Brown Vascular and Interventional Radiology Symposium for Medical Students

[Med2015VIR]

Dear Medical Students, Medical Schools, and Radiology Departments,

You are invited to attend The Warren Alpert Medical School of Brown University's Vascular and Interventional Radiology Symposium.

The inaugural Brown University Vascular and Interventional Radiology Symposium is hosted by The Vascular and Interventional Radiology Interest Group of Brown University with support from the Department of Diagnostic Imaging at Brown. The goal of the symposium is to introduce current medical students to the innovative, minimally invasive, and clinically oriented field of interventional radiology. We encourage you to forward this e-mail to medical students at your institution who have expressed an interest in radiology, interventional radiology, and/or minimally invasive therapy.

Interventional radiology revolutionizes medicine through the use of image-guided, minimally invasive therapeutics. From the use of angioplasty and catheter-delivered stents for peripheral artery disease to the treatment of tumors with thermal ablation, interventional radiology offers an evolving and advancing array of medical procedures.

The Vascular and Interventional Radiology Interest Group at Brown aims to promote learning and networking opportunities for medical students interested in a career in radiology or interventional radiology. The Division of Diagnostic Imaging at Brown is a leader in patient care, education, and research.



Date: Saturday, December 15, 2012
Time: 12pm-6pm (Symposium); 6pm-7pm (Dinner and networking event)
Location: The Warren Alpert Medical School of Brown University, Providence, RI



Registration is free. Sign up today!


Registration, agenda details, and travel information:
http://med.brown.edu/diagnostic_imaging/vir-symposium/


Faculty:

Sun H. Ahn
Assistant Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University
Fellowship Director of Vascular and Interventional Radiology

Gregory J. Dubel
Assistant Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University

Damian E. Dupuy
Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University
Director of Tumor Ablation at Rhode Island Hospital

Jason Iannuccilli
Assistant Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University

Mahesh V. Jayaraman
Assistant Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University

Gregory M. Soares
Assistant Professor Department of Diagnostic Imaging
The Warren Alpert Medical School of Brown University
Director of Vascular and Interventional Radiology

Rhode Island Hospital Brown University


Topics:
- Introduction to Interventional Radiology: Past, Present, and Future
- Interventional Oncology
- Peripheral Artery Disease
- Neurointerventional Radiology
- Clinical Practice Model of IR
- Different Paths to IR
- Vascular and Interventional Radiology Residents and Fellows Panel
- Vascular and Interventional Radiology Simulation Session

Questions: [email protected]

Thank you,
The Vascular and Interventional Radiology Interest Group at Brown University
And
The Department of Diagnostic Imaging at Brown University

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[chronicidal]

Nice. Exam week.

 

[shark2000]

You don't need to go. I am telling you the gist of each topic. And the truth.

Topics:
- Introduction to Interventional Radiology: Past, Present, and Future:

No community in medicine made as huge mistake as IR did in 90s and early 2000s. They refused to do pre and post procedure care and refused to cover the hospital 24/7. They lost most of their turf.
Currently there is a lot for IR to do, as IR is the hospitalist of procedures. All low end procedures in the hospital will be turfed to you. Comparison of IR to Vasc surgery or cards, is the same as comparing hospitalist to Endocrinology or ID. Most hospitalists make more with better job oppurtunities.
Future: If IR stays will radiology the future is good for them, as there always be tons of low end procedures in the hospital to do. If they separate, their specialty will go down the drain.

- Interventional Oncology

Mostly confined to big academic centers and big hospitals. Not a lot is done in community. The future is not clear. It is just a matter of inventing a new superselective chemotherapy agent to make the TACE obsolete. Anyway, it is not really done broadly in pp.

- Peripheral Artery Disease

Lost to vasc surgeons and cardiologists. Some places are doing a little. It is almost impossible to break into a market already controlled by vasc surgeons. You may be able to find some cases, which are the most complicated ones that vascular surgeons do not want to do.
If I get PVD, I will go to vascular surgery everyday.

