karenwkyk

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I love IR, i think it is the most amazing field. Today, when a radiology resident found out that i would like to do IR, he said IR is the trash can of the hospital "IR only do what others don't want to do like placing line and tube, and they are going to lose all the business to the vascular surgeons and other specialists". Is it really that bad? what do you guy think about the future of IR?
 

hans19

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I love IR, i think it is the most amazing field. Today, when a radiology resident found out that i would like to do IR, he said IR is the trash can of the hospital "IR only do what others don't want to do like placing line and tube, and they are going to lose all the business to the vascular surgeons and other specialists". Is it really that bad? what do you guy think about the future of IR?
I just donated to PBS last week. In homage to Sesame Street this
message is brought to you today by the letter 'S'. ;) j/k...

Interventional radiology is a dynamic field.

First of all, the procedures in IR: A. work-- many times, better and with less collateral damage than the open procedures they compete with
B. They Reimburse well, thus it has attracted the ire and perhaps jealousy of other subspecialties. As a result many nonradiologists are trying to get into the minimally invasive business.

Like any field under competition, those who do not adapt will die, those who are willing to innovate will thrive.

It is true that IR no longer does the bulk of endovascular interventions for peripheral artery disease. Vascular surgeons and cardiologists are jockeying for supremacy to that end. Those IRs who have not adapted to this fact are condemned to do low level line and tube work.

However there are those who have embraced change and are pushing the envelope with UFEs, and oncologic interventions like Chemoembolization and RFA, palliating stents that are flourishing. They also perform intermediate level work like dialysis access maintanence and biliary interventions.

Secondly IRs that directly seek referrals from and provide good service to clinicians will do get more cases and better cases than those IRs who sit back and wait for the tertiary (wouldn't touch them with a ten foot pole) referrals from other subspecialists.

Adapt or die...
 

dphoenix

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I think a better question is when are IR docs going to stop being employees of hospitals or employees of DR groups which basically send all the trash procedures to them, while cards and vascular gleefully workup all the good procedures. IR docs need to start practicing a model more akin to a surgical subspecialty such as ortho, ophtho, or ENT, and gather referrals from the PCPs. I think that this will not really happen unless you work in an IR only group and not under a hospital salary.

your thoughts hans?


I just donated to PBS last week. In homage to Sesame Street this
message is brought to you today by the letter 'S'. ;) j/k...

Interventional radiology is a dynamic field.

First of all, the procedures in IR: A. work-- many times, better and with less collateral damage than the open procedures they compete with
B. They Reimburse well, thus it has attracted the ire and perhaps jealousy of other subspecialties. As a result many nonradiologists are trying to get into the minimally invasive business.

Like any field under competition, those who do not adapt will die, those who are willing to innovate will thrive.

It is true that IR no longer does the bulk of endovascular interventions for peripheral artery disease. Vascular surgeons and cardiologists are jockeying for supremacy to that end. Those IRs who have not adapted to this fact are condemned to do low level line and tube work.

However there are those who have embraced change and are pushing the envelope with UFEs, and oncologic interventions like Chemoembolization and RFA, palliating stents that are flourishing. They also perform intermediate level work like dialysis access maintanence and biliary interventions.

Secondly IRs that directly seek referrals from and provide good service to clinicians will do get more cases and better cases than those IRs who sit back and wait for the tertiary (wouldn't touch them with a ten foot pole) referrals from other subspecialists.

Adapt or die...
 
OP
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karenwkyk

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There is one thing i don'r understand? Since most of the IR procedures are invented by IR doc., why none of them get a patent for their "invention" and restricted who can learn the procedures (e.g. only board certified radiologist allow to learn them), in this way, none of the other specialist can steal their business
 

DaTruMD

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Tall answer: Yes

Grande answer: Yes but it will be a while, there's still plenty of patients to stick and money to be made -- and that'll likely last for another 10 years at least.

Venti answer: Hans' whole "adapt or die" battle cry is inspiring and all (not really), but pie-in-the-sky at best. Forget the crap for a second and consider a few basic facts: 1) IR's are far outnumbered by clinicians/surgeons, 3) Clinicians/surgeons in general hate their jobs and envy IR's, 3) IR procedures are generally easy as heck to do, and 4) IR procedures generally pay quite well with little/no complications/follow-up. You do the math.

