In 2010, Vivek Padha, MD, FSIR, received a life-changing offer: Creating an IR service line within a group of four DRs in the West Virginia University (WVU) Health System.
“There was pretty much nothing,” Dr. Padha said. “They didn’t have a room, nurses, equipment, inventory … nothing.”
Dr. Padha, a former family medicine physician and colonel in the U.S. Army Reserve, and the Radiology consultant to the Surgeon General of the Army, accepted the challenge and got to work setting up an IR service at the WVU Berkley Medical Center in Martinsburg. They went from zero IR presence to a strong clinical practice with six registered nurses, six radiologic technologists and two dedicated IR rooms. He had support from the hospital system and his DR colleagues. And although he still provided DR call coverage and image reading support, his partners would help in return by performing some of the simpler IR procedures, such as breast biopsies or thoracentesis and paracentesis procedures.
For 10 years, the service grew and the partnership flourished—until the COVID-19 pandemic. After providing telehealth services during the lockdowns, Dr. Padha’s colleagues decided they would not return to in-hospital services and did not renew their contract. Only Dr. Padha would remain, becoming a WVU employee.
“I spent 10 years building up very strong relationships with the community and the staff, and I did not want to leave,” Dr. Padha said. “The staff, referring physicians and patients relied on us, so I decided to stick it out and stay on site.”
The challenge, Dr. Padha said, became how to maintain both the IR and DR service lines, emergency room, and trauma coverage with only one board-certified radiologist in the hospital.
Covering the basics
Despite advertising for new DR and IR physicians, the growing shift toward teleradiology, paired with the difficulty of hiring in rural West Virginia, meant that the hospital system was unable to find anyone to replace their previous DR group.
“Eventually, I sent out requests on social media for anyone who would be willing to help us,” Dr. Padha said. Through this, he connected with radiologists at other West Virginia DR groups, who agreed to read remotely.
“They were kind enough to help, and I think they also realized that the community would suffer without the support,” Dr. Padha said.
With these agreements, the hospital now had coverage for emergency reads—but there are still many services that require an in-hospital presence, which now fell to Dr. Padha.
“When a five-person group shares responsibilities, you don’t realize how many administrative tasks there are,” he said. “But when you’re the only one left, you have to cover all the meetings and fulfill all the regulations.”
To comply with the hospital’s regulatory requirements, Dr. Padha served as the system’s radiation safety officer. He also had to maintain a Mammography Quality Standards Act (MQSA) certification to read mammography—which required completing over 20 hours of CME work.
“This was my hospital, so I had to take ownership,” he said. “I’ve learned in the army that sometimes you just have to step up and do your best.”
At this time, Dr. Padha was covering the two hospitals within the Eastern West Virginia healthcare system, as well as the local Veterans Affairs hospital. As a result, he was providing all the IR/DR call for three hospitals while maintaining his IR service line at WVU.
24/7, 365
Over the previous 10 years, Dr. Padha had established a strong IR clinical practice, providing consults as well as interventions for everything from biopsies and drainages to peripheral arterial disease and interventional oncology. In addition, his system regularly hosted students rotating in from West Virginia medical schools.
“I was very busy,” he said. “I was averaging 20 plus cases a day and had to make myself available 24/7, 365.”
Even with support from other radiology groups, the patient volume required a regular in-person presence, Dr. Padha said. If the internet went down, for example, someone had to be on site to read trauma cases. And hospital staff needed someone they could turn to with questions.
“You want to be available to relay with a surgeon if needed,” he said. “And if a technologist has a question about a scan, they would seek me out, because they didn’t know any of the radiologists who were reading.”
At times, even an on-site presence wasn’t enough: Dr. Padha needed someone with more specialized imaging knowledge such as high-level MR details or neuroradiology expertise.
“I don’t think remote radiology is the perfect solution for patient care,” he said. “Teleradiology is vital but it cannot replace good radiologists who are on site.”
Fortunately, Dr. Padha said, his hospital and colleagues understood the challenges, as well as the value that the IR service line brought to the community.
“I have nothing but good things to say about our hospital administration and colleagues from other specialties,” he said. “They were very encouraging and understood there were times I could not be there. But they knew that if I said we couldn’t do something, there was a very good reason why. But in general, we never really said no. If I could get up, get in my car and go provide care to a patient, I would.”
Innovative recruiting
Even with support from his hospital and other West Virginia radiology groups, Dr. Padha knew that serving as the only on-site radiologist in a three-hospital system wouldn’t be sustainable in the long term. Since they had been unable to recruit another physician, they had to get creative.
“I wanted to bring on board a nurse practitioner (NP) and physician’s assistant (PA) to help,” he said.
Because this had never been done in his hospital system, they had to get approval from the state medical board and the hospital’s legal staff. Dr. Padha even consulted with other SIR members who had employed NPs/PAs in their practices. Eventually they were able to hire both a PA and an NP.
“I trained them to do several procedures, and so now they will do procedures during the day, while also helping with a fair amount of my consults and follow-ups,” Dr. Padha said.
According to Dr. Padha, these additional roles were instrumental in helping the service line survive. If a practice is unsuccessful at recruiting physicians, and if state regulatory rules allow, hiring an NP or PA can help sustain provision of services.
“When I tell people about my practice, I get goosebumps. I realize how blessed I am with a wonderful team and staff,” he said. “I wouldn’t have been able to do this without them.”
Since then, Dr. Padha has been able to recruit two more on-site diagnostic radiologists. However, they still leverage teleradiology to keep up with the demand created by the emergency department (ED).
“Our emergency room is the busiest in the state, even though we’re not the largest hospital. So, it’s a busy diagnostic service,” he said.
By leveraging teleradiology to help with the ED, Dr. Padha and his DR partners are now able to cover more elective procedures and have begun rebuilding their medical education mission.
The face of clinical radiology
Dr. Padha is still the only IR in his hospital system, managing a service line that sees up to 30 cases a day. And despite the immense challenges, Dr. Padha said that the experience has reinforced his belief in the role of IRs as clinical leaders.
“I think IR training inherently gives us an edge, because we are a patient-facing specialty that is comfortable communicating with patients, staff and referring physicians. It’s a natural fit for us to be the face of clinical radiology.”
While his experience has been unique, he doesn’t think it’s unusual. The IR workforce shortage, as well as the push and pull between IR clinic and DR call, is a common issue across radiology practices, Dr. Padha said, no matter the group’s size.
“When any larger practice loses IRs, they get stressed out as well. Mine is at a different scale, true, but it doesn’t mean that a practice with five IRs can lose two of them and be fine.”
The advice he would give other IRs—as well as his younger self—is to remain flexible and seek every education opportunity.
“Even if you are training to be an IR, do not dismiss your diagnostic training, because you never know when you’ll need it,” he said. “You have to be a good DR to be a great IR.”
He also encourages younger IRs to broaden their skill sets, especially if they plan to work in a more rural area. That means learning specialized skills like interventional oncology, understanding how to provide pain injections and kyphoplasty, familiarity with neuro IR, and more.
“A broad foundation will help you adapt to pretty much any environment—or any challenge that it brings.”
