charcot said:
Yup,
just to followup with the previous thread, I heard that IR at our hospital is now doing primarily line placements.
Cards- Angios
Vasc- AAA repairs
Urology- perc nephs
Pain- Vertebroplasty
and neurosurgery is doing carotid/intracranial stents, intracranial stents following the CREST and Sapphire trial results.
I think lifestyle issues are at least in part responsible for the declining numbers in VIR. IR is a demanding subspecialty with surgery-like hours, ie. long days and frequent calls. In the recent past, a lot of private practice groups paid their partners equally, thus the Dx guys got get paid the same as the IR guys who had to bust ass for the same pay. As lifestyle issues come into play, it makes IR less attractive in an equal compensation scheme.
Secondly, there is the threat of turf issues ie. Vascular cherry picking all the 'easy' angioplasty and stent cases and leaving all the less compensating vascular access and complicated A-V fistula declots to IR. (Granted Vasc surg used to place central lines). Why is vascular doing this? Because endovascular interventions would otherwise 'eat up' a lot of vascular surg's bread and butter and BECAUSE THEY CAN. In the past, vascular surgery would refer to IR, but now that they are learning the techniques they are doing the procedures. After all, THEY control the supply of patients.
These issues are scaring away some prospective interventionalists. As a result there is a huge man power shortage at a lot of institutions. Some fellowships need a warm body to help with the work and are more than willing to train an eager vascular surgeon. Next year my institution will train a vascular surgeon, b/c no rad grad wants to step up to the plate to do an IR fellowship. So its a bit of a vicious cycle.
A lot of these issues will also affect interventional neuroradiologists with respect to neurosurgeons and inverventional neurology (yes neurologists want to start doing endovascular work).
None-the-less, the future is bright for minimally invasive procedures. There will be more than enough work to go around despite inteventional cards and vascular surgery's inroads into IR. Interventional Radiologists will need to become more 'clinical'. IE admitting and rounding on their own patients, and handling their own complications rather than pawning them off to vasc surg or medicine. They need to agressively seek referals from primary care docs before they go to vasc surg.
There will always be work for interventionalists. And there will always be new procedures being developed. (UFE and chemoembolizations). If you think you want to do interventional, just do it!
-Hans
PS.
Just make sure you keep up on your diagnostic skills... not because IR will die, but in case you want to slow down later on. ; ) If any of you guys decided to go the neurosurg or vascular route, what would you have to fall back on? General neurosurgery or general surgery? No thanks!
