Dr. Joan Thomas and Her Improbable Journey as a Cardiologist

This transcript of their discussion has been edited for clarity and length.

Mike Sacopulos: Recent years have seen the number of female medical students surpass male medical students. However, it was not many years ago that female physicians were uncommon. My guest today started her career as an RN before becoming a nurse practitioner and ultimately a physician. Her career in cardiology came with a number of firsts. Prepare to hear from a true physician leader. Let's begin.

My guest today is Dr. Joan Thomas. She is a retired cardiologist who practiced in Rochester, New York, and she is also the author of The Heart of the Story: My Improbable Journey as a Cardiologist. Doctor, welcome to SoundPractice.

Dr. Joan Thomas: Thank you for having me.

Sacopulos: I'm interested; tell us your motivation for writing the book and why did you choose the subtitle, “My Improbable Journey”?

Thomas: I was actually prompted by friends; we would meet every morning after we'd work out at the gym and we'd have coffee and we'd all be talking about our issues, our careers, you tell stories. That's what it's all about and we'd all go on to work. One day, one of my good friends just said, "Joan, you have just got to write your memoirs. Your stories are fascinating. Some are funny, some are crazy, some are sad, but they're so interesting. You really need to write this down."

I started thinking about it for a year. I was transitioning from full-time practice to part-time. At first, I said, "Well, who would want to read about me?" He encouraged me to keep thinking about it and I said, "Yeah, maybe I have a story to tell, and maybe I can help the next generation of young women get interested in math and science and be encouraged to try medical career and go into cardiology. Maybe that would be the ultimate goal. Yeah.”

“The Improbable Journey” is because I grew up in the '50s and '60s, pre-Title IV, when a guidance counselor in the high school would tell all girls that you could be basically a secretary, a nurse, a teacher, or a stay-at-home mom. Those were really our options. We weren't ever asked or encouraged to think outside the box, so it's the improbable journey because cardiology and being a physician at that time was almost unheard of for a woman.

Sacopulos: Let's talk about some technical parts of the book and the process. Can you give me some details around publication and how did you decide on the way to structure the book? How long did it take you? Maybe give us a little bit of the background of how the book actually came together.

Thomas: The first thing I knew when I decided I would want to write it was that I couldn't be the writer. I have everything in my head, and I know all my background and I know all the dates and I know the timelines of everything, but no one would want to pick up and read the book if I wrote it. I'm a scientist, I'm a physician. I needed to have someone that could put it into prose so that people would be like, "Oh, I want to pick this up. Oh, I can hardly wait to get to the next chapter."

I knew I needed that person, so I started searching for a writer and I finally found the right one, who's an English professor at the University of Brockport in Rochester and teaches writing and had written books and articles on her own, had been previously a journalist in California. We met and it turns out coincidentally, we didn't know it at the time, we met right before COVID. I signed on with her and we started writing and then COVID hit.

We thought it would take about a year and a half. It turns out it took a little over two years and I think mostly probably because of COVID. A lot of our meetings ended up having to be on the phone. Two/three-hour conversations on the phone, long distance. I mean, early in COVID we didn't even have a vaccine, so we didn't even want to get together.

There were a lot of conversations and a lot of work on the telephone. Then finally, once we were all vaccinated, we could get together again. Yeah, that was sort of how it all started.

Sacopulos: Did you enjoy the process of working with a writer?

Thomas: I did. Actually, Sandra and I became friends during that process because we spent so much time together. We had a lot in common and we really enjoyed the process and got to be friends. This became a vested interest for both of us. We both wanted this to succeed.

Sacopulos: Doctor, in your leadership journey as a physician, you chose cardiology. When in your training did you choose cardiology? Can you tell me a bit about that decision?

Thomas: When I was four, I had acute rheumatic fever and at the time in the '50s a lot of people didn't survive having that. We didn't know it at the time. My brother and I were both sick at about the same time for over a year. When we went through that process, we came out on the other side and afterwards when we were older, my parents said, "Well, they told us we have a 50/50 chance whether your son and daughter would survive or not."

Obviously, the outcomes were good for both of us. Then I always wanted to be a nurse after that. That drew me to the healthcare field. So I went into nursing, and I started working at the hospital and within a year I ended up in the cardiac care unit. That was the intensive care unit at the time for people having heart attacks. I loved it. I worked with cardiologists.

I knew from then on that probably if I ever went on to med school it would be the path that I would take. Cardiology always fascinated me.

Sacopulos: You're a member of the AAPL and you also obtained the status of CPE, certified physician executive. Can you describe your leadership training there and are you pleased that you pursued that credential?

Thomas: Yeah. I think my only regret is I didn't do it sooner. I became chief of cardiology at our healthcare facility in 2007. I wished I had actually pursued the CPE degree a little bit sooner, but it took about two to three years to take all the courses. 150 hours of communication, management, ethics, law, finance, every aspect of the physician executive degree.

