It's funny how people finish residency and assume they're the best...largely likely related to not being overread constantly by a subspecialist.
Yeah, being overread by a subspecialist is why I constantly feel inadequate. We'll go with that.
It's funny how people finish residency and assume they're the best...largely likely related to not being overread constantly by a subspecialist.
Obgyn, rad onc and heck, even IR, have more patient contact than DR outside of mammo perhaps.This is for medical students since I feel some people on this forum try to make them scared of going into radiology:
AI won't endanger DR during our lifetime. That is a myth. But even IF in an imaginary world it happens one day in the future it will effect IR more than DR. Most IR jobs are 50% IR and 50% DR. The DR that IR doctors do in most places are general and non-high-end studies. In the Imaginary world that AI evolves, low end studies like portable CXR will be affected most by AI. As a result, the IR doctors will lose their share of DR more (I know that some IR doctors on this board read all high end studies. While they read all Neuro, body and MSK MRs, the Neurorads and MSK rads in their group read portable CXRs, normal outpatient Xrays and USs).
Also in the imaginary world that AI takes over, don't think IR or any other fields will be immune. For example, what will happen to OB-Gyn? What about rad-onc? What about cardiology? What about DR itself? What about oncology? It will be very natural for DR to learn IR skills, for cardiology to try to expand their catheter work aggressively (since they will have a big loss from imaging part). Dermatology may lose a lot of its business. Similarly, surgeries will be more automated. Drain placement and biopsies will become automated and etc.
So don't worry about it.
You don't know what you don't know.
Since IR has always been the jack of all trades, it has a very "generalist" mindset. Believing in "specialization and sub-specialization" is a suicide for IR. In DR they have to compete with subspecialty trained radiologists. In PAD, they have to compete with vascular specialists (vascular surgeons and cardiologists). As a result, it is very natural for IR to say that there is nothing magical about a certain field and they are as good or even better in many areas. Otherwise, it will be always second in the game.
People can be very good at a few things but not everything. For example vascular surgeons in my hospital are very good at Aortic work, PAD, Dialysis work, lines and two of them are very good at embolizations. But they don't put in drains. Also when they look at CTAs they don't have any idea about liver lesions or pelvis masses. Similarly, IR is very good at thoras, paras, putting drains and lines and biopsies, but not at high end DR studies including neuro, MSK, body, Nucs, OB, mammo, Chest and etc. Some people may be superstars and may even be better than DRs but it is not the norm. Similarly, some cardiologists do EVARs, but that is not the norm and EVAR in most places is done only by vascular surgeons. Medicine is becoming more sub-specialized and nobody can be very good at multiple areas. It is very obvious.
Since you claimed to be practicing radiology for many years, you MUST surely understand that IR were the foremost expert on EVAR, and then vascular surgery came in, learned the procedures from IR and took away the patients, yes?
Your statement sounds like something a medical student, not something a faculty would say.
Whoever controls the patient, is the expert.
Obgyn, rad onc and heck, even IR, have more patient contact than DR outside of mammo perhaps.
People don't want to talk to a robotic oncologist about their prognosis
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First I say that you guys don't get anything by personal attacks. One person call me medical student and the other call me bitter jealous. It is going nowhere. OK. I may be a medical student, but you can at least listen to see what I say and you are entitled to your opinion. I have been in this business for 15+ years and this is what I have learned.
It was not about expertise. It was mostly about referral pattern and dealing with the complications. Later it again happened with PAD both with vascular surgeons and cardiologists.
What I learned from my experience? A service should be available, high quality and comprehensive.
Controlling the patient is a general statement. In reality, family doctors, PAs, NPs and ED doctors (and probably OB doctors) are the only ones who control the patients. Vascular surgeons, cardiologists, neurosurgeons and everybody else including radiology and IR are all dependent on referral from primary care providers and this trend is becoming more and more.
DR doesn't own their patients and I agree. But they have made themselves available and provide a comprehensive and high quality service. The patient comes to the ED or goes to Primary care with headache and they order CT or MRI BEFORE sending the patient to neurology (As a result, something about 70-80% of all studies are orders by primary care providers). But similarly, the neurologist also doesn't have control over the patient who is in ED or in primary care's office. It all depends on who is more available. Right now, CT is more available than neurologist so the ED orders CT before neurology consults.
