← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Transforming Cardiology Through Innovation, Training, and Technology with Pranav Loyalka, MD
00:13:22
Loading summary
Transcript14 lines
- [00:00]
A
Welcome everyone, to the Becker's Healthcare, Cardiology and Heart Surgery Podcast. I'm Mariah Taylor, assistant editor, and I'm thrilled to be speaking with Pranav Loyoka, cardiologist at HCA Houston Healthcare Medical center, medical director of structural heart disease, heart failure, heart transplant, and mechanical circulatory support at HCA Gulf Coast Division, and the program director for the Cardiology Fellowship Program at HCA Kingwood Hospital. Thank you so much for joining me today. I'm really excited to learn more about everything you're doing in cardiology, but before we dive into that, I'd love for you to introduce yourself and tell us a little bit about your background.
- [00:38]
B
So thank you so much. Really happy and excited to be on the show and get in front of you to answer questions. I actually grew up in Columbia, Missouri, spent my life running around the country getting educated, and after about 16 years of education after high school, ended up being a cardiologist here in Houston. I've got two kids, a wife and furry baby at home and really enjoy living in Houston.
- [01:13]
A
Excellent. Now, you've obviously been in cardiology for a long time, and interventional cardiology has undergone a lot of transformation, even just in the last two decades. So from your perspective on the front lines, what's the single advancement, whether that's a device, a technique, or a procedural approach, that has most changed what's possible for your patients?
- [01:36]
B
So interventional cardiology has been a very exciting field. We have really changed since the time I trained in 2005, when I ended my training to where we are now. Interventional cardiology at the time I trained really dealt just with coronary artery disease. In other words, the arteries that sit on top of the heart that get blockages. The surgeons do bypasses. We put stents into it. The single biggest advance probably happened, and I was very fortunate to be a part of this in 2008, 2009, when we started the trials for the new heart valve that we could replace through the leg in patients called the transcatheter aortic valve replacement. That really opened a new era in interventional cardiology. We were a part of the early trials that were performed in the United States and got FDA approval later. Basically, patients with what we call aortic stenosis, a disease that leads to death, especially in the elderly. It was a disease either you got surgery or you passed away from it. So many elderly patients, 80, 90, even 100 years old, would be medically managed, would get congestive heart failure and have really poor quality of life. We were now able to rescue those patients, place a heart valve through the leg and send them home the next day. That's probably the biggest advance that we've had, and that's led to subsequent advances in the other valves, whether it's what we call the tricuspid valve, mitral valve, pulmonic valve. Now we have options other than surgery. To be sure, surgery plays a role, will always continue to play a role, but now we have alternatives, which is really exciting.
- [03:36]
A
Absolutely. And as I said in the beginning, you are the program director for the cardiology fellowship, and it can be a little bit hard as a fellow coming into the industry as a whole, but especially with all the changes that have happened recently. So what's one piece of advice you have for someone who's a first year cardiology fellow that you wish you had gotten early in your training?
- [04:01]
B
So, probably the one piece of advice, and we had it in our training, but it's different in this generation, is that you really need to put in a lot of time and effort in order to master this craft. We educate, we talk, but at the end of it, it's a hand skill. And just like any hand skill, and it's probably Malcolm Gladwell all over again, it's the 10,000 hour rule. You just have to do a lot of it to get good and you have to pay attention to details and you just have to be prepared that you're in it for the long run. It's not just, hey, two, three years, four years, you've learned your craft, you're going to end up learning your craft well into your practicing years.
- [04:51]
A
Absolutely. And knowing what you do now about the field and how it's evolved, is there anything you would have done differently in your training or how you built your career if you were to start all over again?
- [05:04]
B
No, not really. Actually, I'm very fortunate that I ended up in the right place at the right time. I actually did my early training, my residency in internal medicine and pediatrics. For folks who don't know for cardiology, you have to either start an internal medicine or pediatrics to then go on to what we call fellowship. I actually did both and then I started cardiology fellowship in the adult world. When I was at St. Luke's I was very fortunate. I met Charles Mullins, who was the father of pediatric interventional cardiology. When he found out that I had done both and that I was interested in interventions, he took me under his wing. At that time, pediatric interventions, unlike adults, was dealing with the big arteries, the valves, holes, in the heart. That skill really paid dividends when we started fixing aortic valves through the leg, because that type of work we were doing in pediatrics, although they weren't valves, they were bigger stents, bigger arteries. I also had the ability, when I was at Texas Heart Institute, some phenomenal teachers who taught me peripheral vascular, in other words, the plumbing and the pipes in the arteries outside of the heart. And so that skill also layered onto that. And the other field that I did, heart failure transplant, really evolved to where we learned how to support the heart if things went bad. That also added to this field. So I actually considered myself really lucky to have been there at the right time, right place. There's thing that happens now in medicine, people train to be an expert in less and less and less. In other words, somebody may pick one valve to work in and then they become super specialized in that one area. But really where I was fortunate was that I had a broad and deep education in all of those areas. And it's been, you know, I think, paid dividends over the years for me to be able to pivot, to be able to research where those fields overlap. If I had to advise a fellow, train broadly and train deeply. Just don't learn more and more about less and less, which is what super specialization is.
