← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Andrew Tang, MD, Cardiac Surgeon at Medical City Heart & Spine Hospitals
00:16:52
Loading summary
Transcript19 lines
- [00:00]
A
This is Scott Becker with the Becker Healthcare Podcast. We're thrilled today to visit with a true leader in cardiothoracic surgery. We're joined today by Dr. Andrew Tang. Dr. Tang is both a brilliant physician. He got his medical degree from Texas Tech in Texas. He's double board certified. He's also the Author of almost 50 or more than 50 peer reviewed articles and textbook chapters. He also, in addition to being a physician, obtains his master's in clinical statistics from Case Western Reserve, which itself is a magnificent institution. Dr. Tang, tell us about your current practice, your move to Texas, and about yourself.
- [00:41]
B
Thanks for having me on. I, you know, I'm originally from Plano, did all my undergrad and medical school in Texas and my wife and I actually couples matched in Cleveland and that's where I was for the last 10 years, completing my training in general surgery and also cardiothoracic surgery at the Cleveland Clinic. So that's where I've been and that's where I did all my training. And as you mentioned, I also obtained a master's in clinical statistics during my dedicated research years, which really I think helps me understand the research and also allows me to kind of help other people in terms of completing high quality research as well.
- [01:20]
A
Thank you. When you look at cardiothoracic surgery today, there seems like so many things have changed over the years. At one time everybody was doing cardiac bypass surgery. Then it seems like more stent work. What's the evolution today? What are the big trends you're watching in cardiothoracic surgery?
- [01:40]
B
Well, I think that with technology there's obviously a lot of excitement and there's obviously a lot of benefits for the patients. But I think one thing holds true, especially in cardiothoracic surgery, I tell patients this all the time, is that no matter what, there are some things that are tried and true and stand the test of time. And I think one example, example of that is the lean to led. I think that, that, you know, single, that single bypass is, you know, keeping patients alive, keeping our field alive. And it also allows us to kind of do other things as well, a little bit, you know, things that are a little bit more complex, multi component surgeries. So yeah, I know, it's, it's, you know, it's funny that you mentioned stents and, you know, and how things have kind of changed a little bit. But now we're also seeing, it's just like anything else. It's just like any other field. There's, there's a pendulum and it swings one way and Sometimes it swings back. And so actually I was just taking care of a patient who got transferred in from another institution because they had severe multivesal disease and probably have lower ejection fraction from the sun myocardium and have some mitral regurgitation. There's so many things that the transcatheter that we have from a transcatheter option, but this patient's gonna need surgery. But to support her through her immediate issues, we actually had to put in a microaxial pump to basically help offload the left ventricle in order to get her out of trouble now so that we can eventually get her to a point where she's recovered and is able to actually undergo the surgery that she needs. So one thing right now is that we've kind of, you know, you mentioned one, a couple things in our toolbox, and we've now kind of combined a lot of these things to help patients, to provide them with the care that they need. And it's not just one, it's not just with one trick. We have a lot of different tools now that allow us to do that.
- [03:26]
A
You know, it's so funny, Dr. Chang, because what you're saying sure resonates with me. It seems like over the last several decades, decade or so, we such a. Saw such a movement towards stents. And now as I, I don't know if it's because I'm aging or the population's aging, I just seem to hear more and more people having different types of, more open heart surgery. Again, compared to what I was seeing for a period of time. It really does. Your, your, your notion on it being a pendulum seems exactly what we're seeing out here. Tell us a little bit about where you practice and also what you're most focused on and excited about for 2026.
