10-Minute Interview: Charlie Young, MD, Director, Electrophysiology Service, Kaiser Permanente Santa Teresa Hospital

Please describe your medical background and education. Why did you choose to work in the field of electrophysiology?

I completed my undergraduate at UC Berkeley, then graduated from Stanford Medical School. I performed my postgraduate clinical training in Internal Medicine and Cardiology at Kaiser Foundation Hospital in Los Angeles, and finally, a Clinical EP fellowship at Good Samaritan Hospital in Los Angeles. I did an away elective in EP at Cedar Sinai Hospital during my internal medicine residency and read the entire Josephson EP book. Electrophysiology was just getting off the ground then in 1986, and it excited me. I convinced Dr. David Cannom, who implanted the first defibrillator in the LA area, to let me be his first EP fellow at Good Samaritan Hospital. It was the heart hospital at the time, and the right place to be for me. This laid the ground work for my education, and fostered my pioneering spirit in both the clinical and administrative aspects of EP.

How long have you been at Kaiser Permanente Santa Teresa Hospital? When was the EP program started there?

I started the program 16 years ago in 1988 after my fellowship. The goal was to regionalize care for all of Kaiser's 1.8 million members at the time. I worked alone for five years, then in 1993, hired Dr. Michael Lauer to join me. Since then, we have hired two more EPs: Dr. Jennifer Han in 1999, and Dr. Leonard Chen just this year in 2004. Our service population has grown to over three million, making us one of the busiest EP labs in the San Francisco Bay Area.

As Director of the Electrophysiology Division, what do you consider are some of the components of a successful EP program?

The most important component is to have dedicated people with a shared vision who communicate openly with each other in order to help patients who need EP care. You can say everything else is just details or icing on the cake. You need a leader with vision and organizational skills. On a practical note, the leader must lead by example and create the environment that supports everyone as a valuable member of a team. Assuming they already have dedicated facilities and staff, this is not that hard to achieve. That is because people who choose to be in EP have already opened their minds to be challenged by new things, and you simply have to create an environment that promotes this and includes everyone in learning and contributing as a team.

You are also a Clinical Assistant Professor of Medicine (Cardiology) at the Stanford University School of Medicine. What has this experience been like for you?

All of our EP docs are members of the faculty because we have had a formal combined fellowship training program with Stanford since 1993. Besides the title, it has been our roles as teachers in EP that continues to keep all of us motivated and excited about maintaining and improving our knowledge and skills. After over a decade of being in this role, I can now look back at all the EPs we ve trained and see today how they are all established in their own practices. The legacy of this is extremely satisfying.

Describe a typical work week for you.

We have weekly rotating duties include taking call, working in the lab, or seeing patients in the clinic. As a group, work is shared as evenly as possible and everyone relies on each other. This forces us to work together and trust one another. The rotation keeps things fresh, so even if you get bombarded doing a lot of lab cases one week, you can look forward to seeing patients in the office the next week. In a typical lab week, from 7:30 AM to 6:00 PM and with the help of an EP fellow, I will do three elective outpatient cases followed by any inpatient cases that need to be done. A busy day may include three ablations and a couple of device implants. On Tuesdays, after the EP fellow teaching conference, I do an atrial fibrillation ablation case. On Wednesdays, we have a department meeting for everyone, which starts with an educational paper presentation by the fellow, followed by a meeting on administrative issues. In the remaining available times, I manage to do administrative work and still manage to squeeze in a three-mile run at work about three times a week.

What has been your most challenging EP case as of yet?

There have been so many challenging cases that have ended with success, and you move on ready for the next one. It s a privilege to have a job that allows this. One case does stand out, not just because of the technical challenge, but also because the procedure we performed made such a tremendous difference in the patient's life. This patient was receiving daily frequent ICD shocks for VT, despite being tried on every drug available. We decided to perform catheter ablation to target his VTs. He turned out to have many VT morphologies, and we targeted at least four. In the end, we eliminated enough of the VTs that he no longer had ICD shocks.

What is your best piece of advice for others in the field of electrophysiology?

EP is still a young dynamic field that is ever evolving. Be a life-long student of electrophysiology, and try to create an atmosphere of open learning and respect for those who will work with you. Be creative and continue to find better ways to do things, and don t get caught becoming dogmatic in how you approach things. Lead by example, and infect others with your genuine interest for EP.

What findings and improvements in the treatment of atrial fibrillation do you think we will see in the next decade?

We will settle on the best way to cure atrial fibrillation within the next five years. I believe it comes down to how completely the pulmonary veins and the surrounding left atrial tissue in the antrum can be isolated, and also, whether additional ablation lines are needed. Ablation may still be done conventionally with improved imaging and guidance, or alternatively: new devices that deliver complete lesion sets within a single application will become available. Catheter ablation of atrial fibrillation may become first-line therapy for atrial fibrillation, just has it is for most SVTs today.