Interview with Dr. Gary Siskin
Read Gary's advice on networking, dealing with turf wars, and the skill sets needed to become an effective speaker and trainer.
Before we dive in, here’s a little more about Dr. Gary Siskin’s medical background:
Current: Professor and Chairman of Radiology, Albany Medical Center, Albany, NY
Fellowship: Vascular and Interventional Radiology, Columbia Presbyterian Medical Center, New York, NY
Residency: Diagnostic Radiology, SUNY Health Sciences Center, Brooklyn, NY
Medical School: Mount Sinai of Medicine, New York, NY
Thanks for joining us, Dr. Siskin. Let’s dive in!
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?
I had a very comprehensive experience during my residency and fellowship. As a result, I had good exposure to most areas of Interventional Radiology (IR) in the areas of vascular and nonvascular diagnosis and treatment, and I do not feel that any one area was particularly lacking. At that time, Interventional Radiologists were just beginning their involvement with venous access work and ultrasound guidance, and I actually do wish that I had gained more experience with this during my training. However, I did receive the skills I needed to figure it out as I started working as an attending physician.
Many residents and fellows leave training with a sense that they aren’t fully prepared for clinical practice. Do you remember a time when you felt like you weren’t ready for “prime time”? How did you overcome this?
As more time has passed since my training, it does become a little harder to clearly remember everything. However, I do not think that any training program in any specialty gets residents and/or fellows fully ready for everything they are going to face once they start working as an attending physician. I was no exception.
Even cases I had done as a fellow became more complicated when the responsibility for their completion was entirely mine. It is impossible not to feel the pressure under those circumstances, but I always found it helpful to accept the advice of my new partners and the staff I was working with. When I combined that with input from the fellows I was training and memories of the teaching points given to me by my attending physicians during training, I found the skills were there to overcome the perceived lack of confidence.
It certainly helps to have worked in a supportive environment right out of training because when mistakes were inevitably made, I was able to self-correct and do the right thing for my patients.
Dr. Siskin, can you tell us about a time in your residency or fellowship that was completely unexpected?
I completely enjoyed my residency and fellowship because of the enormous opportunities I had to grow as a Diagnostic and Interventional Radiologist.
I do remember a time when I was working in the middle of the night and was asked to perform an angiogram with possible embolization on a patient who had some trauma to their face. I enjoyed trying to start these cases on my own before my attending physician arrived from home. This particular physician always tried to make things interesting and enjoyable, which clearly conveyed the joy he got out of his career (which was completely infectious). That evening, he had me catheterize each branch of the external carotid artery and timed me, always encouraging me to beat my previous time. It did not escape me that I was navigating through the vessels of the external carotid artery on my own.
This was clearly a moment that pushed me into this specialty, but more importantly, I have never forgotten the impact enthusiasm can have on someone making similar career decisions for themselves.
When thinking about the business of healthcare, what are 2-3 concepts that you wish you knew coming out of your fellowship?
The business of healthcare is complicated, and there is a lot to learn. It is certainly important to understand CPT and ICD-10 coding because those systems form the basis for letting payors know what you have done for a patient. Ultimately, this will help you get paid for the services you provided.
As a member of a device-driven field, I wish I understood the concepts behind value analysis earlier in my career. There are many occasions when a selfish desire for new equipment likely compromised the budget of my department and the hospital. A better perspective of this dynamic earlier in my career could likely have saved my hospital thousands of dollars and make it known that I was (and remain) interested in being a good partner with the hospital within which I work.
You have friends and colleagues across multiple healthcare disciplines. For a young clinician, how important is networking? Are there 2-3 tips you can pass along on how to network better or more effectively?
There is almost no work setting and no specialty where networking cannot help you succeed. Certainly, if you have national aspirations, the importance of networking is evident.
Building contacts within your specialty can provide you with opportunities ranging from specialty society involvement, research project and clinical trial participation, and speaking invitations.
Networking with contacts in industry can help build your profile and provide you with opportunities to gain early access to new drugs and devices. Ultimately, this can help you provide state-of-the-art care to your patients locally. While some might equate networking to opportunities outside of your hometown, it is equally important for success at home.
