We can agree to disagree. And I'm not trying to disparage when I ask this, but do you practice IR?
I am not an IR.
I have been in practice for about 10 years and I've worked at half-dozen hospitals ranging from 200 beds to the largest being about 500 beds, and I've done a TIPS in every one of them. I can't exactly say the same for Y-90 -- but mostly because I've only done that procedure for the last few years.
We're affiliated with multiple hospitals within the same system of similar sizes to those. Perhaps this is due to their practice, but I think only two sites will do high end stuff because they have the needed available consultants to manage those patients not because the IR doc isn't capable at the smaller sites.
My own group, and most of my IR friends at other places who have recently hired, require that their new hires to be capable of the full spectrum of IR. An oncologist or a hepatologist at a small hospital doesn't want to refer their patient to a tertiary center for fear of losing business. They want their local IR to be able to perform the procedure.
Agree you should be capable upon graduation to do anything but my point was that your practice has a lot to do with what the referring docs are comfortable with treating and managing themselves. Even then the patients still end up at the tertiary care center for transplant evaluation or clinical trial enrollment.
Now if you're at a small hospital that doesn't have a full fledged oncology service, then you're right, it's unlikely to need the local rads to perform such procedures. But the fact of the matter is that the need for those procedures is growing by leaps and bounds. And if your group doesn't hire, well, that tertiary center that is getting the business does need more IRs to do high-end work. So the jobs are there.
There are lots of those small hospitals out there. They want coverage for the bread and butter IR stuff. Just enough stuff outside the scope of a generalist or Body guy with procedural experience.
Again, not every job is 100% IR. But many require you to be able to do high-end work. And there's enough of that work out there for the 200+ IR fellow graduates each year.
I agree there is work. IR has one of the better job markets in radiology although things are improving overall. My main statement is that just like any specialty, the practice at a training institution can vary drastically from the majority of community practice.
