We are proud to announce the launch of EP Lab Digest's podcast series in May 2019! In our augural podcast, we talk with Dr. Suzanne Feigofsky, creator of EPLD's “Women in EP” series and a cardiac electrophysiologist at the Iowa Heart Center in Carroll, Iowa. Included here are the transcripts of our interview.
Why did you become an electrophysiologist?
That’s complicated! I went into cardiology mainly because I wanted to be a surgeon who wanted to have long-term relationships with her patients. Then, in cardiology, I was originally interested in interventional, but quickly learned that the patients would continue their lifestyle choices that would result in recurrent myocardial infarction in the middle of the night, and I would find myself getting very frustrated and unhappy with the patient. What I learned about electrophysiology is that if the patients came back with recurrent arrhythmia, it was typically my fault — where I didn’t successfully complete an ablation or fully ablate a pathway. I felt better about patients having recurrent symptoms related to something on my end rather than their continued poor behaviors. The other thing that I love about electrophysiology is the diversity of your day. There are so many niches within electrophysiology and nuances that you could focus on within your career, that every day can be something different. Interventional cardiology has grown since I was a fellow; at the time, it was just heart caths and stents — it was pretty much what you did. With electrophysiology, it is device-based therapy, it is electrophysiology study and ablation, tilt tables — so there was a huge amount of diversity, where every day could be something different, and I found that to be incredibly appealing. I also liked that our patients get better, which is something that I find so gratifying.
Tell me a little bit about your medical background.
I was accepted to the accelerated medical program at the University of Florida, which I think is now called the medical honors program, which is a 7-year combined undergraduate and medical school program. I ended up staying for internship, residency, and fellowship. I can’t say enough good things about the University of Florida — it was a really lovely experience.
Then you moved to California, correct?
I did, I moved to California to a place I had never been. I was briefly married — I was married when I started electrophysiology and divorced before I finished, so I really wanted to move as far away as possible but with good weather. I ended up in southern California, which had all of the above!
How long have you been in Iowa?
It will be 5 years in June, and I spent 10 years in southern California before that.
What was your first year like as a practicing electrophysiologist?
It was chaos. I would say, don’t do what I did, which I think Dr. Rahul Doshi probably gave a lecture similar to that regarding me, actually! Don’t do what I did. Because I had been divorced and was going through that personal trauma, I moved somewhere far away, but in doing so, didn’t have a support system. I moved somewhere without family, without friends, without mentors — and that, I think, was setting me up probably for burnout many years later. The practice that I joined had an electrophysiologist there who then left the practice shortly after I joined, so there was no mentor within my practice. I am thankful for all the attendings that I had in Gainesville, who allowed me to call them many times during my first year. But the first year is hard — you’re spreading your wings and it’s the first time you’re on your own two feet, and you’re a little bit insecure. Not having a support network, I think, was challenging for me. Not having a reputation from staying near my fellowship was also, I think, challenging. Fortunately, I had electrophysiologists in other groups who did mentor me and support me — Rahul Doshi was one of them, Jay Lee was another. They really pitched in to help me become successful. But, it was really a struggle that first year.
Tell us about some of the specific challenges have you encountered in your career thus far as a female physician.
