Matthew Feinstein, MD
Following an initial research spark, Feinstein hopes to forge a career studying cardiovascular disease outcomes in HIV patients.
Matthew Feinstein, MD, is a cardiovascular disease fellow at Northwestern University Feinberg School of Medicine (Chicago, IL). Graduating magna cum laude from Princeton University where he did his undergrad, he then earned his medical degree from and completed his medical training at Northwestern; and he is expected to complete his master’s in clinical investigation this year. Feinstein has received several research and teaching awards and has co-authored 20 papers in peer-reviewed journals. After training, he is interested in pursuing a career in academic cardiology with a clinical focus in general cardiology and prevention and a primary research focus in cardiovascular complications of inflammatory diseases, particularly HIV.
How did you decide on your specific research pathway?
My initial research training was in cardiovascular epidemiology, and completing a physician scientist program at Northwestern—that’s 2 years of general medicine residency followed by 2 years of clinical cardiology fellowship and then research—enabled me to work with Donald Lloyd-Jones, MD, on using emerging methods, for instance computing risk methods, to look at cardiovascular and other health risks that are associated with highly comorbid diseases. One that really stood out to me was HIV because it's an emerging chronic disease population. There are nearly 1.5 million people living with HIV in the United States and 35-40 million in the world, and those numbers are growing because even though the number of people who are getting it year over year has remained fairly stable in the last 5-10 years, people are living longer with HIV. People living with HIV aren't dying as often from end-stage or age-related complications, but instead are increasingly experiencing chronic disease complications associated with HIV such as cardiovascular disease and cancers. The proportionate mortality for cardiovascular diseases has more than doubled in the last 15 years for HIV. So it's a big population and according to observational data, they have about double the risk for MI, double the risk for heart failure, and more than double the risk for sudden cardiac death. These are in pretty well-adjusted analyses that account for demographics and cardiovascular risk factors. So it’s an area in need, and it has served as an opportunity for me to not only do some research in cardiovascular epidemiology, but also ask somewhat more mechanistic questions to start engaging with people translationally.
What has been your most meaningful clinical experience so far?
My overnight CCU calls were definitely the most meaningful for me and where I cut my teeth and felt the greatest amount of responsibility. Obviously you are responsible for procedures and decisions, but these nights also tested how I prioritize different things. There were certain circumstances where if I thought a specific intervention was needed and I really advocated for it, I could then see the outcome in real-time and understand what works, what doesn't work, where my biases lie for better and worse, and how to continue improving in my clinical learning. It's immediate feedback. Every decision was important there.
What do you think is the biggest challenge facing cardiology fellows today?
It would have to be striking a balance between specializing early and really picking out a specific area of focus, but also making sure your area of focus is really what you want to do. It's tough. Usually within the first year of fellowship, most people are really trying to track into one specific area, whether that's interventional, EP, imaging, heart failure, or general cardiology as a clinical focus, while also in many cases trying to figure out specific focus areas. It's really hard to figure out where the passion all lies within that first year, but it must end up working out as most of us end up doing it and kind of sticking with these courses we plot for ourselves early on.
What are you most looking forward to after you finish fellowship?
The opportunity to really grow independently as a clinician and as a researcher and to be the one with whom the buck stops for patient care, even more so than already. We're fairly autonomous during fellowship, but it's a whole different story when there's no one to present to and no one to ask what their opinion is before putting in final orders. Of course the simple notion of being done with training itself is appealing, although the last couple of years of this program I'm in haven't been as clinically heavy or call heavy. So I don't think it will be as abrupt a transition to normalcy as it is for some, but earning above a fellow salary won't be the worst thing either.
If you weren't a physician, what else could you see yourself doing and why?
Honestly, civil engineering and architecture have always been a draw for me. Having to understand structural integrity and how buildings are built and fall down is fascinating from a scientific perspective. But you also get real-time feedback and get to see your work out there in the world and see people interacting with it. That would have been an area I would have loved.
What his nominator, Donald Lloyd-Jones, MD, says:
Matt is an exemplary fellow, who has created his own research platform and received an AHA Fellow-to-Faculty Award as well as additional project funding as a result of his dedication and skills in research and collaborative networking. Using our very large Northwestern Medicine Enterprise Data Warehouse, he has been able to study the effects of chronic HIV infection of cardiovascular diseases, publishing extensively and making major new insights into mechanisms and consequences of HIV on the cardiovascular system. Matt is also a dedicated and outstanding clinician, who provides exemplary care to our shared clinic patients. He voraciously digests the medical literature and applies his extensive knowledge base in a thoughtful and compassionate way. In short, Matt is a superstar!