Building relationships with physicians in other specialties will no doubt increase referrals into your practice. And solid relationships with hospital administration and others at home can increase opportunities to grow the profile of your practice, which in turn can help sustain success.
In order to help accomplish these goals, you just have to look for and take advantage of opportunities. Teaching hospitals often provide them more obviously, including invitations to teach residents in other specialties or to be a part of tumor boards or other multi-specialty conferences or meetings. While more of an effort is needed in the community, these opportunities are still present. Attending staff meetings, multidisciplinary conferences, and hospital meetings all represent opportunities to meet others in your field. If all else fails, learning to play golf can help as well.
Physician-industry relationships can be very valuable, but they are sometimes perceived in a negative light. How do you effectively work with industry partners?
I work in a device-driven specialty that is extremely dependent on industry. As a result, building relationships with industry partners is going to be critical to your success and your ability to offer cutting-edge care to your patients.
I highly value my industry partners. I welcome them into our procedure rooms and try to listen to them tell me about techniques they have seen throughout their territory. I also try and teach them about what we do in order to make them better at what they do.
I have always believed that we can make each other better, and in turn, offer our patients better care. By establishing this type of relationship, I have frequently been given opportunities to influence decision-making with our major industry partners, which again, helps me to have input on innovation and provide the best care available to my patients.
Dr. Siskin, you speak on podium at many conferences and do a fair amount of physician training. What are some of the important skill sets needed to be an effective leader in these types of initiatives?
It should be obvious that to have the opportunities to speak on the podium at many conferences and to be involved in physician training, you have to first gain expertise in several subject matters within your specialty. This starts with taking care of a lot of patients and performing a lot of procedures. There is no substitute for experience.
The next step is to publish. It is rare for someone who doesn’t publish to be perceived as an expert. Once you have the clinical experience and have published on that experience, I believe these types of opportunities will present themselves.
To succeed in podium talks and physician training, you must have a few important skill sets. First off, you have to be able to speak simply and clearly. It is truly an art to be able to “dumb down” what we do in a way that everybody listening will understand. I think this applies to all of your potential audiences, including your future patients. This skill is essential.
Similar to that is the need to understand how to construct an effective PowerPoint presentation. These days, everyone uses this software as the vehicle for communicating information during a lecture. Slides need to be carefully constructed to maximize your ability to sequentially discuss important points regarding your topic in a way that is clear to see and easy to understand.
COVID-19 has sped up the process (and technology adoption) in which virtual learning and remote case observation are becoming more prevalent. How do you see this playing out for residents and fellows?
No matter how society progresses through the end of this pandemic, I suspect that virtual learning will not be going away very quickly. While I do believe that there is no substitute for in-person teaching and in-person learning, I do believe that virtual learning opens up many different opportunities for residents and fellows to maximize their education.
Therefore, I believe that residents and fellows should be encouraged to take advantage of these different opportunities. Whether it is virtual symposiums or YouTube videos, there are so many different ways to learn in ways that are not restricted to a conference at a certain place or at a certain time. The fact that learning can now occur on the learner’s schedule as opposed to the teacher’s schedule is a major change and one that I believe will ultimately benefit residents and fellows in ways that we do not yet understand. At our center, we have tried to incorporate these resources into our teaching program in order to supplement the lectures we offer.
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?
These days, it is impossible to practice my specialty and not encounter some form of a “turf war.” Interventional Radiology has developed many of the tools used by both surgical and medical specialties, and if they are adding those procedures to what they do every day, it by definition means that IR is doing less. I have really tried to address this challenge head-on.
First off, I do believe that cooperation amongst specialties is important, so I do not shy away from providing assistance to my colleagues in other specialties, even those that do offer competitive services to my practice.
Second, I try and practice in a way that reflects the expertise I have in my field. I still maintain some faith that other physicians will turn to the people that do the best job with these procedures, so I do try and focus on doing a great job for my patients and providing great service to my referring physicians.