However, IR is not in that position. I mean usually the patient gets to IR after he/she is seen by other specialists. This is a problem with IR referral pattern and I don't have a solution for it. One way to overcome this problem is to be a part of a DR group so you are aware of the pathologies that come through ED or Primary care offices. For example, if there is a liver lesion call the primary care doctor and offer biopsy. This is what we do in our current practice and we do also some PAD. Separating IR from DR is going to hurt IR from this aspect because they will lose this advantage and in fact, DR may start to offer biopsies and nonvascular work themselves. It seems the new IR residency is going to have some ICU rotations and some vascular surgery electives. It can be helpful but is not going to change the referral pattern. My 2 cents.
Please don't mistake what I say as a personal attack. Your lack of knowledge about recent history of EVAR is just a curious finding, something I would expect a faculty to know but not expressed by your thread.
Saying this knowledge is common knowledge to a radiologist who has been in practice for 10 years but probably unknown to a medical student is just a factual statement, not a personal attack.
Pretty clear what the point of my post was. Sorry but those specialities =/= DR in terms of being taken over by AI regardless of your opinion. No one is talking to a PA when they get diagnosed with cancerWhat was the point of this post?
No, but a PA with the help of AI can replace the oncologist. A family doctor with help of AI can replace an oncology referral. The insurance will pay much less to a rad-onc because a great portion of his job will be automated. The insurance will pay much less to oncology for doing chemo because probably AI will be able to put most of the orders and make all the calculations.
Ob-Gyn makes a lot of money by OB US. It will be replaced by AI.
A PA with the help of an AI device can diagnose skin lesions.
Yes, patient contact is very important but nobody is going to pay a rad-onc half a mil a year for just talking to the patients about their prognosis while the rest of the work can be done by AI.
@Tiger100 can yourself and whoever wants to argue with you about DR vs. IR go make your own thread about this and stop derailing every other thread on SDN with your agenda? We get it. You believe that IRs underestimate the complexity of the work DRs do, etc. etc. We've all been thoroughly convinced by your comments.
Pretty clear what the point of my post was. Sorry but those specialities =/= DR in terms of being taken over by AI regardless of your opinion. No one is talking to a PA when they get diagnosed with cancer
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"What was the point of this post?"If AI can completely replace radiologists, then it will be a totally different world. If you can completely trust AI to diagnose your liver metastasis, why can't the same AI put in the orders for chemotherapy? Why AI with the help of PA can't do radiation therapy?
Anyway, it is all imaginary discussions.
"What was the point of this post?"
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I think that it is growing more and more difficult to practice part time IR and build a "successful" IR practice in a conventional radiology group. I agree that historically IR physicians have obtained their referrals from specialists (vascular surgeons, hematologists, oncologists, surgical oncologists, transplant surgeons, urologists etc). This is not sustainable as the specialists will also want to provide minimally invasive options.
In order for IR to thrive in private practice environments, it is vital to get referrals from primary care, NP, PA's , urgent care, ER. The key to success is being available at all times and affable. The IR physician needs to have dedicated time to see outpatient consults and follow up (1 to 2 days a week) as well as inpatient consults . They should not accept any orders for invasive procedures and provide consultation on all patients. The IR physician has to aggressively market their practice by giving talks to the various healthcare providers as well as accepting direct patient referrals.
Now, it is important to have some disease processes that you can comprehensively manage. These would include varicose vein disease, DVT, PE, PAD, back pain /compression fractures. In order for you to be able to compete in this space you need to be able to evaluate the patient's leg pain, wounds (CEAP), venous reflux/obstructive studies, compression stockings. You should be able to provide all aspects of care from anti-coagulant therapy, EVLT, sclerotherapy, and ambulatory phlebotomy and you will need a place to follow the patients (outpatient clinic) .
IR physicians are also increasing their presence at outpatient vascular centers, wound care centers or working jointly with podiatry to prevent amputation. Again, it is important to provide comprehensive and long term care of these patients with treatment of lipids, anti platelet regimens, off loading, orthotics, and assisting in debridements and wound care.
Now as far as endovascular aneurysm repair , this initiative was started by Juan Parodi a vascular surgeon who went to Argentina to perform one of the initial repairs. He did this in conjunction with Julio Palmaz an interventional radiologist who developed the balloon expandable stent. Early adaptors of this were vascular surgeons (Veith) and some IR physicians such as Katzen at Miami Vascular. However, IR physicians historically did not evaluate and manage these patients in the office setting and did not have admitting privileges and did not follow these patients.
We have been able to treat AAA and iliac aneurysms but this is based on following lots of small aneurysms over the course of years and marketing to primary care providers and providing screening ultrasounds. We also have had admitting privileges as well.
