Dr. Eric J. Keller has a background in bioethics, medical anthropology, 4D flow MRI, and legal guardianship. He’s the founder of the Applied Ethics in Interventional Radiology (IR) working group, a multi-institutional team of faculty and trainees developing practical approaches to challenging situations in IR. Dr. Keller also serves on the Board of Directors of the Interventional Initiative, a nonprofit devoted to patient and clinician awareness, access, and advocacy regarding minimally invasive image-guided procedures.
Shortly after you completed your residency and fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
Not specifically. Every IR training program covers different things, but I was able to get at least some exposure to most of the procedures I plan to do in practice. That said, IR is a dynamic field. You often get asked to do things in practice that you may not have been exposed to in training, like GAE, SphenoCath, or nerve blocks. That’s why people describe your first year out as your second fellowship. Often, the skills and principles you learned are transferable.
Many residents and fellows leave training with a sense that they aren’t fully ready for clinical practice. Do you remember a time when you felt like you weren’t prepared for 'prime time'? How did you overcome this?
Certainly, and I think that’s both common and healthy. Most people feel that way for their first year or so out of training. As I said, it’s like a second fellowship, and so finding a supportive practice with good mentors is important. It’s better to remain humble and accept that this nervousness is normal. That wards you against overconfidence, which can get you in trouble. At the same time, you should balance this out by celebrating your successes, so that the anxiety doesn’t paralyze you.
Considering you’re well-published and have extensive experience in medical research, how would you recommend a fellow get involved with clinical trials or establish collaborative research with other specialists?
Honestly, I think half the battle is just being willing to ask. Remain skeptical and curious and ask those “why” questions that lead to innovative research. Ask others what they think or if they’re willing to collaborate to cross-pollinate across specialties. Ask people to mentor you and be willing to politely move on if the mentor-mentee relationship isn’t right for you.
If you haven’t done a lot of research before, it’s good to start small, with something like a case report or a retrospective chart review, before working your way up to more complex studies.
When thinking about the business of healthcare, what are 2-3 concepts that you wish you knew earlier in your career?
I hadn’t realized how intricately intertwined the clinical and business aspects of healthcare are. While this can result in conflicts of interest, good business practices can also support good healthcare. For example, in building a referral base and advocating for patients, you have to be willing to do some ground work, get out there, talk to people – both clinicians and the public – about what you have to offer. Following up with referring clinicians or patients and their families immediately after a procedure can also go a long way, even if it’s just a text or a quick call. I also think it's important to keep your finger on the pulse when it comes to your digital footprint. If someone searches your name, what can they find about you online? And how can you maintain a positive digital footprint and image?
So-called “turf wars” are inevitable in almost any workplace setting, including healthcare. How do you approach this challenge and what’s your advice for graduating residents and fellows?
I actually studied interspecialty turf wars for years as a graduate student. I would say that disciplines and territories in healthcare are naturally going to overlap, ebb, and flow. You maintain your “turf” not by claiming you’re entitled to it but by demonstrating that you are best equipped to be there. Often, the teams that “compete” most effectively are multidisciplinary. We all have different strengths and weaknesses in our training, so I think remaining humble about what you can learn from others and how you can collaborate is key. I once had an interviewee put it like this: competition in healthcare should be Bears vs. Vikings, not linemen vs. wide receivers or IRs vs. vascular surgeons.
Dr. Eric J. Keller has a background in bioethics, medical anthropology, 4D flow MRI, and legal guardianship. He’s the founder of the Applied Ethics in Interventional Radiology (IR) working group, a multi-institutional team of faculty and trainees developing practical approaches to challenging situations in IR. Dr. Keller also serves on the Board of Directors of the Interventional Initiative, a nonprofit devoted to patient and clinician awareness, access, and advocacy regarding minimally invasive image-guided procedures.
Shortly after you completed your residency and fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
Not specifically. Every IR training program covers different things, but I was able to get at least some exposure to most of the procedures I plan to do in practice. That said, IR is a dynamic field. You often get asked to do things in practice that you may not have been exposed to in training, like GAE, SphenoCath, or nerve blocks. That’s why people describe your first year out as your second fellowship. Often, the skills and principles you learned are transferable.
