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Physician career pivot: navigating the path to professional reinvention and fulfillment

Physician career pivot: navigating the path to professional reinvention and fulfillment

Dr. Jafar Golzarian
Dr. Kavi Krishnasamy

Drs. Jafar Golzarian and Kavi Krishnasamy share their views on the value of career change, making bold moves based on reflection and not frustration, the many flavors of mentorship, and more.

Episode Transcript

Narrator (00:00):

Recorded live from the Cook booth at SIR and featuring leading experts in the field of interventional radiology discussing a wide range of IR related topics, this is the Cook@ SIR Podcast Series.

Dr. Kavi Krishnasamy (00:17):

Good morning, everybody. One thing we want you to think about as we talk about career change today, as you progress through your career, you may be bored. You may be developing new interests and passions. You may be looking for different pathways within the IR field. Fortunately, IR as a specialty offers a number of different pathways to explore, and it’s possible to make really any of them work for you. So, embracing career change can lead to a healthier you, which in turn can help you provide better care for your patients. Whether it’s academic to private, private to academic, anything to OBL, career change is really part of all of our processes.


So, with that, again, welcome everybody. We’re live at SIR within Cook’s podcast booth. My name is Kavi Krishnasamy, and I’m here and honored to be with my esteemed guest, colleague, and friend, Dr. Jafar Golzarian. We’re here to share something in common: career change. However, we want to delve into why we chose the paths we did and our journey during our shift in career. Before that, let’s start with some quick introductions and why we chose IR in the first place. Go ahead, sir.

Dr. Jafar Golzarian (01:19):

Hi, Kavi. Thank you for the introduction. It’s a pleasure to share this broadcast with you. Yeah, I was a resident in Belgium way back, and I had no idea what was IR, but in the University of Brussels, we had a very advanced team of physicians, both in MR and interventional. When I did my rotation in intervention, I was really stunned by all the things that these guys were doing. The early times where the stent was coming, I remember the first Glidewire coming in. So, I look at that and say, “That’s what I want to do.” Since then I never regretted even one second my choice of going to IR.

Dr. Kavi Krishnasamy (02:19):

So that’s a great question. You’ve had a lot of transitions and changes in your career from Belgium to the US and then even within the US. So, tell me a little bit more about that.

Dr. Jafar Golzarian (02:29):

Yeah, so I’m originally from Iran, as you know. When I was 17, I was a good student. With my brother, we wanted to go to the university, but there was revolution. The university was closed, so we decided to go to Belgium, because my family had friends there. So, first big move from the comfort of our home to Belgium, learning French, which was more painful than going through medical school, and then medical school at the University of Brussels for seven years and then radiology training at the Erasmus Hospital, which was the major hospital of the University of Brussels. Then I stayed on board as the division head for 10 years.

Dr. Kavi Krishnasamy (03:28):

In Brussels?

Dr. Jafar Golzarian (03:29):

In Brussels. Yeah.

Dr. Kavi Krishnasamy (03:30):

Oh, wow. Okay.

Dr. Jafar Golzarian (03:31):

Before I tried to move. But let me ask you the question. Why did you choose IR?

Dr. Kavi Krishnasamy (03:35):

Yeah, that’s a great question and I think a similar sentiment to you. So, I started in general surgery and I think that is a common theme for a lot of IRs. We start in other specialties and then we discover IR and then we become a little bit smitten with IR. Part of it is the devices and part of it is the technology. Part of it is the breadth of the specialty and the ability to really focus our career in any service line. So, I was exposed not in medical school, but as an intern, and then again, smitten.


It was an easy decision to transition and lucky to have the avenue to do that and then have never looked back. For me, radiology was a pathway to IR. We both trained before the advent of the IR residency, but there was just no question from the beginning. It was a pathway to get to IR. Then practice is 100% IR.

Dr. Jafar Golzarian (04:27):

One thing in IR that is amazing and we all know that is: IRs are innovators. When I started to take over the leadership at University of Brussels, I would try to continue to innovate and develop the practice. Ten years later, I had a meeting with a lot of my faculty and look at the schedule comparing 10 years before and then 10 years after. Half of the procedures that we were doing at that time didn’t even exist 10 years before. That’s the trend that I’ve seen over the last 30 years being in IR, which is really amazing. I think it’s very unique to our specialty.

