Episode 12: IRs in focus | Guest: Jeanne Laberge

"One of the big organizations that are groups of people/stakeholders that really change things, in terms of education for sure, are medical students, themselves .” —Jeanne M. Laberge, MD, FSIR

Warren Krackov, MD, FSIR, speaks with interventional radiologist Jeanne M. Laberge, MD, FSIR, about her role in the development of the IR Residency, the power of IRs-in-training to impact their future, and the pros and cons of retirement from interventional radiology practice. 

Learn more about SIR's Residency Essentials curriculum program.

Note: This episode was recorded on Aug. 18, 2020.

SIR thanks Boston Scientific for its support of this episode.

Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.

(c) Society of Interventional Radiology.

Transcript

The Kinked Wire – August 2020
Episode 11: IRs in focus: Jeanne M. Laberge, MD, FSIR

Warren Krackov, MD, FSIR: I’d really like to thank you for being here, and I’d like to say that this is kind of an honor for me. I don’t recall ever having the opportunity to meet you, so this is kind of a thrilling experience for me.

There’s certainly a lot I want to talk to you about and I think we could turn this into a 24-hour session and still leave things uncovered. But I wanted to start real briefly with—it’s certainly a strange time in health care, certainly a strange time in the world. How are things going where you are now with COVID? What’s your sort of 30,000-feet snapshot take on that for now?

Jeanne M. Laberge, MD, FSIR: You know, it’s interesting Warren. I am a person at risk, being over 65, and it’s hard for me to believe that I am, but I am over 65 now. So I am shut in in my house, and have only been out hiking and backpacking and doing those things. I haven’t really even been into the hospital because, you know, I’d hoped to do a lot of teaching and things at UCFS in terms of research, but because of the COVID, that’s limited my ability to get out. So it’s been a very bizarre experience for me. But I hope in the future that I’ll have more of an opportunity to participate in some of the IR aspects of being an emeritus professor. Although I do enjoy the non-medical aspects of getting out. I’ve had a lot of opportunities to go mountain climbing and hiking and all sorts of things I didn’t have time to do before. So a mixed bag.

WK: Like everything, I suppose, there’s always a bright side to things. And certainly teaching, you mentioned, it would be impossible to have this conversation and not talk about the IR Residency and so on. Really, a couple things come to mind, but one of the things I think a lot of us would be interested in hearing is, the genesis of the IR Residency but also the process you went through, right? Obviously several organizations were involved and lots had to happen. It’s been pointed out that the average IR resident now may not know any of that, and they may just say “okay, here I am, doing what I’m doing.” What was the experience of that? What happened?

JL: Well, thank you for asking, Warren. It was an incredibly interesting process and I learned a lot. There’s a lot I learned about the way medicine works, going through this process, and nobody ever told me about any of that. 

The first thing I would say is that it’s amazingly easy or possible to contribute to changing your specialty or making changes to your education, that the system really allows doctors to participate and it’s really a physician led-process. So that’s the first point I would make, particularly as it applies to the future of IR, is that people, residents in particular or young doctors, should know that if they want to change things or if aspects of IR change that require changes in education or credentialing, that it’s really quite possible for you as an individual or participant in an organization to help change that. But you need to know how the system works.

What I learned is that there’s really three organizations that control what a doctor is, how a doctor is defined and even what they do and how they get paid. And those are three things—one is the professional organization that people belong to—in this case for IR it would be SIR—the board credentialing process (in our process the American Board of Radiology, called the ABMS), and then the third is organization is the one that kind of is involved in the teaching, and that would be the ACGME or the RRC. And all three of those organizations really are interested in making sure that this specialty thrives, and in particular that patients are well cared for. So if you participate with those organizations, you can really get a lot done.

The kicker on this, though, is that it’s not only these physician-led organizations, but there’s some kind of realities of finance and business that come into play. So the other kind of organizations or people that were really important as stakeholders in any change that goes through are the people that control the finances, and the medical practice governance. So we really needed to reach out to hospital administrators and people who control funds for residents and department heads, group practice leaders for people in private practice, to make sure they understood what was going on and that any change that we conceived of was actually feasible and doable for them, and that they bought into it. And then, surprisingly for me, one of the big organizations of stakeholders and people that really changed things, in terms of education for sure, are medical students themselves. Medical students as a group hold huge amounts of power, and what medical students think really motivates a lot of people in this whole situation. But medical students are not a group of people that as IRs we naturally know how to communicate with. So one of the struggles in this was creating bridges and communication techniques to get to explain to these other non-physician stakeholders, either medical students or administrators, what we were doing and why we were doing it and that it would actually be good for them. And that was the key to our being able to make some progress both in changing the certification and the training program or IR.