Many residents and fellows leave training with a sense that they aren’t fully ready for clinical practice. Do you remember a time when you felt like you weren’t prepared for 'prime time'? How did you overcome this?
Certainly, and I think that’s both common and healthy. Most people feel that way for their first year or so out of training. As I said, it’s like a second fellowship, and so finding a supportive practice with good mentors is important. It’s better to remain humble and accept that this nervousness is normal. That wards you against overconfidence, which can get you in trouble. At the same time, you should balance this out by celebrating your successes, so that the anxiety doesn’t paralyze you.
Considering you’re well-published and have extensive experience in medical research, how would you recommend a fellow get involved with clinical trials or establish collaborative research with other specialists?
Honestly, I think half the battle is just being willing to ask. Remain skeptical and curious and ask those “why” questions that lead to innovative research. Ask others what they think or if they’re willing to collaborate to cross-pollinate across specialties. Ask people to mentor you and be willing to politely move on if the mentor-mentee relationship isn’t right for you.
If you haven’t done a lot of research before, it’s good to start small, with something like a case report or a retrospective chart review, before working your way up to more complex studies.
When thinking about the business of healthcare, what are 2-3 concepts that you wish you knew earlier in your career?
I hadn’t realized how intricately intertwined the clinical and business aspects of healthcare are. While this can result in conflicts of interest, good business practices can also support good healthcare. For example, in building a referral base and advocating for patients, you have to be willing to do some ground work, get out there, talk to people – both clinicians and the public – about what you have to offer. Following up with referring clinicians or patients and their families immediately after a procedure can also go a long way, even if it’s just a text or a quick call. I also think it's important to keep your finger on the pulse when it comes to your digital footprint. If someone searches your name, what can they find about you online? And how can you maintain a positive digital footprint and image?
So-called “turf wars” are inevitable in almost any workplace setting, including healthcare. How do you approach this challenge and what’s your advice for graduating residents and fellows?
I actually studied interspecialty turf wars for years as a graduate student. I would say that disciplines and territories in healthcare are naturally going to overlap, ebb, and flow. You maintain your “turf” not by claiming you’re entitled to it but by demonstrating that you are best equipped to be there. Often, the teams that “compete” most effectively are multidisciplinary. We all have different strengths and weaknesses in our training, so I think remaining humble about what you can learn from others and how you can collaborate is key. I once had an interviewee put it like this: competition in healthcare should be Bears vs. Vikings, not linemen vs. wide receivers or IRs vs. vascular surgeons.
Dr. Eric J. Keller has a background in bioethics, medical anthropology, 4D flow MRI, and legal guardianship. He’s the founder of the Applied Ethics in Interventional Radiology (IR) working group, a multi-institutional team of faculty and trainees developing practical approaches to challenging situations in IR. Dr. Keller also serves on the Board of Directors of the Interventional Initiative, a nonprofit devoted to patient and clinician awareness, access, and advocacy regarding minimally invasive image-guided procedures.
Shortly after you completed your residency and fellowship training, was there a therapy area or subject matter you wish you were taught or had more experience in?
Not specifically. Every IR training program covers different things, but I was able to get at least some exposure to most of the procedures I plan to do in practice. That said, IR is a dynamic field. You often get asked to do things in practice that you may not have been exposed to in training, like GAE, SphenoCath, or nerve blocks. That’s why people describe your first year out as your second fellowship. Often, the skills and principles you learned are transferable.
Many residents and fellows leave training with a sense that they aren’t fully ready for clinical practice. Do you remember a time when you felt like you weren’t prepared for 'prime time'? How did you overcome this?
Certainly, and I think that’s both common and healthy. Most people feel that way for their first year or so out of training. As I said, it’s like a second fellowship, and so finding a supportive practice with good mentors is important. It’s better to remain humble and accept that this nervousness is normal. That wards you against overconfidence, which can get you in trouble. At the same time, you should balance this out by celebrating your successes, so that the anxiety doesn’t paralyze you.
