Parag J. Patel, MD, MS, FSIR, will complete his term as SIR president during the Annual Members' Business Meeting on Tuesday, March 7, noon–1 p.m. SIR Today spoke with Dr. Patel about his presidency, his upcoming plans and areas of focus, and more.
Parag J. Patel, MD, FSIR
Perhaps the biggest event of your term as president was the governance change. Can you tell us why that evolution was needed?
PP: Our prior governance structure was admittedly a little confusing—even for the engaged volunteer—in part because there were so many levels of leadership. Everyone knew who the president, president-elect and past president were, but (for example) members might not know who ran the annual meeting. Or they might know we led initiatives focused on standards, economics, education and general membership, but it wasn’t as clear how these different divisions, subcommittees and work groups interfaced and collaborated. The need, then, was to reorganize them in a way that made more sense to our volunteers and membership. Also, it needed to improve communication and collaboration within the organization.
How do you feel about how the governance restructure transpired? Were there any lessons learned from the process?
PP: There was widespread support for a reorganization of our governance, but we all came to it through our own lenses. We did our best to make these changes based on direct feedback from survey results and stakeholder interviews of current and past leaders and volunteers. There were multiple cycles of feedback. We have developed a structure that will allow us to grow with further specialization.
I think in the coming decade, the efficiencies gained in large part by improved communication across divisions and clinical specialty councils and elimination of redundant efforts will make the improvements much clearer and easier to understand. The final version of our governance structure resulted from quite a bit of volunteer and staff work during the pandemic as we tried to organize ourselves for what would be best for the field of IR in the long term. I am proud of the work we achieved, but time will tell if we did a good job.
What would you say were the other big issues during your term?
PP: We have many partner organizations or societies with which we interact. The manner in which we create these partnerships has not been formalized. We are developing ways to organize these relationships with regulatory bodies, specialty societies and disease-focused organizations. This will allow for more consistent stewardship of these partnerships across leadership eras.
The first subspecialization training has been established with a new neurointerventional fellowship training pathway developed for graduating IR residents.
Finally, we have focused efforts to better understand the needs of our members as they relate to practice environments. Over the past decade, the lines between truly academic practice and private practice have blurred. Also, how we define private practice has a much more varied appearance than it did 10 years ago.
Traditionally you had an IR within a DR practice, but now we’re seeing more and more IR standalone practices, or IR as part of a multidisciplinary practice, or even IRs who are hospital employees but no longer directly linked to DR. The growing acceptance of this approach has allowed us to start addressing things like exclusive contracting and carve-outs that are most appropriate for a distinct specialty like interventional radiology.
We’ve convened a workgroup that has a varied representation of all the different types of practice settings: small, large, rural, urban, standalone, DR-based, hospital-based and so on—as well as academics. I hope to see that group’s work done through my time in leadership where we can update our own statement on exclusive contracting and support IRs’ ability to practice in the manner and setting of their choice.
We’re just passing the 10-year anniversary of the American Board of Medical Specialties (ABMS) approving IR as a primary specialty. As one of the leaders instrumental in that process, especially with the IR Residency curriculum development, can you comment on its ongoing success and impact?
PP: Thanks, but I cannot take that much credit. This was a decades-long process in which a number of past leaders had the forethought to initially organize us within radiology, then develop recognition as a subspecialty, and then eventually to primary specialty status 10 years ago. I just happened to carry the baton at the time when IR was finally recognized as a primary specialty.
The ABMS recognition triggered a need for distinct training programs that were different from our prior fellowship training programs. We have to give credit to a large group of past leaders for the development of those program requirements.
To support the trainees, a number of those leaders worked together to create and launch Residency Essentials. Training program experiences varied from institution to institution, so what a resident got out of training could differ significantly between one program and another. Residency Essentials represented our effort to normalize and somewhat standardize that educational experience.
With that new platform in place, a trainee from New York could go to a practice in California and succeed and thrive just as well as the reverse. We made sure that a trainee who had significant interventional oncology exposure still had education and training in peripheral vascular disease, because their subsequent job back in their Midwest hometown could have a high prevalence of that disease state.
We continue to tweak Residency Essentials, and I think we’ve made great strides. We now have contact with our trainees at an earlier stage, helping them recognize SIR as their home—not only at the onset of their training, but beyond and throughout their career.
Was there anything you wanted to focus on during your presidency that you weren’t able to?
PP: It was an unusually short term from June to the following March, but I’m sure there is always something the outgoing president wishes they’d been able to get to.
That said, I look at it in the greater context: it’s a 4-year stint in leadership as you rotate through the secretary, president-elect, president and past president roles. That single year as president isn’t your only opportunity to affect change—you have a voice and an opportunity to influence at every stage.
While I had a slightly shortened stint as president, I also had a longer stint as president-elect and that might arguably be the busiest of the four leadership positions, as that role is responsible for organizing our leadership agendas, our Steering Council, our strategic meetings, etc.
So through that time I had the opportunity to affect not only the governance change, but also focus on such areas of need as data repositories (i.e., VIRTEX), improving engagement with our private practice members, and realizing our first path to subspecialization in neurointerventional. We consider these efforts to be critical to the field, not only over the next 18–24 months, but for decades to come.
Have you shared any specific advice with incoming SIR President Alda L. Tam, MD, FSIR?
PP: We have worked closely together for several years and I’ve seen what a phenomenal leader she is. She takes a thoughtful, measured approach, but is laser focused and has a knack for readily identifying obstacles and developing a path forward. SIR is in good hands.
I’d tell her that it’s a good idea to consider your group of leadership as a critical sounding board for views that may be different from your own. The open conversations the leadership regularly has creates opportunities to hear and share varying opinions. That’s what ultimately allows us to land on the right decision for the organization. I know she’s going to be a great president, and I’ll be around as past president to provide some institutional knowledge I’ve gained over the years as well.
What is next for you as you complete your term as president? As active as you’ve been in the peripheral vascular space, do you foresee getting involved with the PAD Clinical Specialty Council (CSC)?
PP: I certainly would welcome that. I still currently serve as the program director of an integrated IR residency program, which is near and dear to my heart, so continuing educational initiatives and clinical practice focused within vascular disease will keep me quite busy.
Honestly, we have so much great talent coming into the field and I would love to help them as a supportive mentor/adviser, helping them reach whatever position may be best suited for them and for IR.
