the norm that two of the four residents would do an IR mini-fellowship with us before moving on to another academic center for their IR fellowship. This created a culture where we were, in essence, running a quasi-IR fellowship with high-level residents, many of whom were first operators on complex cases. My partners and I found it gratifying to be teaching IR at such a high level.


When IR became a primary specialty, we applied and were approved to be a new residency site—one of the only community-based, nonuniversity programs, as well as one of the few who had not had a prior IR fellowship.


After building it up over the past 4 years, we now have one resident a year in the Integrated IR program, ESIR and Independent IR program. In June 2020, we graduated our first Integrated IR resident, Radu Serban, MD, amidst the COVID-19 pandemic.


Challenges Like similar radiology groups, the recent expansion of our health system has led to both excitement and growing pains in figuring out how to keep the same level of IR care across multiple locations, keeping or improving our clinical presence while increasing patient load and procedures, and balancing the need for more IRs to cover our busy call while still allowing them to practice mostly IR.


We have found this last challenge especially vexing and have added more IRs to the call pool. This also helps us get days off, since four IRs are needed to cover our IR service daily: two at our main hospital (including clinic), one at our second hospital and one at our vein clinic. Conversely, each added IR will decrease the amount of time each of us are on an IR rotation, and will likely increase the amount of DR we do. Finding the sweet spot in balancing IR call burden without sacrificing IR-focused practice has been like trying to hit a moving target, but it seems that we are close.


Other issues that I have encountered in this hybrid practice include performing many of the requirements of an academic residency without the built-in support of a university, such as having to fight for administrative help or having to work hard to get admin time. Additionally, relearning the way we practice has been difficult as we transition to a completely resident-run IR service (including having residents be primary operators and see all patients in clinics), but it has been gratifying.


Finally, COVID-19 has exposed how challenging it is to be an independent practice in a hospital-system-driven world, as well as the stress of taking care of not only your patients but your staff and the financial well-being of your practice.


The value of partnership I often realize how lucky I am to have joined such a democratic radiology group, where every partner is equal. We split all compensation equally, with the ethos that everything we do as individuals is for the collective good of the group and the betterment of our patients. There are no incentives or perks for leadership roles such as chair, group president or program director, nor for other time- consuming projects.


Equality also means that, at a partner meeting, a junior partner has just as much voice and vote as our most senior partner. While some could argue that we are too democratic on occasion, it has worked for our group, as we are happy and are able to provide truly outstanding patient care. A few years back, a radiology consulting firm we brought in noted that, as a radiology group, they were surprised by how harmonious and content we were in a macro sense. I believe that is because of our core values as a partnership and valuing our group over the individual. And that is why I am so proud to be a part of this practice.


Listen to Dr. Pyne discuss his practice and advice he gives to IRs-in-training on The Kinked Wire at bit.ly/KW-011.


20 IRQ | FALL 2020


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