New Chapter

Yania Lopez-Alvarez, M.D. (RADV ’17), was raised in a fisherman’s village in Puerto Rico. Her grandparents enrolled in the army to raise the family out of poverty. As a result, education became a core value in the family. Both of Dr. Lopez-Alvarez’s parents have Ph.D.s. She’s the first physician in the family, and she was educated through residency in the public education system in Puerto Rico. She went to Mayo Clinic in Arizona for two years of radiology fellowship and returned home to put her training to use. The new hospital where she’d committed to work had ordered new breast imaging technology and needed a subspecialized radiologist to operate the new equipment — the best laid plans. Two months after Dr. Lopez-Alvarez’s return, Hurricane Maria devastated the island. Many physicians left due to the hurricane and economic crisis, but Dr. Lopez-Alvarez remains rock solid in her commitment to remain in Puerto Rico and be part of the solution to improve life on the island. She says Mayo Clinic’s investment in her medical education will have significant dividends for her fellow islanders.

“Mayo Clinic gave me the opportunity to train and bring that expertise to our island. The benefits of my Mayo training are impacting a large group of people. Mayo Clinic invested in me, and a lot of people will reap the benefits. I’m truly grateful for that.”

Why did you choose a career in medicine?

I liked science. I spent time in some labs in summer programs. Toward the end of college at the University of Puerto Rico, I went to Harvard School of Public Health and worked in a diabetes clinic. I discovered my love of medicine there. Upon return to college, I took the MCAT and got into medical school at the University of Puerto Rico.

You went to Mayo Clinic for your fellowships. How did that come about?

I wanted to stay close to my family in Puerto Rico for residency in diagnostic radiology, so I remained at the University of Puerto Rico School of Medicine. I knew I wanted to do a fellowship, and I was passionate about breast imaging. I interviewed at many institutions, including Mayo Clinic in Arizona. From the beginning, I felt welcomed at Mayo Clinic in Arizona and wanted to be there. The attendings I interviewed with were very approachable.  When they took me around the department, they introduced me to all of the staff, including nurses and techs. I could tell it was a team environment versus different parts working separately. I felt I’d be part of a team, not a low-level fellow. By the conclusion of my interview, they offered me a spot. They said I could take some time to decide, but I decided on the spot. And from the start of my fellowship, I was integrated into the system and worked with nurses, techs, medical students, residents and attending physicians.

I was at Mayo Clinic for two years for fellowships in advanced radiology – women’s imaging, and advanced radiology – cross-sectional imaging. Mayo Clinic had a huge impact on my life.

How did you decide on radiology?

In medical school, I didn’t learn as much about radiology as I learned about other specialties. I thought I’d pursue pathology. During my third year, I had a small radiology rotation and liked it even better than pathology. Every field of medicine needs radiology; it’s at the center of almost every clinical discussion. I believe having a good radiologist as part of the medical team really makes a difference for patients, and that’s exactly what I was looking for in my career.

I recognized that radiology can lack patient interaction. Breast imaging, however, involves patient contact. I saw my breast imaging attending physicians relay information to women patients and work with them in a personal way. In breast imaging, you can really get to know patients and build relationships year after year. I think it’s the single greatest job in radiology.

Tell us about your experience in Mayo’s International Health Program.

My program director told me about the International Health Program, and I applied and received an award. I went to Cambodia for five weeks — an experience that made me a more well-rounded fellow and gave me a good feel for how to work with a population to get things done. Little did I know at the time that that experience would prepare me for returning home to Puerto Rico post-hurricane.

Did you always intend to return to Puerto Rico after your training at Mayo Clinic?

I did. I regarded my training at Mayo Clinic as a way to prepare myself to return to Puerto Rico. There’s a huge economic crisis in Puerto Rico as well as a shortage of physicians and lack of physician specialization. Due to the economic situation, physicians have left the island in huge numbers. I wanted to return and serve my homeland. My heart is in Puerto Rico.

Hurricane Maria hit Puerto Rico in September 2017, two months after you returned there to practice. What was that like?