So it was a complicated set of things to do that we kind of learned as we were going along, but one thing I would like to emphasize, especially for medical students or residents listening to the podcast, is that if you want to make a change—particularly with this new residency and how it works—it’s really possible to get in there and make some changes if you participate in the system. 

WK: First of all, a fascinating story, and the last point you made is particularly useful, because I know it wasn’t all that long ago that I was a medical student or trainee, and I did not feel that I was a key opinion leader or had any power or anything. And I think that perhaps had more to do with me and the era in which I trained, but from what you’re saying I think one of the take home messages is to realize that as a medical student and trainee, you are empowered to help make your future. And I think for all the younger folks listening that’s a great point for sure.

JL: There’s one other point that really struck home in this whole process, is that—the role of the doctor really is to care for patients, and the health care system as a whole. And if you’re introducing a change that is clearly going to be better for patients, that is the one thing that everybody will agree with. And if you can show that whatever you want to do is going to be clearly much better for individual patients, then you have a winning argument. Now, obviously, any change like a certification change or training program change, carries with a lot of other implications—there are financial aspects, political aspects, all sorts of other things come into play. And there’s no agreement among that, based on different specialties and positions within he hospital or administration or government, but everybody does come to understand that patient care is why we’re all here. So the strongest arguments we made to win this over was the clear benefit of the new trainee program and new certification program in managing patients that are treated by IRs. And that I found to be heartening. We had all sorts of arguments about everything, but in the end the argument that this is better for patients and trainees was a winning argument.

WK: And it is heartening to hear that putting the patient at the center of the process still gets us places, as a society or as health care providers. I feel in some ways over prepared, because we have a great group of folks who come up with questions and you sent me a wonderful slide deck as well, I’ve had that before and it’s been very useful. I know you’ve put a question on there which is an interesting question, but I’d like to take it a bit further. Will the IR residency be a success? I’d like to hear what you have to say on that—but I have sort of a different take on it as well. How will we know when? When will it be baked in the cake in the sense of, oh you’re a surgery resident, oh you’re an OBGYN, oh you’re an IR resident.

JL: Yes. Warren, that’s really interesting. What are the criteria by which you judge success, and how do you evaluate it? That is a really interesting aspect of this whole process is, I’ve come to realize, there really are no, within these organizations, there’s no mechanism to try to sort out whether the changes we made are useful or not. You would think that the American Board of Radiology would be looking closing at metrics to see whether, after all this trouble, people are better doctors or there’s better patient care of people are happier with the system. Similarly on the ACGME perspective, you would hope that they would go back and look to see are things any better than they were before we started this. But there’s no real mechanism for that, as it turns out. And that’s the way that physician-led organizations tend to work. One of the things I realized is that what these organizations do is dependent on the people that are populating the organizations at a particular time, and those people move on. And they’re usually, for the SIR leadership, like what, a five year rotation where you work your way up and then you’re gone. And each new group of people leading these organizations have their own particular interests and what to make their own particular mark on the society or organization. So there’s not too much follow-up. And that’s why I think that one of the challenges for the residency is to have someone kind of take charge of it. Like, who is in charge of the future of the residency? Well, there’s nobody really. There’s all these people that are interested, there’s the SIR, the ABR, the RRC, department chiefs, all sorts of people are interested in seeing what happens and wants it to be a success, but there’s not really anybody that’s controlling it. Which is why I would suggest that the residents, the medical students, the young doctors now, are really the ones that are affected by it and they’re the ones that should be monitoring it and deciding what happens.

And the other point to make is that this is not a fixed deal that is done now and will never be changed. One of the things I realized in this process is that IR is always changing. And we’re very focused on IR but what I realized is that what IR did is what all specialties are going through. Medicine these days is just constantly evolving. Huge changes, as you alluded to earlier, are happening. SO it will be necessary for IR to change within the scope of these organizations over time. So what I think is critical is that the young people involved monitor the situation. So if residents don’t think that the education is what they want or if they want it to be better in some way, they should make sure they make it known to the powers that be, and that they realize they’ll have a way to make it change. 

So I think what we’ve seen so far is that the system works. It’s feasible to run it this way, that all these different options are legitimate and that things will work out in general, which is something we didn’t know when we started this process, but how it works out, whether the integrated or independent residency is really the better way to go and how to tweak it and change it to make it better are things that people that are living in the experience right now need to try to process and make better as things go on.

WK: And to your earlier point about empowering yourself if you’re a trainee to change your specialty for the better, given where we are and sort of accepting that I guess we would call it what, this iteration of the IR residency that exists right now—how does that match from what you had in the planning process? Is this pretty much what you expected or are there surprises for you?