It's so important because doctors, when you go to medical school, you learn to treat patients, but you don't learn about how to run a healthcare system. Often time healthcare systems are run by non-physicians, and they have a business background instead of a medical background. The goal for the American Association for Physician Leadership is to teach more physicians how to run healthcare systems. I wanted to be a part of that.

Part of that process wasn't just taking courses and it wasn't enough that I was chief of cardiology. They said, "No, you got to do something else." I actually became vice president and then president of the medical staff at my institution for two years, so going to board meetings and representing all the physicians at our hospital. That was another layer before I could get my CPE degree.

I'm very happy that I got it. I was in my early 60s by the time I got that degree. I thought, "Well, maybe I could become a chief medical officer or chief quality officer." But those opportunities tended not to come up. What it did help me with was becoming a better chief of cardiology. I learned so much getting that degree about communication with my colleagues and my employees. It really made me a much better chief of cardiology and a much better communicator with everybody.

Sacopulos: You mentioned that you wish you would've pursued it earlier in your career. If you're giving advice to younger physicians, when would you advise them to consider doing the CPE?

Thomas: Well, my career was 30 years, and I was over 20 years into my career. I think if I was 17 years into my career, so a little over half, by the time I became a chief of cardiology, but I was already on committees before that, so I was becoming more active. I think when you first start your career right out of training, out of residency and fellowship, you really need to build your practice.

Part of that building the practice is to gain the trust of not only your patients, but your colleagues and to gain that respect. Then once you've got that, because there's a lot of learning that happens in the first, I would say five or six years of building a practice. I learned probably more some weeks than I learned when I was in training. Things are constantly changing.

Cardiology's one of those fields where things change rapidly and so you really have to constantly keep up. I would say that after you've got your feet on the ground, you've built a good practice. Your colleagues respect you. Then you can start looking to branch out and take some leadership roles maybe a little bit at a time getting on some committees and then working your way into it.

Sacopulos: I understand that there's a WIC or Women in Cardiology section of the American College of Cardiology. Could you describe what the section does? Is it mentoring or advocacy or what exactly is its mission?

Thomas: Initially the American College of Cardiology, which I've been a member of for many, many years and when we take our board, you become a fellow of the American College of Cardiology. We all are long-time members. Within that, the Women in Cardiology first came up and was informal, but it finally became a recognized full chapter of the American College of Cardiology. It's a very active group of women and some men cardiologists and we meet every time.

We have national meetings. We have state chapters. We encourage some of the women in the different state chapters to go on and become governors of the state chapters of the American College of Cardiology so that women play a role. At the meetings, we talk a lot about how we can get more women interested into going into cardiology. I still stay very active in that even though I'm retired.

I felt when I was writing this memoir, that my writing it, I wanted to reach out to a lot of these women, whether they're in college, whether they're thinking about medical school, whether they're partway through medical school, not sure what to do, or if they're in residency programs, not sure where they're going. We encourage them all, and we get all different levels coming to our meetings and they ask a lot of questions.

What we have noticed is that there's a leveling-off of women coming into cardiology, maybe about 15/16/17% of all cardiologists are women. When I became a cardiologist in 1990, it was only 5%. It's risen up to about 15/16%, but it's not going up like you would hope it would, that we could get more women interested in that. A lot about what we talk about as faculty is how can we get more women to come after us? How can we get more women interested in this wonderful subspecialty?

Sacopulos: Let's stick with the young women physicians for just a moment. What two or three suggestions would you give to a young female physician as she's beginning her career?

Thomas: I went through internal medicine residency and out of that, you can go into any specialty you want. A lot of people when they come out of medical school and start residency, they're not sure where they're going to ultimately end up. In internal medicine residency, you can go into cardiology, oncology, pulmonary, hematology, infectious disease. There's many, many choices. We would like to see more women choose cardiology as a field.

I would encourage women to really look around and spend some time taking electives in cardiology because we're one of those fields that you can be invasive, you can be interventional, you can be noninvasive, you can be in testing. Cardiology's constantly changing. Pharmacology is changing. The testing is changing. The procedures we can do to help patients live and live with good quality constantly changes.

To me, it's a fascinating field so I'd like to encourage more women to stick their toe in the water and say, "I want to look into this." Taking more electives and working side by side with some other cardiologists wherever they're doing their residency is a good starting point.

Sacopulos: It's interesting that you mentioned that the number of women going into cardiology has somewhat plateaued in recent years. Why do you think that is?

Thomas: We talk about that a lot. I think it's multifactorial. Part of it, I think, is cardiology has a background at least in the past of being a lot of call, patients can come in critically ill, and you really need to go in. Early in my career, I was on call every third night. We were on call a lot and you had to go in. A lot of women if they want to balance career with having a family and that kind of thing, I think that makes a lot of women shy away.

Another reason I think women tend to shy away is, and this was actually published in an article in the last year in the Journal of the American College of Cardiology, that cardiology's one of those specialties that could still be a hostile work environment for minorities, which it would include women as well as racial minorities.

