Passing the torch after 20 years leading the UC Cystic Fibrosis Program

When Patricia Joseph, MD, came to the University of Cincinnati (UC) College of Medicine from Massachusetts General Hospital in 1999, she did so to build up the Adult Cystic Fibrosis (CF) Program at the UC Medical Center. After serving for almost two decades as director, she is turning over the reins to Veronica Indihar, MD, who has worked with Joseph for the last two years as a co-director of the program.

Joseph, who is a professor in the Division of Pulmonary, Critical Care and Sleep Medicine in the Department of Internal Medicine and a UC Health physician, says the biggest challenge when she arrived in Cincinnati was that most adult CF patients were being treated at Cincinnati Children’s. In 2000, the CF Foundation mandated that adult patients should be cared for in an adult setting. However, Joseph says a lot of pediatric facilities did not want to have their patients go and some patients and their families were reluctant to change care locations. As a result, the transition process took several years.

CF is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. The average life expectancy of a CF patient is approximately 37 years.

The CF patient and family population is one of the factors that makes her so passionate about what she’s done over the course of her career. She describes the patients as an interesting population with medical issues that have intrigued her despite the challenges of managing their treatment.

“Taking care of patients with CF has been a real privilege,” she says. “The patients are amazing, they are so nice, they are so interesting. They’re not just medically interesting, they’re just really great people, and I’m glad that I got to know this whole patient population.”

Joseph is proud of what she has accomplished with the CF program in her time at UC Medical Center.

“We’ve built a world-class program, we’ve got great care,” she says. “There is full transparency on the CF Foundation website where you can look at outcomes for a wide range of areas, and for most of the metrics, we are better than the national average.”

Joseph says the CF Foundation has been a great partner in building the program at UC Medical Center, saying they are on the forefront of medical research, not only for CF but for other rare lung diseases.

“They are a model for how clinical research can be done in a really effective manner for rare lung diseases,” Joseph says. “The CF Foundation is committed to quality improvement and have been since 2000 when quality improvement wasn’t even a thought for a lot of hospitals.”

As for the future of the CF program, does she see any of herself in Indihar, the new director?

“Oh yeah, you’ve got to be tough in this field, you’ve got to be hard-headed, you’ve got to be outspoken and a fighter and a patient advocate, and she’s all of those things,” says Joseph. “That’s why she’s a great replacement.”

Meet the new director:

Veronica Indihar, MD, associate professor in the Division of Pulmonary, Critical Care and Sleep Medicine in the Department of Internal Medicine came to the United States from her native Argentina in 2002 with her fiancé who was getting his PhD at the University of Wisconsin. She received her medical degree from the University of Buenos Aires-Argentina, and completed her internal medicine residency at John H. Stroger Hospital of Cook County in Chicago before doing her fellowship in pulmonary and critical care at the University of Virginia.

How long have you been at UC?

My husband and I moved to Cincinnati in 2014 for a variety of reasons. My husband accepted an offer at UC’s Lindner College of Business in the economics department, while I was looking for a place to work with CF patients. Plus we have a daughter who has special needs and we needed a place that can handle craniofacial conditions, so having Cincinnati Children’s here was a big plus. Our four years in Cincinnati have been great. Unlike Buenos Aires and Chicago, it’s a mid-sized city and it’s a very comfortable city to live in. My son who is in the fifth grade and my daughter who is in kindergarten love it here. We are really happy in Cincinnati. We like the people, we like the Midwest and love the jobs we have.

How did you decide to get into CF?

During my pulmonary training in Virginia, the person in charge of the CF center left after 17 years. This brought the possibility of working with my mentor Cynthia Brown to revitalize and restructure the CF adult center there. I took it as a challenge and felt in love with it. CF is a very tiny and specialized area with only 30,000 patients in the United States, but there are about 15,000 to 20,000 researchers and the progress they’ve made in terms of what can be done for the patients is something I cannot do in any other field in pulmonary.

What do you like about being at UC?

UC has a long-standing reputation in CF adult care. The interaction with basic research in CF, personalized care generated through translational research and the CF patients makes it a great place to work.

What has it been like to be co-director of the CF program?

Dr. Joseph and I approach CF in a very similar way. She’s very holistic in her patient care, she knows everything about them. I think I’m becoming a little bit like that which is something I like. I’m very driven, I don’t accept ‘no’ for an answer and I will try to fight for reasonable things for the patients. We both are critical care doctors as well, so we’ve seen a lot of very sick patients. I also think we know when to stop treatment and I think the patients and families appreciate that from us.

What are your goals as director of the CF program?

We know our clinic is going to grow because CF patients are living longer. Cincinnati is a place where we get a lot of patients transitioning from Children’s. We want to be able to accommodate a growing population and adapt as a care team to be prepared to be able to manage those life changes in our patients.