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Why Cardiac Electrophysiology (EP)?

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Tamirisa chose the field of cardiac electrophysiology and why it is a great field.

Referring to my professional choice, the most common comment I get is “What is that?”

My reply, “Electrician just for the heart”

I entered Medical School with two areas of fascination – Cardiothoracic Surgery and Cardiology. I loved everything about the heart and I knew I would enjoy doing procedures. As I sailed through medical school, I decided to enter Internal Medicine. I was the first doctor in my family, the field of internal medicine gave me the medical skills necessary to give advice to my large family whenever my input was requested. During my IM training, I was drawn towards EKG's and patients with electrical problems of the heart. That made it easy for me to land on Cardiac EP!

A report of the Committee on Women in Cardiology identified 5 barriers for women to pursue career in Cardiology – radiation exposure, family concerns, lack of advancement, discrimination, and disparity in compensation. Recently, recommendations were made to overcome these barriers in 2018. I will touch on radiation exposure, family concerns, as well as other factors when career choice in EP is considered.

1. Sub-Specialization Advantage: Since you are in very high demand, you can negotiate your contract to achieve work-life equilibrium. For example, you can choose to work 4 days a week and plan your procedure days (which are unpredictable and tend to be longer) and clinic days (which are shorter).

By having designated procedure days and clinic days, you can plan your family life around that. You can also make time for clinical research depending on the “phase” of your life.

2. Procedures & Radiation: Unlike 10-15 years ago, radiation exposure can be minimized with effective use of 3-D mapping systems to navigate catheters, wearing lighter radio-protective gear, collimating the beam, and using low pulse rate and energy of radiation. The newer labs are equipped with radiation equipment that is anchored to the roof and drops down to cover the operator.

3. Immense Gratification: Success rates for EP procedures are in the high 90's, especially for young patients with Wolff-Parkinson-White syndrome (WPW), Supraventricular tachycardia (SVT), etc. I have seen SVT misdiagnosed as anxiety or panic attacks, especially in young women. A single ablation cures them for life, without any further “anxiety” attacks. Implantable cardioverter-defibrillators (ICDs) have proven to be life saving time and again based on multiple studies. Approximately one in twelve lives are saved with ICDs. Additionally, heart failure becomes past history for many patients who receive resynchronization therapy.

Most of the EP procedures are highly curative or lifesaving.

4. Variety: EP offers a wide variety of procedures which means you will never get bored! From venoplasty on an occluded subclavian vein, to putting leads in, to accessing the coronary sinus, and even implanting the world’s smallest pacemaker (size of a small pill!). We perform a wide range of ablation procedures for things like atrial fibrillation, WPW, SVT, and VT. The list goes on, and continues to grow with new advances in stroke prevention and lead-less technology. Every day brings new challenges and advances.

5. Bonding and Network: Given the small pool of board-certified EP physicians, you will get to know everyone in the field. EP physicians and lab staff all function as one unit and share life’s successes/predicaments. Since we all face the same challenges, we have room to vent, share, and both give and receive advice. This results in a tight knit community. For example, Heart Rhythm Society has an open member forum where all ideas, challenging cases, or policies are discussed. It's much easier to come up with action plans to problems, given the small number of specialists.

6. Demand: Only 12% of the board-certified cardiologists are women. When it comes to EP physicians, only 6% of them are women. So, clearly, the job market is wide open for women both in academia and in private practice.

Cardiac EP as a field is relatively young and fascinating! It offers a fantastic opportunity to have a rewarding career with a great work-life equilibrium.

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