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20 Questions: Erin Cook Grady, MD, Nuclear Medicine

Created June 2, 2013 by Juliet Farmer

Dr. Erin Cook Grady is a nuclear medicine attending physician in the Department of Internal Medicine for Christiana Care Health System in Newark, Delaware. Grady received a bachelor’s degree in microbiology, zoology and physiology with a minor in chemistry from University of Wyoming, Laramie (2002). She received her doctor of medicine degree from University of Washington School of Medicine in Seattle (2007) and completed an internship in internal medicine at University of Oklahoma, Tulsa (2007-2008), followed by a residency in nuclear medicine at Loyola University Medical Center (2008-2011).

Dr. Grady has been published in the Journal of Graduate Medical Education, Journal of Nuclear Medicine, Journal of Nuclear Medicine Technology, Journal of Clinical Densitometry, Journal of Nuclear Cardiology, European Radiology, and Journal of Investigative Medicine. She is involved with several professional organizations, including the American College of Graduate Medical Education, American College of Nuclear Medicine, Society of Nuclear Medicine & Molecular Imaging, International Society of Clinical Densitometry, American Society of Nuclear Cardiology, American Medical Association, and American Medical Women’s Association. She was the 2012 recipient of the first SNM Robert E. Henkin Government Relations Fellowship, and the 2007-2008 Intern of the Year at University of Oklahoma, Tulsa.

When did you first decide to become a doctor? Why?

I first decided to become a doctor in the second grade after reading the biography of the first woman doctor, Elizabeth Blackwell. Along the way I had several other experiences that solidified that early notion. In particular, my undergraduate work in zoology, physiology and microbiology with a minor in chemistry further cemented my aim of practicing medicine one day.

How did you choose the medical school you attended?

Choosing the medical school I attended was easy. The University of Washington School of Medicine in one of the top medical schools in the country and has good access to both rural and urban medicine. Additionally, they have many professors who are world-renowned and who place an emphasis on sound teaching.

What surprised you the most about your medical school studies?
This is a difficult question. If I were going to have to pick a surprise, it would be how much I enjoyed my first two years that were mainly physiology. While the last two years were great too, it was hard to find one specialty I liked more than the other, until I came upon nuclear medicine.

Why did you decide to specialize in nuclear medicine?

Because of my interest in physiology, I discovered that I truly love nuclear medicine. My first real exposure to it was when I followed one of my otolaryngology patients who had a melanoma of the helix of the ear to the NM department for a lymphoscintigraphy. When I found out that the specialty of NM uses the tracer principle to visualize physiologic processes in addition to chemistry, physics and plenty of math (that day I even used the Pythagorean Theorem), I fell in love. Yes, I’m a proud geek and was so happy to find a specialty that married many of my interests.

If you had it to do all over again, would you still specialize in nuclear medicine? (Why or why not? What would you have done instead?)
Yes. Even though finding a job in the specialty of nuclear medicine is difficult, I wouldn’t change a thing. This is a field that is very technology driven and promises to be a powerhouse for the future of precision medicine. The ability to label antibodies to treat and image different pathologies based on physiology is amazing. In the future, other more molecular based forms of nuclear medicine imaging and treatment will give us additional precision and personalization in the treatment of our patients. This greatly excites me. If NM hadn’t been invented, I would have pursued forensic pathology.

Has being a specialist in nuclear medicine met your expectations? Why?
Yes, absolutely. Not only do I get to think about physiology, physics, math and chemistry daily, but I also get to spend time with patients.

What do you like most about being a specialist in nuclear medicine?

The thing I like most about being a nuclear medicine physician is being able to make a difference in a patient’s care. This is most often in the form of giving feedback in the form of F-18 FDG PET/CT to let the patient’s oncologists or radiation oncologists know how the treatment is working. But, this is a tie with being able to give radionuclide therapies either to prolong survival with patients who have differentiated thyroid cancer or give palliative therapy for pain in patients with widespread osseous metastatic disease. Being able to make a difference for patients is very rewarding.

What do you like least about being a specialist in nuclear medicine?

This is a tough question, but I think the best answer I can give is that not many people know what nuclear medicine is. This is a small specialty with a different knowledge set. We have a lot of work ahead of us educating our colleagues in other specialties as well as the public.

What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?

It was difficult. This is not a field for the faint of heart. One must keep all the options open and be willing to be anywhere in the U.S. or even the world. I was fortunate enough to choose between three jobs. I decided on my current job because it provided the opportunity to teach residents and fellows, engage in research and also be involved with my specialty on a national/international level. All of these things are very important to me.

Describe a typical day at work.

A typical day at work for me usually starts at 8 a.m., but some tumor conferences start at 7 or 7:30 a.m. At 8 a.m., along with my colleagues, I go over the “overnight cases” that were read by the residents and have an opportunity to discuss with them what questions they may have. From around 9 to 10 a.m., we wait for the radiopharmaceuticals to localize in our patients and for them to be imaged: we can only go as fast as our patients’ physiology. While we wait, we teach technologist students, work on research or work on administrative things.