I don’t know if it’s unique — I’m sure it’s unique to women, although I’m not necessarily sure in cardiology — I think the issue in cardiology is that we are such a minority that I think if there was a way that I could have had women surrounding me early on in my career, I think that would have been more helpful. I think the first thing I noticed outside of training, because in my fellowship, we actually had Jamie Conti and Anne Curtis as faculty, and in general cardiology we also had women faculty. So I didn’t realize the lack of women in electrophysiology until I went out into the real world, because I was so sheltered in our fellowship, where we had almost a 50/50 divide, that I didn’t really appreciate the paucity of women until I went out into practice. [When] I went into my first job in California, I was the first woman they had ever hired, and the practice had been in place I would guess at least 20 years. That was challenging on many, many levels, and that ended up not being a good fit for me. My second job was a year and a half later, and that was a better fit, but again, I was one of very few women. There were two interventionalists who joined after I did who were very short lived within our practice, and we had an older, more senior woman who was a wonderful mentor to me, who was about 10 years my senior, who was a noninvasive cardiologist and who had never had children of her own. So when I became pregnant after being in my practice for five years, that is when I first realized the issues of being a woman in cardiology. I think in a very male-dominated profession, I really was shocked at my then boss’s reaction to my pregnancy, which was anger. It’s supposed to be this amazing, joyful time in your life, and you’re worried and you’re nervous, and there is not a lot of data at that time about radiation exposure in pregnancy, and you’re just trying to do the right thing. It was a really challenging part of my life, where my boss was not terribly receptive to my being pregnant and my not wanting to be in long cases in double lead and wanting to minimize radiation exposure, and that really opened my eyes a little bit to the potential for hostility regarding fertility. I don’t mean to imply that that is present everywhere, and I honestly don’t know, because it’s something we haven’t traditionally talked about. I don’t know — I was co-fellow with another woman who was a noninvasive cardiologist — I have no idea how her pregnancies went. I’ve never asked her, because I think we just don’t talk about it. I honestly have no idea if my situation is unique or not. Then after I had my daughter, being in a very busy practice, I would go days without seeing her awake. She was asleep when I left, and she was asleep when I came home. For me as a new mother, I found that to be really difficult to try and balance my professional career with wanting to be a good mother, and I found myself at the time discussing with my male colleagues, “I don’t have a wife at home to take care of my baby!” I am the wife, I am the mother, and I’m also a full-time cardiologist, and I really struggled. I didn’t have day care, my mother-in-law was gracious enough to move to California and help us raise our daughter, but I wasn’t the mother that I wanted to be or that I envisioned myself to be. I think everybody’s goals and desires are different. I wanted to be more present as a mother than I was, and that prompted my career change in moving to Iowa — where I wasn’t sitting in traffic and I wasn’t covering as many hospitals — to allow myself more time to be with my daughter because I wasn’t fulfilled as a mother. I was fulfilled as an electrophysiologist, but wasn’t fulfilled as mother, and I think that is hard to admit. I think you have to be honest with yourself — yes, did we go to school forever? Absolutely. Did we sacrifice everything to be the very best in our profession? Absolutely. But none of that is less important, I think — or being a mother, I should say, isn’t less important to me. It’s a different part of me, but it’s still me. I really grappled with that for a very long time to admit that I needed more time at home. I felt like a failure for not wanting to work full time anymore. I don’t know if other people feel that way, but that is how I felt — that if I wasn’t working full time, that I wasn’t a real electrophysiologist. It took me a long time to be okay with the fact that I am more than just my career.
Is this why you wanted to create the Women in EP column?
It is! I am so glad that we met, because what I found is electrophysiologists — there aren’t that many of us to begin with, and then 6% of us are women, and we’re scattered throughout the country. We do have the women in EP community in heart rhythm societies, which traditionally has not been very active up until recently, I think. I felt like I was missing a connection with other women electrophysiologists, except for the one time a year we would have a "women in EP" luncheon and I would see old friends. I thought the column would be a great way for us to identify with one another, to be open about our struggles or the differences between being a man vs a woman in electrophysiology, but also to attract more women into our field so that they could see that it’s possible, number one. Number two, that we all love what we do, and number 3, that whatever you perceive to be a barrier to becoming a woman electrophysiologist may not be the case — that what you may perceive as a barrier really isn’t — and by putting names and faces out there, it allows us to become accessible to those we might never meet in our career.
I love reading the articles when they come out, because I relate to everything that has been published, and it just warms my heart to know that 1) I’m not alone, and that 2) there is a common experience that we have that we’re experiencing as individuals. I think somehow reading someone else’s successes, failures, makes it more human to me — makes me feel like I’m a part of something bigger instead of feeling as though I’m experiencing all of these things in isolation.
When I first met you last year, you mentioned the importance of addressing burnout. What effects do you see it having on healthcare professionals, and what can be done to manage it?
