Incoming SIR President M. Victoria Marx, MD, FSIR, is professor of clinical radiology, residency program director, and vice chair for education in the Department of Radiology at the Keck School of Medicine, University of Southern California (USC).
Dr. Marx has played a critical role in the evolution of IR training from fellowship to residency while maintaining an active clinical practice and educational role at USC.
She was the first IR fellow at the Mallinckrodt Institute of Radiology at Washington University in St. Louis and the IR section chief at the University of Michigan before moving to California.
Before SIR 2018 started, Dr. Marx talked with SIR Today about the society and interventional radiology. Answers were edited for length and clarity.
How did you become interested in interventional radiology?
Interventional radiology wasn’t even our specialty’s name when I became interested. It was “angio.” After I entered the Ohio State general surgery residency, my observation of the faculty in my department was that the older they were, the more unhappy they looked. I wanted a happy life. I had observed some angio procedures and was acquainted with the head of angiography at OSU, Dr. Michael Van Aman. So I made an appointment with him and said, “Do you like what you do? Do you like coming to work every day?” He said, “Sure, I love it.” That was it for me. IR combined the patient care and technical aspects of general surgery without the culture of that specialty that leads to such a high rate of burnout.
There are several more people who mentored and inspired me through my career. I consider Dan Picus from Mallinckrodt Institute to be an early mentor; he was my IR fellowship director and faculty colleague after fellowship. After joining the faculty of University of Michigan, Reed Dunnick was a mentor to me as my career progressed. Many leaders in SIR have provided guidance and mentorship to me over the years. The ones who come to mind most quickly are Drs. Mike Darcy, John Kaufman, Kathy Krol, Jeanne LaBerge and Alan Matsumoto. They have contributed to my leadership development in general and specifically to my role helping to shepherd the IR residency into reality.
How important is mentorship in this field?
Without mentors, when you’re a young professional, you may not know how to make career progress and you may lack opportunities to grow. In the academic world, mentors are the people who encourage young professionals to do research studies, help them make time to do those studies, advise them on where to submit the finished work, and encourage others in the field to invite them to speak at meetings, work on committees, and get known regionally and nationally. Mentors pave the way for new talent to succeed.
What does SIR mean to you?
SIR is a family I chose. This community provides me with intellectual stimulation, constant innovation and camaraderie. Without the energy and focused collaboration provided by the Society of Interventional Radiology, and societal efforts in science, education and advocacy, IR wouldn’t be a primary specialty. The society has also fostered a professional culture that’s wonderful to be a part of. I have made many friends through my work with SIR, and I’m sure I’m not the only one to say that. SIR is a wonderful group of people.
What motivated you to become active in the society originally?
It was exciting to participate in a community of people who were so enthusiastic about their specialty at the time it was just becoming recognized as “IR.” I don’t actually remember a specific event, but Dan Picus was very involved with SIR when I was a fellow at Mallinckrodt. He provided me with early introductions that allowed me to volunteer. I think one of my first roles was to edit the monthly newsletter that was mailed to members several times a year – snail mail! My experience was positive, and I sought out other opportunities to contribute to the organization.
What makes you happy about IR?
In my “day job,” the things that bring me the most satisfaction are the medical decision-making that goes into planning procedural patient care, achieving technical success with challenging procedures and then seeing patients in follow-up to assess the outcome. Patients are so appreciative of good care, and I appreciate that personal connection. The other benefit of my day job is that I am fortunate to work in an IR group at USC that is tremendously collaborative and supportive; we discuss patient care decisions, challenge each other’s decisions and help each other succeed in our work every day. From a point of view of a society leader, I am very happy with the direction our specialty is taking and the progress we are making in developing an robust infrastructure for scientific progress (registries), advocacy (working to increase GME funding on Capitol Hill), and education (development of an IR curriculum). I am also happy with the work being done to increase diversity in IR; the wider the pool of talent that we recruit from, the bigger SIR’s impact will be.
How has interventional radiology changed since you first started?
How has it not changed?! First, technical innovation has brought innumerable new tools and techniques to the specialty. IR has driven the trend toward minimally invasive procedural patient care. Next is the evolution of IR from being just a procedural specialty to a clinical specialty that plays a significant role in medical decision-making for patients with a broad range of diseases. Finally, IR has been recognized as a unique primary specialty by the ABMS with a graduate medical education path that can recruit talent directly from medical school. The rapid, early success of the IR residency training program is unprecedented.
You said earlier that watching IR grow into a primary specialty gave you great satisfaction. Did you think years ago that would be the case?
In 1998, the concept of IR as a primary specialty was a glimmer in the eyes of some society thought leaders. But it hadn’t occurred to me. Even as the idea trickled out to a wider group of people, I wasn’t sure it was practical. I didn’t have the self-confidence at that time to believe in the goal. I really admire the leaders who made this happen, particularly Matt Mauro and John Kaufman. They were walking uphill for a long time.
There’s a lot of positive momentum in the field right now, but what challenges do you see for the upcoming year, and maybe even beyond?
There are challenges from within. As interventional radiologists complete IR residency training and identify themselves as members of a primary specialty, the current practice patterns in most of the country may not match what these new IRs see as their chosen practice pattern. A challenge for interventional radiology and SIR is going to be helping our members navigate this change and ensuring the well-being of the specialty. Inevitably, recognition of IR as its own specialty will change SIR’s relationships with other medical societies and entities. A second challenge we are addressing is the need for large data to support the efficacy and safety of IR procedural care. SIR is addressing this with the implementation of standardized reporting templates and IR registry participation. A goal for me is to successfully encourage large numbers of IRs to participate in the IR Registry. A third challenge is the continued need to navigate turf issues. It may be that being a primary specialty with clinical patient care at its core rather than a procedural subspecialty will help IR in that regard.
What are your goals as president, and what do you think will make your term successful?
The role of societal president is threefold. One role is to represent SIR and the interests of its members to outside entities, including other medical societies, regulatory bodies, government, payers and corporate partners. The second is a responsibility to ensure that leaders of the society are listening to member priorities and focusing societal initiatives and investments on those priorities. The third role, and possibly most important role, is to ensure that societal work always keeps high-quality patient care at the center of SIR. Specific goals of mine are to continue implementation of SIR’s new strategic plan, to continue SIR’s advocacy for increased GME funding, to support the continued roll-out of the IR residency, to work toward a system where minimally-invasive treatment for thrombotic stroke is widely available to all who need it, and to realize a future where more women and underrepresented minorities choose to enter the field of IR. I will consider my year of leadership successful if I look back on the year and smile.