I did not understand the OP, and I suspect the confusion is that the OP has not done any MS3 and is all confused about the different procedures. So since he got some answers, I wanted to ask additional questions that are confusing. So, I have pretty much decided to apply for radiology and am in the process of setting up 4th year electives. And I want to know a bit more about different procedures in radiology. Something that I could aspire to get a "niche" in after some type of fellowship. So here are the questions:
1) if you do IR fellowship, how likely is it to have an outpatient practice and do uterine, prostate, and veins only? Do you feel that vascular surgeons wouldn't want to take away prostate(once it is fda approved) or gynecologists take away uterine(in other countries those procedures are done by gynecology and urology respectively)?
2) I notice that most programs no longer offer AAA, does it mean that IR in private practice no longer do it or will no longer do it in 5yrs?
3) If you do an IR fellowship does it mean that you will never be specialized in any diagnostic reads, and so u will never be able to do telerads? Alternatively if instead of IR u do something like msk, is it possible to still pick up some of those IR procedures if u decide some day to open a vein and pain clinic?
It all depends on the location that you work. I live in a big coastal city. Here, if you through a stone, there is high likelihood that it hits a doctor esp a specialist (any field). A few months ago, we were evaluating the referral potential in our area and the number of doctors within 10 miles of our offices is ridiculous. As a result, any doctor is doing a lot of "scut work" to be able to pay for the business overhead. Successful practice here means to do whatever comes by and not your interest in most part. The only exception is academics where you can narrow your practice according to your interest. On the other hand, if you move to the middle of nowhere, there is a high likelihood that you can have the type of practice that you want for most of it. Now back to IR:
1- As you see above, IMO most of your competition will be other IR doctors and not necessarily vascular surgeons.I personally don't think Gynecologists and vascular surgeons will done UAE or prostate. At the same time, I don't think UAE or prostate embolization will be high volume in the future. You may get to do a few between your cases but not most of your time. PAD is something that if you put time and energy you can get more cases.
2- You will be able to learn AAA but there is a huge pressure from vascular surgery. I don't think you have to choose your field based on one procedure.
3- If you do IR in big cities, expect to do a lot of DR and also a lot of bread and butter procedures like biopsies, lines and drains. Your DR work will be a lot of bread and butter radiology like CXR, bone XR, anything CT and anything US. Higher end studies like MSK MRI, Neuro MRI or Body MRI will be read by sub-specialists. Telerad is a different beast. I don't think it is doable if you do IR at the same time.
3b- I am MSK trained and I do about 30-40% of my time procedures. I do pain management and spine procedures including kypho/vertebro. Also I do bread and butter procedures like biopsies, biliary tubes, drains including percut chole, lines and ports. I don't do something like IVC filter or angio, but I have heard some non-IR trained people do. Personally, I think other than ports and lines, anything vascular (excluding vein) should be done only by IR. For non-vascular procedures some body fellowships train you to do most of them like biopsies, drains, biliary tubes, Perc chole, PCNs and tumor ablations. Many MSK and Neuro fellowships train you to do pain management. Vein work like varicose vein is no man's land. It is something like Botox injection or Derm-ablation. The busiest vein clinic in our area belong to a family physician.
Bottom line: There are lots of opportunities in this field. If you do IR, you will be very well trained to do tons of procedures. But even if you are not IR, still you can do lots of procedures.