Surgery Without Scalpels: Interventional Radiology with Nic

Show Notes

In Episode 5 of No Referral Required, Mandy, Courtney, and Lara welcome interventional radiologist Dr. Nic to break down one of medicine's best-kept secrets. Dr. Nic explains how IR uses minimally invasive, image-guided procedures — through incisions the size of a pen tip — to treat everything from liver cancer and uterine fibroids to blood clots and infections, making IRs what he calls "the last true generalists." The conversation covers his training pathway through a combined BS/MD program, diagnostic radiology residency, and IR fellowship, plus how the specialty has evolved from its non-clinical roots into one that now emphasizes longitudinal patient relationships and dedicated clinics.

The group digs into the turf wars that come with a specialty whose procedures overlap with vascular surgery, urology, and other fields — and why a nationwide IR shortage makes that tension worse. Dr. Nic shares how AI and robotics could reshape the field, from flagging patients who need urgent procedures to enabling remote care in rural areas hundreds of miles from the nearest IR. The episode also touches on burnout, the unique safety net of being dual board-certified in diagnostic radiology, and the mental load of being responsible for patients around the clock. The speed round reveals Dr. Nic's superstitions, his favorite saying ("all bleeding stops"), and a dream second career as a political strategist.

Transcript

Lara [00:00:08] As a reminder, this podcast covers sensitive and sometimes difficult medical topics. Listener discretion is advised.

Courtney [00:00:20] Hey, everybody, and welcome to episode five of No Referral Required. Hello. Everybody here? Hi. Hey. Yeah. We have a great guest today, and I’m going to let Lara introduce him.

Lara [00:00:32] Thank you. We are very excited to have Nick here with us today, who is an interventional radiologist, which is a very interesting career path, I think, and something that the general public doesn’t know a ton about.

Mandy [00:00:44] And we’re just gonna call it IR from now on.

Lara [00:00:48] Otherwise we’re gonna trip over that name the whole hour. So we’d love to start, tell us a little bit about IR to start with. What is that? What sorts of things do you do in lay terms? How would you help somebody who isn’t in medicine understand what it is that you do?

Nic [00:01:07] Thank you all for having me here. I’m really excited to talk about something that I’m very passionate about as a specialty. Obviously, that’s my career choice. IR is not something that’s well-known by the general public. I would say there’s a lot of people in the medical field who don’t really know what IR is, so the opportunity to talk about it. is something I’m always happy to share more about. So interventional radiology is a specialty and it’s essentially minimally invasive surgery using image guidance. And a lot of IRs don’t like the term surgery because we always say we’re better than surgeons because we do everything without a scalpel.

Lara [00:01:37] I don’t say that. I don’t say that. Oh, you wouldn’t.

Nic [00:01:46] And there’s a documentary called Without a Scalpel, which I always thought was so silly, because I use a scalpel in almost every procedure.

Mandy [00:01:52] I was about to say, ah. I’ve seen an 11, believe it or not.

Nic [00:01:55] I was like, there’s an 11 blade all the time. But it’s essentially a series of minimally invasive procedures using a variety of type of image guidance. So interventional radiology sprung up from diagnostic radiology. And so just to kind of detour a little bit, so anytime you get an imaging study, there’s a physician who reads that study. So whether that’s a CAT scan, an ultrasound, MRI, X-ray, there’s a physician who’s interpreting that imaging. And I come from a long line of radiologists. My mother was a diagnostic radiologist for over 30 years. So I always kind of had an idea of what that was. And then I kind of changed paths slightly and going into the interventional part. So while her career was about reading the images and kind of interpreting them and kind of coming up with diagnoses, I then use live imaging to then treat patients for their variety of conditions. And I feel like IRs are kind of the last true generalist sometimes because, you know, for instance, in a week’s period, I could get a catheter into the liver and treat liver cancer. I can get that same type of catheter into the uterus and treat a patient for fibroids. I could then use a different catheter and suck a blood clot out of the veins and then stunt that scarred down vein open so that the blood clot doesn’t come back. I can then use a needle to biopsy any organ in the chest or belly or legs, sometimes even the bones. And then I can also put catheters in to drain infections from the belly. And I feel like there’s so many other procedures that we do that affect kind of every single organ system. And I get to do all of that in a week. And so that’s why I sometimes feel like we’re kind of the last true generalists.

Mandy [00:03:19] Now, Nick, when you say catheter, everyone who’s not in medicine listening is like, isn’t that what goes in your pee hole? In your bladder? So what do you mean when you say catheter?

Nic [00:03:30] So catheter is just like a very, very tiny tube. And I’ll say what I say to all my patients in pre-op clinic, which is that the incisions about the size of the tip of a pen. And for most of my procedures, the catheter doesn’t get more than the thickness of a pen. So it’s a very, very small tube that does not have to go into the bladder. Those are very large catheters. I work very small catheters. I think the catheter that you’re describing is, you know, that’s usually like about five millimeters wide, right? If you know, if we’re converting French to millimeters for, for the audience, and then, whereas like the catheters that I’m using are not much bigger than two. And so it’s like very, very small catheters, and then we can put smaller catheters through our small catheters to get further out to where we need to go, what we call those microcatheters, so even tinier. That way we can kind of treat patients kind of where, no matter where the problem is in their body.

Lara [00:04:16] Interesting. Tell us a little bit about how you got here. What does it look like to learn all of this?

Nic [00:04:23] Well, so after graduating high school, I attended a seven-year combined BSMD program. So I did college and med school kind of at the same time. So the first five years were kind of at a college, and I did four years of college and the first two years of medical school, which are the non-clinical rotation. So those are kind of your classes that you take in medical school. So I did those. I did sexually six years and five years. And then I went off to a more traditional medical school to do my clerkship rotations, where I did my surgery, my OBGYN, my internal medicine, my radiology rotations. And then from there, I applied to residency. I matched into a diagnostic radiology residency originally. And then, so I did a one-year internship. So after you graduate from medical school, you do a one-year internship. I did mine in internal medicine. And then I transferred over to my radiology residency, where I did three years of diagnostic radiology, followed by two years of interventional radiology.

Mandy [00:05:13] Is that the traditional path?

Nic [00:05:15] That was the traditional path. About a couple years after I would have matched, they changed it. So now there’s a separate interventional radiology residency. And so those trainees still do their one-year intern year, usually in surgery now. It’s more requested that these trainees will do surgery. And then they’ll do the five-year interventional radiology residency where they get dual board certified in diagnostic and interventional radiology. So their rotations are kind of mixed. So at the center that I work at, I’m the associate program director for the residency. And so our residents will do in their first three years, they’ll do about two to three months of interventional months. And then the rest of the time they do their diagnostic months. And then the last two years is pretty much full-time interventional.