I was doing administrative work while I was in the process of getting credentialed when the hurricane hit. I felt compelled to spring into action to help people. I worked frantically to get credentialed so I could assist in the aftermath. The island was without electricity and water for weeks. People died because they didn’t have electricity for their insulin. Many patients were unable to get their oxygen. We had outbreaks of communicable diseases due to the lack of electricity and potable water. I got in contact with a group of colleagues, loaded up my pickup truck with supplies and went where help was needed. People couldn’t get to hospitals, so physicians went to them.

The hospital where I work was damaged and is still working to get back to 100 percent strength. Patients were being treated in the streets. The experience I had in Cambodia came in handy. Everyone pulled together as a community to recover, but there was a huge exodus to the mainland. Many physicians were forced to close their offices and leave the island.

A year and a half later, we’re still seeing patients suffering because there was such a delay in their treatment post-hurricane.

How’s life after training?

Because I trained in breast imaging at Mayo Clinic, my hospital in Puerto Rico acquired the technology for contrast-enhanced digital mammography for our new cancer center. We recently installed the first machine of its kind in the entire Caribbean. It’s a great tool to have for a patient population that is underserved and undertreated. My colleagues at Mayo Clinic have been critical for the implementation, working with me every step of the way and providing valuable feedback on our protocols.

Mayo Clinic gave me the opportunity to train and bring that expertise to our island. The benefits of my Mayo training are impacting a large group of people. Mayo Clinic invested in me, and a lot of people will reap the benefits. I’m truly grateful for that.

I had a reality check when I left Mayo Clinic. I planned to implement patient-centered care like Mayo Clinic provides, with the needs of the patient driving the entire system. I tried really hard to replicate that at my hospital in Puerto Rico, including better access to care and biopsies the same day as mammograms. I didn’t expect it to be so difficult! Mayo Clinic has so many administrative and economic resources that aren’t widely available here. Our system isn’t arranged around the patient. Rather, it’s arranged around the insurance companies. I am fortunate to work with an amazing team of people that goes the extra mile — sometimes spending hours on the phone to get a procedure authorized. Unfortunately, those kinds of resources are not widely available. It’s a constant battle.

On the bright side, I’m involved in resident education, training our future radiologists. I want to be a role model for physicians to remain here. It’s difficult, but we can support each other and make it work. I encourage residents to get outside the bubble of the capital city, see the needs of our big island and be an engaged part of the community.

What are you most often asked about Mayo Clinic?

Many trainees ask how to prepare for interviews at Mayo Clinic. There’s a perception that it is impossible to be accepted to a Mayo training program if you don’t come from an Ivy League school. I believe you should always strive to be a well-rounded, balanced individual and have a strong work ethic. If you train yourself to be a valuable member of your community, you will be able to be part of the Mayo community.

I also tell them Mayo is great but demanding. It makes you grow in every aspect — professionally, emotionally, mentally. I acquired many skills and reshaped my whole way of thinking. You’re part of a team at Mayo Clinic; the nurses, your colleagues and techs are your team. I tell our trainees that member of the team offers a learning opportunity. The better they do with everyone on the team, the better the outcome for the patient.

What do you do in your spare time?

I nurture — with myself, my family, my friends, my partner and, course, my dog!

Growing up, I spent a lot of time at my grandmother’s house with all my cousins. We have different lives now, and Abuela is growing old. But we still make it a priority to get together often. Spending time with my family is one of my biggest joys. Family is everything!

Finding quality time with my partner is both a big challenge and a huge source of happiness for me. We both work long hours, but we make it to the gym together almost every day and make it a priority to have a weekly date. He has been one of my biggest supporters throughout this long journey of becoming the professional I am today, and we know how important it is to prioritize each other.

We love to travel and discover new places at home and abroad.

What’s your career goal?

My immediate goal is to build a strong breast imaging division for our department at the University of Puerto Rico School of Medicine. This is a brand new division for us, so it is quite a challenge but a very necessary one for our residency program. I want to continue developing my academic career and eventually develop an education platform to address health care barriers — lack of education and information about mammography. This is a widespread problem in Puerto Rico. We need Spanish-language education materials and to engage with our patients at a community level. The future of radiology relies on radiologists stepping away from the workstation and into the patient world.

See past New Chapter stories here.