The scope and breadth of IR and the truly minimally invasive approach is what sets it apart from vascular surgery and other surgical or procedural specialties. Being able to do a stroke case, a vertebroplasty, biliary procedure, endoscopy, a renal stent, nephrostomy tube, a gastrostomy tube, GI bleeder, ,TIPS, BRTO, fibroid embolization. Cryoablation, rfa/microwave of various tumors. TACE, Y90, Rhizotomies. Prostate embolotherapy. gallstone extractions. Vascular malformation treatments. Peripheral arterial revascularizations. EVAR/TEVAR/visceral aneurysm treatments. PE and DVT thrombectomy. IVC filter retrievals and IVC reconstructions. MSK interventions etc.
Radiology gives you a strong foundation in anatomy that enables us to go from one organ to another, this is similar to general surgery 60 years ago where they would do cardiac surgery, trauma, vascular, oncology, ortho etc. The problem with current IR training is inadequate clinical exposure and training, but that is shifting with the new IR residencies. A proceduralist (IR/GI/Int cars/pulmonary etc) (who does not have an open option) is more likely to exhaust all minimally invasive options whereas a surgeon with procedural and open skills may be more likely to go directly to an open approach or convert to an open approach sooner.
If you have a primary interest in one organ space and like open surgical techniques, surgical subspecialties would make sense ie ENT/neurosurgery/urology/ortho/vascular/plastics/gyne etc. If you like less invasive procedures and like one specific organ (ie GI, cardiovascular, renal, pulmonary) an IM subspecialty makes sense.
Those who go into IR tend to like the current scope, breadth and innovation in the specialty. But, it is morphing into a more surgical specialty including the surgical lifestyle, when compared to our historic diagnostic roots.
IRwarrior, how many jobs being advertised on the SIR job board RIGHT NOW allow you to do all those procedures listed? Or indeed, 90% of them? I know maybe one or two. I do not mean to offend, but to start a discussion.
The dilemma faced by IR is that they are less subspecialized clinically than their organ based colleagues and unable to offer surgical options such as open bypass compared to vascular.
No amount of clinical training will produce, on the average, an IR stronger than nephrologist in the management of kidney disease, an oncologist in management of different types of cancers, or a neurologist in nuanced management of stroke etc, right out of residency. Clinical superiority/parity is an aspirational goal and are ultimately achieved by many attendings where their clinical expertise in specific areas rivals or exceed other specialists, including clinical specialists. However, I doubt an IR trainee’s clinical training will ever be more in depth than any of their organ based colleagues from the getgo in any reasonable training scheme simply because 3 years of DR is the bare minimum (and some would say less than the minimum) needed for DR competency.
IRwarrior, I believe what pull IR apart from other specialists are their excellent technical skills, unparalled skills in image interpetation, and then their clinical acumen. They bridge clinician to radiologist and to therapies based on image guidancs.
IRs are better clinicians than DRs and better diagnostic radiologist than clinicians. That’s the core identity of IR in my opinion and what make IR strong. If a specialty become more adapt than IR in both technical skills and image interpertation in addition to clinical acumen in a specific service line, the reality is that IR loses that service line. I doubt an IR more clinically adapt than a VS in PAD will earn back PAD if the said VS has better techical skills AND referal bases. In fact, as you know, many VS have their midlevel see many consults...
Meanwhile, I hear stories, even as a med student, specialist like nephrologist who run into issue performing interventional works due to technical incompetency. I believe having a stone cold superiority in technical ability AND adequate clinical acumen is the key, not the otherway around (improved clinical skill from sacrifing DR or IR training).
Because of that, I think the current training paradigm, with addition of clinical focus in PGY1, PGY5 and 6 years are perfect. They cannot sacrifice DR training any further. I think that diagnostic radiology and technical skill are the actual cake. Clinical skill for most IRs in most jobs are icing on the cake in my opinion.
I personally happen to think that clinical experience can be learned through experience but DR skills as well as “the eyes” are hard to come by and need to be trained at the workstation.
But what do I know, I am just a medical student with several family members in the radiology business and a sister who is about to sign on with her first IR academic faculty job who told me about all those challenges.
