What I learned from two jobs that turned into nightmares, and why I finally fired my bosses and took control of my career.
I used to think that if you just trained hard enough, and worked hard enough, at the right places, the rest would fall into place. Big name residency. High-volume fellowship. Check, check. I was going to take care of the sickest patients with the coolest procedures. That was the plan.
Reality hit fast.
Job #1 (2020): The ex with all the red flags I ignored
I wanted an academic practice within driving distance of my family in northern West Virginia after losing someone very close during residency. My options were slim. I chose a large private nonprofit academic center about five hours away, if driving toward the sun in the morning. Googling might tell you which one. Don’t @me, lawyers. I didn’t say your organization, or even your state.
The Red Flags
I asked for a 12-month procedure log. It was 85% PICCs, ports, biopsies, and nephrostomies. Very few TIPS, Y90, ablations, complex oncology work. All of the things I wanted to do were omitted, and I made that loud and clear. “I trained at the largest Oncology system in the world. I want to do complex oncology work.” “Don’t worry, the system just pulls data funny. We do tons of those.” (Lie #1)
Ten attendings had left in the prior five years. “They were all from big cities and their spouses hated the rural location.” was the excuse given. All ten of them?! I wish I had recorded myself asking this question in total disbelief of the audacity of it. Yes, I’m sure that all 10 of the highly trained physicians with intelligent and supportive significant others were dumb enough to come to this site, knowing it’s 3 hours from any major city, on a whim. I can hear the imaginary conversations that would have been had at those dinner tables, “We’ll figure it out, honey. Costco is only an hour and a half away.” “You’re right, dear. You’re always right.”
Despite these red flags blowing in Gale force winds, I signed anyway. I was destined to become turnover victim #11.
The honeymoon lasted maybe three months. I was doing 14–16 cases a day while the senior partners cherry-picked two or three. Referrals were sloppy, leadership had the consistency and spine of wet paper, and when I pushed back on an improperly evaluated biopsy request (and convinced the patient to get an MRI first, then biopsy expeditiously), the ordering physician threw a fit. My chair slithered behind my back and had another partner do the biopsy anyway. Inconclusive, of course. Due to sampling error. Should have gotten that MRI. Whaddya know? The cancer expert understands cancer.
Lesson #1 for trainees and those in early career: When people and organizations show you who they are, believe them the first time.
Job #2: The one that was perfect… until it wasn’t.
After a very unpleasant conversation with the chair related to that event, I decided to leave that Fisher-Price organization, and I made a list thanks to a mentor’s advice. This advice I’ve now parroted to every IR asking me for advice (am I old enough to be giving advice?), including my list:
- Must-haves (non-negotiable)
- Partners I trust and like
- Leadership that fights for us
- Colleagues who are so smart, they make me one of the dumbest people in the room
- Department structure – dedicated clinic, clinical service, etc
- Can tolerate
- Location -Cold winters, not NYC/LA location
- Call volume
- Don’t really care
- Money (within reason)
After several uninspiring interviews, I submitted my letter of resignation without another job lined up. With some conversations throughout my network, I found that a site that, theoretically, checked all my boxes was about to lose a physician. I cold-emailed the section chief every month until they finally caved and interviewed me. Everything went fairly quick, and they hired me. Headed out and moved to the Northern Tundra.
And reader, it was glorious for about 18 months. And not the honeymoon stuff. This was a real subspecialty practice, brilliant colleagues, supportive leadership, clinic time, great trainees, research, the works. I finally felt like I belonged.
Then the health-system rot set in. Budget cuts, administrative bloat, morale collapse. Three of us (including 15- and 20-year veterans) looked at each other one day and said, “We’re out.” Our simultaneous departures forced the section to spin out as its own entity (yes, you read that correctly…A department of Interventional Radiology) and gave the remaining staff about a 75% raise (yes, you also read that correctly). The other two docs fortunately remained on as staff with these changes and a new seat at the table. They’re great assets, and I’m glad for everyone, including the trainees and the system, that they decided to stay.
But I was done rolling the dice on someone else’s organization. I was done relying on someone else for my happiness. I was done waiting for the support of someone above me to get me what I needed.
Going 1099: Firing my bosses and becoming self-employed
I decided that if even the “perfect” job can turn toxic overnight through no fault of my section, I no longer wanted a system as a king.
So, I became a 1099 independent contractor Interventional Radiologist.
That means:
I contract directly with hospitals, private practices, and hybrid teleradiology/IR groups.
I set my own schedule, choose my partners case-by-case, and say no to toxic environments.
I finally have bandwidth for family, fitness, investing, and side projects that make me a more complete human.
I’m not going to sugar-coat it: the first six months were scary. Building a reputation as “the reliable contractor who actually shows up and does the hard cases in literally any environment” takes time. Malpractice (sometimes) and taxes are on you. But every month since has been better than the last.
Final lessons for anyone reading this in a dark call room at 2 a.m.
Red flags are data, not vibes. Turnover numbers, procedure logs, and Reddit whispers are your friends. Start establishing your network early. I am not a social butterfly, but I established enough contacts, especially after the first job, to understand where I should be and why.
Culture > everything. You will spend more waking hours with your partners than your spouse. Choose accordingly. Also, if your department chair is more interested in developing AI workflows for MRI than they are in making sure a department runs smoothly, maybe look for another department.
Even fantastic jobs can implode from forces outside your control. The only real job security in medicine right now is the reputation and skill set you carry with you.
You do not have to stay employed by a system that treats you (or your patients) poorly. Locums and 1099 IR are viable, lucrative, and increasingly common paths — especially for subspecialists. I maintain that I’m a better physician now than I was a year ago. Not because I’m doing complex, high risk, X posting worthy cases, but because I have more patience. I am also the fun divorced dad. When I go to a site and work IR my one or two weeks per month, I’m in a good mood – I *want* to be there, and I’m happy to take care of patients. I’m not bogged down by the drag of every day, 7:30 AM until ? PM work life. The feeling I get every work week is the feeling you, reader, get when you’re about to be on vacation the following week.
To every early career, burned-out IR attending reading this: Your training was the hard part. The career design part is supposed to be the reward. Don’t settle for a practice that makes you miserable just because “that’s how medicine works.” Stand up for yourself. And if you’re not in an environment where you can stand up for yourself, walk away into a different environment. I’m not going to pretend to know your situation, but always thinking, “It will change, it will get better,” is a sign that you’re in an abusive relationship.
When I went to leave my first job, I had the vice chair (a friend of mine) give me a cautionary, “The grass isn’t always greener.” My response to him was, “Maybe. But the grass here is scorched, dead, and there’s no water or sun.”
And always, always, always remember that you have more power than you think.
If you’re an IR (or any proceduralist) considering the independent route and want the unsexy details, network. There are Facebook groups specifically for DR and IR physicians, and general physician groups that require verification before letting you in. Contracts, rates, malpractice, taxes, retirement, how to find the good gigs can all be learned. You’ve learned how to do complex procedures with sound waves or photons, you can learn this.
Special thanks to @theblanketdog on X for sharing his experience with the IR community. Look out for more words of wisdom soon.