Mandy [00:05:53] Wow. . Are there subspecialties in IR? Like there are a lot of things or do, as you mentioned, you do like kind of everything?

Nic [00:06:01] So I would say yes and no. So in the sense that once you graduate from an interventional radiology residency, as long as your interventional radiology residency offered those procedures, you can be credentialed in essentially anything. But there are a few subspecialties that have kind of sprung up now within the residency where there’s now some fellowships So the big one is interventional oncology So a lot of the liver cancer and kidney cancer work that we do that that’s kind of almost created its own subspecialty and it kind of its own subculture and so I also do interventional oncology as part of my work like my main area of expertise is treating liver cancer. That’s primarily what I do in my job, and that was what I was recruited to do when I started my job. But then because we are so general, I ended up doing a lot of other things, including women’s health procedures.

Lara [00:06:43] I was like, not fibroids? I thought that was the main thing, from my perspective.

Nic [00:06:47] Fibroids are my favorite procedure. You can ask any of my favorite clinic visit is the six-month follow-up after a uterine artery embolization when the patient feels so much better because they never believe they’re gonna feel that good and You know I meet them at the pre-op visit and they’re, you know, obviously dealing with a lot because it’s a really horrible condition to have when you are suffering from fibroids, as you all know. And then six months later, they feel so much better. And that’s always my favorite visit. And I’ve told patients that multiple times. But so going back to your original question about the subspecialty, the way IRs practice around the country is very heterogeneous. So what I did in my training, someone in a different training program may have done other stuff and someone in a completely different training program may have done different procedures where the focus was a little bit different. I trained at a liver transplant center, so we did a lot of liver cancer work, but some people train at more vascular-directed center where they do more what probably most people would think of as vascular surgery. Even though a lot of those procedures were invented by IRs, they’ve since been adopted by vascular surgery and cardiology, but some places IR has been able to keep a lot more of that, so their training program is more heavy in that. And so there’s subspecialties in interventional oncology, kind of more vascular IR, and then I think as the specialty grows and expands that there may be additional fellowships down the road.

Mandy [00:08:06] So you touched on something that I saw online when I was looking up current things about IR, and that is turf wars. Because you have a lot of reach into it. Do you know that term, Courtney?

Courtney [00:08:17] Yeah, but not on a medical area. This feels like Sharks and the Jets going on here.

Mandy [00:08:27] So, because you have such a big reach with a lot of variability that crosses a lot of specialties, do you run into that a bunch where you go to work and someone’s like, no, this is ours, you can’t touch that, that we own that?

Nic [00:08:39] I would definitely, I want to be very careful. to answer that question. I would say more generally, there’s definitely a lot of, in speaking to friends and colleagues in the specialty, it kind of depends where you work. So some places are a bit more collaborative between the specialties, and some places are a bit less collaborative. And I think one of the issues is that IR is inherently a referral-based specialty. No one’s gonna come off the street and be like, I need an IR. That would be so silly.

Courtney [00:09:04] And then also, we don’t have an organ system in our name.

Nic [00:09:11] So it’s just kind of like, well, what is that? What do I do for that? And so some people in the field are like, oh, we should change our name to endovascular surgery so that people know what that means and it puts vascular in the name. But if you have a vascular problem, you’re gonna go to a vascular surgeon. If you have a cardiology problem, you’re gonna go to a cardiologist. If you have a GYN problem, you’re gonna go to a GYN. And then also, a primary care physician who may not be aware of what IR does in their Area or if there even is an IR in their area because there’s a major shortage is just gonna send somebody to the next You know referral based on kind of subject matter, right? And then you know, everything’s a little always with politics as well If there’s like a particular expert from one specialty in a field They may be able to keep that in their specialty and then so when someone else isn’t allowed to touch it So it’s really about building relationships with your refers. And then there’s also turf wars in the sense of like, you know, if you practice in a specialty that’s like one organ system base and you have a procedure to offer for that patient, you may not think of the IR procedure.

Mandy [00:10:05] Oh, right. Yeah. You don’t want to send the patients away when you could treat them with the thing that you do.

Courtney [00:10:10] Or you may not be aware, maybe is what he’s saying, right? Like you may not even know like, oh, there’s somebody who could do this a hundred percent, like does it all the time.

Nic [00:10:17] Right, I hope it’s always kind of that latter one where it’s just people aren’t aware, but I think there are definitely in some situations where it may be a bit more malicious in that, you know, oh, well, they don’t know anything about this. This is my area of expertise. And also, but I think that I’m very lucky where I work and, you know, not just because I’ve worked with both of you for a while now and I’ve treated both your patients before, But I have a really great relationship with, I think, the GYN department, where we send patients back and forth to each other. One of your partners in particular, I do a lot of cases for her, and she sends me patients, and sometimes I do the procedure, sometimes we do procedures together, and sometimes I’m doing a procedure so she can do a procedure later. And so it just kind of depends on what the patient population is. I have a really great relationship with my liver surgeons, my hepatologists, and my medical and surgical oncologists, where sometimes they’re like, hey, Nick, you take care of all this, we don’t need to do it, or sometimes, hey, this is our plan, we need you to do step by step, and then sometimes I look at a patient, or I’ve been treating a patient for a long time, and I have to call one of them and be like, hey, I have this patient, what I’m doing has run out, it’s not working anymore, can I send them to your clinic for you to take a look? And so in that area, I’ve been really lucky, but definitely where there’s other specialties that perform our procedures, that can be a bit more tension-filled, just because everyone thinks they do well at their job, as they should, everyone’s trying to do the best.

Courtney [00:11:31] Yeah, that’s what I was gonna ask. So what you’re saying is, this is the non-medical person talking, you do this in a lot of areas, a lot of organs, you work with a lot of organ systems or whatever, I don’t even know the proper way to say it. And another doctor who is a specialist in that particular area, organ system might be able to similarly get the same result as what you would get? Is that what we’re saying? Like they could do the procedure but it wouldn’t be radiology based or like what what how does that like if I’m a patient and they’re like okay I could take care of this but I also could send you to someone who does it a different way, but gets the same result, maybe is, are there, cause you said minimally invasive, right? So that’s the big selling point that we want to give to patients is that when you involve IR, it’s minimally invasive. Cause you said the size of the incision, that’s very important to me. Yeah, that’s a big deal. So is that, am I, am I breaking it down correctly?

