Oct 4, 2010
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Here is a link to all of the programs that offer DIRECT PATHWAY training

http://theabr.org/ic/ic_vir/ic_vir_direct.html

The list inlcudes:
  • Brigham and Womens
  • Christiana
  • Emory
  • Georgetown
  • Medical U of South Carolina
  • NY Presbyterian Hospitla , Cornell
  • Northwestern
  • SUNY Downstate Med col
  • THoams Jefferson
  • UAB
  • U of AZ
  • U of Arkansas
  • UC San Diego
  • U of FL health Science Center, Jacksonville
  • U of Illinois at Chicago
  • U of MN
  • U of MI
  • U of VT
  • U of Utah
  • U of Penn
  • U of NJ (Robert Wood Johnson)
Not currently recruiting new residents
  • Johns Hopkins
  • Stanford
  • U of CO
  • U of NM
It would be great if those familiar with any of these programs could comment on them. Particularly if you happen to inview at them.
 
Oct 15, 2010
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Hey, thanks for starting this list. MS1 here with a big interest in the DIRECT programs so any info is a great read :)

Out of curiosity, any idea why some programs stopped recruiting new residents? And is there any word on the street whether the number of DIRECT programs will expand in the future?
 
OP
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I suspect that the programs that are not currently accepting new applicants have filled internally for this year. Can't be sure though. Glad your looking seriously into the DIRECT programs.
 

PistolPete

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So do you apply for these during your PGY-1 year? Or during PGY-2, since you need two years of clinical medicine?
 
Oct 15, 2010
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Looks like there's variability in all these DIRECT programs, so I'd imagine we would have to check out each program's requirements individually.
 

phatfarm

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Brigham and Women's DIRECT pathway

DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training and Certification Pathway)
Applicants who wish to pursue a career in interventional radiology can apply for the DIRECT Pathway during medical school or after two years of clinical training in other disciplines. This 6-year program combines two years of clinical training, 27 months of diagnostic radiology training, 9 months of non-fellowship interventional radiology training, and a 1-year fellowship in interventional radiology. Currently, Dr. Rajasekhara Ayyagari is in this program. The new American Board of Radiology Examination structure may change the sequence of the DIRECT Pathway rotations. Please refer to the ABR website for any updated information.
 

phatfarm

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Christiana

The Department of Radiology offers a one-year, ACGME-accredited clinically based fellowship for graduates interested in pursuing a career in Vascular/Interventional Radiology. More than 13,500 studies are performed each year by the Vascular/Interventional Radiology Division. Fellows gain experience in all aspects of diagnostic and interventional vascular studies, encompassing the full spectrum of invasive and noninvasive procedures: (carotid stenting, endovascular repair of AAA, PTA, stenting, embolotherapy and thrombolysis) venous access, dialysis access maintenance, diagnostic and interventional GI and GU procedures (TIPS, radiofrequency ablation, chemoembolization, biliary decompression and stenting and fibroid embolization), percutaneous nephrostomy, nephroureteral catheter placement, percutaneous abscess drainage and biopsies. The high volume and broad range of procedures, coupled with excellent instruction by our dedicated faculty, provide a superior opportunity to develop the knowledge and skills necessary for a career in vascular and interventional radiology.

The DIRECT Pathway offers a six year program that allows for more clinically dedicated training. This combines two years of medical/surgical training, followed by two years of diagnostic radiology as well as two years of interventional radiology training. Within the newly established Center for Heart and Vascular Health, is the development of a comprehensive vascular program with collaborative efforts from the Vascular and Interventional Radiology Division, the Vascular Surgery Division and the Department of Cardiology. This will allow for a wide range of state-of-the-art diagnostic and therapeutic options for patients with vascular disease. Opportunities for study broaden the dimension of our fellowship program. For more information about how to apply for the Vascular/Interventional Radiology Fellowship contact the Department of Radiology via e-mail or call 302-733-5582.
 

phatfarm

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Georgetown

( Diagnostic and Interventional Radiology Enhanced Clinical Training and Certification)

Welcome to the Georgetown University's Vascular and Interventional Radiology DIRECT Pathway program. Our ABR-approved program provides in-depth clinical and interventional experience while preparing participants to qualify for the diagnostic radiology boards.

The program is structured to offer participants a substantial amount of time in the interventional radiology department. The DIRECT Pathway, is designed for the trainee who intends a full-time career in interventional radiology. The official description of the program can be found on the ABR Website

Application to DIRECT Pathway at Georgetown.

The typical applicant will enroll in their PGY-1 or PGY-2 year of a clinical specialty, including General Surgery, Internal Medicine, Emergency Medicine or other clinical specialty at an ACGME approved program. Georgetown University Hospital Department of Radiology will use the ERAS (The Electronic Residency Application Service) to review the applications. Selected applicants will be invited for an on-site interview.
In addition to applying through ERAS, the applicant should e-mail the Residency Program Coordinator, Mrs. Silvia Villaorel [email protected] to earmark the application for the DIRECT Pathway review.

Due to the fact that this is a PGY-3 position at Georgetown, there are no provisions for the application to the DIRECT Pathway while the applicant is still in medical school.
Successful applicants will typically be in the first or second year of residency training and will have passed steps 1 and 2 of USMLE. Strong applicants who are beyond 1st or 2nd year of Residency training or have finished their training will also occasionally be considered.

Any additional questions can be directed to Dr. Filip Banovac, the DIRECT Pathway Program Director at [email protected]
 

phatfarm

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The Interventional Radiology (IR) division consists of 5 full-time attendings, up to 2 fellows per year, 1 DIRECT Pathway resident per year as well as dedicated IR physician assistants, technologists, nurses, and secretaries. The clinical service has approximately 4,500 patient encounters each year encompassing the spectrum of vascular and non-vascular procedures.

The clinical service is oriented toward fellow training. The daily schedule includes patient rounds and review of the scheduled procedures for the day. The division plays an active role in admitting its own patients and performing clinical follow-up. On a weekly and monthly basis, there are several multidisciplinary conferences held with oncology, transplant surgery, gastroenterology and nephrology divisions of medicine and a monthly Journal Club for the IR division. In addition, the fellows are given didactic lectures throughout the year and on a weekly basis, interesting cases are reviewed with the IR fellows. Fellows are required to attend one educational meeting per year, such as the Annual Scientific Meeting of the Society of Interventional Radiology and are provided funds for this purpose.

The IR division accepts 2 fellows each year for one-year terms. Fellows must have completed a radiology residency. The one-year fellowship consists of 12 months on the IR clinical service at Thomas Jefferson University Hospital, allowing fellows ample time in the year to meet the minimum curriculum requirements for vascular and interventional radiology accreditation, including non-invasive vascular imaging, research and clinic experience. The division is approved to offer one position per year in the DIRECT Pathway, the alternative radiology training that enhances clinical and interventional training during the board-certified residency. For more information please contact Isabella Corcoran at (215) 955-6028.
 
