Interventional Radiology Lifestyle?

Thaitanium · Aug 31, 2005

Can someone tell me a little about IR? How do you get into IR? Hours? Lifestyle? Interesting procedures they do? Competitiveness to get into? Salary? Future of the field? Anything you can supply will be appreciated!

Thanks in advance.

f_w · Aug 31, 2005

> How do you get into IR?

Typically by doing an internship, a 4 year diagnostic radiology residency and a typically 1 year fellowship. (There are some new pathways including 2 years of surgery training, but I don't think they have produced graduates yet).

> Hours?

Depends on the size of hospital and the spectrum of procedures. If you are the single IR at a 75 bed community hospital in the styx, you can afford to run your practice 9-5 and take wednesday off for golf. If you are at a major academic center with busy trauma, transplant and vascular surgery services, you will spend long hours in the hospital and be busy on call.

> Lifestyle?

At a busy place: Closer to general surgery than to radiology. Definitely not the place for you if you are in it for 'lifestyle'. You would be better off doing derm.

> Interesting procedures they do?

- peripheral vascular disease / renal artery stenosis / carotid stenosis
- aortic aneurysm repair using stent-grafts
- treatment of inoperable HCC using chemo-embolization embolization with radioactive glass/resin beads.
- embolization treatment for various acute bleeding situations such as GI bleeds or pelvic trauma
- pre-operative embolization of bone and soft-tissue tumors (to reduce intra-op blood loss).
- treatment of uterine fibroids with uterine artery embolization
- treatment of varicocele
- treatement of 'pelvic congestion syndrome' (female varicocele)
- treatment of varicose veins with radiofrequency or endovascular laser-ablation
- RF ablation of liver or kidney tumors in non-surgical candidates

There is lots of other stuff to do, but most of it is fairly routine and not necessarily interesting (such as dialysis access maintenance, central catheters, chest-ports, drainages, chest-tubes, various biopsies.)

> Competitiveness to get into?

The hurdle these days is getting into a diagnostic radiology residency. The good fellowships are somewhat competitive, but most people who want to do it find a good place to go to.

> Salary?

Good.

> Future of the field?

Glass half full / glass half empty.

A good share of the peripheral vascular work seems to be shifting into the practices of vascular surgeons and cardiologists. Both groups have direct access to these patients because they see them for other problems. If PVD comes up, they rather keep the procedure revenue in their own practice rather than referring the patient to an interventional radiologist.
What seems to be developing quite nicely is the entire 'interventional oncology' field. Radiofrequency or cryoablation of various lesions. Chemo-embolization or 'radio-embolization' of liver tumors etc. In addition, the routine stuff I mentioned earlier pays the bills quite nicely (if you have a well organized interventional radiology department).

Send me a pm if you have questions. Are you a medstudent ? What year ?

Carb Addict · Sep 1, 2005

I don't totally agree with the above on hours worked in IR. A local community IR guy told me that if you're in a small practice (2-3 docs), you'll tend to be busier because of more frequent call. If you join a large group (i.e., many IRs), call is much better and you have the opportunity to do particular types of procedures that you like or are good at. It is much harder to mainly do what's called "high-level" cases (e.g., those listed in above post) in smaller group practices. Also, some groups mainly focus on vascular work, while others may do lots of oncology, but most will have a decent mix. Now, I will grant that if you're the only IR in town, you could set-up your practice to be cushy. Generally, though, I was advised to steer clear of 2-3 IR groups because you just work your ass off.

As far as the future of the field, I was told that if you're good at what you do, you will be successful. Don't worry about the surgeons and cardiologists. In fact, there are cardiology groups that look for IRs to do their peripheral work. Multispecialty vascular groups are also an option. I worked with a vascular surgery fellow who plans on practicing with an IR. Turf battles are wastes of time and energy.

f_w · Sep 1, 2005

The scenario of a single practicioner in the bundoks was not meant to represent the most typical situaion. It was meant as one example illustrating a practice setting that allows you to dictate your hours. There are also IR's who only do outpatient dialysis access and only during bankers hours. If you need emergent access, there is allways the hospital ;-))

The worst situation is indeed a hospital based radiology group of maybe 10 people with 2-3 doing IR. A handfull of factors conspire to make these positions very demanding:
- The call-pool for IR is too small. You are on q3, and often in addition you have to cover diagnostic call q10.
- Purely hospital based practices are often forced to do even the most idiotic procedures after hours. With the exclusive contract often comes an obligation to jump at the request of even the laziest and manually inept IM attending.

