One year after leaving the University of Chicago, I found myself having a conversation with my father that I don’t think I will ever forget. My father is not someone who often talks about himself. Like many immigrant fathers, he is stoic, practical, and measured with his words. He worked hard, provided for his family, and rarely made his own sacrifices the center of conversation. But on this particular day, as we spoke about the first year of Joint and Vascular Institute, he told me something I had not fully appreciated at the time I left my academic position.
He told me he had been very worried about me.
From the outside, I understood why. I had a stable job at a world-class academic institution. I had recently been promoted to Professor of Radiology at the age of 41. I had built a clinical and academic niche in musculoskeletal embolization. I had published more than 150 peer-reviewed manuscripts. I was invited to national and international meetings. I had an NIH-funded trial preparing to begin. I had helped build a pulmonary embolism medical device startup. By most conventional measures, I was exactly where an academic interventional radiologist would hope to be.
But my father’s worry came from a deeper place.
He began telling me about his own life. After immigrating from India and holding a master’s degree in chemistry from University of Georgia, he took a better-paying job at Cook County Hospital in Chicago to support our family and his family back home in India. It was a job that, at least on paper, required only a high school diploma to start. He didn’t tell this story with bitterness. He told it simply, as fact. He had done what he needed to do. And then he told me something that stayed with me: he had not always been able to take the risks he wanted to take.
That conversation reframed everything for me.
Leaving the University of Chicago was not an impulsive decision. It was not because I lacked appreciation for academic medicine. In many ways, academic medicine had given me my professional identity. It trained me, challenged me, and gave me a platform. It allowed me to develop as a researcher, educator, clinician, and mentor. I had tremendous colleagues and extraordinary patients. I was proud of what I had built there.
But something inside me did not feel right.
It was not burnout in the traditional sense. I was not tired of medicine. I was not tired of interventional radiology. I was not tired of building. In fact, it was the opposite. I was afraid of slowing down.
I had reached a point in my career where, despite outward success, I feared plateauing. I felt constrained by the pace of large institutional life. Every new idea required layers of discussion, approval, committee review, administrative alignment, and institutional bandwidth. Even small changes could become slow and complicated. I do not say this to criticize universities; large systems are built that way for a reason. But for someone who wanted to move quickly, build directly, and create something different, it began to feel limiting.
The commute didn’t help. Driving nearly an hour and a half each way into the city became a daily reminder that my time, energy, and focus were being spent in ways that did not align with where I wanted the next phase of my career to go.
I still had too much I wanted to do.
I began thinking about whether there was a way to build an interventional radiology practice that combined the best of academic medicine with the best of old-fashioned patient care. I wanted to create something that felt academically serious but personally accessible. A practice that could participate in clinical trials, publish, teach, host trainees, collaborate with industry, and attend national and international meetings — but also feel like going to your doctor when you were growing up.
That became the philosophy.
An academic-oriented outpatient practice with a personal, concierge feel.
I wanted to build a place for patients who did not want to go to a hospital for an elective procedure and deal with the same frustrations I had watched patients experience for years: long drives, long waits, inefficient systems, confusing bureaucracy, and the gradual erosion of the doctor-patient relationship. I wanted a practice where patients could be seen quickly, treated thoughtfully, and followed closely. I wanted the physician to remain central to the experience.
Initially, I proposed a version of this model within the university. But it became clear quickly that even if the idea was sound, the timeline would not work for me. The more I worked through the proposal, the more I realized something important: my partner, Dr. Mikin Patel, and I had the skill set to do this ourselves.
Mikin brought a level of financial discipline, operational thinking, and business judgment that was essential. I brought experience building clinical programs, developing referral networks, creating academic momentum, and telling the story of new procedures in a way that patients and physicians could understand. Together, we began to believe we could do this.
We spoke to mentors. One of the most important was Dr. Jafar Golzarian at Northstar in Minnesota, who had already shown that an independent IR practice could maintain clinical excellence, academic credibility, and entrepreneurial independence. Those conversations helped us see that there was a path, even if it was not the conventional one…. Eventually, we decided to take the plunge.
We opened Joint and Vascular Institute.
The beginning was not glamorous.
In fact, it was humbling.
We started very lean. At first, it was just Mikin and I. We rented some small office space from a GI practice. We answered the phones ourselves. We checked in patients. We placed orders. We followed up on labs. We called patients back. We dealt with scheduling, insurance, supplies, forms, vendors, and every small operational issue that comes with starting something from nothing.