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phatfarm

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UAMS

DEPARTMENT OF RADIOLOGY
UAMS COLLEGE OF MEDICINE
SELECTION & APPOINTMENT OF DIRECT PATHWAY RESIDENTS

(Diagnostic & Interventional Radiology Enhanced Clinical Training & Certification)
The Department of Radiology in the UAMS College of Medicine was the 5th program in the nation approved by the American Board of Radiology to offer the DIRECT pathway, a 6-year curriculum that incorporates the transitional year (internship), diagnostic radiology residency, and IR fellowship. It provides more clinical and interventional skills training than the traditional radiology pathway. Residents with training in other surgical/medical disciplines may receive credit for their prior clinical training.
________________________________________
The DIRECT Pathway differs from diagnostic radiology in that:
1. Two years of clinical training are required
2. The core diagnostic imaging training is 27 months
3. Non-fellowship VIR training is 9 months
4. VIR fellowship is in PGY5/final year of diagnostic radiology training is in PGY6.
We offer one DIRECT pathway position each year on a competitive basis. Applicants must demonstrate their qualifications for the diagnostic radiology as well as their interest in pursuing a career in interventional radiology.
________________________________________
UAMS DIRECT Pathway
↓
Entry Position (PGY1)
Length of training is 6 years
Offered through the NRMP, one position each year
Application through ERAS to Ms. Susan Rose, Program Coordinator
Application deadline is November 15th
Applicants selected for interview should tell Program Coordinator they want to be considered for DIRECT pathway
Candidates may rank DIRECT pathway and diagnostic radiology Advanced Position (≥ PGY2)
Length of training depends on prior GME
Offered when an opening occurs and funding is available
Application and supporting documents submitted to Dr. Deloney via e-mail, fax, or conventional mail
Applications reviewed on continuous basis
Applicants selected for interview will meet with radiology and IR faculty
________________________________________

The graduate of the DIRECT pathway will be eligible for American Board of Radiology certification and the subspecialty certificate of added qualifications in VIR. (See http://www.theabr.org/VIR_DIRECT.htm for more information.)
On-call responsibility is expected to be on parity with (if not identical to) current radiology residents (or fellows during the fellowship year).
If the resident should leave the DIRECT pathway, acceptance into the traditional diagnostic radiology residency is not guaranteed. Any resident/fellow who considers a transfer to another program must abide by the UAMS GMEC policy and AGEMC program requirement regarding transfers.

The DIRECT pathway resident will complete his/her fellowship in the UAMS College of Medicine unless an alternative fellowship is arranged by mutual agreement of the IR fellowship program director and the resident. As internal candidates, residents are accepted for the fellowship prior to the NRMP's Fellowship Match.

Program information is available on-line at http://www.uams.edu/radiology.
Applicants with questions about the pathway may contact the department's
Linda A. Deloney, MA, EdD
Assistant Professor, Department of Radiology
College of Medicine
University of Arkansas for Medical Sciences
4301 W. Markham #556
Little Rock, AR 72205
-----------------------------
501-603-1174
 

phatfarm

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UCSD

THE DIAGNOSTIC RADIOLOGY RESIDENCY PROGRAM
The Department of Radiology at UCSD has a large, nationally and internationally recognized faculty whose members subspecialize in all fields of clinical radiology and radiologic research. At UCSD, you will learn from world-renowned educators and have the opportunity to perform cutting-edge research in a pleasant and intellectually stimulating environment.
Three tracks are available within our Diagnostic Radiology Residency Program. We are currently ACGME approved for 40 Diagnostic Radiology Residents. Each year we recruit approximately 6 residents for our 4-year Traditional Track, 3 residents for our 5-Year Research Track and 1 resident for our DIRECT Pathway Track.

4-Year Traditional Track
Four Years of Clinical Radiology
This traditional pathway provides extensive training in all aspects of clinical radiology. All modalities are covered, including Fluoroscopy, Ultrasound, PET, PET-CT, MRI, CT, Scintigraphy, and Radiography. All subspecialties are covered with dedicated faculty, including obstetrical/fetal imaging, magnetic resonance imaging, vascular and interventional radiology, body imaging, neuroradiology, head and neck imaging, pediatrics, chest and cardiac imaging, musculoskeletal imaging, physics, nuclear medicine, and breast imaging.
Each resident spends four week periods in subspecialty sections at UCSD Medical Center, VA Medical Center, Thornton Hospital, and Children's Hospital. All institutions are equipped with PACS. The resident works closely with a member of the faculty on a one-to-one basis. Intensive exposure to each of the clinical areas and appropriate staff is assured for every resident. Time and opportunity for clinical laboratory research projects are also available.

5-Year Research Track
One Year of Research
Four Years of Clinical Radiology
This pathway is for the budding academic radiologist who wishes to perform research and publish early in residency. These residents push the envelope of radiology knowledge and are all but guaranteed a prestigious position in academic radiology.
The Chairman of our department, Dr. William G. Bradley, a distinguished neuroradiologist and world renowned pioneering MR scientist, has continued to expand the already extensive research infrastructure present at UCSD. The department has numerous facilities including a 3T MR unit, under the directorship of Dr. Graeme Bydder, a world renowned MR scientist and researcher, for basic and applied research as well as a long tradition of superior clinical research. The Functional MRI center has four dedicated research magnets for both animal and human studies. In addition, we are continually updating our magnets, scanners, and angiography suites to provide the latest tools for clinical research.

DIRECT Pathway
The DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training and Certification) Pathway is an American Board of Radiology pilot program and is currently being offered by our Department. This Pathway allows a resident, who has already completed two years of clinical training in another specialty, to complete a four-year Diagnostic Radiology residency and be eligible for the subspecialty VIR certificate from the American Board of Radiology. Additional information concerning this Pathway can be located on the American Board of Radiology website http://www.theabr.org/


CONFERENCES AND DIDACTICS


Noon Conference- These daily didactic and case-based conferences are provided for all residents at the VA and UCSD Medical Center.
Core Lecture Series- Twice a week the residents have didactic lectures covering all topics in radiology on a two-year rotating schedule.
Physics Lecture Series- Our Physics Division conducts weekly didactic lectures to prepare residents for the physics portion of the Boards.
"Curie"osity Lecture Series- These lectures cover non-interpretive topics in radiology such as risk management, debt management, ethics, contract negotiation, and radiology politics.
George Leopold Club- Dr. George Leopold, our former chairman, started this program meeting first year residents each week until they finish a general radiology textbook. Dr. Katherine Richman, our former Program Director, will be teaching this group beginning in September 2010.
Section Conferences- Residents attend section and multi-specialty conferences related to their current rotation. These conferences enhance the residents' understanding of the role of the radiologist in patient care.
Bone Conference- Dr. Donald Resnick and his musculoskeletal department give case- based conferences and didactic lectures every Thursday and Saturday morning.
Grand Rounds- Twice a month, prominent radiologists from our own faculty and around the country focus on the newest developments in basic research and clinical interpretation.
GENERAL INFORMATION
Meetings: The department allows residents to attend scientific meetings when they are presenting a paper. Expenses up to $1000 each year are reimbursed for travel to meetings if the resident is the first author on a paper or exhibit.
AIRP: Each resident is given the opportunity to attend the four-week course at the American Institute Radiologic Pathology in Washington, D.C. Tuition is paid by the department and a stipend of up to $1,500 is available to each resident for expenses.
Vacations: Residents receive four weeks of paid vacation per year (20 working days).
Maternity/Paternity Leave: Residents are allowed (in addition to vacation time) 4 weeks for maternity leave or 2 weeks for paternity leave.
Medical Coverage: The University offers an excellent health benefit package for residents. Professional liability insurance is supplied by UCSD Medical Center. Residents are officially registered as graduate students at UCSD.

