Interventional News talks to Professor John Kaufman, Professor of Interventional Radiology and Chief of Vascular and Interventional Radiology, Dotter Institute, and SIR President elect, about his love of interventional radiology, the great influences in his career and why the SIR will go from strength to strength...
When did you decide you wanted a career in medicine?
It wasn't really a decision in the sense that I carefully considered anything else. I knew in high-school that I wanted to go into medicine.
Why did you decide to specialise in interventional radiology?
I liked and considered a lot of different medical specialties. I ended up in diagnostic radiology almost by a process of elimination, and I wasn't too sure about it at first. I certainly didn't know much about interventional radiology at the time. However, on the first day of my first rotation on 'specials', I knew that I had discovered my specialty. Interventional radiology was the right mix of technical, clinical, and people skills. We seemed to do a lot of different and important things, such as stopping bleeding, draining obstructed livers and kidneys, and implanting devices. The IR team was dynamic, aggressive, smart, hard-working and well respected. And they were a lot of fun to work with. Twenty years later I still think that IR is the best job in medicine.
Who have been your greatest influences in your career?
I've had a lot of help in my career, so list could be very long. Without my wife, Cathy, I would not have a career (or much else in life). The course of my career has been deeply influenced by several people. It started with Alan Greenfield, the Chief of IR during my residency at Boston University. He offered me a fellowship after my first rotation, which hooked me completely. Michael Bettmann, one of the other attendings in my fellowship, taught me the importance of involvement in professional organisations. My first job was with Arthur Waltman in the Division of Vascular Radiology at the Massachusetts General Hospital. Arthur welcomed me as one of his own, and not only started me in academic medicine, but in the SIR [Society of Interventional Radiology] as well. At MGH [Massachusetts General Hospital] I also worked with Stuart Geller, who is absolutely brilliant. I tried to learn as much from him as I could, and what I learned still influences how I think today. I moved from MGH to the Dotter Interventional Institute in 2000, where I was welcomed into another great tradition by Fred Keller and Josef Rosch. Fred's boundless passion for IR and the SIR is inspiring. He is a great interventionalist, and a great friend and mentor as well. I am very proud to hold an endowed chair in his name. At the Dotter I have worked with and learned from Paul Lakin, Rob Barton, Bryan Petersen, and most recently Ken Kolbeck. Lastly, everyone who knows Josef Rosch understands what I mean when I say that it is impossible not to be influenced by his humility, compassion, intellect, and enthusiasm. He sets the bar.
What have been your proudest moments?
Whenever I have been referred to as Nick, Claire, or Alex Kaufman's Dad.
As the SIR President elect, what do you hope to achieve during your term?
One of the greatest strengths of the SIR is the cohesiveness of its leadership in terms of the mission and goals for the society and specialty. We all share a similar vision and priorities, but bring different strengths to the task. I am extremely fortunate to work with David Sacks (President), Kathy Krol (past President), Brian Stainken (Secretary), Howard Chrisman (Treasurer), and Pete Lauer (SIR Executive Director) on an almost daily basis. The larger Executive Council meets face-to-face three times a year for two days, during which much of the real work of the SIR is accomplished. This is an incredibly talented and dedicated group.
In terms of the specialty, we want IR to continue to expand and prosper through strong research, the development of clinical practice, quality training programmes, adequate reimbursement, increased public recognition, and vigorous representation in organised medicine. We are particularly impressed by the importance of Asia to the future of the specialty. The quality of clinical work and research in India, China, Japan, Korea, and other countries is superb. If the specialty of IR can be strong in Asia and the Pacific Rim, it will be strong everywhere. I know that this view is shared by leaders of other western IR societies, such as CIRSE. Hopefully, we will be able to collectively develop a global IR community that nurtures and empowers the specialty everywhere.
Closer to home, it is essential that the SIR continue to work for its members by providing excellent educational and practice resources, effective advocacy, and meaningful research. We have a very diverse group of members in terms of practice styles, procedural mixes, and political environments. It can be very challenging to always fulfil the needs of every single member. The balance between what is best for the specialty in the long run and what is best for members right now is sometimes difficult to achieve. All of us in leadership hope to leave the SIR and our members stronger and better.
The people of the SIR staff are absolutely wonderful. They believe in this specialty just as passionately as the physician members and volunteers. Because of this, we think of ourselves as a team, and each other as friends. Whatever the SIR leadership is able to achieve is due to the hard work of these individuals.
What do you believe are the current problems/issues faced by interventional radiologists?
Each generation feels that it faces new and difficult challenges that are different than the past. The challenges right now certainly are different, but I am not convinced that they are entirely new or more difficult. Our challenges are the need to compete effectively for (I believe) all of our procedures, not just peripheral vascular interventions; the paradigm shift to a truly clinically-based specialty; improved clinical and basic research in IR; management of the exploding IR portfolio such as oncologic and musculoskeletal interventions; lack of professional and lay public awareness of IR; and the maturation of the specialty into a core discipline of medicine.
