why interventional radiology?

[MedRad1990]

Hey guys.

I am currently R1 in diagnostic radiology. I am sort of confused about the competitiveness of IR. Currently IR integrated residency is the most competitive match (over 3:1)for medical student. It was not that competitive back in fellowship match(around 1:1). I also don't understand that if a teleradiology job can make you 400K with 1 week on 2 weeks off schedule and if you increase your workload, you can easily make up to 600K as what most interventional radiologists are making in private practice. Still more off time with no call. I frankly don't understand what is attracting people into IR? The feeling of being the man and saving lives while others cannot?Maybe fear of AI and that the job market for DR will not always be this good?

Frankly, I don't understand.

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[badasshairday]

Because angiography is cool.

 

[irwarrior]

What he said. Essentially those who love IR love the immediate impact it has on patients and get an adrenaline rush from the life saving procedures we offer. They are less concerned about the finances and the lifestyle implications, otherwise they would be unhappy when they compare their revenue per hour or total vacation time or hours spent in the hospital in comparison to the DR lifestyle. The field is rapidly expanding and has a significant clinical focus with longitudinal care clinics which are also quite rewarding. We get to treat and cure cancer, improve bleeding and bulk symptoms in women with fibroids, fix aneurysms, open up leg vessels to allow for better walking or to prevent amputation. We can relieve the pain of patients with compression fractures that make them bedridden or opiate dependent. We can remove clots from the brain and give someone functional independence. We can stop bleeding throughout the body.

There are growing fields in IR, bariatric , geniculate embolization for arthritis, prostate embolization (already prime time) etc.

It is a special personality that would give up the lifestyle and money of radiology , to work a lot harder and longer hours and for less pay per hour to do IR, but those who pursue this field have a passion for this and otherwise would have likely chose a surgical field .

 

[NDcienporciento100]

Hey guys.

I am currently R1 in diagnostic radiology. I am sort of confused about the competitiveness of IR. Currently IR integrated residency is the most competitive match (over 3:1)for medical student. It was not that competitive back in fellowship match(around 1:1). I also don't understand that if a teleradiology job can make you 400K with 1 week on 2 weeks off schedule and if you increase your workload, you can easily make up to 600K as what most interventional radiologists are making in private practice. Still more off time with no call. I frankly don't understand what is attracting people into IR? The feeling of being the man and saving lives while others cannot?Maybe fear of AI and that the job market for DR will not always be this good?

Frankly, I don't understand.

Nothing to do with money.

Obviously the ones doing it don’t value lifestyle as much as you do. I going to make an assumption here but your tone strikes me as a work to live kinda person not a live to work kinda person. I’m definitively the 2nd of the two. Nothing wrong with the either.

Innovation, to me IR is the most innovative specialty in all of medicine and it’s not even close in the impact that it has had on modern medicine in a short period of time.

Do you like to get your hands dirty
? It sounds like you don’t. I don’t like surgery/cutting, but I love procedure. IR is specialty king for procedures.

IR as fellowship was less competitive. It was drawing from those originally interested in DR, now IR draws people less intreasted in DR more interested in IR stronger/desire for procedures. Do you think if cards had a direct path it would be more competitive than IM, it’s obvious it would be.

 

[MedRad1990]

Nothing to do with money.

Obviously the ones doing it don’t value lifestyle as much as you do. I going to make an assumption here but your tone strikes me as a work to live kinda person not a live to work kinda person. I’m definitively the 2nd of the two. Nothing wrong with the either.

Innovation, to me IR is the most innovative specialty in all of medicine and it’s not even close in the impact that it has had on modern medicine in a short period of time.

Do you like to get your hands dirty
? It sounds like you don’t. I don’t like surgery/cutting, but I love procedure. IR is specialty king for procedures.

IR as fellowship was less competitive. It was drawing from those originally interested in DR, now IR draws people less intreasted in DR more interested in IR stronger/desire for procedures. Do you think if cards had a direct path it would be more competitive than IM, it’s obvious it would be.

Yes but cards also have better income and way better varieties in terms of practice styles. Please don’t assume cardiology is only procedure, they have everything in it (imaging, interventional, CCU, EP, heart failure, from clinical trench fight to relaxing reading style). I don’t think that cards over IM is comparable to IR over DR in terms of competitiveness.

Anyway, I heard your point. We will see how the competitiveness goes in the coming years especially after the first few IR/DR combined classes have graduated. For now, my gut feeling is IR’s competitiveness among med students is very ungrounded. Adrenaline is not going to excite you in your 50s on overnight shifts. A lot of IR trained old fella turned back to DR/administration at least this was my impression on the interview trail. Maybe that’s why IR should really be isolated from DR?