APPLICATION REQUIREMENTS
Applicants must be in their fourth year of medical school or a graduate of an American or Canadian medical school (including osteopathic schools). In addition, the applicant must either be eligible for licensure or hold a valid medical license in the State of California.
Applicants must apply through the Electronic Residency Application Service (ERAS) and participate in the National Residency Matching Program (NRMP).
International Medical Graduates will be considered on an individual basis. UCSD accepts ECFMG-sponsored J-1 visas. Please note that H-1 visas are not available to trainees at our institution.
This residency program requires a non-radiology clinical internship prior to beginning radiology training. The application process for internship is entirely separate from this radiology residency application process. Your internship does not need to be at UCSD Medical Center.
November 1, 2010 is the deadline for all application materials. However, for current graduating seniors, we are aware your Student Performance Evaluation Letter (Dean's Letter) will arrive soon after November 1st , and we will extend our deadline to November 3, 2010. Once applications are received and reviewed by members of our Selection Committee, you may be contacted to schedule a personal interview with members of the Committee. Please do not anticipate any correspondence from our Selection Committee concerning interviews until the end of November. We receive approximately 500 applications and interview approximately 70 applicants each year. All interviews are scheduled during the month of January.


SELECTION CRITERIA
We are often asked about our selection criteria for granting interviews. We have listed answers to some of the most common asked questions concerning this process.
USMLE Scores- We do not use USMLE cutoff scores. The Selection Committee reviews each application in it's entirety and considers the USMLE score in conjunction with the entire application.
Medical School Graduation-No cutoff for year of graduation from medical school.
International Medical Graduates-International Medical Graduates are accepted into the program if they met all screening criteria and the applicant qualifies for a J-1 visa through the ECFMG.
Letters of Recommendation-Three letters of recommendation are required. At least one letter should be from a radiologist who knows you well and is familiar with your clinical work. You may submit more than three letters.
Transitional Year-We do not offer a Transitional Year as part of our program.


INTERVIEWS
Interviews are held on six days in the month of January at the UCSD Medical Center in Hillcrest. We begin our interview day at 7:45 am and will conclude in the late afternoon. An optional "low key" dinner is available the night before interviews and is an excellent opportunity to meet the residents and find out more about the program.


Schedule for Interviews
7:55 am Orientation and Welcome – Tudor H. Hughes, M.D., Program Director
8:20 am Research Overview – Robert Mattrey, M.D., Vice-Chair of Research
8:40 am Welcome – William G. Bradley, M.D., Ph.D., Chairman
9:00 – 12:00 pm Interviews with Selection Committee and Research Committee
12:00 pm Noon Conference
1:00 pm Lunch with residents
2:30 pm Meet with Research Faculty – UCSD Moores Cancer Center


ADDITIONAL INFORMATION
The UCSD School of Medicine, Office of Graduate Medical Education has information on their website concerning terms and conditions of appointment, sample appointment letters and housestaff benefits. This information can be found at http://meded.ucsd.edu/gme/
You may also wish to visit our residents' website http://radiology.ucsd.edu/radres/ to obtain more information concerning the program from our residents' perspective.
If you have questions about the status of your application, contact Kathleen Shepherd, the Residency Program Coordinator, at (619) 543-3534 or send an email message: [email protected].
Visiting Resident Electives

The Department of Radiology offers electives to visiting residents currently enrolled in ACGME accredited training programs. These electives are arranged 3-4 months in advance of the date of arrival. Interested residents will need to contact the program coordinator with the following information:

* Exact dates of the requested elective, usually 4-weeks.
* Subspecialty of interest: Body Imaging, Chest Imaging, Magnetic Resonance Imaging, Musculoskeletal Imaging, Neuroradiology, or Vascular & Interventional Radiology.
* Current CV.



The program coordinator will send the elective request and CV to the Chief of the Division for approval. Once the elective time is approved, the program coordinator will contact the visiting resident with information needed to complete an appointment though the Office of Graduate Medical Education. For more information or to apply for a visiting resident elective, please contact Kathleen Shepherd at: [email protected].
 

phatfarm

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UMN

Positions

There are 9 positions available in the Diagnostic Radiology Residency Program.

8 Categorical (5 year)
1 DIRECT Pathway

The Diagnostic Radiology Residency Program at the University of Minnesota participates in the Electronic Residency Application Service (ERAS). We do not accept paper applications.

Eligibility and Application

To be eligible for appointment, the clinical-base candidate must be a student in good standing at an American or Canadian medical school approved by the Council of Medical Education of the American Medical Association. A rotating or straight internship approved by the ACGME (Accreditation Council for Graduate Medical Education) also meets admission requirements and may be used to satisfy the PGY-1 requirement. Graduates of foreign medical schools must hold an ECFMG or FLEX certificate or possess a license to practice medicine in the United States. A Minnesota medical license is not required for appointment, but each resident should make the necessary arrangements early in their CA-3 year if they anticipate remaining in Minnesota.

Applicants with a foreign medical degree should check with the Educational Commission for Foreign Medical Graduates (ECFMG) for information.

Completed application via ERAS to include:

1. Three letters of recommendations
2. Dean's letter
3. Personal statement
4. Curriculum vitae
5. Official medical school transcript(s)
6. USMLE (Step I and Step II, if available) or COMLEX scores
7. Photograph

Application deadline is November 1st

For more information, please contact:

Tim Emory, M.D., Radiology Residency Program Director
(612) 626-5529
[email protected]

Judy Lally, Residency Recruitment Coordinator
(612) 626-3342
lallyjumn.edu
 

phatfarm

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UPENN



Residents interested in Interventional Radiology (IR) can follow three different training pathways, all requiring a total of six years. The Traditional pathway is an internship, four-year diagnostic radiology residency, and a one year IR Fellowship. The Clinical Pathway is a subspecialty track within the traditional residency. You complete a traditional internship, three years of radiology followed by two years in IR including medical and surgical electives, vascular imaging and dedicated research time.

The newest track, the Direct Pathway, is designed for the medical student who intends a full-time career in image-guided therapy. The Direct Pathway starts with two years of surgery, followed by diagnostic radiology and 22.5 blocks of IR (which incorporates the fellowship year). Penn has matched to this track since 2005. Matching into this pathway guarantees a spot in surgery at the University of Pennsylvania (no need for a separate application or match).

Applicants to the Direct Pathway follow the standard ERAS process for the radiology residency. There are separate match numbers for the Direct Pathway and for the Research tracks. Applicants can rank any or all. Please note that once a candidate is matched to the Direct Pathway, it is not permissible to transfer into the traditional diagnostic or research track.
 

phatfarm

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UMDNJ - Robert Wood Johnson

Alternative Pathways

The RWJMS Radiology Residency Program supports the specialized DIRECT pathway program for those who are interested in a career in interventional radiology.

DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training and Certification Pathway)

Applicants who wish to pursue a career in interventional radiology can apply for the DIRECT Pathway during medical school or after two years of clinical training in other disciplines. This 6-year program combines two years of clinical training, 27 months of diagnostic radiology training, 9 months of non-fellowship interventional radiology training, and a 1-year fellowship in interventional radiology.
 

BrockDoc

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What are the prospects of someone who is in his or her third year of internal medicine residency and then doing the DIRECT pathway program for IR? I am currently a 3rd year internal medicine resident who hasn't committed to a subspecialty fellowship yet. I was planning on working as a hospitalist for a year or two. I stumbled upon some websites for the DIRECT pathway for IR. I never knew it existed until now. I had always been drawn to IR because of its procedures, but never pursued it because I didn't want to completely lose the clinical contact. Now that I see that IRs are becoming more clinically focused, it is a very intriguing field for me.

I have some elective time in a couple of months, and I am wondering if I should try and set up an IR rotation. I would do that if I thought it was worthwhile to pursue this DIRECT pathway...both from a "what are my chances" standpoint (as a soon the be finished internal medicine resident) and a "future of the field" standpoint. Any thoughts on this?

Thanks
 

phatfarm

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BrockDoc, What about the Clinical Pathway?

