To my three loyal followers, I am very much alive. It has been over 7 months since I last posted. Where has the time gone? Well, interesting question seeing as this probably has been the worst year in recent history for most people. While we all want to turn the page and head into a brighter 2021, I can’t help but look back at this year as being one of incredible change for me with the lowest of lows and highest of highs.
Quitting my former IR/DR job back in March felt like a low point in my life. I had worked so hard to make into medical school, residency, fellowship and subsequently into a position that seemed so promising only to grow extremely disenchanted with my job and more or less burnt out. What most people don’t know is that while being incredibly pissed off towards the last 4-6 months in my prior job, I was working very hard on the side to fund and plan what is now my outpatient practice. This included partnering with someone I trust who brings to the table what I was lacking: experience and a national reputation.
In July my non-radiology partner and I opened up our outpatient practice in the middle of a global pandemic. My partner had a robust critical limb ischemia practice at a local hospital system. He was running strong out of the gates with a patient panel of over 300. I on the other hand basically started from scratch: a handful of patients and no real reputation outside of my last hospital. I started the summer with really thin clinics. I think I saw 4 new patients in July. Well 4 became 8, 8 became 16 and now I am seeing between 20-25 patients each week.
Financially speaking, this has been a rewarding experience. I am now making more money than I was when I was in a diagnostic radiology group being subsidized by imaging. The difference is I now have control over my practice and I still have significant room to grow in terms of both clinic and procedural volume.
I take pride in the fact that I do very intellectually satisfying work. This week alone my procedures included: deep venous recanalization in a chronic post-thrombotic MTS patient, 3 critical limb ischemia interventions including primary pedal work and pedal loop interventions, a varicocele embolization which came to me as a second opinion after a failed embolization attempt at a local academic practice, two prostate artery embolizations and several vein ablations in venous wound patients.
Going from gainfully employed but miserable, to unemployed for over three months while the world around me continued to burn, to an owner of a small business in a hypercompetitive market saturated with academic medical centers and radiology private practices has been a rollercoaster ride. I still am learning something new everyday and I am far from being where I would like to be. But when I look back, I’m pleasantly surprised by the growth. None of this would be possible without the support of my partner who has been my biggest ally. He has pulled all the strings he could to get my name out there in the local medical community and really help unleash my potential. My first prostate artery embolization patient was one of his PAD patients who happened to have severe BPH and has refused urologic procedures!
What makes me sad despite the success is the lack of support from other interventional radiologists. Whether it’s the president of the local radiology group who is an IR at the hospital across the street from the OBL sending me cryptic text messages and telling me that my endeavor with my partner is “risky,” or if it’s my former IR fellowship program director telling me to kindly “back off” when trying to find nurses to work for our practice, it has become very clear that what I am doing is deemed as “experimental.” I’m not sure if people are jealous or they think I’m crazy or perhaps a combination of the two, but this experience of mine has been somewhat isolating. It is also stressful knowing that there are colleagues of mine in my own specialty who perhaps expect me to fail. The interaction with the local radiology group is particularly weird seeing as I derive my referrals from a different pool and interventions are clearly not in their economic interest. Every referral and subsequent patient encounter for me is a true test. The stakes are much higher than they are in a hospital-based radiology group. It can be very stressful. But it’s also kind of fun to know that I have haters. I must be doing something right!
I am however encouraged by the number of medical students, residents and other early career attendings who have reached out to me over the last few months to learn more about what I’m up to. I’m also encouraged by academic practices who have reached out to me to invite me to give virtual lectures to their trainees. Our field is undergoing a culture change, but we have many obstacles to overcome. You know what the biggest obstacle is? Ourselves.
Limiting beliefs, fear of traditional practice establishments and frankly golden handcuffs to some extent keep interventional radiology from truly achieving its potential in many practice settings. There is no one definitive path forward for any given interventional radiologist. The thing that needs to be constant however is the burning desire to be a patient’s doctor and not just a doctor’s doctor. Some may ask, what exactly does this mean and why does it matter? This is often referred to as “Clinical IR.” More to come in a future post.
Until then, please leave a comment and let me know what you’d like to hear more about. Always happy to answer questions and am looking forward to writing more.