It’s been a little over a year since I opened Image Guided Solutions of Missouri (www.igsmissouri.com), and looking back, the road to get here has been anything but straight. My career trajectory hasn’t followed the neat, linear path many imagine for an interventional radiologist. I finished fellowship in 2018, jumped into a traditional IR job for two years, walked away right before the pandemic, built an outpatient practice with a cardiologist, left that after two years, spent several years doing locums across hospital systems and OBLs—and eventually arrived at the place I always wanted to be: building something of my own.
This past year has been one of the hardest of my life. Starting a practice when you have zero name recognition is brutal. Doing it in an era of collapsing reimbursements and massive healthcare consolidation is—honestly—borderline insane. But here I am, one year later, still standing.
It took me many years to figure out what I was actually chasing: control, autonomy, and the ability to design the clinical environment I believe patients deserve. I wanted fewer barriers between myself and the people I treat. I wanted the freedom to practice medicine the right way.
IGS Missouri was built around a low-cost, high-impact outpatient model. Over time, it has evolved into a practice centered on high-value services: venous disease, MSK interventions, and embolization therapies. We operate Monday through Thursday, with Fridays reserved for hospital work or time spent on other projects to grow the future of independent IR—Physician Staffing Solutions and Travelier—inevitably peppered with IGS administrative tasks from the week.
The truth? Some days this work feels incredible. Some days I want to rip my hair out. Insurance headaches, patient worries, staffing challenges, and the ever-present grind of running a business can wear you down. Supporting my team as we grow is its own challenge. And, like many IRs, I’m still fighting daily to prove the clinical value of what we do to people who do not understand us.
Today, while on a Travelier retreat, I found myself answering patient messages at 7:30 p.m. in an airport terminal. Is it annoying when patients text my personal cell on a Friday? Absolutely. But there’s a strange satisfaction in knowing I can be available when people need me. And when I think about the future of radiology and the hype around AI, I’m reminded: a robot isn’t going to replace the human connection patients rely on.
People often romanticize practice ownership, but the reality is simple: freedom requires sacrifice. I self-funded everything. For months, I spent a week at a time away from home doing hospital work while remotely managing the office. I picked up teleradiology shifts after hours just to keep the lights on. The first six months were filled with sleep deprivation, financial stress, and uncertainty. Taking a traditional job or making more money from home as a teleradiolgist would have been easy. But I know myself—and what drives me—and quitting wasn’t an option.
A year in, I have real data that this model works. We’re providing services the community needs, often faster and more conveniently than the hospital systems can. The practice is profitable. I take home a salary higher than my first post-training job. By every traditional measure, this is a success, especially considering that we have significant room for future improvement.
None of this would have happened without my team—my MA, sonographer, technologist, and nurse. Keeping costs lean, staying efficient, and delivering excellent care is only possible because of their commitment. Our affiliation with the Columbia Orthopedic Group as a management partner has also been invaluable—it gives us access to the infrastructure and support of a large organization to achieve leverage not possible as a solo practitioner, while allowing me to retain full ownership and control of our practice. It’s a model worth studying.
I’ll be sharing more about this journey—and the business realities of modern IR—at the SIR Business of IR Meeting in Atlanta on January 31, 2026.
Will we continue to succeed? I’m optimistic, but honest enough to admit nothing is guaranteed. I’m committed to independence and autonomy, and I will keep adapting as healthcare evolves.
But here’s a message for anyone inspired to follow a similar path: this is not for everyone. In fact, statistically, most who attempt what I’m doing will fail. I wouldn’t recommend it unless you truly feel there’s no other way you can practice medicine. You need a chip on your shoulder. You need to turn every “you can’t” into fuel. If that’s not in your DNA, a traditional job might be the saner option.
For every outpatient IR success story I know, I know five failures. The old adage of “if you build it, they will come” is dead. The modern IR must understand the business of healthcare—local dynamics, referral patterns, payer mix, and operational structure—just as much as the clinical component.
Not long ago, I was dismissed as “just a hired gun.” I was told I lacked purpose. I was told I had to “pay my dues.” Many of these comments came from leaders in our own specialty. They labeled me as an early career disgruntled IR making noise on the internet for no clear reason.
Fast forward to today: I run a growing practice, am creating opportunities for other IRs with Travelier and Physician Staffing Solutions, hold a board position at OEIS, and am invited to contribute to the same professional society that once doubted me. And I still make noise on the internet and will continue to do so until we have done the requisite work to protect and enhance the practice of interventional radiology as a clinical specialty which deserves to be on the same playing field as its counterparts in surgical and medical specialties.
I share all of this not to boast, but to remind you: your path is yours to define.
IR is a specialty still searching for its identity. If we want it to grow, we have to do hard things. We have to challenge old assumptions. We have to build the future we want instead of accepting the one handed to us.
Push forward. Take risks. Don’t let anyone else define your specialty.
Create the future you want to see.