JL: Well interestingly, when we got started with this we anticipated that  minority of groups would want to take part in an integrated training program, and that most of them would just like to continue with a post-graduate fellowship-style program like the independent program. And it turns out there was a lot more interest in the integrated program than anyone had thought to begin with. And the real hurdle with the integrated program was that it posed a much more difficult financial problem, in terms of how to pay for these people. And so I think that was the major limiting constraint, but despite that, many programs—quite a significant percentage—were able to figure out how to structure an integrated program.

WK: It is interesting how some of these things tend to work out. Oftentimes the blueprint and the house don’t exactly line up 100% based on a variety of factors that we may not have control over. And speaking of things we don’t have control over, at the outset you had mentioned, you know, for a variety of reason you’re not obviously practicing clinical IR right now. Do you miss it? Are there things you miss? Are there things you’re happy you don’t have to do anymore?

JL: Yes, I definitely miss it. You know, I’ve been retired now for about a year, and I guess things I miss most are direct patient care. Being able to see patients every day and do something positive for them and sometimes in very small ways and sometimes in very life changing ways. IT was a real thrill, and a blessing, to be an IR and be able to do that for patients. And the other thing I miss is interacting with young people. Teaching and learning things from them and being constantly surprised by the things they come up with and their enthusiasm and ideas and things like that. So that’s why I hope to have some role in teaching as time goes on, because I really appreciate getting to meet and be inspired by these young physicians coming through.

WK: Unfortunately we have to start winding things down here, you allude to this a little bit before—how do you see things for IR in the future? If you could put on your crystal ball, where do you see IR going?

JL: You know, one of the things I was thinking about when you mentioned some things we may talk about is that there’s been a lot of emphasis on the new residency and new certification and patient care and the IR’s role in taking care of patients, managing patients and being at the table in terms of decision making. And that’s all really important and that was the impetus for all of the IR residency. But what is at the core of IR really is the innovation and procedural expertise that we bring to the table in terms of our ability to treat patients and do the procedures we do and the innovation we come up with and being really quite imaginative in how to take care of patients for whom there are no good solutions at the current time. And when I look back on my career in IR, what really the hallmark of IR was being one of the few sections in the hospital people would come to when they couldn’t figure out how to manage their patients. Somehow we would come up with innovative new ways of doing things that really stretch the boundaries of what is possible in medicine. And I think we shouldn’t lose sight of that and try to nuture imagination and innovation in our trainees and try to have them think outside the box.

You know as an old doctor, I get kind of peeved sometimes when the young people would think out of the box, because I know that sometimes that’s dangerous, and you kind of get set in your ways and you know what will work and you’re interested in knowing what is successful without complications and all of that. But really what drives the future of medicine is people being able to think beyond that and think of what could be better rather than how can we do the best at what we know we can do—how can we do even better by thinking of new things. And I think that’s really what the core benefit of IR is. And it’s really unique. What we do touches so many different specialties and involves so many aspects of medicine that it really offers great potential to improve patient care. So I guess that’s the one thing I would like to leave with the trainees, is that that is really what IR is all about.

WK: That’s great and it really resonates with some of the things you mentioned earlier about trainees empowering themselves and really having a choice—that if is a trainee does think outside the box, hey there may be a new technique on the horizon. And hey it may need some work or some modification, but there may be a different way to approach things. And I think that may be an excellent way to trainees to approach the way they think about things, and really as you pointed out, for all IRs, so many people I think are drawn to IR because of that out of the box mentality, and why wouldn’t the residency be the same way?

As we close up here, one thing we do like to ask our guests is sometimes the hardest to answer, but if you had the power to change one thing in health care as it stands right now, what would it be? What would you change?

JL: I think my response is somewhat influenced by the fact that I’m now retired and am a Medicare beneficiary. And I can tell you that the finances of health care are just so complicated. SIR has a workshop for people thinking about retirement, and what they need to know about their health care finances. It’s incredible complicated and having been in the system—fortunately I was in an academic institution where I was shielded from a lot of the complexities of health care finance, but that is without a doubt the overwhelmingly number one problem that faces health care in the U.S. Just sorting out the finances and figuring out how to make it manageable and easy for people to get health care. I had no idea how to do that and unfortunately as an IR that’s not my area of expertise. But hopefully there’s some smart people out there that can figure that out. But as far as practicing as a doctor and a specialty, I’m just so thankful that I got to spend my career as an IR. It was just an amazingly fun, interesting occupation, and I hope the young people that are listening have a similar experience, and when they’re 67 years old they can look back at their career with the same fondness that I do. 

WK: That’s really wonderful, and at least from what I’m hearing, it sounds like the career is still going, it’s just changing into something a bit different, and you’ll continue to inspire and teach, and there’ll be a lot of really lucky IR people who will be recipients of it. I’d really like to thank you for being here and I wish you all the best. 

JL: Thanks very much Warren.