Why did you decide to choose DR over IR / IR over DR? Excluding reasons of patient contact/AI

[Tman507]

* Besides the usual reasons of patient contact or possibility of AI taking over(lol) that I hear very often
*why DR over IR? Is it only due to lifestyle? What keeps you from going into IR?
* Also those in IR, people keep saying that the hours are horrible but pay is relatively the same, I understand some people love doing more procedures, and also issues with vascular and cvs battling for domain where you're often given the worst cases...why IR over DR?

Thanks!

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[redoitall]

The notion of a split is classic divide and conquer and was not a great move to be honest. At my institution, every section did both diagnostic and procedures until very recently when “IR” became its own separate section by combining Vascular Radiology and Abdominal intervention. When I started residency, the most popular fellowship was abdominal imaging and intervention where you did both. They had to close it down because of the IR split.

I think almost everybody agrees that splitting DR and IR was not a great move, particularly when seeing the amount of "shuffling" post match. All IR residents of my class switch to DR! IR is not for everyone and unless you do it, you can't really know what it is.

The local IR culture is toxic. At my residency, the IR attendings refused to read cases and refused to have their trainees rotate on vascular CT/US or even abdominal despite honestly not having enough cases to do, often opting to send fellows home early or use them for consults, and instead preferred to use NPs to do ultrasound procedures or ports rather than supervise trainees. They would heavily criticize overnight CT/MR interpretations which resulted in IR consults despite whatever finding being true. They were just mad it was off hours work.

By contrast, the diagnostic sections which refused to give up “their” portion of IR (thoracic and MSK) continued to read cases and do procedures, realizing that you need to do both to be an effective proceduralist. I ended up doing MSK fellowship instead.

Well that is amazing. It sounds very different from my institution. Fellows work way too hard, attendings are overwhelmed, probably the busiest in our radiology department. They also seldom criticize anyone's read. In fact, our IR faculty crew is among the best, most friendly and nicest crew in the rad department. I mean how often did a faculty apologize to you as a resident for the amount of teaching that was not as high as they'd like, simply because the workload didn't allow it (and they made every effort to teach!). They are a pleasure to hang out with, which is mind blowing given the insane work load.
As for our fellows, and during all my rotations I have had in medicine and so forth, I don't think I have witnessed any fellow in any other specialty working as hard as they do. On Q3 Week-end call, covering like two 600+ beds hospitals. They were just working all he time. I get that maybe you can do that for 1 year as a fellow, but now with IR residency, IR residents will have to do that for several years. I am not sure how you can keep this rhythm for so long. My 1 month IR rotation was exhausting frankly. I had a lot of fun though. But still with kids and stuff, the long hours were not worth it to me (but I can understand that this can be worth it to someone else).

So to answer the original question about IR, and based on my own experience, the workload is a killer for me. Granted, this is institution specific (although I think that most IR services are probably very busy), but as much as I like procedure, I am not fond of the long painful ones (like TIPS, and complicated embos...) I like the quick, not involved and satisfying procedures (biopsies, I&Ds, joint injections etc) and rad has plenty of those to offer in pretty much almost all fields.
While may applicants want to do IR, you will find that many will change their mind. Similarly with DR. The point is that if anyone is interested by IR, then they should make every effort to rotation with IR as early as possible in Med School. Given that lack of exposure to radiology in general during Med School, this may be quite challenging. I can't fathom that someone would elect to do IR over DR because of AI or patient contact. These would not be valid reasons in my opinion because IR is too intense to assume that these benefits would make up for the pain. Doing IR for any reason other than true passion would be insane, and you would likely be miserable, at least during residency/fellowship. Now if you can survive the pain, your attending setting may be more pleasant (although I have heard of a few cases and witnessed a real life example of attendings quitting their attending jobs with the associated paycut to do another fellowship!). We have also few attendings who are IR trained (and at some point certified) who are not doing IR anymore.

 

[Tman507]

The notion of a split is classic divide and conquer and was not a great move to be honest. At my institution, every section did both diagnostic and procedures until very recently when “IR” became its own separate section by combining Vascular Radiology and Abdominal intervention. When I started residency, the most popular fellowship was abdominal imaging and intervention where you did both. They had to close it down because of the IR split.

The local IR culture is toxic. At my residency, the IR attendings refused to read cases and refused to have their trainees rotate on vascular CT/US or even abdominal despite honestly not having enough cases to do, often opting to send fellows home early or use them for consults, and instead preferred to use NPs to do ultrasound procedures or ports rather than supervise trainees. They would heavily criticize overnight CT/MR interpretations which resulted in IR consults despite whatever finding being true. They were just mad it was off hours work.

By contrast, the diagnostic sections which refused to give up “their” portion of IR (thoracic and MSK) continued to read cases and do procedures, realizing that you need to do both to be an effective proceduralist. I ended up doing MSK fellowship instead.

-I really dislike it when physicians giving their procedures to the NPs that's how they start.
-IR trainers cannot expect to hold a DR lifestyle in their fellowship by sacrificing DR time, thats practically +-60% of their work.. If I'd go into IR I'd want to still do readings.
-also I've heard some groups use IR attendings to do msk, is this an issue for someone in your line of work in future? Or does this only apply to small start up groups?

Thanks for your reply, much appreciated

 

[Tman507]

I think almost everybody agrees that splitting DR and IR was not a great move, particularly when seeing the amount of "shuffling" post match. All IR residents of my class switch to DR! IR is not for everyone and unless you do it, you can't really know what it is.



Well that is amazing. It sounds very different from my institution. Fellows work way too hard, attendings are overwhelmed, probably the busiest in our radiology department. They also seldom criticize anyone's read. In fact, our IR faculty crew is among the best, most friendly and nicest crew in the rad department. I mean how often did a faculty apologize to you as a resident for the amount of teaching that was not as high as they'd like, simply because the workload didn't allow it (and they made every effort to teach!). They are a pleasure to hang out with, which is mind blowing given the insane work load.
As for our fellows, and during all my rotations I have had in medicine and so forth, I don't think I have witnessed any fellow in any other specialty working as hard as they do. On Q3 Week-end call, covering like two 600+ beds hospitals. They were just working all he time. I get that maybe you can do that for 1 year as a fellow, but now with IR residency, IR residents will have to do that for several years. I am not sure how you can keep this rhythm for so long. My 1 month IR rotation was exhausting frankly. I had a lot of fun though. But still with kids and stuff, the long hours were not worth it to me (but I can understand that this can be worth it to someone else).

