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Thoughts on IR programs?
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Penn is the best on list hands down. Some huge names in the industry get broad exposure.
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Go there and you will be prepared for any practice.
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Penn
Vanderbilt
to be honest have not heard much, just a guess that they do tons of Y90, TACE, TIPS, and trauma. My guess is all the PAD and probably venous disease goes vascular.
Emory
Strong reputation. Rotate at multiple places. Large residency. They get exposure to everything. I would not particularly like rotating at that many places but I have heard nothing but good things. Probably number 2 on this list.
Wake Forest-not sure.
Cleveland clinic
attending run program. 20ish Attendings and they will not let you do much during the case. super high end hospital where they do tons of IO, TIPS, probably a lot of arteriovenous malformations. No PAD, No Neuro (many fellows). There former program director who was awesome just left. Probably the best part of the program is the time you will be spending away from CC such as CC-Florida, or metro. Weak program and you will come out weak.
Beaumont
strong well balanced program. Huge hospital. Get exposure to a little bit of everything.
Yale
They do tons of venous work and PE. Have a strong reputation. You end up here and you will come out strong.
USF
super high volume IO, big name in PE, lots of prostate artery embolizations. They do lots of endoleaks. Great group of attending’s. Draw backs, the IR that really built the program just retired and it has to have hurt the program. He was a highly respected IR. No PAD other then a VA, no neuro.
Michigan
Only a few years ago I might have put them number 1. They have lost a bunch of big name IRs. I am sure it’s still good. variety of procedures is strong. Lots residents probably a little low on volume to support it. There VA experience is strong. IR does the thoracic aneurysms. No neuro.
Ohio State
Strong reputation. Don’t know the specifics.
Utah
There MSK docs do the Kyphoplasty’s (lol)
UT Dallas
High volume IO, TIPS. No PAD or neuro.
MUSC
At one point probably around 10 years ago they were one of the strongest IR programs in the country. They are nothing like they used to be vascular took there Aorta and PAD work. Neuro took there Carotids. There just average.
Vanderbilt
to be honest have not heard much, just a guess that they do tons of Y90, TACE, TIPS, and trauma. My guess is all the PAD and probably venous disease goes vascular.
Emory
Strong reputation. Rotate at multiple places. Large residency. They get exposure to everything. I would not particularly like rotating at that many places but I have heard nothing but good things. Probably number 2 on this list.
Wake Forest-not sure.
Cleveland clinic
attending run program. 20ish Attendings and they will not let you do much during the case. super high end hospital where they do tons of IO, TIPS, probably a lot of arteriovenous malformations. No PAD, No Neuro (many fellows). There former program director who was awesome just left. Probably the best part of the program is the time you will be spending away from CC such as CC-Florida, or metro. Weak program and you will come out weak.
Beaumont
strong well balanced program. Huge hospital. Get exposure to a little bit of everything.
Yale
They do tons of venous work and PE. Have a strong reputation. You end up here and you will come out strong.
USF
super high volume IO, big name in PE, lots of prostate artery embolizations. They do lots of endoleaks. Great group of attending’s. Draw backs, the IR that really built the program just retired and it has to have hurt the program. He was a highly respected IR. No PAD other then a VA, no neuro.
Michigan
Only a few years ago I might have put them number 1. They have lost a bunch of big name IRs. I am sure it’s still good. variety of procedures is strong. Lots residents probably a little low on volume to support it. There VA experience is strong. IR does the thoracic aneurysms. No neuro.
Ohio State
Strong reputation. Don’t know the specifics.
Utah
There MSK docs do the Kyphoplasty’s (lol)
UT Dallas
High volume IO, TIPS. No PAD or neuro.
MUSC
At one point probably around 10 years ago they were one of the strongest IR programs in the country. They are nothing like they used to be vascular took there Aorta and PAD work. Neuro took there Carotids. There just average.
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Hey do you have any thoughts or observations on UCSD?
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Sorry don’t really know them.
Kaiser LA is probably the best program in California. Dr Vatakencherry has built an incredible program. You go there you will have the tools capable of practicing anywhere.
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Maybe I’ll do an updated what I consider top 10 programs and why. Feel free to ask about any program.
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Please do the top ten. Would really like to see that
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In no particular order. Places to do your last two years of training.
-Medical College of Wisconsin.
-Brown.
-Mount Sinai.
-Rush.
-Oregon.
-UPENN.
-University of Virginia.
-University of Illinois Peoria.
-Kaiser LA.
-Michigan.
-Medical College of Wisconsin.
-Brown.
-Mount Sinai.
-Rush.
-Oregon.
-UPENN.
-University of Virginia.
-University of Illinois Peoria.
-Kaiser LA.
-Michigan.
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Hey, thanks for your input.
Which programs are most like Kaiser, but also have a strong neuro-ir focus?
Yeah, I really like the way the Kaiser program is structured (or at least advertised as such), with clinical integration and a broad scope of practice. However, I have to grapple with the reality that they only have a couple spots each year for which numerous applications apply.
Which programs are most like Kaiser, but also have a strong neuro-ir focus?
Yeah, I really like the way the Kaiser program is structured (or at least advertised as such), with clinical integration and a broad scope of practice. However, I have to grapple with the reality that they only have a couple spots each year for which numerous applications apply.
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-Brown
-Arkansas
-Dotter
-UF Jacksonville (not as strong overall but do a lot of neuro). Mayo eats up all the IO and TIPS. But Mayo does not do stroke. Siragusa seems like he would be a good one to train under.
-If you know you want to do neuro Brown is king. The other ones are good as well. As far as other places... Do your homework and stay away from any place that have IR Fellows. They will get all the cases.
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Can you comment on MCW for IR? I'm applying DR, but strongly interested in ESIR. Thank you in advance 🙂
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MCW is as strong as anyone! Parag Patel MD is a huge name and has elevated the program. They do all the Thoracic Aorta’s, there vascular surgery department is weak and there residents get a lot of PAD exposure. Patel does a ton of venous work. Tutton is a leader in interventional pain. There IR department essentially runs the hepatobilliary cancer conference. No NIR fellows you could probably get stroke certified. You rotate with Burrows, world renown peds IR. can’t go wrong.
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Thoughts on Colorado or MD Anderson? And as far as MCW I am certainly under the impression that their IR is strong but I worry about the DR side a bit.....seems like a place that would be great for fellowship but not for residency.
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Colorado has a strong reputation for getting training in a little bit of everything. MD Anderson is weak no doubt about it. Obviously you will be doing Y90 and TACE tell you are blue in the face. Good luck on everything else! I once spoke to one of there fellows who basically told me that IR has no business doing PAD. You will come out with a poor skill set other then IO. Brown has a very strong reputation in neurointerventional. that’s what they are known for. Mount Sinai is probably the best program in the North East and maybe the entire east coast. But Mount Sinai Does not do neuro.. Pick what you like and hope what you like picks you.
