My SIR 2023 Experience

After a several-week hiatus, I’m back writing on this blog from 30,000 feet en route to one of my OBL sites. I had the pleasure of attending SIR this past week. It was my first SIR meeting since 2018 in LA. Back then, I was wrapping up my fellowship at UNC, ready to take on the world.  It’s amazing how quickly five years can go by. 

What a week it was. In general, I’m not a huge fan of large conferences. I find them exhausting. I usually don’t come to these meetings unless I’m giving a talk. Of course, I was asked to speak in three sessions this year. The blog had something to do with at least two of those invitations.  I always like going to Phoenix, so I said, why not?

I started the meeting at the SIR Business Institute. I ponied up the extra money to attend this because the organizers have put a lot of work into creating this programming, and I also know I could benefit as I look to create my own OBL in the near future. What made this session unique this year was the fact that none of the speakers were physicians. The topics varied from an overview of starting an OBL to marketing, supply-chain management, legal considerations of medical practices, revenue cycle management, electronic medical records, and cybersecurity. For those of you who have attended OEIS, there was significant overlap in content, with many speakers being recurrent faculty in OEIS talks. In general, it was good the SIR is starting to focus on content relevant to the independent IR, and I found some of the talks helpful. It was too much information to digest in one day, and there needs to be a week-long conference dedicated to these topics. I also find that it’s challenging to cater the content to IRs who are part of radiology groups and those like me who are fully independent. I trust the organizers will continue evolving their approach to these topics. Also, I know this isn’t the organizers’ fault, but the SIR shouldn’t charge extra. Is a $950 annual fee, not enough? 

The highlight of the SIR Business Institute was one of my good friends dropping off some pizza for me from Pizzeria Bianco. I sat in the back eating this delicious pie while the other attendees ate their bag lunches. This is how you win. 

Saturday night was spent at a fancy dinner with a couple of friends. For those of you who haven’t been, check out Binkleys. The chef trained under Thomas Keller. This was one of the best dining experiences I’ve had in a while. We didn’t stay up too late because Sunday was a big day.

On Sunday morning, I was part of a session by Dr. Bill Julien to demonstrate non-traditional IR practice patterns. The goal was to demonstrate how IRs have carved out a presence practicing outside the traditional radiology group model. I talked about the challenges and triumphs of the early career independent IR. I’ll be sure to recap this talk shortly in a future blog post. 

Session topics varied from a review of private equity investment in IR practices, training residents for success, practicing within a surgical context, reflections of a career spent as an independent IR, pseudo-exclusive contracts, and more. I wish the talks were better attended because this content is highly valuable for those looking to advance their careers outside of traditional practice models. Still, it’s a tough ask for a Sunday morning. My Instagram feed made it readily apparent that many in our field, regardless of seniority and perceived importance, were having a grand time in Scottsdale early Sunday morning and were likely in no position to attend this session. 

After the session, I had lunch with a couple of early-career friends, then hung out with the BackTable team for a couple of hours, recording a follow-up to the popular locums podcast, which came out last year. This was the number two downloaded BackTable podcast of 2022. I’ve been fielding a lot of calls from people who want to do locums. In this episode, I reveal a lot of my secrets and answer some common questions. Shamit, Vishal, and I are looking forward to the release. If our podcast is not the number one downloaded podcast of 2023, I will be extremely disappointed.

After the podcast recording, I caught up with some friends outside of the expo hall and then attended the latter half of one of the OBL sessions. I spent some time at an industry happy hour geared toward of OBL folks, then made my way to dinner with a couple of friends. As we were getting in our Uber on our way to the Arizona Biltmore, we saw many people getting on the bus to the Gala. Looked like a fun event, but those types of things aren’t my scene. After dinner we  returned to the Sheraton, where I spent the next 3 hours catching up with people at the hotel bar. Honestly, I wasn’t even trying. I stood in the same spot for 3 hours, and people just approached me. Conversations were mostly positive, but there were a few not-so-great encounters there. Seeing prominent academics in our field get embarrassingly sloppy was very funny. 

I took Monday off from the conference completely. I had the pleasure of meeting with a good friend for breakfast and then hit the links with one of my friends from training, who is now an academic IR. Fun fact, on Sunday mornings, the call team at UCSF would play golf. It was almost a tradition. So playing golf with my buddy brought back some good memories. I’m glad we were able to make it happen.

On Monday night, I caught up with friends from UNC at their SIR dinner, then met with another private practice IR friend for a second dinner nearby in Scottsdale. It was great catching up with old faculty and trainees. Seeing my best medical student from when I was a fellow as a current fellow about to graduate was pretty cool. It also made me feel old. 

I slept in on Tuesday and got a solid workout in. I stayed at an Airbnb up the road from the conference. It was kind of nice having a bit of separation from all the chaos. I finally made my way over to the conference later in the morning before making an OBL session where one of my friends gave a couple of great talks. After that session, I headed over to the AVIR conference at the Sheraton, where I talked to the technologists regarding PAE. BPH is a huge professional interest of mine, and I always love supporting AVIR.  Shoutout to my friend Dana Kanfoush for the invite. Some of the technologists had some awesome questions. Loved the engagement and the energy. 