So to answer the original question about IR, and based on my own experience, the workload is a killer for me. Granted, this is institution specific (although I think that most IR services are probably very busy), but as much as I like procedure, I am not fond of the long painful ones (like TIPS, and complicated embos...) I like the quick, not involved and satisfying procedures (biopsies, I&Ds, joint injections etc) and rad has plenty of those to offer in pretty much almost all fields.
While may applicants want to do IR, you will find that many will change their mind. Similarly with DR. The point is that if anyone is interested by IR, then they should make every effort to rotation with IR as early as possible in Med School. Given that lack of exposure to radiology in general during Med School, this may be quite challenging. I can't fathom that someone would elect to do IR over DR because of AI or patient contact. These would not be valid reasons in my opinion because IR is too intense to assume that these benefits would make up for the pain. Doing IR for any reason other than true passion would be insane, and you would likely be miserable, at least during residency/fellowship. Now if you can survive the pain, your attending setting may be more pleasant (although I have heard of a few cases and witnessed a real life example of attendings quitting their attending jobs with the associated paycut to do another fellowship!). We have also few attendings who are IR trained (and at some point certified) who are not doing IR anymore.

-Sounds quite hectic, but i guess it depends on your institution then.
-You're correct, pre-exposure is poor, I guess they didn't know what they were getting themselves into.

Thanks soo much for your input
much appreciated

 

[Radology]

They’re entirely different fields.

IR is about doing procedures. Imaging the is the means with which they do procedures.

DR is about interpreting studies.

I found procedures to be uninteresting, and I enjoyed interpreting studies. It’s that simple

The better hours, lack of patient interaction, predictable call, same pay is just a nice byproduct

 

[Tman507]

They’re entirely different fields.

IR is about doing procedures. Imaging the is the means with which they do procedures.

DR is about interpreting studies.

I found procedures to be uninteresting, and I enjoyed interpreting studies. It’s that simple

The better hours, lack of patient interaction, predictable call, same pay is just a nice byproduct

I thought IR consisted 50-60% of DR in practice, is this changing?

Thanks for the reply, much appreciated

 

[JoshSt]

For me, I liked general surgery and being in the operating room almost enough to do it and figured if I wanted to do a career in procedures, I'd prefer to do general surgery operations rather than IR procedures. I don't mind patient contact (but am certainly fine without it) but felt like there was more continuity of patient care with surgeons. IR is certainly shifting to a stronger in-clinic presence and some centers have it, but it's not the same level as most surgical subspecialties. An IR acting doing a lot of vascular would be an exception, but vascular surgery has ruled vascular procedures where I did medical school and am doing residency.

For me, I thought a 4-hour exploratory laparotomy, hemicolectomies, and cholecystectomies (as an observer with the occasional cut this, suture that, and point this camera) were cooler than TIPS and TACEs. I'll never be well trained or a primary operator on these advanced IR procedures, so maybe I'm missing out. I find ports, abscess drainages, and percutaneous nephrostomies enjoyable, but not enough to do IR. You can certainly do these 'lesser' procedures in some practices as a DR, but where I will practice after fellowship I won't be able to as it's all done by IRs.

I certainly went into residency with a strong interest in IR (there were very few integrated IR residencies) but ending up loving all aspects of DR. Most subspecialties at my institution have a decent procedural mix, so doing ultrasound biopsies, breast work, and MSK injections scratch the procedural itch.

 

[Tman507]

For me, I liked general surgery and being in the operating room almost enough to do it and figured if I wanted to do a career in procedures, I'd prefer to do general surgery operations rather than IR procedures. I don't mind patient contact (but am certainly fine without it) but felt like there was more continuity of patient care with surgeons. IR is certainly shifting to a stronger in-clinic presence and some centers have it, but it's not the same level as most surgical subspecialties. An IR acting doing a lot of vascular would be an exception, but vascular surgery has ruled vascular procedures where I did medical school and am doing residency.

For me, I thought a 4-hour exploratory laparotomy, hemicolectomies, and cholecystectomies (as an observer with the occasional cut this, suture that, and point this camera) were cooler than TIPS and TACEs. I'll never be well trained or a primary operator on these advanced IR procedures, so maybe I'm missing out. I find ports, abscess drainages, and percutaneous nephrostomies enjoyable, but not enough to do IR. You can certainly do these 'lesser' procedures in some practices as a DR, but where I will practice after fellowship I won't be able to as it's all done by IRs.

I certainly went into residency with a strong interest in IR (there were very few integrated IR residencies) but ending up loving all aspects of DR. Most subspecialties at my institution have a decent procedural mix, so doing ultrasound biopsies, breast work, and MSK injections scratch the procedural itch.

Very interesting, thanks for your input, much appreciated

 

[Radology]

Much more common for DR people fill in IR gaps than vice versa.

Unless it’s a really small practice, IR guys are more often 75%+ doing IR

 

[Tman507]

Much more common for DR people fill in IR gaps than vice versa.

Unless it’s a really small practice, IR guys are more offer 75%+ doing IR

Thanks for clearing that up, much appreciated

 

[irwarrior]

Yes. VIR is pretty busy and with lots of emergencies. The training is also quite rigorous. If you are not passionate about it , would do DR with procedure. The field is more like surgery with surgical days and hours. I think if you are strongly considering IR, early exposure with busy rotations is crucial ie 3rd year and 4th year rotations. You have to love complex cases TIPS, BRTO, vascular reconstructions etc.

 

[UChicagoIR]

I disagree with some of what's been posted above. I think the original poster should consider the background of the individual answering the question as there will be biases in any answer. My own background is I practiced 50/50 DR and IR in private practice and and 100% IR in academics. I train IR fellows, DR residents (and now IR/DR residents). My 2 cents:

1) I think the need for separation of IR and DR was absolutely necessary. IR and DR, though rooted in imaging, are different specialties to practice. And many of the procedures that IR pioneered have, in the past, been lost to other specialties for various reasons including lack of clinical training for IRs and lack of support/understanding from DR colleagues in building practices.

2) There were and are very few "abdominal imaging and intervention fellowships". The only one I knew of back in the day was at MGH. I can't speak to local popularity, but it was never the most popular fellowship nationally to combine abdominal imaging and intervention.

3) I can't comment on individual IR practices, and it's unfortunate that some have experienced "toxic", but at my practice every IR absolutely LOVES what they do. We have have more cases than we can handle on most days and they're very intellectually stimulating with lots of "McGyvering" involved. My fellows spend 95% of their time performing cases and NOT doing scutwork.

4) The IR lifestyle is much more that of a surgical subspecialty than DR. You will work harder than your DR colleagues, but you will be compensated more. Radiology groups must compensate the IR employees/partners more for taking call and doing the things that ensure they keep their contract with the hospital. A radiology group without a strong IR presence is too easily commoditized and replaced.