THE CLINICAL PATHWAY
FOR VASCULAR AND INTERVENTIONAL RADIOLOGY TRAINING


INTRODUCTION

The Society Interventional Radiology recognizes the need for enhanced training options for individuals interested in obtaining a broader clinical and research experience in the pursuit of a career in vascular and interventional radiology (VIR). To address this need, a clinical pathway is offered at participating institutions for trainees interested in obtaining a more in-depth clinical and research experience in the field of VIR.

The primary intent of this Pathway is to provide a broader and more in-depth experience in the clinical diagnosis and care of patients with diseases commonly treated by VIR during radiology residency. The secondary intent of the pathway is to allow the trainee an opportunity to become more familiar with and/or participate in research to further the field of VIR.


REQUIREMENTS

The Clinical Pathway is recommended for physicians who are planning a career that focuses primarily on the subspecialty field of VIR. Other physicians whose primary interest is not VIR should pursue the standard five years of training in Diagnostic Radiology. Entry into the Clinical Pathway implies a commitment to its completion.

Because of the uniqueness of this program, the trainee must work closely with the radiology residency and the IR fellowship program directors to design an appropriate training plan that provides adequate clinical radiology experience in order to meet both the ABR and CAQ requirements for Diagnostic Radiology and IR, respectively, during a 6 year training period. Planning for this Pathway should occur either as a medical student or during the PGY-1 year. In special circumstances, exceptions can be made as late as the PGY-2 or the PGY-3 year.

Although it is preferable for the individual entering the Clinical Pathway to do all six years of training at one institution, in certain situations, it would be acceptable for the individual to obtain the PGY-1 year of training at one institution, the PGY-2 through 5 years of training at a second institution, and the PGY-6 year of training at a third institution (or any combination of the above), as long as all the training programs are ACGME-approved.


TRAINING

The total period of training is designed to comply with the normal six-year (combined) requirement for a Diagnostic Radiology residency and IR fellowship training program.

CLINICAL PATIENT CARE TRAINING:
As for the traditional training pathway, a minimum of 12 months of direct patient care in the PGY-1 year is required in an ACGME-approved program in Internal Medicine or its subspecialty areas (i.e. cardiology, nephrology, pulmonary, critical care, gastroenterology, or hematology/oncology); Pediatrics; Surgery (General, Cardiovascular, Pediatric, Thoracic, or Urological); Family Practice; Emergency Medicine; OB-GYN; or any combination of these specialty areas.
In addition, seven months during PGY-2 to PGY-6 will be dedicated to research and clinical training in areas relevant to the practice of VIR (i.e. consult service for cardiology, nephrology, vascular surgery, oncology, hepatology, gastroenterology or other non-radiology clinical rotations).
Programs may also provide a resident IR clinic to provide the trainees opportunity for managing outpatients and to provide enhanced continuity of care.

DIAGNOSTIC RADIOLOGY TRAINING:
Thirty-two months of full-time radiology is required including 3 months of IR during the PGY-2 , PGY-3 and PGY-4 years. Because of the attenuation of the traditional clinical radiology training, it will be imperative that the Radiology residency and IR Fellowship program directors make annual evaluations regarding the residents' progress in radiology. This diagnostic radiology training will be obtained during the PGY-2, 3, 4, and 5 years.

ADDED INTERVENTIONAL RADIOLOGY TRAINING:
Nine months of subspecialty training in IR will be scheduled during the PGY-5 ("mini-fellowship") year. These nine months could include training in the noninvasive peripheral vascular lab, MRA, CTA, neuroangiography, neurointerventions, cardiac MRI or IR. This is IR fellow-level training that is in addition to the required PGY-6 fellowship year in an ACGME-approved IR fellowship training program.

RESEARCH/VIR CLINICAL TRAINING:
Seven months will be dedicated to research and clinical training in areas relevant to the practice of VIR. Of these seven months, the trainee should have a minimum of 3 months dedicated to basic or clinical research activities.

CALL SERVICE:
During the IR rotations in the PGY-5 year and non-radiology clinical training rotations during the PGY-2 through 5 years, call responsibility for the trainee will be determined by the Residency and Fellowship Program Directors.


CLINICAL PATHWAY
FOR VASCULAR AND INTERVENTIONAL RADIOLOGY
YEAR DESCRIPTION DURATION
PGY-1 Transitional-clinical year 12 months
PGY-2-5 Diagnostic Radiology (*includes 3 months IR during PGY-2, 3 or 4) 32 months
PGY-2-5 Clinical Training and Research 7 months
PGY-5 Interventional Radiology "mini-fellowship" 9 months
PGY-6 Interventional Radiology Fellowship 12 months
Total Training 72 months



ASSESSMENT OF TRAINING QUALITY
Trainee - The following are criteria that might be used to evaluate performance in addition to the traditional radiology criteria:

Clinical:
1. Quarterly evaluations while on the vascular and interventional radiology and clinical services
2. Participation in VIR, clinical, and multi-disciplinary conferences
3. Number of patients admitted and followed
4. Number of formal consultations done
5. Number and type of procedures participated

Research:
1. Participation in research
2. Participation in seminars, journal clubs, etc.
3. Publications and patents.
4. Presentations at scientific meetings
5. Grant proposals
6. Honors






ENVIRONMENT FOR CLINICAL TRAINING:
An environment suitable for providing the trainee an opportunity to directly participate in inpatient and outpatient clinical care and follow-up of disease processes pertinent to the practice of VIR shall be available.

The trainee shall also have a clinical mentor who is either CAQ-certified or eligible in VIR. The mentor shall have experience in the management and care of patients frequently seen by a VIR service.


ENVIRONMENT FOR RESEARCH TRAINING
An environment suitable for a positive research experience should exist. This environment should include adequate space, equipment, clinical volume, funding, and a central mass of mentors and support personnel in VIR. The research mentor, who may be the same individual as the clinical mentor, must accept the responsibility for supervision or assignment of supervision of the trainee's research experience.
 

BrockDoc

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What are the pros and cons of the clinical vs. DIRECT pathway? I guess the DIRECT pathway seemed slightly more appealing at first glance because I could start as a PGY-3 since I'll be board certified in internal medicine come July 2011. I also wonder whether or not having the internal medicine training under my belt will make me more or less desirable as an IR candidate? If the field of IR is moving toward the direction of being more clinically focused, wouldn't it seem reasonable that feeling comfortable taking care of patients in both the inpatient and outpatient setting would be an asset rather than a disadvantage?

I guess I am just thinking aloud, but I do appreciate any insight into this field. I guess my biggest question is am I better off putting my eggs in the basket of a medicine subspecialty or would it be worth pursuing IR?
 

phatfarm

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Unfortunately there is not much information about the DIRECT pathway out there. I have tried to contact many individuals in the field about the pathway. I have heard from a few residency programs that they are not interested in the pathway and those that have the pathway are not sure they will continue offering the pathway.

A couple of reasons I have heard regarding this:

1. The initial residents in this pathway did poorly on their boards so many programs are skittish about offering the pathway because of this.
2. Many of those programs that have it on the books are not offering it every year and are offering it inconsistently. Some programs have only had 1 or 2 residents go through this pathway through the whole pathways existence, but leave it on the books for the rare exception.
3. I have spoken to a couple of residents in this pathway and they have felt that they had to cram the radiology knowledge in 1 year less and hence feel a little less comfortable with radiology. They also mentioned difficulty with attendings not understanding the pathway they are on and not necessarily having good support for this pathway.
4. Some I have spoken to mentioned that that DIRECT pathway residents can only get IR jobs and will not be as competetive for regular radiology jobs due to 1 year less of radiology.

Supposedly there is a movement for a primary certification pathway for IR that will be available in 2012 or 2013 -- where individuals will not need to complete a radiology residency.