Dr. Kavi Krishnasamy (05:19):

That’s a great point. I mean, it feels like every day there’s a new discussion of a new technique or something. You’re right. I mean, things that I did as a fellow in 2012 are not even on the radar anymore and things that I couldn’t even comprehend at that time or things we do every day now. So, it’s very, very cool to see. But after Brussels, then was Iowa, then was Minnesota. So, tell me about those transitions.

Dr. Jafar Golzarian (05:44):

Yeah. So, in Belgium, academic positions are very competitive. So, you need to publish, you need to be showing your leadership, and the positions are limited. So, let’s say you are four physicians at the same level and you want to get promoted to the associate professor. There’s only one position available, so not everybody can be automatically– So, I got to the position that we call tenure position, and I was 37. The usual practice was for many physicians that when they get to that position, they say, “Okay, now I’m a permanent member of the university.” They slow down, and I was not in a mood to slow down and started to really think of “What’s next for me?” So, already I started to realize that maybe if I stay there, I may be just, I would say, sclerosing over time.


Then there are also some of the other things related to my kids. So, after a lot of discussion with my wife, we decided that we need to look at some other adventures. I sent out my CVs in North America and other countries. Actually, I was very fortunate to get offers from McGill and from other places. When I was negotiating with McGill, I had an amazing offer from University of Iowa. So, we discussed and decided to go from Brussels to Iowa City, which a lot of people would say, “What happened to you? Did you have a stroke to go from Brussels to Iowa City?” But it was an amazing, amazing move, and I was very confident that I could be successful. I realized that of course any change comes with a lot of pros and cons and it was not easy for me the first few months to get adjusted.


The practice was different. There were not many peripheral vascular done because of the competition and turf problem. The relationship between techs and nurses and physicians were different and more regimented than a country, like in Brussels, where things were very spontaneous, I would say, even though there were really some good rules. But in Belgium, we were all as a team. Everybody stayed there until everything was finished. In Iowa, you had the techs that had their decision-making leaders and then nurses. Then they decide at what time they should call a patient. So, it was lots of adjustment, but it was one of the best move I’ve ever done.


What is very impressive when you change even more from one hospital to another is when we go from one country to another or going from Europe to the US or continent from another, you start to see a lot of opportunities for improvement. You realize what could have been done better in your previous life. I really think that I became a better person as a whole and much better IR physician. I remember I was going back to Belgium and discussing a lot with my partners and friends. I’ll say, “If I had to come back, I will change this and this and the other.”


Some of the things that I never thought that were good ideas, but when I saw, for example, vascular surgeons be more involved with peripheral vascular, I realized by their knowledge of endovascular procedures, I get much more complex cases now. These are something that in Belgium, it was, “Oh, no, that should be surgery,” because they didn’t have at that time that level of knowledge. So, I think with each move and each change, you improve. You improve in your personality. You improve in your strengths, I would say. Also, you improve in your professional career in terms of knowledge, learning from different people, how they do it, and you can learn from everybody. So, I think it was very, very important move for me and my family.

Dr. Kavi Krishnasamy (10:55):

Yeah. Well, two things I want to highlight. I mean, I think one, that experiences you’re alluding to, it’s truly additive in an exponential way. So, with every transition, you’re bringing a whole new set of ideas to the new place and just engaging in different ways, which is unparalleled. But then I also want to go back to one thing, you left a tenured position and you’ve done that multiple times.

Dr. Jafar Golzarian (11:20):


Dr. Kavi Krishnasamy (11:21):

Which is amazing in its own right.

Dr. Jafar Golzarian (11:25):

I think tenured positions are important, but I think one of the enemy of innovation is comfort. As long as you don’t go out of your comfort zone, you won’t be challenged to come with solutions and do innovation. It’s in every aspect of life, not only in academia. I just feel that the tenure was offered as a recognition of your effort. You have done a lot of effort that’s great. Now, you are permanent member of the university, but it was not supposed to be an end of the career. A lot of tenured person that I talk to say, “Oh, I am already a tenured professor. I don’t need that.” So it’s not a question of need. If you want to be relevant and if you are passionate about what you do, you just need to get out of your comfort zone. So, I left my tenured position in Brussels.


