the reason most IRs are not running clinic is not lack of skill. It is just they are not interested. Let's be honest. Even most clinician's are tired of patient contact. Despite what people say in medical school a lot of clinicians do not like it.
In the current environment you need a clinic to be able to run a productive IR service.
We have a very clinically oriented IR department. Clinician's want to exaggerate it. You do not 10 years to do it. I don't say it is easy, but can be easily done by a radiologist.
Don't forget that new generation of clinicians do not have clinical skills more than us!!
Cardiologists and vascular surgeons are constantly doing carotid stenting. Other than acute hemodynac instability, they do not know that much clinically about it. It causes neurological symptoms and the understanding of them are even less than us. At least we see head CTs and MRs constantly. When was the last time a vascular surgeon saw a TIA? Can an average cardiologist tell you where does this carotid go up to ?
The only reason they are doing it is that they have patients and clinic. It is not because of their clinical skill or any other magical reason. If you start a clinic you can compete with them.