BackTable Vascular & Interventional

Our hosts Dr. Aparna Baheti and Dr. Michael Barraza talk with Dr. Mina Makary about what constitutes a conflict of interest, and how we can reduce bias in research without stifling innovation. Reflect on how this Podcast applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ via point-of-care learning activities here: https://earnc.me/WV7gzp --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES In this episode, our hosts Dr. Ally Behati and Dr. Michael Barraza interview Dr. Mina Makary about his recent article with the Applied Ethics in IR Working Group about physician conflicts of interest and disclosures in image-guided research publications. Dr. Makary walks us through the study design. The analysis over one year of JVIR articles had two goals. Firstly, the study aimed to assess the prevalence of disclosures in US-based IR research. Additionally, the researchers inspected the level of agreement between disclosed financial relationships and open payment data for top-cited image-guided procedure research. Since 2013, the open payment data has been available on the CMS Open Payment database. Key results showed that disclosures were reported in 29% of JVIR publications in 2019. When comparing reported versus actual financial relationships, it was found that 97% of researchers failed to disclose at least one active financial relationship. Furthermore, there was an average of $58k in undisclosed payments for each publication. Finally, we discuss important takeaways from this study. While industry support is a necessary driver of IR device innovation and practice building, it can influence research agendas. Dr. Makary advises all IRs to be cognizant of the underreporting of financial relationships and how this could make authors implicitly or explicitly biased in their research. He advocates for the construction of an open global registry that automatically links payment information to research disclosures. --- RESOURCES Potential Bias in Image-Guided Procedure Research: A Retrospective Analysis of Disclosed Conflicts of Interest and Open Payment Records: https://pubmed.ncbi.nlm.nih.gov/34756998/ In Science We Trust? (A response to the above study): https://www.jvir.org/article/S1051-0443(21)01446-9/fulltext CMS Open Payments Database: https://openpaymentsdata.cms.gov/

25 Mar 202229min

Dr. Vishal Kumar invites Tawny Newsome and Elaine Martin to the show to discuss how we talk about race, and the language of oppression. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rnCu1p --- SHOW NOTES We begin by discussing the JAMA tweet from 2021, reading “No physician is racist, so how can there be structural racism in health care?”. Newsome relates this to arguments she hears often from the tech industry stating that algorithms and computers cannot be racist. She adds that humans created the programs and wrote the medical journals, which means that biases will be present, and that neither computers nor physicians are entirely objective, and both can indeed be racist. Next, the three discuss the power of language, and the critical relationship of language and the biases we hold. Elaine Martin speaks to her experience as a nurse in San Francisco, and what she notices about the language that is used when interacting with patients. She reflects on how medical providers' choice of language can be dismissive or hurtful to patients. She shares experiences from her family members interactions with medical providers, and how she has learned to communicate with patients differently based on these experiences. They discuss a New York Times article by Rachel Gross about the linguistic origins of the pudendal nerve and its ties to patients with pudendal neuralgia who feel shame due to their condition. Finally, our guests give advice to current medical trainees. They discuss how we can examine our current structures and systems and change them where we identify problems. They express their hope that future generations of medical providers will take the time to examine their biases and dismantle harmful and dismissive treatment of marginalized groups. --- RESOURCES Tawny Newsome's Instagram, Twitter: @trondynewman, Subscribe to Tawny's podcasts: @suboptimalpods Yo, Is This Racist? Instagram, Twitter: @yoisthisracist Elaine Martin LinkedIn: https://www.linkedin.com/in/elaine-martin-4b618128/ JAMA: https://jamanetwork.com/journals/jama Taking the 'Shame Part' Out of Female Anatomy by Rachel Gross: https://www.nytimes.com/2021/09/21/science/pudendum-women-anatomy.html Vishal Kumar, MD: https://radiology.ucsf.edu/people/vishal-kumar