Thoughts on Duke?
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I am a long time lurker to SDN and an academic IR faculty that has been out in practice for a few years. I just want to say that NDcienporciento100's rank list is...somewhat misleading. My understanding is that he is a current trainee so I want to give my prospective as a relative junior faculty who's been through job searches a few years back.
There are many factors in what makes an IR program "top" program. Reputation of the program can be different depends on the audience, whether it's to other IRs, other radiologists, referring docs, and lastly the general public. Strength of procedural training, which breaks down into the type of procedural performed (difficult to learn dialysis work if you do zero dialysis work) and also the autonomy afforded to the trainee. Clinical training is important, but more so for integrated residency and ESIR versus IR independent pathway as you need to learn all the procedural skill you need to learn in one year (unless you do two years, but why?). If you are looking into an integrated program, beware of hospitals that have a strong IR department but relatively weaker diagnostic department.
The weird thing about IR, is many of the most advanced IR procedures are practiced at a community level. For example, in a world renowned top 5 hospital in the US, vascular surgery tend to do all the endografts, neurosurgery will do all the endovascular neurosurgery and GI will be sophisticated enough to take care of a lot of biliary stenting and GI bleeding, but at the no-name community hospital where one of my co-fellow is practicing, he does all the EVAR, TEVAR, endovascular stroke surgery and complex biliary work because the specialists who are able to do them are not available. As a result, many of the program with the strongest IR training are understandably not at places with the biggest name.
But in my personal opinion, the most important quality of a top fellowship is to be able to get you the job you want. So let's take a look at where people come from in different places. To entertain NDcienporciento100, I will use some of his own programs. You can decide for yourself what's the most important quality that will get folks jobs that they want.
As far as getting an IR job, keep in mind that it's more about luck and timing rather than where you've gone to fellowship. In my experience, fellowship only become a deciding factor when you are competing against many other candidates. This tend to occur in desirable location or desirable practices. Usually, one would not encounter significant difficulty break into a non-coastal, non-popular location, unless you want to live in a specific small town that has 3 IRs who are all years away from retirement, then no fellowship will break you into that town.
I'll be looking at practices in locations that are difficult to break for candidates (because it doesn't matter which fellowship you went to for job in Fargo, ND), and also academic IR practices.
Kaiser LA: The IR faculty comes from the following places, none on his list.
- UCLA x4
- Miami Vascular
- Wash U/MIR
- NYP Columbia
- Hopkins
Mount Sinai NYC main campus: 4 comes from Sinai as one may expect since places like to take their own, but none from other places on his list.
-Christina health
- Sinai x 4
- Miami vascular
Let's look at some private practices
Cedar Sinai
- UCLA
- 2 other older physician who did not do a fellowship (grandfathered in)
ARA in Austin which is a dominant group in the area, 3 people in this group comes from the program on his list.
- Northwestern x 2
- Emory x 2
- MD Anderson
- Miami Vascular
- Brown
- UCSF x 3
- UCLA x 2
- USC
- MGH
- Dotter x 2
Let's look at some county/VA programs in competitive location
SF VA
- Northwestern
- Some who didn't seen to have do a fellowship? (older docs)
Santa Clara Valley Medical Center in San Jose
- Stanford
- University of Washington
- UCLA
- NYP Columbia
- older doc, not clear if he did fellowship
Washington Hospital Center in Washington DC: 3 people from program on his list.
- UVA
- Washington Hospital Center
- U of Minnesota
- Mt Sinai x 2
- Georgetown
- NYP (not sure Columbia or Cornell, not listed)
All the practices I've listed above are in locations difficult to break into or academic practices difficult to break into. Those would be places where the connections matter, where your fellowship matters.
So what's our take away from this list? DO YOUR TRAINING WHERE YOU WOULD LIKE TO END UP. One of the most important predictor where you'll end up is where you trained, based on Merrill Hawkins recruitment data. It's not a great idea to go to places far away from where you'll end up by chasing name or supposed top 10 list etc as those can change all the time. Faculties move around, service line changes, etc.
In my opinion, most IR programs will prepare folks well in a career in IR, academic or private practice. There are IR programs that I would tell my trainees to avoid but those are not public knowledge and require first hand experience, so ask your IR faculties and they should have some first hand knowledge (especially the junior faculties who's out only for a few years).
In summary, pick a program where you would like to end up. And if you have a dream job in mind? Find out where rads in that practice come from.
Don't put all trust in people on a forum. Trust objective data (like job placement data) or at least data from your own IR mentors.
There are many factors in what makes an IR program "top" program. Reputation of the program can be different depends on the audience, whether it's to other IRs, other radiologists, referring docs, and lastly the general public. Strength of procedural training, which breaks down into the type of procedural performed (difficult to learn dialysis work if you do zero dialysis work) and also the autonomy afforded to the trainee. Clinical training is important, but more so for integrated residency and ESIR versus IR independent pathway as you need to learn all the procedural skill you need to learn in one year (unless you do two years, but why?). If you are looking into an integrated program, beware of hospitals that have a strong IR department but relatively weaker diagnostic department.
The weird thing about IR, is many of the most advanced IR procedures are practiced at a community level. For example, in a world renowned top 5 hospital in the US, vascular surgery tend to do all the endografts, neurosurgery will do all the endovascular neurosurgery and GI will be sophisticated enough to take care of a lot of biliary stenting and GI bleeding, but at the no-name community hospital where one of my co-fellow is practicing, he does all the EVAR, TEVAR, endovascular stroke surgery and complex biliary work because the specialists who are able to do them are not available. As a result, many of the program with the strongest IR training are understandably not at places with the biggest name.
But in my personal opinion, the most important quality of a top fellowship is to be able to get you the job you want. So let's take a look at where people come from in different places. To entertain NDcienporciento100, I will use some of his own programs. You can decide for yourself what's the most important quality that will get folks jobs that they want.
As far as getting an IR job, keep in mind that it's more about luck and timing rather than where you've gone to fellowship. In my experience, fellowship only become a deciding factor when you are competing against many other candidates. This tend to occur in desirable location or desirable practices. Usually, one would not encounter significant difficulty break into a non-coastal, non-popular location, unless you want to live in a specific small town that has 3 IRs who are all years away from retirement, then no fellowship will break you into that town.
I'll be looking at practices in locations that are difficult to break for candidates (because it doesn't matter which fellowship you went to for job in Fargo, ND), and also academic IR practices.
