Is Vascular surgery

[allendo]

Is Vascular surgery like interventional rads? Can someone tell me the sim and diff? Which one has the brightest future?

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[Leukocyte]

Not all procedures in vascular sx are minimally invasive, for example AAAs and Fem-pops are long invasive procedures. On the other hand, all IR procedures are minimally invasive.

Vascular sx and IR compete for the minimally invasive procedures. But there are procedures in IR that are not done by Vascular sx, and there are procedures in Vascular sx that are not done by IR.

Vascular Sx advantage:

-Invasive and Non-invasive

Vascular Sx disadvantage:

-Lifestyle worse than IR, more stressful and longer training

IR advantage

-Lifestyle, less stress, shorter training, can do general radiology on the side and make bank.

IR disadvantage

-Noninvasive only

Please remember that an IR is a Radiologist, while a Vascular surgeon is a General Surgeon.

 

[droliver]

Which one has the brightest future?

I think the writings on the wall that Vascular Surgery is in a much better long-term position to be the leading provider in this area. IR is going to be in the weakest position eventually for this in mature markets, as they will usually have the least access to patients for directing their care as opposed to the surgeons and cardiologists. The Vascular surgeons are in the catbirds' seat as they don't require surgery backup for complications or failed procedures. In addition, the ideal global care of the peripheral vascular patient (surveillence, staging, wound care, foot care,amputation) is just not possible for any Radiology or Cardiology practice I've ever heard of. In addition, a good bit of the future for interventional vascular work is going to be a lot of combination between stenting and bypassing peripheral disease during the same case, a service not able to be easily provided by other competitors (IR/Cardiology).

You're still going to have a lot of places where there is strong IR presence for the near future, I just think as more of the contemporary Vascular Surgeons are trained the #'s will dwindle for the radiologists at most tertiary centers first, while IR programs at many smaller community programs or rural areas thrive as you're less likely to have a strong vascular surgery program at those hospitals.

Just my long-term view ramblings......

BTW this is not an indictment of the technical skills of IR/Cardiology re. these procedures, but rather a political assessment of the future of the field

 

[MD Dreams]

Will the incorporation of endovascular procedures in vascular surgery translate into higher compensations? What kind of bothers me is the discrepancy in the salary of these two specialties. I've been looking at some job postings and typically the offers for vascular surgeons are 250K starting and a "potential" to earn 400K, whereas for IR most of them are 300k-400k starting and guranteed 600K as partner (usually only after one, two years). It just seems discouraging to have the knowledge and skill to perform endovascular procedures, operations, pre-and post patient care (although IR is heading towards this route) and perhpas train and work longer and harder (perhaps) only to be compensated less. Any thoughts?

 

[droliver]

Will the incorporation of endovascular procedures in vascular surgery translate into higher compensations?

Ironically, advances in many surgery procedures actually have resulted in lower reimbursement (as is the cases with a number of laparoscopic procedures) then older techniques. It is unlikely that there will be any signifigant compensation in the zero-sum payer perspective for procedures (ie. 3rd party payers have a set reimbursement fee budgeted for a given DRG) for, as the savings realized from decreasing length of stay or morbidity are being dwarfed by the cost of the technology. This was the fallacy of some of the early studies with the endografts for AAA's, the cost analysis failed to recognize that the grafts were being provided for free from the companies or at substancial discount. When the actual cost of these is looked at, it can be quite a bit more expensive up front to do many of these procedures and the Physicians & Hospitals get their % of the DRG global fee schedules eaten up quickly.

 

[Smurfette]

Also worth mentioning is that some vascular surgery fellowships include a year of IR as part of the training.

 

[doc05]

Also worth mentioning is that some vascular surgery fellowships include a year of IR as part of the training.

not exactly. IR encompasses more than the endovascular techniques that a vascular surgeon would use.

 

[mandar]

There was a presentation on this topic at last year's RSNA meeting (RSNA: Radiology Society of North America) which is the biggest organization for radiologists in America. The data which was presented at that meeting basically suggested that IR is losing big time to Vascular surgeons (The number of non invasive procedures done by vascular surgeons last year jumped 300% while there was a 10% decline for IR). So does that mean that IR is no longer going to be around after 20 years. Not Really.
IR is trying to venture into new areas like localized drug delivery for onco drugs which can be a very lucrative business. The IR physician under whom I work right now, his research focus is localized drug delivery for HCC (liver cancer).