Alda L. Tam, MD, MBA, FRCPC, FSIR, FACR
Professor
Department of Interventional Radiology
University of Texas MD Anderson Cancer Center
Houston, Texas
alda.tam@mdanderson.org

Neginder Saini, DO
Resident Physician
Department of Diagnostic Radiology
Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, New York
radiologysaini@gmail.com

Thank you for taking the time to speak with me about your career. Please start by telling us about yourself and where you did your training. 

I was born and raised in Canada and completed my medical training at the University of British Columbia in Vancouver, Canada. For residency, I joined the University of Southern California (USC), Los Angeles before moving to Houston for fellowship. Since my fellowship here at MD Anderson, I’ve practiced as an academic interventional radiologist for the past 18 years.  

How did you decide on interventional radiology (IR) as a specialty? Were there any other specialties you considered? 

Like most medical students considering their future careers, I noticed two paths quickly emerging—choosing a medical specialty or a surgical one. Would I be more interested in using my hands and performing procedures or seeing patients and engaging in more cerebral work? I enjoyed both, and, leaning toward surgery, I dipped my toes into neurosurgery. After completing a summer research internship and shadowing neurosurgeons in the operating room, I began to have second thoughts. During one of the cases, I remember seeing brain tissue in the Yankauer and suction container and thinking, “I don’t know…maybe there’s something out there with more finesse?”  

During medical school, I made a conscious effort to investigate different specialties that weren’t traditionally part of the curriculum. After considering radiology, I was on rotation and someone recommended IR because I was initially drawn to surgery. It only took a few assignments in the IR suite to realize this was it: the complexities of surgery with the finesse I desired. That’s how I ended up entering the field.

At USC, I had awesome mentors; Drs. Sue Hanks, Victoria Marx, Michael Katz, and Donald Harrell comprised the entire IR department when I was there. Not only were they rockstars in the IR suite but they were also really fun people to hang out with, and I think that’s important. As a medical student or resident, you can usually spot a good fit depending on the personalities you encounter in that specialty. 

When it was time for me to apply for fellowship, my husband had already matched and was practicing at MD Anderson. I knew the values of the institution and felt it would be a great place to continue my training. Downstairs in the Dunn Lab was practically the birthplace of modern IR. Here, I found more fantastic mentors, including Drs. Marshall Hicks, Michael Wallace, and Sanjay Gupta. They gave me my first job, and the rest is history. 

Awesome. I was also interested in neurosurgery coming into medical school. I completed a master’s degree in neuroscience and was involved in lab/bench neurosurgery research. I worked on a spinal cord injury project using rat models. As I learned more about the field of neurosurgery, I started to have doubts due to the intense lifestyle and long surgeries. I completed an IR rotation during my fourth year and found a great mentor. I think having a great mentor can really make an impact on your career decision. I’m currently a diagnostic radiology (DR) resident planning to apply for IR fellowship. 

I hear similar stories of students seemingly stumbling into the specialty in much of the same way. They get connected with a great faculty, and it opens an entirely new world. The structure of IR education programs has undergone significant change over the last 5 years, and having two paths to participate in the specialty, including an integrated residency, is great. We anticipate there will be a shortage of IR physicians in the future as the demand for imaged-guided surgery grows across disciplines.

Can you tell us about your IR research career? 

Depending on specialty, research is either emphasized or not during training. I really think this has an impact on whether physicians choose to pursue research after they graduate. Oncology for example is heavily researched based. You must be comfortable interpreting clinical trial results to see if a drug is going to change how you manage your patients. 

IR is probably one of those specialties that hasn’t necessarily emphasized incorporating research within the training curriculum. Several subspecialty fields of surgery, including surgical oncology, have made a conscious decision to require their residents to do at least 1 year of dedicated research. Surgical residents will complete a couple of years of clinical work, spend a few years in the lab to gain exposure, and then return to their clinical roles before fellowship. I hope the field of IR will consider moving in that direction in the future. More data on the effectiveness of our therapies is what will allow us to compete with other specialties.

Because research is not yet required, I would encourage all trainees to build on their typical case report or retrospective case series and seek out research experiences in a lab or help with a clinical trial. This might be challenging, but it would provide valuable exposure to different aspects and types of research. IR needs more physician-scientists!