There were moments when it was a significant hit to the ego. I had just left a major academic institution as a newly promoted professor. Now I was sitting in a small rented office space, answering phones and figuring out workflows that had previously been handled by layers of staff.
There were also moments of fear.
I wondered if I had made a mistake. I wondered whether patients would come once the university was no longer attached to my name. I wondered whether referring physicians would trust a new independent practice. I wondered whether leaving the security of a major university had been reckless.
But slowly, something began to happen.
Patients came. Referring physicians called. Procedures were scheduled. Follow-up visits turned into success stories. The practice began to take shape.
More importantly, we began to feel the power of independence.
If something needed to change, we changed it. If a workflow was inefficient, we fixed it. If we wanted to launch a new service line, we built the pathway. If patients needed to be seen quickly, we made room. If a referring doctor had an idea, we could meet, decide, and execute.
We could move at the pace we wanted to move.
That was the most liberating part.
Independent practice does not mean easy practice. In many ways, it is harder. There is no large institution behind you absorbing every problem. Every decision matters. Every hire matters. Every expense matters. Every patient experience matters. But there is a clarity that comes with that responsibility. The work you put in has a direct relationship to what you build.
One year later, Joint and Vascular Institute looks very different than it did at the beginning.
We now have two sites, with a third site coming soon. We have fourteen employees, including two nurse practitioners, a research fellow, a research coordinator, medical assistants, an X-ray technologist, a manager, revenue cycle support, marketing support, and in-house counsel. We have medical students and residents who still come spend time with us. We have built clinical programs in musculoskeletal embolization, hemorrhoid artery embolization, prostate artery embolization, fibroid embolization, thyroid embolization, venous disease, and other outpatient interventional therapies.
Just as importantly, we have maintained our academic identity.
We are participating in multiple clinical trials and registries. We are continuing to work with industry. We recently hosted a genicular artery embolization workshop through GEST. We remain involved in national and international meetings. We continue to teach, publish, collect outcomes, and contribute to the broader development of the field.
That was always the goal.
I did not leave academics to stop being academic. I left to build a different academic model.
I believe independent interventional radiology practices can occupy a unique space in medicine. They can be nimble without being superficial. They can be patient centered without being small in ambition. They can be entrepreneurial while still being evidence-based. They can create new clinical pathways faster than large systems, while still holding themselves to high academic standards.
For interventional radiology specifically, I think this matters.
Our specialty has always been built by people willing to create new paths. We have repeatedly taken procedures that did not exist, built the evidence, educated referring physicians, trained the next generation, and convinced patients that there was another way. In that sense, independent IR practice is not a departure from the spirit of the field. It is very much aligned with it.
But it requires a different mindset.
You have to be willing to do things that feel beneath your title. You have to be willing to build before anyone believes in what you are building. You have to tolerate uncertainty. You have to accept that there will be days when the prestige of your old position feels very far away. You have to be comfortable with the fact that no one is coming to save you.
At the same time, you get something rare in return.
You get alignment…. You get to decide what kind of practice you want to build. You get to decide how patients are treated. You get to decide what procedures matter. You get to decide how fast to move. You get to decide whether research remains part of the mission. You get to decide whether education is built into the model. You get to create the culture rather than inherit it.
That is not a small thing.
When I think back to the conversation with my father, I realize now that taking risks is itself a luxury.
My father did not have that luxury. He had responsibilities that came first. He had a family to support here and a family to support back home. He made choices that gave me the ability to make different choices. His sacrifice created my optionality.
That is not lost on me.
When he tells me now that he is proud of what we have built, it means something different than a professional compliment. It connects his journey to mine. It reminds me that independence is not just about autonomy or entrepreneurship. It is also about honoring the opportunities that other people sacrificed for you to have.
Forging your own path is risky. It is scary. It is time intensive. It can be lonely. It will challenge your identity, your confidence, your finances, your relationships, and your assumptions about what success is supposed to look like.
But it can also be deeply rewarding.
Because when you build something yourself, there is a direct return on what you put in. The extra call to a patient, the late-night planning session, the difficult hire, the new clinical protocol, the research registry, the community lecture, the referral relationship, the follow-up visit. All of it matters. All of it becomes part of the structure.
One year in, I know we are still early.
There is much more to build.
But for the first time in a long time, I feel that the pace of my career matches the pace of my ambition. I feel that the practice reflects the kind of medicine I want to deliver. I feel that we are creating something that is both personal and academically meaningful.
And most importantly, I feel like I am not slowing down.
I am just getting started.