The details matter, and have not been critically evaluated.
The assumptions everyone is making with the split is the clean break of all IRs who are now no longer tied down by exclusivity contracts. That of course means the DR groups will NOT want to subsidize the IRs in their group, and will simply tell the contract hospital that as the specialties are now split, they are no longer bound to provide the service. The existing IRs will be told to read 100% DR or walk. The median IR does 50/50 IR/DR, half less than that, half more, some rudimentary math implies that you are now going to have over a relatively short time scale (very roughly) twice is many IRs as there is a need. Some may be happy to drop out of procedures, but many will be unwillingly forced to become diagnostic radiologists given the abrupt oversupply, and IR will contract to a 100% gig.
The long and short of my point is that a split from DR will render the IR job market bloated with too many people to do procedures, and your ability to leverage a high salary despite performing poorly reimbursed procedures is because of the DR skillset. Moreover, the market niche for higher paying elective IR procedures is completely indeterminate, and the split will force a whole bunch of people to make enormous quality of life sacrifices to re-establish themselves, all at once.
Details: Once a clean split has happened, DR may no longer want to educate IR residents enough to board certify them as diagnosticians. And once that happens, your ability to leverage your salary is gone out the window. There is no formal pathway to an established practice to recruit highly reimbursed complex procedures that people can follow like a cook-book. There is no formal analysis done to even determine the size of the market niche for what IR is capable of performing electively. Many will stumble and fail establishing practice as they realize their market is too glutted and they don’t want to shoulder the enormous startup costs, that hospitals will often not be as interested in them starting up an endovascular practice as they hoped, and the specialty will find itself heaped in uncertain, bleak looking chaos for years as it tries to stabilize itself in a future where it has little to no bargaining power with congress/CMS because of the small size and SIR’s weakness, where you don’t know the layout / accessibility for the market for your procedures, and where you’re competing in desirable markets against much larger, more formally established, and on average more clinically competent Vascular surgeons and cardiologists, all the while battling an abrupt oversupply of IRs for the same small piece of the pie. Individual IRs will be forced to shoulder advertising costs and business-building obligations, what they are more than capable of doing now through the existing DR practice schema, especially in this job market where you have a much easier time tailoring a specific setup (within reason).
Look, I love IR. I love the high end work. But the call for the IR split is driven by angry zealots who are thinking too much with their limbic system and nowhere near enough with their prefrontal cortex. They haven’t dreamed of the horrible trap they’re setting themselves up for. Moreover, I’m proud to be a diagnostic radiologist. I love the skillset that comes with it. I think it’s feasible with enough careful planning and discussion with a practice, and setting reasonable expectations for both parties, to build up a service you both find valuable.
Not every practice is like this. But if you approach with a highly detailed game plan and set specific, exact expectations—so long as the DR group is not subsidizing a whole bunch of your pay—they probably just won’t care. It depends on how much of your own time, blood, sweat, tears, and own money you want to contribute to building your practice. At least with the DR partnership you have the option. But the split will force you into making the sacrifice, without the enormous benefit of the added safety.
