Renewed Focus: Introducing LineMonkey 2.0

Dear Reader,

Every year around July, I can’t help but reflect on my journey in medicine. July is exciting because it is the Medical New Year marked by transitions and fresh starts. Newly matriculated medical students are starting their medical journey, graduating medical students become interns, interns move on to residency, and graduating trainees move on to attending jobs. Even in attendinghood, July is a time of transition. Many leave jobs and move on to new ones or retire.

New trainees or attendees may be looking for resources and stumble upon this blog each July. Welcome to new readers, and thank you to those who continue to follow. Admittedly, I need to do a better job keeping up with this blog. I attribute my tardiness with blog posts to two main reasons. First, I am undergoing a new transition in my career, which is very time-consuming, and second, I just needed a break from engaging with people about the future of IR. It was burning me out.

More on that in a second, but first, I want to reintroduce myself and my journey in interventional radiology. Contrary to what some believe, I am a real IR with a real name. I am entering late early careerhood as I enter my 7^th year as an attending. I have now had as many summer or fall transitions as an attending as I have had as a student or trainee. Here are the highlights:

·  July 2018: Enthusiastically started a job in a small IR/DR group, failing to establish a clinic in a culture that wasn’t ready for that and moving on to a new opportunity.

·  March 2020: I started an OBL with an interventional cardiologist and subsequently learned more than ever about the OBL world, CLI, PAE, business ownership, leadership, partnerships, pseudo-exclusive radiology contracts, and more.

·  September 2021: Leaving the OBL to embark on three years of what a colleague calls the “think tank.” During this time, I took over 32 weeks of hospital calls a year and lived out of a suitcase with “anchor” hospital locums’ contracts in the upper Midwest and OBL contracts in Florida. I spent countless hours thinking, dreaming, reminiscing, and observing. Most of the long-form blog posts you see here were created during this time, with 2022 being a particularly fruitful year of writing.  

·  September 2024: After the most unconventional six years possible, I am now entering a new phase of my career. I am hyper-focused on the things that matter to me: growing my solo outpatient practice and supporting independent IRs through two business ventures aimed at promoting independent practice in our community. 

Some wonder why I care so much about “IR issues,” and the truth is I never did until I realized that forces impacted my livelihood I had no idea about when I was training. I felt a deep sense of injustice about the matter, and to this day, I still do. My first job was such a shock to my system, followed by an OBL opportunity that took me years to psychologically recover from, only to enter into what seems like constant discussions with my colleagues, the majority of whom disagree with me, probably because they’ve never experienced what I did, are naïve, or they have a different perception of our field.

I’ve learned that trying to change people who don’t want to change is useless. Whether it’s egotistical academics, Twitter trolls, Ponzi-scheme operating legacy radiology group leaders, bean-counting hospital administrators, evil genius sell-out entrepreneurial IRs, adventurous cardiologists with a newfound passion for particle embolization, or your friends, it is easy to waste energy on people who don’t deserve your time. The challenge with caring is that if your knowledge can help someone avoid mistakes you’ve made, it’s hard to stay silent and let the world continue: another day gone, another young IR getting hosed or worse.

Getting back to the focus of this blog, I started writing over six years ago as a form of therapy for myself. I didn’t have a formal outlet to voice my concerns, so I started writing. The writing exploded when I intentionally shed light on the daily reality of most IRs. It further intensified as I critically examined the traditional diagnostic radiology paradigm for our training and workforce culture. But the truth is all those matters, while important, are not as crucial as the real-world connections I have developed with new friends and colleagues due to this blog. Using this as a means to connect with people with people to help them navigate their issues and for me to also lean on others for support has been priceless. Even though I have not written anything for nearly six months, I continue to have people reach out to me, asking questions about things I have written on this blog, seeking mentorship or advice. It has become clear that some posts will live on for a while. I’m happy to see that and take tremendous pride that I can actively help people improve their happiness and career longevity through writing. 

I have intentionally chosen a path in medicine that is not easy: the path of IR independence, both from diagnostic radiology and that of the young private practice physician choosing not to become employed by a healthcare system. It’s akin to swimming upstream while being shackled with chains, but I do it because independent physician practice is the best way to practice medicine. The more layers that exist between a patient and their physician, the worse the care and the less likely it is for that physician to experience joy practicing something they have worked so hard to train in. When independent practice thrives, patients and their doctors win.

As I move forward with this blog, I intend it to serve as a resource for others and, at times, a sounding board for my internal thoughts that you may or may not find entertaining. I aim to help the minority of interventional radiologists who feel the way I do so they don’t have to experience some of the not-so-great things I have experienced.

If you’re someone with this nagging feeling in the back of your head telling you something in medicine doesn’t feel right, and things specifically in IR seemed insanely messed up, then I think you’ll find this site useful. I hope to provide some clarity and guidance in my journey as I run towards the thing most are currently running away from. If you are a trainee, this blog can serve as an excellent counter-perspective to certain truths, half-truths, and blatant lies perpetuated in traditional academic training programs. The real world is not kind, but there is beauty in the struggle, and I hope you learn to appreciate that.

As I evolve in my career and stage of life, this blog will also. Looking to the next phase of this site, there will be fewer long-form blog posts, fewer social media engagements beyond blog announcements, and more frequent, short, and readily digestible pieces focused on independent IR practice and healthcare finance as it relates to IR.  I will start introducing some audio and video, but no TikTok dances. There are enough IR FIGS ambassadors for that.

I appreciate your support. Happy Medical New Year.

Sincerely,

Kavi Devulapalli