Then five years after Iowa, I had an amazing offer that allowed me to open my embolization lab and everything from University of Minnesota. I stayed there for 15 years as a division head and tenured professor and vice chair. Then recently, I decided to give it up again. I am still an emeritus professor and go to university, but I opened my OBL with my partner, Dr. Astani. We tried to bring that experience to an outpatient facility with some other benefits of the patient, I think. Also, our commitment was to show that you can still do an office-based lab work with the same quality but with more focus on patients and patient comfort because of all the difficulty to go to the hospital and all these things. So, I did that move recently again. So, it’s taking time.

Dr. Kavi Krishnasamy (13:54):

Okay. Wow. I want to come back to a point real quick, but I want to say something and I’ll echo what you said. I think getting out of my own way, getting out of my comfort zone led to my first career transition, when I spent the first five years of my career at the NIH. I loved my time at the NIH. I loved the preclinical lab, the whole team, my boss Brad Wood. But what led me to Atlanta and to Emory was career change and getting out of my comfort zone, and then what led me to New York after that was a little bit different. It was actually getting out of my comfort zone in my personal life and getting married.


So, I think there’s a lot of flavors for getting out of that comfort zone. Now, as I look to my next transition, it is about building a full-fledged academic team and an interventional MRI suite and things that I’m very passionate about, but again, getting out of my comfort zone. So, lots of transition for both of us. Where does family and peer support come into play with each of these moves?

Dr. Jafar Golzarian (14:52):

It’s a great question. I truly think that job or work and passions are important for us, but they’re only important as part of yourself, I would say. What is bigger for yourself is your family, your friends. With every decision you make, there is a give and take. You definitely acquired something, but to acquire something, you give away something. But I think it’s extremely important that these moves are in line with the best interest of your family. I think for most of us, we couldn’t do what we do and we can’t be successful if there was not a strong family support behind us. I would say my better half has always been very supportive and sometimes even to a degree of sacrificing her, I would say, interest for the better of the family.


I really say always the family is extremely important and you can’t be successful without a successful family and without support from your family. Of course, all of these decisions should be based on a lot of reflection. We discussed about that before. You should not change because of frustration or emotion. You have to discuss and actually do a research. The same thing that we do at our work, we research everything. You have an idea. What do you do? You go and do a research. You look at the Medline. You start to see what has happened in that area. You talk to people and then you start to do the same thing for this decision.


We can probably go back and I can ask you the same question, but what really made you change your last career and why did you change? But one of the important thing is that, and I always say that to my fellows and friends, you don’t change because of frustration, but you change for a better cause. So, maybe asking this question, compared to the last job that you had, what made you decide that it’s time for me to change?

Dr. Kavi Krishnasamy (17:52):

Yeah, absolutely. That’s a great question. I think part of that comes down to priorities and our priorities evolve over the course of our career. I think as I’ve gotten further advanced and gained more experience, like you already alluded to, there are more things that I want in my career. So, my next step is to build out a full interventional oncology service line, but not just build the clinical service line, the ability to add the academic side to it and then change some of the patient care algorithms in the next 5 to 10 years. That’s what I’m passionate about. So, that’s the opportunity that I was looking for, that I am looking for, and looking forward to, but I feel like I’m at the right stage in my career to do that. Five years ago, I don’t know that I could comprehend that.


Then I think going back to family, that’s important as well, because my wife is an IR, you know that. When we made the transition, it was for her job and her career, which she has an amazing career in New York. Now, as I’m making a transition, it’s with her support, because I’m leaving her in New York and moving away. To your point, without supporting each other’s in each other’s careers, we wouldn’t be able to do that. So, I’m very lucky and very blessed to have that opportunity but then to have my wife support me just like that as well. But yeah, it is dependent on I think where we are in our careers and what our next aspirations are, right?

Dr. Jafar Golzarian (19:13):

So each time I go to a meeting and people hear that probably I would’ve been the last person that people would ever imagine to leave academia. A lot of people ask me, “Are you out of your mind? Why did you at this age give away your tenure?” or “I hope you know what you are doing.” That’s one of the things I heard recently, and I just want to go back to really this decision. Why at some point I made that drastic decision to leave a tenured position and not to go for a chairman position or a division head position somewhere else. Just to go to a private practice. So, there are multiple reasons. Really I think the division of interventional ideology at the University of Minnesota is we build with the team an amazing, amazing group of physicians.