Now let's watch Hans get his panties in a bunch.
It's interesting that you say IR procedure are generally easy to do because someone I know had it done for no apparent reason and the doctor totally screwed it up.:thumbdown:

So according to you, it must have been the money, eh?
 

dphoenix

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I think i must be up too late. . .did apacheindian just admit that some part of radiology is going downhill? :eek:

seriously though, he has a point that technology is always transferrable. . . but i don't agree that these procedures are "easy" - i know of an orthopod in my area who got "trained" at a weekend seminar to do kyphoplasty, and ended up injecting the cement into some poor woman's spinal cord, paralyzing her from that level down :( although i am sure that this guy is probably decent at reading spine films, fact is that using imaging during interventional work is not a skill which is straightforward and needs to be obtained in a supervised environment (such as residency or fellowship).

Right now IR guys are the only ones that are trained properly during residency/fellowship to do the procedures. . . except that this can change as cardiology and vascular have integrated catheter skills into their own residencies and practices. Thats why for now the only "safe" procedures are oncologic procedures such as UFE, chemoembolization, RF ablation as well as the bread and butter procedures such as PICC, vasc access, drains, biopsies, etc. Vascular procedures in IR (stents) are pretty much dead and are already almost completely in the realm of cardiologists and vascular surgeons.

Will Gynecologists and Oncologists be doing our procedures in the future? Depends if IR docs are still stupid enough to keep teaching nonrads how to do their procedures. Can't we learn anything from what our cards and vasc brothers have done to us? (fool me once, shame on you. . . fool me a third and fourth time. . . .well. . .)


Tall answer: Yes

Grande answer: Yes but it will be a while, there's still plenty of patients to stick and money to be made -- and that'll likely last for another 10 years at least.

Venti answer: Hans' whole "adapt or die" battle cry is inspiring and all (not really), but pie-in-the-sky at best. Forget the crap for a second and consider a few basic facts: 1) IR's are far outnumbered by clinicians/surgeons, 3) Clinicians/surgeons in general hate their jobs and envy IR's, 3) IR procedures are generally easy as heck to do, and 4) IR procedures generally pay quite well with little/no complications/follow-up. You do the math.

Now let's watch Hans get his panties in a bunch.
 

hans19

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Venti answer: Hans' whole "adapt or die" battle cry is inspiring and all (not really), but pie-in-the-sky at best.
Pie-in-the-sky? OUCH! Really? I was going to give a rebuttal but...

You got it baby -- IR guys are the uber-referral specialists... the guys that other docs call when there is no one else to call... the buck stops at the IR suite... as an IR you will save lives, bail clinicians out of trouble, and be a hero.

Turf issues certainly exist and while it's true that many procedures historically done by IR's are now going to other specialists (e.g. I know of cards guys doing UFE's), for every procedure lost (e.g. perc neph) there is a new one on the horizon (RF ablation).
I couldn't have said it better myself. :thumbup:.
 

hans19

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Average, proletariat, bourgeoise, Hoi polloi -- call me what you will.

You feign noblesse with talks of money, misinterpretations of social philosophers, and the occasional use of foreign words. Yet with your enthusiasm for comic book heroes, wedgies, spitballs, babes, super cars-- your aesthetics are that of a junior high malakas.
 

colbgw02

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I have heard multiple interventional radiologists admit that CTA is replaces DSA in most diagnostic (obviously) cases. <<shrugs>> There's plenty of other stuff for IR docs to do though.
 

hans19

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You feign noblesse with talks of money, misinterpretations of social philosophers, and the occasional use of foreign words. Yet with your enthusiasm for comic book heroes, wedgies, spitballs, babes, super cars-- your aesthetics are that of a junior high malakas.
Yo momma!
Again, you've proven my point.
 

hans19

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I have heard multiple interventional radiologists admit that CTA is replaces DSA in most diagnostic (obviously) cases. <<shrugs>> There's plenty of other stuff for IR docs to do though.
And the radiologists interpret the CTA's.
 

Mariah246

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Average, proletariat, bourgeoise, Hoi polloi -- call me what you will.

You feign noblesse with talks of money, misinterpretations of social philosophers, and the occasional use of foreign words. Yet with your enthusiasm for comic book heroes, wedgies, spitballs, babes, super cars-- your aesthetics are that of a junior high malakas.
yeah but it's hard not to like that dancing spiderman :p
 

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There was a long thread on auntminnie about IR's future.

Opinion of majority of residents and attendings is that IR has to become more like clinicians and get referrals directly. If they don't, IR will go down the toilet. I'm not optimistic about IR's future because a) most people going into rads have no interest in doing clinical medicine b) most people including referrers don't even know what IR can do. Cards have done a much better job of marketing themselves.

