IR programs with good resident autonomy and culture?

[Promised_Consort]

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Hello everyone,

Rising M4 looking for recommendations on programs which will provide me with lots of hands-on experience.

I’m interested in the West Coast (OHSU, UWash, California), Colorado, and possibly New York.

I’d be very interested to hear about programs with:

1. Good autonomy
2. Good culture/lifestyle
3. Good moonlighting

I’m also happy to learn more about any programs which are known for overworking their residents or being toxic work environments as I would like to avoid these places.

 

[tomballunger]

Washu Dr residents are overworked, malignant. 14 hour dr call shifts are not good, my place does 12 hour call shifts and that is bad enough

 

[tomballunger]

Best to cast a wide net and interview , ask the pgy4-6 about their perception of the program (pgy1 to 3 won't truly understand and I never really understood either as a jr reaident). Many ir training programs these days I suspect are becoming lines and tube factories on super sick pt dumps and the rare once in a blue moon interesting tips or bleed which isn't good education for 2 years of fellowship

 

[irwarrior]

Hello everyone,

Rising M4 looking for recommendations on programs which will provide me with lots of hands-on experience.

I’m interested in the West Coast (OHSU, UWash, California), Colorado, and possibly New York.

I’d be very interested to hear about programs with:

1. Good autonomy
2. Good culture/lifestyle
3. Good moonlighting

I’m also happy to learn more about any programs which are known for overworking their residents or being toxic work environments as I would like to avoid these places.

Volume of cases and autonomy doing biopsies and tube changes will not get you as far as case complexity from a techniques standpoint . Granted you should be comfortable gaining vascular access (femoral/radial/brachial/pedal etc). You should be comfortable catheterizing multiple vessels carotids/subclavain, renal, mesenteric, internal iliac, lower extremity arteries etc. Most importantly you should be able to run your own clinic when you get out. You need to be able to build a service line and grow a practice from scratch, otherwise you will be delegated to procedures others in the hospital do not want to do.

 

[tomballunger]

Volume of cases and autonomy doing biopsies and tube changes will not get you as far as case complexity from a techniques standpoint . Granted you should be comfortable gaining vascular access (femoral/radial/brachial/pedal etc). You should be comfortable catheterizing multiple vessels carotids/subclavain, renal, mesenteric, internal iliac, lower extremity arteries etc. Most importantly you should be able to run your own clinic when you get out. You need to be able to build a service line and grow a practice from scratch, otherwise you will be delegated to procedures others in the hospital do not want to do.

Agree with the above completely, many ir programs have become biopsy drain line factories. When our service line leaders left at home program, many of the better cases disappeared - hospital reasoned the obgyn can manage to fibroids surgically, urology can do turps, Ortho can deal with knee arthritis, and Ortho and neurosurg can manage spine . All that's left now is lines tubes biopsys running late till 7 8 pm doing these so called length of stay dispo procedures (someone gets a gtube or tunneled lines means hospital can discharge and save a lot of money ) with an interesting case like a trauma or bleed or dvt pe or tips coming in at odd hours when we are overwhelmed with lines tubes and biopsys. It begs the question as linemonkey puts it, if someone wants to do vascular work and is entering match without red flags why not go do gen surg with vasc surg fellowsship or do Im cardiology interventional cards (cardiology fellowship match isn't impossible for us md grads when compared to ent or urology, and you're just basically doing 2 years of I'm and off to the match as a early 3rd year ). My issue was I had to scramble into diagnostic radiology given a disastrous original failed to match urology and I'd try to salvage it with ir fellowship but still a huge uphill climb - or you are stuck working from scratch to build that clinic referral line while fighting off lines tubes biopsys vs cardiology or vascular surg, the clinic is often already there plug and play

 

[irwarrior]

Current interventional training is too focused on DR and bread and butter (biopsies and drains and vascular access) and TIPS and y90. In order to succeed in the real world you need to build elective outpatient referrals of PAD, dialysis, fibroids, prostates, knee pain, compression fractures, etc. You are not going to get those referrals from primary care if you do not do a lot of clinic and know how to medically manage ie prescribing meds etc. This is the current challenge of the VIR structure. You need to practice like a surgical department where you have elective OR block time to book patients from your clinic. But, this means you need to have a paradigm shift of a clinic centered on diseases not procedure and an inpatient consult service that sees all consults. If you look at the main OR they often have elective block schedule an an add on room. Interventional should practice similarly.

 

[tomballunger]

95 percent of ir training programs focus on inpt work doing lines tubes drain dumps with the occasional tips emergent embo and y90 . The inpatient ir call coverage comes first, then Dr call, then outpt ir cases and clinic last; Residents fellows are considered free labor by most gme institutes/hospital admin/faculty covering inpatient and ir and Dr call always takes precedence over clinic and outpatient elective cases. Trying to fight this as a resident or fellow at the bottom of the totem pole is a losing battle that ends in switching out to a totally different/better ir program at best , switching to Dr only, or just finishing up being highly dissatisfied

Ohsu rush mcvi mcw mt Sinai nyc uva generally are the big names in integrated ir that have a strong clinical focus. Unsure of autonomy at these big names though, probably mixed

 

[irwarrior]

One should check the graduates case logs and clinic logs as well as their role ie primary operator status. Also what do the graduates do after graduation. especially what kind of interventional they practice in the private sector. Clinic is critical to garnering referrals and future success as an interventionalist. If you can not garner your own referrals from primary care or direct patient marketing, you will bee delegated to lines and drains and biopsy service or things that other services do not want to do . Medical students should focus on these things first and foremost. You need to do to get better as a surgeon or proceduralist. Imaging/pathology is learned during the day and on call, but a lot of it is really learned on your own time after hours and on weekends studying.