A few other things I have observed is that the field is changing significantly. There are huge TURF wars in the field of IR. Peripheral stents are becoming harder to do now due to vascular surgery now managing those patients. 25% of the procedures done by IR at a couple of the places I observed, are procedures that are traditionally done by hospitalists such as thoracentesis and paracentesis. Another problem is that IR is changing and becoming more specialized. For example at Brigham and Woman's hospital, the IR fellows don't do traditional image guided biopsies, those are done by either the chest fellows or the MSK fellows.

IR seems to be a field that is trying to define itself currently and that these pathways were ways to get more people interested in the field. Unfortunately the field is not doing a good job of supporting these pathways except at a few rare institutions.

These are my observations.
 
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Another issue I have run in to is:

UPENN for example clearly wants persons to match out of medical school in to their program which includes 2 initial surgery years. Other programs are similar. Some programs match 2 years in advance. A few match 1 year in advance. So every programs seems to want a little bit different resident. Yet very few programs let you know what they are looking for exactly. Factor in the fact that there is usually only 1 spot offered for this pathway at most yearly, there are very few opportunities to enter this pathway.
 
Nov 7, 2010
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2 year thread bump here. What's the consensus regarding the DIRECT, CLINICAL route, and traditional DR residency/IR fellowship in 2012? When this thread was started two years ago, there wasn't that much info about the DIRECT and CLINICAL routes.
 
Dec 9, 2011
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2 year thread bump here. What's the consensus regarding the DIRECT, CLINICAL route, and traditional DR residency/IR fellowship in 2012? When this thread was started two years ago, there wasn't that much info about the DIRECT and CLINICAL routes.
1- You will become a better IR doctor. How much it helps in turf wars? Nothing. Turf war does not have anything to do with quality. It is purely a financial incentive.
2- Your DR education will not be as robust and solid. More importantly, most DR people do not see you as a competent DR person.
3- In summary, if you want to do IR and you are sure that you want to work 100% IR in the future, go for it. It is a better pathway to IR.
4- Many who entered IR did not want to do it from the beginning and entered it because they disliked the rest of radiology or wanted to find a job in desirable location. Many who wanted to do IR from the beginning, didn't do it after they've found out it is not the sweat geek once the had thought.
 
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I agree that it's better for people that want to do 100% IR in the future. I think with the dual certificate (which is very similar to the Clinical pathway), most people going into IR will match directly from medical school. I also think there will be more and more 100% IR practices in the future, so getting more clinical training is critical. To med students reading these forums, I would encourage you to go to meetings like SIR to learn about IR and it's future. The mentality of a DR and IR are so different, it's hard to appreciate what IR is truly like from a DR like Shark (however good his/her intention is). I think you'll get a better understanding of the true breadth/depth of the specialty. It's really difficult to not be a successful IR if you do it right. IR is amazing, I encourage everyone who is thinking about other clinical specialties (any type of surgery/GI/cards etc...) to look into it.
 

badasshairday

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Interventional Radiology is the best sub-specialty in medicine. End of story.
 

Dr. USMLE

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Interventional Radiology is the best sub-specialty in medicine. End of story.
That might be true if there were no turf wars, no emergent cases, and the economy/reimbursements continued to promote the cycle of innovation. It's definitely a lot of fun as an intern though, when I don't have to deal with these issues.
 
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From the new medicare reimbursement rates that came out yesterday, IR got killed: 3% cut. But I have talked to a few IR guys and they say that ANY medical specialty has ups and downs, and to base a life decision on recent trends is absolutely ridiculous. Who knows, maybe in 8 years (when I'm finished with all my training), reimbursements will be different. Concerning turf wars, I think it depends on what hospital at which you work. For example, IR are the GO-TO guys in the private hospital in my city for everything, but across town, the IR department at the main community hospital don't have as much freedom.

Nonetheless IR has such a large array of procedures that even if vascular surgery "takes over" the vascular stuff, IR will have hundreds of other procedures from which to choose. Also don't forget the fact the IR continues to reinvent themselves as testament to the new procedures that have been implemented in the last 10 years.

Back to my main point, the DIRECT or CLINICAL path do seem a better fit for me since I plan on doing IR, but is it more competitive to get into these programs since it seems that there are only a handful of positions? Also, does one match into a DIRECT or CLINICAL programs after med school or do you apply during a PGY?

Happy Turkey Day.
 
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http://www.sirweb.org/fellows-residents-students/pathway-options.shtml


This is a link to a site that showcases the programs. UVA has a robust clinical pathway and a solid curriculum and they recruit out of medical school. The other programs that I know of recruiting from medical school include Christiana Care in Delaware. I heard that Georgetown and UPenn are DIRECT programs recruiting out of medical school as well. Hope that helps you get started on your search.
 
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1- IR is the hospitalist of hospital procedures. IR has already changed to trash can of the hospital, esp in pp. Whoever does not want to do a procedure, turf it out to IR. It includes are complex ones, after hours, bad insurance, ....
2- PVD is almost lost to vasc surgeons. Most community hospitals are not doing TACE or any other cancer work. Can somebody tell me in a practice that vasc surgeons controll PVD and there is not cancer work, what kind of high end procedures other than abscess drainage and thora is left for IR to do?
3- My friendly advice: If you are surgical type and think about IR, go and do some more reasonable surgical field. There are tons of them with much better turf, better pay and IMPORTANTLY much better hours.
4- Many IR doctors kiss IR goodbye after 8-10 years. I can say it is the case for most. If you do DIRECT pathway, the problem is nobody will give you a job in DR unless they job marker is very good at that time.
5- The only reason is IR in high demand right now, is that nobody want to do it. And by nobody I don't mean MS4. I mean more experienced radiologist. Most IR people in groups switch to DR after 7-8 years. Then as a senior partner they do DR and hire an IR to take care of ****. Afterall, most radiologists (even IR ones) are smart enough to see the light after 7-8 years.
6- Many think I am trolling. Please keep my post in your records and read it again when your are an IR guy 2-3 years into pp.
 

MossPoh

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I've heard of some larger groups switching to a more shift based schedule for IR guys where they cover it for certain times. The guys that like nights just read out until something comes in. A few guys that burned out from IR were thinking of switching back because of the more doable schedule.
 
Nov 7, 2010
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Anyone actually apply or know of people that are in these DIRECT or CLINICAL programs?
Is it a special application? Are these programs competitive to match into?
 
Nov 11, 2012
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Anyone actually apply or know of people that are in these DIRECT or CLINICAL programs?
Is it a special application? Are these programs competitive to match into?
Let me ask some of my colleagues and get back to you on this. I know the SIR Resident and Fellow section (http://www.sirweb.org/rfs/index.shtml) is working on updating information regarding the training pathways, but it's not on the website yet.

What stage of training are you in?
 
Feb 2, 2012
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Anyone actually apply or know of people that are in these DIRECT or CLINICAL programs?
Is it a special application? Are these programs competitive to match into?
I know a few people that have trained in the Direct and one person that has done clinical pathway. From what I have heard, they are excellent programs. They are made for people that are sure they want to do IR and want more clinical and IR training.

The competitiveness is variable. One limiting factor is the number of programs. In the end, I think that you can use the competitiveness of the program in diagnostic as a proxy for the Direct program (i.e. hypothetical...I think that it is not much harder to get into Stanfords clinical pathway than getting into their diagnostic residency).

There are some hidden gems that have pretty much the same time distributions of IR time without the official designations of clinical or Direct. Kaiser LA, Ohio State, Baylor Houston....any program can give upto 16 months of IR training without a application for pathway from the ACGME. The SIR RFS is compiling information about these types of programs and it should be available in the next few months. (SIRweb.org/rfs).
 