After the AVIR talk, I came across a former UCSF mentor outside, and we caught up for a good 45 min or so. I wrapped the day up by attending some more OBL programming, followed by dinner with a couple of IRs with their own OBLs, then a second dinner with a friend from fellowship. After that dinner, I got to catch up with one of my fellowship mentors before finally calling it quits for the evening. 

On Wednesday, I went to the conference in the morning, where I got to catch up with some more friends before making my way to the Crash Course in IR Finance in the afternoon. In this session, I was invited as a panelist as part of a debate with Dr. Frank Facchini. For those who don’t know Frank, he is a senior partner at VIR Chicago and the President of Interventional Solutions at Varian, a Siemens Healthineers Company. Don’t ask me what a Healthineer is because it sounds kind of dumb, but Frank is not stupid. He’s incredibly intelligent and isn’t afraid to tell you how smart he is. We were originally invited to have a debate about the ideal site of service when it comes to alignment with value and reimbursement. He is fully hospital-based, and I now do a mix of hospital and OBL, though anyone who knows me knows that my heart is in the OBL world. 

Leading up to our debate, we heard from some great speakers about hospital and OBL reimbursement. You have heard about many of these themes on this blog and other venues. I then gave my position that the OBL is the ideal site of service. It is one where patients, physicians, and payers are fully aligned. The truth of the matter is arguing that the physician-owned and operated OBL is not the ideal site of service when it comes to value and reimbursement is like trying to argue that the sky isn’t blue. So naturally, Frank turns up the charm with cute quips about his Italian heritage to deflect from the main points I raised. He tried to claim that there is less cognitive work involved in OBL work than in hospital work, which is total crap. He also tried to claim that there is more abuse in OBL settings than in hospitals, which is also total crap. At the end of the day, he had many good points, and I like that his group can do good work within a hospital setting, though I would contend that VIR Chicago would be significantly stronger if they had an OBL for their outpatients.  I bet you, in private, he would agree, though he will never admit it.  He also knows he’s just one bad hospital CEO away from losing a lucrative contract. Perhaps not all that different than me losing a locums contract, honestly.  Despite the disagreements on certain points and his attempts to “son me” like others have tried in the past, the truth is as independent IRs we have much more in common than not, and the ideal private practice should have both hospital and OBL components. Both of us have said no to the traditional IR/DR practice pattern in which most of our field participates. To do this takes courage and commitment toward real clinical care. He and his partners are pioneers when it comes to independent hospital-based practice. It was a fun session, and I’m glad I had the opportunity to “debate” him. 

I ended my conference by catching up with another early-career friend in an independent IR group. We had a great dinner “off campus,” and my world got even smaller. On Thursday, I slept in, had a nice workout, and enjoyed some chilaquiles from The Little Diner before boarding a plane back east. 

As fun as SIR was sometimes, it was equally exhausting and frustrating. The conference is massive, and the heterogeneity in our field is tremendous. While we all seem to love diversity, I’m not sure the diversity in IR career paths without a unifying identity is truly something to be proud of. I found myself talking to way too many IR Apologists. There is still a generalized failure to acknowledge that outpatient care with a longitudinal clinic must be our focus moving forward.  It also bothered me that many medical students still view diagnostic radiology training as a key element of their future. Of course, in some sense, they need to say that to match. Many wish to have mixed practices, which, more likely than not, is asking for a future of trash collection. As much as I like to think a culture change is happening, it’s too slow. Many academics are still pushing the importance of diagnostic radiology training and its associated culture.  My interactions with many make me more convinced that IR independence from DR is the path forward, and we must prioritize it more than ever. The SIR will always support its largest constituent, and directing frustration at the society is a losing battle. I donate to SIRPAC every month and do my part to remain active in the SIR, as frustrating as it can be with its academic-centric elitism, nauseating self-congratulatory tendencies, and own degree of administrative bloat. We cannot expect a professional society to change things for us. We have to change the culture of IR before the SIR will do anything of substance. 

With that being said, there are more people now than ever who want to see change. More of us in “private practice” (still such a nebulous term) need to model that change, create opportunities for the next generation, and be proactive in supporting the handful of academic practices doing things the right way. I will continue playing my small role by documenting my journey here as I make my own moves. 

I will end this post with a plug for an alternative society meeting that deserves serious attention. The Outpatient Endovascular and Interventional Society will host its 10th annual meeting on May 18-20 at Disney World. This conference is important because the entire focus of the conference is centered on sharing best practices for developing an outpatient practice. While there are several routes to independent IR practice, the outpatient one makes the most sense for those committed to a future of longitudinal clinical care. Even for those who want a hospital presence, it would make lots of sense to incorporate an OBL or ASC as part of your practice.

Trainees can attend this conference with a generous scholarship to offset costs. Please click this link and submit an outpatient IR case, case series, or research abstract to be considered for the scholarship. If you don’t have a case, email me at kavi.devulapalli@gmail.com, and I will help you. Remember, this is not an OBL society, even though much of the programming pertains to OBLs. Anyone who participates in outpatient care, including those in hospital-based practices, is eligible to participate. I don’t personally benefit from helping anyone out as there is no pathway for promotion for someone who is their own boss. No obnoxiously long ribbons at conferences, large dollars from industry, or alphabet soup credentials after my name. So know that if it makes this blog, chances are it is because it means something to me, and I’m looking to share knowledge and opportunities to help create the change I want to see.