phatfarm

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I love IR! I think it's the best thing since sliced bread, but I'm not sure everyone agrees with me. I'm curious to hear what bad things you guys have heard about IR. Maybe that way we can figure out how to improve the field!
 
Oct 15, 2010
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I love IR! I think it's the best thing since sliced bread, but I'm not sure everyone agrees with me. I'm curious to hear what bad things you guys have heard about IR. Maybe that way we can figure out how to improve the field!
Heya, thanks for dropping in phatfarm! Med student here who's super interested in IR...here's some observations/concerns (not sure if all will fit the purpose of your thead).

1. IR people have a poor understanding of disease processes, don't control patients, which is sometimes attributed to...

2. Training right now for prospective IR is heavily focused on diagnostic rad and lacks real solid IR training (1 year not enough? too much DR?)

3. History of working hard to develop/innovate new techniques only to lose them to other specialists. Commonly cited example of IR losing majority of vascular work to VS and Int Cards, and maybe IR losing interventional oncology work to surg onc/rad onc in the future as well?

4. While the DIRECT program is very appealing to those of us medical students that are very aggressive, and want to focus on inteventional rads, there's a) not many programs and b) the lack of readily available information on these programs is discouraging. (just a quick example, I would *love* to enter Stanford's DIRECT program but its pretty vague how one would even apply to it...)

5. Not really a direct criticism of IR as a whole, but I hear a lot of talk about these concerns being brought up at SIR meetings, (issues regarding training, competition, etc.) but haven't heard anything about whether SIR has actually decided implement serious changes to make trainees more competitive. It would be very disappointing if all this talk about change never really materialized into any actual changes.

6. One of the IR fellows here complained about a serious lack of research going on in IR, which struck me as odd (the school is in the "top 3" radiology programs fwiw) but since it's something I'm very interested in perhaps you could mention your perspective?
 
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phatfarm

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Nappingguppy,

Always glad to have a medical student interested in IR. I believe you guys are the future of our specialty so if there is anything we can do to help, let us residents know!

1. IR people have a poor understanding of disease processes, don't control patients, which is sometimes attributed to...

I understand why some may feel that IR people have poor understanding of diease processes but don't necessarily agree. The current training methodology requires diagnostic training and as a result we are very exposed to tons of pathology, across every single organ system. So although we may not be the specialist in one organ system, we are generally well rounded.

But I agree that we can do better jobs in understanding disease processes and it will take more work than our peers in other fields who are exposed to say renal failure every day.

I know there is a push to become disease experts as sub-specialists, if you will, in IR. I think this additional level of focus will help us push the field forward, by developing experts in the field who are incredibly knowledgeable in a small segment of IR and this will help push the field forward. Patients are becoming more and more cognizant about physician credentials with all the information on the web today, even to the point of knowing publications. And referring physicians are not going to refer to someone who does not provide excellent specialist care. So we as IR physicians need to develop that expertise to provide the best quality of care to our patients.

2. Training right now for prospective IR is heavily focused on diagnostic rad and lacks real solid IR training (1 year not enough? too much DR?)

Agreed! I wish I could do more IR and less DR. While I see some merits of DR (building rapport with a relatively untapped source of referrals - diagnostic radiologists, understanding the imaging needed to work up some patients, being able to read such imaging), in order to be better interventionalists, we need to spend more hands-on time caring for patients. I know there is a push by the Society of Interventional Radiology to integrate more clinical training for future interventionalists. Programs such as the DIRECT pathway do allow for additional IR time while meeting the requirements for DR.

3. History of working hard to develop/innovate new techniques only to lose them to other specialists. Commonly cited example of IR losing majority of vascular work to VS and Int Cards, and maybe IR losing interventional oncology work to surg onc/rad onc in the future as well?

I think when you take a bunch of smart people with Type A personalities, throw them in medicine, divide them up into specialties, you are inevitably going to get turf battles. By nature, those who control the referrals, tend to have the upper hand. Cardiologists are in essence self-referring because they have non-invasive colleagues who can refer to the invasive cardiologists. We in IR do not have that luxury. The way to keeping our turf IMHO is to the best at what we do. Keep innovating, keeping working hard to understand the disease processes, know the literature, put out high quality research. If you are the best, you will ultimately get the referrals. But you can't wait for the referrals to fall in your lap. What do you do?

Give grand rounds, give lectures to primary care physicians, give a public talk about UFEs. Go out there and show everyone that you know the disease process thoroughly. We need to do a better job marketing ourselves!

4. While the DIRECT program is very appealing to those of us medical students that are very aggressive, and want to focus on inteventional rads, there's a) not many programs and b) the lack of readily available information on these programs is discouraging. (just a quick example, I would *love* to enter Stanford's DIRECT program but its pretty vague how one would even apply to it...)