We build an infrastructure that is unmatched, because we have clinic, we have coordinators, we have PAs, we have NPs. But what I realized at some point in my career is that I don’t see any other path to just phased retirement, because I think it’s very important for the leadership and that’s my message to all the leaders that would listen to us is that it doesn’t matter how important or famous or accomplished are the people who are working under your leadership. You should have a development plan for all of them.


If you can’t offer that and you can’t sit down and discuss with them and propose and offer some development plan, say, “What are you passionate about at this stage of your age? What do you want to do?” people start to get bored and start to get to this when you ask them, “How are things?” same old, same old. That’s one of the worst answer you can give to someone. When you say, “Same old, same old,” I’m bored, I don’t get anything fancy anymore. I go to work and it’s just the job. I hear that a lot. A lot of my friends, colleagues who were working with me were saying that.


I say, “Wait a minute. Let’s sit down,” and say, “What are we doing every day? It’s not just a job. We are working every day to improve patient’s life, patient quality of life. We have fun doing that. So, it’s not just a job.” But at some point, when you start to look at your retirement, suddenly you start to say, “Okay, what is there for me for the next few years?” You start to become with that mindset of this is just a job. You go every morning, wake up and say, “Okay, you look at when you’re going back home.” These are really signal that you are not happy in your job. I think happiness is important. Goal is important. Motivation is important. I think there are all of these things that come to play.


So, for me a few years ago, when I try to look at what is next in my career, and by the way, one thing just in the parenthesis, I said, being part of a diagnostic radiology team sometime can be a good thing, but very often it’s a hustle for convincing the team to be doing your work at the highest level, because it is a difficult situation to make them understand a lot of things that we do and especially to justify why with the RVUs that we are getting and the whole department is losing money, why there’s still a good thing for them. But overall, I think all of that were important, but one thing that really made me think about OBL is I went to talk to a lot of people. I actually studied that for two years.


One of my good friends, Dr. Bulent Arslan, helped me a lot to connect me with a lot of other people who have done that. I really studied, went to see other people and how they do, and realized that for most procedures that are outpatient, you could do a better job outside a hospital. This is my opinion. I don’t say that us as a physician in a hospital, we don’t do a good job. I think we do all we can do, but for a patient to come to a parking lot, to get to the angio suite, has to go through a big institution, start to talk to find their way. “Where is the waiting room?” “Oh, you are not here. You have to go the other way.” Then there’s so many other things that happens, the delays we have, and all of this makes the patient to have a very negative experience.


I realized that in an office-based lab where there is access to the patient parking, patient come in, they are the first, they are the center of attention. You don’t do a big hospital of 10 different procedures at the same time, so you can’t focus on a patient at a time. I think that’s important, and that was one of the important decision for me to do that. The other thing that was very important is to see that you can blame only yourself on the quality of job you are offering. So, you don’t need to ask for five years to be in line to get your next machine. So, you work on 15 years, 16 years, 20 years, sometimes to get those machine in institution. This is now your responsibility. You are in charge. You need to actually put now your money where your mouth is.


When you talk about complaining all the time in the hospital, “We need a better machine, we need a better machine,” then you go to your private practice and you work with the bad machine, then that shows the hypocrisy. So, I think it’s important for the decision-making, the control, and really realize that you can actually do a good job in a private setting and put the patient at the center of attention. So, all of this, the possibility of development, the difficulty in the hospital setting to make decisions, and the layers of decision-making, the shortage of techs and nurses, and that you were not in charge to be able to then address that.


All of this and then the study that I did in comparison with other discussion with other people and going to see other people how they did. I was and I am convinced that for certain procedures, an office-based lab is the right way to help the patient. So, I made that decision and I just had to give away my tenured position to be able to do that. I know it’s a bold move, but I think it’s a move based on a lot of reflections and not emotion and not frustration.