Dec 6, 2012
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I am a DIRECT pathway resident. I don't have a good feel for how competitive these programs are. The resident fellow section of the SIR is working on getting the SIR's webpage updated with a list of programs. I think the most complete list of DIRECT pathway programs right now is at http://theabr.org/ic-direct. Unfortunately, the list doesn't say who is or is not currently recruiting for their pathway. If you know you want to do the DIRECT pathway, your best bet at this point (though cumbersome) would be to email all of the programs on the ABR's list, to ask if they are currently recruiting people at your level of training, and if so, how to apply. I don't know for sure, but I believe some will be recruiting MS4s, some PGY1s, and some PGY2s and beyond. I also think some will have you apply through the match, and others may be outside of the match.

I think the DIRECT pathway is a great way to go if you know you want to do 100% IR when you're done (as opposed to a mix of diagnostic and interventional). You'll end up with strong clinical training, and strong IR training. It's a bit more of a hassle to apply up front, given the lack of good information, but on the bright side, you can then skip the step of applying for fellowships if you match in a DIRECT pathway, as the fellowship should be incorporated into the program.

As for Clinical pathways, the most complete list that I am aware of is at www.sirweb.org --> Fellows/Residents/Students tab --> Training Pathways link. Again, there is variability among these programs, so I would email them for details about their curriculum and the application process.

Finally, as another person mentioned, there is an increasing number of programs offering IR mini fellowships/tracks that don't strictly fall under the category of DIRECT or Clinical pathway, but which offer exceptional IR training opportunities in residency. SIR-RFS is working on compiling a list of such programs, which we hope to eventually add to the SIR webpage. If you apply to traditional radiology residency programs, be sure to ask about opportunities for training in IR during residency.
 
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I think the DIRECT pathway is a great way to go if you know you want to do 100% IR when you're done (as opposed to a mix of diagnostic and interventional).

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So does this mean that if you do the DIRECT Path you'll most likely be doing 100% IR and 0% DR?

From the limited exposure I have with IR, I was under the impression that IR guys still do some DR readings on the side, either for extra revenue or their practice requires that they do readings.

I don't know for sure, but I believe some will be recruiting MS4s, some PGY1s, and some PGY2s and beyond. I also think some will have you apply through the match, and others may be outside of the match.
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That's another thing I'm not too sure about because I remember reading that some programs recruit PGY1s. So I'm guessing it's a whole different match?? So do you match at rads program first, apply to a DIRECT program during your PGY1 or 2, and if they accept you do you just leave your current rads program?

I am definitely interested in hearing about your process if you don't mind posting it.
 
Dec 6, 2012
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If you do the DIRECT pathway, you will still be board certified as a diagnostic radiologist, so you could certainly do a mix of IR and DR. But in the DIRECT pathway, your training can essentially broken down into two years of clinical medicine, two years and three months diagnostic radiology (of which a minimum of four months is nuclear medicine and three months is breast imaging), and a year and nine months of IR. So this pathway emphasizes IR and clinical medicine at the expense of the more extensive training you would have in DR in a traditional radiology residency. My personal opinion is that the DIRECT pathway is good for someone who knows they want to do 100% IR (or close to 100%). If you think you want to do a substantial amount of DR in addition to IR, then it probably makes sense to do the traditional pathway. That can be a tough thing to figure out in med school-- the best way is to spend time with radiologists and interventional radiologists when you can.

With regards to your second question, some DIRECT pathway programs are likely to take a resident in their first or second year of training from another field of medicine who has decided they want to switch. The advantage to this for the DIRECT pathway program is that they don't have to pay for the two required clinical years, and the applicant can immediately begin with the radiology department having already fulfilled the clinical requirement. There may be some programs though who are prepared to take applicants right out of med school (either they have agreements with other departments such as surgery who can offer clinical years and pay the salary during those years, or the radiology department has funding to pay for that time). The only way to figure that out though right now will be to contact the individual programs, let them know where you're at in your training, and see if they would accept an application from someone at your level of training.
 
Nov 11, 2012
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So does this mean that if you do the DIRECT Path you'll most likely be doing 100% IR and 0% DR?

From the limited exposure I have with IR, I was under the impression that IR guys still do some DR readings on the side, either for extra revenue or their practice requires that they do readings.



That's another thing I'm not too sure about because I remember reading that some programs recruit PGY1s. So I'm guessing it's a whole different match?? So do you match at rads program first, apply to a DIRECT program during your PGY1 or 2, and if they accept you do you just leave your current rads program?

I am definitely interested in hearing about your process if you don't mind posting it.
This is from my buddy who knows a LOT about the two pathways you're interested in. Hope it adds something for you.

Sorry it's taken me a while to reply-- I've been insanely busy lately with IR and a research project we're trying to wrap up.

The question this person asked is vague, so I'm not sure what specific information they want to know. Here's an attempt at a response.

As the field of IR continues to grow, there is a need for trainees to spend more time on IR rotations to learn the wide variety of procedures we do, and to become experts in the diseases that we treat. The DIRECT and Clinical pathways meet this need. Both pathways lead to board certification in diagnostic radiology, but training through these pathways leads to more in-depth clinical experience on rotations on the clinical services with which we frequently interface, such as vascular surgery, urology, gastroenterology, etc. The tradeoff with these pathways is that you will spend less time on diagnostic radiology rotations. Which pathway is best for you ultimately depends on what you want your practice to be like when you finish your training. If you see yourself living in a big city, doing 100% IR, with high-end complex cases, then these pathways are a great option. If you want to live in a medium or smaller city, and see yourself practicing a combination of diagnostic radiology and IR, then the traditional pathway may be a better option for you.

The other thing to pay attention to is that the "traditional pathway" is evolving as the radiology boards format changes. Incoming radiology residents will take boards at the end of their third year of radiology. Many programs are responding to this by offering mini-fellowships in radiology subspecialties during the fourth year of radiology. This could include multiple months on IR, or even rotations on non-radiology clinical services. Many of these programs are being developed by residents in cooperation with their program directors. If you decide to take the traditional pathway route, ask at your interviews or before your interviews if there are opportunities to do a mini-fellowship in IR or another IR track. Right now, there is no complete resource listing all programs with IR tracks/mini-fellowships, but the SIR resident fellow section (SIR RFS) is in the process of gathering this information with the goal of making it available to applicants interested in pursuing careers in IR.

These websites offer a general overview of the two IR pathways. Within these curricula, programs vary, so be sure to inquire about the details of programs you are considering (i.e., How many months of IR will you do each year? Are there opportunities to rotate through non-IR clinical rotations during your radiology residency? Will you participate in IR clinic, consults, inpatient admissions? What types of cases do they do? What are the opportunities to work in the vascular lab and to learn non-invasive vascular imaging?).

http://www.theabr.org/ic-vir-direct
http://www.sirweb.org/fellows-residents-students/pathway-options.shtml

The FREIDA website should have a list of programs recruiting residents for the DIRECT pathway. Many Clinical pathway programs move radiology residents into that track after they match through the regular radiology match.

Hope this helps.
 
Dec 9, 2011
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1- IR as clinician is a Joke of decade. I don't know where and when you guys have learned all these clinical knowledge. Rotating in other departments to learn clinical skills is a second joke in your post. Who will give you full responsibility of the patient like the way they give to a senior surgery resident.

2- The truth is IR procedures are easy to learn. Much easier than every IR doc says. You can train a monkey to put Port-A-cath. You can train a monkey to do Y-90, PVD or to drain Abscess. Oh, I forgot that most places are not doing Y-90 and in most places Vascular surgeons do PVD. Sooner or later, surgeons will drain abscesses under CT guidance.