Kaiser LA: The IR faculty comes from the following places, none on his list.
- UCLA x4
- Miami Vascular
- Wash U/MIR
- NYP Columbia
- Hopkins
Mount Sinai NYC main campus: 4 comes from Sinai as one may expect since places like to take their own, but none from other places on his list.
-Christina health
- Sinai x 4
- Miami vascular
Let's look at some private practices
Cedar Sinai
- UCLA
- 2 other older physician who did not do a fellowship (grandfathered in)
ARA in Austin which is a dominant group in the area, 3 people in this group comes from the program on his list.
- Northwestern x 2
- Emory x 2
- MD Anderson
- Miami Vascular
- Brown
- UCSF x 3
- UCLA x 2
- USC
- MGH
- Dotter x 2
Let's look at some county/VA programs in competitive location
SF VA
- Northwestern
- Some who didn't seen to have do a fellowship? (older docs)
Santa Clara Valley Medical Center in San Jose
- Stanford
- University of Washington
- UCLA
- NYP Columbia
- older doc, not clear if he did fellowship
Washington Hospital Center in Washington DC: 3 people from program on his list.
- UVA
- Washington Hospital Center
- U of Minnesota
- Mt Sinai x 2
- Georgetown
- NYP (not sure Columbia or Cornell, not listed)
All the practices I've listed above are in locations difficult to break into or academic practices difficult to break into. Those would be places where the connections matter, where your fellowship matters.
So what's our take away from this list? DO YOUR TRAINING WHERE YOU WOULD LIKE TO END UP. One of the most important predictor where you'll end up is where you trained, based on Merrill Hawkins recruitment data. It's not a great idea to go to places far away from where you'll end up by chasing name or supposed top 10 list etc as those can change all the time. Faculties move around, service line changes, etc.
In my opinion, most IR programs will prepare folks well in a career in IR, academic or private practice. There are IR programs that I would tell my trainees to avoid but those are not public knowledge and require first hand experience, so ask your IR faculties and they should have some first hand knowledge (especially the junior faculties who's out only for a few years).
In summary, pick a program where you would like to end up. And if you have a dream job in mind? Find out where rads in that practice come from.
Don't put all trust in people on a forum. Trust objective data (like job placement data) or at least data from your own IR mentors.
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Duke: Same scenario as MD Anderson. If you want to train in the Triangle UNC is king! Great very well rounded program big names in the IR field. Leaders in prostate artery embolization and other areas. You train here you will be ready to go anywhere!
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Still looking for the exact explanation for why my rank list is misleading....?
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If your “top 10” list is for procedural /clinical training then I cannot comment because I haven’t personally had much experience with grads from your list and I don’t personally have partners who have gone to those places. Our residents also don’t tend to go to those places listed as they tend to go to some other fellowships and find their ideal jobs year after year.
I merely point out that competitive location and sought after practices are mostly filled by grads from programs not included in your list. I am in one of those location. Caveat is that I don’t do hiring so I haven’t interacted with candidates who are from your list besides some Sinai grads. Sinai does provide excellent and solid training but that’s common knowledge. Sinai is also one of the only programs from your list that put grad into the practices I’ve listed above. I haven’t personally worked along side of them though so I can’t comment on their training and ability.
In fact, unless you’ve personally gone to all ten programs, have close friends who trained there or worked with their products, I am not sure how you can speak about those programs with enough certainty to come up with a top 10.
In my humble opinion, there are outstanding programs, good programs and weak programs. Outstanding programs tend to place their grads into competitive practices or competitive locations and that is an objectively verifiable fact, just look at where people have gone (especially Junior faculty) in competitive practices.
Most programs are good and will not hold you back in anyway in your journey to become a great IR.
Some programs are deficient. Ask your staff what those are.
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I get what you’re saying but the fact remains that I have to rank programs in a year that is very unpredictable. I’m obviously looking for a program that has good DR and IR, but it’s very hard to get a sense of which programs meet these criteria. And faculty are not particularly helpful at my school. I don’t care about prestige as much , I just want good training. It seems like you are sorta saying to go for the name brand though bc it makes you more marketable. I don’t know where I’m going to end up for a job, at this point I’m just trying to get good training in both IR and DR. Are there places on any of the above lists that you would avoid or have heard good things about?
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In general, big named program in a location that you like to end up is a safe bet. The strength of diagnostic radiology program generally correlates with how famous the hospital is.
Big academic centers also have a big residency and bigger alumni network (sometimes all over the country) making job hunt flexible and easy. More over, having a fancy name help with advertisement to your referring doc or the public and is something practices consider.
The institutions listed by the other posters are all very fine institutions and do provide incredible IR training. However, I don't think it's appropriate to really have a "top 10 list" for IR programs, and if a trusted trainee ask me to come up with a top 10 list, my list would be different from the list by the other poster and I suspect many of my colleague would come up with a list that is more similar to mine.
A few institution in the other poster's list became very popular in the recent years due to a few big name attendings that are not very well known outside of SIR/interventional radiologist circle. While they are famous, they can easily change jobs. Also, usually the hiring person is the department chairman, who may or may not know the details of who is who in IR (I certainly don't know many famous rads outside of my specialty).
Also, I personally think choosing IR program based on access to PAD or EVAR or a service line is short sighted for a medical student. Service lines absolutely changes in the span of a few years. There is a pitfall in the thinking of some IR trainees, that if an IR program doesn't do PAD, dialysis work or neuro IR, it's a poor program. This line of thinking is wrong. Most IR programs will train you to have all the tool sets to work with. If anything, the only story I've heard about regarding limitation of training program ironically come from complaints about a grad of a certain, very famous, vascular heavy program. Apparently the said grad is uncomfortable performing a gallbladder drain / cholecystostomy tube. Most of my day to day IR work is the bread and the butter type of procedures and a trainee will be well-served to be proficient in those bread and butter type of procedures.
The reality is that whether you'll do PAD or not have very little to do with your training. Any IR from any program will have the endovascular skill set to do PAD, hell, that's how vascular surgery started. What's good to learn is business acumen and the ability to compete for those cases. In general, you either join a practice that does PAD and gets mentored by other partners to do them, or you join a practice that absolutely will not do PAD and essentially no amount of effort on your part will change this. For a great many practices out there, PAD are considered a surgical or cardiology thing and there is no way an IR would touch those cases doesn't matter where the said IR received his training. PAD isn't the end all or be all in IR.
So in summary, my recommendation is to apply to the biggest name program in the area of the country you like to work in and choose the program that you vibe with the most. You cannot go wrong with big, well known radiology programs with many alumni.