Third, I try and provide great care to my patients because they are literally walking billboards for my services. If they are happy, they will likely tell their friends, families, and other physicians about their experience, and that will ultimately help us overcome the turf wars and maintain our practice.
Finally, I believe that getting engaged in hospital-based activities is critical for IR success. This has afforded me many opportunities to talk about what I do every day and to educate people on my specialty, which ultimately lets other physicians know when to utilize my services.
Who were your biggest mentors throughout your medical training and what key learnings did you gain from them? How should residents and fellows go about finding (and keeping) a mentor?
I have been fortunate to have many mentors during the course of my career. Certainly, senior members of the Radiology departments I trained within were important to my development and helped steer my interests in Interventional Radiology. What they all shared in common was their enthusiasm for their profession. Whether it was treating trauma patients, writing research papers, or building successful clinical practices, each of my four major mentors served as role models as I moved forward in my career.
I also gained a lot through my relationships with individuals in other specialties. One, in particular, was a well-known Vascular Surgeon who taught me about the importance of seeing patients quickly and addressing problems definitively. Lessons like that are frequently discussed but rarely seen in active clinical practice. He demonstrated that every day and it now represents the cornerstone of how I practice.
For residents and fellows, I would suggest having honest conversations with the individuals you admire in your departments and seek their advice often. The more you speak to them, the more they will get to know you, and in all likelihood, will become more invested in your success. If done right, the relationships will continue long after you leave your program.
Also, don’t be shy; reach out to leaders in your field. Most people working in academic institutions enjoy teaching and being mentors, so take a chance and reach out to someone outside of your program whose work you admire. You might be surprised at how easy it is to develop these relationships, but it does take work.
Okay, let’s transition to some fun, rapid-fire questions.
When it comes to personal finance, what do you wish you knew coming out of your fellowship?
I am fortunate to have family members with backgrounds and careers in finance, so it’s easy to leverage advice from these relationships.
Having said that, I do think it’s important to understand contracts and your ability to negotiate with potential employers.
I also wish I better understood how important early contributions to retirement accounts can be. The last thing a trainee wants to think about is their retirement which presumably won’t be happening for 30+ years. However, smart planning that occurs early is probably the best thing one can do. Even though I am doing fine, I wish I was more aggressive early in my career.
When operating, if you had to choose 3 songs to play on repeat, what would they be?
As a piano player, I enjoy a wide range of piano-based music so I tend to like artists such as Billy Joel, Elton John, etc.
But I have come to appreciate contemporary country or pop music. As I often joke with my kids and the staff members I work with, I am good at listening to anything with a melody. If you can sing or hum along to it, I am okay with it.
Which mobile app are you addicted to – personally and professionally?
It’s a toss-up between Apple News, Spotify, and various solitaire games. Lately, I find myself playing around a lot on the Nonogram app, which is just an interesting puzzle-based game.
Starting over in your late 20’s or early 30’s, knowing everything you know now, what would you do differently?
The good news for me is that my answer is actually very little. I am happily married, love my kids, love where I work and who I work with, and love what I do. I appreciate what life has offered me so far!
Do you have any conferences, symposia, or other resources that you’re trying to raise awareness for?
In fact, I do. I actually think that the best meeting I have been involved with throughout my entire career is the GEST meeting. This is a global meeting that focuses on embolization, which has been a professional passion throughout my career. I love the meeting and am thrilled that I have been given the opportunity to serve as a course director. The meeting takes an entire procedure, and all of the different indications for that procedure, and offers a deep dive into the materials, techniques, and outcomes associated with that procedure. If you are an Interventional Radiologist and enjoy performing these procedures, then this meeting is clearly the best of its kind.
Thanks for doing this interview, Dr. Siskin!
Where’s the best place fellows and residents can connect with you online?
I am not actively engaged in social media but am on Facebook and Instagram. I have a Twitter account but confess that I check it infrequently and don’t really post much.
We have our own website and try to keep it updated as best as we can. The one thing I check compulsively is my email. I give out my address to patients and their families and can always be tracked down that way.