In this episode, host Dr. Michael Barraza interviews interventional radiologist Dr. David Johnson about practice building in an IR/DR group, including factors that make a good job, and how he formed one of the largest PAE practices in the Southeast. --- CHECK OUT OUR SPONSOR Viz.ai https://www.viz.ai/ --- SHOW NOTES Dr. Johnson found his current job, his first out of fellowship, via a job board. His wife, an ER physician, was looking for a job at the same time, which complicated their search slightly. They ultimately found their current positions by being flexible and understanding that no job is perfect. Dr. Johnson believes that when searching for a job, “you can't let the best be the enemy of the good.” What he was looking for in a job was a practice where he could do a lot of IR in a situation where he could build the IR practice that he wanted. He notes that this is something you should try to find out beforehand during the job search because, at some practices, it’s very difficult to change the way things work and the types of procedures they do. One of the most important things to consider and something he recommends to anyone looking for an IR job is the potential for growth. He cautions that this is a long game you must be ready to play. You can't expect to come in and change or build a practice in 2-3 years. After he found his footing and established himself in his new job, he began to grow his practice by finding out what the need was in his community. He started by marketing multiple service lines and seeing which would stick. He did this so that he could feel things out and see which physicians ended up referring to him, and which didn’t. It can be hard to balance practice building while in a combined DR/IR practice due to your DR responsibilities, due to quotas and RVUs. He says that you need to keep your mind on the long game in this situation. He did this by talking to at least one clinician every day about a patient he could help in some way. He figured that if he did this for two years, he would slowly get his name out and build a referral base. Most of these calls were low yield, but it paid dividends for him in the long run. About 1-2 years in, he began getting calls from physicians that he had talked to asking if he could do something for a patient. Finally, Dr. Johnson speaks on how he approached prostate artery embolization (PAE), a procedure that previously didn’t exist in Fort Myers, FL, and used it to turn his practice into one of the biggest PAE centers in the Southeast. He thought of the procedure as a challenge, which he was looking for, and he knew there was a need in the community, so it was something he realized could grow. He didn’t know how to do PAE, but he turned to the STREAM Meeting to learn the technique. He stresses that this was not a fast process. It took 18 months from when he attended STREAM to when he got his first patient on the table. His first patients were self-referred. He built referrals by doing the procedure well and garnering good outcomes. Importantly, he provided good consults and follow-ups, always making sure to include a follow-up with their urologist to whom they reported the good results. To help his clinic run successfully, he had to hold himself accountable to ensure things got done. He relies heavily on digital reminders as well as a great medical assistant who does most of his scheduling. For his PAE patients, who often experience post-PAE syndrome, it is important to him to be available for them; he doesn't want them to feel abandoned. He gives them his cell phone and tells them to call him day or night. It is important to him to be more than just the technician. He wants to be there for them, to be the first person they call, to be their physician. He also believes closing the loop with referring providers is crucial to maintain rapport and a strong stream of new referrals. --- RESOURCES STREAM Meeting: https://www.thestreammeeting.com