- [04:04]
B
So I work for a medical city. I'm part of a group with our senior partner, Todd Dewey, and we're part of the HA system. And, you know, for me, when I was looking for a job, the most important thing that I was looking for was good senior mentorship. And I've really got that with Todd and with Mike McBride. And I've just been fortunate to have very good leadership here at Medical City Heart and Spine with our CEO Andrew Daniels as well. When I was interviewing for jobs, you know, I was telling all my friends that it's not, it's very rare that the CEO of the hospital actually calls you or he writes you a handwritten, you know, card saying congratulations on passing your boards or Congratulations on the birth of your new daughter. So I'm very fortunate to have great leadership, great partners, and that's allowing me to continue what I've already kind of started in my career, which is complex surgery. I hope to bring back home some of the things that I learned in Cleveland. You know, the Clinic was number one in heart care for 30 years. And I think there are people who travel from all over the world just to get their care there. And I was hoping to bring some of that experience and the quality of care to Dallas Fort Worth. And so from my standpoint, I don't really have one specific thing that I focus on because the training that I got allows me to take care of anything under the sun from a cardiac standpoint. And we just had a patient who came in in cardiogenic shock, so we put in an impeller in her and we're going to work up for multi vessel bypass and mitral valve repair replacement. And then we, you know, the other day we'll have someone who comes in with, you know, mitral annual disjunction and then needs a repair or someone who has, you know, aortic aneurysm disease and needs, you know, needs a root replacement. So I think from my standpoint, I'm just focusing on getting better each day and trying to bring in some, you know, high quality. And there's not one specific thing that I'm necessarily focused on. But I will say that one thing, as you mentioned earlier, with technology, it allows us to also fold more patients in and learn more about disease processes. So, for example, one thing that we're noticing is that even with the advent of tavr, obviously there are more patients who are getting their aortic valves replaced when they may have been a marginal surgical candidate beforehand. And we're seeing that even for some of these patients, despite the fact that they get a very high quality tavr, that maybe in general for patients who have aortic stenosis, maybe their lifespan is not the same as for someone who doesn't, even after you've fixed the aortic valve disease. And so one thing that we're looking into is, well, how does that actually translate? There have been studies out of Japan that have shown even for patients who have moderate aortic stenosis, their survival curves do separate when they're diagnosed with aortic stenosis at an earlier age, even despite, you know, surgical or transcatheter valve replacement. So that's something that we're looking into, you know, with Todd and Bruce Bowers being here you know, this institution is one of the leading experts in aortic valve disease and was one of the first places in the country to actually implant TAVR in the United States.
- [07:21]
A
So fantastic. And you're having this great career. And talk about being a lifelong learner. I love that you went back or did it while you were working a master's degree in qu, Clinical statistics. Talk about that and that commitment to constantly improving and how important that is for emerging physicians and emerging leaders.
- [07:39]
B
I think, you know, there. There's this misconception that amongst some of the, you know, the lay people or the patients, whoever might be, that once a. Once someone's out of medical school, that they really don't have to study. And every day, even after residency, even after fellowship, every day is a learning day. You know, there's always a chance to improve. There's always a chance to get better, and that comes from having good mentors. So I got my master's in clinical statistics through an NIH grant paid for by Eugene Blackstone. And Dr. Blackstone has actually had several retirement parties, but yet somehow is still working. And so he's kind of an example of someone who always tries to continue to learn and continue to get better. And a lot of my mentors back in Cleveland also were the same way. Despite having busy clinical practices, they were always trying to learn more and get better. And I think that that's what keeps you. That's what keeps you, one, relevant, but also two, I think it keeps you humble, too, because if the day that you decide that you don't need. You don't need to learn anything else, I think is the day that you stop growing as a person and growing as a physician. And it's also the day that I think that the patients are at a disservice, because if we're not looking to get better, then that means that we've already fixed everything that we can fix, and we know that's not true. Heart disease is still the number one killer in the United States. And you. We still have surgical complications that can happen. And so there are things that we can learn in terms of how to prevent those things and also in terms of how to adequately address those things should they happen. I think that being here with Dr. Dewey and with Andrea, we have a good team where we are encouraged to continuously look at ways that we can improve our system processes. For example, right now, I think that we live in a difficult environment to practice clinical medicine. I know a lot of people around the country and other hospital systems feel Especially after Covid, still have this lingering burnout effect. But one thing that I was looking for was a place where everyone was hungry to continuously get better and continue to provide high quality care. And that's something that I think is encouraging. Whenever any new grad is looking for a job, you want to find a place that's not, you know, just resting on laurels and kind of just continuing status quo, but you want to find a place that is growing. You know, Dallas Fort Worth market is. Is one. It's one of the fastest growing cities, which means there's a lot more patients who are going to be coming in who need health care. And so we've already expanded our hospital capacity by at least 28 ICU beds. And that means that we got more patients to take care of and, you know, more things to do. And that's. That's encouraging because as a young surgeon, you want to continue to be operating. So.
- [10:29]
A
And how do you balance. One of the things I do see is that physicians that aren't learning and trying to get better, it's not that they stagnate, and some are very, very good at what they do, but you also can get burnt out if you just keep doing the same thing over and over without learning and constantly learning. On the other hand, it takes tremendous energy to keep on getting better and keep learning. How do you balance that with making sure you're able to stay focused and not burn out and stay after it and so forth? I mean, it seems like you got to do both. You got to do great work, you've got to keep learning, and you have to have enough space for yourself to keep on regenerating or recovering. How do you sort of balance all that?