5) There's certainly a large number of 50/50 IR/DR practices, but this is changing and will continue to change. My personal outlook is that within 10 years any radiology practice in a mid-to-large city will have full-time interventionalists. It's simply more efficient to have your DRs stick to churning out films and your IRs sticking to procedures. Jumping from one to the other during a workday is not efficient. The hybrid practice will still exist in smaller locales. I've trained roughly 25 fellows and I'd say 80-90% of them have joined 100% IR practices.

6) The procedures that diagnostic radiologists perform are simple things like biopsies or drains or injections. Personally, I don't consider that to be interventional radiology. If you are interested in things like TARE, UFE, PAE, PAD, etc then you simply have to do an IR fellowship. A DR is just not capable of doing those procedures.

7) Many people go into residency thinking they want to do IR. I think there's a cool/jock factor involved in doing procedures (much like a surgeon versus an internist). But not everyone is cut out for it and there's lots to like about diagnostic radiology once you start studying it and reading images yourself - which you unfortunately can't do as a medical student. So it's not surprising that you hear of people wanting to go into IR as a 1st year resident but then sticking with a DR career.

Lastly, and this is just my personal bias, but I think AI is a real concern. Medicine is an art. But a lot of it boils down to an algorithm. And those parts that can be algorithm-ized and commoditized will be. This applies to things like internal medicine as well as DR. How soon that happens is unclear to me, but it will happen. At my hospital we already have AI facilitating mammo and chest films to look for tiny nodules/masses.

 

[Tman507]

Yes. VIR is pretty busy and with lots of emergencies. The training is also quite rigorous. If you are not passionate about it , would do DR with procedure. The field is more like surgery with surgical days and hours. I think if you are strongly considering IR, early exposure with busy rotations is crucial ie 3rd year and 4th year rotations. You have to love complex cases TIPS, BRTO, vascular reconstructions etc.

Thanks, will definitely make sure I get adequate exposure

 

[Tman507]

I disagree with some of what's been posted above. I think the original poster should consider the background of the individual answering the question as there will be biases in any answer. My own background is I practiced 50/50 DR and IR in private practice and and 100% IR in academics. I train IR fellows, DR residents (and now IR/DR residents). My 2 cents:

1) I think the need for separation of IR and DR was absolutely necessary. IR and DR, though rooted in imaging, are different specialties to practice. And many of the procedures that IR pioneered have, in the past, been lost to other specialties for various reasons including lack of clinical training for IRs and lack of support/understanding from DR colleagues in building practices.

2) There were and are very few "abdominal imaging and intervention fellowships". The only one I knew of back in the day was at MGH. I can't speak to local popularity, but it was never the most popular fellowship nationally to combine abdominal imaging and intervention.

3) I can't comment on individual IR practices, and it's unfortunate that some have experienced "toxic", but at my practice every IR absolutely LOVES what they do. We have have more cases than we can handle on most days and they're very intellectually stimulating with lots of "McGyvering" involved. My fellows spend 95% of their time performing cases and NOT doing scutwork.

4) The IR lifestyle is much more that of a surgical subspecialty than DR. You will work harder than your DR colleagues, but you will be compensated more. Radiology groups must compensate the IR employees/partners more for taking call and doing the things that ensure they keep their contract with the hospital. A radiology group without a strong IR presence is too easily commoditized and replaced.

5) There's certainly a large number of 50/50 IR/DR practices, but this is changing and will continue to change. My personal outlook is that within 10 years any radiology practice in a mid-to-large city will have full-time interventionalists. It's simply more efficient to have your DRs stick to churning out films and your IRs sticking to procedures. Jumping from one to the other during a workday is not efficient. The hybrid practice will still exist in smaller locales. I've trained roughly 25 fellows and I'd say 80-90% of them have joined 100% IR practices.

6) The procedures that diagnostic radiologists perform are simple things like biopsies or drains or injections. Personally, I don't consider that to be interventional radiology. If you are interested in things like TARE, UFE, PAE, PAD, etc then you simply have to do an IR fellowship. A DR is just not capable of doing those procedures.

7) Many people go into residency thinking they want to do IR. I think there's a cool/jock factor involved in doing procedures (much like a surgeon versus an internist). But not everyone is cut out for it and there's lots to like about diagnostic radiology once you start studying it and reading images yourself - which you unfortunately can't do as a medical student. So it's not surprising that you hear of people wanting to go into IR as a 1st year resident but then sticking with a DR career.

Lastly, and this is just my personal bias, but I think AI is a real concern. Medicine is an art. But a lot of it boils down to an algorithm. And those parts that can be algorithm-ized and commoditized will be. This applies to things like internal medicine as well as DR. How soon that happens is unclear to me, but it will happen. At my hospital we already have AI facilitating mammo and chest films to look for tiny nodules/masses.

Yes, I am keeping open mind as to whom is answering
1)that is a valid point, alone DR would never be able to reach the competency of IR fellows today and vice versa, especially in respect to the development of IR. In fact vascular could have taken the IR domain if it IR didn't separate from DR.
2)kind of unrelated: I know some academic hospitals have gastroenterologists performing fluoroscopy. Is this normal?
3) I'm glad fellows have lots of cases, was concerned that they might be doing lots of scutwork
4) yes, that does sound more fair
5)that's impressive, I haven't heard of that before... Thats good, shows progression of the field
6)yes, I understand complex cases should be performed by those with more IR experience
7) I agree

Yes AI is kind of shaking things up, I'm not sure how far AI will go, but i personally belief with proper legislation in place DR can definitely keep their spot, however the workforce would probably be cut.

Thanks for your very comprehensive response, much appreciated

 

[Cognovi]

2)kind of unrelated: I know some academic hospitals have gastroenterologists performing fluoroscopy. Is this normal?

Fluoroscopy + endoscopy is the basis for endoscopic retrograde cholangiopancreatography.

 

[Tman507]

Fluoroscopy + endoscopy is the basis for endoscopic retrograde cholangiopancreatography.

Thanks I didn't know that...However I'm confused now

The Gastroenterology attending specifically told me he does fluoroscopy to "treat tumors" and according to my understanding(correct me if I'm wrong) ERCP is used exclusively for stones, that's what was confusing to me.

Then(unrelated to above) In my general surgery rotation in a patient(female 70yrs) with pruritic jaundice (urine and stool changes) and no other signs/risk factors/precipitating events/pain...the radiologist report presented with findings of thickening of the common hepatic duct that's in keeping with cancer with no signs of stones and at the end of the report stated that he recommended the patient have an ERCP done...the senior general surgery fellow then told me that it was incorrect because ERCP is only for stones.

Sorry for the questions...But what other fluoroscopy would the Gastroenterologist then be referring to?

