20 Questions: Allan S. Stewart, MD: Cardiothoracic Surgery

Thoracic surgeon Dr. Allan S. Stewart is director of the aortic surgery program and co-director of the valve repair center at Mount Sinai Health System. Stewart received his bachelor’s degree in biology magna cum laude from St. Peters College (1991), and his MD from University of Medicine & Dentistry of New Jersey (1995). Dr. Stewart completed an internship and residency in general surgery at Hospital of the University of Pennsylvania. He completed a postdoctoral research fellowship in the division of cardiothoracic surgery/department of physiology at University of Pennsylvania School of Medicine, a chief residency in general surgery at Hospital of the University of Pennsylvania, and a residency in cardiothoracic surgery at Columbia University Medical Center. Lastly, he completed a fellowship in ventricular assistance at Columbia University Medical Center. Dr. Stewart is currently associate professor of cardiothoracic surgery at Icahn School of Medicine, Mount Sinai Health System.
Dr. Stewart is a member of the Alpha Omega Alpha Honor Medical Society, Association of Academic Surgeons, American Association of Thoracic Surgeons, American College of Surgeons, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation, New York Society for Thoracic Surgery, Society of Thoracic Surgeons, and New York County Medical Society. He has been published in numerous medical journals, including New Jersey MedicineAmerican Society for Artificial Internal Organs JournalCirculationSurgical ForumMolecular TherapyAnnals of Thoracic SurgeryJournal of Thoracic and Cardiovascular SurgeryHeart Surgery ForumJournal of Immunology, and Journal of Heart Valve Disease.
When did you first decide to become a physician? Why?
I decided to become a physician when I was 11 years old. As a boy, my grandfather (a car mechanic) gave me a toolbox. Every birthday and Christmas, he gave me a tool for my toolbox, along with my gift. The gift was always broken. It never occurred to me until much later in life (unfortunately after his death) that the “broken” gift was altered by him before he wrapped it. The tool that he gave me for my toolbox was the necessary item to fix the problem.This led me to an early fascination with problems that required both my mind and dexterity to fix. I came home from a family party when I was 11 and saw a NOVA episode while flipping through the TV channels. On the program, a heart transplant was being performed. I decided then that I wanted to be a surgeon.
How/why did you choose the medical school you attended?
I attended Rutgers Medical School (formerly UMDNJ-NJMS). I applied early decision because I thought there was a high likelihood I would get in there and it was the best decision for me economically.
What surprised you the most about your medical studies?
I went to medical school in Newark in the height of the crack war and at the peak of the AIDS epidemic. I was frankly shocked at the consequences of urban warfare. I was also ill prepared for caring for kids with pediatric AIDS. It created a feeling of helplessness that I never experienced before.
Why did you decide to specialize in aortic surgery?
I enjoy the diversity and the gratification that, with grace under pressure and creativity, I can positively impact in a patient’s life.
If you had it to do all over again, would you still specialize in aortic surgery? (Why or why not?)
Yes. I operate on a wide range of ages and a diverse pathology. It is a field of specialization that is dominated by a small number of people. For instance, in New York City, there are really only two prolific aortic surgeons.
Has being an aortic surgeon met your expectations? Why?
Yes. I enjoy the complexity, diversity, and high case volume. Aortic surgery involves ultra high-risk emergency surgery when treating an aortic rupture or aortic dissection. Additionally, it involves 3-D reconstruction of the aortic valve and aortic root. There are exciting new technologies with endovascular stunting and transcatheter aortic valve replacement.
What do you like most about being an aortic surgeon? Explain.
I like that technical skill is directly related to the [patient’s] outcome. I also like that, while patients may arrive moribund, a perfect operation may completely cure the problem and allow patients to live a normal, robust life.
What do you like least about being an aortic surgeon? Explain.
Sometimes the problems that people arrive with are unfixable. Aortic dissection, for instance, carries a 20% operative mortality. These are folks who may have awoken completely normal, had breakfast with their families, and then suffered a life-altering or perhaps life-ending tragedy.
What was it like finding a job in your field–what were your options and why did you decide what you did?
I had the good fortune of doing an advanced fellowship in heart failure surgery when I covered the weekend call for my boss. During that weekend, I transferred in and assisted on the surgery of President Bill Clinton. That was a career-altering event and led me to a busy clinical practice before actually finishing my training. Once I finished my formal training, I was invited to stay on the faculty at Columbia University, where I spent the next 10 years.
Describe a typical day at work–walk me through a day in your shoes.
I arrive at 6:30 a.m. and make rounds on my patients from the previous day. I then say hello to my first patient. I typically do two to three heart surgeries a day, five days a week. I have fellows that open and close the cases. While they are starting or finishing, I see new patients or post-op patients in the office. At the end of my day, I usually exercise in my office
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work 60 to 70 hours a week. I sleep six to seven hours a night. Most of my vacations are linked to giving talks throughout the world, but I do have a lake house 65 miles outside of New York City. I go there every Friday and return to the City early Monday. The house abuts a large lake and is like being in paradise.
Do you feel that you are adequately compensated?
Yes.
If you took out educational loans, is/was paying them back a financial strain? Please explain.
I had academic scholarships to both college and medical school, so no. I see it as a major strain for some of my colleagues though.
In your position now, knowing what you do – what would you say to yourself when you were beginning your medical career?
Stay focused. Exercise. Maintain a hobby. Keep your sense of humor. Remember to stay balanced. Your patients aren’t typically doctors, so learn how to talk to people without using complex medical words.
What information/advice do you wish you had known when you were beginning your medical studies?
The Kreb’s Cycle is less important than what you’re led to believe. Make friends with your classmates; they will be your colleagues and referral base in the future. It’s critical to do well on your exams but try to keep things in perspective. Most of what you really learn will not be in medical school. It will be in residency and in practice.
From your perspective, what is the biggest problem in health care today?
Focusing purely on the US system, the transition from fee-for-service to population-based management. This is not an easy transition and will create major difficulties in sustaining academic medical centers.
Where do you see your specialty in five years?
I see it as more catheter based and less open procedure oriented. It will more of a hybrid specialty between cardiac surgery and interventional cardiology.
What types of outreach/volunteer work do you do, if any?
I do mission trips outside of the US. I have operated in the Dominican Republic, several areas of China, and South America. I find these trips both gratifying and sad. The level of medical care we have in the US is far superior to anywhere else I have experienced.
Do you have family? Do you have enough time to spend with them? How do you balance work and life outside of work?
Yes. I have two daughters from my first marriage (ages 13 and 11) and a son from my current marriage (age 3). I did not have enough time to spend [with family] during the beginning of my practice, but now my life is much more manageable.
What is your final piece of advice for students interested in pursuing a career in your field?
I believe it is a wonderful field that continues to evolve. It’s an exciting time to be a heart surgeon.