The trend is occurring slowly and with more and more IR physicians are coming out of training wanting to see patients,admit them and follow them longitudinally. Unfortunately, most radiology practices are not inclined to give the time , space and infrastructure to practice "clinically" as this is a huge opportunity cost to a radiology practice. Large overhead without a return on the investment until 3 to 5 years of building the practice. It is becoming harder and harder to succeed in a conventional radiology group because of these constraints, pressure to generate RVUs, and lack of clinical infrastructure.
About to finish residency, the nature of academic DR training means that I feel very comfortable doing all those "high end" DR studies you mentioned. I have no interest to read those studies though. If I have to do another day of DR I rather quit. I enjoy reading images, but loath the idea of producing reports.
Also, I am not sure why you are so fascinated with PAD. A healthy IR practice can thrive despite no PAD. Just IO volume can sustain a regional IR practice.
The most laughable part of your post is that somehow the DR cert is only good for chest x rays...I will be completing an entire DR residency. Should you stop reading any CT abdomen and pelvis since you aren't body fellowship trained? Or noncon CT head since you aren't neuro trained? Silly.
Speaking from purely a financial point of view, do you believe that fully clinical IR groups, once established, generate more revenue/ profit than a comparably sized non-clinical group? I am just curious how people would be able to make the business case for movement toward such a practice structure to the higher ups at a hospital.
Also most IR jobs have about 50-60% DR work.
Then why do IRs, on average, make more? That doesn't really add up.The answer is No.
Even in the current model, in many groups IR does not generate its own salary; its salary is supported by redistribution from DR which I think is very fair and should be done. An RVU based radiology group is not sustainable. Also most IR jobs have about 50-60% DR work.
Then why do IRs, on average, make more? That doesn't really add up.
Haha ok.
You'd better join academics. Otherwise, you will be really miserable in IR since you have a very very wrong understanding of the practice of IR in private practice.
For all the students out there, google SIR job board and see for yourself whether most IR jobs are 50-60% IR or not.
And for this poster above, I get that IR residency is really competitive and if you can discourge your competitiors from applying, that's swell.
I am not convince that you have graduated residency given your lack of knowledge about the actual practice of radiology.
For all the students out there, google SIR job board and see for yourself whether most IR jobs are 50-60% IR or not.
And for this poster above, I get that IR residency is really competitive and if you can discourge your competitiors from applying, that's swell.
I am not convince that you have graduated residency given your lack of knowledge about the actual practice of radiology.
The IR job market is solid if you are willing to do about half DR. This is something that I know from "real life practice". But 100% IR jobs are uncommon outside academics.
I was very curious about SIR Job listing.
I searched the SIR job listing. It is a real mess. It gives you 436 job but a lot of these jobs are RN, PA, tech jobs and even it has a few jobs for breast imagers.
But you can narrow down your search in the left side by choosing "Interventional radiologist", the percentage of IR and by private versus academic practice.
My results:
I ran the search by choosing "interventional radiology", choosing all options except for academics and one time 75-99% IR and one time 100% IR.
The result is again a mess with RN and Tech jobs mixed with IR jobs. But if you look at it, OUTSIDE ACADEMIC JOBS there are only 8 jobs in IR in the whole country that has 75% or more IR.
Conclusion:
I am pretty sure there are more than 8 predominantly (more than 75%) IR jobs out there but the job listing shows 8.
- Getting a 75%+ IR job is very hard.
- IR Job market is solid if you are willing to do about 50% DR.
- If you want to do only IR, most likely you have to join academics which can be good or bad.
@Tiger100 - why are you so hell bent on disparaging IR with false facts in an IR discussion board? What is your agenda here? This discussion thread is meant for medical students and those of us in IR who can provide real world advice.
Please go away.
Signed,
Lowly interventional radiologist
For those of you that have reported the above post for trolling, please understand there is no way we can police such things.The IR job market is solid if you are willing to do about half DR. This is something that I know from "real life practice". But 100% IR jobs are uncommon outside academics.
I was very curious about SIR Job listing.
I searched the SIR job listing. It is a real mess. It gives you 436 job but a lot of these jobs are RN, PA, tech jobs and even it has a few jobs for breast imagers.
But you can narrow down your search in the left side by choosing "Interventional radiologist", the percentage of IR and by private versus academic practice.
My results:
I ran the search by choosing "interventional radiology", choosing all options except for academics and one time 75-99% IR and one time 100% IR.