 

[NDcienporciento100]

Ok I read everyone’s response

Thanks I didn't know that...However I'm confused now

The Gastroenterology attending specifically told me he does fluoroscopy to "treat tumors" and according to my understanding(correct me if I'm wrong) ERCP is used exclusively for stones, that's what was confusing to me.

Then(unrelated to above) In my general surgery rotation in a patient(female 70yrs) with pruritic jaundice (urine and stool changes) and no other signs/risk factors/precipitating events/pain...the radiologist report presented with findings of thickening of the common hepatic duct that's in keeping with cancer with no signs of stones and at the end of the report stated that he recommended the patient have an ERCP done...the senior general surgery fellow then told me that it was incorrect because ERCP is only for stones.

Sorry for the questions...But what other fluoroscopy would the Gastroenterologist then be referring to?

ERCP is used to decompress the biliary duct system, not just stones. The higher you have to go up the biliary system the worse off you are going with ercp and better off going perc approach.

 

[Tman507]

Ok I read everyone’s response

ERCP is used to decompress the biliary duct system, not just stones. The higher you have to go up the biliary system the worse off you are going with ercp and better off going perc approach.

Thanks, won't forget it!

 

[NDcienporciento100]

Ok there has been a lot said coming from both sides DR and IR. Little about me, I am currently and Integrated IR Resident. You have to decide what you want to do with your life, I want to do crazy high end procedures that have only been around in some cases a few years, I didn’t pick it because I want to sleep in every morning, I did not do it for more money, I chose this field because I love it. Some may say why not do general surgery of vascular surgery. Here is my take on that, surgery has been taking out gallbladder’s, and fixing hernias more or less the same way for a long time now, the big one people like to argue is vascular, I know a lot of vascular surgeons in fact one of my best friends is a vascular surgery resident, and guess what when you talk to them about what it is they love about there job it’s usually not the endovascular work, they do it because they have to, because if they don’t someone else would like IR or cards, PAD is to them what hernias are to general surgery and about 2 decades ago they decided they had to learn the endovascular skills or die as a field. “All”let me say again “all”of modern vascular surgery owes its existence to IR, we invented balloon angioplasty, we invented the stent, we invented seldenger technique they would still be doing cutdowns for everything if it was not for IR. Back to point would you want to be the specialty that is “avant-garde” always pushing the envelope on what is possible through minimally invasive procedures or do you want to be the specialty that had to have another specialty teach them how to do those things. I chose IR. DR vs IR there two different beasts, I don’t know what else to say to you, do want to get your hands dirty or not, part of picking a specialty is knowing yourself and what will make you happy to come to work everyday. Those who say it’s a bad thing to break off I completely disagree, this field has outgrown the 1 year fellowship and there is a lot more I could say but ChicagoIR covered most of it. When it comes to one poster saying IR gets all the junk while cards, vascular get all the good procedures, I say to them when was the last time you saw cards/vascular do a TIPS, Y90, TACE, BRTO, Stroke Thrombectomy, GI bleed, CT guided ablation, Kyphoplasty. PAD, aorta cases? If you like image guided endovascular procedures IR is KING and the Integrated Residency is going to ussure they remain so!

 

[irwarrior]

VIR has truly expanded its role in medicine and continues to do so at a record pace. But, it requires strong clinical acumen, a dedicated clinic, inpatient consults , rounding on patients. Inbox management and charting. For those high end procedures and practice, the hours and lifestyle are becoming similar to surgery and are becoming more and more different from the DR lifestyle.

 

[NDcienporciento100]

VIR has truly expanded its role in medicine and continues to do so at a record pace. But, it requires strong clinical acumen, a dedicated clinic, inpatient consults , rounding on patients. Inbox management and charting. For those high end procedures and practice, the hours and lifestyle are becoming similar to surgery and are becoming more and more different from the DR lifestyle.

I agree! The former status of doing procedures and signing off is no longer an option.

 

[Tman507]

Ok there has been a lot said coming from both sides DR and IR. Little about me, I am currently and Integrated IR Resident. You have to decide what you want to do with your life, I want to do crazy high end procedures that have only been around in some cases a few years, I didn’t pick it because I want to sleep in every morning, I did not do it for more money, I chose this field because I love it. Some may say why not do general surgery of vascular surgery. Here is my take on that, surgery has been taking out gallbladder’s, and fixing hernias more or less the same way for a long time now, the big one people like to argue is vascular, I know a lot of vascular surgeons in fact one of my best friends is a vascular surgery resident, and guess what when you talk to them about what it is they love about there job it’s usually not the endovascular work, they do it because they have to, because if they don’t someone else would like IR or cards, PAD is to them what hernias are to general surgery and about 2 decades ago they decided they had to learn the endovascular skills or die as a field. “All”let me say again “all”of modern vascular surgery owes its existence to IR, we invented balloon angioplasty, we invented the stent, we invented seldenger technique they would still be doing cutdowns for everything if it was not for IR. Back to point would you want to be the specialty that is “avant-garde” always pushing the envelope on what is possible through minimally invasive procedures or do you want to be the specialty that had to have another specialty teach them how to do those things. I chose IR. DR vs IR there two different beasts, I don’t know what else to say to you, do want to get your hands dirty or not, part of picking a specialty is knowing yourself and what will make you happy to come to work everyday. Those who say it’s a bad thing to break off I completely disagree, this field has outgrown the 1 year fellowship and there is a lot more I could say but ChicagoIR covered most of it. When it comes to one poster saying IR gets all the junk while cards, vascular get all the good procedures, I say to them when was the last time you saw cards/vascular do a TIPS, Y90, TACE, BRTO, Stroke Thrombectomy, GI bleed, CT guided ablation, Kyphoplasty. PAD, aorta cases? If you like image guided endovascular procedures IR is KING and the Integrated Residency is going to ussure they remain so!

Thanks, straight to the point! Much appreciated

 

[Tman507]

VIR has truly expanded its role in medicine and continues to do so at a record pace. But, it requires strong clinical acumen, a dedicated clinic, inpatient consults , rounding on patients. Inbox management and charting. For those high end procedures and practice, the hours and lifestyle are becoming similar to surgery and are becoming more and more different from the DR lifestyle.

I agree, the pace of IR development is unlike any other new specialty...surgery lifestyle, although seems dreadfull compared to DR, but is a sign of IR progression. IRs just need to be as aggressive as cardiologists and NPs at getting their way... I just hope they can keep NPs away from learning any IR

Thanks, much appreciated!

 

[NDcienporciento100]

I agree, the pace of IR development is unlike any other new specialty...surgery lifestyle, although seems dreadfull compared to DR, but is a sign of IR progression. IRs just need to be as aggressive as cardiologists and NPs at getting their way... I just hope they can keep NPs away from learning any IR

Thanks, much appreciated!

