A.J. Conrad Smith, MD, is an associate professor of medicine at the University of Pittsburgh School of Medicine where he serves as associate chief of cardiology for diversity, equity, and inclusion. Dr. Smith also is director of the Cardiac Catheterization Laboratory at the UPMC Heart & Vascular Institute. His clinical practice focuses on interventional cardiology with an emphasis on treating complex coronary disease, and transcatheter therapies for valvular heart disease.
His long-standing efforts to promote equity and diversity were honored by the school of medicine in 2021 with the creation of the Conrad Smith Leadership Council. Supported by an endowed fund, the council provides resources for internal medicine residents interested in the study and promotion of equity and diversity in health care.
As an undergraduate, you played defensive back at Stanford University before attending medical school at the University of California, San Francisco. Can you talk about that experience?
I loved playing football in high school. At Stanford, I walked on to the team during my freshman year and played until a knee injury in junior year forced me to quit. I had some great teammates there. John Elway was our quarterback, so I had a front row seat to the career of an amazing future Hall of Famer.
Playing football as a pre-med major was challenging, with long afternoons of practice and weekends spent traveling for games. Division I athletics taught me to be very efficient with my time, and learning this lesson early in my academic career helped me later throughout medical school and post-graduate training. Team sports also ask you to work hard in coordination with your teammates for the best end result. That concept carried over into medicine for me, too. Health care teams must collaborate closely to provide efficient, high quality patient care.
When did you decide to become a doctor?
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In elementary school, I had to undergo surgery for a fractured arm. That early exposure to medicine planted the seed that working in healthcare might be an interesting and important career to consider. I also was blessed with supportive parents who led me and my siblings to believe we could do anything. We’re living proof of their encouragement. Two of my siblings work at Apple, another is a homeopathic physician, and one is a professor of English at Harvard University.
My grandparents were farmers in rural Alabama. My parents were high school sweethearts who saw something in themselves that carried them beyond what their circumstances might traditionally dictate. My mother started college at age 16 and went on to a long teaching career. My father entered the military, where the opportunities were greater for him than as a Black man in the Jim Crow South. He earned an engineering degree as an enlisted man in the Air Force — and ultimately worked as an engineer on the Hubble space telescope.
What led you to specialize in cardiac care?
In medical school, I became fascinated by the physiology of the heart. I went on to do my residency and two fellowships in cardiology and interventional cardiology at Harvard University and Massachusetts General Hospital. I was fortunate to be mentored there by several attending doctors and older peers who graciously gave of their time to mentor me.
For me, interventional cardiology offers the best of both worlds. It allows us to make immediate, sometimes life-saving changes in a patient’s life – with a stent procedure we can stop a heart attack and prevent heart damage that could be devastating for a patient. That type of intervention historically resided only with surgeons. By the same token, I can establish longitudinal relationships with my patients so that I can help them never have another cardiac event. The technology used in interventional cardiology has helped transform how we care for the heart. It’s opened new ways to treat patients in a much less invasive manner. We can view an image of the heart and its valves in real time in a way that rivals what surgeons see when the chest is open. Using these advances, we can treat coronary artery and valvular disease that would previously required open heart surgery. This is particularly important because many of the patients we treat are older and not good surgical candidates. We can instead do these very minimally invasive procedures so that many patients are able to be discharged the next day.
What are some of the challenges you’ve faced as a Black interventional cardiologist?
I think nearly every Black medical professional can tell a story about going into a patient’s room to only be handed a meal tray to take from the room. Thankfully, most patients are embarrassed by their mistake and apologize – most but not all. Truthfully, though, much of this behavior comes from the implicit biases (an unconscious bias against a group of people) that societal representation of people of color has fostered. If we never see people of color as doctors, or judges, or presidents when we do see a person of color in those contexts, we assume they are in some other role. In addition, I am grateful to be in an environment where my nonminority colleagues are supportive. Increasingly here at UPMC and Pitt, they get it, they support you in the face of these challenges.
The reality is there are far too few people who look like me in medicine. To help encourage high school students of color to consider a career in medicine, I’ve helped create shadowing opportunities, given lectures, and participated in workshops. That’s been possible through the support of Chenits Pettigrew, EdD, associate dean for diversity, equity, and inclusion at the School of Medicine, and Paula Davis, MA, associate vice chancellor for diversity, equity, and inclusion for Pitt’s Schools of the Health Sciences. They have been tireless supporters of building a sustainably diverse healthcare work force.
What first brought you to Pittsburgh and why have you stayed?
I came for the opportunity to be part of a heart and vascular program with an amazing vision for the future. I clearly remember coming into Pittsburgh for my interview. I was driving through the Fort Pitt Tunnels and thought, “This is Pittsburgh? This is a steel town? This is beautiful!” On my next trip to the city, I was joined by my wife, who is a Pediatric emergency doctor. She was equally smitten.