- [11:13]
B
I think for me personally, you know, I'm grounded by my family, by, you know, my wife, who's also a physician and is my biggest supporter. And I. I think having a life outside of the hospital is extremely important. Knowing that you personally can't handle everything, knowing that there are just. You have limitations. You're a human being first and foremost. And even though we are in a field where we are expected to fight death and to basically be an immovable force in an otherwise chaotic world, I think you also have to have enough humility to realize, yeah, I'm just.
- [11:57]
A
Just.
- [11:57]
B
I'm just a man. I'm just a human being. I'm flesh, I'm bones. And so you have to know that you have certain limitations, and then everything isn't up to you. And. And you just do the best that you Can. And, and I think that that mentality is, Is tough to maintain at times because, again, there is such a high demand for you to, To. To be perfect, basically. And I think you just have to know that you, you do what you can and you continue. And the only way is to strive for perfection, but not actually, but knowing that it's unattainable, but you keep striving for it. And I think for me, you know, I, I have a lot of friends who are in the field as well that I can rely on and people I train with who we, you know, we still text and we still kind of talk to each other. And I think that's important because it's. It's hard to kind of keep everything to yourself and just kind of stew on things, but sometimes you need to, you know, talk with your colleagues, talk with your mentors. I still text with, you know, a lot of my attendings back in Cleveland frequently. And I'm very fortunate to have trained at a place where, number one, you know, you have the world's leading experts who are phenomenal surgeons, but also, two, they're good people. And I think, again, having great senior mentorship, you know, my office is right next to Todd's, and I will frequently just pop over and say, hey, what do you think about X, Y and Z? And having that outlet really helps, especially when you're a junior surgeon, because you don't know everything. You come out on top of the world and you quickly realize there's still so many other things that you just never had to deal with, never had to see until you're actually attending. Then you realize, okay, yeah, there's a lot more to it than just cutting and sewing. There's a lot more to it than just, you know, putting in the valve. There's a lot more to it than just, you know, managing the patient post op. And I think that if. If people are blind to that, then. Then they will quickly be reminded of it because reality will set in. And I knew coming out that, you know, it was really important for me to find a good fit in terms of finding a good practice. And I think part of that is just having great mentorship from back home, talking with, with, you know, the likes of Dr. King, Dr. Spidera, Dr. Gilanov, all those guys, they basically. Dr. Murthy, they all, they all were very instrumental in my training and also, and also how I would build my practice because, you know, they've done it, so they've kind of told me that the things that they learned.
- [14:08]
A
Thank you. So much. Let me ask you one final question. Any advice you would give to emerging leaders, emerging physicians?
- [14:17]
B
I think collaboration, the other part that I really love about being here is that we have a great collaborative relationship with our intensivists, our cardiologists, our interventionalists. And I think one thing that really has been encouraging here is that we pick up the phone, we call each other without hesitation, no matter what time of day, and we bounce ideas off of each other. You know, like I said earlier, there's not one tool, there's not one thing that's going to help a patient. You know, open heart surgery isn't the answer for everyone. And, you know, stents aren't the answer for everyone. And tavrs are necessarily the answer for everyone. And having a collaborative team, I think, is the most important thing. And we have that here at Medical City. You know, we know each other by name, we know each other's families. I don't have to worry that, oh, you know, I don't want to call so and so because they're not going to want to hear from me because I'm just the junior guy. No, if Dr. Bowers has. If I need him for anything, he's just a phone call away. He's one of the leading interventional cardiologists in the country, and, and he talks to me as if, you know, I've been his partner for 20 years. And so I've been fortunate to. To be in a position where I can, you know, rely on other people for their expertise. And I think that, you know, it's easy to get siloed into your own field, into your own space. But there's so many people who have, you know, great experience, but also they themselves are also pushing the envelope and trying new things. And so it isn't until you. You kind of talk to them and that you realize, okay, there's maybe a better way of doing this.
- [15:57]
A
There's.
- [15:57]
B
There's other things that we can do to help these patients. And so we're very fortunate that we have a really good heart team approach here where, you know, it really is kind of1unit.
- [16:09]
A
Dr. Tang, what a remarkable career in leadership. Congratulations, and thank you for joining us today on the Becker's Healthcare podcast. A true pleasure for us. Thank you very, very much for joining us.
- [16:22]
B
Thank you so much for having me. And happy holidays.
- [16:25]
A
Happy holidays. You too. Thank you so much. Dr. T. Sam.