care focus in IR has really grown as the specialty has grown, and as we've started to do more complicated things, right? Whereas when I started, the majority of things that we did were very episodic—biopsies, lines, drains, those sorts of things where longitudinal care is probably not as critical compared to cancer work or what I do with HHT or vascular malformations.
Today, you’re going to inherit patients probably for the rest of their lives and follow them as such. I had a patient that I recently treated with a recurrent infrapancreatic duodenal artery aneurysm that I first treated in 2006. We followed him for 20 years, and he developed a second one that we just treated.
He is the first example reported in the literature of somebody having a recurrent gastroduodenal artery aneurysm or IPDA aneurysm. So, longitudinal care is important throughout. And if you can do it, it's certainly encouraged, I think, and important.
Dr. Tullius: This might be a controversial topic, but why do you continue the mixed IR-DR practice, even as there’s an increased focus on 100% IR? And do you think having less DR training during residency will be as beneficial to incoming IR attendings? Dr. Funaki: So, for me personally, I've always done both because I like diagnostic radiology, and I didn't care what anybody thought about it one way or the other. I wanted to do what I wanted to do, and that's what I was going to do. I've always liked DR. That's why I started in radiology to begin with.
And personally, I feel like being in DR as well as IR really strengthens both sections. If I'm reading a body CT and I see X, Y, or Z that's applicable to be treated in IR, I just call service and say, send this patient to IR because they need this, that or the other thing. Similarly, I can see the follow-up a lot of times on those patients.
There’s a couple of people in our section that do that, like Steve Zangen, MD. He and I treat all the hereditary
hemorrhagic telangiectasia patients, and Steve also reads thoracic CTs. He sees a lot of those patients before and after. We follow them in clinic, but he's also doing the diagnostic reads on those patients. So, I think that having that liaison helps make the department stronger because we're not as siloed as some places would be.
But overall, I think people need to do what they want to do. There is certainly a large percentage IRs who hate diagnostic imaging and don't want to do it. But I think that if you like doing it, you should also have the opportunity to do it.
There’s also some practical reasons to continue to do DR. If you're injured in some way and can't practice IR anymore, you might want to do DR. Certainly, that happens as you age; you wear lead for 30 years, and your back might not want you to do cases all day long. So, to transition into DR might be interesting for some people.
It's a personal decision. I don't think that you should practice a lesser form of IR simply because you do DR. I still see patients in our clinic and follow them. I think it certainly may limit you in some regards, because you can't devote the amount of time that somebody who does full-time IR would. But I've never felt that it has hindered me clinically or academically or otherwise.
Dr. Tullius: One of the other questions we get a lot is, how do you go about being a great clinician while focusing on your own well- being and preventing burnout? Dr. Funaki: Everybody’s going to be a little different, right? And it’s also changing. There was no such thing as burnout early in my career. Nobody talked about that. Nobody acknowledged it even existed. So, the fact that we recognize it's even a problem is a step forward.
Again, I was able to make the decision to practice the way I want to practice in the sense that I was able to decide how I wanted to partition my career in terms of DR, IR and academics. And at the University of Chicago all the academic
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For me, doing both DR and IR has also helped a lot because I'm not in lead five days a week, eight hours a day, nor am I in a dark room reading X-rays five days a week, eight hours a day.
faculty have a day a week for academic things. So that also helped.
For me, doing both DR and IR has also helped a lot because I'm not in lead five days a week, eight hours a day, nor am I in a dark room reading X-rays five days a week, eight hours a day. Either of those things would probably send me over the edge. For me, this balance has helped me to stay relatively mentally healthy and happy and content.
Everybody's different, though, and you need to find what your balance is.
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