Yeah as far as the lifestyle goes you just need to discover what is right for you. I would love to here from IRWarrior and ChicagoIR on there thoughts on competing for cases. The best example I have is a Group of IRs in a major metropolitan city 800+ bed hospital. They did all endovascular PAD(cold legs,CLI etc) they did the highest number of Aorta cases in the hospital, all endovascular venous work, carotid artery stents, and all the procedure only IR can do Y90, UFE etc. the head IR doc lives by the matto “if you don’t do it someone else will” they always make themselves available for questioning to other specialty’s, they take Q3 call, for less complex procedures Aka paracentesis etc they don’t have time so they hired a PA to do them. They are friendly to both cards and vascular, if either of those specialty’s have a question for them they try to help them out. They do Aorta cases with vascular, I saw this doctor do an entire EVAR by himself when there was supposed to be a vascular surgeon there but the surgeon got help up and was late, the case was done percutaneous he could have closed and said to the vascular surgeon I’m billing for this one but he didn’t he waited an extra ten minutes to allow this vascular surgeon to get there and close this 1/2 inch bilateral incision not because he could not do it but because he wants to maintain that healthy relationship that allows for everyone to eat(RVUs) but also allow for best patient care.

 

[Tman507]

Yeah as far as the lifestyle goes you just need to discover what is right for you. I would love to here from IRWarrior and ChicagoIR on there thoughts on competing for cases. The best example I have is a Group of IRs in a major metropolitan city 800+ bed hospital. They did all endovascular PAD(cold legs,CLI etc) they did the highest number of Aorta cases in the hospital, all endovascular venous work, carotid artery stents, and all the procedure only IR can do Y90, UFE etc. the head IR doc lives by the matto “if you don’t do it someone else will” they always make themselves available for questioning to other specialty’s, they take Q3 call, for less complex procedures Aka paracentesis etc they don’t have time so they hired a PA to do them. They are friendly to both cards and vascular, if either of those specialty’s have a question for them they try to help them out. They do Aorta cases with vascular, I saw this doctor do an entire EVAR by himself when there was supposed to be a vascular surgeon there but the surgeon got help up and was late, the case was done percutaneous he could have closed and said to the vascular surgeon I’m billing for this one but he didn’t he waited an extra ten minutes to allow this vascular surgeon to get there and close this 1/2 inch bilateral incision not because he could not do it but because he wants to maintain that healthy relationship that allows for everyone to eat(RVUs) but also allow for best patient care.

Wow, that's impressive.
I think in future IR group start ups should employ like 2 vascular surgeons(depend on group size) to be part of their group for standby....That way it'll be easy for IR and vascular to flourish at what they do best

 

[Cognovi]

Then(unrelated to above) In my general surgery rotation in a patient(female 70yrs) with pruritic jaundice (urine and stool changes) and no other signs/risk factors/precipitating events/pain...the radiologist report presented with findings of thickening of the common hepatic duct that's in keeping with cancer with no signs of stones and at the end of the report stated that he recommended the patient have an ERCP done...the senior general surgery fellow then told me that it was incorrect because ERCP is only for stones.

Sorry for the questions...

The purpose of the ERCP recommended in this case is to obtain bile duct brushings for a cytologic diagnosis.

 

[irwarrior]

The problem with brushings they are not that high yield. Would check CA19-9. Could consider endoscopic vs transhepatic spyglass with tissue sampling or even some have used the myocardial forceps or even atherectomy to garner tissue. But, if pretest probability is high. PET negative for extra hepatic disease and there is no significant nodal disease, could go to resection with hepaticojejunostomy.

 

[Tman507]

The purpose of the ERCP recommended in this case is to obtain bile duct brushings for a cytologic diagnosis.

Thanks soo much, seems like surgery needs to brush up their knowledge

 

[Tiger100]

There will be definitely practices in the future that IR will be a seperate group from DR especially big hospitals and academic centers.

Regarding mid size and smaller hospitals, it will be like many other specialties. I don't see IR will be a seperate group in smaller community hospitals (Similarly, not every hospital has a pediatrics surgeon or 100% cardiac electrophysiologist). There will always be room for a DR who does procedures or an IR who does a good amount of DR. The number of smaller hospitals in US are pretty high.

So while a lot of IR graduates will end up doing 100% IR, I doubt there will be enough 100% IR jobs available for all of them and many of them will end up doing a fair amount of DR (similarly many cardiac electrophysiologists end up doing a lot of general cardiology or some vascular surgeons end up doing general surgery).

The number of body fellowships that do procedures are not that small. At least in many places they do biopsies. But a handful of them do also ablations and drains. In the community, the number of non-IR people who do procedures are not that small.

While nobody can predict the future, I am not worried about the future of AI and radiology in the next 2-3 decades. Nevertheless, if someone is really worried about it, they are better choosing a different field. The only problem is you will never know whether another field will be immune or not. If we reach a point that AI can replace radiologists, probably 90-95% of the jobs will vanish.

The main problems that I have with the new IR modelare the followings:
1- It is very very early for a medical student to choose such a specialized field during their 3rd year especially giving the fact that most MSs don't know what is IR about and due to nature of the field, it's hard for them to learn.

2- Having a seperate IR group can be very good but it can cause "internal turf war" within radiology at least for bread and butter procedures. DR has an upper hand for simple procedures since they see the images. But IR can have an exclusive contact with hospital for these procedures. This opens the door for conflicts.

Back to the OP question. It is a very personal choice. Some people like DR more and some like IR. Some hate DR and some hate procedures and a lot of people are somewehere in between. Do some soul searching!

 

[UChicagoIR]

If I can address your 2 concerns:

1) I think choosing IR as a med student is no different than choosing a direct residency in plastic surgery, vascular surgery, etc. The only way you learn about them is by rotating or shadowing. I also think the awareness of IR among medical students is exponentially growing. Let's not forget the match statistics which indicate that students are well aware of the field. Lastly, I would also point out that most students going into diagnostic radiology really have no idea what it's really like to be a radiologist since students have no way of participating in study interpretation. There's a bit of a blind leap of faith involved. Whereas a student rotating through surgery or IR can actually scrub into cases and assist, contribute on rounds, etc.

2) I think radiology has changed over the last 10-20 years. There was a time when a general radiologist who was a jack of all trades was doable for most practices and most radiologists didn't do fellowships. The trend has been subspecialization and I believe it will continue to do so. This is best for all involved. Those who are good at imaging should spend their time on imaging. Those who are good at procedures should focus on procedures. Patients get better care and radiology practices are much more efficient. As far as exclusive contracts, that would only apply if the IRs were not a part of the radiology group which is possible but less likely to happen. But even if it did, I doubt any IR is going to quibble over, say, biopsy privileges. They would be more interested in retaining control of vascular access, IO, etc.