Nic [00:12:36] No, you are I think it’s kind of it’s two different scenarios So one would be like for instance vascular surgeons do a lot of the same vascular procedures that we do whether I’m talking about like blood clots or stenting arteries Okay, their training also includes kind of the techniques that I are pioneered Okay, and so there are some that a lot of those vascular surgeons do that so you’re probably you know you come in you say I have a blood clot in my leg right and And your doctor, maybe in the emergency room or your primary care physician is like, okay, I’m going to send you to the doctor that takes care of blood clots. Sure. Well, it makes sense from anybody that like, oh, a vascular surgeon would take care of blood clots. Right. But the procedure that they’re going to do is the same as the procedure that I’m going to do. Yeah. to where you work, where the referral goes, right? Conversely, this one’s kind of on a more controversial side. So men can get something called prostate artery embolization, which is we put catheters into the arteries of the prostate and kind of shrink them down with small particles. It’s essentially the male equivalent of uterine artery embolization.

Mandy [00:13:28] Wow, I didn’t realize that was a procedure either.

Nic [00:13:32] However, urologists, who are typically the ones managing prostate issues, have a myriad of procedures to treat patients with benign prostatic hypertrophy, which is kind of an enlarged benign prostate. So if you’re a urologist and you have four tools in your toolbox to treat something, are you gonna necessarily think of, and again, not even necessarily maliciously, are you gonna think of, oh yeah, there’s this other person down the road who can also do something to help with this, and then kind of, I think, to go back a little bit into the history of IR, IR traditionally was not super clinically based, because we come from a non-clinical specialty. My mom almost, she saw some patients, she did a few minor procedures, she did hysterosalpingograms. She spent a lot of her career doing it.

Courtney [00:14:13] So what, hold on, what is that? That’s a big word.

Nic [00:14:15] So it’s an injection of contrast into the uterus to assess the patency of the uterus and the fallopian tubes. I’m gonna defer to my GYN colleagues.

Lara [00:14:22] I don’t know how to do that for safety. Fertility issues to see if the tubes are open or if there’s, sometimes you can have anomalies of the uterus and they’re not shaped normally. So you’re following the contrast.

Courtney [00:14:35] The radiologist would follow it and see, oh, there’s a, There’s a pileup on aisle nine. Okay, all right.

Nic [00:14:43] So that was a procedure that she did, but that was like a very small part of her practice. She was a neuroradiologist, so she mostly just read CAT scans and MRIs and didn’t interact with patients. And interventional radiologists, we came from that specialty, right? And so especially earlier interventional radiologists were not as clinically focused, and in a lot of private practices even today, they’ll have, because we’re dual board certified, so we can do both, and I do both. And so they, you know, if you’re working in a private practice where maybe they need to make sure that you’re getting your productivity, it’s a little easier to get your productivity on the diagnostic side than it is on the interventional side. So you may not be taking ownership of that patient. And so, you know, so interventional radiologists weren’t traditionally taking ownership of those patients. And now I’d say in the last 10 to 15 years, there’s been a major push by our society, the Society of Interventional Radiology, to have clinics, to have, you know, where we do take ownership, where we have longitudinal care. And I have clinic every one afternoon a week, every week, it’s like dedicated time for my clinic. And that’s where I see patients, you know, before any major procedure that they’re going to have. You know, so for biopsies or maybe like chemo ports that patients need, those will kind of just get scheduled because they don’t, you know, that’s not like a long-term relationship. That’s just something that needs to be done. But like my cancer patients, I’ll see them ahead of time, go over the procedure, kind of go over the options, kind of go over the plan with them. I’ll then do the procedure. We’ll call them and follow up with their results. And then we’ll continue to follow them with the liver teams, with the oncology teams, and see if they need additional procedures down the road. And I get to have these really long relationships with patients that I’ve been in my current position almost four years, that I’ve had patients that I’ve been taking care of for essentially that amount of time. And, you know, they just, you know, they come back, they get a procedure, you know, sometimes, especially if I place those stent in a patient for veins or in the liver, you know, that stent is there forever, right? Someone needs to be in charge of that stent. If you referred a patient to me and I put the stent in and said, okay, now you handle it, you’re never gonna send a patient back to me again. And so I think it’s really important that I am involved in the longitudinal care of these patients where the patients know I’m the stent doctor. You put the stent in me, I’m having problems, those symptoms come back, I know exactly who to call, I’ll see them every six months, right? And that way you just check in and I get to know their spouses, their children, I get to see pictures of their grandchildren. And so it’s not clinical, I think, it’s still not as clinical as I think more traditional clinical specialties where you’re really building a stronger bond. I guess probably more in GYN you probably have that kind of relationship with patients. But it’s more than what was traditional in the specialty and I think that’s where we’ve kind of tried to overcome that referral issue because

Mandy [00:17:09] I didn’t realize that it had made that turn because I, I mean, all my interactions, mainly more in the past had been like, yeah, we’ll do the thing, but you admit them and you watch them and you see them afterwards. And then, you know, and it was like, well, okay, I guess you’re just a proceduralist, but that’s kind of nice.

Courtney [00:17:27] Is that what drew you to it? Is that why you wanted to go a little different than diagnostic?

Nic [00:17:33] So during my residency, you know, we rotated through interventional. I rotate through all the diagnostic rotations and I kind of the two rotations I like the most were interventional radiology, which was kind of procedures and seeing patients and helping patients. And then the other thing I really liked was emergency radiology, which is overnight radiologists. That’s a subspecialty of diagnostic radiology where you’re reading anything that comes into the ER, and it’s busy, and you might be the only person covering the ER. And I really like that. I like calling that overnight radiology.

Lara [00:18:00] It’s its own thing. It is, it really is.