- Neurointerventional Radiology

Does not have anything do with IR. It is like talking about Stroke in a GI conference.

- Clinical Practice Model of IR

Rather than begging for patients now, 20 years ago IR should have taken care of pre and post procedure management.
This is a BS made and has not helped at all. Clinical model has been there for a while and has not helped turf wars at all. When something is lost, it is lost.

- Different Paths to IR

Do a surgical subspecialty with better money/hour and more preserved turfs and higher end cases,

- Vascular and Interventional Radiology Residents and Fellows Panel

For residents: don't do IR just to find a job. The job market is bad, but not as bad to do Sh.. to get a job.

 

[samsoniter]

I must respectfully disagree with Shark2000,
IR is indeed losing some turf, and as more specialties see the procedures they do as attractive (financially) and effective it seems they are gradually taking larger slices of our proverbial pie. This is confounded by the fact that many non radiologists can land IR fellowships, and to be honest radiologists are not the best protectors of their own turf...so where is the disagreement? IR is not just low end procedures, and many community hospitals are doing oncology, and some of the high end procedures. I feel there are elegant procedure that will never be taken from IR bc nobody else has the experience or kahonas...also we are continually rolling out new procedures and innovations. IR is still infantile and it remains to be seen where along the spectrum of specialties it will eventually become established. Which, fortunately we can still affect..IMHO there are a lot of clinically oriented people going into IR that will be outstanding guardians of our turf, and of great benefit to the image of IR, eventually making it an indispensable part of even small town medicine.
PS: if I were in the NE I would totally go to this convention, there is no such thing as too much networking.

 

[Dr. USMLE]

No community in medicine made as huge mistake as IR did in 90s and early 2000s. They refused to do pre and post procedure care and refused to cover the hospital 24/7. They lost most of their turf.
Currently there is a lot for IR to do, as IR is the hospitalist of procedures. All low end procedures in the hospital will be turfed to you. Comparison of IR to Vasc surgery or cards, is the same as comparing hospitalist to Endocrinology or ID. Most hospitalists make more with better job oppurtunities.
Future: If IR stays will radiology the future is good for them, as there always be tons of low end procedures in the hospital to do. If they separate, their specialty will go down the drain.

I agree with the rest of your analysis, but being the "hospitalist of procedures" isn't necessarily a bad thing. Doing procedures all day with no peri-procedural management is actually very desirable, regardless if some or even many of those procedures are not high-end. Better to fill a quarter or even half of your schedule with quick, low-end procedures than have to spend that time BSing with pts or doing "peri-procedural management," which is mostly doing other services' jobs just so you can "own" the patient. Having worked with VS and IC, I can tell you they hate managing pts and would definitely do procedures all day if their specialties allowed them to do so. The real downside to IR is the lower GIB that GI cannot take care of in the middle of the night; upper GIB isn't really an issue.

Do a surgical subspecialty with better money/hour and more preserved turfs and higher end cases,

The downsides to that are having to go through a surgical residency, pt interaction, doing your own admissions, and peri-procedural management. The purpose of being a surgeon is to do procedures/surgeries. If that's all you want to do and pt management is a nuisance you can barely tolerate to do it, then IR is a better choice.

 

[shark2000]

I agree with the rest of your analysis, but being the "hospitalist of procedures" isn't necessarily a bad thing. Doing procedures all day with no peri-procedural management is actually very desirable, regardless if some or even many of those procedures are not high-end. Better to fill a quarter or even half of your schedule with quick, low-end procedures than have to spend that time BSing with pts or doing "peri-procedural management," which is mostly doing other services' jobs just so you can "own" the patient. Having worked with VS and IC, I can tell you they hate managing pts and would definitely do procedures all day if their specialties allowed them to do so. The real downside to IR is the lower GIB that GI cannot take care of in the middle of the night; upper GIB isn't really an issue.




The downsides to that are having to go through a surgical residency, pt interaction, doing your own admissions, and peri-procedural management. The purpose of being a surgeon is to do procedures/surgeries. If that's all you want to do and pt management is a nuisance you can barely tolerate to do it, then IR is a better choice.