After 10 to 10:30 a.m. or so, images start rolling in and need to be read. During this time I will review the findings with the residents or fellows. In the event that we have radionuclide therapy patients, I will review radiation safety precautions with them and anyone else in their household. I enjoy putting to rest bad information from the Internet and putting the patients at ease. Work continues until somewhere between 5:30 to 7 p.m. Monday through Friday. We are also open for business (mostly inpatients) on Saturday and Sunday; those days are usually quite a bit shorter.

How many hours a week do you work?
This is a tough question to answer. I work until all the patient work is done. We occasionally have work-related meetings after work and I take call for a week at a time roughly every third week. I also will review some things after hours on my own at home for certain situations or patients. If I were to estimate the number of hours I work doing nuclear medicine-related things, it would be around 60 to 80 hours per week.

Are you satisfied with your income? Explain.

In short, yes. While some other specialties make more and others make less, I am able to pay my bills and start to pay off my medical student loans and home mortgage.

If you took out educational loans, is paying them back a financial strain? Explain.
I am currently in the process of repaying my student loans. I’m able to maintain my payments and sometimes pay more than is required.

In your position now, knowing what you do – what would you say to yourself when you started your medical career?

I would say, “Go for it! You’ll love nuclear medicine!”

What information/advice do you wish you had known when you were beginning your medical studies?
Don’t lose heart, things will work out in the end. Keep your focus on doing what you like to do as well as helping patients and you’ll be fine. Don’t forget to always do the right thing for your patients.

From your perspective, what is the biggest problem in health care today?

This is a very difficult question, since in truth there’s quite a lot that can be improved. From the perspective of education, I think it would be great for medical students to have a better understanding of costs of care and the business side of medicine.

Where do you see nuclear medicine in 5 to 10 years?

Nuclear medicine is a field that holds a lot of promise for the future. I’m very excited about the possibility of precision (aka personalized) medicine. Knowing about physiology, biochemistry and physics, we can make a lot of strides toward minimally invasive therapies for a number of pathologic conditions, imaging them to see how the therapy is working and modifying therapy as needed. This may sound a bit like Star Trek, but things like this are happening now and are very exciting.

What types of outreach/volunteer work do you do, if any?

I am fortunate enough to be very involved with professional societies. I serve on the board of directors of the American College of Nuclear Medicine (ACNM) and am editor of the ACNM newsletter. As a resident I was president of the Nuclear Medicine Resident Organization (NMRO), which is under the auspices of the ACNM. This is a great organization and allows for mentoring, networking, educational opportunities and many other exciting things.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is another big part of my life. I currently serve as the Academic Council intern and am developing educational materials for lung scintigraphy in the form of a basic module for V/Q scans and an LLSAP module (a kind of CME required after board certification). I also had the great honor of doing the first Robert E. Henkin government relations fellowship and am now a part of the government relations committee; I find this very rewarding and look forward to continued participation. The coding and reimbursement committee is something that I started serving on while a resident—I found this quite useful since as a medical student and resident we don’t get much education on the business side of medicine and how payment actually works—it’s fascinating and aggravating at the same time. It’s most aggravating when someone needs something that has plenty of good data behind it and her or his insurance doesn’t approve it. I also serve as an officer in the Young Professionals section of SNMMI. We hope to help advance the field and garner awareness of nuclear medicine.

Recently, I’ve been asked to be an associate editor for e-learning at the American College of Radiology (ACR). Radiology residents get quite a bit less training in nuclear medicine (1/9 the training of a NM resident), but are still allowed to practice most aspects of NM. I hope that through all of my roles, I can help bring best practices in nuclear medicine to all who are involved in nuclear medicine regardless of specialty.

Just recently, I rotated off of the American College of Graduate Medical Education (ACGME) NM residency review committee (RRC), as the resident member. They are in charge of accrediting residency programs in the United States. Each specialty has their own RRC and their own resident on each RRC.

Do you have family? If so, do you have enough time to spend with them? How do you balance work and life outside of work?

I have a wonderful husband and two beautiful dogs (a sweet three-year-old Goldendoodle and a crazy seven-month-old Sheepadoodle puppy). We all enjoy dog parks and long walks. My husband and I will be celebrating our five-year anniversary this year and are considering expanding the family with some human children within the next few years.

Do you have any final piece of advice for students interested in pursuing nuclear medicine as a career?
Nuclear medicine can be entered into in various ways. In my opinion the best way is the way that offers the highest amount of dedicated training in nuclear medicine: preliminary year (internal medicine, surgery or transitional year) followed by a three-year nuclear medicine residency. Other considerations include completing an internal medicine residency and then continuing on to a two-year NM residency. Or, finally, one can complete a radiology residency and go on to do a one-year NM fellowship. Since NM is a field that is always changing, more training is better. That being said, finding a job in purely NM is very challenging, requires a lot of networking as a resident and immense amounts of determination. Nonetheless, it’s quite possibly one of the most rewarding specialties around.

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