American Association for Physician Leadership

Professional Capabilities

Reflections on an Improbable Journey

Joan L. Thomas, MD, CPE, FACC

September 12, 2023


Joan L. Thomas, MD, CPE, FACC, discusses her memoir, shares her leadership journey in cardiology, talks about attaining her Certified Physician Executive (CPE) credential, and offers advice for aspiring young women in the healthcare field.

How did the idea of the book Heart of the Story: My Improbable Journey as a Cardiologist come to you? What was the writing process?

Friends urged me to write my memoirs because, based on some of the crazy stories I had told, they believed that my journey was unique. At first, I was hesitant because writing was so different from anything I had ever done; however, I did some research on how to become an author, how to publish, and all the little details and hurdles I would face.

I found a writer to help me develop a story that was readable and told in a way that would keep my readers engaged. I also wanted young women considering the healthcare field to find my story inspirational; I wanted to encourage the next generation to get excited about the possibility of becoming a physician.

How did you decide on cardiology as your specialty?

Early in my first career as a nurse in 1972, I asked to be transferred to the cardiac intensive care unit, which was new and separate from the ICU. I enjoyed the acuity of the patients and the fact that patients’ conditions could change rapidly. We nurses had to be able to make critical decisions quickly and help the cardiologists keep patients alive and improve their outcomes. It was satisfying to watch a critically ill patient with complications from a heart attack get well and be discharged from the CCU and from the hospital.

Later, I began to recognize the wide variety of cardiac illnesses and how fascinating cardiology was as a field. I looked forward to going to work every day in the office or the hospital. I could never predict what the day would be like.

You have your CPE credential. How has that helped your career?

I became chief of cardiology in 2007. After a few years, I began to consider another move in leadership, such as a chief medical officer or chief quality officer. To be qualified, I needed more education. Given my age at the time, I believed the CPE degree would be more useful than an MBA.

While I never became a CMO or CQO, the coursework, especially the communication and management courses, helped me tremendously and made me a much better chief of cardiology. I acquired the skills to communicate better with staff, and I was able to give young colleagues advice on how to handle difficult situations with referring physicians, and I changed how I handled my most contentious colleagues. In the end, my biggest critics became my allies.

I am pleased that I did the extra work to obtain my CPE degree while working full time with a large clinical practice, serving two of those years as medical staff president, and fulfilling my responsibilities as chief of cardiology. It was well worth the effort.

What one overarching recommendation would you make to young women physicians?

I recently met virtually with some young aspiring women in cardiology at Rochester Regional Health New York, where I worked until recently, and that subject came up. Over the years, I always made it a point to meet with all new young cardiologists joining our group and encouraged them to ask questions.

New doctors believe that because they finished their fellowship, they should know everything. Consequently, they are afraid to ask questions when they are not sure how to handle a problem with a patient. The learning curve in the first couple of years of clinical practice is exponential and outpaces that during fellowship. Failing to ask questions is the biggest mistake these new doctors can make.

Most of my colleagues agree that women are more likely to ask questions, but men are less likely to ask questions for fear of sounding unsure of themselves. It is important to remember that we all continue to learn during our careers, and even the best doctors seek the opinions of colleagues when dealing with difficult cases.

Did your 30+ years career in clinical practice turn out as you expected it would?

Not at all. I suspect that when we are in fellowship, most of us envision how our careers will look during clinical practice. I thought I would be doing diagnostic catheterizations along with seeing patients, but three colleagues were already working in the cath lab, and I was needed for pacemaker implantations.

Later, I was asked to lecture on the history of women and heart disease, which led me to research the obstacles preventing women from being included in NIH clinical trials of major topics in cardiology. Women were often excluded in phase III clinical trials. It took several bipartisan female leaders in the United States House of Representatives and the Senate to change the rules for funding NIH trials to be more gender inclusive.

I also became active in the American Heart Association, lecturing and teaching women about the importance of knowing their risks for developing heart disease. That ultimately led me to establish a large practice composed of women seeking my expertise in diagnosing women with conditions that many male colleagues largely dismissed.

Honestly, I did not expect to experience the amount of gender discrimination I periodically faced. I learned to pick my battles, and when it mattered, I spoke up and demanded equality. I frequently won those battles, not only to my benefit, but also to that of women colleagues as well.

The unexpected turns and twists of my career, for the most part, made it more fulfilling. I would advise my younger women colleagues not to dismiss opportunities that may also make their careers more satisfying.

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Joan L. Thomas, MD, CPE, FACC

Dr. Joan L. Thomas is a retired cardiologist from Rochester, New York, where she healed hearts for 31 years. She volunteers at Volunteers in Medicine, a large free clinic for individuals working without access to healthcare.

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