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VIR training

Discussion in 'Radiology' started by hematomato, Jan 7, 2009.

  1. hematomato

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    Hey I know there is probably a thread discussing this but I didn't find it. What is the story with restructuring of interventional radiology training? I have heard a bit about the "DIRECT" pathway but does anyone know anything else? Will there be further divorce of VIR from traditional radiology?
     
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  3. PeepshowJohnny

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    I think it's still up in the air right now.

    The sense I get (as an outsider) is that there's no consensus. Some interventional guys value themselves as a radiologist first, others see what they do as different enough it should have it's own training. I mean, I've heard rumblings that interventional would be it's own independent field since like my second year of med school and nothing's happened.

    And I think with the current massive changes from the ABR for training/boards, nobody is in any hurry to make any rash moves in the near future.

    As for the DIRECT path, as it stands now, if you're graduating medical school and interested in doing interventional, I think you'd be crazy to do the DIRECT vs. Rads and then fellowship. Two years of a surgical prelim year and THEN you condense radiology by a year? No thanks. It is a great option for those who are changing careers, but not for the fresh graduate to plan on.
     
  4. irwarrior

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    Yes, the SIR (society of interventional radiologists) is looking to have multiple paths to IR training. We as a society are looking for highly motivated medical students who are passionate about patient care and providing effective minimally invasive therapies.

    In response to recruiting medical students who would otherwise go into surgery or surgical subspecialties, the SIR is promoting the primary certificate in Interventional Radiology. This individual will do a 5 year residency fresh out of medical school including an internship and then 4 years of residency which would include about a year of diagnostics (so that you can be good at image guided procedures). But, it will involve much more clinic and inpatientr responsibilities. It will be more like a surgical subspecialty and you will be boarded as an interventional radiologist and not a diagnostic radiologist. This is going in front of the ABMS later this summer.
     
  5. HamOnWholeWheat

    HamOnWholeWheat Senior Member
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    So it will take 5 years to train, and you'll only be boarded in IR, with no diagnostics? Is it just me, or does that seem like too long to train just to do the traditional IR procedures, given that its a 1-year fellowship right now. Are our current fellows not getting adequate training? If so, someone needs to yank their licenses. :rolleyes:
     
  6. banner

    banner Senior Member
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    That's not really true.

    IR is shifting its focus to a more clinical model. Old model was get patient brought to you on a silver platter, do the procedure and then dump the patient on the referring service. Ultimately, this is not good for patient care in that the referring service may not know how to take care of post-IR patients and rightfully resent being dumped on.

    SO while clinical skills are being learned in the current training situation it is inefficient for those who have no desire to read films, which is a growing number of us. The "I'm a diagnostic radiologist first" mentality has not served IR well, and a growing number don't buy into it anymore. Additionally, IR scope has expanded with interventional oncology recently and more time is needed to address this.

    It should be noted that more than one year is devoted to the current system as radiology residents spend a good amount of time on IR and other image guide procedure rotations.

    I dont' think anybody should have their licences pulled in IR any more than the person who did 5 years of general surgery plus two fellowship for plastics as opposed to doing the fully dedicate six years of plastic surgery. Same statement holds for those who are doing general surgery plus one-two of vascular surgery instead of the five year vascular surgery fellowship. I knew some old school internists who only did an internship back in the day and have been practicing for years. I don't think they should have their licenses pulled either.

    The training should reflect the changes in the field. What was good 30 years ago, may not be good for the present or future.
     
  7. HamOnWholeWheat

    HamOnWholeWheat Senior Member
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    Obviously the line about pulling licenses was tongue-in-cheek to make a point about how 5 years of training in IR may not be necessary.

    How much IR time do you get in most residencies? Granted I only just matched, but the most liberal diagnostic rads programs I interviewed at only allowed ~6-9 months of IR during the entire residency. And how many procedures are you doing, versus the fellows? That's all highly variable between programs. So on the high end, we're currently putting out fellows who are doing just fine with a total of ~1.5-2 years of total IR training. Maybe that's enough, maybe not? Regardless, the Interventionalists somehow manage in the current training environment.

    My point remains. The current model is 5 years WITH diagnostics. The proposed model (as I've been told) is 5 years WITHOUT diagnostics. Is the current training model so bad that you have to add an additional 2-3 years of IR training in order to accommodate the newly perceived training needs? If so, how are the current guys possibly managing, given they're so woefully undertrained? (again, obvious tongue-in-cheek comment)

    The reason I'm making this point is simple. Nobody in their right mind would sign up for 5 years of IR training, with the associated surgical-style residency (2 prelim surg years in the DIRECT pathway :eek: ), to have such a limited scope of practice as IR when they could simply do one more year and be a vascular surgeon where you control the patients and have the option of doing interventional or open procedures. There are even a handful of 6-year neurosurgery programs, and the one at my home program gives a dedicated year of NeuroIR during residency(!).

    If you're going to market IR as its own residency, there has to be something more to pull in applicants. Make it streamlined to 3-4 years without fellowships. Otherwise, why enter a field which presently is at the whim of other specialties which have control over the patients? And before you say "the proposed changes are intended to change the practice model so that we control the patients", why take on that burden if you can just put in one more year and become a vascular or neurosurgeon and not have to change anything?

    If there were no Diagnostic->IR pathway right now, I would be in a 6-yr neurosurg residency and simply practice minimally-invasive interventional procedures. I wouldn't even consider a 5-yr exclusively IR pathway.
     
  8. banner

    banner Senior Member
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    I understand your comments. Here are my thoughts.

     
    #7 banner, May 4, 2009
    Last edited: May 4, 2009
  9. ThinkTooMuch

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    im no board expert, but this sounds more like an attempt to save DR and keep it "special" as opposed to bringing IR to the spotlight.

    also, let me get this straight, if this goes through the IR boarded guy is not allowed to read or give his professional opinion about images at all?
     
  10. bonran

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    I am a non-radiology resident who has been interviewing in intervention in my own specialty. I was surprised to get a few interviews from VIR programs who asked me to register in the radiology NRMP match & rank them. I know I will not be getting the CAQ from Am Coll of Radiology for this training but who cares. Its a nice backdoor to get into the Fellowship in my specialty after I get some catheter & interventional skills in VIR. Besides my case log is good enough to get me privileges in peripheral hospitals for procedures.

    What is it with VIR? With all the turf battles, is it less popular with radiology residents? Or is it the lifestyle & the risk of being sued?
     
  11. NYCRES

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    my understanding from talking to a few radiology residents is that they go into radio thinking that VIR is what they want to do. They then end up not liking the hard work they see IR docs put in to make the same amount compared to the diagnostic docs.
     

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