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Born in the South and educated, at least partly, in the North, and now back in the South again, Dr. T. Eric Bowen, a cardiologist with the Heart Clinic Arkansas in Little Rock, knows the differences between the two.

"What you find in the North is that not as many people smoke as down here," Bowen said. "You have a higher incidences of diabetes here ... people up there tend to be real Internet savvy, and you tend to be their third or fourth stop, but a lot of the time, here in Little Rock, you are generally the first."

It isn't just more knowledge on the front end.

"The coronary disease I see here is worse than what I saw in Cleveland," he said. "The diet tends to be worse here. It isn't that you don't have bad things to eat in Cleveland — you have pierogies and things like that — but down here, we have sausage on a stick."

Yes, meat on a stick. Little Rock was also a pioneer of the deep-fried Twinkie. Who says the South doesn't innovate?

Dietary habits aside, "The big difference from North to South is that in the South, people tend to have a more intimate relationship with their physician. When I was in Cleveland, I could go for months and not see a patient out and about. But here, that isn't the case."

Bowen explained why.

"In the North, you may see three or four physicians during your hospitalization," he said. "It's more of a team approach. You may see one in the emergency room; one may stay in the cath lab."

In Arkansas or the South in general, Bowen added, that isn't the case. "People, when they come to this clinic, come to see one physician, the same person who has always treated them, whether it's here or at the hospital."

It makes for a different kind of practice.

"I love seeing patients in the office and I love being in the cath lab," he said. "The majority of the patients that I see in the office are ones that I have seen in the hospital, and they understand what it's like to be a patient in the hospital, and they also understand what it's like to be an outpatient."

That difference in practice styles all boils down to where the physicians did their residency.

"That probably filters down more from the training up North," Bowen said. "There, that's the way they are trained. People tend to practice the way they were trained, and they tend to stay 90 to 100 miles from where they trained."

Bowen, a Little Rock native, went to Harding and UAMS, but is the exception to the rule. He spent three years training at the Cleveland Clinic, plus additional training at Vanderbilt.

Bowen was drawn to cardiology and internal medicine while still at UAMS.

"It's kind of a thinking man's profession," he said. "You have a problem; you have to figure it out. If you are a surgeon, you have that instant gratification of knowing exactly what it is. You also have more interaction with the patients, and cardiology is one of the few fields in medicine where folks come in and you can make a real difference in their lives. Cardiology is very gratifying."

Bowen left Arkansas for training in Ohio, and, "I don't want to sound arrogant, but it's the best place in the United States to train for cardiology," he said. U.S. News and World Report agrees. The magazine recently rated the Cleveland Clinic as the best place in the country for heart and heart surgery with a perfect score of 100.

The key, according to Bowen, is volume and staff.

"When I was at the med center and I was an internal medicine resident, we had three cardiology fellows per year and we had eight or nine staff members," he said. "When I was at the Cleveland Clinic, we had 64 fellows and about 100 cardiologists on staff. We would do 300 or 400 heart caths a year here. At the Cleveland Clinic, it was more like 10,000."

Interviewed on a sweltering day in late July, Bowen's fondness for Cleveland was more than just his residency training.

"Right now," he said, "the high will be, maybe 80. The three years I was up there, I'd have a sweatshirt on for the Fourth of July in the evening since it was probably going to be 60 degrees. It's just different. Each place has its own strengths and weaknesses, but I really enjoyed living in Cleveland. It's a big metropolitan area. Everyone talks about the weather ... it is winter from November to March, probably April. So it's cold for five or six months, but it was a great place to live and it is a great place to train."

But you still have the winters.

"When you aren't on the lake, people don't understand what it's like to get lake effect snow," Bowen said. "But when you live up there, you will understand it, and it is impressive."

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