Our program was very small then. We started an outreach program, traveling throughout the tri-state area, talking and getting to know referring doctors. Our mission: to provide a high-level cardiovascular service for even the sickest patients with the most complex disease so they could make sure their patients have easy access to that level of tertiary care. That approach really resonated, and we worked hard to deliver on the promises that we made. We grew into a cadre of interventional cardiologists who worked hard to bring the latest advances in cardiovascular care to our community. Our commitment to collaboration and teamwork helped us evolve into what we feel is a world-class cardiovascular program.
Can you speak to some of the health disparities you see in the field of cardiology?
In my area of specialization, health disparities are a multidimensional issue. There are many studies that show Black patients are offered cardiac catheterizations, bypass surgery, defibrillators and many other therapeutic measures less often than white patients with similar diseases. In addition, Black patients are less likely to accept appropriate therapies than white patients. This comes in part from our country’s checkered past with respect to medical experimentation in the Black community like the Tuskegee Syphilis Study where black patients with the disease were observed with the disease and the available treatment was purposefully withheld so that researchers could evaluate the natural history of the disease. That history gives many Black patients pause before committing to an invasive procedure like bypass surgery.
It’s important that we as doctors learn from issues of explicit and implicit bias to become more empathic in dealing with minority patients. A big component of this is cultural competence. We have to understand where the patient is coming from, and engage with them on a level so they recognize we really “get it.” When we can break down the barriers between doctor and patient, patients are more willing to have the procedures that we know will benefit them.
Do you see positive efforts underway at Pitt and UPMC to address health disparities?
There’s rich data that shows more diverse organizations have a greater variety of ideas, their populations are better served, and they achieve greater profitability. What organization wouldn’t want that?
I’m very fortunate to be part of the UPMC Heart and Vascular Institute and Pitt School of Medicine, where my colleagues at every level work hard to “get it” for our patients. Samir Saba, MD, the chief of the Division of Cardiology and co-director of the UPMC Heart and Vascular Institute, certainly does. Katie Berlacher, MD, has built and now leads one of the most diverse cardiovascular fellowships in the country.
Dr. Saba succeeded Joon Sup Lee, MD, who is now senior vice president for UPMC. Joon and I trained together in Boston. Back then, we all knew he was destined for great things. While Dr. Lee is a brilliant cardiologist, he understands the business and art of medicine. His compassion and understanding of things like diversity have guided how he deals with both his patients and his colleagues.
Mark Gladwin, MD, chair of Pitt’s Department of Medicine, has done an astonishing job recruiting and retaining diverse chiefs for the divisions he oversees. Last fall, he appointed Naudia Jonassaint, MD, as the vice chair for diversity, equity, and inclusion for the school of medicine. He could not have made better choice.
There are so many other people helping to lead efforts like this, including Drs. James Taylor, Rikki Tripp, Mac Hogan, and David Thomas. Space doesn’t allow me to recognize them all, but the commitment is real and the talent is in place to create real change.
You’re also part of the UPMC Health Disparity Committee. Could you talk about its goals?
This initiative is co-chaired by UPMC’s President and CEO Leslie Davis and Diane Holder, CEO of UPMC Health Plan. This committee signals UPMC’s recognition at a leadership level that there are issues in the Pittsburgh region. And that as a major health care provider in the region, UPMC is committed to working to address and change that reality. The committee has identified several communities of color to determine how we can improve the care that we provide to them: McKeesport, Homewood, and the Hill District. I am one of three physician leads on the committee. Joining me are Tracey Conti, MD, chief of family medicine at the school of medicine, and Robert Edwards, MD, chair of obstetrics, gynecology, and reproductive sciences at UPMC Magee-Womens Hospital. James Schuster, MD, chief medical officer of UPMC Health Plan, has been my partner in the Homewood group.
Over the past year, we’ve reached out to each community to learn what they feel are their greatest health care needs. We’re now partnering with them to address those needs.
I’m also very excited by the depth of the infrastructure behind this effort. Our goal is to address critical disparities that we’ve seen to ensure we provide optimal health care for those communities. Based on what we learn, we hope to develop a model that we can use and export to hundreds of communities facing similar concerns. It won’t be a cookie cutter approach, but rather a process of understanding and addressing each community’s very individual needs.
Are you hopeful for change?
There’s a lot one could be pessimistic about, but I would say I have realistic optimism. To me, pessimism seems self-defeating. I believe change is possible, but that it’s a continuing, nonstop journey. It’s not a destination we’ll reach overnight. But with each incremental gain we make toward that goal we are better as a health care system.
Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.