How I Started My Career in Cardiology: A Conversation with Dr. Gary Francis

Updated:Mar 7,2011

February 2007

For the first installment of this feature, Dr. Heather Gornik, member of the Young Clinicians & Investigators Committee of the Council on Clinical Cardiology, sat down with Dr. Gary Francis, the 2006 AHA Laennec Society Lecturer, to discuss his perspective on starting a career as an academic cardiologist and clinical researcher.

Dr. Francis is head of the Clinical Cardiology Section of the Cleveland Clinic and is a professor of medicine at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.  He is a world renowned clinical leader and researcher in the area of heart failure and is the author of more than 400 scientific publications. Dr. Francis is the immediate past president of the Heart Failure Society of America and the co-author of the ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult.

HG: When did you decide on a career in cardiology?

GF: I guess when I was a medical student.  I regularly attended most of the cath conferences. When I was a resident, I read Circulation and The American Journal of Cardiology.

HG: When did you decide you wanted to have a career in clinical research?

GF: I knew as a Fellow that I would hope to stay in academics. I interviewed at the Brigham. The late Tom Smith offered me a position as research fellow. On the way home, I stopped in Minneapolis to visit my parents, and I visited with Jay Cohn. Jay was doing very interesting things, and he talked me into staying at Minnesota. I took a chance, because not many people turn the Brigham down. Minnesota is a great place.   I worked directly with Dr. Cohn, and I was there two years when he offered: “How would you like to help run my laboratory?” It didn’t take long to say yes. And the rest is history. He allowed me to ask my own questions. He gave me lots of support. He made sure that my salary didn’t come from the university. It came from the government, which really freed me up. You have to have a mentor. I think to really succeed you have to have somebody like that, who will really push you.

HG: Tell me about your first research grant. 

GF: The first grant I applied for it was to study mechanisms heart failure.

HG: Was it an NIH grant?

GF:   It was a VA Merit Review  grant. It was easier back then, I think, to get funding than it is now. We had a lot of grant support at the university with PPGs (program project grants), VA grants, and RO1s. It was a collective effort. The PPGs, as opposed to the RO1s, are what really financed most of the work. We did science as a group. There was a small molecular lab, a chemistry lab where neurohormones were measured, a human physiology lab and an active animal lab.   Grants financed all of these.   There were NIH grants and some money from AHA.  Everyone was expected to have some grant support. It was the people that made it fun. I couldn’t wait to get to the lab in the morning. It was so interesting. We moved our lab meetings to Saturday mornings as the group became larger. The meetings were marvelous. Dr. Cohn would write a question, and he would ask, “How can we answer this? Is this a good question?” The group of anywhere from 10-15 people. It was really fun. I began to think it is easy to get papers in The New England Journal and Circulation. Almost everything we did got published in a high profile journal. I don’t want to say that it was easy though. We worked very hard.

HG: I know you have always balanced a busy clinical and administrative life with your research. Do you have any advice for people starting their careers? I know I struggle with the balance of clinical duties and starting a research career.

GF: I don’t think we give enough protected time to people. It isn’t really free time, but it is protected time. When you first start, if you are going to have an investigative career, you should have about 80 percent protected time. It sounds unrealistic, but you have to have substantial protected time. Now, it is much more about big trials and people writing off of those databases, which is a different way of doing clinical science. It is very hard to get small mechanistic studies published now. So my advice would be to try to work with a group. Science is done in groups…never underestimate the importance of group dynamics.  

HG: I think another issue young cardiologists find immensely important is finding good mentorship. It seems as if finding a mentor is often a matter of good luck.  But if someone has not been lucky enough to find that fantastic mentor, how does she or he find one?

GF: It is partly luck. I didn’t really have a mentor early on. I had people I admired, but they weren’t really mentors. I think Dr. Cohn was probably the best thing that ever happened to me as far as my career.   I still talk to him regularly. He is still very active.  

Cohn was always good to me, but he didn’t praise me. We talked everyday. “What are you doing? What about this? What do you think of this?” You know, a lot of questions – it was wonderful.

“How to find a good mentor?” I am not really sure, except that there has to be mutual trust and respect. You should have similar scientific interests. There has to be a passion for the work. When you are at great institutions, there are a lot of great people around, and some of them are more helpful than others.

HG: If you were to give one piece of advice to a fellow who is just about to start her or his career as a clinical investigator in cardiology, what would you say?

GF: Well, mentorship is critical, but the whole enterprise should be fun. It shouldn’t be arduous or contrived. If you are just doing something because everyone else is doing it, I don’t think it will work. It actually has to come from the heart and the mind. You have to want to do it. You have to want to get up in the morning and go to work because something very interesting is going to happen. Look for that.

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