That's something we spend a lot of time about, how can we get beyond that and make it a welcoming place for women specialists and women cardiologists to work?

Sacopulos: Somewhere along those lines, doctor, in your book you described the inequities that you faced in an academic medicine career because of gender. Do you think progress has been made?

Thomas: Yeah. I think there's more women becoming promoted now. Is it a level playing field yet? Absolutely not, but I think we have made progress. My efforts and my, I shouldn't say struggles, but I had about seven years to get promoted and that became a mantra. I knew friends who had done the work and been refused promotion and so I said, "I am going to have a CV so good; I dare them not to promote me."

At the end I had more than I needed in order to be promoted and they did promote me. It's going to take more people like that to persevere and say so that it makes it the path easier for the women coming behind us. I think we are making progress.

Sacopulos: Now, early in your career you mentioned you were an RN and a nurse practitioner, and I'm interested in comparing the experiences with the struggles or the discrimination that you faced in terms of amplitude and in frequency, how it varied between your roles as a nurse, nurse practitioner and physician.

Thomas: I didn't face much discrimination as a nurse because back then most nurses were women. There was definitely a hierarchy at the hospital so most of the physicians were men. We were a teaching hospital, so we had residents and fellows. Most of them were male. There were very, very few women. There was only one or two women surgeons in the whole hospital so there was a hierarchy, but I didn't really feel much discrimination.

As a nurse practitioner, it was such a new field. We were pioneers and I would say the vast majority early on were women going into these fields. I had two mentors both of whom were cardiologists, both men. They were extremely supportive of me and felt that I was bright enough to go to medical school and just kept pushing me along. Then I said, "Well, I'll become a nurse practitioner. Then we'll see how it goes."

Then I was working as a nurse practitioner and doing clinical research with big research grants, with pharmaceutical firms where I would come up with results and then have to go speak at a national meeting about some of the research I was doing with the cardiologists. All this time, the cardiologists were saying, "Joan, we really think you should go to medical school."

I was happy to have any mentors at the time. They weren't women, but they had my best interests at heart.

Sacopulos: Very nice to hear. I want to talk a little bit more about your book and some of the accomplishments that are listed in it. Again, for our audience, the book is The Heart of the Story: My Improbable Journey as a Cardiologist. The book goes into detail of not only your training and your fellowship, but also your various academic appointments. Now, looking back retrospectively, what accomplishments are you most pleased with?

Thomas: Clinically I think I was pleased with how my patients felt about me. I think that would be the number one asset. I was pleased to become chief of cardiology, but it's the patients, the honor you have to feel where the patients put their trust in you. I think I understood that better almost near the end with a lot of the letters that I got when I was announced that I was going to retire.

But I had patients that I would have for 10/15/20 years. We'd be on a first-name basis, a few of them you would become a little more friendly, but the trust that patients put into you is just the highest honor I think a cardiologist can have. Then I think being the first chief of cardiology that I knew about in New York State, and I looked it up afterwards, because I certainly had no role models to look at when I became a chief of cardiology, that was a proud moment.

To have vied for the position with other male candidate and to have gotten the position that people had enough trust in my ability to become that. I think that was a great accomplishment in my career. I was pretty proud of that. Getting my CPE degree was certainly a great accomplishment as well, but I think one of the things as I became a better chief of cardiology was winning over cardiologists who weren't happy initially that I was their boss.

Over the 12 years that I was chief of cardiology, having earned their respect I think was a huge accomplishment, on their part to accept me, but on my part that I won them over. You basically do that one patient at a time and one conversation at a time, winning over their trust. I always felt as a woman cardiologist, that you have to be better than my male colleagues to be considered as good, and I worked really hard to do that and I felt like I accomplished that.

I think I won over naysayers in the beginning. That gave me a great deal of controversy and tried to make my life difficult hoping that I would fail. In the end I won them all over, so I think that was a huge accomplishment.

Sacopulos: Absolutely. Dr. Thomas, we're almost out of time, but I am sure that there are people that are wondering what you're doing nowadays.

Thomas: Well, I am volunteering at Volunteers in Medicine Clinic in Hilton Head, which is a 10,000-patient clinic for the working uninsured. It's a very active clinic that we have. I work there half a day a week. In my spare time I play some tennis and golf, try to stay physically active. Around here in our community, we have other retired physicians, but we find that a lot of our friends come to us for medical advice, so nowadays I'm giving out free medical advice. That's okay. That's fine. It's a big change, but I really, really enjoy volunteering. A very underserved population.

Sacopulos: Very nice. Good for you. My guest has been Joan Thomas. Her book is The Heart of the Story: My Improbable Journey as a Cardiologist. Dr. Thomas, thank you so much for your time.

Thomas: You're very welcome and thank you for having me.

Sacopulos: My thanks to Dr. Joan Thomas. Her career in cardiology is a good example of physician leadership. My thanks also to the American Association for Physician Leadership for making this podcast possible.

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