I might be wronged though.

 

[GoPelicans]

Is IR a good fit for someone who misses clinical medicine? I like radiology so far but sometimes get the itch to do stuff. The hospital I did my intern year at had one radiologist who was IR trained and he did mostly DR and did basic procedures like thoracentesis, paracentesis, PICC lines, LP's, etc like 2 days per week.

 

[irwarrior]

The field is recruiting those who would have otherwise considered surgery or surgical subspecialties. The lifestyle of the modern day IR is more reflective of surgery. There is a growing amount of direct patient care and that is paramount to being a good IR. However, the lifestyle is not the friendliest and so those who are not ready for that should not go into it or they will be unhappy. You have to love the high end complex procedural aspect as well as the patient care component, otherwise you will be frustrated as opposed to being excited that you are going in to the hospital to save a life at 2 am for a postpartum hemorrhage.

 

[NDcienporciento100]

Yes but cards also have better income and way better varieties in terms of practice styles. Please don’t assume cardiology is only procedure, they have everything in it (imaging, interventional, CCU, EP, heart failure, from clinical trench fight to relaxing reading style). I don’t think that cards over IM is comparable to IR over DR in terms of competitiveness.

Anyway, I heard your point. We will see how the competitiveness goes in the coming years especially after the first few IR/DR combined classes have graduated. For now, my gut feeling is IR’s competitiveness among med students is very ungrounded. Adrenaline is not going to excite you in your 50s on overnight shifts. A lot of IR trained old fella turned back to DR/administration at least this was my impression on the interview trail. Maybe that’s why IR should really be isolated from DR?

I might be wronged though.

If you go to a big hospital or certainly academics cards are Uber sub specialist, meaning IC’s only do IC, EP only does EP there not rounding bread and butter cards consults. The money is comparable, mabe A little more for IC less for none interventional cards. You should try to have more of an open mind in understanding personal desires, there are attendings that are excited to come On the weekend to stent the hepatic artery on a liver rejection case that’s what they love to do.

 

[MedRad1990]

If you go to a big hospital or certainly academics cards are Uber sub specialist, meaning IC’s only do IC, EP only does EP there not rounding bread and butter cards consults. The money is comparable, mabe A little more for IC less for none interventional cards. You should try to have more of an open mind in understanding personal desires, there are attendings that are excited to come On the weekend to stent the hepatic artery on a liver rejection case that’s what they love to do.

I do agree with you about the open-minded part but seriously what do Med student when they opted in for IR?

 

[NDcienporciento100]

I do agree with you about the open-minded part but seriously what do Med student when they opted in for IR?

Not sure what you area asking, I did lots or IR rotations as a medical student.

 

[NDcienporciento100]

The field is recruiting those who would have otherwise considered surgery or surgical subspecialties. The lifestyle of the modern day IR is more reflective of surgery. There is a growing amount of direct patient care and that is paramount to being a good IR. However, the lifestyle is not the friendliest and so those who are not ready for that should not go into it or they will be unhappy. You have to love the high end complex procedural aspect as well as the patient care component, otherwise you will be frustrated as opposed to being excited that you are going in to the hospital to save a life at 2 am for a postpartum hemorrhage.

Please explain what being a clinical IR means?

 

[irwarrior]

There is a lot of variability in what is perceived as "cilnical IR" . I would look to our surgical colleagues and compare our work week to theirs. ie how much clinic they do, they admit their patients to their own service, they round on their patients and follow them longitudinally. Our practices should closely reflect that to provide the ideal care to our patients.

 

[badasshairday]

Ok. I like doing procedures. Having brief but very impactful interactions with patients. We see very sick patients and they literally leave angio much better off. Ie. Had a 70 yo women literally bleeding to death from upper gi hemorrhage, massive hematemesis, scared to death. Embolized and instantly stopped bleeding and she recovered. It felt good.

I do about 2 days a week of diagnostic radiology as well which is nice. Helps me garner more cases. Also keeps my skill varied. One nice thing about IR and doing DR also is that yes, some day I might grown tired and physically have pain wearing lead, but I can stop doing IR and just do DR late in my career. As for now, I would go stir crazy in reading room 5 days a week.

 

[Gadofosveset]

To borrow from Chris Tucker: "Ain't no attending want to be in no hospital at 2 a.m. for no minute" You'll go in as a duty to get the job done right and timely, but "excited" is med student talk.

