Integrated IR Residency Experience

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Dec 18, 2023
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I'm an M3 interested in IR, especially in a clinic-based practice resembling a surgical subspecialty, and curious about what the integrated IR residency experience is like. (1) Does it resemble more so a DR or a surgical residency, or is it something else entirely? (2) Do you feel more prepared for practicing IR as a clinician or as a pure proceduralist? (3) What does a representative week look like in terms of hours and call obligations? (4) What do you enjoy most and least about it? (5) Do you have any general thoughts to share? I appreciate answers to any of these questions or anything else responders have in mind. Thank you!

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1) years r1-R3 tend to be regular diagnostic radiology years, years R4-R5 tend to be full IR years (call varies on program, tend to be M-F 7-5/6 type gig, way more Cush than surgery, the call does get to you though)
2) Ironically IR will need to move towards a clinic model if they want to survive independent of DR and with OBL in the future. But that also entails the headaches of clinical medicine, and having to deal with clinic, over head, more patient contact, building a practice. These are not easy and do not have a straightforward path to entry. The phenotype of an IR has classically been that of a radiologist that wants to avoid patient contact, although that may change in the future. So from a lifestyle perspective would benefit IR to practice purely as a proceduralist, but from a practice standpoint establishing your own clinic is probably better for the specialty and patient care. IR also does not control the patient flow because IM/FM will automatically consult cardiology for PAD for example, and the medication management of these diseases is not something heavily emphasized in Ir training. Fortunately for you you will get to practice how you want to. If you want to be a procedure monkey you can. If you want to be more clinically focused you can as well. Pick your poison
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It is progressively requiring increasing clinical responsibility and continues to become more and more surgical. There is the mixed IR/DR with "lite" IR which includes biopsies, fluid management (paracentesis/thoracentesis/abscess) and vascular venous access. These are starting to be done by IR extenders RA or NP/PAs.

The service line development for example PAD requires wound care understanding , DM understanding, statins , anti platelets, doac etc. Have to deal with emergency bleeding (mass transfusion/pressors/ rapidly getting Endovascular control of bleeding (epistaxis, hemoptysis, GI bleed, solid organ bleeding etc) and managing septic patient (cholangitis/ diverticular abscess, empyema etc). It will keep you pretty busy and more and more call responsibility. More and more are developing longitudinal forward facing clinics with focus on disease processes (osteoporotic compression fractures, oncology, men's health (BPH) , women's health (AUB/fibroids/pelvic pain etc) . Management of pain (blocs/ ablations / rhizotomy/ pain pumps/spinal cord stimulators etc).
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Very variable but years R2-R4 still are very DR heavy. If you dislike sitting in a dark room reading hundreds of films, you will not enjoy your IR path training.
Those who want high end VIR training and early incorporation of clinical rotations etc should make sure they id programs that enable that as well as work with whatever program they go to get more time with direct patient care in the early years.