Unfortunately many of the current IR graduates can not come out and compete in private practice or outpatient based lab environment which is becoming more and more important area for interventional practice. Unfortunately too many graduates come from programs that only train in IO and though that will prep them for transplant centers/ cancer centers, it will not prep them for the majority of hospitals. I would urge one to look at graduates of a program and not see where they end up but see what they are actually doing, ie are they running a clinic and providing a consultative practice or are they doing para,thora, biopsy and drains.
In training are you admitting your own patient or are you admitting to someone else . In training are you "competing" for referrals from primary care or are you getting referrals only from specialists. Mt Sinai NYC gets PAD referrals in a competitive environment with very strong interventional cardiology and vascular surgery. If you are comfortable in the competitive arenas you will be comfortable getting referrals in less competitive waters. In training are you doing clinic and getting undifferentiated patients or has the decision already been made and your clinic is really more of a preoperative clinic?
I specifically chose a place that would give me the mindset of how to successfully compete and build a practice and I would certainly look for IR menotrs with such a mindset. Yes, those individuals can come and go and may not be there by the time you are training but that unfortunately is a gamble.
In training are you catheterizing the various areterial vasculatures? cerebrovascular, upper extremity, intercostals/bronchials, celiac, sma, ima, renal, lower extremity, DP, PT etc and doing interventions? Are you doing VTE work including DVT thrombolysis, thrombectomy and IVC filter removals? Are you involved in PE work ?
PAD is a very common disease and if you are in the current OBL environment , that and dialysis are important to thrive. If you are going to a mixed practice 50/50 IR and DR where you are doing more of the paracentesis, biopsy, abscess drains, gastrostomy tubes it really won't matter where you train and in fact you could arguably just do DR and ESIR without additional VIR training.
I think of the cases that I do the tibiopedal work can be some of the more challenging and sometimes unforgiving stuff. I have seen too many graduates come out now and are uncomfortable doing cerebral angiography, pad interventions, and PE work. Yes, it can all be learned after graduating your training , but it gets harder and harder to acquire those skills and hospital credentialing can put a barrier to your entry in those arenas.
In training are you admitting your own patient or are you admitting to someone else . In training are you "competing" for referrals from primary care or are you getting referrals only from specialists. Mt Sinai NYC gets PAD referrals in a competitive environment with very strong interventional cardiology and vascular surgery. If you are comfortable in the competitive arenas you will be comfortable getting referrals in less competitive waters. In training are you doing clinic and getting undifferentiated patients or has the decision already been made and your clinic is really more of a preoperative clinic?
I specifically chose a place that would give me the mindset of how to successfully compete and build a practice and I would certainly look for IR menotrs with such a mindset. Yes, those individuals can come and go and may not be there by the time you are training but that unfortunately is a gamble.
In training are you catheterizing the various areterial vasculatures? cerebrovascular, upper extremity, intercostals/bronchials, celiac, sma, ima, renal, lower extremity, DP, PT etc and doing interventions? Are you doing VTE work including DVT thrombolysis, thrombectomy and IVC filter removals? Are you involved in PE work ?
PAD is a very common disease and if you are in the current OBL environment , that and dialysis are important to thrive. If you are going to a mixed practice 50/50 IR and DR where you are doing more of the paracentesis, biopsy, abscess drains, gastrostomy tubes it really won't matter where you train and in fact you could arguably just do DR and ESIR without additional VIR training.
I think of the cases that I do the tibiopedal work can be some of the more challenging and sometimes unforgiving stuff. I have seen too many graduates come out now and are uncomfortable doing cerebral angiography, pad interventions, and PE work. Yes, it can all be learned after graduating your training , but it gets harder and harder to acquire those skills and hospital credentialing can put a barrier to your entry in those arenas.
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So UPenn does not place there graduates in competitive places? That is what the above author said, it’s laughable. I feel that it is important to train at a place where you get direct referrals from primary care docs and get to decide the best course of action for a patient (which may mean referal to surgery in some cases). The idea you should just go to the biggest name and don’t worry you Will figure out whatever you are not taught is not smart logic to me. Cerebral interventions are not easy and you could seriously hurt someone with that logic. PAD long segment SFA occlusions, retrograde pedal access are some of the most difficult cases I have been involved in so far in my training. For example doing a subintimal approach until you actually do a few times is very difficult and I could not imagine just doing It on the fly having never done it with an experienced operator. The author above says that it does not matter if you get training in those cases as long as you are taught to compete for them. So they are saying they are going to teach you to compete even though they have not been able to compete.... Very bad logic. When it comes to competing for jobs.... All on what you desire, if you want to work at world famous cancer center, then by all means train at md Anderson. If you want to compete for a job at a 400 bed hospital that does stroke, EVAR, PAD, IO, Trauma, hepatobilliary work then MD Anderson as good as that names rings will not prepare you.
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Except that people that I know who’ve gone to those 400 bed hospitals that does stroke, EVAR, PAD including below the knee PAD work include fellows who had zero PAD training during residency or fellowship. It’s outrageous to suggest that a skilled and well trained rad cannot pick up those skills beyond fellowship when protored appropriately or that they would “hurt people”. Those skills are successfully picked up by cardiologists and vascular surgeons.
Again, it’s helpful to have exposure to certain service lines in training, but not having extensive exposure to those service lines do not disqualify you from taking jobs that requires it. In fact, competition for those jobs is a lot less compared to competition for coastal jobs or academic IR which usually (not always) do not require PAD or EVAR skills.
More over, many, if not most, academic IR programs, mine included, have moved on to a clinical model. Throughout training and in practice, I compete for referral and market share in procedures. Clinical model is the norm in a modern IR training program.
Cardiologists are very good at tibial work because they are used to using CTO wires, 014" wires , atherectomy, DES etc. Vascular surgery has incorporated much of this in their training. Modern day graduates of many of the current programs do very little CTO work and so that skill set is fundamentally different. Have seen too many graduates come out and are unable to manage these patients in the community or in the office based environment. I am not certain the clinical model is yet the norm in most training programs. There are variable definitions of "clinical" IR. Of course anything can be learned after fellowship but most current graduates are most comfortable with vascular access, biopsies, drainage procedures, hepatobiliary and embolization procedures. They are not as comfortable with complex arterial revascularization procedures , cerebral angiography or aortic work.
The challenge is not going to a place with established high end VIR practice, but more importantly going to a place without high end IR and building it from ground level up. That is where your training is most valuable. Now you have to compete with other Endovascular specialists and market your clinical and technical skillset . You may not have a friendly senior IR physician to help you through the learning curve. Instead you will have VS and IC competitors who are watching you like a hawk to see if you make a mistake and shut your practice down. Often, they will prevent you from getting credentialed in the first place stating that you don't have x amount of hospital admissions, x amount of lower extremity interventions , x amount of cerebral angiograms so on and so forth. They will rarely prevent you from privileging to do picc lines, LP, paracentesis, thoracentesis, biopsies or abscess drains but the other procedures are fair game.
