As we all know, practicing IR within a hospital setting can be wrapped up in a lot of politics. Because each hospital seems to have its own local nuances, figuring out how to navigate them can be a significant challenge. If it’s true that all politics is local, though, one solution for some IRs might be to relocate. After all, there can be a bright future just outside the hospital door in the world of outpatient health care.
Those considering the jump to outpatient IR will need to master a range of new challenges.
Patients
Attracting patients to your practice is obviously a primary concern. Some of your loyal referrers will follow you but you should also be able to get more referrers because you can now get their patients treated far more efficiently and quickly—their patients won’t need to worry about getting stuck in the hospital for what might end up being a 15-minute procedure.
However, marketing (which may be new to many inpatient IRs) is critical. People need to know you’re there and what you can do. Hiring a marketer can be helpful, but nothing beats you going out directly to shake hands and talk about what you can do and the superb service you can provide. It is equally important to personally close the loop with your referrers with a quick phone call: it’s an opportunity to emphasize the good work you’ve done.
Staff
You should consider highly skilled, like-minded individuals who are willing to step out of traditional roles: a nurse center manager, for example, can also be trained to scrub, market and run the scheduling desks. You might also consider nurses with critical care backgrounds and techs with many years of service.
Outside the hospital, you won’t have code teams and rapid-response teams; you and your staff are the team, so everyone will need to be on top of their game. In addition, the more interchangeable and multitalented your team, the fewer people you’ll have to hire and the better job they will do. You will also need to make your staff feel invested in the enterprise for it to succeed.
Costs
The bottom line is more important than ever now—you purchased that covered stent you’re placing, not the hospital; you are the cost center now. Look for ways to become as efficient as possible.
Treatment areas
In the past, some considered the bulk of outpatient IR work to be less than glamorous because it consisted of venous work, paracenteses, thoracenteses and other relatively basic US-guided procedures. These procedures remain necessary, however, and meet a significant need. Many IRs who focus on inpatient work find themselves involved in these very same types of cases, but hospitalizing patients for these types of procedures is both inconvenient to the patients and a hindrance to the health care system. This can lead to a very rewarding outpatient practice, where patients and their referring physicians are grateful to have a good IR perform these procedures and keep their patients out of the hospital.
More recently, as the reimbursement climate has evolved, a broader range of procedures have been added to the outpatient roster, including arterial interventions (such as UFE), PAD interventions and even oncologic interventions. This allows the outpatient IR to develop real expertise in niche areas, such as performing radial artery access for UFE and IO procedures that further maximize the potential of the outpatient space. Other options, such as vertebral body augmentation and pain interventions, further enhance the outpatient IR portfolio.
Conclusion
In all, if you choose to leave the hospital setting, you will have to wear many hats, but you may be able to gain more control of your career. You may wish to partner with other like-minded physicians and/or a corporate entity, which will enable you to focus more on high-quality patient care. Outpatient IR is an often-overlooked place for IRs to do what we do best: provide state-of-the-art care for patients.