Good point. As someone not in the DIRECT program, I don't know the intricacies. It seems like a lot of medical student questions stem from trying to understand how the process works. Maybe I can dig around and post the differences between the DIRECT vs other pathways to IR. If you are particularly interested in the Stanford DIRECT pathway, let me shoot an email to them for you. PM me please, if interested.

5. Not really a direct criticism of IR as a whole, but I hear a lot of talk about these concerns being brought up at SIR meetings, (issues regarding training, competition, etc.) but haven't heard anything about whether SIR has actually decided implement serious changes to make trainees more competitive. It would be very disappointing if all this talk about change never really materialized into any actual changes.

I really think the SIR understands these issues and is mobilizing to try to make the changes. Of course it is a huge undertaking to make changes to things that affect credentialing, as well as any large changes that change an organizations structure. But by nature, interventionalists are more men and women of action, and I feel confident that we will see some changes soon.

6. One of the IR fellows here complained about a serious lack of research going on in IR, which struck me as odd (the school is in the "top 3" radiology programs fwiw) but since it's something I'm very interested in perhaps you could mention your perspective?[/QUOTE]

Ah. I feel research is HUGE in pushing the field forward. JVIR, Radiology and AJR are filled with lots of interesting articles by forward thinking individuals. I know we can be doing a lot more research out there. I personally love research and am doing quite a bit at my residency here. But we need more individuals like you who are driven and motivated, to do the research. That is what innovates the field.

And again, let me know if I can help you in any way. I am always glad to mentor to the medical students and junior residents and offer my advice.

Phatfarm
 

badasshairday

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This is pretty bad.


The concern over turf wars is now with Interventional Cardiology (the usual culprit in virtually any turf war) rather than IR. IR is getting pushed out of the vascular arena very fast.

From Goodney et al 2009 (PMID: 19481407):

 
Oct 15, 2010
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Hey, thanks for the reply phatfarm! One thing I've gotta love about IR is the people, never met a smarter and more awesome bunch of folks in medicine :D

Just one more question, in your opinion is it true that if you enter IR through the traditional route of DR out of medical school followed by IR fellowship, expressing a strong interest in IR may hurt your chances of getting into good DR programs (which then could hurt your chances of getting into good IR programs)?

One of our IR professors here gave a talk to the med students in which he stated that he felt pretty ambivalent about expressing a strong interest in IR early on (supposedly due to DR "prejudices" against IR) but I'd like to hear your thoughts since it sounds like you are in the traditional path?
 
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phatfarm

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Hey, thanks for the reply phatfarm! One thing I've gotta love about IR is the people, never met a smarter and more awesome bunch of folks in medicine :D

Just one more question, in your opinion is it true that if you enter IR through the traditional route of DR out of medical school followed by IR fellowship, expressing a strong interest in IR may hurt your chances of getting into good DR programs (which then could hurt your chances of getting into good IR programs)?

One of our IR professors here gave a talk to the med students in which he stated that he felt pretty ambivalent about expressing a strong interest in IR early on (supposedly due to DR "prejudices" against IR) but I'd like to hear your thoughts since it sounds like you are in the traditional path?
N.G.

No problem. I am in a traditional pathway so that's my disclaimer. You know, I think it is a mixed bag. At my institution, one of the committee members is one of our IR attendings so it really wasn't a problem. When I was on the admissions committee, both he and I gravitated towards the IR bound medical students. But I can see how it may not work out so nicely at another institution.

I think you have to play it by ear on the interviews. I don't think you can tell everyone that you are 100% IR or bust, not for your diagnostic interviews. But you can see you are leaning towards IR because you enjoy procedures during medical school and liked surgery but you'd like to keep an open mind because modalities such as body imaging or neuroradiology are also fascinating to you. I think that is fair and safe.

You know, we ask medical students all the time who interview, what field in radiology they will choose. Unfortunately, it's not fair because even our junior residents haven't figured out what they want to do. How can we expect our medical students to know what they want to do?

Good luck.
 
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Hey PF,

Since you're a resident and you've seen way more radiology and IR then most of us medical students, what are *your* concerns for the IR field? How have graduates from your program been doing?
 
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phatfarm

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My concerns are those of complanceny. If we feel comfortable with what we do everyday, then we are aren't challenging ourselves or pushing the field forward. I think where IR got into trouble was being happy with doing things the way they have always been done. When times are good and there isn't any competition, life is good. But when the market tightens up, that's when things go awry.

That's why I'm excited to see clinically oriented medical students and residents enter the field. People who think and act like me. That gives me reassurance that IR will succeed in a major way.

I only worry when we don't attract those types of people in IR. Those who only want to do procedures, who don't care about preprocedural workups, postprocedural care, clinic, research.