Now more than ever, there is a critical shortage of vascular and interventional radiologists worldwide. Most opportunities for IRs are hospital-based, but few have robust outpatient practices focused on conditions afflicting a large proportion of the population.
While I am grateful for my training, I have learned more about IR in the last three years of living out of a suitcase and working in various settings than at any other point in my career. The reality of our field reflects a lack of a unified vision, appropriate leadership, and a culture we can all rally around. This has resulted in us training a generation of folks who will be ill-equipped for the challenges they will face.
Success as a practice has less to do with one’s academic pedigree and reputation among other vascular and interventional radiologists and more with creating a winning product: superb clinical care. The gas for a medical practice is the clinic and clinic infrastructure.
I am amazed by the number of inquiries I have had from friends and colleagues asking about vendor contracts, C-arms, and ultrasound machines, but no one ever asks about the clinic. In retrospect, this observation is not surprising at all. Can you name another procedural specialty that learns how to do a procedure before they even know the nuances of clinical care leading up to that point?
In an increasingly impersonal world, getting back to our roots as physicians has never been more critical. What patients remember is how they feel when they interact with their doctor.
The creation of a practice is slow and messy. The opportunity cost in a marketplace saturated with high-paying trash-collection opportunities is hard to ignore. But a lifetime of wondering what one’s impact could be using the tools they’ve developed to provide unrivaled solutions for patients is something I see in the eyes of many in our community.
Today, I opened my new medical practice, Image Guided Solutions of Missouri. This will be the second time I have opened a medical practice. Only this time, there were no fancy ribbon cuttings, industry-sponsored events, or cardiology partners. I spent my first day beginning the long journey of creating systems, focusing on processes, and developing the culture that will lead to success over many years.
The big elephant in any discussion about practice development is the macro landscape of healthcare. It’s a real issue that keeps many folks away from independent practice. I think trainees and medical students will do themselves a massive disservice by not spending dedicated time learning about the business of healthcare and understanding how various entities, including healthcare systems, insurance companies, and medical practices, are incentivized.
We need more folks in our specialty to make significant changes in their practice if we want to see our field evolve to be truly stand-alone. That change involves focusing first and foremost on developing a patient panel that is no different from any surgeon’s. Know what matters most and chase it.
As a student who is hoping to match into IR this cycle, I’m really eager to push the limits of what we can do with image guided interventions. This was a good read and makes me feel optimistic.
Thanks so much. It’s a great field with lots of potential that is plagued by a self-inflicted disease: radiology. Despite what we can do, the path to get here is filled with all sorts of obstacles and I think there are easier ways to accomplish the mission of performing novel image guided procedures and I’d advise those not committed yet to look at another specialty before diving head first into this one. I know this is a pessimistic take and I’m going to get a world of crap for this, but it’s the truth.
I know you’re committed to IR and probably have good reasons to pursue this field. I love what I do, but I also have a risk tolerance and disregard for other’s opinions that are probably 2 standard deviations above the mean so I don’t think my path is necessarily replicable for most. Happy to chat with you offline. I wish you the best in your match.
Congratulations Kavi! I am sure this is an exciting, exhausting, and stressful time.
Did the community, hospital, and others physicians support your opening your office practice? Any of the typical barriers to getting hospital privileges like the pseudoexclusive radiology contract bologna? Or did you just walk through the front door, ask for privileges like all the cardiologists and vascular surgeons, roll up your sleeves and you were off and running?
Thanks, Bill! Learning from you and folks like you as I embark upon this. Pretty good support from the community in general, but lots of resistance from the hospital. Making it work, but the politics are pretty wild and it took over a year to find an “in.” I initially went with the approach of offering to provide call services to support a service not routinely offered (PE thrombectomy only performed by 1 interventional cardiologist), only to get shot down by fellow IRs who hold pseudo-exclusivity (they don’t perform PE procedures.) I needed the support of a large group of surgeons to navigate the politics and find an avenue to make this work. The issues you have faced decades ago continue to plague our field today and in fact are even worse since most healthcare is consolidated with physicians in employed arrangements. Makes it even more challenging to get on staff. With that being said, I ended up getting on staff at not only at the local community hospital, but also at the academic center in town since I was asked to help with call coverage due to staffing shortages. Go figure.