Surgical subspecialty is not necessary through GS. I meant ortho, Urology, plastics, ENT, ... Now I don't want you to talk about each of them one by one, but the truth is as an IR doc you do not have any control on what you do. You are dependent on referrals.

You will soon see how in pp, the GI doc does all the ERCPs in the weekday and in the weekend ask IR to do percut biliary intervention. Or how the Urologist asks for percut nephrostomy at 11 pm. You will see the vascular surgeon does all the PVD during the day and at night he declares himself incompetent to do acute limb ischemia. You will see your cardiologist does all the renal art stents and leaves the renal trauma at 3 am for you.

The days of just doing the procedure and not taking care of pre and post procedure management is gone. There may be some practices still doing it, but the general trend is that you have to admit the patient in your service once you have done the procedure. And it will not also help to protect the turf. It will be just a pain in the neck.

The only specialty in medicine that can skip the pre and post op management is ortho.

Ortho, Urology, Gyn-Onc, ENT, Ophtho, Neuro spine, Plastics, .... believe it or not, have much better life style than IR, better or equal pay and small number of low end procedures. Also nobody dump their work on you at 11 pm Saturday because he does not want to come to the hospital.

Anyway, I just want to say IR is not Coiling the ACom Aneurysm or PVD that these guys are talking about. They want to deceive people.
IR in academics is 30-40% cancer work and the rest low end procedures like abscess drainage. In pp it is 80-90% low end procedures and 5-10 % high end in addition to all the procedures dumped on you after hours and in mid night. Why the GI can not control bleeder in mid night? Because they scope one time at 8 pm just to document it and then turf it out to IR. Instead they do 5 colonoscopies and make more. Now show me how an IR can turf out unwanted procedures to others?

 

[irwarrior]

Not sure where you are at, but the new crop of clinical IR who have outpatient clinics are doing quite well. The beauty of IR is the gamut of diseases that we cover from vascular disease, oncology, pain interventions, neuro-interventions, varicose veins, cosmetics, dialysis work, nonvascular interventions, central venous access, and fibroids to name a few. Our practice and the practice of many of my colleagues is flourishing. The key thing that had to take place is for us to have developed dedicated clinics and subsets of expertise in our group ie one person who focuses in on oncology, another in vascular cases, another in veins etc.

More and more IR are splitting off from their diagnostic colleagues and setting up independent IR practices. These are thriving. Many of the diagnostic radiology groups will not shell out the money to pay for the overhead needed for clinic. Yes, the lifestyle is far more like surgery but we as clinical IR are blessed to do some amazing stuff.

IR is a relatively new field (started with Charles Dotter in the 1960s) and clearly is evolving at an unbelievably rapid pace.

Often times IR is the face of radiology as the average radiologist does not have a presence on the floors or in the clinics .

We are so busy that we turf many of our procedures out in fact my colleagues in private practice in independent IR practices turf out procedures such as paracentesis on their own patients to the diagnostic radiology group.

It takes considerable amount of work to build a clinical IR practice and it does take some core knowledge of clinical medicine to practice as a modern day clinical interventionalist. But, it is not rocket science and can be easily learned and taught.

IR is an amazing field for those who are willing to practice as clinician physicians if you simply want to do the procedure and expect someone else to take care of the remainder of the work ie getting insurance authorization, admitting the patient, doing the follow up, dealing with disability forms, prescribing medications etc, then you probably should not do IR and should consider a field with minimal patient contact such as pathology or diagnostic radiology.

I have a practice and have had the pleasure and blessing of following many of my patients since I started my practice and will continue to follow them for their life.

 

[irwarrior]

Sorry that the post was hijacked, but I agree that the IR from Brown are quite strong and they have Tim Murphy MD who is the principal investigator in 2 very prominent vascular disease trials.

