[smfst7_929]

Youre overthinking it. If you like to work with your hands do IR. If you want to do IR in a PP, then bust your arse during your diag work in training to learn more imaging. IR these days are at a disadvantage for PP jobs due to having one less year of diagnostic radiology. You can still do whatever you want. Could even do a breast fellowship on top of IR. With IR/mams fellowship PP groups would kiss your feet and pull out the red carpet

[RafC]

Honestly private practice hospitals might get cutting edge tech first. I do 80% IR currently and at that rare I enjoy the 20% diagnostic.

[smfst7_929]

Private peactice hospitals and cutting edge tech usually never go in the same sentence

[SueMarie]

figure out if doing ports and biopsies, paras and thoras is enough for you as that is what will fill up most of your time in most private practice IR. if you want to do high end IR its only going to be in the setting of a large tertiary or quaternary center whether it be private or academic setting.  you will see that even IR trained docs will be more than willing to ‘give up’ IR in the small community based centers.

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[SueMarie]

I think what it really comes down to is this:  why are you interested in IR?  do you truly enjoy interacting with patients and their families… and by ‘enjoy’ I mean are you fulfilled by performing a service for the patient and have the feeling of gratification that you wouldn’t experience reading a stack of plain films, CT’s, or MRIs?  I had the misfortune of working with two PP IR’s who had no business calling themselves IRs. No effort to build IR practice or even encourage it.  They were content to just read the stacks and go home early….  Very sad.  End of career life.
 
 

[suyash.agnihotri]

Quote from Kelsoe

I think what it really comes down to is this:  why are you interested in IR?  do you truly enjoy interacting with patients and their families… and by ‘enjoy’ I mean are you fulfilled by performing a service for the patient and have the feeling of gratification that you wouldn’t experience reading a stack of plain films, CT’s, or MRIs?  I had the misfortune of working with two PP IR’s who had no business calling themselves IRs. No effort to build IR practice or even encourage it.  They were content to just read the stacks and go home early….  Very sad.  End of career life.

 
1) Many things. The clinical aspect (though to be honest, there are days it sucks), the toys, the innovation, the MacGyver-ing, our approach/technique compared to say GI or surgery, and love working with my hands/doing procedures, to name a few.
2) Yes. Even something as simple as a PICC or explaining a procedure for consent provide something I can’t get from reading only.
 
My concern is that I don’t care to have the “founder” mentality of building a practice from the ground up, being extremely aggressive in getting referrals, proactively building relationships. And I wonder if that’s something that would hurt me in the future (and thus, a red flag if I ultimately choose IR). It’s not like I plan on starting a practice from scratch.

[btomba_77]

Then just know that you’re the kind of guy who will only want to jump in to an already established practice.   No shame in that.
 
 
The tension comes when the hiring group says ‘we want you to build your practice’ but they mean ‘we want you to cover your salary with IR RVUs otherwise we’re going to start asking to you read stacks of CTs too.’
 
 

[fun00n66m_267]

Yes.  Very hard to go out and build a practice and even more difficult to build infrastructure.  Ie office space, office staff, schedulers, dedicated billers, marketers .  Dedicated clinic time without imaging or procedural responsibilities (opportunity cost for group who would acutely benefit from you clearing the imaging lists).  Usually takes 3 to 5 years of “hustling” often not paid work ie marketing , branding, generating talks, calling referring and working with hospital administration etc so a “founder” mentality is often required.  
 
The outpatient clinic enables one to build the back pain (vertebral augmentation), knee pain (GAE), BPH (PAE), fibroids (UAE), CLI (PAD/ diabetic wounds). 
 
Those who are more interested in IR “light” often are delegated to more of the biopsies, drains, fluid drains etc and emergency procedures after 5 pm or on weekends that other specialties do not want to.  This can ultimately lead to burn out as you can be treated as the dumping ground of the hospital and be seen as a low RVU generator in the group.  Though you may be working quite hard, the group may see you as not carrying your weight.  The nature of the low professional fees of hospital IR.  The OBL/ ASC/ and technical fees generate a great deal more revenue .
 

[ranweiss]

Don’t do it. Field is going down the tubes In most practices, even most academic centers. Turf wars left and right. Don’t spend your life fighting for every procedure. 

[fun00n66m_267]

It is a field where you have to be aggressive about marketing and not afraid of competing for referrals with other clinical specialists.  One can not hang their hat on procedural prowess or imaging expertise as others are steadily increasing that component in their training.  Key is to have an office space to counsel patients , comprehensively manage them and longitudinally follow them. Without this it will be harder to build a sustainable durable practice.