Nic [00:18:02] And it’s just like boom, boom, boom, boom, boom, it’s like GI, you know, bleed in the stomach, bleed in the head, you know, car accident, you know, fractures, and like it’s just like really, really exciting. I just really, I think both of those kind of specialties, like there’s constantly something happening, there’s constantly something to do. And so that’s kind of where I was deciding. But for me personally, when you’re a night shift worker, there’s a lot of health issues associated with working nights. And I was in my 20s, and I need to make a job that I can do in my 50s. And I was like, I didn’t think that I would want to do night radiology in my 50s. And there’s plenty of night radiologists who do it. One of my partners who’s in his 60s, and they’re great at it. That was for them, that just wasn’t for me. And so that’s kind of how I went down the interventional route and I was really lucky to have some really great mentors who really showed me what it means to be a doctor. Because I don’t know that every doctor still knows what it means to be a doctor and they really cared about being physicians and taking care of patients and being involved in their lives and where, you know, I would do clinic with them and I would see their patients in clinic and they, you know, the attending would walk in and they’d give them a giant hug and like, oh, and how’s Sally doing? Like, is college going well for her? And like, you know, they had these like really strong relationships that they built with patients and how grateful the patients were for someone to just sit and listen to them and talk to them. And that’s not something that you do in radiology traditionally. And I mentioned that I did a year in internal medicine, because that’s kind of a required part of the training pathway. And I really liked that year. I really enjoyed, I did it in my hometown, so all the patients had the same accent as me, which was kind of nice. I could just kind of pour it on a little thicker than I have it now. And so they, you know, it was really fun to like, you know, build these relationships and like, you know, see these patients. And I really did enjoy that. And when I went to the radiology, I was like, I missed it. And there’s a lot of kind of, for lack of a better word, BS that comes with clinical medicine that you sometimes have to do. And the nice thing is in interventional radiology, that’s kind of minimized. And so it’s kind of like I get the best of both worlds. I get to be the proceduralist. I get to do the cool, fun procedure, right? I get to have my clinic. I get to see these patients and watch them grow and get better over time and have that six month uterine artery embolization visit where the woman’s like, oh, I feel so much better. Thank you so much for helping me. But then I also, on the side, I get to still do diagnostic radiology because I’m board certified in that as well. And I still love it. I still really enjoy that as well. So I’m really lucky that I get to do a lot.

Lara [00:20:25] Tell us a little bit, so I feel like we got a nice picture there, but tell us what a typical day is like for you. You get up, you head into work, what’s your day look like? What are your shifts like?

Nic [00:20:34] That’s a great question. So I get up around 6.30ish and then head to work. So we have rounds at 7.30, so it’s not traditional rounds. So if you watch Grey’s Anatomy or Scrubs and you watch them all, The head duck and then the little ducklings walking behind him, you know. It’s not like that. We round in front of a computer screen because what we do is it’s so imaging based. So we need to look at the imaging for the patients that are going to come in that day. And we have a board with all the patients who are scheduled for that day. And so, you know, I’m very lucky. I have residents, so I don’t have to do a lot of prep work ahead of time. The residents can kind of take care of that. And so the residents will present all the patients for the day. So we start with outpatients. So any scheduled outpatient will present. and then we have a board with all of our pending inpatient consults, so any patient that the inpatient service, you know, kind of the hospital service has asked us to help with, and then we go through those, and then as a team, usually there’s, you know, two to three attendings on at any one time, plus, you know, depending on which service I’m on, anywhere between two and five residents, and so as a team, we kind of prioritize, okay, well this patient is bleeding, they’re gonna need to go as quickly as possible, this patient needs a dialysis catheter, but they already have a temporary one, so we can wait on that, you know, because that’s not as priority, And then, oh, we just got a call from the OR. They have a bleeding patient. We got to clear a room and get them down now and try to triage and kind of prioritize all the patients. And so, you know, I’ll be kind of in and out of cases between, you know, essentially we start cases around 8-ish and then our normal day finishes around 5-ish. So, anyway, I always tell when I have medical students, we’re going to be done between 4 and 6. It just kind of depends on how busy the day is. And so, in terms of like, you know, like I said, I could have one day where I’m doing a liver cancer patient, a fibroid patient, and then a venous stent patient. And then in between, I’m also helping out with, there’s patients who have tubes to drain the urine from their kidneys because their kidneys don’t drain well. And so I’m switching out those tubes because they need that for regular maintenance. And then there’s another patient who’s coming down for their dialysis catheter, and I’ll help out with that. And then because I work at an academic center, I’m teaching residents and medical students in the room in between cases, kind of going through that. Doing all of those things there. I try to find always try and find time for lunch every day And then there’s always snacks in the pack you which is nice So then that’s kind of the day and then usually, you know, I’m very lucky I have a lot of partners. So my call is not very frequent So there’s usually one person on call. So kind of around that five to six o’clock mark, you know, our staff kind of downsizes and so we really essentially become the call team. And I work at what’s called a level one trauma center. And so that’s like the highest level of trauma. So these are like gunshots, major car accidents, you know, in the rural areas, like a tractor falls on a person. And so that, you know, we have to be available to help stop bleeding in a lot of those patients. And so that’s kind of our main thing that we’re doing on call, but also, If a patient comes in with a really bad infection that needs to be drained, we’ll put a tube in that to kind of drain that infection out really, really quickly and try to make them better. Again, if there’s any bleeding patients in the hospital, those are patients that are coming in overnight. So then from that like around 5 p.m. mark until 7.30 the next morning, there’s usually one attending and one resident who’s kind of covering the emergencies for the entire health system.

Lara [00:23:33] Great, you’ve mentioned some changes that have happened with your specialty over the last few years with getting its own residency. What do you see coming down the pike? Are any more changes that you’re expecting? And is AI a threat to your field? I think that’s a hot topic in a lot of medicine right now.