Dr. Kavi Krishnasamy (28:08):

Well, what I’m hearing is when the motivations are true, if you will, then it’s a move that may be worth making. Every decision is individual, right? You can’t analogize it to 20, 30, 40 people. But if there’s a right reason to do something like that, then getting out of that comfort zone, as you already alluded to, is maybe the right thing to do. You said a lot of amazing things and I want to delve into a couple of them. I think one is that aspect of mentorship, and don’t give me the side eye here please. But I think the traditional concept of mentorship for junior and mid-career IRs and trainees is looking towards somebody that’s more experienced, more seasoned.


In reality, I find that for me, you already alluded to it, for me, as I made this transition or as I’m making this transition, I must have called 50 people to ask for their opinion. I may not always agree with their opinion, but I still want to know it. Of those 50 people, maybe five or six were older than me and five or six were younger than me. There’s a couple of trainees that I ask for their opinion for various things. There are a lot of contemporaries where I’m in my stage of career. So, I think mentorship has a lot of different flavors and I have a mentor that I go to for clinical things related to liver and a mentor I go to for clinical things related to kidney and for research and et cetera, et cetera. It does not lock into that concept of this person has 30 years of experience. That’s who I need to ask for advice.

Dr. Jafar Golzarian (29:46):

I love that. Actually, I’m so happy you talked about it, because a lot of times, a tenured professor at 60 years old with a lot of achievements start to believe what they say. A friend of mine in Belgium was making a joke about one of his friend that became a professor and said, “Since he’s a professor, he believes what he say.” So I think what you say is extremely important, because at any time of your life and career, there are areas that you just find out, out of nowhere, and there may be someone much more junior to you that has the answer. I totally agree with you and I recommend everybody, go and ask questions, try to do your research. As you said, when you want to change a pathway and go to another path, it’s extremely important to talk to those who have been doing that.


There may be someone who had 10 times less experience than me on doing one procedure or the other, but it doesn’t matter. They have been doing work in OBL for many years and they have seen all of the ups and downs. I think it’s extremely important to ask questions from the right people and not to put your ego in front of yourself and say, “Well, I should be knowing better than that guy. He’s too young.” That’s absolutely true and that’s what I did. Not only that, just some friends, I called some friend. “Hey, this is my situation. I want to do this. Do you think I’m stupid? Do you think it is the right decision?” I listened to them and I try to then make up my own mind after listening to all these guys.


I talked to my brother, to my brother-in-law, my nephew even just to say, “Hey, what do you think about that?” I think what you said is extremely important: nentorship, consultation, discussion, Then down the road I think was important, I really want to mention that to people: Don’t be afraid. As long as you are happy with what you do, as long as you are improving, then that’s fine. There are different reason people may change their career. One of them is they say, “Okay, right now, I am associate professor. I am happy with what I have. I want to go to more leadership.” They go for a division head position somewhere else, a totally right type of decision.


There are some people who say, “I need more financial support and this job doesn’t do that, but I still want to be able to do this type of procedure.” So they evaluate the situation and they do that change. But doing changes is difficult. After you change, there are also a lot of difficulties that will happen. But if their motivation and the goal are reasonable and consulted with mentors, with family and everything, it will result in a much better outcome. But the thing that I always say, “Don’t take a decision by frustration and just for simple reasons.” But if you are not improving every day, stagnation is equal to descent and degradation. I truly believe that.


I know some of my friends that are happy and they’re from age of 45 to 65. They are doing the same things and then they retire, but you cannot keep up if you don’t improve every day. I think at some point, you need to ask yourself this question, “Do I want to become just stagnant in a world that is growing with a speed that is unmatched in the history or you want to just improve every year, every day?” I think it’s a difficult decision, but it’s an important decision. You need to think about that. Every few years, you need to ask the question, “Am I in the right place? Am I doing the right thing? Am I improving?” I really recommend people to do that and don’t be afraid, but make the decision based on facts.

Dr. Kavi Krishnasamy (35:15):

That’s a great point. One of the things that I love to say incidentally to a lot of my trainees is “If we’re standing still, we’re falling behind.” That really ties into career change. I think that ties into innovation, and it’s not just a job. We don’t really live to work. We don’t really work to live. There is an aspect to both in what we do every day. But then going back to I think some of the things you said earlier, the hospital environment is very challenging.


