The end of Radiology?

[bronx43]

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IR isn't "taking" any procedures... they are creating them.

Also, IR is becoming very clinical. IR's done with training in the past 5 years are MUCH more clinical than those who finished training just a decade ago. At my institution IR has their own clinic, admits their own patients, does all vascular interventions.

"Taking" in the sense that the patients aren't theirs. I don't know much about IR at other institutions, but at mine, they don't have their own service and they certainly don't have their own clinic.
How are they getting clinic patients? From whom are they getting their referrals? I don't know many PCPs referring patients to IR instead of the system based specialty. If the specialists are referring these patients, then my initial argument stands that it's only time before those fields are training their own to do these procedures.

 

[badasshairday]

"Taking" in the sense that the patients aren't theirs. I don't know much about IR at other institutions, but at mine, they don't have their own service and they certainly don't have their own clinic.
How are they getting clinic patients? From whom are they getting their referrals? I don't know many PCPs referring patients to IR instead of the system based specialty. If the specialists are referring these patients, then my initial argument stands that it's only time before those fields are training their own to do these procedures.

IR use to get a lot of referrals from Vascular Surgery in the past. Those are drying up to a certain extent in certain settings. Now they are getting referrals straight from Primary Care or self referral as well as some Vascular Surgery referrals. Oncology/Hepatology also refers to IR for interventional oncology procedures. Patients with liver cancers have been known to seek out IR for chemoembolizations. Internal Medicine will refer things like perc PEG tube placements, perc nephrostomy (from urology too), IVC filters, because IR gets it done the fastest. Also patients seek out IR for things like uterine fibroids, DVT busting, varicose veins, themselves or via PCP referral. Vertebroplasties are also big.

IR differs from institution to institution definitely. Mine is one of the stronger clinical IR programs, lots of young, very clinically oriented attendings. Definitely a very busy inpatient service and clinic. They round on their patients in the mornings and in the evenings before leaving (Imagine that, seeing a group of radiologists on the wards rounding like surgeons). My program works very well with the Vascular Surgery department. But remember, IR is much more than just vascular work. It is a very dynamic field with high tech innovations moving it forward. Things like cholangiocarcinoma/hepatocellular carinoma traditionally have had dire prognosis with little treatment, but new procedures from IR have allowed these people to live much longer or even have enough reversal that they can be surgically resected (in the case of liver cancer).

 

[davidjones]

"Taking" in the sense that the patients aren't theirs. I don't know much about IR at other institutions, but at mine, they don't have their own service and they certainly don't have their own clinic.
Then IR at your institution is way behind the times. Any successful IR department have a clinic, consult service, and admitting service for things like UFEs, cancer ablations, even some biopsies that need inpatient monitoring.

How are they getting clinic patients? From whom are they getting their referrals? I don't know many PCPs referring patients to IR instead of the system based specialty. Actually they are, IR markets heavily to PCPs and about 25-30% of PAD is done by IR with referrals coming primarily from PCPs, also UFE come from PCPs, OB/Gyn and patient self-referral, as do varicose veins and the various pain procedures.


If the specialists are referring these patients, then my initial argument stands that it's only time before those fields are training their own to do these procedures.
Most specialists who refer to IR with the exception of vascular and cards don't have the ability to learn the procedure because no one will teach them and it is financially prohibitive as they could never do as many procedures to justify the equipment. Ex. Ob/Gyn, I think there is one in the whole country who does UFEs, and he works in an IR group who limit his ability to teach the procedure to other OB/Gyns. Chemo/radioembolization is technically challenging, and the more you do the better you get, thus surge onc med onc have neither the required training nor the time off to get training nor the option of having someone train them.

CT and MR guided procedures are another story, no rads department would allow another department to use their interventional scanners, if the hospital owned the scanners and tried to do that, in a place with a well established IR group, the IRs would threaten leaving, and given the importance of their services I doubt that would happen


As far as cost of imaging being contributary to health care costs, that is true, but it's because of self-refferal and CYA medicine not because of radiologists, so what needs to be done is stricter enforcement of the Stark Law so that cardiologists can't own PET scanners and orthopods can't own MRI and urologists can't own rad onc equipment.

I'm sure there may be a decrease in volume of imaging, but nothing IR can do is repraceable, people need stents or they will lose their legs, they need filters or they'll get a PE, they need cancer therapy or they'll die, etc.

 

[Radonkulous]

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[davidjones]

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 🙂

 

[badasshairday]

As far as cost of imaging being contributary to health care costs, that is true, but it's because of self-refferal and CYA medicine not because of radiologists, so what needs to be done is stricter enforcement of the Stark Law so that cardiologists can't own PET scanners and orthopods can't own MRI and urologists can't own rad onc equipment.

True. It isn't radiologists who are driving up imaging costs via utilization. It is other specialists who have incentive to read their own imaging such as the cardiologist/orthopod/neurosurgeon who owns their own imaging machines and can collect those fees. Radiologists are the ones who take the brunt of the decreasing reimbursement of imaging despite not being the drivers of the increased utilization.

 

[Baller MD]

No hospital would be willing to take on the liability for using a computer program to do diagnoses. You have to realize that as a physician you are looked at as a liability sponge by hospital/group leadership, not just a revenue machine. Even if you outlive your usefulness as a diagnostician, they'll still want you double-checking things so there's someone to suck up the lawsuits.

This.