The main problems that I have with the new IR modelare the followings:
1- It is very very early for a medical student to choose such a specialized field during their 3rd year especially giving the fact that most MSs don't know what is IR about and due to nature of the field, it's hard for them to learn.

2- Having a seperate IR group can be very good but it can cause "internal turf war" within radiology at least for bread and butter procedures. DR has an upper hand for simple procedures since they see the images. But IR can have an exclusive contact with hospital for these procedures. This opens the door for conflicts.

 

[Tiger100]

If I can address your 2 concerns:

1) I think choosing IR as a med student is no different than choosing a direct residency in plastic surgery, vascular surgery, etc. The only way you learn about them is by rotating or shadowing. I also think the awareness of IR among medical students is exponentially growing. Let's not forget the match statistics which indicate that students are well aware of the field. Lastly, I would also point out that most students going into diagnostic radiology really have no idea what it's really like to be a radiologist since students have no way of participating in study interpretation. There's a bit of a blind leap of faith involved. Whereas a student rotating through surgery or IR can actually scrub into cases and assist, contribute on rounds, etc.

2) I think radiology has changed over the last 10-20 years. There was a time when a general radiologist who was a jack of all trades was doable for most practices and most radiologists didn't do fellowships. The trend has been subspecialization and I believe it will continue to do so. This is best for all involved. Those who are good at imaging should spend their time on imaging. Those who are good at procedures should focus on procedures. Patients get better care and radiology practices are much more efficient. As far as exclusive contracts, that would only apply if the IRs were not a part of the radiology group which is possible but less likely to happen. But even if it did, I doubt any IR is going to quibble over, say, biopsy privileges. They would be more interested in retaining control of vascular access, IO, etc.

About your second part:

I thought you mentioned in your earlier post that separation of IR and DR is necessary, partly because DR does not support/undestands IR. But now, you say that they will stay part of the radiology group.

 

[UChicagoIR]

I think the possibility of them leaving a radiology group is real in some situations/locales, but I personally don't want that to happen nor do I think it will happen in the near future.

If you reference points #4 and #5 from my earlier post (see italics below), I believe that radiology groups need a strong IR presence in order to prevent being commoditized and replaced and I believe each group needs a full time (100%) IR to accomplish that and in order to be more efficient in their workflow.

4) The IR lifestyle is much more that of a surgical subspecialty than DR. You will work harder than your DR colleagues, but you will be compensated more. Radiology groups must compensate the IR employees/partners more for taking call and doing the things that ensure they keep their contract with the hospital. A radiology group without a strong IR presence is too easily commoditized and replaced.

5) There's certainly a large number of 50/50 IR/DR practices, but this is changing and will continue to change. My personal outlook is that within 10 years any radiology practice in a mid-to-large city will have full-time interventionalists. It's simply more efficient to have your DRs stick to churning out films and your IRs sticking to procedures. Jumping from one to the other during a workday is not efficient. The hybrid practice will still exist in smaller locales. I've trained roughly 25 fellows and I'd say 80-90% of them have joined 100% IR practices.

About your second part:

I thought you mentioned in your earlier post that separation of IR and DR is necessary, partly because DR does not support/undestands IR. But now, you say that they will stay part of the radiology group.

 

[Tiger100]

I think the possibility of them leaving a radiology group is real in some situations/locales, but I personally don't want that to happen nor do I think it will happen in the near future.

If you reference points #4 and #5 from my earlier post (see italics below), I believe that radiology groups need a strong IR presence in order to prevent being commoditized and replaced and I believe each group needs a full time (100%) IR to accomplish that and in order to be more efficient in their workflow.

4) The IR lifestyle is much more that of a surgical subspecialty than DR. You will work harder than your DR colleagues, but you will be compensated more. Radiology groups must compensate the IR employees/partners more for taking call and doing the things that ensure they keep their contract with the hospital. A radiology group without a strong IR presence is too easily commoditized and replaced.

5) There's certainly a large number of 50/50 IR/DR practices, but this is changing and will continue to change. My personal outlook is that within 10 years any radiology practice in a mid-to-large city will have full-time interventionalists. It's simply more efficient to have your DRs stick to churning out films and your IRs sticking to procedures. Jumping from one to the other during a workday is not efficient. The hybrid practice will still exist in smaller locales. I've trained roughly 25 fellows and I'd say 80-90% of them have joined 100% IR practices.

1- Replacing a radiology group that is well run and does procedures with the current model (Mostly bread and butter IR stuff with a few high end cases in between) is not easy. In is difficult. In other words, I don't see a whole lot of incentive in the DR group to give clinic time to the IRs or let the IRs practice in the new model that they may look for if the only incentive is to keep their contract.

2- I agree with your statement that larger group may hire Full time interventionalists but again I don't see how it can transform into practicing the new model (clinic, rounds and etc). They will hire full time internvetionalists but most likely they will practice in the current model and not the new model that IRs are looking for.

I believe if IR or some IRs want to practice in the new model, the only way to do it is to make their own group. There is no other way to do it.


Regarding your last statement: You said 80-90% of your fellows joined 100% IR practice. Great. But as a person who is actively involved in hiring people, I can assure you that your experience is not the routine. Most IR jobs in private practice are not 100% IR job. Probably 20% of IR jobs in private practice are 100% IR and if you add academic jobs to it, probably 30-40% of total IR Jobs are 100% IR. The rest are a mixture.


It is very good to have different perspective on this forum especially from someone in academics.

 

[deleted950463]

[QUOTE="Tiger100]Regarding your last statement: You said 80-90% of your fellows joined 100% IR practice. Great. But as a person who is actively involved in hiring people, I can assure you that your experience is not the routine. Most IR jobs in private practice are not 100% IR job. Probably 20% of IR jobs in private practice are 100% IR and if you add academic jobs to it, probably 30-40% of total IR Jobs are 100% IR. The rest are a mixture.


It is very good to have different perspective on this forum especially from someone in academics.
[/QUOTE]

Oh you’ll get people to do a 50-50 IR gig. And of course, the applicant will do a sing and dance about how they love DRs and how they don’t want to lose that skills.

At the end of the day, like UchicagoIR said, many IR fellows prefer a 100% IR job. Not all, but many. And to them your 50/50 job is a compromise.

 

[Tiger100]

Oh you’ll get people to do a 50-50 IR gig. And of course, the applicant will do a sing and dance about how they love DRs and how they don’t want to lose that skills.