CLEVER trial (national randomized controlled trial looking at exercise vs endovascular revascularization in claudications)

CORAL trial (national randomized controlled trial looking at optimized medical therapy vs renal artery stenting in atherosclerotic renal artery stenosis).

The rest of their speakers are also prominent interventionalists and are well respected in their clinical community.

 

[shark2000]

1- Every woman has an OB-Gyn doc and goes to him if she has pain, bleeding and ... Other than boonies and small towns in middle of nowhere, you will not get tons of Fibroids to embolize. Forget about the settings where OB-Gyns are hospital employees (like academic centers, small hospitals with old Gyns) and they refer. Our Gyn docs talk the patient out of fibroid embo by talking how hysterectomy is easy. It is obvious that a woman who had 3 children delivered by her Gyn doc trusts him more.

2- IR and NeuroIR is different animals. Because they both use catheters does not mean they are the same. It is like saying GI and Urology are the same. I don't know why IR doctors always talk about NeuroIR when they want to talk about the scope of practice of IR. I barely know any IR who coils aneurysms. Probably they just want to add it to their practice so their lost turf in PAD gets overlooked.

3- Pain management is in the realm of Anesthesia. Also it is done broadly by Neurorads and MSK rads. I myself took it away from my IR colleagues and I do aspects of it including Vertebro/kypho. IMO, an IR is not qualified enough to do vertebro/kypho and is not qualified enough to do spinal injections. They do it because they do not have anything other than thora and para to do.

4- Thanks god that our group took over all the biopsies away from IR people before I join the group. Probably IR people are more qualified than us, but you know, we first read the patients study and call the oncologist or PCP for a biopsy request while our IR people are doing thoras.

5- Recently our IR people came to conclusion that our group are not supportive enough. They complain left and right why biopsies, drains, pain intervention, kypho/vertebro, CT guided procedures like abscess drainage, ... are done by us. Even one of them was nagging that arthrogram is in the realm of IR. They started their clinic 6 years ago in a big coastal city, but it is almost impossible to break into a market controlled by vasc surgeons and to some extent cardiologists. Eventually we decided to let IR people leave our group and add one or two body trained people to do some more procedures like percut neohro, ... Also a couple of non-IR trained rads in our groups are doing Ports, dialysis catheters and some other light stuff.

6- IR is completely different in pp versus big academic center or special settings like VA and even Kaiser. In pp everything is driven by money. You will end up doing low end procedures. That is the reason IR people love to include NeuroIR into the scope of their practice to make it look better. Other than 5-6 big universities like Brown, Miami vascular, UVA , ... , VA setting where everybody turfs out his job and also small towns in mid west and also boonies, in very few practice radiologists are controlling PAD. Soon the generation of Vascular surgeons without catheter skill will retire.

7- If an IR does not do PAD (very likely in a coastal city ) and does not do oncology (very likely in private practice), what high end procedures he will do? aha UAE ? good luck with having referral from Gyn while he can do hysterectomy himself. NeuroIR? It is not IR and also not broadly practiced. Pain? you even have turf issues with your colleagues, i.e. MSK and Neuro people.

8- At the end of the day, if you like IR, go for it. But when you are called to do an abscess drain at 11 pm because the surgeon wants to sleep at home and when your all day schedule is 7 paras, one dialysis cath and one difficult biopsy that your DR people dumped on you, remember this discussion.

 

[irwarrior]

Very few radiologists that are not IR do vertebroplasty and kyphoplasty. The majority of well trained IR are capable of doing vertebroplasty and kyphoplasty.

I wish our diagnostic colleagues would do some of the biopsies, but the referring physicians prefer IR to do it , because we are more aggressive in general and manage all the issues with the patient.

We can deal with alot of the complications as well, ie if there is a lung biopsy and we get a pneumothorax we take care of it ourselves and place a chest tube and admit to our service and manage the tube.

If we do a solid organ biopsy (kidney or liver) and we get into trouble with bleeding we can do the emoblization procedure.

