best. I don’t do biopsies anymore, for example, because oncologists use the staff at their own hospital, so it didn’t make sense for the patient.


How do you find patients? WN: At first, I did a lot of marketing. To promote uterine artery embolization, I used to have lunches with every obstetric group in two counties to build relationships. In addition, although I was only at the hospital for a year, I did have relationships with some oncologists that I was able to leverage by showing them how I could provide better service for their patients in an outpatient setting. Now I’ve been in the area long enough to have a reputation and gain patients via word of mouth and referrals from previous patients.


Do you practice entirely in an outpatient setting, or do you have hospital admitting privileges? Do you have difficulties with exclusivity clauses? WN: Exclusivity clauses were a big issue for me early on, and they’re a huge issue across the country. If you can’t get hospital privileges, you can’t work in private practice, really. When I left my radiology group, I lost my hospital credentials, and two of the other hospitals in the area wouldn’t credential me because of exclusivity contracts. It was difficult to make the hospitals understand that my goal wasn’t to steal services from the radiology group, but I was still seen as a threat. Eventually, another hospital in my area granted me credentials because I provide services that the other groups don’t. It was a relief because I need those privileges in case someone in my vascular group needs me to fill in. Luckily, though, 90–95% of my practice is in the outpatient setting.


How often do you collaborate with your vascular surgeon colleagues? Do they ever send you patients? WN: They do. When it comes to pelvic congestion, up to 50% of patients get lower extremity and venous disease, and our practice sees a lot of lower extremity disease. My group does our own ultrasounds so if a partner sees a patient who has valve failure in the pelvic tributaries, they may refer the


At the end of the day, if you can throw out egos, the best practices should have IRs, cardiologists and vascular surgeons working together. My partners know their skills and mine, and if they need help they’ll ask and I’ll come and vice versa. There’s no territorial aspect to it. It’s very collegial.


patient to me for evaluation. I also offer headache treatments and the medical assistants will screen patients for me. If a patient has neuralgia and still has headaches despite medication, they’ll be referred to me. There’s a lot of collaboration in that aspect. And when I began practicing, I was nervous about not having another IR for backup, but my partners were very reassuring. They pointed out that when an IR needs to call someone for help, they call a surgeon, and I’m surrounded by surgeons who have my back.


Are you an independent entity within the vascular practice? WN: Yes. The vascular practice is its own entity, and my practice is a piece of that. My partners are pretty hands off.. I have everything I need within reason, like a budget for marketing. Because my partners don’t know IR, they’re very open to any ideas I have to grow the practice from a marketing standpoint or procedures I’d like to add. And because they’re established, they have the flexibility and leeway to help me grow my practice.


It sounds like you’ve received the support from the vascular


surgeons that you hoped to receive in your previous practice. WN: I really have. I know it may be controversial, because my practice model takes a totally different mindset. But each practice is different, and I see larger practices that have a lot of services and support for IR. I know that there are a wide variety of practice situations out there, and my earlier experience isn’t universal.


Historically, there have been turf wars between vascular surgeons and IRs, for a range of reasons. Do you experience that at all? WN: At the end of the day, if you can throw out egos, the best practices should have IRs, cardiologists and vascular surgeons working together. My partners know their skills and mine, and if they need help they’ll ask and I’ll come, and vice versa. There’s no territorial aspect to it. It’s very collegial.


Too often, we try to make people our enemies. We’re here to run a business but operating from a turf war perspective will only build animosity. It’s hard to overcome barriers, but eventually that animosity will cause issues with patient care. Yes, IR and vascular surgery exist in some of the same treatment areas, but the techniques are different and there are things we can learn from each other.


What advice would you give to other IRs who would like to set up a model like this? WN: If they work with other specialties at the hospital, it’s always worth exploring if there are collaboration opportunities. I’ve seen other IRs who partner with urologists, for example. It just comes down to thinking outside of the box and being willing to venture beyond your radiology group. Take a risk and get creative. When I talk about my practice model, people think it’s interesting and wish they had this opportunity.


Establishing a practice is an uphill battle to be sure, but it’s worth it if you’re determined to carve a path where you can practice the way you love. And if you have a bit of luck.


sirweb.org/irq | 9


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16