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Dean Thongkham, MS4, St. George’s University
Dr. George Vatakencherry
Kaiser Permanente Los Angeles Diagnostic Radiology Residency Program Director
Chief of Vascular and Interventional Specialists Kaiser Permanente Los Angeles Medical Center
Training and Experience:
|Medical School||University of Miami|
|Radiology Residency||University of Chicago|
|IR Fellowship||University of California, Los Angeles|
|Type of Practice||Multi-specialty Integrated Health Care system|
|Years of Experience||10|
|Subspecialties||Vascular disease, interventional oncology|
How did you decide on a career in IR?
I always thought I was going to be a surgeon. During my 3rd year surgery rotation, I felt that open surgery led to unnecessary morbidity and the recovery period for patients was very difficult for them. I saw an IR procedure where a biliary stent was placed for an elderly gentleman with Klatskin’s tumor and much to my amazement he did exceptionally well and went home the next morning. At that point I was convinced minimally invasive treatments were the way to go.
How did you choose your subspecialty?
I love vascular pathology and am fascinated by cancer. I am intrigued by vascular biology and cancer biology. Also, it is a tremendous honor and privilege to be able to take care of patients and their families in their time of need.
Please describe your typical week.
When I first began practicing, my time was evenly split between interventional and diagnostic radiology. During this time, without the ability to establish a clinic, my IR work consisted mostly of biopsies, abscess drains, picc lines , central venous access , paracentesis and thoracentesis. But with lots of effort I slowly began building my practice, and the time I spent in IR gradually increased. Now, I am 100 percent IR.
Most of my week is spent in the IR suite, however I spend my Monday mornings and full day Friday seeing patients in the hospital or outpatient clinic. On any given Friday, the patients I see may have diseases such as leg pain, liver cancer, fibroids, back pain, aortic dissections or abdominal/thoracic aneurysmal disease.
What are some of the rewards and challenges you face in your field?
In my practice I seek to treat my patients like family. When you do so there is a huge sense of responsibility but an equally great amount of reward.
Some of the challenges I face include the continual movement of the field towards a more comprehensive, clinically-oriented specialty. The transition from a proceduralist to a clinically-oriented interventionalist requires both resources and training, but is an important and positive step for the field.
Where do you see your field headed in the next 10 years?
In terms of IR, training will be dramatically different with the new IR/DR residency. I believe that providing more comprehensive care, an office-based practice, and admitting privileges will all be important components of future practice. This will take time, but eventually we will get there as a field.
Vascular disease is an interesting subspecialty because many disciplines are involved in the field including vascular surgery and cardiology. I see the involvement of multiple disciplines as a net positive as each specialty brings a unique twist to the discipline and I believe has really expanded our options for this patient population.
Interventional oncology is a fascinating and dynamic field that has tremendous potential but still requires more evidence. To be widely accepted, interventional oncology needs to be similar to medical or radiation oncology in terms of reliance on data. The evidence, considering current randomized controlled trials like SIRFLOX is coming.
What, if anything, have you had to give up to pursue IR?
I honestly don’t believe I have given up anything. While I no longer have time dedicated to diagnostic radiology, I order and read plenty of imaging for my own patients. In some ways my reads are improved and more focused because I have a firmer understanding of what is occurring clinically.
Another consideration is that IR specialists have a lifestyle that is rapidly becoming more demanding like a surgical specialist rather than the relative flexibility of a diagnostician. However, I believe as long as you are passionate about IR, aware of the necessary commitment, and willingly accept it, you won’t feel that you are sacrificing much, if at all.
What are some aspects about your work that medical students may not know?
Interventional radiologists see a wide variety of patients and offer an equally wide variety of therapy options. Traditionally we were technicians or proceduralists. However, in order to provide the optimal treatment for our patients, we also need to provide good pre and postoperative care and recognize that this can be just as important as the procedure itself.
What advice do you have for medical students considering a career in IR?
Current students should try to get involved through joining the Society of Interventional Radiology, in particular the Medical Student Council of SIR Residents Fellows Student section. Students can also join or develop their medical school’s IR Interest Group, find a mentor or local interventionalist, and perform IR rotations. Summer research is another great way to get involved.
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