Deciding on Radiology for IR

[reedgw]

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I've been looking at career stability and turf wars that IR is facing. I know this has been discussed, just wanted to add the opinion of a MS3 in case there are other MS3s out there thinking about it too.

IR looks like a great field, and I think that the challenges they are up against are real but exaggerated. They're up against stiff competition from cardiology and vascular surgery regarding vascular intervention, that is for sure. The IR docs that I've spoken to admit that they do less vascular work than they used to. Most are okay with it because they do a lot of other stuff. In the future, IR will keep expanding and create new procedures, so that should take some of the sting off of losing vascular turf. On the flip side, there are a number of IR docs out there who work in a vascular practice with vascular surgeons and cardiologists side by side. They round on patients, do everything an endovascular surgeon would do and also read images for the group. So, in regard to vascular work in the future, I think it'll be tough for an IR to outcompete cards and vascular surg on their own simply b/c they don't control the referral base. But if you work for a hospital, you'll probably see some vascular work. And if you want to join a vascular practice, you could potentially do nothing but vascular, and make a good living doing it. There are undoubtedly exceptions to this, this is just what I've observed.

Even if vascular does totally dry up for IR, IR does so much else that you can easily stay busy as an IR, even without vascular work. Diagnostic angiograms, venous access, biopsies and drainages are all bread and butter for IR. Biliary and GU interventions handled by IR are certainly out of the reach of the typical general surgeon or urologist. Most OB/GYNs aren't doing UFE, so you can count on doing a lot of this if you position yourself well and develop good relationships with your referrers. Also, interventional oncology is rapidly expanding, and very promising. No one else is doing this stuff and it has great promise to really help cancer patients who aren't candidates for surgery and want another option to systemic chemo or radiation. This doesn't steal turf from any other specialty either, so heme/onc should be ready to refer to IR if the patient is a candidate.

Being board certified for DR is also a huge plus. As an IR, you could do as much DR as you wanted. You will always be able to fall back on DR. Plus, DR is interesting and cool stuff, and in high demand. I think the threat of outsourcing radiology is generally overstated, but IR is one of the few areas of radiology that can't be outsourced. Upcoming reimbursement cuts are definitely realistic, and in the future telerads may play a growing role in everyday practice. As an IR you've got a skill set that hospitals need around, and as such job security tops that of general radiology. The down side is that you'll probably work harder, longer hours in IR, and have to take some call - the reasons many radiologists avoid it. You get in return better job security and a skill set that very few physicians possess.

 

[p53]

Pros for IR

1. Quick turnaround time for procedures rather than long surgeries. This is one of the reasons IR will ALWAYS remain one of the top paid medical subspecialties EVEN if every physician's salary goes down.

2. Number of IR docs double the number of vascular surgeons. Plus the number of new IR docs out of training has nearly doubled the number of new vascular surgeons in the last 3 years. Furthermore, within surgery not many surgery residents want to go into vascular surgery. In fact, many IR physicians are HIRING vascular surgeons for their practice because IR docs have greater income potential. I can foresee vascular surgeons joining IR in the next 10-15 years to survive.

3. Outpatient hospital independant IR centers are booming. They are doing cash only outpatient procedures such as varicose veins, pain interventional treatments, Vertebroplasty, Kyphoplasty, interventional liposuction etc. If you want good hours you can have your own outpatient based practice. 9-5 M-F. With IR training, you can do inpatient, outpatient, or both. Your skillset will be extremely valuable to hospital administrators and patients!

4. Even though many subspecialties contribute to minimally invasive treatments. IR is branding itself as THE MINIMALLY INVASIVE SPECIALISTS. This is a buzzword among patients. Surgery = long recovery time, increase risk of infection etc. IR is in a great marketing position right now.

5. Near complete marketshare of interventional oncology. The lessons learned in the Cardiology battel will keep this high RVU procedure within IR.

6. BETTER hours than ENT, UROLOGY, and ORTHO. Granted IR physicians work longer hours than diagnostic radiologists. However, let's put it into perspective IR physicans still have better hours and pay compared to ENT, UROLOGY, and ORTHO. Optho has better hours but IR physicians have a greater variety of procedures and make 2x as much.

7. With IR training you can live anywhere you want such as Hawaii, Miami, San Diego etc. There is an incredible demand for IR physicians. The only subspecialty in radiology with greater demand in Mammography. Demand for IR is very high at nice locations. This is why in 2008 the salary for IR physicians went UP. One of my best friends is a resident in Ortho. The chance that he will be able to get a job in San Diego or Miami right out of residency is very, very low.

BOTTOMLINE

The interest in IR has increased dramatically in the last three years. Ask any IR physician about this and they will tell you. Interest is near an all time high because of the new branding as minimally invasive specialists. The future is extremely bright. Check out www.sirweb.org.

The only thing missing is a new name for IR to repackage it to the patients and the hospital administrators.