Despite growing up in a family of physicians, I only heard of interventional radiology when I left India to do my vascular surgery away rotation as an MS4 in the United States. After a brief interaction with an IR fellow in the endovascular surgery unit, I changed my future rotations to IR.
Whenever I was asked about IR in India, I had no good answer. Our accredited IR fellowship started in 2017, and when I shared my experiences with my attendings or classmates in India, they weren’t very interested. They couldn’t relate—and some even claimed that IR procedures could not be performed successfully here.
While listening to the BackTable podcast, I learnt of Deepa Shree, MD, an IR in India. Dr. Shree is one of the few women practicing IR in India, where women comprise only 2% of the IR field. I was fortunate enough to speak with Dr. Shree and learn more about the practice of IR in India, as well as how she built her career and what challenges she’s faced.
Dr. Deepa Shree
How did you discover IR as a career path?
I was born and brought up in Hyderabad, a city in southern India. I pursued my MBBS from NTR Health University in Vijayawada, India. During my MRCP I decided to do an observership for 4 weeks in radiology and I happened to be posted along with an IR. That’s when I realized it was quite a rewarding specialty and pursued it at Leeds Teaching Hospital NHS Trust in England. I am currently the head of the IR department at Rela Institute & Medical Centre in Chennai, India. I am also the program director of the accredited IR fellowship at our institute.
What does your typical work week look like?
I work in the liver transplant center and we usually have two to three elective cases like transarterial chemoembolizations or percutaneous transhepatic biliary drainage a day, and eight to 10 USG/CT-guided procedures like ascitic drainages and biopsies. Once a week we have a multidisciplinary meeting where we decide on cases for the week and a tumor board meeting. I have two fellows and a junior consultant with me on my team at our institute. Since IRs are clinicians, not just technicians, we follow up on the patients in the wards on the day after the procedure. It helps us establish rapport with the patient and the patient’s attendings.
What are your clinical interests and favorite procedures?
Hepatopancreaticobiliary (HPB) work is not yet taken up by any other specialties yet, and I believe we can make a mark in this area, which is what drew me to it. I also felt that HPB procedures were most rewarding during my training. My favorite procedures are cases where I get to save a patient’s life, like trauma embolizations. When it comes to trauma, the earlier the IR is referred, the better the prognosis.
What has been the most rewarding moment in your career?
I embolized a male infertile patient for varicocele and his wife conceived within 6 months. He presented me with sweets boxes after his two children were born.
What do you consider the main differences and challenges in practicing IR in India vs. other countries?
I was trained in the U.K., where there is a structured program. We get posted in vascular training and nonvascular training and also get to choose IR from the first year of radiology residency. We had a huge volume and variety of cases in the U.K. and had the opportunity to learn the best technique from multiple IRs.
My fellows in India get to learn only my skills and don’t get this opportunity. In India, we need to do 3 years of DR and even the third-year residents don’t have enough awareness about IR. In the U.K., the peripheral vascular and thromboplasty in cases like hemodialysis were done by IRs, whereas in India the vascular surgeons do them, and as a result the fellows I train don’t get enough experience for such cases.
How has the field changed over your career?
IR practice in India didn’t pick up until recently because there weren’t enough training opportunities. There was also reluctance in our senior generation of physicians to pass on their IR training.
Now this trend has been changing, and in my generation we want the specialty to survive more than we survive as IR physicians. There has really been a paradigm shift in thinking. It was hard to get fellowship applications a few years ago but now we get innumerable applications every year.
IR in India is currently fragmented, and unless we stop competing and start collaborating with each other it will be taken over by other specialties. For example, I had two hepatologists from Bangladesh who shadowed me for a month and went back to their country and performed a TACE by themselves. We need to be protective of our specialty and not give away our hard-earned knowledge.
Have you faced challenges as one of the few female IRs in your country?
I wouldn’t say men dominate IR, but rather that women don’t choose to pursue it. I am one of eight women among 363 IRs in India. There is deeply ingrained thinking in our culture that women can only do certain things, and that thinking isn’t easily erased. Though my family supported me throughout training, I had strict instructions to be back home by 5 p.m. and take care of my child, which is not possible in a specialty like IR where the procedures are sometimes unpredictable. It took my family some time to understand what the field demands.
One of the gastroenterologists I work with once told me that, when I work, my hands look like male’s hands and that I was like a man when I did the procedure. I was bewildered, thinking why do my hands and I need to look like a man to do a great job performing the procedure? When all of us have hands, fingers and brains to work with, I don’t understand why it is believed a man can do a particular thing and women cannot. Making a mark for myself as a woman in a field that is predominantly filled with men is absolutely the biggest challenge I had to face.
You are the author of the book Art of Balance. What is it about?
It’s about how not to get obsessed about one or two things in life and get carried away. I developed an obsession for fitness and posted my workouts on social media for external validation. In IR, since we need to wear lead aprons, we need to protect our back—which I didn’t. Eventually everything culminated in me suffering from disc prolapse and I was unable to walk. I had to undergo microdiscectomy for my prolapsed disc and was bedridden for 3–4 weeks. I learned that we need to do everything in moderation. I still post the same content on my social media channels, but I no longer seek external validation from it. I changed the way I think about it and the way I treat myself.
What advice would you give prospective IRs?
I believe in taking passion to a profession. Passion and devotion are the two most important factors if you want to make a mark for yourself. But if you want your enthusiasm and passion for your specialty to remain until death, you need to maintain a work–life balance.
