Episode 78: Private Practice Advice for Early Career IRs

How does your identity change once you’re fully responsible for patient care?

In this episode of The Kinked Wire, Zachary Berman, MD, and Rupal Parikh, MD, of UC San Diego Health, discuss the transition from training (residency/fellowship) to early and mid-career practice in interventional radiology, with particular attention to women’s health specialization, mentorship and work-life balance.

From fellowship jitters to clinical confidence, Dr. Parikh reflects on early career growth, mentorship, and learning to balance ambition with well-being in interventional radiology.

Navigating work-life balance

The following excerpt was generated by AI. It has been edited for grammar and flow.

Zachary Berman, MD: How did you find that balance, and what struggles did you run into—whether in clinical practice, developing as a researcher, or even outside of work? How did you find balance—or not find balance—in all of that?

Rupal Parikh, MD: Yeah, I think in the first year, I mentally prepared myself to give 110% to building myself clinically.

While there was a work–life balance component, a lot of it really favored work. The “life” part was there, but it wasn’t as much of a priority—and that was a decision I made for myself. As the years have gone by—it's been about three years now—I’ve found the time, flexibility, and headspace to be more intentional about my work–life balance.

In those first couple of years, I really wanted to establish my clinical relationships, build my practice, and develop a strong reputation. I also wanted to feel confident in my role as I joined a new group and hospital system and navigated an entirely new environment.

You hear a lot of people say that the first year can be hard and sometimes mentally exhausting, but that’s part of the process: establishing yourself, building confidence and gaining comfort in your professional life.

Then, over time, you start to ramp up the things that matter to you outside of work. So I’d say my approach has definitely evolved.

Dr. Berman: I like to think about work–life balance more as work–life harmony—trying to find harmony between what I’m doing and how I’m living. And obviously that’s different for different people.

I’ve definitely experienced times when I’ve felt disharmony. Were there moments like that for you? And if so, how did you recognize and correct them before things went too far?

Dr. Parikh: That’s a great question. In my first year as an attending, I wanted to learn as much as possible and get as many reps as I could. Part of that comes from still being in that resident or fellowship mindset. I would stay late for cases—even when I wasn’t the primary attending—just to see how others approached it, especially if it was something I hadn’t done before.

But over time, I realized I needed to recalibrate. I had to find that balance—or harmony—so I could be the best version of myself both at work and at home. That balance looks different for everyone. The key is being self-aware. If one side of your life is negatively impacting the other, you have to adjust.

I try to be fully present wherever I am, but that also means giving yourself permission to step away and take a break from the other side.

I’ve learned that a lot of this comes down to knowing when to take on an extra task or say yes to a project—and when to say, “I’m very interested, but this isn’t the right time. Let’s revisit this in a month or two.”

That first year is really when I started learning how to navigate that, and I’m still working on it. It goes both ways—it’s about finding what balance works for you.

Dr. Berman: I really struggled with that in my first year, too. You come out of training feeling like you can do everything, especially at a large academic center where you're exposed to such a wide range of complex cases. You think, “I can do this, I can do this, I can do this.”

I found myself staying late for the most complex cases and wanting to take on everything. But a few years in, you start to realize—you have partners. You don’t have to do it all. That shift was hard for me at first, with internally recognizing that I didn’t need to take on everything.

Dr. Parikh: Yeah, that’s exactly it—knowing your limitations. And in the beginning, you often learn those the hard way. I definitely did. It’s also about having the confidence to communicate your needs so you can show up as your best self for your patients and your team.

That’s why it’s so important to be in a supportive group—and to contribute to that support as well.

If you start to feel burned out or unable to perform at the level you want, you need to be able to find solutions that work for you without negatively impacting patient care or your team.
Knowing when to say, “This isn’t the right time,” or, “This is outside my wheelhouse” is important. You can always revisit opportunities later, but it’s okay to say no.

But if you want to say yes to everything, that’s okay too—just recognize when you need to scale back.