with them to help with aftercare and transportation,” she said.
The sense of community is something that Thomas Tullius Jr. MD, appreciates most about small practice. Dr. Tullius initially chose to practice in rural New Mexico to be closer to family and developed strong ties with his patients and colleagues.
“It’s nice to have a relationship with the patient that you may not have in a big hospital system,” he said. “And also, because it was a small hospital, I knew most of the other providers. We were a team—there was no competition.”
Part of the challenge in enticing IRs to rural practices is the fact that, due to limited providers, IRs in these communities will likely be required to offer diagnostic radiology services, as well as more basic procedures.
According to a survey conducted by the American College of Radiology on IR services in small and rural communities, 48.8% of IR respondents said they did not want to practice in a small or rural setting, while 67.5% reported that these practices were associated with a perceived inadequate “complexity of case mix.”4
Dr. Ignacio says there can be immense satisfaction found in the “bread and butter” cases of IR, however.
“I really enjoy caring for oncology patients and chronic disease patients,” she said. “They’re already going through their own personal war, and in Hawaii especially they may have to travel frequently by flight across the ocean, even for something small like maintenance on a catheter.” While these cases may be Iess complex IR work, Dr. Ignacio said that there is great professional fulfillment from providing essential IR clinical services and procedures that will positively impact patients’ quality of life, and ease their
2020–2024
worries and already stressful health circumstances.
“Patient interaction and clinical decision-making are the most gratifying part of my job,” Dr. Star said. She enjoys being part of the patient’s clinical care team and helping to guide their treatment plan—especially when able to provide additional therapy options.
“Even if the tumor board at a tiny hospital is just four people, it’s still great to have a seat at the table,” she said. “And you’d be doing your patients a disservice if you’re not there, because you may not be advocating for a procedure that could ameliorate a condition that the referring provider may not even know there’s an IR treatment for, or a therapy that could be a stepping stone toward more chemotherapy or pain relief.”
An IR presence in a community hospital can also open doors for other specialties to enter, said Dr. Ignacio.
“Something I didn’t realize is that a lot of small hospitals are unable to fully staff certain service lines at all because they don’t have an IR,” she said. “An IR entering a community health system can have a huge impact. It can enable a trauma surgeon to be recruited, or a gastroenterologist or a nephrologist with closer locale or better staffed hours, or bring in more advanced practice providers to support and extend healthcare. Having a baseline of specialists and other supportive healthcare professionals that collaborate and integrate with IR is necessary to provide high quality, safe team-based care.”
The future of small and rural practice Even if IRs are interested in pursuing practice in a small or rural area, the jobs may not necessarily be there—at least in the traditional sense. However, new and
2021 Governance restructure, benefit expansion
SIR members vote to amend the society’s governance structure, bringing in greater transparency and direct member involvement. Simultaneously, SIR dramatically expands its member services, resources, guidelines and toolkits, as well as establishing several new development courses.
34 IRQ | WINTER 2025
emerging practice models are paving the way for increased IR representation in underserved communities.
Independent contractors and locums Locums tenens work—or short-term, “fill-in” work—is thriving in small communities where hospitals may not be able to afford a full-time position line, or need proof of its value to the community.
Sonali Mehandru, MD, FSIR, did locums work for 3 years, during which she was able to train and expand her IR toolkit, focus entirely on her patients and gain a deeper understanding of what she wanted from a practice.5
For those interested in working in a small or rural community, but do not want to immediately commit to a position, locums contracts offer an opportunity to “trial” the position before either searching out a full-time role or negotiating the short-term contract into a long-term one.
“Each locums position I worked could be viewed as an extended job interview,” said Dr. Mehandru. “And as an employee, you get the opportunity to try out a group before committing. The experience I had with each group helped me make an informed decision on what opportunity to pursue.”
Bridging disparities Patients in rural areas tend to be older, poorer and have more chronic health conditions, as well as higher rates of tobacco use and obesity—concerns that are impacted by living further from health services than those in more urban areas.5
The 2020 U.S. census showed
that members of racial and ethnic minority groups represent 24% of rural residents, and this proportion grew by 3.5% between 2010 and 2020.
In rural Indiana, IR Nazar Golewale, MD, partnered with a home-visit
2022
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