Most of the diagnostic radiologists had a lack of comfort this and whenever there is a code or contrast reaction in the radiology department the IR docs run to the code and most diagnostic radiologists are not comfortable with a code situation.

I wish all radiologists were more aggressive and kudos to you for doing pain interventions and I hope you do it the right way ie review the literature (VERTOS II), buchbinder, kallmes articles etc. I hope you make an independent assessment of whether it will benefit the patient and follow the patient after the procedure as well. I think that all radiologists ( not just IR) should be more involved in patient care.

As far as abscesses, rarely are they emergent. Usually you cool them down with antibiotics and fluids and if need be pressors and then you ultimately drain it. But, the majority can wait until the next day.

As far as fibroids, there are so many patients that ask for it directly and they get upset when their gynecologist does not bring up the option. So, we get a fair number of direct referrals from patients.

Vein practices are big right now in the field of IR and so some IR just live on a busy vein practice.

Look radiology in general is facing some challenges as they are the "faceless" specialty. It is my opinion that IR brings alot to the table and rather than bickering we should work together with our diagnostic colleagues to improve patient care. I personally like my diagnostic colleagues and they refer some great cases to me. IR is an amazing field and we are privileged to have direct and long term impact on patients and their families. You do have to work very hard to build a practice and you have to be a strong clinician physician. The lifestyle is not that of diagnostic radiology and we often arrive to work earlier and stay later, but as I said it is highly rewarding.

Have an open mind and go learn more about this relatively new but amazing field.

 

[shark2000]

Very few radiologists that are not IR do vertebroplasty and kyphoplasty. The majority of well trained IR are capable of doing vertebroplasty and kyphoplasty.

I wish our diagnostic colleagues would do some of the biopsies, but the referring physicians prefer IR to do it , because we are more aggressive in general and manage all the issues with the patient.

We can deal with alot of the complications as well, ie if there is a lung biopsy and we get a pneumothorax we take care of it ourselves and place a chest tube and admit to our service and manage the tube.

If we do a solid organ biopsy (kidney or liver) and we get into trouble with bleeding we can do the emoblization procedure.

Most of the diagnostic radiologists had a lack of comfort this and whenever there is a code or contrast reaction in the radiology department the IR docs run to the code and most diagnostic radiologists are not comfortable with a code situation.

I wish all radiologists were more aggressive and kudos to you for doing pain interventions and I hope you do it the right way ie review the literature (VERTOS II), buchbinder, kallmes articles etc. I hope you make an independent assessment of whether it will benefit the patient and follow the patient after the procedure as well. I think that all radiologists ( not just IR) should be more involved in patient care.

As far as abscesses, rarely are they emergent. Usually you cool them down with antibiotics and fluids and if need be pressors and then you ultimately drain it. But, the majority can wait until the next day.

As far as fibroids, there are so many patients that ask for it directly and they get upset when their gynecologist does not bring up the option. So, we get a fair number of direct referrals from patients.

Vein practices are big right now in the field of IR and so some IR just live on a busy vein practice.

Look radiology in general is facing some challenges as they are the "faceless" specialty. It is my opinion that IR brings alot to the table and rather than bickering we should work together with our diagnostic colleagues to improve patient care. I personally like my diagnostic colleagues and they refer some great cases to me. IR is an amazing field and we are privileged to have direct and long term impact on patients and their families. You do have to work very hard to build a practice and you have to be a strong clinician physician. The lifestyle is not that of diagnostic radiology and we often arrive to work earlier and stay later, but as I said it is highly rewarding.

Have an open mind and go learn more about this relatively new but amazing field.

1- I don't know about your practice, but the new generation of body imagers are relatively comfortable doing biopsies and drains.

As far as complications, I agree that IR may be able to handle it better, but vascular surgeon is also is better than IR in dealing with complications of vascular work.

In practices that I have been, Oncologists like body imagers more than IR, as these are the people whom they have tumor board with and also consult them in day to day practice. It is like mammo, whoever thinks there is an abnormality should biopsy it.