That does not mean the OBL environment is not challenging, but aspiring to provide high-quality OBL patient care is very, very important, not just cutting corners and worrying about the finances. It is a significant time and financial investment. Tell me more about that. We talked a little bit about the discussions, the advice, the mentorship that you got. How has the transition been as you try to incorporate the OBL lifestyle, if you will—I’ll call it the lifestyle—into your life?

Dr. Jafar Golzarian (36:15):

That’s a great question. So, as I mentioned when we wanted to start this OBL, there are a lot of choices, but our goal was to provide the best patient care in a more friendly setting and put the patient in the center of attention every day. Again, I don’t say that this is not the case in other hospitals, that patient is not the center of attention. We just don’t have the mean to do what we want to do. One example as we mentioned is that the patient comes in and your previous case is delayed. There are a lot of patients waiting and everything. So, in an OBL setting where you have one patient at a time or two patients at a time, but you have two staffs, these are not going to happen. So, the patient experience would be different.


So, I just want to make sure that I don’t say or people don’t have the impression that in hospital or academy hospital, patient is not a center of attention. We just don’t have the mean to do that like an old machine. Or when you are in a situation where you have two techs and four that’s calling in sick and then you have seven cases going on, how to manage that and all this frustration that you can’t change a lot of those things. So, because of that goal and that motivation, every day when we go to the office, that goal and that enthusiasm is taking over all the other difficulties and we are just passionate about it.


Even if there is the building phase, you don’t have patient every day, you go there, you come back and you realize it’s 4:00 pm, 5:00 pm and you have been working on a lot of things that are actually putting always that goal in mind, which is putting patient in the center of attention. How can we make sure the patient coming has a best experience, that the patient can be seen right away? We are going to look at something like patients come and they have an iPad and they want to work on that. We realize most PAE patients, because of their age, it’s much more painful for them to go to that iPad and answer a question.


So, we decided, “You know what? For patient over a certain age or patient who don’t have patience with this, we just give them a paper and ask them to click on the paper instead of going to–” So when you look at that, you realize that your focus is every day how we can improve the patient experience. Of course, to be able to do that, you have to improve the staff, motivation, experience. I really feel so fortunate, all the staff that we have and they are passionate. There is a nurse who is building their nurses station while the patient’s not there.


My tech is doing something else that has nothing to do with her training, because everybody know that the goal here is something really amazing. They all feel that that’s why they went to medical field to take care of patient, make a better experience. That’s why we went to medical school, right? Because that’s a question we talked about interventional radiology. Kavi, why did you go to medicine? For the patients.

Dr. Kavi Krishnasamy (40:12):

Absolutely, for the patients.

Dr. Jafar Golzarian (40:12):

Treating patients.

Dr. Kavi Krishnasamy (40:13):

First and foremost.

Dr. Jafar Golzarian (40:14):

Then you see the frustration that you can’t do that job and you know that this is not the right thing to do. So, when you go to an OBL that you are now—or any other practice, when you are in charge and you can make that happen—you feel happy every day.

Dr. Kavi Krishnasamy (40:31):

Well, you’ve built a team clearly, and then you’ve also empowered those team members to then engage and invest in the team. That’s a big message in itself.

Dr. Jafar Golzarian (40:41):

That’s extreme.

Dr. Kavi Krishnasamy (40:43):

So what about the financial side? I say it affectionately a lot of times, I love to nerd out and learn about devices and technology. I mean that’s what drives a lot of us in IR. But in the hospital setting, I’m not paying for it. I don’t have to worry. I mean there’s an overall budget in finance, but I’m not paying for it. The OBL setting is different. So, when you’re considering what ultrasound platform to put in, whether you’re adding cone beam to your angio unit, how did you learn about these things? How do you then employ them and how do you make those decisions? That’s a complicated process, right?

Dr. Jafar Golzarian (41:19):

That’s a very difficult process. Very good question. There is no doubt that in an office practice, financial factors are extremely important, no doubt. Even now, after three months into my practice, I realized that I could have done a lot of things better, even though I was helped with the management team to set that up and everything. So, making those decisions are important. I have really also studied that. So, because I wanted to be able to provide the best patient care, I am convinced that having a machine that is giving you good cone beam CT and vessel mapping, again, those things are important for my goal of why I went to this practice. But I also studied the fact that is that financially viable? And it is. The question is how much is enough for you?