I plan to stick with dx rads for now.
 

dphoenix

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I think IR needs to separate from Radiology residency, similar to what RadOnc has done. This will create a new breed of clinical radiologists which will solidify the field - i believe that the DIRECT and Clinical pathways are trying to do this, although only offered at a dozen programs or so.

There was a long thread on auntminnie about IR's future.

Opinion of majority of residents and attendings is that IR has to become more like clinicians and get referrals directly. If they don't, IR will go down the toilet. I'm not optimistic about IR's future because a) most people going into rads have no interest in doing clinical medicine b) most people including referrers don't even know what IR can do. Cards have done a much better job of marketing themselves.

I plan to stick with dx rads for now.
 

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With all these procedures being taken over by other specialties, IR is still busy at my institution. Every day on rounds I hear "Plan: Call IR..." What gives? While peripheral and coronary interventions might be lost, body and brain are still the radiologist's domain. Plus, with RFAs and other cancer treatment modalities, there is a niche for interventional oncology. Perhaps with the aging population and increased burden of atherosclerotic disease, there may be enough cases to share with cards/ vascular (wishful thinking).

Bottom line: no one knows exactly what role IR will play in the future, but they will continue to have work.
 

Taurus

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I think IR needs to separate from Radiology residency, similar to what RadOnc has done. This will create a new breed of clinical radiologists which will solidify the field - i believe that the DIRECT and Clinical pathways are trying to do this, although only offered at a dozen programs or so.
IR probably should have branched off and become its own residency. It's probably too late now.
 
P

Pterion

With all these procedures being taken over by other specialties, IR is still busy at my institution. Every day on rounds I hear "Plan: Call IR..." What gives? While peripheral and coronary interventions might be lost, body and brain are still the radiologist's domain. Plus, with RFAs and other cancer treatment modalities, there is a niche for interventional oncology. Perhaps with the aging population and increased burden of atherosclerotic disease, there may be enough cases to share with cards/ vascular (wishful thinking).

Bottom line: no one knows exactly what role IR will play in the future, but they will continue to have work.
I think the last statement is true, but as previous posters have noted, some connection to referral sources must be nurtured. The range of services varies widely by institution. Here in KY, vascular surgery has a strangle-hold on all of those procedures. We have a vascular fellowship in neurosurgery and an interventional neurologist, so the brain's gone. Markey in Lexington and Brown in Louisville have surgical management of the chemoembolizations. So our IR's are doing central lines and the occasional perc drainage. SIR has frequent news on these issues released in their newsletter; joining is cheap for students.
 

OHMAN0125

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I think the last statement is true, but as previous posters have noted, some connection to referral sources must be nurtured. The range of services varies widely by institution. Here in KY, vascular surgery has a strangle-hold on all of those procedures. We have a vascular fellowship in neurosurgery and an interventional neurologist, so the brain's gone. Markey in Lexington and Brown in Louisville have surgical management of the chemoembolizations. So our IR's are doing central lines and the occasional perc drainage. SIR has frequent news on these issues released in their newsletter; joining is cheap for students.
Hmmm...I think that IR will always have jobs with high-paying salaries. However, they will probably have the left over from what other specialties dont want to do. This will be plenty to keep an IR department busy. However, if you want to be the one doing AAA repairs then good luck.
On another note, I've heard of some institutions creating "centers" where Cards/Vasc Surg/IR work together in the same department. Such Vascular Centers take all the reimbursements and divide them up evenly with the practitioners. I've heard the main roadblock to this is that Cardiologists and Vascular surgeons are strongly opposed to the idea. Ego minded?
 

hans19

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Hmmm...I think that IR will always have jobs with high-paying salaries.
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, 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.

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... would you rather be a surgeon?

http://forums.studentdoctor.net/showthread.php?t=516637
 

dphoenix

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On another note, I've heard of some institutions creating "centers" where Cards/Vasc Surg/IR work together in the same department. Such Vascular Centers take all the reimbursements and divide them up evenly with the practitioners. I've heard the main roadblock to this is that Cardiologists and Vascular surgeons are strongly opposed to the idea. Ego minded?
You heard wrong.