21 Mar 202234min

Special guest The White Coat Investor James M. Dahle talks with Christopher Beck about where physicians can start when it comes to financial literacy, including common financial mistakes docs make when start practicing, a primer on mortgage rates, and tips on insurance. --- CHECK OUT OUR SPONSOR DI4MDs Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637. --- SHOW NOTES In this episode, White Coat Investor founder Dr. James Dahle and our host Dr. Chris Beck discuss strategies for physicians seeking to manage their personal finances and gain financial freedom. First, Dr. Dahle explains the reasoning behind the famous quote, “live like a resident.” He explains that for an early career physician, their greatest wealth-building tool is their income. The income jump from residency to attending years can be extremely useful for quickly paying off student loans. Then, he moves on to discuss another way to resolve student debt, the Public Service Loan Forgiveness (PSLF) program. This option is ideal for physicians who have spent a significant amount of time working for a nonprofit institution (for example, during training and in academic medicine). Dr. Dahle advises all physicians to reflect on their priorities when deciding where to allocate their assets. Possible categories could include retirement funds, 529 college savings funds, payment of high-interest debt, and emergency funds. We talk about the power of having a written plan to stay on track with financial goals and prevent ourselves from making rash decisions. Next, we discuss different financial vehicles that can provide benefits for physicians. The “back door Roth IRA” strategy allows for yearly contributions to a tax-free retirement fund, even when a physician’s income exceeds the maximum limit for the conventional Roth IRA. Additionally, the funds in a Health Savings Account (HSA) can be used for investment, and then withdrawn at a later date, penalty-free. Dr. Dahle explains the difference between fixed rate and variable rate mortgages, noting that the latter is better for short-term loans because interest rates are unlikely to dramatically increase from year to year. Finally, Dr. Dahle covers the advantages of buying disability insurance as a way to protect physician income, especially for those working in procedural specialties. --- RESOURCES White Coat Investor: https://www.whitecoatinvestor.com/ White Coat Investor Podcast: https://www.whitecoatinvestor.com/wci-podcast/ White Coat Investor Email: editor@whitecoatinvestor.com Passive Income MD: https://passiveincomemd.com/ Physician on FIRE: https://www.physicianonfire.com/

18 Mar 202259min

Vascular surgeon Krishna Mannava and Chas Sanders (founder of MARGIN) discuss their approach to choosing which disposables and devices to stock up on in the outpatient facility, and how to plan for supply chain issues. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/M9ARhf --- SHOW NOTES In this episode, host Dr. Aaron Fritts interviews Dr. Krishna Mannava, vascular surgeon and owner of Vive Vascular and Chas Sanders, founder and CEO of MARGIN, LLC about supply chain in an office-based lab (OBL), focusing on disposables and how to pivot amidst impending reimbursement cuts. The three start by discussing how Dr. Mannava chose to source equipment when building his OBL. He was introduced to Chas Sanders of MARGIN through his advisory firm as they were looking at ways to approach vendors and build inventory. Chas advises against all inclusive packages with one company. Dr. Mannava states that MARGIN has not only helped him get good deals on equipment, but they have mediated relationships with companies and sales reps which has been crucial for him. Next, they discuss supply chain issues and the impact on healthcare and Vive Vascular. Chas believes the best way to offset this is by not putting all your eggs in one basket. For an OBL, it is better to have a surplus of disposables and throw some out rather than cancel a surgery due to a backorder or recall. Chas shares his thoughts on Management Service Organizations (MSOs) for shared resources, stating that while they can be helpful with sourcing and pricing of supplies, an MSO takes around 10% of revenue which for many OBLs means paying for more than you need. They also discuss the future of multispecialty endovascular centers, and the potential for physician collaboration. Finally, they discuss reimbursement cuts and how to compensate for this loss. Chas recommends reassessing products, evaluating procedure mix and looking at capacity, as these can all be adjusted to improve profits. Dr. Mannava adds that front desk personnel can help by ensuring insurance, coding and charges are accurate. --- RESOURCES Vive Vascular: https://www.vivevascular.com MARGIN, LLC: https://www.margin.care

