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Mark H. Knelson, MD, thought his IR career had come to an early end—until he discovered locum tenens work.
Dr. Knelson’s original career path was similar to many other interventional radiologists. After completing his fellowship at Duke University Medical Center, he stayed on as an assistant professor, and later transferred to a community hospital in Raleigh, North Carolina. This 400-bed hospital was associated with a major cancer center, which offered Dr. Knelson the opportunity to take his experience at Duke and extend it into a community setting.
“That was our mantra,” Dr. Knelson said. “Someone could go down the road to Duke or UNC, but we could do everything they could, and in the patient’s neighborhood.”
Over the years, Dr. Knelson and his colleagues built a robust and fulfilling practice. But when his hospital was bought out and the radiology group let go, Dr. Knelson found himself at a different hospital, one further from his home which didn’t offer the same fulfillment he’d previously found. At that point, Dr. Knelson decided to hang up his lead and take early retirement.
“I was pretty happy, but I did miss the work,” he said.
The unintentional locum
At the start of the COVID-19 pandemic, Dr. Knelson heard that one of the radiology groups in his town was short on IRs. Because it was so close to his home—approximately 13 minutes—he offered to help, including taking call as needed.
“I didn’t get involved in a locum company, and I didn’t really know what that was,” he said. “I was just working when they needed help, if someone called in sick, and to help with call. Early in my career I had to take call every other night, so I knew how much difference it could make as a provider when you’re only taking every other third night.”
It was the start of a great relationship, Dr. Knelson said. But eventually the practice hired several full-time IRs, and his services weren’t needed as much.
“I didn’t really expect to keep doing it, but people kept sending me locum opportunities and encouraging me to think about continuing this work, so I did,” he said.
This work opened the door to a second stage of his career—one that was just as fulfilling 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 effort 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 offering more services.”
On a busy day, Dr. Knelson and his colleagues will cover up to three to five 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 significant 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 financial win.”
The benefit of an IR practice—even a part-time one—is more than just financial. 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 case of an unsuccessful retrograde procedure,” he said.
An uncommon model meets a common need
For Dr. Knelson, locum tenens work comes with all the satisfaction of practice, without the hassle of administrative burden.
“It is a huge gift,” he says. “Thank God, some people are very good at running practices and enjoy everything that goes into it. I have done that before, but I never really wanted it. With my current work, I’m essentially a hired gun. I come in, make sure people are doing well, and I’m happy while doing it.”
An unexpected benefit of locum tenens work is also the number of IRs he has been able to meet, he said.
“Very few IRs get to work with a ton of colleagues. We go to conferences and network, but day-to-day, there isn’t often someone there beside you to collaborate with, in most practices,” he said. “But collaboration is really built into the fabric of locum work. It makes life interesting.”
Although he enjoys the freedom and collaboration involved in locum tenens work, Dr. Knelson does acknowledge it limits opportunities for being involved in longitudinal care. While he has worked at institutions with dedicated IR clinics, he is not part of that service line—and he’s okay with that.
“Most counties in the U.S. do not have a single IR servicing them. Of the counties that do have an IR, most of them don’t have a clinic,” he said. “It’s a huge privilege and luxury to be able to perform IR at an institution with multiple IR rooms, a clinic and dedicated technicians.”
While having a dedicated practice is a wonderful experience—one he calls akin to “being in heaven”—Dr. Knelson points out that much of the IR work in the U.S. is being done in a very different sort of practice pattern. Those are the facilities who need locums, especially ones with IR skill sets who are comfortable with procedures like abscess drainages, biopsies, central venous access and gastrointestinal bleeds.
Dr. Knelson says he has found this work immensely satisfying, even though it wasn’t something he would ever have considered earlier in his career.
“I sort of fell into locum work, and I’m grateful for it, because it has really extended my career,” he said. “I like the casework. I like meeting patients and taking care of them, and I know I’m not alone in that.”
While Dr. Knelson has worked directly with several locum tenens companies, he says that word of mouth and just listing himself as “open to work” on LinkedIn has yielded plenty of opportunities as well.
“I strongly encourage people to at least consider locum tenens work. Deciding when you will work and on what terms is an eye-opening experience,” he said.
