Robert M. Califf, MD

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Capillaries are so small that it takes ten of them to equal the thickness of a human hair.
Progeny in Academic Medicine

I had the chance to commune with our cardiovascular practice last night.  It was a remarkable experience.

Almost 30 years ago, the practice of medicine at Duke Hospital was a one person individual effort.  Every doctor was a member of the Private Diagnostic Clinic (PDC), but beyond that each doc saw patients as an individual with a team that typically included students, house staff and fellows.  Harry Phillips and I found ourselves in the hospital every evening as I was developing the CCU as a place to intervene in the new era of reperfusion for myocardial infarction and Harry was busy building a cath lab practice. In those days, we would round on up to 30-40 patients a day, including every other weekend.  Being on call every other night and every other weekend was a great improvement in quality of life.  After a while we decided to join forces with the blessing of Joe Greenfield and we formed a 2 person group.  Within several years we were up to 5 as others joined in.

Now, of course, like most large academic and private practices we work in functional groups–general cardiology, EP, intervention, imaging, valvular and congenital, heart failure.  These groups have become integrated practices with multiple physicians, advanced practice providers (nurse practitioners, PAs) and staff.  We are closely aligned with the hospital units and clinic staff where we work.

Last night, Chris Granger and Kristin Newby, who head our general cardiology practice group, hosted a get together for many of the faculty, fellows, nurses, pharmacists, PAs and other associated staff.  The event was dominated by the dozens of children, direct progeny of their parents.  But the progeny of our training programs and educational system were equally evident.  Lloyd Smith, my Chair of Medicine at UCSF in 1978-80, gave a great lecture once on “Academic Progeny”.  His point was that academic medical centers are an amazing melting pot of people from all over who convene to learn and practice.  Most of these people move on to teach, learn, and practice elsewhere and some stay with us.  The influence one can have in this environment is remarkable.

Much of the conversation was about children, but we also talked about friends and colleagues who have recently left or soon will leave to spread aspects of our knowledge and culture elsewhere.  The same opportunity exists as we take in trainees and faculty from elsewhere.  We need to remind ourselves more often that our greatest impact in a place like Duke may be in the imprint we leave on people who go elsewhere.

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Category: Academic Medicine

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