3- The difficult part of any procedure is not the technical aspect. The difficult part is the clinical part. It is easier to do an TIPS than managing an ESLD in ICU with tons of complications. IR doctors, no matter what they say, are incompetent clinically. I will choose a vascular surgeon over an IR 100 times if I get PVD.

4- IR has been the biggest loser of medicine in the last decade. Now they want to cover it by starting these societies and different clinical tracks. The only reason is to deceive naive medical students to enter IR. Despite what people say, I really do not see a whole lot of progress in IR.

5- Except for the last 3-4 years, and only because of job market, IR was traditionally the field of less competent radiologists. Those who were not as bright as DR people, entered IR because it is easy to learn. How long it takes to teach a nurse to drain an abscess? One reason that IR lost a lot of turf, is because it has not had the competent staff at least in the past 2 decades. It has been full of people who lost their goal in radiology and found IR as a way to escape. These days it is full of people who are looking for a job and find it a way to go. As a result, I do not really see a whole lot of passionate people in IR. Most IR docs do not care about the field as long as they have their job in a big city.

7- For medical students: Other than very few exceptions, IR is the low end proceduralist of the hospital. It is like being a hospitalist, but training 6 years for it. Even if you become clinician, that I doubt it, no vascular surgeon is going to refer patients to you.
 
Dec 9, 2011
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Sooner or later, the old generation of vascular surgeons will retire and you see near complete loss of IR turf, like what happened with cardiac cath. The new generation of vascular surgeons are much more skillful with catheter than IR people and have many other IR skills including embolization, lines and tubes and ... It is just a matter of 5-10 years, where vascular surgery replaces IR completely. The light IR will go to other radiologists or other groups like surgeons, ....

If you choose direct pathway, you will be jobless in the future. No radiology group will hire you, because you will not be considered a competent DR person. And in 10 years, IR will not exist.

A hospital needs small radiology group, at minimum for mammo and light procedures like barium, arthorogram, light general radiology procedures, ... These people can expand their practice to other light procedures like abscess, drain, pain management,.. or may not. Most likely these telerad companies will go bankrupt in the future. Even if not, telerad is a RADIOLOGY service. It is not done by vascular surgeons. Also a hospital needs a Vascular surgery group. So now, why they need an IR group? I am not talking about MD Anderson which was doing tons of TACE even 10 years ago. I am talking about an average community hospital.

The only reason you may have job as pure IR doc in the near future, is probably because surgeons, vascular guys, cardiologists, Radiologists, ... want to sleep at night and want to have nice weekends. So there should be a trash can to dump their crap on them.
 

irwarrior

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As I have stated before, there are growing number of hospitals who need quality IR who can do the gamut of a skilled technical and clinical interventionalist can offer. I have seen this at the 150 bed hospitals to the 500 bed hospitals.

As far as indications for TIPS, who best to decide then the IR based on MELD, APACHE II, EMORY score etc. Then base the rest on indication and anatomy (ie feasibility). As far as ESLD , not many options but OLT. Bleeders you have few options blood transfusions, banding, TIPS, octreotide drip, pressors and if you get to a Blakemore tube the patient's mortality is nearly iminent.

So we have reasonable IR data prognosticating how a patient will do with TIPS.

Those who are willing to practice it the right way (ie see a patient in the office or as a consultant and follow them longitudinally), practice build, and are easy going and available will do well. Those who expect things to come easy and fall in their laps and believe it is exclusive to them cause they are IR or control imaging will ultimately lose out.

I have seen this time and time again where many of my IR colleagues have done quite well doing a clinical IR practice at a new hospital. But, they worked darn hard for it and it took them several years to build it.

The last 5 years have seen some transformation in the field of IR and more and more trainees come into radiology to specifically to do IR.

There are record number of applicants applying to IR fellowships and it seems to be the most competitive subspecialty of radiology currently (granted this is partly due to the job market). Pursue your passion and if you do it right, with IR you can't go wrong.
 
Dec 9, 2011
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1- IR is the most competitive fellowship, only because of the job market. People do it to find a job. The same as mammo. Mammo was the least competitive fellowship 10 years ago. So your argument that it is competitive because of changes in the field is irrelevant.

2- The reason for good IR job market, is not the field itself. It is because half of radiologists are more than 55 years. They want to sit on their ***** and read MRs making money rather than draining abscesses. Most IR jobs out there are low end procedures and 50% DR. Not high end.

3- No matter how much you know about MELD score, it is hepatologist who decided whether the patient needs TIPS. So your role as consultant is just deciding you are willing to do the procedure or not.

4- IR as clinician is a joke. Where and when did you learn your clinical knowledge? When was the last time you managed a shock patient in ICU? When was the last time you admitted a hepatic encephalopathy?

5- Hospitals needs IR because it needs a low end proceduralist. What if the surgeon wants to sleep at night and have IR drain abscess? What if vascular surgery wants to do all PVD during the day and leave the cold leg at 2 am for IR ?

6- Clinical IR is a disservice to the patient. There are more competent people to take care of patients with much better clinical skills and better procedural skills.

7- Excluding recent 2-3 years because of job market, IR people are generally the least astute radiologists. IR skills are really easy to learn. Those who can not learn radiology, choose it as a way to escape.

8- Medical students choose radiology for IR because they do not know the true nature of IR. Their understanding of IR is a guy who stents a carotid, then coils an MCA aneurysm, then jumps to a Y-90 then does an EVAR and goes home making a million working 3-4 days a week. Once a medical student told me that he wants to do IR to start a coronary intervention service!!!!!

9- IR will be dead in 10 years. Vascular work is done by vascular surgery and sooner or later they will take over cancer work. Don't forget that almost half of cancer work comes from surgery department. It is just a matter of time to being taken over. Many vascular surgeons are doing embolization now. Image guided procedures will be done either by body radiologists or by other groups. Take a look at body fellowship with intervention at MGH or UCLA.

10- The future of medicine is employment model. In a hospital who has well established vascular surgery, cardiology, radiology and surgery, go to the admin and tell them you want to start an IR clinic for PVD. They will laugh at you and not hire you, because you are really redundant. The job is done by another group, so why spend money on you?
 

irwarrior

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I deal with alot of the above issues. Again pretty straightforward.

Many of my patients have hepatic encephalopathy. I give them lactulose and xiafaxin 550 mg tid.for a week. Very straightforward.

TIPS is a consult and I decide who to do it on after frank discussion with the patient and their family. The hepatologist does not decide, he is not dragged into court for the procedure if something goes wrong, it is I.

This stuff is not rocket science. Clinical medicine is not rocket science, it is learned in internship during residency and certainly in fellowship and in practice. Admitting tons of patients and obtaining consults on patients is not rocket science.

I think the best person to take care of the IR patient is the IR clinician. I have seen many of my IR patients who go to other hospitals get grossly mismanaged. This occurs as patients get put on antibioticds for post embolization syndrome, have their uterus prematurely removed post UAE etc. So, again it is the IR physician (clinically astute) who is best suited to deal with these patients.

I feel that half the reports on imaging I order for my patients is misdiagnosed. Endoleaks over or undercalled, aneurysm poorly measured, CTA poorly read, post ablation and TACE images misinterpreted and no evaluation of the concurrent labs such as tumor markers is put into consideration.

IR is so much more than PAD it is dialysis interventions, oncology, biopsies, ablations, fibroids, veins, neuro with carotids and intracranial stenting, vertebroplasty and other pain interveniotns, pain pumps, spinal cord stimulators.