At the end of the day, like UchicagoIR said, many IR fellows prefer a 100% IR job. Not all, but many. And to them your 50/50 job is a compromise.

I think we are talking about two different things.

I was talking about the availability of 100% IR jobs and not people's preferences.

Some may prefer to do a mixture and some (or maybe many) may prefer a 100% IR job and to them doing DR is a compromise. So what?

When there are not enough 100% IR jobs people have to compromise. Almost everybody who gets a job (in any medical or non-medical field) has to compromise to some extent. People can compromise for location, compensation or type of job. Nothing is perfect.

FYI, people don't sing and dance and they don't need to say they love DR. Getting a job is a business negotiation between two mature adults. Both parties should compromise to some extent. Eventually, they either reach an agreement or move on and look for something different (different job and different applicant).

Life is all about compromises. However you have to choose the type of compromises.

 

[UChicagoIR]

Respectfully, I would contend that my knowledge of the job market is more comprehensive since I have advised dozens of fellows that have each interviewed at multiple positions in various states across the country. I help all my fellows review every contract offer. I would presume that anyone in private practice is only familiar with their own job history, and maybe some of the local practices as well.

I think we'll have to just agree to disagree on the practice model of IR.

Regarding your last statement: You said 80-90% of your fellows joined 100% IR practice. Great. But as a person who is actively involved in hiring people, I can assure you that your experience is not the routine. Most IR jobs in private practice are not 100% IR job. Probably 20% of IR jobs in private practice are 100% IR and if you add academic jobs to it, probably 30-40% of total IR Jobs are 100% IR. The rest are a mixture.

 

[Tiger100]

Respectfully, I would contend that my knowledge of the job market is more comprehensive since I have advised dozens of fellows that have each interviewed at multiple positions in various states across the country. I help all my fellows review every contract offer. I would presume that anyone in private practice is only familiar with their own job history, and maybe some of the local practices as well.

I think we'll have to just agree to disagree on the practice model of IR.

Let's agree to disagree. It seems our experiences have been different but I don't know any real private practices (not avademics or employed positions) that give clinic time or clinic space to IRs.

Good Luck.

 

[deleted950463]

I think we are talking about two different things.

I was talking about the availability of 100% IR jobs and not people's preferences.

Some may prefer to do a mixture and some (or maybe many) may prefer a 100% IR job and to them doing DR is a compromise. So what?

When there are not enough 100% IR jobs people have to compromise. Almost everybody who gets a job (in any medical or non-medical field) has to compromise to some extent. People can compromise for location, compensation or type of job. Nothing is perfect.

FYI, people don't sing and dance and they don't need to say they love DR. Getting a job is a business negotiation between two mature adults. Both parties should compromise to some extent. Eventually, they either reach an agreement or move on and look for something different (different job and different applicant).

Life is all about compromises. However you have to choose the type of compromises.

You are talking about alleged lack of 100% IR only jobs. The IRs I know seem to have no problem obtaining those jobs.

I was talking about the fact that 50/50 IR/DR private practice are not desirable to most graduating fellows. There is a post at a prominent radiology online forum right now discussing recruitment difficulties for such a position.

 

[Tiger100]

You are talking about alleged lack of 100% IR only jobs. The IRs I know seem to have no problem obtaining those jobs.

I was talking about the fact that 50/50 IR/DR private practice are not desirable to most graduating fellows. There is a post at a prominent radiology online forum right now discussing recruitment difficulties for such a position.

I didn't say there is lack of 100% IR jobs. I said there is not enough of them if everyone wants to do 100% IR.

It may not be desirable. But eventually both parties have to compromise. Right now it is July and many fellows may not looking seriously or they may not want to compromise at this point (if doing DR is considered compromise to them).

Anyway even if a typical private practice ends up offering 100% IR, I doubt many groups will offer clinic time or rounding or ....

If IR wants to practice its new model, it has to seperate itself from DR. That's the only way.

 

[irwarrior]

There is a growing number of VIR physicians going off on their own and setting up and office based lab. If you are interested in that you should check out the oeis. OEIS | Outpatient Endovascular and Interventional Society. I hope more DR practices will understand the critical nature of clinic for evaluation and management of patient's undergoing minimally invasive procedures. Once you get busy with your clinical roles and responsibilities it can take up to a day or even 2 days of your work week, leaving 2 to 3 days for procedures. If you have time you could try to read imaging (usually CTA/MRA /vascular us) but the challenge is that you are getting paged about inpatients and outpatients that you are taking care of and the list of imaging continues to pile up. You may have to round on your inpatients and that time is not really allotted in the current DR practice. It would be ideal if the DR colleagues assisted with some of the nonprocedural clinical activities and rounded on patients and saw consults and did some component of clinic, but unfortunately many but certainly not all DR physicians want to avoid procedural work and direct patient care.

Now a busy high end clinical practice in the community, certainly does not happen overnight and it takes several years of back breaking work to build a robust practice.

 

[Gadofosveset]

DR can be quite enjoyable if you specialize and then become the go-to person for your local clinical team(s) of choice. One doesn't have as much patient contact, but you can make what contact you do have count (such as in fluoroscopy or light IR), which is usually satisfying enough. The real reward in DR is building radiologist-clinician rapport. It definitely leads to better imaging choices and, in my experience, better patient care.

 

[Tman507]

DR can be quite enjoyable if you specialize and then become the go-to person for your local clinical team(s) of choice. One doesn't have as much patient contact, but you can make what contact you do have count (such as in fluoroscopy or light IR), which is usually satisfying enough. The real reward in DR is building radiologist-clinician rapport. It definitely leads to better imaging choices and, in my experience, better patient care.

Thanks, much appreciated

 

[NDcienporciento100]

Let's agree to disagree. It seems our experiences have been different but I don't know any real private practices (not avademics or employed positions) that give clinic time or clinic space to IRs.

Good Luck.

I’m surprised know one commented on this statement, it’s completely false! Academic radiology departments don’t give clinic time to IR?? Almost all of them do. Same thing with private practice, Radiology groups give clinic time to there IR’s Although less common but it definitely exists.

 

[Tiger100]

I’m surprised know one commented on this statement, it’s completely false! Academic radiology departments don’t give clinic time to IR?? Almost all of them do. Same thing with private practice, Radiology groups give clinic time to there IR’s Although less common but it definitely exists.

Please read again. Either my post was not clear or your biases prevents you from reading it correctly. Since nobody else gave any comments, I assume the latter is correct.

I said "NOT academics or employed positions" to exclude these two types of jobs from my discussion (that give clinic time).

Very few if any private practices give clinic and rounding time to IRs. I don't know of any. I don't say it is right or wrong, but it is what it is.