I think that it is going to have implications in 1) the quality of care we provide, and 2) the number of physicians wanting to continue practicing medicine. I think it is a crisis in healthcare — I don’t think it’s a problem with physicians. As physicians, we are by definition resilient — we have survived medical school, we have survived internship, residency, fellowship. Resilience is not the problem. The problem is a healthcare system that is becoming very depersonalized, and I think that we went into medicine to care for patients, and that intimacy that drew us into our careers is being taken away by electronic medical records, health systems, insurance companies, and it is just a problem that I think unless as physicians we unite and stick together and stick up for what we believe to be important, it’s going to be a while before the pendulum swings back the other way. So, I think as physicians, we need to be open about how we’re feeling, we need to have administration that is willing to listen to what it is to be a physician. I think the goal is that one day we will be replaced with artificial intelligence, and I just don’t think medicine is that black and white. Medicine is very gray, medicine is an art, and I think it is something that is sacred, honestly. I think the doctor-patient relationship is sacred, and I think burnout is coming from that sense that that relationship is being threatened.
Another area I wanted to talk with you about was social media, because you’ve definitely helped transform the field for women, you’re very active on social media. How do you see social media transforming healthcare, especially for women in EP? What changes are you seeing?
I can say for me, social media has introduced me to leaders in the field that I may not have met otherwise. It has allowed collaboration between both women and men in the field, and I think also it’s a rapid way to disseminate information. Honestly, I find out about clinical trials or recalls first through social media. There is a strong presence of not only cardiology, but also electrophysiology, in social media. His bundle pacing I first learned about on social media — before a lot of the articles came out about it, I learned about it on social media. Social media then allows you to touch base with the leaders of the field and ask questions, get pointers during your cases. I’ve had cases that I’m worried about before I go in, and will ask a general, HIPAA-compliant, no personal information question just about technique — how would you approach x, y, or z — and will get responses from leaders in the field who I would never know personally. I’ve never met them through my training path and who I’ve been too intimated maybe to approach at a national meeting, who are more than happy to help out. That is the beauty of social media that I think people don’t understand — it is a way to connect leaders in the field with those of us who aren’t at an academic center who are still trying to deliver high-quality, evidence-based medicine who can then rely on social media to rapidly receive and disseminate information. There has been a lot of controversy, I think with people worried that there will be physicians who declare themselves as experts who aren’t experts. What I like, particularly about Heart Rhythm Society, is that we are all experts in our own way. So you may not have written the 10,000 papers about this one thing, but you still deliver expert care. I think that allowing us to interface in real time with leaders in our field has been extraordinary to me. I have made such amazing connections through social media that I think will in the future stimulate research and papers. It’s just outstanding, I can’t say enough good things about it. In particular, Twitter is where I have the most academic interactions.
Absolutely, I agree — I think Twitter is where the EP field is most active. You see such great interaction there. [Regarding] discussing one-on-one, face-to-face communication, how do you see medical conferences evolving for women in healthcare as well?
Social media has helped that as well. I think globally in medicine, there has been a movement to improve the promotion of women — the use of women speakers at national meetings, co-chairs of meetings — and that, I think, has helped to further my career. I think also having a champion — I have to make a plug for Dr. [Brian] Olshansky, who has really been an amazing promoter of mine. I spoke at Heart Rhythm two years ago, and his fellows were in my session. They told him, "We don’t know who this doctor is from Iowa, but you need to meet her!" That is how I met Dr. Olshansky — he came and found me at Heart Rhythm in 2017, and we’ve been collaborating ever since. I can’t say enough for social media just connecting people, making you more visible. I think this is how healthcare will be changing our national meetings — if you can’t be present, you can virtually be present and still be engaged in the meeting as its happening live, and I think that is priceless.
I know, I follow so many conferences now just through Twitter alone! Do you have anything else you’d like to add?
I can’t say enough good things about what you’re doing. I am thankful for you for taking my idea and running with it. I really think that women in EP as a community are extremely powerful, and have a lot to say and have a lot to offer. So I want to thank YOU for giving us the opportunity to do so!
Thank you! I appreciate you having the vision and coming to me with this wonderful idea. It’s been so great to hear from different electrophysiologists who are interested and hear their perspective. Everyone has been so honest with their experience about what it’s been like for them in the field. These aren’t easy topics generally to talk about, and they’ve been so well received.
Yes, and I think if you can’t be honest, you’ll never have change. If you pretend like there aren’t issues that need to be addressed, we’ll never take a step forward. So I applaud the courage of every woman who has contributed to the series.