Considering you’re well-published and have extensive experience in medical research, how would you recommend a fellow get involved with clinical trials or establish collaborative research with other specialists?
Honestly, I think half the battle is just being willing to ask. Remain skeptical and curious and ask those “why” questions that lead to innovative research. Ask others what they think or if they’re willing to collaborate to cross-pollinate across specialties. Ask people to mentor you and be willing to politely move on if the mentor-mentee relationship isn’t right for you.
If you haven’t done a lot of research before, it’s good to start small, with something like a case report or a retrospective chart review, before working your way up to more complex studies.
When thinking about the business of healthcare, what are 2-3 concepts that you wish you knew earlier in your career?
I hadn’t realized how intricately intertwined the clinical and business aspects of healthcare are. While this can result in conflicts of interest, good business practices can also support good healthcare. For example, in building a referral base and advocating for patients, you have to be willing to do some ground work, get out there, talk to people – both clinicians and the public – about what you have to offer. Following up with referring clinicians or patients and their families immediately after a procedure can also go a long way, even if it’s just a text or a quick call. I also think it's important to keep your finger on the pulse when it comes to your digital footprint. If someone searches your name, what can they find about you online? And how can you maintain a positive digital footprint and image?
So-called “turf wars” are inevitable in almost any workplace setting, including healthcare. How do you approach this challenge and what’s your advice for graduating residents and fellows?
I actually studied interspecialty turf wars for years as a graduate student. I would say that disciplines and territories in healthcare are naturally going to overlap, ebb, and flow. You maintain your “turf” not by claiming you’re entitled to it but by demonstrating that you are best equipped to be there. Often, the teams that “compete” most effectively are multidisciplinary. We all have different strengths and weaknesses in our training, so I think remaining humble about what you can learn from others and how you can collaborate is key. I once had an interviewee put it like this: competition in healthcare should be Bears vs. Vikings, not linemen vs. wide receivers or IRs vs. vascular surgeons.
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What are some red flags to consider when evaluating a practice (eg, starting salary, vacation time, perks, etc.), Any tips for how a fellow or resident can learn about the real behind-the-scenes of a practice they join?
This can be tough because everyone is trying to put their best foot forward rather than showing you the skeletons in the closet. I’d try to talk to different people in the practice in a less formal setting as well as anyone who left the practice, if possible. For IR, the main issue is that many practices are shared radiology practices, providing both diagnostic and interventional services. As an IR, you’re also a board-certified radiologist, and you can generally generate more RVUs per hour for a practice reading scans than doing procedures. So some practices have these RVU cutoffs and speedometers that devalue what we do in IR. This means that the IRs in those groups often have to work extra hours just to meet these benchmarks compared to their diagnostic colleagues. Ideally, it’s great to find a practice that supports you as an interventionist and the care that comes with it – in terms of clinic, rounding, etc.
Let’s move on to the rapid-fire questions. If you had to choose 3 songs to play on repeat when performing an interventional case, what would they be?
Honestly, I don’t have a go-to song. I usually have the patient or techs and nurses choose the music. If left to me, I usually go with country or today’s top hits Spotify playlist.
How about movies – what are your top 3 favorites of all time?
Full Metal Jacket, The Shining, and Meet the Parents.
If you could go back to your late 20s, what’s the one thing you would tell your younger self?
I’d tell myself that a lot of things I worried about then won’t matter in 10 years. This isn’t to say those things aren’t important in that moment, but I used to really perseverate and worry about many things that don’t really matter in the grand scheme of things. In the same vein, I suggest prioritizing the things that will matter in 10 years. Or if this were my last week on earth, what would I spend my time doing? Often, the answer for me is spending more time with friends and family or just doing something spontaneous just for fun.
Finally, are there any events, congresses, clinical research, etc. you’d like to raise awareness for?
I would make a plug for The Interventional Initiative. It’s a non-profit organization I work with to increase awareness for and access to minimally invasive image-guided procedures. The organization has a docu-series called Without a Scalpel as well as content on these life-changing procedures such as standardized informational decision aids.
What are some red flags to consider when evaluating a practice (eg, starting salary, vacation time, perks, etc.), Any tips for how a fellow or resident can learn about the real behind-the-scenes of a practice they join?
