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Coming to Terms With Reality
It’s probably time for an update on my OBL practice. We are coming up on two years now.
Practice & Ownership
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Recent essays
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The State of IR
The State of IR
Why IRs Are Unhappy: It’s More Than Psychological
Part of a multi-blog series on the perceived “IR shortage.”
The State of IRIndependent IR: Illusion or Reality?
Independent IR in the Crosshairs: Why Private Practice Matters Now More Than Ever
I just returned from the SIR Business of IR meeting in Atlanta. I left energized, but also a bit unsettled.
Start here
New to Line Monkey MD? Read these four first.
Seven years and 77 essays is a lot to walk into. These four lay out the argument behind everything else, in the order to read them.
- Essay 18 min
Why I Quit My $300,000 Job
Where the story starts: resigning from a hospital-based job in March 2020.
- Essay 210 min
Clinical IR: An Identity Crisis Rooted in “Ownership”
The core argument about who owns the patient, and why it decides IR’s future.
- Essay 316 min
The IR Hospitalist: Hospital MVP or Glorified Trash Collector?
The most discussed essay on the site, with 82 comments.
- Essay 47 min
What Is an OBL and Why Should I Care?
A plain primer on the office-based lab, the model at the center of this site.
Browse by topic
Five topics, color-coded like sheath hubs from 4 to 8 Fr
6 Fr
Practice & Ownership
Building an office-based lab, referrals, hiring and owning the outcome.
7 Fr
Money
How IR gets paid: RVUs, Stark and AKS, private equity, taxes and equity.
8 Fr
The State of IR
IR and DR, contracts, the hospitalist question, SIR and the specialty’s future.
5 Fr
Careers & Training
For students, residents and early-career IRs: training, first jobs, locums.
4 Fr
Clinical IR
Technique and cases: limb salvage, pedal access, DVT, TIPS and more.
Series
Running threads you can read start to finish
7 essays · 2022
Technical Tuesdays
Short technical tips from the procedure room, one each Tuesday.
3 essays · 2022Financial Fridays
Leverage, payment rules and your financial place in medicine.
4 essays · 2023 to 2026From the Meetings
Notes from SIR, WCVIS and the SIR Business of IR meeting.
2 essays · 2023 to 2025Guest Essays
Other IRs writing about compensation and leaving academic practice.
Your portrait
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About the writer
Written by a practicing IR who went independent.
Kavi Devulapalli, MD, MPH trained at UCSF and UNC, left a hospital-based job in 2020, spent three years doing locums, and in September 2024 opened Image Guided Solutions of Missouri, his own office-based practice in Columbia. He writes here about what independent practice actually takes.
- 2019Starts Line Monkey MD
- 2020Leaves employed practice, co-founds an OBL
- 2021Three years of locums across the Midwest and Florida
- 2024Opens IGS Missouri
- NowAlso building Physician Staffing Solutions and Travelier
The archive
77 essays
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