14 Mar 202250min

En este episodio de BackTable Español, Dra. Gina Landinez entrevista a Dr. Miguel Montero-Baker sobre la enfermidad arterial periférica y salvamento de extremidades en la comunidad latinoamericana. In this episode of BackTable Español, Dr. Gina Landinez interviews Dr. Miguel Montero about peripheral arterial disease and limb salvage in the Latin American community. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/nKsjxN --- SHOW NOTES Los dos doctores discuten el camino de Dr. Montero-Baker a convirtirse en un Cirujano vascular enfocado en el salvamento de extremidades, su experiencia de construir un centro de preservación, y diferencias culturales entre los pacientes latinoamericanos y estadounidenses. Además Dr. Montero-Baker comparte sus consejos sobre sus técnicas, su equipo preferido, y como superó los retos institucionales para empezar un programa del salvamento extremidad. Finalmente, él enfatiza la importancia de la prevención y la educación del paciente sobre la enfermedad arterial periférica. The two doctors discuss Dr. Montero's path to becoming an interventional radiologist focused on limb salvage, his experience building a preservation center, and cultural differences between Latin American and US patients. Additionally, Dr. Montero shares his advice on his techniques, his preferred equipment, and how he overcame institutional challenges to start a limb salvage program. Finally, he emphasizes the importance of prevention and patient education about peripheral arterial disease.

11 Mar 20221h 2min

In this episode we talk with Dr. John Lipman about his journey to going solo and opening an Outpatient Based Lab (OBL) dedicated to minimally invasive women's interventions, including Uterine Fibroid Embolization (UFE). John also gives us advice on the importance of finding your Ikigai in practice, the secret to a long and happy career! --- CHECK OUT OUR SPONSORS Boston Scientific Nextlab https://www.bostonscientific.com/en-US/nextlab.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-nextlab-hci&utm_content=n-backtable-n-backtable_site_nextlab_1&cid=n10008040 Accountable Physician Advisors http://www.accountablephysicianadvisors.com/ Accountable Revenue Cycle Solutions https://www.accountablerevcycle.com/ --- SHOW NOTES In this episode, interventional radiologist Dr. John Lipman joins host Dr. Aaron Fritts to discuss how he came to be one of the first IRs to own an office-based lab (OBL) and how he decided to specialize in uterine fibroid embolization (UFE). Dr. Lipman begins by discussing his path to independent practice. After training at Georgetown, Brigham and Women’s and Yale, he worked in a private practice in Atlanta. In 2004, after 14 years and a growing desire to be an independent IR, he found a hospital to partner with where he could work independently. He started with professional fees only before landing a 50/50 joint venture deal with the hospital. He installed an MRI and angio suite and used a retired ER for his recovery rooms. In 2015 he opened his OBL, the Atlanta Fibroid Center. He was able to lease equipment and buy the real estate with loans and capital he had from his prior practice. He decided to specialize in uterine fibroid embolization for his practice rather than performing a variety of procedures. He says that ultimately, he decided to specialize in what he was most passionate about. The two discuss how Dr. Lipman received enormous pushback and criticism from many who thought opening a center that only offered one procedure was impossible. He used the antagonism as fuel, and after consulting women's groups in Atlanta he opened an OBL that focused on quality and privacy. Dr. Lipman ends by discussing how OBLs are the future of medicine and that they are a method for physicians to take back ownership of medicine from hospital administrators and recover the patient physician relationship. --- RESOURCES Outpatient Endovascular and Interventional Society: https://oeisociety.com Atlanta Fibroid Center: https://atlii.com/

