know a snack here or there, but you can't eat that four times a day essentially. And so it's creating a well-balanced diet, a healthy lifestyle with regular exercise five days a week, at least of aerobic training a couple of days a week of strength training, and then you've heard of VO2 max, which is an oxygen consumption. So the higher VO2 max, the more work you can do, and the work can be speed on while running or watts on a bike, and there's a linear correlation with the higher vo2 max, the longer you live. And so what we really try to push people to do again is live a healthy lifestyle, not smoke, moderate your alcohol, make sure your sleep is good and moderate, you know, making sure you're controlling your mental stress, but then exercising to get your vo2 max as high as possible. Also, and all of that together gives you sort of best chance in the not just living for a long time, but living in a functional way for a long time.
Speaker 1:So what would you do in a situation where you have an athlete now has developed some cardiovascular issues and can't do those kinds of aerobic exercises? What can he substitute that kind of stuff with?
Speaker 2:Yeah, so it depends on. So for most scenarios you can, um, and if they've had some weird leg impairment or some issues there, you can try to do an arm ergometer. There's different exercises and ways to do aerobics with your upper body. Um, you know, if they've got again joint issues, we can try to get them in a pool and do water aerobics or swimming, and so there's different ways to try to work this out and to try to keep people active, as we can.
Speaker 1:What if it's a cardiovascular issue?
Speaker 2:specifically, yeah, there's very few that limit us completely. You're saying you can't do exercise, exercise. And so almost in every scenario doing aerobic exercise is better than not, unless you have something unstable which would need to be treated, and then afterwards we can try to work with you to get you back. And so with people with heart disease, we try to give an exercise prescription. So based specifically on their age again, their wishes, their risk factors, their type of heart disease, work with them to say, okay, do this 15, 20 minutes a day and then build up to 30 or 40 minutes over the next four to six weeks, and so we can work with them specifically to create a plan. But if there's not sort of a blanket statement, it really depending on all the sort of findings for that individual person and then creating that prescription.
Speaker 1:If you had to give us a breakdown of what it is you're actually doing when you're working. How much of it is this kind of planning and laying things out versus actually doing procedures on patients?
Speaker 2:So I'm not an interventionalist or a proceduralist, but we do. So I see consultations, we do stress testing and we do pre-advanced cardiopulmonary exercise testing here. We do stress echoes, we do echoes, I do heart monitors and so I do all the non-invasive testing. So for us a lot of our day is coordinating, so we try to make it efficient for the patient and so when I come here, we do a consultation and try to do all their testing same day. So before they leave I have this data, I can give them a recommendation create that initial plan. That's pretty different in most offices You'll do like a consultation, go back in a few weeks later for an echo, go back in a few weeks later for a stress test, and then at some point we can talk about it, and so we'll do everything in one day and so, yeah, so the days consultations, you know, running tests, reviewing tests- and then regrouping Awesome.
Speaker 1:I think it's really great that you can get all of that done in one day, because it's a real pain in the butt when I have to go to the doctor like four or five times throughout the course of two months. But can you? I know it might vary.
Speaker 2:you might not have a set amount of hours, but if you had to give us an estimate, how many hours would you say you work a week? Yeah, so currently it's probably like 60 to 70.
Speaker 1:Yeah, okay, all right. So thank you so much for taking time out of your schedule to do this. As we finish up, I want to do the mailbag. So to submit for our mailbag, you can email Zane at coolcareersandhowyougothemcom. You can fill out our get in touch form on our website, coolcareersandhowyougothemcom, or you can DM us on Instagram at coolcareersandhowyougothemcom. So today's question is super relevant to this interview. It's from Kyle, who's a freshman in Delaware. So the question is, if you want to do something medical related, how do you know what kind of medicine you want to practice and what is it like trying to narrow that down?
Speaker 2:Yeah, I think the first step is saying that you're interested in medicine in general I think a lot of us. Even once you get through medical school, you're changing careers, you're changing thoughts in your mind, and so the first thing is saying, yes, I'm really interested in this career, making sure you learn about all the nuances, and not just practicing medicine, but what the life looks like after you get through medical school, training. And then, once you're, you know you've made that commitment to say, yes, this is what I want to do. There's different opportunities, whether it be shadowing or internships, and so a lot of practices are will let you shadow, you can apply, you can perform different sort of skills. I think you know if you're an undergrad, there's things you can do, like as a scribe in emergency room or in a clinic, and start learning how the actual practice and day-to-day life works.
Speaker 2:In terms of narrowing down a field, it's just going to be exposure. So you're going to want to specifically see what an orthopedic surgeon does or a neurosurgeon does or a family practice physician does and then decide, yes, I like these things or no. And then, once you get into a specific field, there's actually a lot of subspecialties within that, like cardiology, for example. I mean there's interventional cardiology, electrophysiology, advanced heart failure, sports cardiology, there's imaging so, and every every field has sort of there's a lot of sub sub branches, and so part of it is just making sure you get the right exposure and keeping an open mind. I think some people sort of narrow in really early, and that's probably a mistake, because things change.
Speaker 1:And so just making sure you go in and get a big, big glance at everything is important.
Speaker 2:Okay, Absolutely. If people want to learn more about you or what you do, where can they go? So our website is wwwsportsandperformancecardiologycom. We've got info there and our emails on there as well. Info at spcardiologycom.
Speaker 1:Okay, awesome, and you know, as we wrap up, you've got the ear of many highly ambitious students. Do you have any final advice for them or an ask you have for them?
Speaker 2:So advice I'd say two things. One is, as you go through this process, try to identify and find mentors that so they can be family friends, people through school, mentors that so that could be family friends, people through school, but true mentors who one understand you and your skills and weaknesses. And then, from your end, making sure that, if those are mentors you have identified, that you listen to them and so meaning you take their feedback. You can still disagree, but I think you have to take their feedback and actually listen to it at heart. And if they tell you no, I don't think this is a smart decision because X, y and Z then you have to sit back and really take a look and say do I have these skills? Does this make sense for me? Should I think about this differently? And so good mentors are really important and you should try to maintain that for your whole life and career.
Speaker 2:At any point in stage you're going to need people to bounce ideas off of, and so having good friends and mentors again who are able to provide constructive criticism and you can take it is important.
Speaker 2:They can't always agree with you, that's, that'd be a bad mentor. And then, second is that time doesn't stop. And so you know, especially now, with with everything in our lives being 24 7, you have to create pauses to think about what you want in life, and so at some point I like the idea of having sort of a three to five year plan, meaning you're always thinking about where you want your life to go. Things are never going to go necessarily perfectly, but you have to. At least you have a thought process of where you want it to go, and then you can try to create those things. I think a lot of people get in, get sort of stuck in everyday life, and then then they work up 10, 15, 20 years later and they're like oh man, what happened? And so I think having a purposeful, active planning rather than passively letting things happen to you is really important, and I think that'll help keep you happy and engage in what you want to do.
Speaker 1:Yeah, absolutely. I think in my life so far those have been the two most important things for me is having good people around me to help me out and planning ahead. So thank you so much, dr Shah. I really appreciate you taking the time out of your day to do this and take care Of course, have a good one.