Anyway, in practice if a DR wants to take it away from you, it is easy as he is in better position of getting referrals. The same for vertebro/kypho. Orthopods consult MSK people day to day. But on the other hand I agree that many MSK people are not trained to do it.

2- UFE: your argument is classic for an IR doctor. The reason IR has lost turf is not necessary quality. It is about who gets the patient first. I know patients may ask for it. But any Gyn can talk the patient out of it (radiation risk, recurrence risk, post embo pain/cramp, ovarian damage in theory, .... ). The truth is, there is not a huge benefit in UAE compared to Hysterectomy. At most the benefit is marginal. Do not forget that we live in a system that cards put 6 stent in a 3 vessel disease, while its benefit is almost zero compared to Bypass. Neurosurgeons clip aneurysm, though there is a huge benefit in endovascular coiling.

3- The weakness of IR that will not change despite all these models you are describing, is that it is not the service that decides on the treatment plan. Even in UFE, you are doing it, because a Gyn decided it is better. If someone gets menorrhagia they go to Gyn and not IR. If someone has vascular disease they are referred to vascular surgeon.

In the centers that NeuroIR is controlled by neurosurgeons aneurysms are coiled if meet the criteria. In centers that it done by radiologists, all aneurysms are clipped surgically and are not referred. If you don't believe it, go and check with Neuroradiologists. This fact is the innate huge weakness of IR that will stay with it forever. Never ever an ED doc referrs a patient to NeuroIR directly for headache or aneurysm.

Anyway, good luck with your IR career. You seem very passionate about what you do and I am sure you will be successful. Most IR sections are not like what you are describing and your case, though not rare, is not a typical IR department. I have heard of Neurology groups reading brain MR in Syracuse, but it is not typical for neurology. The same is true about what you say.

 

[irwarrior]

Time and time again I have seen countless IR practice in an aggressive clinical fashion and do quite well. Direct referrals from primary care and the ER. You just need to make yourself available. This is a relatively new trend (the past 5 or so years). The issue that many have is that the older IR do not feel comfortable with clinical practice and so it becomes a challenge to set up.

I agree you have to be the point of referral (ie primary care and ER). It is he who is gatekeeper that will make the decision. I notice that even in my practice when I get a consult I usually offer them all options but there is inherent bias and I am more likely to push my treatment options as I feel they are less invasive with reasonable efficacy.

The more recent graduating average diagnostic radiology resident has inadequate training in procedures and this is getting even worse with the new training paradigm where the average radiology resident may only get 2 or 3 months of IR training. With the expansion of mini fellowships there will be less cases to go around as more of those who want to do IR will do more of the cases and thus reduce the amount of cases for the rest of the residents.

Now as far as who gets the referral, you need to be present at the tumor boards. Be it body imagers or the IR, you need to have a presence. At our place the IR are front and center in most of these conferences and can offer a gamut of services from interpretation of the imaging, providing biopsies (especially challenging ones) and also ablative therapy or adjunctive procedures. For, oncology we can provide ports, dvt thrombolysis, IVC filters, SVC stenting, palliative drains for malignant ascites and malignant pleural effusions, pleuordesis, palliative celiac blocks.

Now, if the IR is not willing to do the groundwork to build a clinical practice then I agree with you.

As far as bailouts for vascular work, it is very rare to need a bailout. The equipment and technology has improved dramatically. We have embolic protection devices to prevent distal emboli, thrombolytics to break up acute clot, suction embolectomy devices to capture clot etc. We have covered stents for ruptured vessels, bail out stents for dissections. In fact it is rare that we can not handle the overwhelming majority of our complications.

But, I am glad that you are being proactive to do procedures and get involved in the tumor boards, this is key to the specialty of radiology thriving and I wish more diagnostic radiologists had a more aggressive attitude.

On average IR tend to be more aggressive than diagnostic radiologists (and it seems like perhaps your group is one of the exceptions) . I hope more DR start getting involved in procedural aspect of medicine and not just focus so much on getting the list done and going home at 5 pm.

