One of the biggest achievements— and struggles, in a DR world—has been with our desire to grow clinically. Converting from performing procedures that were sent to us to becoming a self-sustaining, fully clinical IR service has been a labor of love. We now consult on all of our patients, with the EMR listing “Consult Interventional Radiology” rather than any procedure “orders,” run a full outpatient IR clinic, admit patients as necessary, have a nurse navigator and not only participate in but are a vital piece in all multidisciplinary conferences.
However, doing the above takes a lot more staff than simply doing procedures, and that extra work (though helped greatly by our IR residents and physician assistants [PAs]) is work that is much more difficult to define in the DR language of reading lists and professional work relative value units.
One of our latest endeavors is a new freestanding IR clinic that is housed with our PET/CT, which we are trying to increase from a twice-weekly clinic to a full-time resident-run clinic, all of which is in addition to our fully staffed, separate Vein Institute.
The Vein Institute Upon joining RRA, one of my passions was growing the venous aspect of our practice, including chronic superficial venous insufficiency (varicose veins), pelvic congestion and deep venous disease. After initially performing venous procedures in a makeshift room at our outpatient imaging center, the practice began to grow exponentially. In 2010 we moved these procedures to a site away from the hospital, hired a dedicated PA and opened The Vein Institute. In 2019, we moved again to a larger office.
There was more than a dollop of naivete in thinking that growing a successful private, independent office could be done with just a great medical practice coupled with rudimentary skills in management and business. Learning about profit and loss statements, budgeting down to the penny, and going door
Having a practice where you can be the expert and control your practice without bureaucratic impediment is truly unparalleled.
to door to talk to potential referrers are challenging enough. Without a dedicated practice manager, additional management issues included advertising directly to patients, buying equipment, personnel decisions and dealing with shocking paradigm changes such as COVID-19 as an independent medical practice.
All of this has led to copious stress, especially with the anxiety of trying to keep a small business afloat during COVID-19 shutdowns, balancing what is best for patients and safety with financial survival. But through the highs and lows, the end-result of having a practice where you can be the expert and control all aspects of your practice
without bureaucratic impediment is truly unparalleled.
Training As a private radiology group, RRA has run a successful DR residency program for over 40 years. In my early experiences, most residents were planning to go into DR and had little IR experience or interest. However, as I got involved in the DR residency interview process, I started recruiting one or two residents each year who had a strong interest in IR. There were two factors that I sold: 1) residents would have clear access to cases as there were no IR fellows and would thus be ahead of the game before starting their IR fellowship, and 2) they would simultaneously be learning how to be a successful high- volume private-practice DR. This pitch stemmed from my growing realization that most IRs in the United States are in private practice attached to a radiology group and will regularly have diagnostic duties, despite receiving vastly different training to prepare them for that work.
As this DR interest in IR grew every year from 2013 through 2016, it became
RRA facilities and staff; Photos courtesy of Raj Pyne, MD, FSIR
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