My research has always been driven by the desire to try to find answers to the questions that have arisen during my clinical practice. Research was an integral and expected part of the role when I started as an academic interventional radiologist nearly 20 years ago. I began with retrospective chart reviews, got a few abstracts accepted, presented at meetings, wrote papers, and found I really enjoyed that part of the work. A portion of my career has been concentrated on translational research, working on studying the use of irreversible electroporation in bone. Our focus was on whether this nonthermal ablation technique would be feasible and safe in areas around nerves and the spinal cord, which are prone to thermal injury. After receiving a pilot grant from industry and completing animal studies, our lab sat down and really mulled over its basic applications and thought about how else this research could be applied. This led to additional projects developing, including one to see if we could kill bacteria in an infection model. 

I gained experience writing grants, iteratively learned how to design better experiments, and met a lot of different people. My clinical research has focused on optimizing yield in biopsies that are a part of clinical trials. The current clinical trials I’m working on are one with thoracic surgery to compare microwave lung ablation to surgical wedge resection, and another one that looks at cryoablation and its ability to boost the patient’s response to immunotherapy. 

Did you feel that as you got more involved in research, your clinical responsibilities had to take a backseat? 

In academia, each faculty has a different set of expectations around the volume of research they produce. I’ve been fortunate enough to enjoy a great balance between my research and clinical responsibilities. Most IRs are very comfortable working in the liver after fellowship, which is what I did for many years. I later branched out to providing local therapy to patients with bone and lung metastases. Out of that came questions I tried to answer through my translational and clinical research efforts. At present, my clinical practice accounts for the majority of my academic effort, and I am able to conduct research because of our incredible research team who work on clinical trials and in the lab.

You have also been involved in creating clinical practice guidelines for IR. How did you get involved in that, and can you tell us about your experience? 

The Society of Interventional Radiology (SIR) is the largest professional medical society in the United States that supports IR as a field. They’ve done a great job with resident and medical student outreach. Going to the annual meeting as a trainee was always exciting, and I felt included early on in my career. This eventually led to committee work and the opportunity to network and form friendships around the country through volunteering. As I gained more responsibilities, I applied for a leadership role within the organization and became the Standards Division Counselor in 2017, which is how I got involved in the creation of clinical practice guidelines. I’m really proud of the work that committee achieved because, together, we moved the society to develop National Academy of Medicine–compliant clinical practice guidelines and may very well be the first radiology society in the world to do so. This is tremendously important because we’re still jockeying for position on where IR falls in medical treatment algorithms and the acceptance of IR therapies. For us to be competitive, we needed to put our data through the same methodological scrutiny that is considered the industry gold standard. This was a big step for us in terms of the maturation of the society and the specialty.  

Our first clinical practice guideline was on inferior vena cava filters in the treatment of patients with venous thromboembolic disease. We were able to construct this guideline in collaboration with multiple other medical societies and published it in 2020. When you read this guideline, you’ll see that it’s different in the sense that it’s question-based with a literature search specific to that question and a deep dive into what the nuances are around the data. A recommendation that answers the question and how it weighs out in terms of benefit and harm to the patient is provided.

Leading the Guidelines Committee was a professional and personal growth experience for me and one of the most rewarding leadership/volunteering experiences I’ve had. I was also able to work with residents from University of California San Diego and some of our early career section members to develop and launch the SIR Guidelines mobile app, which is now used worldwide. The app gives you access to periprocedural anticoagulation and antibiotic management recommendations for each IR procedures, all from your phone.

It sounds like you had an amazing experience! Congratulations on being elected as the new SIR President! What were the most significant experiences, whether personal or professional, that influenced your decision to become SIR President? As President, what direction do you want to drive the field, and do you have any specific goals in mind?

It’s a huge responsibility and sometimes I wake up and think “Oh, man!” But, it’s not a one-person job or 1-year commitment. The Executive Committee consisting of the Past President, President, President-Elect, and Secretary has become a very cohesive group that’s been able to provide continuity and consistency in driving forward initiatives for the society and specialty.

