Independent IR lives here.
The IR shortage is usually framed as burnout. The harder answer is structural: who owns the work, who sets the schedule, and who keeps the value it creates.
Notes from SIR 2026 in Toronto on whether independence is a real path or a story we tell ourselves.
Why private practice matters now more than ever. Back from the SIR Business of IR meeting.
Nearly two years into running an office-based lab. What went to plan, what didn't, and what I'd tell myself on day one.
Seven years of writing is a lot to walk into. These essays lay out the argument behind everything else, in the order I'd hand them to a colleague.
Why interventional radiologists are walking away, and where they are going.
The case against keeping every door open.
How IR practices actually make money, and what that means for the people doing the work.
For students weighing the specialty, before the match.
Leaving employment, building an OBL, and owning the outcome.
For students, residents and early-career IRs deciding what comes next.
Kavi Devulapalli, MD, MPH is an interventional radiologist in Columbia, Missouri, and the owner of Image Guided Solutions of Missouri, an office-based lab he opened in 2024. He writes here about what independent practice actually takes, and what it pays back.
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The long-form reading experience
Notes from SIR 2026 on whether independence is a real path for interventional radiologists, or a story we tell ourselves.
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Greetings from SIR 2026 in Toronto. The meeting is off to a great start, and the hallway conversations keep circling back to one question: can an interventional radiologist still build a practice of their own?
The answer depends on what we mean by independence. For some it is ownership of an office-based lab. For others it is simply control over the schedule, the referral relationships, and the kind of cases that fill the day.
Capital, patience, and a tolerance for the unglamorous parts of medicine. Payer contracts, staffing, inventory, and the slow work of earning referrals one physician at a time.
Independence is not a job title. It is a set of decisions you keep making after the easy option has been offered.From the essay
None of that is taught in training, which is exactly why it is worth writing about. The rest of this piece walks through what the numbers looked like in year one, and what I would do differently.
The IR shortage is usually framed as burnout. The harder answer is structural: who owns the work, who sets the schedule, and who keeps the value it creates.
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I was recently invited to contribute to a series of blog posts on the perceived IR shortage. The usual explanation is burnout: long call, thin staffing, and not enough recovery between cases. That story is true as far as it goes. It just doesn't go far enough.
Unhappiness in a specialty is rarely only psychological. It usually tracks something structural: who controls the schedule, who decides which cases matter, and who keeps the value the work creates.The shortage debate often treats these as separate problems. In practice they move together.
An IR can create enormous clinical value in a single day and still have almost no say in how that day is organized. When effort and ownership drift apart for long enough, even people who love the work start looking for the exit.
This is not a complaint about any one employer. It is how most of the system is arranged, and it is worth naming plainly.Margin notes like this keep asides and sources next to the line they belong to, without breaking the argument.
Burnout is the symptom people can see. Structure is the cause they rarely name.From the essay
More control over the schedule. Clearer credit for clinical work. And, for some, a real path to owning part of the practice they built.1
None of these are easy. All of them are more useful than another wellness module.
If the shortage is partly structural, then so is the fix. That thread runs through almost everything on this site, from locums to ownership to the case for independent practice.Related essays are linked automatically by topic at the end of every piece.
Kavi