- [07:37]
A
Absolutely. I'd love to dig into that a little bit more because I'm sure you're well aware that there's a shortage of cardiologists coming into the field. And so there's just going to be a continuing shortage going on as the years come down. And there's a lot of cardiology fellows that appear to be really specializing or focusing on one part of the heart or one kind of a procedure. And right now it appears our system kind of rewards that. Right. We want people to be super specialists, but with an ongoing shortage that leaves a lot of open gaps for care and patients who can't find people who can do maybe more general care or pediatric care or these other kind of more general specialties, I guess. What are your thoughts on kind of the future of specialization within cardiology? And what movement do we need going forward to make sure we're meeting the patients and their needs?
- [08:31]
B
Boy, that's Pandora's box that you're opening there. Right? That question really covers the whole health system, how we function and how we do things. Actually, the shortage that we have of cardiologists is not in the cities, it's in the rural areas. How do you get care into the rural areas? Closer to home to Effect change so that people don't progress to as bad of disease that we see and that we're able to take care of that part of the population that we otherwise couldn't. There's a little bit of an issue. Most cardiologists and most people in medicine get paid by the number of procedures they do, the number of patients that they see. If you're in a rural area, there aren't that many patients, there aren't that many procedures to do. It's much harder to make a living as a cardiologist. So you're really talking about changing the whole system if you have to do something like that and incentivizing. Now, Medicare does pay a little bit more if you're in a rural area per procedure, but it's still not enough to incentivize people to go into those areas and really settle and establish practices. So I think that's going to be an ongoing problem. I don't know that today that anybody in the healthcare system or in the government has an appetite to tackle that big of a problem.
- [10:13]
A
Interesting. I want to ask a little bit more about the future and what's exciting you right now. There's all kinds of new devices coming out, new imaging technology, AI assisted diagnostics, structural procedures. We here at Beckers have covered all kinds of really cool new things. I'm curious, what excites you the most or what you think is going to be the most disruptive to the industry over the next 10 years?
- [10:38]
B
I think over the next 10 years, I think like all fields, I think artificial intelligence is going to be very disruptive in a positive way. I think you will start to see AI not only help in diagnosis, but the management of patients. You know, when patients get really sick, they go to an icu. How do you manage what you're going to do, when you're going to do it? When do you send them on? It may be clear at a place that it's the sickest of the sick, but it may not be easy in a hospital in rural America. What do I do with the patient next? Because part of getting sick patients better who are acutely sick or sick at that moment is really getting them to the right place at the right time. And not a lot of people have the repetition or the training to know how to do that. I think that's where artificial intelligence will come in. It will be able to say, hey, you've got a patient here. This is what we're doing. This is probably the right treatment algorithm for them. And if this doesn't work. This is where you need to send the patient on. Often what we see is that's where we have the gaps in care and the poor outcomes. So I think it'll be a very, very disruptive but useful technology in managing patients. And it'll also double check is the diagnosis correct or is there a better diagnosis? Again, we're good at diagnosing common things, but the things that are a little rarer slip by and don't get diagnosed for many years. And I think AI will probably help with that as well. So I think it's going to have a positive change, but I think there's a lot of work to be done. Then the other thing that's a more practical aspect is physicians spend a ton of time on paperwork. I always liken this to an airplane takes more people places if it spends less time at the gate. If you have a physician doing paperwork all day related to patient care, if you can simplify that, if AI can listen, transcribe, which what we're seeing, it's going to change the nature of that game. That physician is going to be able to see more patients and be more productive. So I think there are a lot of good changes.
- [13:06]
A
Well, thank you so much for taking the time to share more of your perspective and experience. This has been such a great discussion and just really appreciate having you on the podcast today.
- [13:16]
B
Thank you so much. Really appreciate you.