If you compare RVUs generated by nationwide all specialties, IR comes out near the top (higher than diagnostic radiology) along side cardiology and above vascular surgery, even though VS and now cardiology are doing more and more of the peripheral procedures. Why?
In a well organized private practice, the RVUs generated per hour of placing tunneled lines and filters is still greater than the RVU's of per hour of placing a stent graft. The RVU from a chemoembolization may be higher than a single tunneled line, but in the 1 hour it takes to do the embo, you can do 4 tunnelled lines. So even if you aren't doing high level IR you are still be 'productive'.
Sure the Vascular surgeons do high RVU AAA stent grafts and angioplasties, but in the mix they also do 8 hour long grafts, low RVU amputations, a-v fistula placement. If you average it out the RVU's/hour don't come close to IR or cardiology.
Peripheral angioplasty is the IR of yesterday,
(1) Oncology is the IR of the future. In general as technologies get older (ie peripheral angioplasty) the reimbursements decline. Though there is a brief period when a new procedure is NOT reimbursed, once it gains acceptance the newer procedures (ie oncologic interventions) tend to be better reimbursed than older ones.
Finally the advantage of IR is the diversity of procedures it can offer. If one day it turns out that stents aren't what they are cracked up to be and reimbursement gets slashed to zero there are a plethora of other procedures that IR does to maintain its lively hood. If overnight reimbursement for angioplasty and stenting is slashed what does VS have to fall back on? Their standby of grafts that eventually go down and amputations. Cardiology is a one trick pony - without stents and plasties (remember the COURAGE trial?) what does cardiology have to fall back on? Medical management... As long as you enjoy what you do, though, it shouldn't matter.
(2) Is IR under attack? Absolutely! Why? Because the things that we innovate actually work-- sometimes better than the more invasive procedures that they replace
and they are reimbursed well. IRs have wisened up and are becoming more clinical and will lose less ground to other clinicians in the future.
One last thing... If you like to do procedures and you think IR is losing ground... consider the alternative...
(3) would you rather be a surgeon?
http://forums.studentdoctor.net/showthread.php?t=516637