Breast imaging bridges technical expertise and human connection, two recurring themes in Ivy Ewald’s career. A breast radiologist may detect a tumor at its earliest stage and may also be the first physician to tell a patient that cancer is a possible diagnosis. For Ewald, that combination first drew her to medicine.
“In breast cancer screening, we have a lot of patient interaction. We’re often the first physician to bring up the idea of breast cancer if it’s on the differential, and that conversation is really delicate. You can have a huge impact on someone’s day, on someone’s week.”
Ewald appreciates that impact on both the personal and community level. Her interest in access to care developed during medical school at UC Irvine, where she participated in PRIME-LC, a five-year program focused on serving Latino communities, and earned a master's in global health and social justice at King’s College London.
That interest later took her from rotations in Peru and Panama to a partnership with RAD-AID Nepal during residency. Through virtual case conferences, Ewald and radiologists in Nepal learned from one another, “We would share cases one week, then they would share cases the next, she said. “It was very much a partnership.”
Experiences like these sharpened Ewald's interest in how relatively small changes to health systems can make a significant difference in patients' lives. While working at Denver Health during residency, she helped set up a same-day biopsy clinic, allowing patients to come in for diagnostic imaging and potential biopsy in the same visit. For patients who might take several forms of public transportation to an appointment or arrange childcare for the day, eliminating a second visit could make an enormous difference. She observed that,
Anything we can do to make the process easier can have a huge impact on their life.
That attention to the patient's experience predates Ewald's career in radiology. The daughter of a pediatrician, Ewald always knew she wanted to enter medicine. She initially imagined a career in primary care, which dominated much of her early clinical exposure. She explains, “Sometimes it feels kind of random where you end up in medicine. It’s just who you meet and where you rotate at that time.”
In Ewald’s third year of medical school, her internal medicine attending would routinely take her whole team to the reading room to talk directly with the radiologists and ask questions. There, Ewald discovered how much she enjoyed the diagnostic side of medicine and saw how a radiologist's expertise could shape clinical care.
Those reading room conversations were the first of many mentorships that influenced Ewald's career. Later, she found another model in breast radiologists who were enthusiastic about their work and prioritized teaching, which was especially encouraging during the most demanding stretches of medical school.
Now Ewald appreciates from experience how much a teacher can influence someone's career trajectory. Grateful for the mentors who continue to guide her, she sees that relationship as fundamental to medicine, observing that “It really still is an apprenticeship in a lot of ways.”
Born and raised in San Francisco, Ewald always hoped to return to the Bay Area. She considered both private practice and academic positions before deciding that UCSF offered the combination of clinical care, research, teaching, and mentorship she wanted. “Being within an academic facility keeps you on top of your medical knowledge, the newest practices and guidelines,” she said. “That just brings me confidence to know that I'm doing the right thing for the patient.”
Teaching has become one of the aspects of academic medicine that Ewald values most. Working with residents and fellows gives her the opportunity to provide the same kind of approachable mentorship she valued as a trainee. At the same time, as a new attending herself, she continues to rely on colleagues for help and advice.
Ewald most enjoys the variety in breast imaging practice. “I like that each day is a little different. On Mondays, I'm maybe doing screening mammograms. On Tuesdays, I'm doing ultrasound procedures. On Wednesday, I'm doing diagnostic mammograms. Thursday, MRI procedures.”
Away from the reading room, cooking is one of Ewald's favorite ways to unwind. Before medical school, she spent six years working as a sushi chef in San Diego. Today, she particularly enjoys Japanese and Mediterranean cooking. “You learn from every job you've had,” she said.
As Ewald builds this next stage of her career, she continues to rely on the kind of community that helped lead her to radiology in the first place, reflecting that “You can have your dream job, and if you don’t have a good group of colleagues, it doesn’t mean anything.”