Nic [00:23:51] So I think that AI, I wanna be again, very careful. I think that there’s a lot of great ways to use AI, both in professional, any type of profession, and in your personal life. I think whether that will be how everything’s applied in the future, I guess that’s kind of a wait and see. And so I think that any job, regardless, you know, medical specialty, you know, lawyers, business people, whatever job you’re doing, you know, how AI is applied by our leaders and leaders in those fields is gonna be what’s kind of, you know, gonna determine whether it’s good or bad. I think that on the diagnostic side, there’s a lot of AI tools to help the radiologists right now and help triage things. But I know when I use them, sometimes they’re very accurate and they catch things that I miss, which is really great for me and for the patient. And sometimes it’s just a lot of like, Nonsense pictures that occur where it’s kind of like you can kind of think about is like when you’re using those AI image generation tools, right? Like it’s not not that that’s what they’re doing But it’s more like sometimes it makes the image exactly the perfectly the way the prompt is and then sometimes there’s like all these weird typos And the face kind of looks weird So it’s like even with the AI for radiology right now like sometimes it’s amazing and then sometimes you’re like Why did it think that was a fracture that doesn’t make any sense? Like how could you even think that this algorithm works? And so I think that they’re still working out the bugs on that. I think in interventional radiology, where AI can be really helpful, is kind of flagging patients who might need an IR procedure sooner. So in my own residency training, one of the things that we did was we sucked out blood clots from the chest, pulmonary emboli. where we would come in and do that in the middle of the night, and my section chief had an AI algorithm that had been installed on our imaging system that any patient who got scanned, who had a blood clot in their chest, he got an alert that they had that, and he would then log in and be like, is this a patient we should treat? And then if we was, he would reach out to the team and we would do what’s called PERT activation, PE response team activation, and then we would bring the patient in for a procedure. And so there’s a lot of people doing that, so that way you’re kind of getting faster treatment. Stroke services do that a lot. There’s a subspecialty of IR called NeuroIR, and there’s a few different pathways there, but one of the things they do is they help suck blood clots out of the brain for patients who are having strokes. And so there’s a lot of stroke protocols with AI to kind of help triage patients a little bit. So I think that’s where AI can definitely be really helpful. There’s also some interesting robotics I know that robotics have kind of been more in surgery for a while But there’s some interesting robotics to kind of help us direct the catheters a little bit because the way we direct the catheters is We shape a wire and then try to twist the wire to where we’re going But you know, sometimes you can’t get you know It’s a weird angle or the catheter doesn’t want to track so I think there’s gonna be some interesting stuff with robotics and probably in the sooner future with interventional radiology. And then what that would be really great for is rural care. So rural care, there’s a major, I mean, there’s a physician shortage probably in every single specialty. I haven’t looked recently, but I would have to imagine. And interventional radiology is right at the top of the list of major shortages, where especially in rural areas, you may not have an interventional radiologist for 200, 300 miles. And I work at a center where the people are coming 200, 300 miles away for not outpatient care, I’m talking about emergent care. Outpatient care, yeah, sometimes you’re gonna have to travel to the specialized center for whatever you have if you have something uncommon. But if you’re in an emergency, you don’t wanna have to travel that far, right? And so having robotics where maybe there could be a remote physician helping pilot, kinda like the way we do now telehealth for consults and things like that. I know a lot of stroke care, it’s like teleneurology at a lot of places. So that’s something that I think will be interesting in terms of technology helping in the future. And then also, I think just like the internet’s been really helpful for IR kind of getting out there. So when I was a resident, I remember there was something called TwitIR, like when it was still Twitter before it was X. It was like hashtag TwitIR. I signed up for it.

Courtney [00:27:35] You’re not bored.

Nic [00:27:36] It’s okay. I mean, I still think it was a silly thing, but the great thing about it is it allowed physicians to connect with each other, to share cases, to be like, hey, I did this, what do you think? Allowed medical students to find out more about the specialty, because going back to the heterogeneity of IR, you could take 10 IRs in a room, show them a case, and you can get 20 different solutions. And the great thing about it is, I always tell the residents, nobody’s wrong, except the only person who’s right is the attending who’s in the room at that time. And so that’s something where, for instance, a chemo port, which is putting in a port for chemotherapy, we do that. That’s probably the most common procedure we do. And I have 11 partners currently, and I think that the residents know how to put in the ports like seven different ways. And I always tell the resident, I’m like, look, I don’t really care how you put it in, as long as the curve looks pretty and the incisions stay closed and the port works. That’s my concern, I’m not a super stickler. But some people could be a bit more sticklery on it, where it’s like, no, you didn’t put the needle exactly at this particular angle. You should have used your protractor and measured it at 20 degrees. Just like any other job, there’s some people who are really, really sticklers about how they want to do their job.

Courtney [00:28:44] And some people who are like, as long as it feels different when it’s a human, I’ve had a port. So it’s a, that’s a like, I’m like, Oh, I can’t imagine somebody. Getting out their protractor because you’re kind of awake during that you know you’re What scares you the most in your field like if you’re given a situation or or about your field in general What scares you the most?

Nic [00:29:08] I think kind of like on an individual level, you know when it’s the middle of the night and there’s a really sick crashing patient and Maybe that’s a scenario. I haven’t encountered before Because I’m relatively junior into my career, you know, I’ve been practicing attending now for five years And obviously I did, you know, six years of residency and you know traditional medical school So I’ve been doing this for a while, but it’s not like you know I have partners that have been doing this 20-25 years, right? So they’ve they kind of been around the block and they still sometimes get confronted with things. They haven’t seen before and I remember my mom used to tell me when she was practicing that she still sees things every day that she hadn’t seen before. And she was a practicing physician for over 30 years. Which is, in some ways, what’s exciting about the specialty is that you’re always learning, and just healthcare in general and medicine is there’s always something new to learn, right? There’s always some new procedure, there’s always some new disease, there’s always just some new way that something presents that is, and then so just in the middle of the night when it’s you, the one on call, When it’s during the day, it’s nice because you have a bunch of partners around, you can call a friend, you can be like, hey, let’s do this together. Is there someone here who could take a look with me? But when it’s in the middle of the night and it’s you, I think that’s the most scary thing because there is a life on the line, right? There is a person who, you know, and that person matters. That person matters to a lot of people. And I take that responsibility very seriously, and so that’s why it’s always important to be reading, and studying, and doing questions, and going to conferences, and keeping up on all that stuff, because you never know when you’re gonna be in a situation where some lecture you went to one time, somebody said something, and you’re like, that’s it.

Mandy [00:30:38] Yeah. That helps you. Yeah, I have pulled pearls like that from listservs and things.

Lara [00:30:45] Not infrequently, that helped me out. Facebook groups for physicians, I feel like it’s helpful. What’s one thing you wish patients knew about your specialty? Besides that it exists. That it exists.

Nic [00:30:57] We’re here, we’re here to help. We’re here. We’re relatively friendly, you know. That’s good. Honestly, that’s probably, I think, yeah, just that like, When you’re presented with an option from your physician, like, hey, you have this, this is what you should do, ask if there’s an alternative. Because like 90% of the time, IR has an alternative, and so you might end up finding us. And I think that, you know, I saw a patient recently sent to me by one of your partners, and the patient was gonna go through with one surgery, and the patient said, is there anything else? And your partner said, yeah, I can send you to IR.

Courtney [00:31:37] Why do they not start with all the options? Can I ask that question to all three of you?

Lara [00:31:42] I will say that sometimes we sit down with a patient and spend a long time talking and it’s just a lot of information. And I think especially if it’s something new to them, like they’ve never heard of this, It doesn’t always stick or they don’t always have the right, sometimes it takes multiple conversations. So maybe you’ve said it and somebody didn’t hear it.

Courtney [00:31:59] I’ve definitely had that experience.

