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.
Well, you may also notice how much elective time their is at many programs. This can be used to do rotations on image guided procedures. I almost doubled the assigned time and learned a ton. I have fellows at my program, but there is plenty to go around if you are aggressive and take responsibility
for the entire procedure and patient.
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 system is producing good graduates for the time being. We are reaching a point where more dedicated time is needed learning the procedures and peri-procedural workup and care. The growth of the field and where it needs to strategically position itself will soon outgrow the traditional method of training. Training needs to be periodically updated as field progress and change.
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
), 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(!).
Okay, that's one approach. But if you become a minimally invasive specialist and that's what you do through the surgical pathway, you'll soon loose your open skills. It's hard to be good at everything. That leaves you, at best, with the catheter skills of an IR, but a lack of understanding of how imaging relates to minimally invasive procedures. This is why most of the stuff has been developed by IR and little by other specialties. IR seeks the change in training to fix some of its weaknesses and further expand upon abilities to provide a consult (preferably from a PCP) on a patient and provide that patient with minimally invasive options. Patients don't want surgery, and I don't blame them.
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.
Point taken. I could see the value in that.
Otherwise, why enter a field which presently is at the whim of other specialties which have control over the patients?
What do you think is the very definition of diagnostic radiology? Because of this fact, DR is by no means a safe bet. Neurologists, orthopods, neurosurgeons, cardiologists, urologists, vascular surgeons are all after a piece of the imaging pie. They install a scanner in their office and read it themselves or ship it off to the lowest bidding dayhawk/nighthawk while collecting the technical component. Is this best for patient care? No! But, your arguments would suggest that one would be better off going into cardiology, where you control the patients, and specializing in cardiac imaging.
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.
Well, again, I seek to be a minimally invasive specialist and I don't think that I could truly be that with a NS or VS program. I think that IR training provides a broader scope and understanding of these techniques that allow me to offer patients more and to push the boundaries of medicine further. For example, if I work with cancer patients, I can do the biopsy, chemoembo, RF, cryoablate, radioembo, put in the chemotherapy port, treat the pain from metastasis with vertebroplasty or image guide nerve injections/ablations, treat their SVC syndrome, and aggressively treat the DVTs they'll get with IVC filters or catheter directed thrombolysis. No surgery discipline can offer all of those minimally invasive options to a patient. Only an IR can come close to offering the powerful synergy of the whole package of minimally invasive options to patients whose only other option may be nothing vs. a surgical procedure with significant morbidity.