This is flatly not true - the main reason such vascular centers have been failures is due to the diagnostic radiology departments. I refer you to a discussion regarding the setup of vascular centers at several major institutions (including U Rochester, Wash U and others):

Discussion on Five-year results of a merger between vascular surgeons and interventional radiologists in a university medical center. Journal of Vascular Surgery, Volume 38, Issue 6, December 2003, Pages 1213-1217

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WMJ-4B3MDV4-12&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2776ab60d7595ec05ad17296952fc6d5


Particularly, look at what the radiologist from WashU says regarding setting up a vascular center at Wash U:

"But at our institution what made the merger fall apart, although we still have very good working relationships with interventional radiologists—and the educational components of both fellows are being maintained, or we're trying to maintain it anyway—is the unwillingness of the department of radiology to independently separate what is a cash cow for radiology, which is the interventional component of it, from their total cash flow as an independent account. And that is not from the surgery side, but from the radiology side: the new chairman of radiology said that they were happy with the arrangement as long as they kept is as part of their total thing and it was not a separate account. How did you resolve that? And how does the rest of the radiology department at Rochester survive without some of the influx from the interventional radiology money?"

Don't just assume that since the cardiologists and vascular surgeons are historically aggressive types, that they're the ones not letting radiologists into their pockets. In fact the problem is exactly the opposite!
 

OHMAN0125

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You heard wrong.

This is flatly not true - the main reason such vascular centers have been failures is due to the diagnostic radiology departments. I refer you to a discussion regarding the setup of vascular centers at several major institutions (including U Rochester, Wash U and others):

Discussion on Five-year results of a merger between vascular surgeons and interventional radiologists in a university medical center. Journal of Vascular Surgery, Volume 38, Issue 6, December 2003, Pages 1213-1217

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WMJ-4B3MDV4-12&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2776ab60d7595ec05ad17296952fc6d5


Particularly, look at what the radiologist from WashU says regarding setting up a vascular center at Wash U:

"But at our institution what made the merger fall apart, although we still have very good working relationships with interventional radiologists—and the educational components of both fellows are being maintained, or we're trying to maintain it anyway—is the unwillingness of the department of radiology to independently separate what is a cash cow for radiology, which is the interventional component of it, from their total cash flow as an independent account. And that is not from the surgery side, but from the radiology side: the new chairman of radiology said that they were happy with the arrangement as long as they kept is as part of their total thing and it was not a separate account. How did you resolve that? And how does the rest of the radiology department at Rochester survive without some of the influx from the interventional radiology money?"

Don't just assume that since the cardiologists and vascular surgeons are historically aggressive types, that they're the ones not letting radiologists into their pockets. In fact the problem is exactly the opposite!
Wow that is interesting. I wonder why. You'd think the Rad dept already has plenty of cash flow from the imaging side of things in a major hospital to be able to sacrifice the IR work for the greater good. Not sure how much IR is done in Rochester though, maybe it does make up a significant chunk of their cash flow. Who knows. THanks for the info though.
 

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American cultural thinking has a thread that runs through the all the fabric of American Society, and that is this general statement: "If something is going to be done right I might as well do it myself."

Concurrently, since surgeons view intervention as their modality there seems to be this overlapping surgery(intervention) misconception that you can allow a surgeon to do a procedure developed and perfected by IR. Just as a Neuro surgeon has his specialty, a Radiologist has a special procedures in IR, and shouldn't be mixed with surgery in general. Surgeons have their own cash cows to milk.

A surgeon who develops minimally invasive surgery to remove a parathyroid, and is successful at it, will then develop talent (other surgeons) to perform the same procedure, but it will require a sacrifice of time and effort on the part of the new talent to be proficient at it. Well if a surgeon wants to do IR procedures he has to in essence choose to become a radilogist, to be proficient and capable, in the procedure the Rad dept. has developed.

My thought is that I would not want an orthopaedic surgeon drilling a hole in my head just as I would not want a general surgeon performing an IR procudure on me. All doctors are trained in setting IV's yet I would prefer an anesthesiologist to set the IV for obvious reasons, he is more skilled at it.

Take care and Good Luck!
Charles
 

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IR is not a dead field. It must adapt and fill niche needs. There are or will be reimbursement decline issues for standard routine IR procedures. IR is a difficult field because you need to have a minimum of 3-4 IR in a group to make it viable in terms of the lifestyle offered. You have to be aggressive and be a clinician. You need to market your skills to other physicians in your community. You need to build or join a practice that has admission privileges and consults other physicians. The days of being a catheter jockey that just get handed cases are over. If you do not compete with cards, VS, etc, you will be left with scutmonkey procedures and emergency on call procedures. Do you want it?
 