I had answered that question with my partner. We know what we want to do and how we want to do it. As long as we don’t have evening and weekend calls and we can do things the way we want, a hospital salary would be really good for me and I don’t really need much more. But I truly think that a lot of OBLs can sustain having a good machine and have a very successful business also. So, we didn’t cut a really corner on the quality of imaging. That’s very important. We are not going to, and we have not cut corners to not use the material because we think that this is too expensive and it’s not the best choice for the patient. So, we try to do the best choice for the patient, but based on the material.


So, one microcatheter compared to the other, the difference if it’s not huge, we go for what is cheaper. So, when sometimes we can’t get in with the 0.024 microcatheter, we go to 0.020 microcatheter, which is much more expensive. But even though all of this with their actual reimbursement, it’s still reasonable. So, you can make it happen without sacrificing the quality. That’s the message we say to the team, we are here for best patient care outcome and patient experience. So, with that, we have looked at those decisions with consultation with friends, people who have done that, businesspeople. I know there are example that we can talk about.


I know this talk is not about OBL, but there’s example that shows that if you refer one or two patient less to the hospital because they are overweight or you don’t have the cone beam CT, that pays off your investment on the machine. So, there are a lot of business arguments to say that you can’t definitely do a good job with C-arm in some indications, mobile C-arm, but I don’t think having a fixed unit is going to significantly affect your bottom line in terms of business. But you are right. Financial factors are extremely important in your decision when you want to open an OBL.

Dr. Kavi Krishnasamy (45:13):

Well, I still think the overarching themes are you’ve learned through this process: lots of discussion, lots of consultation, lots of mentorship, a lot of learning through this process, a lot of questions that you asked with the overarching goal of providing the best patient care you could offer. Number one, because that’s what you love to do and that’s why you’re in IR. But the best patient care you can offer to the population that you’re serving, right?

Dr. Jafar Golzarian (45:34):


Dr. Kavi Krishnasamy (45:34):

That’s a very important aspect of this.

Dr. Jafar Golzarian (45:37):

I’m sure that’s the same thing for you. I think making that move, of course, your move mostly was also motivated for clinical research and why clinical research is important, because at the end, it comes back to improve patient’s life.

Dr. Kavi Krishnasamy (45:57):


Dr. Jafar Golzarian (45:58):

But where did that interest on research and clinical care came to you? Because that’s clearly your motivation. That’s why you are moving now to your new place.

Dr. Kavi Krishnasamy (46:09):

Yeah, it’s a great question. I think a lot of this for me is rooted in– So, once upon a time, I did a super fellowship. I did the VIVA super fellowship, and part of that was the experience of being in Thomas Fogarty’s medical incubator. So, I learned a lot about the IP process and the development of novel technology devices, innovations, to optimize patient care going forward. But I can honestly say the IP process is something that I just don’t have a lot of patience for, unfortunately. As we all move forward, we all have great ideas in our careers. What do you do with them? So for me, the outlet is then scientific, academic—not accomplishment, that’s the wrong word—but projects and foresights to then change the future algorithms of care. That’s what it has become. That’s what I’d love to do.


So, interventional MRI is a great example. To me in my practice, one of the deficiencies in CT are those small, invisible lesions that are hard to biopsy. They’re hard to ablate. Is there a better solution in 10 years where we can clear the liver of tumor, multiple small tumors just like clock, and do it in a more workflow efficient, better safety, better efficiency overall, and hopefully better outcomes? That’s what it has become for me, and I’ve become very passionate about that and device development and altering patient outcomes through changes in algorithms of care.

Dr. Jafar Golzarian (47:37):

Well, that’s very interesting. So, we are talking about two different career change between you and me. So, I’m going for this private experience where control and decision making is different than my previous experience. You are going for an improvement in your research potentials. No matter what is the change, there are challenges with that. But the motivation and research is the first step, but after that is the decision making and then applying that decision and then take the next step. That’s where a lot of people fail. I wonder, what is your advice to people who listen to us? When you have done your research and you know you want to change, but you can’t make that decision? What’s your biggest advice?