This may seem an odd statement, but I think that the loss of our historical monopoly on image-guided interventions, though extremely painful, was beneficial in the sense that it prompted a necessary and critical evolutionary step in the specialty. We were forced to think collectively about who we are, and what we wanted to become. We realised that an active role in the care of patients before and after the procedure was essential for the specialty (something that Barry Katzen, and Charles Dotter before him, had been telling us for years). Fortunately, UFE [uterine fibroid embolization] came along just as this monopoly was collapsing. The women who sought us out for the procedure did us an invaluable favour, as they showed us that we really could independently consult with patients, recommend treatments, perform the treatment, and care for the patients afterwards. The momentum created by these patients has carried over into other areas of IR, and helped stimulate the development of IR office practices. Were it still the 'good old days', other clinicians would be making all of the management decisions while we just performed the procedures. We would be doing only what was allowed by other clinicians, and not many of the IR procedures we consider standard today.
Do you believe that best medical therapy may make such interventional procedures as UFE obsolete in the future?
Sure, but change is an inherent part of life. My hope is that we will continue to innovate and create new ways of doing things, so that we will have a long and exciting future.
Please tell us more about what is involved with SIR's Primary Certificate and the rationale behind it?
The SIR has worked very closely and productively with the American Board of Radiology [ABR] on residency and IR fellowship training for a long time. The Primary Certificate is the next and penultimate step for the specialty. Clinical care is the characteristic and distinguishing feature of IR when compared to the diagnostic radiology specialties. Current training programmes produce diagnostic radiologists with added secondary skills in IR. The Primary Certificate in Vascular and Interventional Radiology would be a separate and fourth primary certificate from the ABR. This would be in parallel to, not replacing current programmes. The primary certificate would be an integrated programme that combines imaging, clinical, and IR rotations. Imaging training would be curtailed to a level that ensured a sophisticated ability to utilise imaging, but not sufficient for formal diagnostic interpretations. Clinical rotations would occur throughout the residency. The IR training would be tiered in structure and occur over several years, so that residents would gain longitudinal exposure to the patients and diseases that we treat. The training would culminate in a chief resident year. The result would be a person with Primary Certification by the ABR as an Interventional Radiologist, without general diagnostic radiology competency.
The person who would graduate from this programme does not exist today, but would combine superb clinical and image-guided intervention skills with very strong imaging skills to provide the highest level of care to IR patients. Their practice would necessarily be 100% IR, either as part of a large diagnostic radiology group or in another arrangement. In the future, subspecialty fellowships in areas such as oncology, PVD [peripheral vascular disease], women's health, and paediatric interventions could be developed. This would allow our specialty to mature even further.
About 10% of the SIR membership already practices 100% IR. We believe that there is a cadre of individuals who are excited about image-guided procedures and direct patient care, but who do not want full diagnostic radiology certification. Instead of pursing a more circuitous and less comprehensive route to image guided intervention through a non-radiology specialty, these people could train in the SIR Primary Certificate programme. Those who do want to have full radiology certification as well as IR secondary certification would continue to train in the existing fellowship programmes.
Lastly, I should emphasise that this has to be an ABR certificate. IR must remain within Radiology, as this is not only our heritage but out greatest strength.
What are your current areas of research?
Primarily IVC filters, but also aortic endografts. We have recently developed an animal model for traumatic aortic transection and hope to use it to study endograft repair of this injury.
Outside of medicine, what other interests do you have?
My family, food, collecting wine, hunting wild mushrooms (to eat!), travel, modern art, museums and good books.
Fact File
John A Kaufman
Born
Boston, Massachusetts April 4, 1956
Education and qualifications
1978-1982: Boston University School of Medicine
1982-1983: Intern in surgery, Hospital of the University of Pennsylvania
1983-1985: General Medical Officer, US Indian Health Service Hospital, Tahlequah, Oklahoma
1985-1986: Resident, Ob/Gyn, Women and Infants' Hospital, Brown University
1986-1991: Diagnostic Radiology Residency and Vascular/Interventional Radiology Fellowship, Boston University Medical Center/Boston City Hospital
1991-2000: Department of Radiology (Division of Vascular Radiology), Massachusetts General Hospital.
2000-Now: Dotter Interventional Institute, Oregon Health and Science University. Professor of Interventional Radiology, Diagnostic Radiology, and Surgery.
Selected offices held
1995-1998: Chair, SIR Membership Committee,
1996-1997: President, New England Society for Cardiovascular & Interventional Radiology
1998-2000: Chair, SIR Educational Materials Committee,
1999-2002: Chair, Annual Meeting Program Committee, American Heart Association (AHA) Council on Cardiovascular Radiology and Intervention
2000-2003: Councilor, SIR Education Division
2003-2005: Chair, AHA Council on Cardiovascular Radiology and Intervention
2003-2006: Annual Meeting Committee/Annual Meeting Chair SIR
2006-2007: Secretary, SIR
2007-2010: Chair, Interventional Radiology Program Subcommittee, RSNA
2007-2008: President-Elect, SIR
Awards
1978: Cum Laude, Distinction within the Major, Yale University
1982: Alpha Omega Alpha, Boston University School of Medicine
1985: United States Public Health Service Achievement Medal
1989: Chief Resident, Diagnostic Radiology, Boston University/Boston City Hospital
1995: Resident Teaching Award, Massachusetts General Hospital
1996: Figley Fellowship in Radiologic Journalism, American Journal of Radiology
2000: Fellow, SIR
2003: Fellow, AHA
2005: First occupant of Frederick S. Keller Endowed Chair of Interventional Radiology, OHSU
2006: Corresponding Fellow, CIRSE
2007: Distinguished Alumnus Award, Boston University School of Medicine
Society memberships
SIR, CIRSE, AHA, RSNA, ARRS, ACR, AMA, SVM
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