One group I know of has 10 people with 2 of them doing full-time IR during the daytime. Another 3 out of the group are able to do the typical 'emergency IR' stuff (GI bleeders, arches, cold feet). They are also pretty rigid in what they refuse to do. As a result, their IR call is not too frequent and too bad despite the fact that there are only 2 full-time IRs.

So, overall the amount of on-call work is higher than in general radiology but in most cases still better than in lets say general surgery. Also you can't outsource this work like you can do the diagnostic after-hours coverage (on the upside, your daytime job can't be outsourced as well).

Al Pacino · Sep 1, 2005

I'm an intern right now, but I'm pretty sure I'm doing IR. I realized that I do enjoy patient contact, and that doing just purely diagnostic radiology will probably drive me crazy. That being said, I have 4 months of electives in my intern year. What do you guys recommend that I do to best prepare me for a career in IR? I keep hearing that IR is becoming more clinical so I don't think I should waste my elective time??

Right now, I've penciled in general diagnostic radiology, general surgery, nephrology, and infectious diseases. Should I replace one of those with heme/onc or make other changes, such as adding IR?

Thaitanium · Sep 1, 2005

Thanks for all the helpful info.

I am a M3 now. In addition to the above poster, what electives can someone recommend for a 3rd year other than the obvious IR and general radiology rotation. Does one need to do an elective in surgery also?

Thanks in advance.

f_w · Sep 1, 2005

vascular surgery
Heme-onc
Maybe urology

I don't think nephrology is so useful, in IR you won't be faced with the question of adjusting FK506 doses or steroids so often.

bnichols0330 · Sep 4, 2005

I am a MS-3 very interested in IR. Is there a way to set up a happy medium b/w interventional work & diagnostic? I really like the lifestyle aspects of diagnostic, but I also like the interventional part of IR. Can you find a practice or start one that primarily does DR with the occasional routine IR (drainages ...)?

Also, if you were going to do something like this is an IR fellowship mandatory or can you just do you DR residency at a program that allows you to do a lot of IR work & if you are comfortable do the procedures without actually pursuing the fellowship?

Thanks

f_w · Sep 4, 2005

> Is there a way to set up a happy medium b/w interventional
> work & diagnostic? I really like the lifestyle aspects of diagnostic,
> but I also like the interventional part of IR. Can you find a practice
> or start one that primarily does DR with the occasional routine
> IR (drainages ...)?

Probably the majority of IRs in a community setting will practice IR only part of the time, maybe 2 days a week. The other days they will do general DR, depending on what their strengths are this will often be standard stuff like body CT.

> Also, if you were going to do something like this is an IR
> fellowship mandatory or can you just do you DR residency at
> a program that allows you to do a lot of IR work & if you are
> comfortable do the procedures without actually pursuing the
> fellowship?

The basic 'body IR' stuff like drainages and biopsies is something often done by general radiologists without specific IR fellowship training. Also, most older radiologists will be comfortable with doing diagnostic angiography (e.g. lower extremity runoffs) but won't do vascular intervention.

Just like there are general surgeons who will throw in the occasional fem-fem, there are diagnostic rads who did lots of IR during residency and are comfortable to add it to their practice. But as a general rule, most people practicing IR these days did a fellowship. (in addition, you will find older neuroradiologists who have plenty of angio experience, some of them will practice IR).

DocM · Sep 8, 2005

f_w said:
> How do you get into IR?

Typically by doing an internship, a 4 year diagnostic radiology residency and a typically 1 year fellowship. (There are some new pathways including 2 years of surgery training, but I don't think they have produced graduates yet).

> Hours?

Depends on the size of hospital and the spectrum of procedures. If you are the single IR at a 75 bed community hospital in the styx, you can afford to run your practice 9-5 and take wednesday off for golf. If you are at a major academic center with busy trauma, transplant and vascular surgery services, you will spend long hours in the hospital and be busy on call.

> Lifestyle?

At a busy place: Closer to general surgery than to radiology. Definitely not the place for you if you are in it for 'lifestyle'. You would be better off doing derm.

> Interesting procedures they do?

- peripheral vascular disease / renal artery stenosis / carotid stenosis
- aortic aneurysm repair using stent-grafts
- treatment of inoperable HCC using chemo-embolization embolization with radioactive glass/resin beads.
- embolization treatment for various acute bleeding situations such as GI bleeds or pelvic trauma
- pre-operative embolization of bone and soft-tissue tumors (to reduce intra-op blood loss).
- treatment of uterine fibroids with uterine artery embolization
- treatment of varicocele
- treatement of 'pelvic congestion syndrome' (female varicocele)
- treatment of varicose veins with radiofrequency or endovascular laser-ablation
- RF ablation of liver or kidney tumors in non-surgical candidates

There is lots of other stuff to do, but most of it is fairly routine and not necessarily interesting (such as dialysis access maintenance, central catheters, chest-ports, drainages, chest-tubes, various biopsies.)

