Radonkulos, I am hardly an expert on IR, I am just a PGY2, but had a lot of exposure to it, this question may be better answered in the IR forum or by doing a search of already posted topic. Also, Gvataken is a much better resource than I.
1)Yes the training pathway is outdate, IR does not need 4 months of mammo, and unless you are doing INR you really don't need the neuro stuff either. And you need more clinical training for sure, many people can pick up clinical skills,as it's merely a refresher, just like many specialties "pick-up" imaging skills, however, that is less than an ideal. The best IR fellowships have the clinical stuff built in, and if you go to those residencies you will also be doing the clinical work, but yes IR is a clinical specialty and needs clinical training that is hard to come by unless you look for it in DR residency.
SIR is trying to get a primary certificate for IR, like radiation oncology (which used to be a fellowship from DR)
2)DIRECT pathway people don't have "suspect" imaging skills, from what I understand their oral boards aren't as good as DR, peole, but you aren't training DRs, you are training IRs, and they are much more clinically sound. Also there are more and more practices where you do 100% IR with clinic etc. And with the new board format, (i.e.) take boards 16 months of out residency and can choose what you are tested on, I think it will really favor the DIRECT pathway people.
3)DR is kind of a drag for me, it is very very hard, and like anything else in medicine, the less you love something the harder it is to pick up, however, I come from the point of view that the harder you work for something, the sweeter the reward. Right now the only way to be an IR is to do a DR residency and then a fellowship, if I could be an IR through a different pathway I would have done it, but such is life. Medicine is a field of delayed gratification.
As far as turf etc, not really an issue if you're aggressive and don't expect business just to come to you, unless you are in academics in which case you can expect that 🙂