IRQ Articles

Feature: Improving patient care on a whole new stage 

09-25-2018 12:18

An interview with Anne Giuliano, MD

By Terence Matalon, MD, FSIR, Chair, SIRPAC  Fall 2018 (preview)

Anne Giuliano headshotAnne Giuliano, MD, a longtime SIR member and past member of the society’s Venous Service Line, ran unopposed in the June 5 Democratic Primary for the Montana State House District HD46 and is now campaigning for the Nov. 6 general election. I recently sat down with Dr. Giuliano to discuss her experience running for public office and her views on health care.

Terence Matalon, MD, FSIR: What first drew you to interventional radiology?

Anne Giuliano, MD: There are two types of physicians—those who want to fix problems and those who just want to talk about them. I’ve always been a problem-solver. In my training, I saw that interventionalists were the ones who surgeons and others would call for their most difficult situations. I saw IRs could get it done and make a tremendous difference for patients.

I think another aspect of IR that drew me is the “cool” factor. Interventionalists are the ones who come up with the procedures and implement them—other specialties pick up on the procedures/techniques afterwards.

I also loved the variety—the broad scope of IR and how you can make a difference in so many areas. In most fields you need to pick something to specialize in—medicine, oncology, women’s health. But IR is the full spectrum—kids, adults, medicine patients, cancer patients, orthopaedic patients, surgical patients—you name it.

Dr. Matalon: On your LinkedIn page you cite wound care as a specialty. Is that still an area of focus?

Dr. Giuliano: The first 13–14 years of my practice was hardcore hospital-based IR. Back then, when IR was all arterio/vascular disease (before IO came on the scene), referrers would send me their patients, I’d perform a procedure and then I’d pass them back. In about 2012, I shifted to outpatient IR and picked up wound care as a way of controlling my own patient base.

As an IR in wound care, I order studies and labs. I control the patient—so with the shift I became much more beneficial in the eyes of hospital administrators. I could say, “That patient needs an arteriogram—I’m going to take him in and do an arteriogram on him.”

Today as a clinician, I can see 30 patients a day, mostly doing varicose veins and wound care. I do read some films for my radiology group, Medical Imaging Associates in Idaho Falls, Idaho. I’m the only member of the group in Billings, but I have a full-service outpatient varicose vein practice and I do wound care one day a week.

I find wound care to be incredibly rewarding. I see the same patients every week and, if they do what I ask them to do, they heal and they’re incredibly happy. There’s a tremendous need for problem-solving in wound care. Why is this chronic wound not healing? Is it too wet? Too dry? Is there infection or underlining osteomyelitis? Is that why this pressure ulcer isn’t healing? Is there arterial insufficiency? Is there venous hypertension? This fits perfectly in the IR wheelhouse.

It also helped boost my standing in the medical community as a clinician. They saw that I was in the pits working with them, working with internal medicine physicians, with the plastic surgeons and making referrals. I ordered tests and treated my own patients. All in all, I think wound care is a nice fit for interventional radiology and that more IRs should get into it. Plus, some of my wound care patients stay with me to treat their varicose veins.

Dr. Matalon: Speaking of fixing problems, what drew you to public office? Have you always been interested in health policy?

Dr. Giuliano: I never really paid attention to politics until the last election cycle. I gradually became more concerned—and then distraught—about our political environment—particularly our health care (which is awful at every level) and the deep divide between parties. Those at political extremes are so entrenched in their views, they’re not willing to talk to each other and work together.

So I ended up going from being completely disengaged a few years ago to jumping in feet first. Now I’m running for the Montana state legislature because our health care system is a disaster, our public education programs are in trouble (at least in Montana), and the divide in politics keeps anything from getting done. We need to work together—that’s when we can come up with solutions that benefit us all.

Dr. Matalon: How do you feel you’d be able to improve health care in Montana?

Anne Giuliano, MDDr. Giuliano: A big health care crisis In Montana is Medicaid expansion. In 2015, moderate Republicans and Democrats worked together to pass the Medicaid expansion. This ended up covering 95,000 people, which is almost 10 percent of our state’s population. It’s mind boggling that so many people needed coverage, and more are enrolling as we speak. Over 60 percent of nursing home residents receive Medicaid help as well.

The expansion led to the creation of over 5,000 jobs and brought in $500 million of outside revenue from the government to help pay for it. It saved our state over $40 million.

That Medicaid expansion is set to expire in 2019 during the next legislative session if there’s not enough support to renew it. We have a lot of critical access hospitals in Montana—small hospitals with 10–15 beds, as well as many rural health clinics. Without the expansion these places will close. We were losing our small hospitals prior to the expansion in 2015. After the expansion several small hospitals have been built and rural communities are having an easier time getting health care. I support the renewal of the expansion. It mostly pays for itself so there’s no financial reason not to support it.

Dr. Matalon: What aspects of running for public office have been most challenging and most rewarding?

Dr. Giuliano: The most challenging piece is the time commitment. I completely underestimated how much time it would take to campaign. You have to fundraise like crazy—Montana has very tight campaign finance laws. The most a single person or PAC can donate is $180—and since you can’t take corporate money, this makes fundraising a challenge. The other challenge is to find the time to knock on doors. This is the best way to meet the voters.

The most rewarding part turned out to be knocking on people’s doors. I wasn’t sure if I’d enjoy doing wound care before going into it, but I loved the contact with people—and this is a different way to do just that. My district has over 7,000 people and I have made about 1,700 contacts so far. We have attempted over 5,000 contacts, but often people are not home when you try to meet them. We’re about to do our third pass through the district, and I’m enjoying it more than I thought I ever would.

Running is truly a public service. In Montana, the legislature meets every other year for a 90-business-day session, from January through April. I’ll have to do something with my practice when I go to the legislature, so it has the potential of hurting my business and my career. However, I’m so concerned with what’s happening at the big-picture level that it doesn’t matter. When I’m in my wound care clinic I can see 20–30 patients and make a difference in their lives. If I get elected, I can go to Helena and work to save health care coverage for 95,000 people. That’s huge.

Dr. Matalon: What else would you like to tell IRQ readers?

Dr. Giuliano: I’d ask them to realize that someone running for office is funded through donations. Thank you, Terry, for your support—I really appreciate it.

Some professionals like lawyers seem to understand how supporting those in politics benefits them. It’s much harder to get the support of doctors—I was the same way myself before I started running for office. We’re busy, our heads are down in the trenches and we’re thinking about our patients. We tell ourselves that the big issues will take care of themselves. This is not the case and we have to get involved to make a significant impact.

If I can get elected, the increased exposure will benefit IRs in general and it will be beneficial if we can keep reimbursement reasonable.

Candidates and organizations like SIRPAC are always going to be asking for money. If we don’t support the campaigns of those who recognize the value of IR, it will be a challenge to get them elected. If we do, though, we can start working together to make a significant difference for patients across the country.

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Read more about Dr. Giuliano's platforms on her website, her Facebook page or follow her on Twitter

  

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