> Competitiveness to get into?

The hurdle these days is getting into a diagnostic radiology residency. The good fellowships are somewhat competitive, but most people who want to do it find a good place to go to.

> Salary?

Good.

> Future of the field?

Glass half full / glass half empty.

A good share of the peripheral vascular work seems to be shifting into the practices of vascular surgeons and cardiologists. Both groups have direct access to these patients because they see them for other problems. If PVD comes up, they rather keep the procedure revenue in their own practice rather than referring the patient to an interventional radiologist.
What seems to be developing quite nicely is the entire 'interventional oncology' field. Radiofrequency or cryoablation of various lesions. Chemo-embolization or 'radio-embolization' of liver tumors etc. In addition, the routine stuff I mentioned earlier pays the bills quite nicely (if you have a well organized interventional radiology department).

Send me a pm if you have questions. Are you a medstudent ? What year ?

Where did you hear about the "two years of surgery training"?

f_w · Sep 8, 2005

The two years don't have to be in surgery, but it would make sense as 60-70% of our work overlaps with surgery. If you want to do stent grafts in a community setting (without the plethora of surgery residents and fellows) it is helpful if you can do an arterial cutdown yourself while your vascular surgeon does the other leg.

http://www.theabr.org/VIR_DIRECT.htm

DocM · Sep 8, 2005

f_w said:
The two years don't have to be in surgery, but it would make sense as 60-70% of our work overlaps with surgery. If you want to do stent grafts in a community setting (without the plethora of surgery residents and fellows) it is helpful if you can do an arterial cutdown yourself while your vascular surgeon does the other leg.

http://www.theabr.org/VIR_DIRECT.htm

Thank you for the reply and the link. Very helpful

hans19 · Sep 9, 2005

f_w said:
TIf you want to do stent grafts in a community setting (without the plethora of surgery residents and fellows) it is helpful if you can do an arterial cutdown yourself while your vascular surgeon does the other leg.

http://www.theabr.org/VIR_DIRECT.htm

Hey FW,

How do you go about learning how to do a cut down? I suppose its something that can be picked up in a vascular surgery month during fellowship?
Do you forsee any credentialling issues with hospitals in the real world, regarding performing cut-downs?

Thanks...

f_w · Sep 10, 2005

> I suppose its something that can be picked up in a vascular surgery
> month during fellowship?

I don't know. With any kind of surgical procedure, it is not the 95 times when it goes smooth that you train for, it is the 5 times when things go south. Maybe after 2 years of surgery residency and having seen a couple of cases go bad, I would be confident enough to do it myself.

> Do you forsee any credentialling issues with hospitals in the real
> world, regarding performing cut-downs?

The only time I could imagine doing it would be if I had a vascular surgeon working on the other leg who could bail me out if I tear the wall while placing that big garden hose of a sheath. I would never dare to take it upon myself to do this without backup.

DocM · Sep 30, 2005

f_w said:
The two years don't have to be in surgery, but it would make sense as 60-70% of our work overlaps with surgery. If you want to do stent grafts in a community setting (without the plethora of surgery residents and fellows) it is helpful if you can do an arterial cutdown yourself while your vascular surgeon does the other leg.

http://www.theabr.org/VIR_DIRECT.htm

If you dont mind, I have a question Concerning the post aboveCould one use the first two Approved Clinical Training * years to do Internal Medicine and then decide to take a year off to complete the Internal Medicine residency (includes taking the BC exam) before moving on the remainder of the programPGY # 3, 4, 5, 6,etcThis way one would get board certified in Internal Medicine, Radiology and IR

Any insight would be appreciated

DocM · Oct 5, 2005

DocM said:
If you dont mind, I have a question Concerning the post aboveCould one use the first two Approved Clinical Training * years to do Internal Medicine and then decide to take a year off to complete the Internal Medicine residency (includes taking the BC exam) before moving on the remainder of the programPGY # 3, 4, 5, 6,etcThis way one would get board certified in Internal Medicine, Radiology and IR

Any insight would be appreciated

Does anyone have an answer to this question?