Dr. Kavi Krishnasamy (49:03):

That’s a tough question. I think number one, no job is perfect. There are pros and cons to everything. Part of this is understanding what you can tolerate in a job and what you can’t tolerate in a job. That being aside, there’s a large spectrum here. All of us probably pick a little bit of a different point in the spectrum when it comes to professional and personal satisfaction. I think for a large part of us, we need a little bit of both. So, it’s finding that right fit that gives us a little bit of both. But I’ll also say that change is inevitable. As you already alluded to, if we’re standing still, then we’re languishing, we’re stagnating, we’re falling behind.


Change is inevitable. It’s very hard, but it usually leads to a positive outcome. For you, you’ve seen that now multiple times in your career with big, big, big changes. That shows the rest of us that we can and should be done, which is exciting.

Dr. Jafar Golzarian (50:00):

Excellent. Yeah.

Dr. Kavi Krishnasamy (50:02):

So with that, Jafar, I want to ask you one last question. What is your call to action? As we close this episode, what is your call to action? What do you believe that someone should do if they want to achieve what?

Dr. Jafar Golzarian (50:23):

I think from my three major changes in life, one thing you mentioned is that no change is easy. What is important is to know, as you say too—again and we talked about that—with everything you get, you have to give away something. It is just the question of having that balance and put plus and minuses and see if there’s more plus and minuses is what happens. In your changes, there are a lot of unexpected things that will happen. So, what I thought was the most difficult thing when I moved from Belgium to Iowa was absolutely not at all a problem and things that were much more difficult were things that I never thought that would be something important for me. But when I look at the outcome, I say, “Well, there were much more positive than negative.”


My opinion is that if you are happy going every morning to work, it doesn’t matter what work you have and you have established a goal in your mind, I really recommend people that, especially physicians, specialists who have spent that many years of investment of time and money to study and go to treat patient, if you go to work just for work, if you go to work and you don’t have a real goal and motivation, you have to rethink that. You need to have a goal. Don’t go to work because you need to earn money for your family. This is not IR. This is not what we do. You need to be passionate about what you do. You need to be happy every day to go to work and enjoy what you do and recognize the impact that you have on people’s well-being. Everybody has an impact on people in every job.


If you do it correctly, you can impact people. So, it’s important for every job, but much more important for us as a physicians to know that you’re impacting people’s life. It’s being in good humor, having fun every day, and doing your job the best you can. But when you get to a situation where you start to say, “Man, I have to go to work,” or “It’s Monday. I don’t like Mondays,” or “I’m going to work and I’m not happy because of this and the other,” so start to look at why you are not happy. Is there anything you can do to change it?


If you can’t change it, what is the best option for you? But I really think that the people who are the most successful that I’ve seen in life are those who don’t like stagnation, and it takes a lot of courage to do those changes. But if it is studied, evaluated, and it’s reasonable, the outcome is always better than the stagnation. So, I really think that people have to think of that, have a goal, and be happy.

Dr. Kavi Krishnasamy (54:14):

That’s very well said. I think that applies to everybody from trainees all the way to individuals getting ready to retire. So, I’m glad you brought that up. That’s again very well said and very, very good advice. As cliche as it sounds, it is pursuit of happiness and satisfaction.

Dr. Jafar Golzarian (54:30):

I love that, pursuit of happiness. It is a cliche because it’s true and it is possible. I just feel that it takes some guts, but the outcome is always better.

Dr. Kavi Krishnasamy (54:51):

Yeah, absolutely. Well, thank you, Jafar. I appreciate the time today. It was a wonderful conversation, and I know that our listeners will enjoy. So, thank you.

Dr. Jafar Golzarian (55:01):

Thank you.

Dr. Kavi Krishnasamy (55:02):

Good luck to you. Good luck to both of us, right?

Dr. Jafar Golzarian (55:03):

Of course. I will come and visit you hopefully when your MR is running.

Dr. Kavi Krishnasamy (55:09):

Looking forward to it.

Dr. Jafar Golzarian (55:10):

Thank you so much.

Dr. Kavi Krishnasamy (55:10):

Anytime. Anytime. All right. With that, well, I guess we’ll close the episode.