The result is again a mess with RN and Tech jobs mixed with IR jobs. But if you look at it, OUTSIDE ACADEMIC JOBS there are only 8 jobs in IR in the whole country that has 75% or more IR.
Conclusion:
I am pretty sure there are more than 8 predominantly (more than 75%) IR jobs out there but the job listing shows 8.
- Getting a 75%+ IR job is very hard.
- IR Job market is solid if you are willing to do about 50% DR.
- If you want to do only IR, most likely you have to join academics which can be good or bad.
For those of you that have reported the above post for trolling, please understand there is no way we can police such things.
It is up to the users of this forum to point out where others are being intentionally misleading or posting false information.
It would be inappropriate for staff to take action against another user where we cannot verify the accuracy of what they're posting. Thank you for your cooperation understanding.
For those of you that have reported the above post for trolling, please understand there is no way we can police such things.
It is up to the users of this forum to point out where others are being intentionally misleading or posting false information.
It would be inappropriate for staff to take action against another user where we cannot verify the accuracy of what they're posting. Thank you for your cooperation understanding.
So I got some downtime between cases and decided to teach this "attending" how to use the SIR job board.
I just looked at it this morning. 60 jobs total there. Mind you there are only 240-250 IR grads each year and majority of jobs are not advertised as they go directly to the fellow.
When academic setting is unchecked, there were 40 jobs. 30 of those jobs were 100% IR.
Did you look on the wrong website?
I respectfully disagree. It's one thing for someone to post their views and engage in a discussion. It's another for them to post repeatedly over and over and over in the same thread. The individual in question posted **23** times in this thread and continued to agitate the aspiring IRs and practicing IRs who are active users on this forum.
Moreover, the individual in question is admittedly NOT an interventional radiologist. Imagine if there was a chiropractor thread and I posted 23 times as a physician how chiropractor shouldn't have their own school or degree or that their business model is doomed to fail. Or imagine there was a thread for CPAs and someone with an MBA posted 23 times how an accounting degree is less than an MBA. This is the very definition of trolling. It would be one thing to hear the views of that MBA for, say, 5 posts.... but 23??? Any reasonable person can see this for what it is.
@Tiger100 - why are you so hell bent on disparaging IR with false facts in an IR discussion board? What is your agenda here? This discussion thread is meant for medical students and those of us in IR who can provide real world advice.
Please go away.
Signed,
Lowly interventional radiologist
So the relationship between Radiology and IR is like the relationship between chiropractor and physician? Lol. You are funny.
A reasonable person can do the search on SIR job listing and see the results. I mentioned that IR Job market is solid if you are willing to do 50% DR. the poster disagreed and mentioned SIR job listing. I looked at SIR job listing and there are 8 NON_ACADEMIC IR jobs that has more than 75% IR in the whole country.
I just said the facts. No false information. Everybody can do the search themselves.
Relax, the application season is still early. I get IR/DR residencies are competitive now. Wish you best of luck of getting in.
Lol. So since you don't have anything to defend your false statement again you try to deviate from the main discussion by personally attacking me.
What happened to SIR job listing?
Just look at your posts above. You mentioned SIR job listing. I did the search. The results to me is good and to you is a disaster. Now rather than having any LOGIC you talk about my training. Lol.
Your understating about real world IR is very obvious from your post that you claimed IO is enough to build a busy IR practice.
Would probably help if a third party settles it once and for all. Obviously IR has to do a lot of DR in practice in most situations or it doesn'tWe're now up to 27 posts by the same individual in a 2-page thread. This is trolling.
Will one of the moderators please put an end to this insanity?
Would probably help if a third party settles it once and for all. Obviously IR has to do a lot of DR in practice in most situations or it doesn't
Well that's what the last several pages of this thread has been aboutThis isn't really a point of contention. Most private practices, IR physicians are expected to cover a decent amount of DR work. IR-only attendings are really only concentrated in academic institutions and a few private practices. SIR is pushing for more gung-ho hardcore IR physicians, but even many of the newer graduates will most likely be doing a decent amount of DR. I mean, it's called IR/DR integrated residency rather than IR-only residency for a reason.
Agree with qxrt, and I'm also not sure why folk's are jumping down Tiger's throat.
Know many guys out of fellowship in their first pp jobs and pretty much all of them do at least 40% diagnostic. Only people I know doing 100% IR are in academics. This is also in line with the groups I shadowed when I was a med student, and with the group I currently moonlight for.
While I don't doubt 100% IR jobs exist out there in the private world (I know of 3 IR only groups, though only one of which has >5 people) these seem to be the exception rather than the rule.