This can be tough because everyone is trying to put their best foot forward rather than showing you the skeletons in the closet. I’d try to talk to different people in the practice in a less formal setting as well as anyone who left the practice, if possible. For IR, the main issue is that many practices are shared radiology practices, providing both diagnostic and interventional services. As an IR, you’re also a board-certified radiologist, and you can generally generate more RVUs per hour for a practice reading scans than doing procedures. So some practices have these RVU cutoffs and speedometers that devalue what we do in IR. This means that the IRs in those groups often have to work extra hours just to meet these benchmarks compared to their diagnostic colleagues. Ideally, it’s great to find a practice that supports you as an interventionist and the care that comes with it – in terms of clinic, rounding, etc.
Let’s move on to the rapid-fire questions. If you had to choose 3 songs to play on repeat when performing an interventional case, what would they be?
Honestly, I don’t have a go-to song. I usually have the patient or techs and nurses choose the music. If left to me, I usually go with country or today’s top hits Spotify playlist.
How about movies – what are your top 3 favorites of all time?
Full Metal Jacket, The Shining, and Meet the Parents.
If you could go back to your late 20s, what’s the one thing you would tell your younger self?
I’d tell myself that a lot of things I worried about then won’t matter in 10 years. This isn’t to say those things aren’t important in that moment, but I used to really perseverate and worry about many things that don’t really matter in the grand scheme of things. In the same vein, I suggest prioritizing the things that will matter in 10 years. Or if this were my last week on earth, what would I spend my time doing? Often, the answer for me is spending more time with friends and family or just doing something spontaneous just for fun.
Finally, are there any events, congresses, clinical research, etc. you’d like to raise awareness for?
I would make a plug for The Interventional Initiative. It’s a non-profit organization I work with to increase awareness for and access to minimally invasive image-guided procedures. The organization has a docu-series called Without a Scalpel as well as content on these life-changing procedures such as standardized informational decision aids.
What are some red flags to consider when evaluating a practice (eg, starting salary, vacation time, perks, etc.), Any tips for how a fellow or resident can learn about the real behind-the-scenes of a practice they join?
This can be tough because everyone is trying to put their best foot forward rather than showing you the skeletons in the closet. I’d try to talk to different people in the practice in a less formal setting as well as anyone who left the practice, if possible. For IR, the main issue is that many practices are shared radiology practices, providing both diagnostic and interventional services. As an IR, you’re also a board-certified radiologist, and you can generally generate more RVUs per hour for a practice reading scans than doing procedures. So some practices have these RVU cutoffs and speedometers that devalue what we do in IR. This means that the IRs in those groups often have to work extra hours just to meet these benchmarks compared to their diagnostic colleagues. Ideally, it’s great to find a practice that supports you as an interventionist and the care that comes with it – in terms of clinic, rounding, etc.
Let’s move on to the rapid-fire questions. If you had to choose 3 songs to play on repeat when performing an interventional case, what would they be?
Honestly, I don’t have a go-to song. I usually have the patient or techs and nurses choose the music. If left to me, I usually go with country or today’s top hits Spotify playlist.
How about movies – what are your top 3 favorites of all time?
Full Metal Jacket, The Shining, and Meet the Parents.
If you could go back to your late 20s, what’s the one thing you would tell your younger self?
I’d tell myself that a lot of things I worried about then won’t matter in 10 years. This isn’t to say those things aren’t important in that moment, but I used to really perseverate and worry about many things that don’t really matter in the grand scheme of things. In the same vein, I suggest prioritizing the things that will matter in 10 years. Or if this were my last week on earth, what would I spend my time doing? Often, the answer for me is spending more time with friends and family or just doing something spontaneous just for fun.
Finally, are there any events, congresses, clinical research, etc. you’d like to raise awareness for?
I would make a plug for The Interventional Initiative. It’s a non-profit organization I work with to increase awareness for and access to minimally invasive image-guided procedures. The organization has a docu-series called Without a Scalpel as well as content on these life-changing procedures such as standardized informational decision aids.
