Barry T. Katzen, MD, FSIR, is widely known for founding a successful multidisciplinary IR practice (Baptist Cardiac and Vascular Institute, Miami, Fla.), founding a meeting designed for multidisciplinary audiences (the International Symposium on Endovascular Therapy; ISET), and developing and guiding publications and forums developed for a diverse audience (Endovascular Today and the Endovascular Forum). He is also the recipient of the 2013 SIR Foundation Leaders in Innovation Award. IRQ recently talked with Dr. Katzen about the value of partnerships in interventional radiology.
IRQ: What first inspired your vision for multidisciplinary health care?
Katzen: When I began my career in 1974, I was excited about the potential for angioplasty across multiple organ systems and areas. However, I found that all the physicians involved in those areas were incredibly siloed—cardiologists treated heart disease, neurologists treated stroke, nephrologists managed hypertension, etc. Interaction between them was limited even when everyone was treating essentially the same disease. In addition, radiologists (before we were called interventional radiologists) weren’t in the mainstream of patient care, so patients might not benefit from the minimally invasive treatments we could provide.
It struck me that a better model would 1) involve multiple disciplines from the start, 2) establish horizontal communication between all medical professionals involved, and 3) focus on the patient—not on the politics. A new model that involved radiologists from the start would ensure our clinical engagement and provide a greater range of treatment options for the patient.
IRQ: How do you convince others of the value of that kind of partnership?
Katzen: That’s shifted over time. In the early days, I had to help other physicians see how the new model would benefit them, explaining that the new model would drive patient volume and create growth for everyone—a “rising tide” model. A small group of people bought into it from the start and we were able to demonstrate its value rapidly. The growth gave everyone the security that this new model had a legitimate potential for success.
After 25 years, multidisciplinary collaboration has become woven into our practice’s culture. If someone wants to do something that threatens the collaborative model, I don’t have to be the only one who addresses the situation—the average cardiologist or surgeon at our practice will also say, “That isn’t how we do things here.”
Convincing people these days is different. In some ways it’s more difficult, as specialties are more developed and more entrenched. In other ways, it’s easier, as everyone’s coming to see that multidisciplinary team work really delivers a better, more cost-effective product. There’s also more external pressure today to push collaboration.
IRQ: Where does that pressure come from?
Katzen: It largely comes from health care reform and industry. There have been times where manufacturers said that they would only work with practices that that have a multidisciplinary approach in place.
IRQ: What else can make this kind of model difficult?
Katzen: With so many disparate groups working closely together, you have to create an environment that supports and understands the fine art of compromise. That takes a clear vision and demonstrable, balanced leadership, where the leader is equally worried about everyone’s success. It’s hard to execute. Highly aggressive individuals from different disciplines who all want to be in charge can be a real barrier. In the end, everyone has to see that it’s in their self-interest.
IRQ: Are there any groups you’ve wanted to partner with but haven’t been able to yet?
Katzen: Not really. Or not anymore, I should say. Early in my career, when image-guided spine intervention was just being developed, I approached a neurosurgeon with what we could accomplish together. He just said, “No thanks—I work alone.” He simply wasn’t interested. There will always be idea killers who aren’t willing to bend—but there are others you can reach out to who will be interested, and you can grow from there. You don’t need to be defeatist about it.
IRQ: From what you’ve said, though, the value of a multidisciplinary model has become far more self-evident, anyway.
Katzen: Yes, absolutely. That’s because the value is real now. The value in the early years, in the old feefor- service model, was all about volume and driving business to become more competitive and to differentiate yourself in the marketplace. The value now is in creating high-quality, cost-efficient care and in increasing your ability to think outside your own box.
For example, IRs will likely think of what they can do for their patient with catheters. Surgeons will mostly think of what they can do surgically. It’s like the old adage—if you’re a carpenter and you have a hammer, everything looks like a nail.
In an integrated group, you don’t have to be anything—you can simply think of what’s the best approach for the patient. If you need to marry a little bit of IR with a little bit of surgery, you can. It affects how you look at problem solving. When you have a multidisciplinary approach, your ability to create unique, innovative solutions is much greater.
IRQ: Can you give an example?
Katzen: We once had a patient with with a complex thoracic aneurysm. We partially treated it by putting a graft up from the groin arteries. The patient wound up with a leak that needed to be repaired. We couldn’t repair it through the groin for technical reasons. Typically, that would mean sending the patient to surgery to open up the chest. Since we have cardiac surgeons on the team, however, we made the decision to treat the patient through a small incision underneath the rib cage and via a trans-apical approach to the heart to treat the aorta, which had never been done before. That kind of solution wouldn’t have been possible if we hadn’t established such a close working relationship with different disciplines.
IRQ: Congratulations on receiving this year’s SIR Foundation Leaders in Innovation Award.
Katzen: Thank you.
IRQ: What areas would you still like to bring innovation to or accomplish in years ahead?
Katzen: Baptist Cardiac and Vascular Institute just got a new expansion approved, where we’re going to create a sort of playground for innovation of procedures. We’ll create an environment where physicians of different disciplines can come together to find new solutions—I’m really excited about its potential!