Carb Addict · Oct 14, 2005

DocM said:
This way one would get board certified in Internal Medicine, Radiology and IR

So you seriously want to keep up with 3 board re-certifications? I don't mean to be overly frank, but there are plenty of people who find it tough to keep up with just 2 boards. Besides, board certification is meant to protect the integrity of the field, as well as be a sort of guarantee to patients, hospitals, etc., that a physician is capable in a given specialty. Being BC in IM means little for an IR. That is, it adds nothing to the perception of his/her practice. Might I also add that you're "wasting" a year that delays a higher salary later on (not a money-grubber here, just practical - maybe you don't have monster loans to pay off

).

DocM · Oct 19, 2005

Carb Addict said:
So you seriously want to keep up with 3 board re-certifications? I don't mean to be overly frank, but there are plenty of people who find it tough to keep up with just 2 boards. Besides, board certification is meant to protect the integrity of the field, as well as be a sort of guarantee to patients, hospitals, etc., that a physician is capable in a given specialty. Being BC in IM means little for an IR. That is, it adds nothing to the perception of his/her practice. Might I also add that you're "wasting" a year that delays a higher salary later on (not a money-grubber here, just practical - maybe you don't have monster loans to pay off ).

Thanks for the reply. as I told f_w....I ask b/c I am interested in doing programs like Doctor's w/o Borders, Red Cross etc...They tend to hire/recruit EM and or IM docs. That's why I thought the dual BC would come in handy. But I also like Rads alot!! I was an Engineer in undergrad/grad and have a huge interest in physics and technology as it relates to Bio-Medicine.

Btw: Do you know if Doctor's w/o Borders, Red Cross etc..take Rads docs. I don't know if the facilities needed for Rads (MRI/CT,IR suites) would exist in too many developing nations.

Any info would be appreciated. Thank you

Stillwater45 · Nov 5, 2005

Your information was very helpful, thanks...

I was also wondering:

Do IR's round on patients? Are they responsible for them outside of their procedures.

Also, How much physics is involved in IR and radiology as a whole. Is physics heavily represented on the Rads Boards and in daily practice? I ask this because I am more of an "anatomy minded" person and less of a "conceptual minded" person. I love anatomy but strongly disliked physics in college. Thanks

f_w said:
> How do you get into IR?

Typically by doing an internship, a 4 year diagnostic radiology residency and a typically 1 year fellowship. (There are some new pathways including 2 years of surgery training, but I don't think they have produced graduates yet).

> Hours?

Depends on the size of hospital and the spectrum of procedures. If you are the single IR at a 75 bed community hospital in the styx, you can afford to run your practice 9-5 and take wednesday off for golf. If you are at a major academic center with busy trauma, transplant and vascular surgery services, you will spend long hours in the hospital and be busy on call.

> Lifestyle?

At a busy place: Closer to general surgery than to radiology. Definitely not the place for you if you are in it for 'lifestyle'. You would be better off doing derm.

> Interesting procedures they do?

- peripheral vascular disease / renal artery stenosis / carotid stenosis
- aortic aneurysm repair using stent-grafts
- treatment of inoperable HCC using chemo-embolization embolization with radioactive glass/resin beads.
- embolization treatment for various acute bleeding situations such as GI bleeds or pelvic trauma
- pre-operative embolization of bone and soft-tissue tumors (to reduce intra-op blood loss).
- treatment of uterine fibroids with uterine artery embolization
- treatment of varicocele
- treatement of 'pelvic congestion syndrome' (female varicocele)
- treatment of varicose veins with radiofrequency or endovascular laser-ablation
- RF ablation of liver or kidney tumors in non-surgical candidates

There is lots of other stuff to do, but most of it is fairly routine and not necessarily interesting (such as dialysis access maintenance, central catheters, chest-ports, drainages, chest-tubes, various biopsies.)

> Competitiveness to get into?

The hurdle these days is getting into a diagnostic radiology residency. The good fellowships are somewhat competitive, but most people who want to do it find a good place to go to.

> Salary?

Good.

> Future of the field?

Glass half full / glass half empty.

A good share of the peripheral vascular work seems to be shifting into the practices of vascular surgeons and cardiologists. Both groups have direct access to these patients because they see them for other problems. If PVD comes up, they rather keep the procedure revenue in their own practice rather than referring the patient to an interventional radiologist.
What seems to be developing quite nicely is the entire 'interventional oncology' field. Radiofrequency or cryoablation of various lesions. Chemo-embolization or 'radio-embolization' of liver tumors etc. In addition, the routine stuff I mentioned earlier pays the bills quite nicely (if you have a well organized interventional radiology department).

Send me a pm if you have questions. Are you a medstudent ? What year ?

p53 · Nov 6, 2005

Stillwater45 said:
Your information was very helpful, thanks...