Nic [00:32:01] And I think also, yeah, I think that’s a really good point. And I think that sometimes you don’t really realize that they’re talking to you about alternatives. They didn’t sit down and say, and these are the alternatives. But this patient in particular was referred to that physician for a specific procedure by a different physician in the same specialty saying, you need to see this person for this. So that visit’s obviously going to start a little bit differently where it’s like, hey, you’re coming for this, right? And the patient was told that that was the only option. So now they’re talking to another doctor, and they’re like, well, is this my only option? And they’re like, oh, no, you have other options. Here are your other options. I thought you were here for this, but I’m happy to send you to my friend down the street who has other options for you. And that’s a good doctor. And so I think that in general, sometimes patients don’t know, but I think it’s sometimes just to say, hey, is there another choice? And sometimes that other choices also do nothing. And I think that’s another thing that patients maybe aren’t as empowered to say sometimes, where sometimes you don’t need to get treatment because the treatment may not make you as better as you think it’s going to.

Courtney [00:33:05] Yes, the risk of possible side effects. I had to make that decision. I was like, I’m not gonna do that. And that was… somewhat well-received. I don’t know. My surgeon was telling me not to do it in no uncertain terms, but she couldn’t come out right and say it. And so I had to make a very educated decision based on other doctors, not me, but it was definitely not what was considered protocol, so I wanna say that to anybody who’s listening, who’s like, people tell me that I have to do this, I have to do this, and I’m not saying go on the internet and listen to an influencer and let them, I had medical professionals read medical journals that were literally, studies that were NIH funded that were coming out as the decision was being made, and we went from there, and now that standard of care, I actually talked to a doctor yesterday, is actually swinging toward what I did, what I chose, so I’m like, Okay, great. It hasn’t totally jumped, but it definitely is swinging that way. So, that’s good to know that you would agree that sometimes that’s what to do, is not to do anything yet.

Nic [00:34:10] Oh, I’ve seen patients in clinic that they’ve been referred for a very specific procedure, and I’ve looked at them and I’m like, I don’t think you need this. Like, I can do it, but I don’t think you need it. Because, and, you know, the patient, I think that really confuses patients sometimes, because like someone’s like, do, do, do, and then someone else is like, eh, not really.

Mandy [00:34:28] Of course.

Nic [00:34:29] And I think in that particular patient, I could tell the patient really didn’t want the procedure. I could see it. He was kind of going through the motions because he’d been told he needed this. And I was like, look, I think we can watch you for a bit. I’m happy to do this whenever. If you’re telling me you want to do it right now, I’ll get you booked as soon as I can. If you’re telling me you want to wait six months and reassess, we can wait six months and reassess. If in that six-month period you change your mind, you’re like, no, let’s just go through with it, well, go through with it. We’ve already talked about it. We’ve met, we’ve gone through all this. I think especially sometimes with our elderly patients, I think a lot of people push for aggressive care, both on the physician and then on the patient or family side, when that’s really not what’s appropriate. And sometimes patients feel like they’re a little bit I don’t want to say bullied, but might be pushed into a pathway that if they were given the option of saying no, maybe wouldn’t have gone down that pathway. Because not really presented with that option, it’s always like, you could do this or you could die. And that’s not really true. It’s like, you could do this. or you could do nothing, and it probably will get worse, the thing that’s happening to you, but the treatment may not make you better, so why are we doing something that’s gonna not extend your lifespan at your age with your comorbidities? And so I think that that conversation doesn’t happen enough.

Courtney [00:35:45] I think there’s a generational thing, just in my personal experience, a lot of people that are of the older generation don’t know that they can ask questions of their doctor, like legit questions, like what am I trading here? I’m trading to get better in here, but what’s gonna be the side effect? Or I don’t wanna do that, or I wanna get a second opinion. I know that with family members in my life, it’s like, did you ask that question? Well, no, they didn’t tell me, and I’m like, you have to ask that question. You have to be an advocate for yourself and a lot of, I think, older generations, a doctor is the ultimate authority, which you are, but also, you need to at least have the knowledge. A doctor that doesn’t explain what’s happening, I feel like is not a great doctor. I mean, sorry, is not a great doctor because it’s really important for a patient to know what’s happening. So I appreciate that, that you’re saying that, that it’s okay.

Nic [00:36:44] I got really great advice when I was in medical school. I worked with a primary care physician, and he never asked patients, do you have questions for me? Because that’s kind of, it’s a little bit conflictatory, right? Because it’s like, well, you know, I’ve obviously done everything. Do you have questions, right? Yes. And so he always phrased it as, what questions do you have for me? And so I’ve adopted that when I speak to patients. I never ask them, do you have questions? I just tell them what questions you have, because then there’s, the expectation is that it’s okay to have questions. And sometimes patients are like, oh, well, actually, here’s my list, right? And other times patients are like, well, actually, this was my list, but you answered all those things, and I really appreciate that. Or it’s like, well, and sometimes they ask, well, what questions should I ask?

Courtney [00:37:19] That’s what I ask. That’s what I learned to ask as I was going through a lot of things. I was like, I don’t even know, what questions should I be asking right now? And they can rattle them off. So it’s good. And usually they’ve already addressed those questions, because they know, you know, whatever. But it is a good thing. I’d be like, what questions do other people ask? And they’ll let you know. So that’s a good thing, if you don’t know what to say.

Mandy [00:37:40] Nick, it feels like your field is moving real fast, based on everything you’ve told us, both in the training aspect and the shift towards some clinical care. the differentiation into all the super sub-specialties. You’re really quick to adopt new technologies. Are there any threats based on how fast you move? Do you see something on the horizon from a specialty side that you guys think that’s gonna be a problem when we get there? Or internally are there threats? We talked about turf wars a little bit, but anything that kind of puts you guys on guard?

Nic [00:38:15] I think the shortage and then the kind of accelerates the turf war aspect a little bit because the reason that like other specialties started doing the procedures is there weren’t enough interventional radiologists and radiologists wanted to do because again traditionally radiology is a non-clinical specialty so those people who are doing the procedures and reading at the same time They weren’t as interested and that’s kind of where a lot of those procedures were eventually taken out of radiology and interventional radiology. And I think that the shortages can potentially accelerate that. For instance, I talked about prostate artery embolization, right? That’s, you know, there’s nothing in urology training that would really allow them to learn that procedure traditionally. Because they don’t do contrast exams through the artery. They’re not getting arterial access. That’s not what they do but there’s a subspecialty of urology called interventional urology and I know a couple and they do IR procedures as urologists and I’m sure most of them are excellent and really take pride in what they do, but in terms of a threat to a specialty, if the traditional referrers start doing the procedures themselves, then the specialty itself is going to fall apart. And because there is a lot of innovation from the specialty, there’s a joke in interventional radiology circles that it’s like, I are inventing procedures for other specialties since 1962.

Mandy [00:39:29] You just hit one of your speed round questions. You jumped ahead with a joke about your area, but that’s awesome. That is both awesome and sad.