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I am not so sure if lack of x amount of lower extremity interventions or cerebral angiograms prevented vascular surgery, cardiologist and “endovascular neurologist” from obtaining privileges. If anything, the pseudo-exclusive contract is a bigger issue.
Either way, I’ve not met any IRs who had trouble adapting to a PAD practice coming out of fellowship.
For medical student who is reading this, who would like to do radiology, the smartest thing from a job search prospective is still choose the largest, most well known IR/DR program closet to your ideal location.
And if vascular disease is really, really your thing, I recommend medical students to consider vascular surgery. It’s astronomically easier to practice endovascular aortic or arterial disease surgery as a VS than as a radiologist, as of 2020.
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I have met many who have struggled with PAD and in fact I get a fair number of questions about it from young graduates about PAD, as the reality is if you go to the bulk of jobs out there and want to build a practice PAD has to be a component of it.
This is the purpose of the SIR LEARN meeting as they recognize there is a lack of training in PAD at many centers.
If you want to do bread and butter cases, you can just do DR and perhaps body.
Agree with exclusive contracts being a detriment to graduates and one that has to be tackled.
If you want a job I agree chose any center as the jobs that are 50/50 and primarily doing fluid drainages, biopsies etc these are plentiful including many of the private equity firms.
But, if you want to be ready to run your own practice, work in an OBL environment, be comfortable competing with other specialists than I would say go find a high end clinical VIR training program where you go to clinic, admit your own patients and that offers all aspect of VIR including PAD, CLI, stroke, pain, fibroids, veins, DVT/PE, and IO, hepatobiilary.
This is the purpose of the SIR LEARN meeting as they recognize there is a lack of training in PAD at many centers.
If you want to do bread and butter cases, you can just do DR and perhaps body.
Agree with exclusive contracts being a detriment to graduates and one that has to be tackled.
If you want a job I agree chose any center as the jobs that are 50/50 and primarily doing fluid drainages, biopsies etc these are plentiful including many of the private equity firms.
But, if you want to be ready to run your own practice, work in an OBL environment, be comfortable competing with other specialists than I would say go find a high end clinical VIR training program where you go to clinic, admit your own patients and that offers all aspect of VIR including PAD, CLI, stroke, pain, fibroids, veins, DVT/PE, and IO, hepatobiilary.
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Would you say the bulk of the job out there for IR grad right now has PAD or stroke or the potential to build such a service line? Curious to hear your thoughts.
If you want to join an OBL environment which is becoming more and more common place and desirable to enable one to practice 100 percent IR, you will need to provide PAD. Hospitals are trying to hire groups that can offer stroke coverage as they lose those patient to stroke centers if they don't have that coverage. Not enough neuroir physicians to cover the stroke calls.
Outpatient Prospective Payment System and Ambulatory Surgical Center final rule empowers beneficiary choices and unleashes competition to lower costs and improve innovation
Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency's efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration's Executive Order on Protecting and Improving Medicare for Our Nation's Seniors, and will take effect on January 1, 2021.
"President Trump's term in office has been marked by an unrelenting drive to level the playing field and boost competition at every turn," said CMS Administrator Seema Verma. "Today's rule is no different. It allows doctors and patients to make decisions about the most appropriate site of care, based on what makes the most sense for the course of treatment and the patient without micromanagement from Washington"
In this final rule, CMS will begin eliminating the Inpatient Only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a three-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by CY 2024. This will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the hospital inpatient setting when inpatient care is appropriate, as determined by the physician. In the short term, as hospitals face surges in patients with complications from coronavirus disease 2019 (COVID-19), being able to provide treatment in outpatient settings will allow non-COVID-19 patients to get the care they need.
In addition to putting decisions on the best site of care in the hands of physicians, allowing more procedures to be done in an outpatient setting also provides for lower-cost options that benefit the patient. For example, thromboendarterectomy (HCPCS code 35372) is a surgical procedure that removes chronic blood clots from the arteries in the lung. If this procedure is performed in an inpatient setting, a patient who has not had other health care expenses that year would have a deductible of about $1500. In contrast, the copayment for this procedure for the same patient in the outpatient setting would be about $1150. Patient safety and quality of care will be safeguarded by the doctor's assessment of the risk of a procedure or service to the individual beneficiary and their selection of the most appropriate setting of care based on this risk. This is in addition to state and local licensure requirements, accreditation requirements, hospital conditions of participation (CoPs), medical malpractice laws, and CMS quality and monitoring initiatives and programs.
Beginning January 1, 2021, we are adding eleven procedures to the ASC covered procedures list (CPL), including total hip arthroplasty (CPT 27130), under our standard review process. Additionally, we are revising the criteria we use to add surgical procedures to the ASC CPL, providing that certain criteria we used to add surgical procedures to the ASC CPL in the past will now be factors for physicians to consider in deciding whether a specific beneficiary should receive a covered surgical procedure in an ASC. Using our revised criteria, we are adding an additional 267 surgical procedures to the ASC CPL beginning January 1, 2021. Finally, we are adopting a notification process for surgical procedures the public believes can be added to the ASC CPL under the criteria we are retaining.
CMS is announcing that it will continue its policy of paying for 340B-acquired drugs at Average Sales Price (ASP) minus 22.5% after the July 31, 2020 decision of the Court of Appeals for the D.C. Circuit upholding the current policy. This policy lowers out-of-pocket drug costs for Medicare beneficiaries by letting them share in the discount that hospitals receive under the 340B program. Since this policy went into effect in 2018, Medicare beneficiaries have saved nearly $1 billion on drug costs, with expected Medicare beneficiary drug cost savings of over $300 million in CY 2021.
As part of the agency's Patients Over Paperwork Initiative, which is aimed at reducing burden for healthcare providers, CMS is establishing a simple updated methodology to calculate the Overall Hospital Quality Star Rating (Overall Star Rating). The Overall Star Rating summarizes a variety of quality measures published on the Medicare.gov Care Compare tool (the successor to Hospital Compare) for common conditions that hospitals treat, such as heart attacks or pneumonia. Along with publicly reported data on Care Compare, the Overall Star Rating helps patients make better-informed healthcare decisions. Veterans Health Administration hospitals will be added to CMS' Care Compare, which will help veterans understand hospital quality within the VA system. Overall, these changes will reduce provider burden, improve the predictability of the star ratings, and make it easier for patients to compare ratings between similar hospitals.
