This work opened the door to a second stage of his career—one that was just as fulfi lling as his earlier work, and which allowed him to do what he loved: 100% IR service.


Since that initial job, Dr. Knelson has gone on to work at various practice types, from Level 1 trauma centers to 100-bed community hospitals. He has not taken any work outside of his home state of North Carolina, which means he has not had to pursue any additional licensing.


“I get to experience a nice mix of practices and caseloads, and it’s been surprisingly gratifying,” he said.


Building an IR presence Currently, Dr. Knelson is working part- time at Scotland Memorial Hospital in Laurinburg, NC. Dr. Knelson was contacted by a founding partner at Locums National, who informed him that the hospital’s radiology group was going almost exclusively to telehealth. Although they had a very nominal IR presence before, there was one radiologist left who was willing to cover IR service.


“She had done IR earlier in her career and was very well-trained, but she was nervous about taking it up again and wanted someone to mentor and help her for a bit, and they asked if I would come down to help,” Dr. Knelson said.


Scotland Memorial is an unusual hospital, Dr. Knelson said, because it isn’t owned by a larger company, and is essentially run by community leaders—a model that has become increasingly rare.


“Because of their ownership model, the hospital administration is very dedicated to putting in the eff ort to make sure the community is cared for, and I really admire that ethos,” Dr. Knelson said.


Unfortunately, although the radiologist he went to help was very skilled and eager to learn, she did not ultimately feel comfortable with the breadth of IR procedures, Dr. Knelson said. As a result, the hospital asked Dr. Knelson to cover the service instead.


Because he lives over two hours away, it was not feasible for him to have a daily


presence—so he reached out to several friends and colleagues to pull together more robust coverage.


“We can now cover three days a week, virtually all weeks,” Dr. Knelson said, an arrangement that currently covers most of the facility’s needs.


“Obviously, we can’t do everything,” he said. “We don’t have an angio suite, and we can’t predictably get into the cath lab. But we’re trying to work through those things and progressively off ering more services.”


On a busy day, Dr. Knelson and his colleagues will cover up to three to fi ve cases; on a slow day, it may just be one or two. Currently, they are working to convince the administration to build out a full IR practice with a dedicated IR suite. In the meantime, however, they have portable technology that they utilize, and they share space with other specialties.


“Sometimes we get called in and I have to say no. We don’t have the room, or the catheters or other specialized materials. I can do the procedure, but I can’t do it at that facility,” Dr. Knelson said. “In those cases, the patients unfortunately have to be transferred out.”


Even still, this is a signifi cant improvement from previously, according to Dr. Knelson, when all patients would have to be transferred out for IR services.


“People may not realize how expensive it is to transfer patients, even on the ground in an ambulance,” he said. “Once you start dealing with helicopters, it is stunningly expensive. If a hospital can avoid transferring even one patient out, that’s still a meaningful fi nancial win.”


The benefi t of an IR practice—even a part-time one—is more than just fi nancial. Fewer transfers mean that patients can stay and be treated within their community, resulting in a better experience and less disruption. Additionally, Dr. Knelson says, having an IR presence makes the other physicians feel more comfortable.


“The other specialists appreciate that there is someone in the hospital who knows the bread-and-butter techniques, who can, for example, perform a percutaneous nephrostomy in the


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“I get to experience a nice mix of practices and caseloads, and it’s been surprisingly gratifying.”


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