7 Mar 202239min

In this episode, Interventional Radiologist Sabeen Dhand talks with Interventional Cardiologist S. Jay Mathews about novel techniques for arterial thrombectomy, including a discussion on using large bore devices, a variety of technique tips and tricks, and what's on the horizon for new devices/techniques. --- CHECK OUT OUR SPONSOR Boston Scientific Eluvia Drug-Eluting Stent https://www.bostonscientific.com/en-US/medical-specialties/vascular-surgery/drug-eluting-therapies/eluvia/eluvia-clinical-trials.html?utm_source=oth_site&utm_medium=native&utm_campaign=pi-at-us-de_portfolio-hci&utm_content=n-backtable-n-backtable_site_eluvia_1&cid=n10008043 --- SHOW NOTES In this episode, interventional cardiologist Dr. S. Jay Mathews and our host Dr. Sabeen Dhand discuss various devices used in arterial thrombectomy, including large bore aspiration catheters, the preclose system, separators, and stentrievers. Dr. Mathews clarifies the definition of “large bore” as a catheter that is 8 Fr or larger. He notes these devices face some resistance in the interventional community, due the belief that arteries may be size prohibitive. However, he notes that the pre-close systems make arterial closure very feasible. Large bore catheters are able to achieve higher aspiration force compared to smaller catheters. Dr. Mathews prefers to use the Lightning 7 or 12 systems from Penumbra because of their angled/atraumatic catheter tips and their flexibility in navigation. In cases of highly organized thrombus, Dr. Mathews may use separators to break up the clot into smaller and more manageable parts. He also speaks about using filters to capture the clot, but always in conjunction with aspiration, to prevent distal embolization. The doctors also discuss the role of thrombolysis. Although thrombolysis procedure time is shorter than that of thrombectomy, patients remain ischemic for longer, leading to more reperfusion symptoms. Before placing a lysis catheter, Dr. Mathews recommends re-establishing some flow and creating a channel for more effective delivery of tPA. Finally, we talk about new research in thrombus morphology and how this will affect future innovation in ultrasonic energy and nano-magnetic particles. --- RESOURCES Penumbra Lightning Catheter: https://www.penumbrainc.com/indigo-lightning/ Noninvasive thrombectomy of graft by nano-magnetic ablating particles: https://www.nature.com/articles/s41598-021-86291-2

4 Mar 202235min

The episode begins by discussing the training of a sales rep, which includes learning customer relations, procedure and product details as well as the disease states and anatomy of procedures. Aaron Weeks discusses how a key aspect of sales is understanding product compatibility and knowing what alternatives are available. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/pl1jCp --- SHOW NOTES In this episode, Aaron Weeks, program manager at Cook Medical joins host Dr. Aaron Fritts to discuss what it takes to become a sales rep, qualities of a good sales rep, and how to establish customer rapport. The episode begins by discussing the training of a sales rep, which includes learning customer relations, procedure and product details as well as the disease states and anatomy of procedures. Aaron Weeks discusses how a key aspect of sales is understanding product compatibility and knowing what alternatives are available. The speakers discuss degrees and pay next, and Weeks clarifies that an MBA is not a requirement. He says around half of IR sales reps now were previously techs or nurses because they know the procedures well, making them great trainees and knowledgeable reps. Pay is variable, but often starts as a base salary when training, with quotas or other incentives added later on. Next, the speakers discuss what qualities make a good sales rep and pitfalls to avoid on the job. Weeks notes the importance of emotional intelligence and being able to read the room. He notes that those who are easily frustrated or trying to make a quick sale will not be as successful. The speakers agree that one of the biggest strengths of a good sales rep is knowing their product's limitations and when to step away. The speakers touch on the difficulties that COVID has placed on the job. Weeks discusses how he stays up to date on current products and techniques being used for the procedures he covers. He says podcasts, virtual society meetings and other digital media outlets have played a key role in this aspect of his job. --- RESOURCES JVIR Website: https://www.jvir.org Salesforce Website: https://www.salesforce.com Cook Medical Website: https://www.cookmedical.com Aaron Weeks Linkedin: https://www.linkedin.com/in/aaron-weeks-753bb1

28 Feb 202244min