Focus on Internal Medicine Careers: Cardiology.
Following is an interview with William Hopkins, MD, FACP, Associate Professor of Medicine at University of Vermont College of Medicine and the Director of the Adult Congenital Heart Disease and Pulmonary Hypertension Program at Fletcher Allen Health Care. The interview was conducted by Talia Ben-Jacob, a fourth-year medical student at University of Vermont College of Medicine and the Vice Chair of the ACP Council of Student Members.
IMpact: Why did you decide to go into internal medicine?
Dr. Hopkins: The very first clinical rotation I did as a third year student was internal medicine. I did it first because I had no interest in the field, and I thought it would be a way to improve my skills for the rotations I was more interested in, such as surgery. But then a funny thing happened; I fell in love with internal medicine. I really enjoyed the organ-based approach and the emphasis on pathophysiology. I think many students have little or no understanding of internal medicine until they are exposed to it in their clinical training.
IMpact: Would you please give our readers a brief introduction to your career, fellowship training, and some of the things you have done?
Dr. Hopkins: I grew up in the Chicago area and attended the University of Chicago Medical School. I thoroughly enjoyed my time in medical school at the University of Chicago. Then I did my internship and residency at the Brigham and Women’s Hospital in Boston. I completed residency training in 1988. During residency, I confirmed my love of cardiology. We moved from Boston to St. Louis, where I was a cardiovascular fellow at Washington University’s Barnes Hospital from 1988 to 1992. While I was a fellow, I developed an interest in congenital heart disease and did some of my training at St. Louis Children’s Hospital. At the completion of my fellowship training, I joined the cardiovascular faculty at Washington University. Burton Sobel, MD, MACP, who was Chief of the Cardiovascular Division at that time, gave me the opportunity to start and develop the Adult Congenital Heart Disease Program. I also worked very closely with the lung transplant team at Washington University. It was through the adult congenital and lung transplant programs that I developed an interest in Down Syndrome and pulmonary hypertension. I joined the faculty of the University of Vermont College of Medicine in 1995. Dr. Sobel had become Chairman of the Department of Medicine at University of Vermont the year prior.
IMpact: If you could go back in time would you still choose internal medicine?
Dr. Hopkins: Absolutely.
IMpact: You have a multitude of experience in internal medicine. What led to your decision to become a cardiologist?
Dr. Hopkins: As I mentioned, my first clinical rotation as a third year medical student was internal medicine. Third year students did three separate blocks during the internal medicine rotation at the University of Chicago—one block in general internal medicine and two in subspecialty rotations. The very first block I did was cardiology. I was immediately attracted to the field. I thoroughly enjoyed the pathophysiology, clinical exams and the fast pace of the field. My attending was a phenomenal teacher as were the resident and intern on the team. I pretty much knew then that I wanted to be in the “cardiovascular field”. It was a question of whether I would pursue it through internal medicine, pediatrics, or surgery. Early in my fourth year, I decided on internal medicine.
IMpact: I was in the first class that had you as a basic science teacher. What made you decide to return to the classroom and get more involved with medical education after so many years of being a clinical professor?
Dr. Hopkins: I have always enjoyed teaching. I was frustrated by my lack of involvement with the medical school. Changes in the curriculum provided an opportunity for me to increase my involvement. I have thoroughly enjoyed the experience.
IMpact: What was the biggest challenge that you had to overcome as an internal medicine doctor?
Dr. Hopkins: I think there are many challenges. One important one is death. Some of our patients don’t get better and some die. It is important to know how to work with patients who are dying. I have found that when you deal with death in an honest and compassionate way that you can have an enormous positive impact on a patient’s family.
IMpact: Who is your most memorable patient?
Dr. Hopkins: I have many memorable patients. My most memorable patients are young ones that died because of congenital heart disease or pulmonary hypertension. I not only had a chance to connect with the patient, but also with their families.
IMpact: What advice would you give to third years who want to excel on their internal medicine clerkship?
Dr. Hopkins: (1) Learn to present well on rounds. Do it without reading off cards and do it “crisply”. Everyone notices a good presentation and everyone notices a bad presentation. (2) Know the details about your patient and know them well. (3) Be enthusiastic, show that you’re interested. (4) Improve your understanding of pathophysiology and how it applies to your patients.
IMpact: Do you have any advice for medical students who may be interested in becoming cardiologists?
Dr. Hopkins: Take things one step at a time. To get a good fellowship you need to do well in residency. To get a good residency, you need to do well as a student. Try your best to excel at each step in the process.
IMpact: What is the lifestyle like for a cardiologist?
Dr. Hopkins: It is variable and it often depends on an individual’s own priorities. Cardiologists can coach, teach Sunday school, go to school activities, etc. Alternatively, they can spend all their time at work if that is what they choose to do.
IMpact: Do you recommend that students who are interested in internal medicine fill their elective clerkship time with internal medicine-related rotations or is it preferable to gain experience in other areas of medicine?
Dr. Hopkins: I would do enough time to make sure that internal medicine is truly the field for you and to get letters from supportive faculty. However, it may be the last time you will have to spend time in other fields. I think it would be unfortunate to miss this opportunity. I have never believed that the purpose of medical school, especially the clerkship years, is to prepare students to be good interns. I don’t care if you become a good intern. I care if you become a good doctor.
IMpact: What would you say to medical students who are not choosing internal medicine as a career choice due to decreased salary, difficulty dealing with managed care, and lifestyle issues?
Dr. Hopkins: I never try to talk anyone into internal medicine or cardiology. I think everyone needs to determine their own priorities and make their own decisions. I want all of our students to be the best they can and ultimately to reflect well on the University. Students should remember that the issues mentioned above are potentially applicable to all fields of medicine.
IMpact: Where do you see the field of internal medicine growing, expanding, or changing in the next 20 years?
Dr. Hopkins: This answer could go on forever!! We will have far more genetic-based diagnostics and therapeutics in the future. We will also have therapies that are more directed to individual needs.
IMpact: Where do you see the field of cardiology growing, expanding, or changing in the next 20 years?
Dr. Hopkins: This could also be a very long answer. Cardiovascular disease is far and away the number one killer in the United States and the developed world. I look forward to the day when we have eradicated atherosclerotic-based disease.
IMpact: Is there any advice you would like to share with our medical student readers?
Dr. Hopkins: I hope they end up in a field that they enjoy and feel passionate about. Try to excel and continue to grow. We cannot afford to be mediocre, because we have been given the privilege of being doctors. With this privilege comes great responsibility.
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