I was also wondering:

Do IR's round on patients? Are they responsible for them outside of their procedures.

Also, How much physics is involved in IR and radiology as a whole. Is physics heavily represented on the Rads Boards and in daily practice? I ask this because I am more of an "anatomy minded" person and less of a "conceptual minded" person. I love anatomy but strongly disliked physics in college. Thanks

Not only is the Rads Boards exam heavily respresented in physics. THE FIRST RADIOLOGY BOARD EXAM IS CALLED THE PHYSICS BOARD EXAM (ALL PHYSICS). Think of it as USMLE STEP 1 (in difficulty) with 100% physics questions.

I know people that passed Step 3 with two days of studying but flunked the Physics Radiology Board Exam. Step 3 has a much higher pass rate than the Physics Board Exam. Granted, most programs have didactics and board prep to help you BUT you better not FLUNK it more than once.

p53 · Nov 6, 2005

There is a reason radiology residents are rarely seen. They are at the library or at home studying for one of the hardest board exam in any specialty!

It is tough to relearn physics from undergrad and build upon that knowledge with new physics information that pertains to US, CTS, MRI, FLUROSCOPY etc. That's not even including the amount of information you have to relearn from pathology and build upon that knowledge base concerning pathophysiology of all diseases from all medical specialties so you can have it at your fingertips when you are reading an image.

Just read an interpretation, or listen to an interpretation of an image by a radiologist to hear about possible pathologies and anatomical defects. You will realize that most radiologists have a huge body of knowledge that was acquired with nightless days of studying.

------------------------------------------------------------------------
Part I: Physics of Medical Imaging, Biological Effects and Safety

Emphasis is placed on the principles and applications of physics, technology, statistical analysis, visual perception, dosimetry, radiation biology, exposure management, safety and quality assurance as they apply to the practice of diagnostic, interventional, and nuclear radiology.

Topics include:

* General Radiography
* Mammography
* Fluoroscopy/Fluorography
* Digital X-ray Imaging
* Computed Tomography
* Nuclear Radiology
* Ultrasound
* Magnetic Resonance
* Radiation Safety/Protection
* Radiation Biology/Effects

f_w · Nov 6, 2005

> Do IR's round on patients?

On patients admitted under the IR service, we round bid like any other service.

On patients of other services who had a procedure we round at least once, or longer if there are active issues (e.g. neph tubes).

> Are they responsible for them outside of their procedures.

Most patients are taken care of for their underlying problem by a different specialty. For some patients (mainly liver tumors and biliary drainage patients) the IR often ends up as the primary point of contact (including their wellbutrin refills).

> Is physics heavily represented on the Rads Boards

There is a separate physics written board exam. It is mostly applied physics and knowledge about regulations and laws relating to the use of radiation. There are good review books and most of it can be studied for. Some people fail once, but I haven't heard of anyone who couldn't get board certified due to physics.

> and in daily practice?

If you want to be an academic radiologist tweaking the parameters of some MRI sequences, you should really understand physics. If you practice like most people do, the physics you learned during residency will be sufficient. Don't worry too much about it. If you were smart enough to make it into medical school, you can deal with the physics required to practice radiology.

I ask this because I am more of an "anatomy minded" person and less of a "conceptual minded" person. I love anatomy but strongly disliked physics in college. Thanks

Stillwater45 · Nov 6, 2005

Thanks for the quick feedback, your knowledge is very much appreciated. Thanks

f_w said:
> Do IR's round on patients?

On patients admitted under the IR service, we round bid like any other service.

On patients of other services who had a procedure we round at least once, or longer if there are active issues (e.g. neph tubes).

> Are they responsible for them outside of their procedures.

Most patients are taken care of for their underlying problem by a different specialty. For some patients (mainly liver tumors and biliary drainage patients) the IR often ends up as the primary point of contact (including their wellbutrin refills).

> Is physics heavily represented on the Rads Boards

There is a separate physics written board exam. It is mostly applied physics and knowledge about regulations and laws relating to the use of radiation. There are good review books and most of it can be studied for. Some people fail once, but I haven't heard of anyone who couldn't get board certified due to physics.

> and in daily practice?

If you want to be an academic radiologist tweaking the parameters of some MRI sequences, you should really understand physics. If you practice like most people do, the physics you learned during residency will be sufficient. Don't worry too much about it. If you were smart enough to make it into medical school, you can deal with the physics required to practice radiology.

I ask this because I am more of an "anatomy minded" person and less of a "conceptual minded" person. I love anatomy but strongly disliked physics in college. Thanks

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