In response to stakeholder feedback about the current methodology used to calculate the Overall Star Rating, CMS is not finalizing its proposal to stratify readmission measures under the new methodology based on dually eligible patients, but will continue to study the issue to find the best way to convey quality of care for this vulnerable population.
Finally, in order to address the ongoing public health emergency, CMS is finalizing a new requirement for the nation's 6,200 hospitals and critical access hospitals to report information about their inventory of therapeutics to treat COVID-19. This reporting will provide the information needed to track and accurately allocate therapeutics to the hospitals that need additional inventory to care for patients and meet surge needs.
For a fact sheet on the Calendar Year (CY) 2021 OPPS/ASC Payment System final rule (CMS-1736-F), please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0
The proposed rule can be downloaded at: https://www.cms.gov/files/document/12220-opps-final-rule-cms-1736-fc.pdf
Most DR groups that hire IR are not willing to support the high overhead that is required to run a clinical VIR service ie 1) leasing office space 2) hiring staff (medical assistants, nurses, schedulers, billers, marketing, office manager etc).3) dedicate physician time to clinic ( huge opportunity cost for DR group who want their IR physician clearing the list and taking care of minor procedures such as LP, myelograms, arthrograms, joint aspirations and injections, biopsies, drains etc so that the DR colleagues can just read and can avoid low rvu generating procedures.
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So what percentage of jobs that a new IR fellowship grad can pursue right now would require them to build a PAD service? How many of those OBL jobs are open to brand new fellowship grads versus experienced staff? Again I am curious to see your thoughts.
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The jobs are available , but most fresh graduates don't have the commensurate experience to thrive in that environment. Thus, the importance of training in PAD etc.
Currently most of the jobs out there are run by large corporations such as Radnet, Sheridan etc . If that is the goal job, I agree PAD training and frankly high end IR training are not needed as you will be mostly doing DR with some "light" IR.
Currently most of the jobs out there are run by large corporations such as Radnet, Sheridan etc . If that is the goal job, I agree PAD training and frankly high end IR training are not needed as you will be mostly doing DR with some "light" IR.
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In my experience, the OBL jobs are unicorn jobs at this moment, unless you are talking about exploitive OBL chains. Most IR who practices at an OBL setting are experienced IRs. Frankly, I caution new fellowship grads to practice in a setting where more experienced partners are readily available and in a hospital setting because it takes some time for a new staff IR to become truly adept at their craft and OBL is a tricky environment to learn the ropes.
Also, the majority of IR jobs are not corps. Many academic, private practice and hospital employed job with varying amount of clinical model are present. I admit patients myself and I see them in clinic, and that is becoming standard in most academic IR department I know.
Frankly, it’s a false dichotomy to suggest IR jobs are either high end or folks doing paracentesis while reading a lot of diagnostic studies working for a corp. I get a sense that you have a lot of discontent with traditional radiology group, but there is a whole gradient of IR jobs out there. OBL job is a very small percentage of this gradient.
It is true, however, that if you are only looking at job board you will mostly see corp jobs because they are hard to recruit. A lot of the more competitive jobs are filled by word of mouth to fellowship grads in programs that I am familiar with.
If you do not have access to extensive networking brought by large residency/fellowship programs, it can seem like all that’s available is corporate jobs or small hospital where you have to build a practice everytime. Not every one want the headache of practice building especially when you are in a hospital employed setting as you don’t even control the billing and earn the reward for your effort.
Again, for a medical student, if your passion is aortic/arterial work or endovascular neurosurgery, in my opinion it’s better to persue vascular surgery or neurosurgery.
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For a data point, I’ve opened up SIR job connect. The society of interventional radiology job board is the primary job board for higher end IR jobs.
There are 77 results right now when I select interventional radiologists.
There are 2 result when I select the practice setting as outpatient office based.
1 of them state they prefer candidate of several years of experience as staff (as they should for OBL).
The other job is a varicose vein only practice. Essentially those type of practice only do a very small subset of IR procedure and really is not an appropriate job for a young IR grad who want to maintain their skills.
I then selected the filter for PAD, and 11 result showed up. I have friends working or have worked in two of those places and one of them actually do not do any PAD (VS took that service line several years ago).
Again, don’t take anyone’s word, look at the data.
There are 77 results right now when I select interventional radiologists.
There are 2 result when I select the practice setting as outpatient office based.
1 of them state they prefer candidate of several years of experience as staff (as they should for OBL).
The other job is a varicose vein only practice. Essentially those type of practice only do a very small subset of IR procedure and really is not an appropriate job for a young IR grad who want to maintain their skills.
I then selected the filter for PAD, and 11 result showed up. I have friends working or have worked in two of those places and one of them actually do not do any PAD (VS took that service line several years ago).
Again, don’t take anyone’s word, look at the data.
I have talked to quite a few graduates and also have seen many graduates come out and heard their struggles in getting a practice going and the lack of support from their DR counterparts and even their IR colleagues.
The reality is most radiology groups won't spend the overhead needed to run a "clinic" and support a robust outpatient practice. It takes years to get a clinical VIR practice to showcase a return on investment. Another key thing is to develop all service lines 1) Vascular. (PAD/CLI/ DVT/PE/ varicose veins/ IVC filters/ IVC filter retrieval) 2) Neuro '(stroke interventions) 3) GI/GU/Reproductive (BPH/ PAE; Fibroids/ UAE/ fertility tubal recan/varicocele Embo/) TIPS/ BRTO 4) Oncology (renal ablations, ports/ palliative catheters, liver tumor trans arterial therapy/ ablations) 5) pain (esi/facet/ rhizotomy/ vertebral augmentation) . In order to do this well it takes clinic and longitudinal follow up.
Quite frankly in most groups DR at its current reimbursement pays the bills and so IR is seen by many radiology groups as a "necessary" evil to get and keep a hospital contracts (boots on the ground). There is very little interest in most DR groups in paying the overhead to provide the necessary infrastructure for IR to thrive.
The reality is most radiology groups won't spend the overhead needed to run a "clinic" and support a robust outpatient practice. It takes years to get a clinical VIR practice to showcase a return on investment. Another key thing is to develop all service lines 1) Vascular. (PAD/CLI/ DVT/PE/ varicose veins/ IVC filters/ IVC filter retrieval) 2) Neuro '(stroke interventions) 3) GI/GU/Reproductive (BPH/ PAE; Fibroids/ UAE/ fertility tubal recan/varicocele Embo/) TIPS/ BRTO 4) Oncology (renal ablations, ports/ palliative catheters, liver tumor trans arterial therapy/ ablations) 5) pain (esi/facet/ rhizotomy/ vertebral augmentation) . In order to do this well it takes clinic and longitudinal follow up.