Many of the recent initiatives were focused on establishing a foundation to allow us to be able to compete as a primary medical specialty. A great example of this is the integration of the clinical specialty councils into the governance structure. What this does is allow the voices of our key opinion leaders to be heard and participate in strategic decision-making. This affects each of the clinical areas IR supports, such as interventional oncology and peripheral artery disease.

We are also committed to listening to the feedback from our members and have a number of website and user interface/user experience improvements coming up soon. In my presidential year, we will continue to push initiatives and take on projects that will align SIR and, by extension, our members with the needs of IR for the future.  

How do you achieve work-life balance and avoid burnout? Do you have advice for young trainees who are just starting out?  

I think everyone has a different philosophy on this topic, and you have to find something that works for you. Recently, I was asked to give a talk about academic achievement and what it means to succeed. Initially, I wasn’t sure how to tackle this topic, but I eventually came up with three ideas. First, you need to be a really good clinician. Clinical excellence means you need to know when you can do things and when you shouldn’t do things (it’s ok to say “no”) and have a good understanding of the disease state that you’re interested in. Second, you need to be curious. Your curiosity is going to make you want to discover things that will benefit your patients and may push you toward research to look for answers. Third, you have to think about how you’re going to fit all the hard work that will be required for the first two things with the rest of your life.

In retrospect, I experienced burnout during college and the initial part of medical school and learned early on that I didn’t want to be in that position again. I’ve tried to keep this in mind throughout my career, and although I have taken on a lot of different roles, including clinical practice building, research, administration, and volunteer leadership, I’ve never done all these things at the same time with the same level of intensity. There’s that ever-popular question, “Can you have it all?” I think you can have what you want, but I’m not sure you can have it all at the same time. If you’re doing something at a really high level, you need a certain amount of time and focus in order to do a good job. 

I agree that balance is super important. What I like about the field of IR is the flexibility it provides to change your practice style to fit your lifestyle with the option to engage in DR as well. Is there any general advice you have for current and aspiring IRs-in-training? 

Medical school and residency place the focus in one direction: It’s the next exam, the next rotation, and then before you know it, you’re done training and you ask yourself, “How do I bill? What is the business plan?”

Begin looking at different models of practice early. You could graduate and work part IR/DR in a private practice group or hang your own shingle in an office-based lab. You can go into academics and have a focus on clinical or translational research or around quality and safety initiatives. There are a lot of job models out there, and the curriculum in medical school and residency isn’t designed to expose you to what your “working life” might look like. As trainee physicians, we don’t do a lot of career shadowing, and I think that is something that would be really helpful. Don’t be afraid to ask questions so you can figure out what that job might look like for you.   

Do you feel like if you ask too many specific questions, it might rub your future employer the wrong way? 

There are ways to gather the information you need without coming across in an unflattering light. You could shadow someone and ask directly, or better yet, observe and the answers may become apparent just by experiencing a day in their shoes.  

This is great advice! So, you’ve accomplished so much over your career. Have your career drivers changed over the years?

When I first graduated, I remember feeling quite stressed because now as the attending physician, every decision and action became my responsibility. That took some getting used to, and I suspect everyone adjusts. Then came a heavy research period for me, and that became my focus at work. I knew I wanted to gain experience in the traditional areas of academics, including administration, research, and clinical; I took on different projects to get there. I would say my main driver really hasn’t changed: I try to have a lot of fun with whatever I am doing. I’ve never had a 5- or 10-year career plan per se. Although I am goal oriented, I also meander through when it feels right. I made a choice to be an academic radiologist who works in a cancer hospital. Everything else that I’ve done since then has been because I wanted to focus on that one area for a bit, see where it led and what opportunities it opened. 

I’m glad you’re enjoying the journey! What are your hobbies? Any exciting trips planned?

Hanging out with my family, traveling, and assuaging teenage angst occupy the rest of my life. During the pandemic, I took up running and completed my first half marathon. My family likes hiking and traveling, and we have been to a fair number of national parks. I have two dogs and am fascinated by TikTok dog videos and could watch them for hours!

That sounds like fun! This was a pleasure, thank you for the interview!