If IR wants to practice its new model (which may be great or may not be) , the only way to go is to seperate itself from DR. It doesn't mean that the traditional model of practice won't exist but those who want to practice the new model, can seperate to avoid all the potential conflicts.

 

[NDcienporciento100]

Please read again. Either my post was not clear or your biases prevents you from reading it correctly. Since nobody else gave any comments, I assume the latter is correct.

I said "NOT academics or employed positions" to exclude these two types of jobs from my discussion (that give clinic time).

Very few if any private practices give clinic and rounding time to IRs. I don't know of any. I don't say it is right or wrong, but it is what it is.

If IR wants to practice its new model (which may be great or may not be) , the only way to go is to seperate itself from DR. It doesn't mean that the traditional model of practice won't exist but those who want to practice the new model, can seperate to avoid all the potential conflicts.

There about 150 Integrated IR residents. In the country add more for ESIR it’s about 200-250/year it’s a small number and big country. Everyone I know that wanted a 100% IR job got one. The ones that I know that did not was one of two scenarios, actually wanted the mix of both (nothing wrong with that) or they had to live in X town of 20k people for there spouse which only had a mixed practice job. DR groups give heat to there 100% IR partners because they generate less RVUs, but the realty is that 1 IR makes way more money for the hospital then any one DR because of secondary’s that come with IR billing for anesthesiology, bed for the night in the hospital, all the nursing staff, etc it all adds up to less RVUs for the group but to the hospital that IR is worth more then any one DR. Dr groups should recognize this and allow for IR to round/clinic but many don’t and this is the disconnect that DR has and it’s going to end up hurting DR more then IR in the long run.

 

[Tiger100]

There about 150 Integrated IR residents. In the country add more for ESIR it’s about 200-250/year it’s a small number and big country. Everyone I know that wanted a 100% IR job got one. The ones that I know that did not was one of two scenarios, actually wanted the mix of both (nothing wrong with that) or they had to live in X town of 20k people for there spouse which only had a mixed practice job. DR groups give heat to there 100% IR partners because they generate less RVUs, but the realty is that 1 IR makes way more money for the hospital then any one DR because of secondary’s that come with IR billing for anesthesiology, bed for the night in the hospital, all the nursing staff, etc it all adds up to less RVUs for the group but to the hospital that IR is worth more then any one DR. Dr groups should recognize this and allow for IR to round/clinic but many don’t and this is the disconnect that DR has and it’s going to end up hurting DR more then IR in the long run.

There is nothing right or wrong about wanting to do 100% IR or 50% IR. But if someone wants to do 100% IR in the new model with clinic, they are better seperate from DR.

I don't understand what is the push to be part of a DR group. According to some of you here, DR does not support IR enough. Your can not force people to act in a way that you want. For many reasons, they don't see any benefit to give IR clinic or rounding time. And don't think these people are bunch of stupid people. Many are business-savvy and very good administrators. But in any case, you may think they are shortsighted.
Anyway, Just leave DR alone and make your own IR group and practice in a way that you want to do. There will always be some people who want to do 100% and people who want to do 50% IR or be a part of traditional private practice.


Live and let live.

 

[deleted950463]

There is nothing right or wrong about wanting to do 100% IR or 50% IR. But if someone wants to do 100% IR in the new model with clinic, they are better seperate from DR.

I don't understand what is the push to be part of a DR group. According to some of you here, DR does not support IR enough. Your can not force people to act in a way that you want. For many reasons, they don't see any benefit to give IR clinic or rounding time. And don't think these people are bunch of stupid people. Many are business-savvy and very good administrators. But in any case, you may think they are shortsighted.
Anyway, Just leave DR alone and make your own IR group and practice in a way that you want to do. There will always be some people who want to do 100% and people who want to do 50% IR or be a part of traditional private practice.


Live and let live.

At the end of the day DRs and IRs have different revenue model. If you are only getting profees then having IR in DR group is a loss leader. A DR group president wouldn’t care who orders the advanced imaging (IR, cards, VS or NP) as long as the downstream advance imaging is there.

I think separation of some IR from DR will make IR stronger because it gives option to IRs so they aren’t tied down to working in a traditional pp.

I do agree that clinic time as of now in a traditional pp does not generate enough revenue for the time invested for the group in the form of pro fee.

 

[JoshSt]

For another data point and perspective, the number of our IR fellows over the past few years that went into PP have a far lower proportion of 100% IR jobs, about 3/15 went that went into PP are 100% IR (and 2 of the 3 are from last year's graduates). About half are 50/50 or less. Maybe others in this thread have a stronger PAD presence that accounts for the higher proportions.

I imagine things vary greatly region-by-region. The rural-ish area I'm from has a good number of high-paying 100% IR PP positions in the large and dominant group, but it's all drains, fistula checks, and biopsies. I know this is probably not the national norm for 100% IR PP jobs, but just a different data point.

 

[Tiger100]

For another data point and perspective, the number of our IR fellows over the past few years that went into PP have a far lower proportion of 100% IR jobs, about 3/15 went that went into PP are 100% IR (and 2 of the 3 are from last year's graduates). About half are 50/50 or less. Maybe others in this thread have a stronger PAD presence that accounts for the higher proportions.

I imagine things vary greatly region-by-region. The rural-ish area I'm from has a good number of high-paying 100% IR PP positions in the large and dominant group, but it's all drains, fistula checks, and biopsies. I know this is probably not the national norm for 100% IR PP jobs, but just a different data point.

4+

 

[irwarrior]

Historically, the VIR graduate did primarily DR in their training, but this is changing with the advent of the integrated training . Of their 6 year program well over 50 percent is clinical/procedural which often includes a busy surgical internship. Also, if you include the number of surgical and clinical rotations they do 4th year this amounts to closer to 4 of the 7 years being mostly clinical/procedural. The IR graduate is also going to more and more dedicated IR meetings(SIR/WCIO/GEST/LEARN/Synergy/ISET/AIR/AIIMs etc) as opposed to DR meetings (RSNA/ARRS). This is much different than when their 4 th year of medical school was more DR rotations and the internship was often a prelim IM or even a TY and they only did about a year of traditional procedural IR fellowship. So just around 2 of the 7 years was clinical/procedural in nature. Those deciding that they want to go the integrated IR route are far more willing to sacrifice the historic ROAD lifestyle to pursue a higher end IR practice.

The IR graduate may also feel more comfortable in the angio suites and the clinic as opposed to the reading room.

So though the current trend still favors mixed practices and that will likely be the majority for some time. There is a transition to more and more pure outpatient IR jobs and even more and more independent IR practitioners and independent IR groups. This trend is likely to increase as the needs of the IR clinician include a clinic to see and counsel patients, which most DR groups in the current structure are unable to easily provide.