I am curious to how the residency spots(numbers) are going to be affected when this comes into effect. Also what do you think on how this will affect the competitiveness of both .
That is a really great idea.DR people will do 70% of what IR is doing right now. Body people will do biopsies, drains, percut nephrostomies, biopsies,...
MSK people will do bone biopsies, joint injections, nerve block and probably kypho, vertebroplasties.
Vascular surgeries will continue their PVD and may start doing embo/chemoembos.
The best part is that we DR people will get rid of these arrogant, constant complainer IRs.
Good Luck.
That is a really great idea.DR people will do 70% of what IR is doing right now. Body people will do biopsies, drains, percut nephrostomies, biopsies,...
MSK people will do bone biopsies, joint injections, nerve block and probably kypho, vertebroplasties.
Vascular surgeries will continue their PVD and may start doing embo/chemoembos.
The best part is that we DR people will get rid of these arrogant, constant complainer IRs.
Good Luck.
My home institution has probably the strongest AI department in the country and even there there's no way they'd do PCN and hepatobilliary stuff. They're busy enough doing CSIR stuff like microwave and cryo ablutions and biopsies. They also don't want the call that additional non-scheduled procedures would require.
Sorry what is AI?
Also, agreed, hepatobilliary procedures are definitely solidly in the realm of IR as well.
My home institution has probably the strongest AI department in the country and even there there's no way they'd do PCN and hepatobilliary stuff. They're busy enough doing CSIR stuff like microwave and cryo ablutions and biopsies. They also don't want the call that additional non-scheduled procedures would require.
As far as vascular surgery goes, certainly they may turf things like ivcf, fistulograms, etc, as well as renal artery stents, but I don't think interventional oncology is a field they're really interested in entering. Some heme/onc and hepatobilliary GS people are getting involved there but those are both long training pathways as it is.
1- Take a look at body fellowship at UCLA, MGH and BWH and many other programs. In all of these, I know personally that body people are doing almost all the non-vascular interventions including hepatobiliary work, perc nephrostomy, biopsies and ...
2- You are right. In many places it is not done by Body people, and done by IR. It will be the case as long as the money stays in radiology department. The moment IR split itself, it bet it will be lost to body people. I am not body or IR fellowship trained, but was trained in a well organized program and I do perc nephrostomies once in a while. Most general radiologists can do it. [/img]
It's not a question of being able to do them or not. I spent 6 weeks on urology and 10 weeks on IR in med school and 4 weeks on it in residency. I can easily do a PCN w/o supervision. The question is whether I want to take time away from reading CTs to spend an hour doing so (for less money)
3- The reason it is done by IR, is that senior partners or even your radiology department prefer to hire an IR person to do it rather than body person as long as the money stays in the radiology department. But as soon as the money goes to IR as a split department, they will hire a body person and start to compete. Then IR will enter a new turf war, probably one of the most serious ones.
4- Your statement about chemoembo may or may not be true. It is not still a big money maker in pp. If an IR only wants to do chemo-embos he will not probably find a job.[/QUOTE]
Why don't you ask geschwind about that?
I rotated at bwh last year, all the hepatobilliary stuff and pcn stuff was done by IR. I'll let you know about UCLA next year.
Why don't you ask geschwind about that?
If your only way to protect your turf is that other services do not have time to do it or naming a person who may or may not be in practice in a few years, good luck with your career as IR.
The more I talk with IR people, either the 60 year old Guru or 25 year old new generation resident who claims a clinical model of IR, the more I come to the conclusion that this is not vascular surgery or cardiology who took it form them, it is IR itself who gave its turf to others. The model of IR that you guys are dream of, is neither practical nor sustainable with this mindset that you have. It is not your DR colleagues or your clinical training that hurts you, it is your mindset that hurts you.
Agree. IR is a truly fascinating field, arguably the most innovative in all of medicine and has the potential to disrupt every surgical field with enough advancement. But people in IR seem to get blindsided by that and miss the bigger picture. The reality is that IR's pie will always be shrinking and the only way to make it bigger is to innovate. When a disruptive innovation does occur, the affected surgical field will clamor to overtake the breakthrough and will always win due to the very nature of the business model. A clinical practice model does not protect against this because medicine is conservative - the referral will almost always go to the appropriate regional specialist first. Unless there is a breakthrough innovation in the business model itself, there is no way to break that first referral pattern. In other words, the cards are stacked against IR before the game even starts and the house always win. The only relevant counterargument is what IR did to CT surgery, but even in that case you have interventional cards who stepped in and took it all back anyway.
you make it sound like there were IR docs doing all the heart interventions and then all of the sudden cards came and took it... cardiologists were involved with the beginnings of this stuff. A radiologist originally developed it but a cardiologist (Gruentzig) trained in it as well. So at the very beginning there was already a split happening, if one ever even occurred in the first place.
However, what you say about the practice models of medicine and surgery are true in my opinion. Medicine will likely at the least most always consult surgery first before seeing if there is an IR procedure for some issue since right now surgery is the gold standard for most of the conditions they treat. Therefore IR will continue to lose turf they have gained from surgery if what was gained significantly decreases surgery's turf. Surgery will just train in that stuff and get the turf back. That is not to say there won't be work for IR, but high end cases will be few and far between outside academic institutions, and even there they will decrease as surgeons start doing it. The clinical model just seems really late to the game as people in medicine specialties are beginning to be trained in some of these procedures as well (nephrology, heme/onc, etc).
So the question is will a medicine doc refer their newly diagnosed cancer patient to IR or their friend oncologist who can treat the patient both entirely medically and even interventionally if necessary or who can also decide if surgery is the best option and then consult surgery from there...
While some of what you say may be true, heme/onc is not exactly clamoring to do interventional procedures. Especially considering that it requires extensive imaging skills and microcatheter skills, something maybe a surgeon can pick up. That is like saying surg/onc can take over chemotherapy from heme/onc.
While some of what you say may be true, heme/onc is not exactly clamoring to do interventional procedures. Especially considering that it requires extensive imaging skills and microcatheter skills, something maybe a surgeon can pick up. That is like saying surg/onc can take over chemotherapy from heme/onc.