Why would a successful cardiologist leave private practice for the rigors of academic medicine? The challenges of teaching weren't entirely unknown to
Marc Pritzker, M.D.; he had been an English professor before going to medical school. It was the opportunity to direct the cardiology training program that led Dr. Pritzker back to the University of Minnesota. The promise of shaping the future of medicine by engaging in innovative clinical research and educating the next generation of cardiologists was appealing. When he realized that
Jonathan Ravdin, M.D., Chair of the Department of Medicine, wanted to forge a program that offered students the best clinical cardiology opportunities in the Twin Cities, regardless of where these resources existed, it didn't take him long to say yes. "It was a bold and innovative idea," says Dr. Pritzker. "It was too great an opportunity to pass up."
Here is Dr. Pritzker's story, in his own words.
Working Together to Advance Medical Knowledge
From a clinical and research point of view, returning to the University of Minnesota and Fairview has made me feel like a kid in a candy store. My research is in an area called endothelial function, the way in which the linings of blood vessels regulate healthy blood flow. Endothelial function can become disturbed in a variety of diseases including atherosclerosis, pre-eclampsia, sickle cell anemia and pulmonary artery hypertension, as well as in survivors of chemotherapy for cancer and patients with non-healing wounds.
Our work has centered on the "Viagra Principle" - the use of nitric oxide to dilate blood vessels - and how it might be useful in a variety of diseases. We have already tested the principle with interesting and promising results in patients with pulmonary artery hypertension, some forms of anemia, scleroderma, and non-healing wounds.
The FDA has approved Viagra for the treatment of pulmonary artery hypertension. This dreadful disease primarily affects patients in the prime of their life, resulting in significant disability and, sometimes, premature death. I have had the good fortune to work with Monica Colvin-Adams, M.D., and together we have been able to expand the clinical and research opportunities available to patients throughout the Upper Midwest. Since this is a poorly understood disease for which there has traditionally been little in the way of therapy, it is important to couple thorough patient care with a carefully considered program of clinical and basic research designed to validate new therapies and acquire new knowledge about the disease.
Endothelial function has important clinical implications in a wide range of diseases, and provides a broad basis for research opportunities and important improvements in patient care. Faculty and community physicians from across disciplines are coming together to see how a common and collaborative investigative strategy may lead to greater insight into this area. Colleagues working in oncology, infectious disease, bone marrow transplant, cardiology, rheumatology and pulmonology among others have all contributed to the kind of interdisciplinary collaboration that makes the University such an inspiring and energizing place to conduct research.
Training Tomorrow's Cardiologists
Working with the cardiology fellows has been a dream come true. It's like having your adult children come home for fun, open, honest, and stimulating discussions. They have so much energy and always bring a new insight or question that causes me to re-think my attitude and understanding of a subject. My son called home after my first day of work to ask how it went. I told him it was the best and worst of times. It was the best of times because it was like having him and his sister home again. He asked then how it could be so bad. I replied that it was like having him and his sister home again - it requires a lot of energy to keep up with young, facile minds.
The cardiology community in the Twin Cities has really come together to provide unparalleled training opportunities for the cardiologists of tomorrow. Our fellows spend time at the University, the Veterans Administration Hospital, Hennepin County Medical Center, The Minneapolis Heart Institute, and Methodist-Park Nicollet. This provides them with otherwise unmatched opportunities to see a broad variety of patients in a broad variety of environments, and to be mentored by exquisitely experienced cardiologists with a diverse outlook and approach to cardiology problems. The arrival of Daniel Garry, M.D., Ph.D., as the head of cardiology and the Lillihei Heart Institute will only multiply the opportunities to provide premier cardiologic education.
Dan and I share the belief that cardiologists, wherever and in whatever setting they may end up practicing, should be thoroughly trained in clinical practice and research. We know that our understanding of the heart and its functions will continue to evolve. We hope to instill in our students a lifelong commitment to reflective patient care based on seeking out and understanding the new medical knowledge that will dominate their career years. They, in turn, will have the opportunity to contribute to this knowledge, and bring it to the patient's bedside or clinic room.
Putting It into Practice
I have been involved in developing the cardiology program at the new Fairview Maple Grove Medical Center. It has been a great deal of fun and very interesting to create a new practice environment for academic physicians that brings the best state-of-the-art knowledge, patient care, and translational research into a more accessible environment. It is a beautiful facility, designed to be patient and family-friendly, as well as warm, innovative, and efficient. The infrastructure has been carefully designed to integrate primary and specialty care. The Maple Grove location has complete cardiac diagnostics available and provides both general cardiology consultative services and cardiology sub-specialty expertise in areas such as congestive heart failure, preventative cardiology, arrhythmia management, syncope, valvular heart disease, pulmonary artery hypertension and blood vessel diseases.
The location in Maple Grove also makes it ideal for outstate patients to get consultative or second opinions from University of Minnesota cardiologists. These patients don't have to take the additional time to drive to campus to see a cardiologist. Instead, they can sit overlooking the preserved wildlife area around the Maple Grove clinic or spend time in the patient education center. In many cases, by the time they get home their report from our cardiologist will be on its way to their doctor's office.
I have been fortunate to participate in a tightly integrated group of cardiologists, cardiovascular surgeons, nurse specialists, social workers, and researchers at the University of Minnesota, in one of the largest and longest running programs of its kind in the United States. Last year we placed fifty-two mechanical heart devices in congestive heart failure patients who had deteriorated while awaiting transplantation or for whom there were no conventional care options. Even more exciting is that results in patients who underwent mechanical assistance as a bridge to transplantation are equivalent to the results obtained in patients who could be maintained until transplantation on the careful medical and self-care program that is in place at the University of Minnesota.
Advantages of Academia
I have had two really fabulous experiences over the last year that exemplify why I returned to academic medicine. One was participating in the small group discussions on cardiovascular disease that form a critical part in the training of second year medical students. They are so smart, eager, and altruistic. I had a ball teaching them in class, then took them to the University of Minnesota Medical Center, Fairview to see, interview, and examine patients on the in-patient heart transplant and artificial heart service. Both the students and the patients were in awe of each other!
The second experience was joining an inter-disciplinary group of pediatric and adult specialists discussing various approaches to treating cerebral malaria, a disease that kills 500,000 children each year. Six professors spent two hours discussing how we could collaborate to come up with new and perhaps highly effective ways to reduce both the long-term complications and mortality from this horrible disease.
These opportunities - to take part in the training of tomorrow's physicians and to work towards improving the outlook for our patients and patients around the world - are why I returned to the University. They are what make academic medicine such a challenging and rewarding endeavor.