Nic [00:39:39] I think what happens is because it is such an innovative specialty and the personality leads to innovation, that if the specialty falls apart, innovation in the rest of medicine may not accelerate at the rate that it currently has. Because like you said, we are really quick to adopt new technologies, which I think in healthcare is rare, because I think you probably have older partners who are very set in their ways, and I’m very lucky that I have older partners who are doing new stuff, or when I brought some new procedures that weren’t offered in my practice, they were like, oh, that’s cool, let’s find patients we can do this together on. And that’s kind of IR, that’s how it is, it’s collaborative. It’s like, let’s do more, let’s push the next generation, because someone pushed us. And also because the specialty’s relatively young, a lot of our catheters are actually named after people, and I’ve gotten to meet a lot of those people. or hear them laugh. Or trained under the one generation removed where they trained who I trained under. Or I get to work with people who are like, oh yeah, you know that wire? That was my attending. And so because it’s such a young specialty in that way, and you have these people who did push the boundaries originally still around, and we use their names every day, that that’s something that I think if we don’t have enough people to move the specialty forward could cause some problems down the road.

Mandy [00:40:54] All right, so there are some reports that IR has one of the highest rates of burnout. Do you sense that? Do you see that around you? What’s your experience with that?

Nic [00:41:03] I think a lot of medical specialties are really suffering with burnout, so I don’t think it’s unique to IR. I think the difference between IR and other medical specialties is that you have a bailout plan in diagnostic radiology. Like if tomorrow I decided I don’t want to do procedures anymore, There’s a major shortage of diagnostic radiologists. I get phone calls from recruiters all the time with really good jobs that pay more than what I make and would have better vacation and maybe a better lifestyle, but it’s not what I want to do right now. I think when you have a plan B, that’s a great plan. A lot of people, it’s their plan A. because there’s all the people who went into diagnostic radiology. And especially because of our traditional pathway of going through diagnostic radiology, it’s something that seems viable. We all have friends who do it. So I think whereas maybe another physician, if they don’t do medicine anymore, they’re gonna have to go back to school, start a business, have that million dollar idea. We’re very lucky we don’t have that. My co-chief resident said, the best thing about interventional radiology is that we can smarten up and do diagnostic radiology one day. And he still does interventional radiology, but I had six co-fellows, so we were a class of seven, and one of them does 100% diagnostic now, does zero IR. And of my six co-fellows, of the seven of us, I think I’m the only person with a 100% IR job. So all of them do do some diagnostics. So when you’re doing that sometimes, I think it’s like, you’re like, oh, I could just do this all the time. And especially now, one of the things the COVID-19 pandemic did, it did two major changes to radiology is one, there was this period of time where patients couldn’t get radiology scans. So they were kind of delaying their care. And that’s led to kind of essentially a deluge since then of like all these people now like getting all these imaging studies, which has led to a real overload across the country. And then also radiologists moved home. There had always been teleradiology that always been a thing but because they were trying to keep people out of the hospital All of a sudden all these places where the radio where there was a reading room that you could go down and see people a lot of those places Got moved, you know now they have the workstation in their home like my mom. She had a workstation in her home You know the last few years of her practice where she didn’t you know? She didn’t always have to if she was like I just don’t feel like going in today. And she was someone who liked coming in, because she liked talking to the clinicians, she liked seeing people, she liked making social rounds, right? She liked going to the coffee shop and seeing the other doctors and going to the physician lounge and interacting with people. And I think a lot of diagnostic, now that diagnostic radiology has moved home, it’s like, well, oh, I don’t have to commute to work? That sounds pretty good. Oh, they’re doing work on my house and I can be there to let the people in? That sounds really nice. Oh, my kid is sick and can’t go to school today? Oh, okay, well, I can’t find a babysitter at a last minute, so I’ll just be home. And I think that that’s really enticing. I think work-life balance, it’s a major discussion across not just medical specialties, but work from home is a big thing in corporate America right now. A lot of companies saying, no, you can’t work from home, you have to come to the office, because commercial real estate prices are falling apart, right? And the same thing is happening in medicine as well.

Mandy [00:44:07] All right, before speed rounds, last heavy question. All of us tend to take some of our workload home. How is it for you, your specialty? What part of your mental load is taken up with work after you leave?

Nic [00:44:25] So I think there’s two aspects of it. There’s obviously like charting, like I still have to do charting. So for instance, like last night, you know, I finished, I left the hospital yesterday, probably around 5.30, and my residents were working on their like reports, so I couldn’t take them myself. So, you know, I got home, had like dinner with my wife, and then we, I went to sit at the computer, because I have a workstation at home, and I just like finished up my reports. And that took me like maybe 15, 20 minutes. And then you’re always answering emails, or checking on things, or on a Sunday before a busy week, and I just kind of take a look at the imaging of my patients, just kind of refresh what I’m planning to do for the week and such like that, or on a day-by-day basis. So there’s definitely some degree of that work aspect of it, but then I also feel like sometimes when you’re a physician, you’re kind of always on, because just because you’re not on call doesn’t mean your patient didn’t walk into the ER, and you’re responsible for that person. I remember we were on vacation somewhere, and we were on a helicopter tour, And I got a call from one of my schedulers trying to rush schedule one of my patients for right when I got back from vacation. And I was like, hey, can I call you back?

Mandy [00:45:23] I’m in a helicopter.

Nic [00:45:28] Or sometimes I’ll be out to dinner and I can see that someone from the hospital is calling. where it’s someone that I refer, who I work with a lot, and they’re calling, and it’s six o’clock, and I’m not on the clock, I don’t have to answer that phone, but that’s a person I know really well, and they’re asking for help, and they’ll call, and they’ll be like, hey, I have this patient, I just saw them in clinic, I need you to see them, can you get it set up? And I’ll be like, okay, let me take a look. pull up their imaging and their chart on my computer, and I’ll take a look, and that can take me five to 10 minutes, and then I’ll send an email to my schedulers being like, hey, Dr. So-and-so is putting in a consult for us, please get them on my next clinic schedule. And that’s 15 minutes out of my time at home that I’m working, but I feel like I’m responsible for that. I’m responsible to maintain that relationship with my friend who I know that if I called them at six o’clock, they’d also pick up the phone. I feel like I’m responsible to the patient who is calling, trying to get in. Just because I’m on vacation, that’s still my patient. I’m still responsible when I’m home. And I feel like that’s where I take most of my work home with me.

Lara [00:46:26] Okay, speed rounds are closing. Okay, so these are short, fun questions. This is my personal favorite one. Are you superstitious?

