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docshop12

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Over the years I have heard things about IR being the future of medicine. Students say they are at the forefront and will only expand. However after seeing it first hand now for the past month I have to say that I don't really understand where that sentiment is coming from. I am at a school with a respected IR program. But a majority of the day is vasc access, diagnostic imaging, g-tubes, etc. When they use radiochemoembolization they must have nuclear medicine int he room. The IR guys hate seeing patients and actually managing any care. I can only imagine when you get out in private practice or smaller centers IR does even less. One of the big things I've notice too is that many other doctors, e.g. surgery, don't have respect for the field and docs in it as clinicians.

So why do you guys think students want to do IR so badly? Why is the field becoming more competitive when they don't even make any more money and most private groups don't want to take on the hours?

IMO students think IR docs know everything and can treat anything. I find this attitude sorely lacking in understanding that IR is essentially there to do a simple procedure (granted usually only they can do it or maybe cards/vasc surgery but they have more important things to do than vascular access) and IR doesn't want to manage patients on a large scale. I find it interesting on auntminnie to see all the students saying they will be different and IR will take over more control of patients... but they been saying this stuff for years and years and nothing has changed like they all say.
 

colbgw02

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Lots of physicians pretend not to have respect for radiology, intervental radiology included. Of course, they usually can't tell their ***** from their elbow until we explain which end is which.

In any case, I wouldn't universalize your experience too much. Most surgeons I know have plenty of respect for IR because they can intervene when surgery can't/won't (perc nephs, bilis, choles) or messes up (abscesses). Also, it takes decades for a field to diverge from its origin, so your timeline of a few years is too short, I think.
 

DrBowtie

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Your comment about the private practice world isn't always true. It all comes down to each institutions departmental politics. There are certain procedures that are consumer driven (vein work, UFE) that advertising can work with. Otherwise its all about what the specific IR is comfortable with and how aggressive they are about seeking referrals.

SIR is pushing very hard for the clinical model for IR and I do think the climate is slowly changing. Almost all of the programs I interviewed at had some aspect of clinic, many had residents or NPs do post-op floor work. It all comes down to having partners in the group supporting that model. Its a tough sell given the relative loss of RVUs for seeing a clinic patient vs. procedures vs. diagnostic reads.

I know in the other thread you mentioned you were an MS4, what did you match into?
 
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IRneuroIR

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IMO, you had an unusual IR experience or were working with "old school" IRs. Most IRs now are running clinical practices and enjoy seeing patients.

Also, IMO, IR has always been well-respected by our colleagues, especially in surgery, for what we can offer and, as the previous post referenced, when we can help with their "messes".

This past week, I helped the surgical oncologist with two patients who had prior Whipple's who came in with biliary obstruction at the anastamotic site. I performed PTC and biliary stenting (they are non-surgical candidates at this point with recurrent disease). He was very grateful and, more importantly, so were the patients.

To your specific point regarding radioembolization, an IR does not need to have nuclear medicine present if he is an AU (authorized user).

I hope that you didn't get a skewed perspective of IR, especially if you matched into a different field.
 

badasshairday

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Agree with Dr. Bowtie. It differs everywhere. The differentiation is based on individual groups rather than academic vs private practice vs regional.

Based on my personal experiences I can tell you this. In my non-coastal city, the academic center IR have their own admitting service, go and see consults and place formal notes, hold outpatient clinic, they basically run it like a surgical subspecialty. They do a lot of oncology work and arterial disease. They do plenty of arterial work as do the vascular surgeons who they have a good relation with.

On the other hand one of the private community hospitals in town has IR run as the old model. In addition to bread and butter procedures like vascular access, they do a lot of endovascular arterial work which is based purely on tertiary referrals. They do not take care of the patient post procedure. Guess what will happen when the group of surgeons at that hospital hire a vascular surgeon with endovascular skills? If you don't take care of the patient, you will lose your referral base. Also at this hospital some of the cards are dabbling in peripheral interventions.

Then you can check out these guys,
www.endovascularsurgery.com
They are a private practice located in a very desirable west coast city. They do it all; arterial, venous, pain, women's, neuro, oncology, vasc imaging. And they aren't the only group who work in such a patient centered manner. These two IR's that started this group also hired surgeons to work in their group as well. I talked to an orthopedic surgeon from the region when I was a third year med student and when I told him I was thinking vasc surg or IR, he said, "Go IR they are taking over." And his opinion is based on this group and other clinical minded IR.