Quite frankly in most groups DR at its current reimbursement pays the bills and so IR is seen by many radiology groups as a "necessary" evil to get and keep a hospital contracts (boots on the ground). There is very little interest in most DR groups in paying the overhead to provide the necessary infrastructure for IR to thrive.
I do agree that most IR graduates are not ready for the OBL environment fresh out of training as it takes some years to learn how to bail yourself out of complications (ruptured vessel, clot going down the tibial, managing an arterial dissection, getting comfortable with closure devices and alternative accesses). I also agree that many of the best jobs are heard from word of mouth or cold calling practices /hospitals and seeing what is available. Another great source for jobs are the device reps. They know exactly who is hiring and what the best practices are.
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Most private practice groups see IR as loss leader though some are beginning to innovate.
The real headway comes from IR academia which are fully embracing outpatient practice (NYP groups) as well as full clinical model in many academic settings. Some of the academic associated OBL are extremely revenue positive.
Ironically enough, some corporate practice actually recognize the value of IR more than traditional private practice and are able to appropriately place value on a clinical model by using margin from their diagnostic side to supplement clinical efforts. They have to, since otherwise they can’t recruit young IRs.
In the academic centers in NYC David Sperling has been a big proponent of the OBL.
There are a few forward thinking private practice groups that have established OBL , but sometimes this can be seen as "competing" with the hospitals that the DR groups have contracts with so it can have variable response. Sometimes they will do it as a joint venture (so both parties benefit). The Global is quite high for many of the procedures we can do such as atherectomy and embolization codes.
Agree , that it is getting harder and harder for the conventional DR groups to recruit some of the modern day VIR graduates as they are requesting/ demanding clinic. In fact the ACR now has a Taskforce looking at the challenge of providing IR services in the smaller hospital/ rural setting. I am glad that more academic places are seeing the light and practicing in a more clinical fashion, and recognize that without this key component VIR can not thrive.
There are a few forward thinking private practice groups that have established OBL , but sometimes this can be seen as "competing" with the hospitals that the DR groups have contracts with so it can have variable response. Sometimes they will do it as a joint venture (so both parties benefit). The Global is quite high for many of the procedures we can do such as atherectomy and embolization codes.
Agree , that it is getting harder and harder for the conventional DR groups to recruit some of the modern day VIR graduates as they are requesting/ demanding clinic. In fact the ACR now has a Taskforce looking at the challenge of providing IR services in the smaller hospital/ rural setting. I am glad that more academic places are seeing the light and practicing in a more clinical fashion, and recognize that without this key component VIR can not thrive.
I am not familiar with which large corporations / private equity are supportive of the outpatient clinic model and inpatient consults etc for VIR. The only ones I know will allow existing models to continue to practice in a "clinical " fashion, but I would be curious to see which large corporate group is interested in providing high end VIR care with dedicated outpatient clinics, inpatient consults and rounding etc in the hospital setting.
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There are people like me who have absolutely no interest in working in an OBL setting. I love hospital work and all the urgent/emergent cases that come with it, and couldn't imagine giving it up to do a relatively limited array of procedures. You're missing interesting procedures such as TIPS or acute limb/mesenteric ischemia or weird/interesting traumas or PE work in that setting.
Also, I don't know why you guys (or gals) automatically assume corp/private equity means diagnostics with a side of paras/thoras/drains for IRs. I know of at least one such group where IR does everything from complex below-knee recanalizations to TACE/Y-90/ablations to PE/DVT interventions and even covers stroke work. PE means leeches are skimming off the top of practice's salaries, but it doesn't necessarily mean IR is crippled or delegated to doing drains/venous access.
Also, I don't know why you guys (or gals) automatically assume corp/private equity means diagnostics with a side of paras/thoras/drains for IRs. I know of at least one such group where IR does everything from complex below-knee recanalizations to TACE/Y-90/ablations to PE/DVT interventions and even covers stroke work. PE means leeches are skimming off the top of practice's salaries, but it doesn't necessarily mean IR is crippled or delegated to doing drains/venous access.
The bulk of PE /corporate jobs are mostly DR driven with light IR, and have not historically funded the infrastructure necessary for clinic. Now, if there is the pre-existing infrastructure to support high end IR, they will usually not disrupt that process as by that point it has become another area of high revenue and justifies the VIR physician's income and also to disrupt that process would threaten their hospital contract as the hospital generates a substantial revenue from those high end cases (technical fees).
As far as the high end cases , agree that the emergent PE work, trauma, GI bleeders, hemoptysis, stroke, epistaxis , TIPS, BRTO etc would be things that would be lost. In the OBL you are able to grow the practice organically and build multiple service lines including dialysis work, PAD with CLI, fibroids, varicose veins, IVC filter placement and removal, varicose veins, PAE, vertebral augmentation and other pain procedures. You could even do hospital inpatient work if you are allowed to get hospital privileges, but this is often the biggest challenge IR graduates have due to exclusive contracts.
As far as the high end cases , agree that the emergent PE work, trauma, GI bleeders, hemoptysis, stroke, epistaxis , TIPS, BRTO etc would be things that would be lost. In the OBL you are able to grow the practice organically and build multiple service lines including dialysis work, PAD with CLI, fibroids, varicose veins, IVC filter placement and removal, varicose veins, PAE, vertebral augmentation and other pain procedures. You could even do hospital inpatient work if you are allowed to get hospital privileges, but this is often the biggest challenge IR graduates have due to exclusive contracts.
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You all keep mentioning that DR groups don't want to subsidize clinical IR practices because they aren't profitable. Is that not true? Or is it that it just takes time but after say 3-5 years the IR group would be making more than enough to cover the overhead and their own salaries?
Mainly talking about an IR group that's functioning like a surgical service doing the higher end inpatient work (not primarily OBL based), inpatient rounding, and clinic followup. Not really considering that benefit of having the IR presence to help secure the hospital contract as it seems pretty obvious IR plays a valuable role for that.
Basically what kind of RVUs would an average clinical IR doing the above be pulling compared to an average DR? My understanding is that unless things like equity in a lab or surgery center are coming in to play or it's a primarily outpatient centered practice, the DR end of things is generally still more profitable. Curious to know if I have a false impression of the current economics though.
Mainly talking about an IR group that's functioning like a surgical service doing the higher end inpatient work (not primarily OBL based), inpatient rounding, and clinic followup. Not really considering that benefit of having the IR presence to help secure the hospital contract as it seems pretty obvious IR plays a valuable role for that.
Basically what kind of RVUs would an average clinical IR doing the above be pulling compared to an average DR? My understanding is that unless things like equity in a lab or surgery center are coming in to play or it's a primarily outpatient centered practice, the DR end of things is generally still more profitable. Curious to know if I have a false impression of the current economics though.