But anyway again getting back to the original post, the students should go check this out and learn more about this great field.

 

[shark2000]

IR is for someone with your mindset. With this approach, I totally agree that you can have more case referrals that you can handle. No doubt. It may take a few years, but eventually you will be successful.

Let me tell you my experience. I started to market myself as relatively aggressive body imager ( I did a mini-fellowship) and also MSK pain management specialist (did a fellowship in MSK) only less than a year ago. In this market that you know about, I have had a very good amount of referral to my surprise. I had a great amount of support from my DR colleagues and they have been also very proactive. For example if we read a body CT, almost in every case that is amenable to biopsy, we call the oncologist in person, and talk about options.

For example, I almost work one extra day just to build my referrals. This includes tumor board, preparing for it, talking with referring doctors, having a light pain clinic, talking with PAs and talking with PCPs if they have time. Though a lot of these are just fun, like having lunch with our oncologist while talking only 10 minutes business, this helps us a lot. As a result oncologists consider us as specialists for cancer staging (whether it is CT, liver MR, PET, US, biopsy, ....) and they almost follow all of our recommendations.

Fortunately as a result, our number of lighr procedures including body and MSK light procedures are going high exponentially which were handled by our IR guys before. Now our IR people want us to prepare all the background and then have them do the cases. They have started fighting with us to the point that once one of them told my oncologist friend that if he wants his patients to be safe, he has to refer them to IR and not us.

Anyway, unfortunately I have had a horrible experience with IR people in my new practice. They block our work, and refuse to cooperate. I have worked much easier with general surgeons and orthpods. On the other hand, I was trained at one of the most respectable programs in the country and though it is considered one of the top IR fellowships, we had the same problems with IR over cases, esp in body section. Probably these two experiences made me think really bad about IR.

Good luck.

 

[irwarrior]

Well it seems to me you have the mindset of a modern day IR and the IRs at your group have a sense of entitlement. They need to be at the table to compete and if they are not going to the tumor boards, giving the talks, cold calling referring well then they should not complain about not getting the cases.

Kudos to you for building the pain practice, that is a great area for development.

If people expect to build a quality IR practice in the confines of a 9 to 5 day, then they are mistaken.

Again I wish that more diagnostic radiologists would be proactive like you and I encourage my diagnostic colleagues to have more of a presence at the tumor boards and in the procedural realms and also encourage them to take more global care of the patients.

Well hopefully more diagnostic radiologists will take your lead and again I believe your mindset and mentality are more like a modern day clinical IR rather than the average diagnostician.

Good luck in your pursuits.

 

[Dr. USMLE]

Let me tell you my experience. I started to market myself as relatively aggressive body imager ( I did a mini-fellowship) and also MSK pain management specialist (did a fellowship in MSK) only less than a year ago. In this market that you know about, I have had a very good amount of referral to my surprise. I had a great amount of support from my DR colleagues and they have been also very proactive. For example if we read a body CT, almost in every case that is amenable to biopsy, we call the oncologist in person, and talk about options.

For example, I almost work one extra day just to build my referrals. This includes tumor board, preparing for it, talking with referring doctors, having a light pain clinic, talking with PAs and talking with PCPs if they have time. Though a lot of these are just fun, like having lunch with our oncologist while talking only 10 minutes business, this helps us a lot. As a result oncologists consider us as specialists for cancer staging (whether it is CT, liver MR, PET, US, biopsy, ....) and they almost follow all of our recommendations.

Wow, this seems like an exciting approach. Lots of questions...So between all of these light procedures, what percentage of your time is spent doing DR vs. light IR? How do you have so much time and energy to develop these others areas if there is so much pressure to read tons of studies in pp? What are your hours? Why are your DR colleagues supportive of this? Is it just the local incompetent IRs or is this work more profitable than the same time spent reading studies? What does it mean to have a "light pain clinic" as a diagnostician? As far as tumor board, do you guys just go to a nearby academic institution and sit in on them or are there tumor boards in pp, too?