IR vs. interventional cards

[goobernaculum]

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I'm hearing mixed things about competition from interventional cardiologists to do procedures. Will IR demand eventually go down as int. cards guys expand from their home at the heart? Damn those cardiologists!

 

[Primate]

Just wait until neuro and neuro-surge start taking the neuro-IR cases, too. If rads as a field doesn't get creative, they're going to be "stuck" doing the high complexity, low paying procedures while cards and neuro(s) skim off the gravy.

This is not to say that IR is dead. By no means. However, my best guess is that there will be increasing competition for the high $$ procedures from the specialties that control the referral base.

Diagnostics should be safe. Oh wait, that whole teleradiology bit....

Seriously, I think that there will be far greater competition for IR from other US specialties than diagnostics will face from overseas.

As usual, some well organized radiologists could prevent alot of this, but organizing physicians to act in a concerted manner is not dissimilar to herding cats.

Dissenting opinions?

P

 

[RLMD]

bump
Anyone have anything to add to this debate?

 

[Fab5Hill33]

I've heard people say that the bread and butter of IR is central line placements and that these won't be taken away from IR. I can see why Cards and Neuro want control of the heart and brain, but I can't see why they'd bother with lines when they've got their own organ system to worry about. Now do these line placements pay the bills? I don't know and I'd be interested in hearing anyone elses thoughts on this.

Which procedures are the most lucrative and which are more hastle then their worth?

 

[RADRULES]

Go to the SIR meeting and it will be obvious to you that IR is FAR from dead, and is actually probably the most dynamic field in medicine.

 

[hans19]

All we need now is another person to bring up Vasc Surg vs IR.... AGAIN!!! 🙄

Let the pissing contest begin...


PS.
Then its just a matter of time before 'that certain troll' chimes in on how peripheral interventions will be obsolete because PAs and nurses are gonna take over the field.

 

[itchyscrot]

I've heard people say that the bread and butter of IR is central line placements and that these won't be taken away from IR. I can see why Cards and Neuro want control of the heart and brain, but I can't see why they'd bother with lines when they've got their own organ system to worry about. Now do these line placements pay the bills? I don't know and I'd be interested in hearing anyone elses thoughts on this.

Which procedures are the most lucrative and which are more hastle then their worth?

Venous access work became the workhorse for IR when HIV and AIDS came about, do a lit search it is a pretty interesting phenomenon. Prior to that venous access was done in the OR by surgeons many whom LOVED doing venous access work....easy money. A monkey can do venous access work. I am a resident and by the end of my andio training I could put in permcaths in 15 minutes, we would acutally time our selvers otherwise it was too boring. There is a lot of AV fistula and declot work on the table right now, that will either stay with us or go to , get this i hope you all are sitting, intervention nephrologist, yes you heard me correctly nephrologists are starting to to permcaths and declots. So what does that leave us with? PCNs in the middle of the night, nice i like. Percutaneous billary work, of which there isn't a whole lot of anymore due to great advances with laproscopic and endoscopic techniques. Hmmmm arterial work FORGET about it cards, and vascualr surgery will and are doing a majority of the arterial side work, especially on the coasts...the rest of the country will follow. People get all excited about chemoembo and rf ablation but they are pretty few and far between. IR is pretty much dead, for the radiologist. Venous work all day would suck. NIR is on its last legs. Neurosurg is taking over most coiling and glueing for vascular malformations. Carotid stents are being done by cards and vascular surgery. Intracerbral catether directed directed thrombolytic therapy will probably go to cards or neurology. I am a PGY5 rads resident and I really love angio and almost went into IR but decided against it due to the bleak LONG term outlook. I will say this, RIGHT now there are a lot of groups looking for IR people that is because NO radiology residents are doing it. In this years match they only filled 35 positions out of about 150. Pathetic. If you want to practice in an underserved community IR will be good for another 10 years, in the big cities the clinicians have already taken over a LARGE chunk of the fun work. The field is ALIVE and vibrant just NOT for radiologists. If you love catheter work do vascular surgery or cards, in retrospect I wish I did vascular surgery or neurosurgery. Ohh well such is life. Diagnostic radiology is still pretty nice 😉

 

[badasshairday]

Venous access work became the workhorse for IR when HIV and AIDS came about, do a lit search it is a pretty interesting phenomenon. Prior to that venous access was done in the OR by surgeons many whom LOVED doing venous access work....easy money. A monkey can do venous access work. I am a resident and by the end of my andio training I could put in permcaths in 15 minutes, we would acutally time our selvers otherwise it was too boring. There is a lot of AV fistula and declot work on the table right now, that will either stay with us or go to , get this i hope you all are sitting, intervention nephrologist, yes you heard me correctly nephrologists are starting to to permcaths and declots. So what does that leave us with? PCNs in the middle of the night, nice i like. Percutaneous billary work, of which there isn't a whole lot of anymore due to great advances with laproscopic and endoscopic techniques. Hmmmm arterial work FORGET about it cards, and vascualr surgery will and are doing a majority of the arterial side work, especially on the coasts...the rest of the country will follow. People get all excited about chemoembo and rf ablation but they are pretty few and far between. IR is pretty much dead, for the radiologist. Venous work all day would suck. NIR is on its last legs. Neurosurg is taking over most coiling and glueing for vascular malformations. Carotid stents are being done by cards and vascular surgery. Intracerbral catether directed directed thrombolytic therapy will probably go to cards or neurology. I am a PGY5 rads resident and I really love angio and almost went into IR but decided against it due to the bleak LONG term outlook. I will say this, RIGHT now there are a lot of groups looking for IR people that is because NO radiology residents are doing it. In this years match they only filled 35 positions out of about 150. Pathetic. If you want to practice in an underserved community IR will be good for another 10 years, in the big cities the clinicians have already taken over a LARGE chunk of the fun work. The field is ALIVE and vibrant just NOT for radiologists. If you love catheter work do vascular surgery or cards, in retrospect I wish I did vascular surgery or neurosurgery. Ohh well such is life. Diagnostic radiology is still pretty nice 😉

6 years later, is this still an accurate picture of IR's future?

 

[vietwind]

I don't know. At my institution now (2010), IR does a lot (PICC line done by PAs), we do carotid stenting (neuro-interventional), cerebral angio, yesterday mesenteric stenting (SMA), etc...We'll see what happen this year at SIR Chicago.

6 years later, is this still an accurate picture of IR's future?

 

[C5toC9]

didn't even realize this thread was 6 years old, since the arguments seemed as relevant as today's are

 

[Zoom-Zoom]

Yeah it certainly seems to have grown quite a bit in the last 6 yrs. I'd like to know if these concerns are still valid also. My impression though is that int cards and neuro are both still losing ground to IR...