Nic [00:46:36] I’m a little stitious.

Lara [00:46:41] I’ve been surprised by some of the answers. I definitely think call call makes you it makes me superstitious. I was sort of a black cloud. So I feel like it was hard to get away with not being.

Nic [00:46:52] There are certain procedures that are more prone to complication than others, and so I always tell my tech, leave this out to scare away the evil spirits.

Lara [00:47:01] What other specialty do you have to ask for help from the most?

Nic [00:47:11] probably internal medicine to admit our patients after procedures. Because they have a lot of complex medical problems that I can’t really manage in addition to whatever they need to be admitted for.

Lara [00:47:25] What’s a word or phrase you end up saying multiple times a day? You said a couple of them, but anything else that pops up a lot when you’re talking to your colleagues, when you’re talking to patients?

Nic [00:47:34] All bleeding stops.

Lara [00:47:36] That’s a good one. Eventually. Who in your inner work circle could you not live without?

Nic [00:47:46] I have a couple of my partners who, one of them was on vacation recently and I was like, I need a vent so I’m just texting you. I have a lot of really great partners. I don’t want to name them because I don’t want someone to feel bad that I didn’t name them because no matter who I’ve ever called, no matter what hour, they’ve always all picked up the phone. I’ve woken up my boss in the middle of the night. I’ve woken up some really senior partners in the middle of the night. One of my partners, I called him because I didn’t know how to use a device that I thought I needed in a case, and he’s trying to talk me through it, and he’s like, you know what, I’m just gonna come in. I was working with the resident. I was like, well, let’s just try it. I think we figured this out. we got what we needed to get, and he walked into the room, and I’m like, oh, dude, I don’t need you. I’m good. And he was like, oh, great. And he just felt better that he knew that I was okay. And so that happens. Because I am so collaborative, that happens all the time. So all my partners are great.

Lara [00:48:38] I think that’s so key in the burnout question, is colleagues who have your back no matter what. It’s gold. You can’t live without that. If you could ask your boss or chair for one thing, what would it be?

Courtney [00:48:52] It doesn’t have to be medical, it can be anything. Like you want Starburst in the morning. I don’t know, I’m trying to think of something. You want green M&Ms, I don’t know.

Nic [00:49:01] I can always ask for more vacation.

Courtney [00:49:03] Yeah, that’s good.

Lara [00:49:04] Yeah, fair. What other medical specialties gross you out? Do you have something you could not have gone into because you’re like, I just can’t. Podiatry.

Courtney [00:49:14] I’ve been to a podiatrist, and I was like the waiting room smells like feet we still have our shoes on what? Yeah

Nic [00:49:29] I worked with a surgeon once when I was a med student and he was one of those old school, gruff, mean surgeons and he said, I don’t respect any specialty except OBGYN because somebody’s gotta do it and it’s not gonna be me. And that’s how I feel about podiatry.

Lara [00:49:47] Somebody’s got to do it, but it’s not going to be me. Which actually don’t know if you have kids, but if you do, or if you would in the future, would you encourage them to pursue a career in medicine?

Nic [00:50:00] So I don’t currently have children. I got married a little over a month ago, so.

Lara [00:50:05] Congratulations.

Nic [00:50:07] Thank you, thank you. So we’re definitely thinking about having children, and so we hope to get blessed with that one day. But I would encourage my children to go into medicine. I was encouraged by my mom to go into medicine.

Lara [00:50:19] You come from a medical family.

Nic [00:50:21] Yeah, and when I was little, my mom would take me to work with her, and I’d have a little bag of Burger King, and I’d have my action figures, and I’d be sick. on the floor of her reading room, eating my Burger King and playing with my action figures while people would walk in and ask her questions and she’d be reading x-rays, and those are some of my favorite memories. My dad would just drop me off from 11 to one, and then he’d come and pick me up, because I had a stay-at-home dad. He was always just bringing me wherever my mom was. She’s retired now, but she loved being a physician. It was one of her favorite things. She loved being a mom more. And then the second thing she loved was being a physician, because she loved learning. And that’s what I always think is so cool about medicine, is there’s always something new to learn. I’m sure there’s other jobs where that’s the case, but I guess my bias was that in medicine there was always something new to learn, and I always like learning new things.

Courtney [00:51:08] Very good, yeah. Okay, our last question is not speed round. You can, I mean, we want you to just, whatever you think, but if you could do any job in the world outside of medicine, so medicine is not allowed, and still support yourself, you don’t have to start over, you don’t have to go to school for it, you just wake up with the knowledge and the, if it’s a store, you have it, you know, like whatever, you don’t have to put a lot of work into this, but you get to do this job, what would it be?

Nic [00:51:37] a political strategist. As a kid I always liked history and learning about politics. I know especially nowadays it’s really hard to talk about politics. I like talking about it, not in the sense of I’m right, you’re wrong. That I don’t enjoy. I like the process of it. in the sense of how people think about things, how politicians make their message, how campaigns kind of frame what they’re trying to say and choose what positions to focus on and what not to focus on. I mean, it’s a science, right? It’s political science, right? And I find that fascinating because it affects everything. It affects everything in our lives, and how a politician chooses to focus on an issue. There’s so many people involved in researching and figuring that out, and it’s such an intricate field that I don’t think gets a lot of credit, because I think we generally think of politicians as blowhards who are just going out there and spewing whatever they want to spew, and they’re just lying about everything. And it’s like, well, no, no, they’re lying in a very specific way. That has been market tested and I just find that entire process So fascinating. And I am personally not charismatic to be involved in politics in any way, shape, or form. I always say I have a radiology personality. Healthcare people will know what that means. So that wasn’t something that I could have.

Lara [00:53:03] I have an interventional radiology personality.

Nic [00:53:10] Because we’re getting radiated, so it’s like getting the sunlight. The diagnostic ones are in the computer room and just looking at blue light. And so I would never have been able to survive in that world because I think that maybe I’m too honest. But I think that just the science behind it is something that’s really super interesting.

Courtney [00:53:33] It’s a great answer. Well, thank you, Nick, for being here with us. Thanks so much.

Nic [00:53:38] Thank you so much for having me. I really enjoyed our discussion.

Courtney [00:53:40] It’s great. Well, thank you guys for listening, and we’ll be back soon.

Mandy [00:53:43] Bye, guys. Bye. This podcast is intended for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The views and opinions expressed by the host and guests are their own and do not constitute medical guidance for any individual case. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or health concerns. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast. By listening to this podcast, you acknowledge that the hosts, guests, and producers are not responsible for any decisions or actions you take based on the information discussed.