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I just donated to PBS last week. In homage to Sesame Street this
message is brought to you today by the letter 'S'. ;) j/k...

Interventional radiology is a dynamic field.

First of all, the procedures in IR: A. work-- many times, better and with less collateral damage than the open procedures they compete with
B. They Reimburse well, thus it has attracted the ire and perhaps jealousy of other subspecialties. As a result many nonradiologists are trying to get into the minimally invasive business.

Like any field under competition, those who do not adapt will die, those who are willing to innovate will thrive.

It is true that IR no longer does the bulk of endovascular interventions for peripheral artery disease. Vascular surgeons and cardiologists are jockeying for supremacy to that end. Those IRs who have not adapted to this fact are condemned to do low level line and tube work.

However there are those who have embraced change and are pushing the envelope with UFEs, and oncologic interventions like Chemoembolization and RFA, palliating stents that are flourishing. They also perform intermediate level work like dialysis access maintanence and biliary interventions.

Secondly IRs that directly seek referrals from and provide good service to clinicians will do get more cases and better cases than those IRs who sit back and wait for the tertiary (wouldn't touch them with a ten foot pole) referrals from other subspecialists.

Adapt or die...
I disagree with Hans about who should do endovascular stuff in the brain--he's biased--but the bolded quotes answer the OP's question in a definitive fashion. IR is far from dying. I'm bumping this thread because somebody started an identical one recently.
 

DrDre311

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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
(1) and (2) True. As the child of a radiologist, ever since I've been old enough to pay attention to such things, I've heard my father talk about the continued encroachment by other specialties into the traditional domain of radiology. Hopefully rads can hold on to the future developments in oncology--let others complain about radiologists clinging to a cash cow, because it's about time that the field stood up for itself.

(3) Yes.
 

CherryRedDracul

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In my opinion Interventional Radiology is not a dead field, But it is more helpful to treat disease like Cancer, Uterine Fibroids and Liver failure, etc. And very helpful for those who do not want the surgical procedure for cancer etc. Every person wants to save their life without surgery.
Thank you for bumping a 7 year old thread.
 
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There was a long thread on auntminnie about IR's future.

Opinion of majority of residents and attendings is that IR has to become more like clinicians and get referrals directly. If they don't, IR will go down the toilet. I'm not optimistic about IR's future because a) most people going into rads have no interest in doing clinical medicine b) most people including referrers don't even know what IR can do. Cards have done a much better job of marketing themselves.

I plan to stick with dx rads for now.
Is it even possible to get a job without a fellowship these days?
 
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Is it even possible to get a job without a fellowship these days?
Night job, yes. But other than that, no.

People make a big fuss over fellowship. Except for IR, other radiology fellowships are easier than a typical private practice job. You don't work most of weekends and you won't probably take a night call. Most people can do outside moonlighting and make extra cash.

I don't say doing one extra year of fellowship is great. But it is also no big deal. I don't understand why people get so obsessed about it. Doing one extra year of training that you can make low 6 figures by doing some moonlighting should not be a deciding factor for choosing between DR, IR, Surgery or any other field.

I don't understand what was the relation between sticking with Dx rad and doing a fellowship.
 
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Night job, yes. But other than that, no.

People make a big fuss over fellowship. Except for IR, other radiology fellowships are easier than a typical private practice job. You don't work most of weekends and you won't probably take a night call. Most people can do outside moonlighting and make extra cash.

I don't say doing one extra year of fellowship is great. But it is also no big deal. I don't understand why people get so obsessed about it. Doing one extra year of training that you can make low 6 figures by doing some moonlighting should not be a deciding factor for choosing between DR, IR, Surgery or any other field.

I don't understand what was the relation between sticking with Dx rad and doing a fellowship.
I like diag rad and I am an nontrad student who would prefer not to do fellowship if I end up choosing rad... I still have time to decide since I am a MS2.
 
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I like diag rad and I am an nontrad student who would prefer not to do fellowship if I end up choosing rad... I still have time to decide since I am a MS2.
It is your life for sure. But again, I don't understand what is all this stress about one year of fellowship. We have a guy who is moonlighting for us and he is a fellow right now. His makes primary care salary. But at the same time I hear from people multiple times that you have to avoid rads because you have to do a fellowship.

If you don't like radiology, you shouldn't do it. But if you like it, one year of fellowship is a very minor thing that you should not even think about it.