The imaging is key and every IR is board certified as a radiologist and can read imaging, but most diagnostic radiologists are not capable of treating an acute stroke with penumbra, merci, solitaire ,trevo etc and don''t have a concept of ASPECT scoring or NIH stroke scales or modified RANKINs etc.

The way to learn clinical medicine is to see patients and follow them.

If anything imaging is becoming more and more a commodity as groups like imaging advantage take over academics (Wayne State) and private practice (midwest).

IR can not be outsourced to VRAD or the lowest bidder as easily as imaging which can be streamed over PACs.

A strong IR group can be a foothold and centerpiece of the hospital and the radiology group.
 

irwarrior

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There are a large number of new independent IR practices and IR physicians who are doing 100 percent IR. They practice more like surgeons rather than dabble in low end hospital based interventions mixed with alot of imaging.

Different ways to do IR, but there are more and more of these solo IR or IR groups popping up. And radiology groups tend to be willing to give up the IR as they are high overhead and radiology groups are more focused on finishing the lists. My concern is that more and more radiology groups are losing their contracts with the hospitals as other businesses (not necessarily radiologists) are swooping in and taking over hospital contracts and employing radiologists.

ie radisphere, imaging advantage, vrad, statrad to name a few corporations.

See the following websites to showcase the newer model of IR


http://www.pacificinterventional.com/procedures.html

http://www.endovascularsurgery.com/

http://www.beautiful-legs-again.com/

https://www.riversiderad.com/services.cfm?category=interventional_radiology

https://www.riversiderad.com/services.cfm?category=neurointerventional_surgery

http://www.visoc.org/

If you want to do it I recommend you get good clinical training at a strong fellowship. This is an exciting specialty but you have to work to develop a great practice. The above groups are very aggressive about marketing and are strong clinicians who market directly to patients and primary docs as well as podiatrists


http://www.southfloridavascular.com/AboutUs/DoctorJulien.aspx
 
Dec 9, 2011
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1- NeuroIR is not IR. It is totally a different animal. It is like saying OB-Gyn and Orthopedics are the same. An IR trained guy can not do NeuroIR, unless double trained. Anyway, that is also being taken over by Neurosurgeons. Nobody will consult IR for AVM rupture. The patient should be admitted to neurosurgery critical care. Though, in your opinion it is easy. You just need to kill 100 people to learn it.

2- VRAD is taking over some hospitals. Wayne state was taken over by IA. But IA are radiologists reading the study. It was not taken over by orthopods. But The PAD at Wayne state was taken over by cardiologists and vasc surgeons many years ago. PAD was the most common high end IR procedure.

3- Biopsies and ablations are done in many places by Body imagers. I may agree that in pp, it may be done more by IR. The moment you separate yourself as a specialty, it will be taken over by Body imagers, as they have more robust relation with oncologists.

4- More and more vascular surgeons are doing Dialysis intervention. The reason you do it is because of old vascular surgeons with no catheter skills. Don't forget that every ESRD patient needs a vascular surgeon. An IR guy is incapable of putting an A-V fistula. New generation of vascular surgeons will take care of the fistula themselves. No need for you.

5- Everybody and their mom is doing vein. I have seen Dermatologists and General surgeons doing varicose veins. Good Luck.

6- Pain management is done by Neurorad, MSK, IR and anesthesiology. The moment IR separate from DR, the pain will be taken over by DR. Don't forget DR people read spine for spine surgeons and have better relation with them.

7- UFE does not have a huge benefit over surgery. You may get a few patients from family doctors, but most should go trough Ob-Gyn. Fibroid presents as bleeding. An IR doc is not capable of w/u perimenopausal bleeding. Though from your point of view it is easy to learn. It just needs 100 cancers to miss to learn it.

8- Once these are taken over, you will have a job composed of thoras and paras.

9- IR in 90s was high end procedures. In 2000s a mixture of high and low end procedures. In 2010s will be low end procedures. In 2020s it will extinct.

10- If you can read a post TACE better than body imagers, good luck. I had one of cancer-IR gurus in my residency program and he always consulted body people for his post procedure CTs or MRs. Probably you have to change your institution as they are not giving good reads. I do not believe that a radiologist can not measure aneurysm correctly.
 
Dec 9, 2011
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There are a large number of new independent IR practices and IR physicians who are doing 100 percent IR. They practice more like surgeons rather than dabble in low end hospital based interventions mixed with alot of imaging.

Different ways to do IR, but there are more and more of these solo IR or IR groups popping up. And radiology groups tend to be willing to give up the IR as they are high overhead and radiology groups are more focused on finishing the lists. My concern is that more and more radiology groups are losing their contracts with the hospitals as other businesses (not necessarily radiologists) are swooping in and taking over hospital contracts and employing radiologists.

ie radisphere, imaging advantage, vrad, statrad to name a few corporations.

See the following websites to showcase the newer model of IR


http://www.pacificinterventional.com/procedures.html

http://www.endovascularsurgery.com/

http://www.beautiful-legs-again.com/

https://www.riversiderad.com/services.cfm?category=interventional_radiology

https://www.riversiderad.com/services.cfm?category=neurointerventional_surgery

http://www.visoc.org/

If you want to do it I recommend you get good clinical training at a strong fellowship. This is an exciting specialty but you have to work to develop a great practice. The above groups are very aggressive about marketing and are strong clinicians who market directly to patients and primary docs as well as podiatrists


http://www.southfloridavascular.com/AboutUs/DoctorJulien.aspx

http://www.pacificinterventional.com/procedures.html

I don't have time to check all groups. But this one does surgery for peritoneal malignancy. Is this also part of IR? You are putting everything under IR, like NeuroIR, abdominal surgery ,... And in this group, you can clearly see that all PAD is done by vascular surgery. Dialysis AVF is put by vascular surgery and it is hard to believe that they do not do all the maintenance needed.

Man your example is horrible. It shows complete lost turf to vascular surgery.

I hope your level of care is more in your practice than here.
 

irwarrior

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Oct 19, 2008
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clearly you do not know this group as it was started by MIchael Arata an IR guy who started this multi specialty group. They have recruited various specialites, but the IR do alot of the vascular and they have partnered with surgeons.
 

irwarrior

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Oct 19, 2008
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Fibroid evaluation is pretty straightforward is it menstrual or intermenstrual bleeding if the periods are regular and the patient has submucosal periods and the periods are heavy requiring transfusions or requiring fe supplementation and interfering with life or if patient has bulk symptoms (pelvic pain, back pain, constipation , urinary frequency) then the patient is a candidate for fibroid embolization. We only get endometrial biopsy for those with intermenstrual bleeding and this either gyne or family practice or the NP will obtain for us. The MRI guides us for who is a candidate. We have even had success with adenomyosis. These patients are often being evaluated and referred by family practice to my practice. As far as efficacy compared to surgery look at the FIbroid registry, REST and EMMY trials which are some randomized control trials. Again we get a huge patient referral for this as the recovery period is much shorter and the hospital length of stay is either a day and/or sometimes we do it as an outpatient procedure.
 
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irwarrior

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Oct 19, 2008
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Very few MSK people do pain. The bulk of MSK fellowships don't train in pain and most diagnostic radiologists (in general) do not like to do procedures and dump even the minor procedures on IR. We would love for them to do some of the minor procedures, as we are quite busy with more complex treatments at our group and we have discussed with our hospital administrators.

Hospital administration is very supportive of us as we actually bring in patients to the hospital and generate millions of dollars of revenue for them. The hospital is aware that we can take many of our patients to nearby hospitals where we also have procedural and admitting privileges.

The radiology group does not actually bring in patients, so the hospital sees them as potentially expendable and replaceable.