Establish Your Vision

One of the amazing things about making my thoughts on our profession public is that it has resulted in some really great conversations with many different people in the world of interventional radiology. On any given day, I may receive text messages from division chiefs of prominent institutions or presidents of large private practices, founders of OBL networks, early career IRs who are facing their own unique challenges, and residents and medical students considering interventional radiology as a profession. I even received a cease and desist letter pertaining to some earlier content which was also a first for me. Greetings to the lawyers reading this post! Needless to say, every day brings new challenges which are exciting, sometimes frustrating, but always entertaining.  I’m a firm believer in the concept that if you aren’t making someone uncomfortable, you probably aren’t moving any needles.

I’m often asked, what exactly is it that you are trying to accomplish? This question usually comes up in one of two contexts: 1) Disenchanted and underappreciated IR who loves what I’m doing, or less often 2) Older academic type or entrenched private practice IR who finds my content suspect and perhaps somewhat threatening to their comfortable existence. More recently I had a very enlightening conversation with a prominent figure in the OBL world who challenged me with a very specific question: If you had unlimited resources, what would you seek to accomplish?

I’ve been thinking about that question a lot lately.  Anyone who really knows me understands that I love interventional radiology. I’m actually somewhat obsessed with it. Everything from our history to our future is all very fascinating to me. Anyone who knows me well also understands that I’ve been through some really bad experiences and have made my fair share of mistakes which have absolutely nothing to do with patient care but everything to do with a lack of mentorship and basic knowledge pertaining to the other facets of our professional existence including politics, relationships, and finances. The truth of the matter is others out there have made similar mistakes and have faced similar changes, but have perhaps shied away from reaching out for support to avoid embarrassment, or perhaps they simply didn’t know where to turn for guidance. I started writing in an effort to discuss my challenges so others may learn from them and not repeat my mistakes. I do it because I love to teach and I truly love seeing my friends reach heights that they never thought possible. Guiding others gives me energy and adds a dimension to my life which no amount of money or fame will ever match in satisfaction.

For better or worse, the writing is working, because all of a sudden, I’m faced with a large number of requests to chat with people. To those who have reached out recently, I promise you I will get in touch soon.  As I write this article at 27,000 feet heading to one of my OBL clients, I think about the scenic path I have taken to get to this point and the many conversations I’ve had with my current and future colleagues. I can’t help but think about the idea of having a mission and vision. I’m going to share my 1, 5, 10, 15 year missions and overarching vision with you.

My Missions

Year 1:

Create a community of like-minded individual IRs who can lean on each other for support.

Year 5:

Build a model office interventional suite treating the types of patients which brings me the most joy and professional satisfaction. 

Year 10:

Create a network of physician-owned free-standing outpatient practices with like-minded colleagues to share clinical, technical, and business best practices, as well as leverage economies of scale for group purchasing agreements, fairly negotiated insurance reimbursement rates, and high quality clinical research trials.

Year 15:

Normalize the financial independence of interventional from diagnostic radiology in the healthcare marketplace to improve the number of high quality career opportunities for future generations.

My Vision:

For interventional radiology to formally evolve into the field of image-guided surgery.

These are some lofty goals, perhaps somewhat egotistical in certain people’s minds, but I think big goals are necessary in order to accomplish something truly remarkable. By making these goals public, you can all hold me accountable. And maybe I won’t succeed, but I guarantee you that I’ll go further than what was possible had I not created this vision for myself.

When I have conversations with other current and future IRs, what I sense is a collective lack of vision. People conflate money with purpose and “doing cool cases” with building clinical practices. There is a global failure to acknowledge the fundamental factors that play a role in partnerships. We are a bunch of confused monkeys with no clear purpose. In fact, I don’t think these challenges are unique to IR. I think it’s pervasive across medicine. We are brought up in a system which is very linear, deeply political, and unjustifiably hierarchical. The lack of independent thinking is a major hindrance to us collectively reaching new heights as physicians.

We worked hard in high school to get into college. We worked hard in college to get into a great medical school. We played some ridiculous games in medical school to get into residency. We use arbitrary and frankly faulty metrics to evaluate and compete for “good jobs.”  Those on the academic path tend to play even more games to climb the promotional ladder with an eventual goal of becoming a division chief or department chair. Those in private practice play games to achieve partnership status for financial gains and practice leadership roles. These are individuals each playing their own boring game of solitaire. But medicine is a team sport; so I ask, what are we collectively trying to accomplish as a profession?

This is what’s unclear to me. We are so fragmented as a field because we lack a unifying vision. 

Vision To Heal

That’s cute. I still don’t know exactly what that means, do you?

I’m going to set aside society politics for the moment, because it truly deserves a dedicated post, and return to the discussion of each individual’s professional vision.

Maybe your goals aren’t as lofty as mine. Or maybe they’re loftier. Either way, it doesn’t matter, because at the end of the day, we all have our own personal circumstances and motivations. Regardless, everyone has to have a clear vision for their future. They need a 1, 5, 10, and 15 year plan. I think everyone should write it out. Show it to a friend, or a mentor if you’re fortunate enough to have one. Get feedback. Internalize that vision then start connecting the dots to get there. Everything becomes a lot clearer when you do this.

I think good mentors go through this process with their mentees. This is something that’s sorely lacking in medicine as a whole, and severely in IR. How is it possible that academic physicians can be our main source of mentorship when 80%+ of us do not end up in academic jobs? I also don’t think one can simply create a database of possible mentors and mentees and hope some awesome connections spontaneously come about. What I do think is possible is for those physicians looking for mentorship to find someone doing something that they want to do then reach out to them to establish a connection. In the process, find ways to add value to their lives so together you can create a mutually beneficial relationship which can be long lasting and fruitful.

How do you find someone doing what it is that you want to do? Better yet, how do you figure out exactly what it is that you want to do? These are the hard questions. It took me 32 years to figure out exactly what I wanted to do with my life and find the person who has helped steer me in the right direction. It took another 2 years before I became really serious about making that vision a reality. I didn’t start making real progress in these endeavors until I started thinking less and doing more. Doing more means making some uncomfortable moves and taking calculated risks. Sometimes you just need to make a move and course correct later, otherwise you’ll be stuck in “analysis paralysis.” Sometimes you will fall flat on your face. Mistakes are inevitable. Embrace it. As intelligent and relatively risk-averse individuals, physicians are prone to perseverating and missing out on many opportunities for success.

As I move forward with this blog, I want to seriously begin creating a community where we can support each other. No politics. No ribbon measuring contest. Just passionate people interested in a future of image-guided surgery supporting and challenging each other to be better physicians and leaders.

Is this something you’d be interested in? Let me know.