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If you are talking about a small hospital environment, the challenge being faced by IR is that many other services can do their high RVU work. For example, cardiology/VS can do PAD or even venous work, surgeons can do port and vein, etc. nephrologist/VS can do dialysis work, etc.
On a revenue prospective, my understanding is that if an IR does exclusively high revenue procedures that at the moment are mostly done by vascular and cardiology, then they maybe more or less revenue neutral compared to their DR colleagues.
However, that is not realistic in most settings, especially not realistic for a new IR grad, unless there is already an infrastructure in place.
Most new IR grad, regardless of training, tend to have the majority of their complications within the first five years. This is the transition from trainee to attending. No amount of training will completely eliminate complications. If this new grad is attempting to breaking into an arena that is already firmly established by other service, the most likely scenario is that it will simply not be possible due to existing referral pattern and politics. Even if possible, one complication, and if this new grad is expanding a service line, he/she may need other services to bail them out. This one complication can spell the end of their attempt at building this service.
This is another reason why it’s a lot easier for VS to take over PAD services. They can offer surgical repair for traumatic vascular injuries for the extremities or surgical bypass. They can offer surgical salvage for endovascular complications. There are endovascular complications that essentially necessitate surgical bail out (for example, when an angioseal device accidentally close off an artery). Meanwhile, a competent modern vascular surgeon will not require any IR bail out in their area of practice (PAD or large vessel disease).
More over, many surgeons basically demand high RVU endovascular work to go to them as a part of their contract. For an IR, hospital can and will give away a service line they spent decade to build in an instance because the economy just make more sense to hire a vascular surgeon to deal with all thing vascular rather than hire a surgeon and then also pay the IR for endovascular work.
Exceptions exist. Most commonly are managed care setting like Kaiser or VA and some academic setting where everyone are insulated from production pressure a bit. This is where you predominantly see IR doing PAD in a setting where there are actually vascular surgeons or cards. The other setting which I think is what irwarrior allude to alot is the podunk (for lack fo better word) community setting where there isn’t much VS or endovascular savvy cards around so IR can develop and keep those service lines. It’s incredibly difficult for IR to build those services in a saturated market and incredibly easy for them to lose those lines.
Lastly, I have some personal distaste for IRs that seem to think lower end procedure is beneath them. I am lucky that I practice the whole gamut of IR, including PAD, in an academic setting, but some of my most rewarding cases are difficult PICC lines or central access. Those cases has very low revenues and some make fun of IRs for doing “lines and tubes”. But we should strive not to be physicians who are only chasing the highest reimbursed procedures and take care of every patient’s need. I still derive a lot of pleasure from a simple paracentesis.
I’ve had trainees who only want to do high end cases day in day out the moment they graduate. Frankly, for most, this is not a realistic hope. Most of my day still revolve around lines, tubes and drains because that’s simply the majority of a hospital based IR work load.
Again, if you are a medical student and you don’t like diagnostic radiology work, wants to have a clinic and want to do high end PAD work all day, my recommendation would be to go into vascular surgery. For many markets, competiting for PAD or EVAR as an IR is simply not an option or possiblity.
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Re: PAD in first job after fellowship
Lists can be helpful for choosing a place to train. IR training is heterogeneous. No practice does everything.
Big names make it easier to get into a regional DR practice that offers IR services, to publish, and to get academic jobs. Some of the big names have IR training in all service lines.
Robust IR training makes it easier to get into an all IR private practices that cover multiple hospitals, OBL groups, start your own practice, compete with other specialties, join a multispecialty group with cards and vascular, or bring a new skill set to a DR group.
Some programs still train you in PAD with IR attendings. The rest should have a setup to work with vascular or have IR sometimes and vascular sometimes training you.
Almost no programs are doing aorta mostly with IR, others have good relationships and co-scrub cases with vascular, and others will have off-service exposure.
Neuro - Very few programs do this on IR rotations, many others will have this as a rotation. The quality of off-service rotations will vary greatly and is a good thing to ask current residents about.
Getting the exposure that you want in these areas requires it being available to you, and making the effort as a trainee to get what you need.
As far as everything else on this list (compliments of IRwarrior) most things should be done in house with IR.
If many things are missing, you may have gaps in your training.
Things are very dynamic, with faculty coming and going, and service lines developing and sometimes going away, especially PAD and aorta.
MUSC for example, as mentioned above, used to do more aorta and PAD. Now, MUSC does a lot more pain, has a PAE program and does essentially the rest of IRWarrior's list.
You can compile your own list as an applicant by doing your research and asking the right questions.
Lists can be helpful for choosing a place to train. IR training is heterogeneous. No practice does everything.
Big names make it easier to get into a regional DR practice that offers IR services, to publish, and to get academic jobs. Some of the big names have IR training in all service lines.
Robust IR training makes it easier to get into an all IR private practices that cover multiple hospitals, OBL groups, start your own practice, compete with other specialties, join a multispecialty group with cards and vascular, or bring a new skill set to a DR group.
Some programs still train you in PAD with IR attendings. The rest should have a setup to work with vascular or have IR sometimes and vascular sometimes training you.
Almost no programs are doing aorta mostly with IR, others have good relationships and co-scrub cases with vascular, and others will have off-service exposure.
Neuro - Very few programs do this on IR rotations, many others will have this as a rotation. The quality of off-service rotations will vary greatly and is a good thing to ask current residents about.
Getting the exposure that you want in these areas requires it being available to you, and making the effort as a trainee to get what you need.
As far as everything else on this list (compliments of IRwarrior) most things should be done in house with IR.
If many things are missing, you may have gaps in your training.
Things are very dynamic, with faculty coming and going, and service lines developing and sometimes going away, especially PAD and aorta.
MUSC for example, as mentioned above, used to do more aorta and PAD. Now, MUSC does a lot more pain, has a PAE program and does essentially the rest of IRWarrior's list.
You can compile your own list as an applicant by doing your research and asking the right questions.
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Can you touch upon the benefit of doing IR training versus going into vascular surgery if we are just looking at PAD and aortic work?
can you also touch upon the difficulty of getting into multi-disciplinary groups? If anything, the multi-disciplinary groups with card and surgery prefer first and foremost experienced IR (aka not a fresh grad from fellowship), then grad with fellowship from big name (regardless of supposed strength or weakness in PAD training). I have not seen grad with big name but less pad experience in fellowship run into difficulty getting any jobs. I have seen trainees from non-coastal, non big name programs having issue breaking into coastal IR jobs, however.
In the study you quoted, over 60% respondent did not feel PAD training correlate to their first job. This is what I’ve seen with my trainee as well.
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