Overall, as it was pointed out before, it really just depends on what you want to do as an IR. Also you can also have a special focus for your practice. Another group I know of in the midwest at a private hospital focuses on doing a lot of pain interventions in addition to the bread and butter such as vascular access, paras, thoras.
 
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badasshairday

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Also, IMO, IR has always been well-respected by our colleagues, especially in surgery, for what we can offer and, as the previous post referenced, when we can help with their "messes".

Definitely has been my experience as well. Also the respect goes both ways.
 

Illusive Man

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I think IR has a very bright future. The clinical model of seeing patients and handling pre-and post-procedural care has really taken off. The new generation of IR docs have a different mind set and from my experience the specialty is respected among other specialties. There has been a push to create 1 year sub-specialty tracks (i.e. onc, biliary/gi, vascular) after a general IR fellowship which will further increase specialization skills. SIR has been key to this transition.
 

shark2000

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Some of your points are correct, a lot of them are BS. Overall, your post is fishy and seems a troll to me.

1- agree with you about popularity of IR in the last 2-3 years. It is a total fake. I have fellow residents who matched into IR solely for job market. They claim they were dreaming of IR since childhood. I know one who loved neurorads by the third year, but changed his mind in the lastminute before applying for fellowship. Now he claims he loved it since he was a med student.
About 8 years ago, some big names in IR could not fill their spots and now they get 50 applications for one spot that was not filled internally. Only 8 years ago people agrred that you only need a pulse to match into IR. I can never believe radiology residents interest change so fast. It is all about job market.

2- medical students who dream of IR are totally clueless. They have just seen a few sessions of angio and are talking about their love for IR. IR Is a great field but
For tenth time I write it here, if you do not like DR do not choose radiology only for IR. it is crazy.Also do not choose radiology and IR as ashortcut to surgery. It is not surgery.

3- the added value of IR for a hospital can be HUGE. Even simple procedures are life saving. Dialysis catheter seems simple to you, but can be more life saving than many procedures. Do not forget that many procedures we do now imcluding biopsies were among some of the complicated ones inthe past. In 80s biopsy of a liver mass was an open surgery with lots of complications.

4- regarding surgery doing it, you are right and wrong. First of all everybody can learn everything in medicine. It is no brainer. Do you thing it isvery difficult for a radiologist towork in the ED? But it does not mean that ED doctors do not have any role. Also many procedures do not need surgeons anymore. I pick up a lesion on an abdominal CT ordered by an oncologist, I myself charachterize it as suspicious and I myself call the oncologist, discuss the case and biopsy it. Also i can handle the main complication which is blleding for which i can embolize the artery. I can argue that i am giving a full service, but a surgeonor even a liver surgeon can not. An average surgeon can not charachterize the lesion as malignant or benign and is dependent on my interpretation. Also an average surgeon can not embolize the bleeder.

5- I personally do not give a **** about what other people think about me or their level of respect. Honestly if this is a big issue for you, radiology is not for you. go for a BIG surgery field like BRAIN SURGEON or HEART SURGEON. Then your grandma thinks your are a better doctor. If i don't respect peds it does not mean they are not important. The first time my kid gets sick, I find them the most respectable important doctors in the universe.

6- A one line advice: after doing any field for 5 years, you will find it no more challenging. At least for radiology once in a while a very cool case will appear on the screen. You will not care who thinks what. You will not even care about having higher income. You will only look for a reasonable income in a job that has controllable and less hours that you do not hate.

Every interesting case in the hospital is doomed to pass through the radiology department.
 

Bob2009

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Docshop12, your experience is limited to one facility and one month, which is hardly representative of an entire specialty. I'm not sure how it works at your facility, but who is commanding the computer at your vascular conference? Where are most of the questions directed? Who gets pulled aside in the hallway after conference because your conference time is up? IR bro!!! How about thoracic, hepatology, and pancreatic tumor boards? Same answer!!!

Who's doing a UAE consultation one hour, visiting the ED for an acute dissection the next, then a renal cryoablation followed by a TACE? IR BRO!! And the patients are stoked. No pages for an upset family member at bedside. No pages for a post-op SBO or ileus. IR does the fixing. You need to do another month of IR at another facility. Your perspective is antiquated.
 
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