John H. Rundback, MD, FSIR, is the director of the Interventional Institute at Holy Name Medical Center in Teaneck, New Jersey. Lawrence V. Hofmann, MD, FSIR, is section chief of interventional radiology at Stanford University Medical Center in Palo Alto, California. I recently spoke with them about how the IR team can vary within different environments.
PATEL: Who are the key members of your IR team outside of the procedure room?
Rundback: We have an excellent nursing and technical staff, as well as administrators who are committed to the Interventional Institute. However, I think a very important individual has been our marketer. Just as companies have sales representatives who go out and sell their products, IR has many different products, many different service lines and procedures. Many of these are not familiar to referring physicians, but utilizing a marketer who goes out and sells our products makes physicians aware. Our marketer brings examples of cases before and after, holds grassroots meetings with physicians, and puts together materials for patients and physicians. We’ve been able to increase our profile, increase our recognition and grow our direct referred business.
Hofmann: One of the key members on the IR team at Stanford outside the procedure room is our business manager. He’s responsible for helping us grow the business as well as the operations of our “back office,” which includes our consultation clinic. He also oversees five medical assistants who are responsible for scheduling our procedures and doing preauthorization, as well as two nurse coordinators who also participate in scheduling the complex procedures. In addition, we have three administrative assistants who work with the faculty on predominantly academic endeavors, but our business operations manager helps with management of those people as well.
PATEL: Who would you like to add to your ideal IR team?
Rundback: We perform up to 400 peripheral arterial interventions a year with a particular interest in critical limb ischemia. We have a very, very robust clinical practice with regular office hours to provide comprehensive vascular medical care and longitudinal follow-up for those patients. That has become a burden because these patients stay under our care for so long that the office foundation keeps getting larger. With that in mind, the ideal person to add to our team would have to be a vascular medicine specialist. They would see the patient in advance and in follow-up of the procedure, handle the vascular lab and add to our academic pursuits, while freeing up the IRs to do the procedures. Many individuals seek to have a clinically active IR program. Once we had a very robust clinically active IR program, that became the least valuable use of our time. Basically, we have very good interventionists managing patients in the office.
Hofmann: We currently are fortunate to have six fellows every year. I think that’s the appropriate size, with two residents on the service. I think having additional nurse practitioner (NP) support to help us with IP rounding as well as patient follow-up would be beneficial.
PATEL: How do the physicians in your IR team divide the different IR service lines?
Rundback: Subspecialization has the advantage in that individuals can be familiar with the most cuttingedge research within a field, they can champion that field and they can grow practice in that field probably more capably than if you were just a sort of generalist or an IR who did everything. So I think it’s important that individuals find areas where they can excel and thrive. However, being in an academic private practice within a community hospital, the reality is that we all need to cross cover. So while we each have particular expertise in one or more areas of therapy, we all need familiarity with everything.
Hofmann: We have 11 IR faculty members. Two faculty are devoted primarily to pediatric IR. Two faculty do Y-90 radioembolization. Those two plus another two faculty, a total or four faculty, do the vast majority of the chemoembolization. Three faculty are focused on the venous thromboembolism side of our practice—i.e., complex filter retrieval, chronic venous reconstruction and acute deep vein thrombosis. We also have a dedicated NP who puts in all of our tunneled catheters. The rest of the service work—the biliary interventions, gastrointestinal (GI) bleeds, abscess drainages, biopsies and the like—is covered by the entire team. We have found this to be an effective way to take care of our patients, but at the same time provide hypersubspecialization that is really expected at a quaternary care center.
PATEL: Is there a member of a different specialty at your hospital who you consider part of your team despite not being part of your section?
Rundback: We benefit from the fact that the surgeons in our market, for the most part, are general surgeons who do vascular. While they’re very skilled and competent surgeons, this is not their lifeblood or their sole focus, so they’re very, very happy to work and collaborate with us. It’s turned out to be a very strong alliance in helping to maintain and grow our vascular profile and our vascular referrals. The chief of surgery is a good ally and a long-term friend of ours. When we find that we have material needs or political battles, he’s on our side because that’s the relationship that we’ve built.
Hofmann: I can’t really say that there is a particular member, but there are teams that we feel very closely integrated with, including the liver transplant team, the hepatologists, the hematologists and the ICU teams. We work very collaboratively and put together multidisciplinary protocols so that everyone is on the same page.