 

[YoungDoc25]

Ok. I like doing procedures. Having brief but very impactful interactions with patients. We see very sick patients and they literally leave angio much better off. Ie. Had a 70 yo women literally bleeding to death from upper gi hemorrhage, massive hematemesis, scared to death. Embolized and instantly stopped bleeding and she recovered. It felt good.

I do about 2 days a week of diagnostic radiology as well which is nice. Helps me garner more cases. Also keeps my skill varied. One nice thing about IR and doing DR also is that yes, some day I might grown tired and physically have pain wearing lead, but I can stop doing IR and just do DR late in my career. As for now, I would go stir crazy in reading room 5 days a week.

The bolded part of your post is a lot of what pulled at my interest with IR. From what I’ve been reading lately though, it seems like IR is pushing away from DR to become more clinical. Do you think that will change the way you’re currently practicing and limit DR training for those going through training in the future?

 

[Splenda88]

To borrow from Chris Tucker: "Ain't no attending want to be in no hospital at 2 a.m. for no minute" You'll go in as a duty to get the job done right and timely, but "excited" is med student talk.

So true... I thought it was cool when nurses or whoever call doctors because they are needed in the hospital to do something that would make a difference in a patient's care. I am an IM PGY2 in a specialty service and last week another resident called me at 5:30 pm for an urgent consult as I just got home. I went ballistic on him to the point I had to apologize to him the next day. Carrying a pager or having a work phone seems to be cool when you are a med student, but that sh...t is no longer cool 2-3 months into residency.

 

[NDcienporciento100]

So true... I thought it was cool when nurses or whoever call doctors because they are needed in the hospital to do something that would make a difference in a patient's care. I am an IM PGY2 in a specialty service and last week another resident called me at 5:30 pm for an urgent consult as I just got home. I went ballistic on him to the point I had to apologize to him the next day. Carrying a pager or having a work phone seems to be cool when you are a med student, but that sh...t is no longer cool 2-3 months into residency.

I hear there is a DR spot in Colorado if your interested in throwing your hat in the ring for a switcharow!

 

[Splenda88]

I hear there is a DR spot in Colorado if your interested in throwing your hat in the ring for a switcharow!

Lol... I am ok with IM. Probably won't be competitive for that spot.

 

[Derv]

Likely its all the cool procedures and innovation in the field that attracts the high achiever surgery types. I know for myself, after about the second night of IR call getting woken up every 30 minutes by pages at home, I had enough to convince myself that I never wanted to live that lifestyle. It certainly attracts the guts and glory types which is great - we need good interventionists. Me, I will be extremely satisfied working my regular hours job churning through CTs and MRIs all day and then going home and living my life.

 

[Tiger100]

1- Depending on your student loans and the location that you practice, after 5-10 years of practice money is not that much important to you. You will have enough to have a comfortable upper middle class life.

2- The difference between the salary of most specialists is not HUGE. Yes, there is a significant difference between the salary of a pediatrician and a Spine Surgeon but not any meaningful difference between most fields. Other factors like your spouse's income and your investment return are more important.

3- You live only once. So do what you like. But it is a cliche since a medical student doesn't have any idea what he/she likes. We don't know ourselves until we reach 45-50.

4- As others mentioned, after 5-10 years of practice everything is the same boring repetition. The CABG number 500 is no more exciting than the appy number 1000 which is not more exciting than carotid stenting number 300 which is not more exciting than reading MRI number 5000. HOWEVER, the dirty and terrible parts of your field will stay with you. You will get used to what you like but things that you dislike will become worse.

5- Don't think too much about choosing a medical specialty. Most doctors deal with the same $hit everyday and most doctors do the same boring thing over and over again. Most doctors are not excited to go to work (despite what people may advertise) and most doctors make enough to have a comfortable living. The rest of life is what you make out of it.


Yes. Life is what you make out of it. If you are not happy doing IR, you won't be happy doing GI or IC or DR or derm or .... Most people that are happy with their job and with their life are happy because of their own personality. The satisfaction comes from inside of them and not outside. Doing a certain field or making a certain amount of money doesn't make you happier or miserable.

Do IR or any other field for good reasons and you will be fine. But if you calculate how much money other people make, your chance of being happy in any field will be extremely low.

 

[irwarrior]

Agree. Some of it is just the individual's personality and are passionate about whatever they do. But, the beauty of IR is that it is constantly changing with the incorporation of completely brand new disease processes . ie BPH, knee pain, obesity, the whole pain intervention etc. The spectrum of IR is so broad and the impact factor is so great, it is hard not to get excited as you can continually expand and reinvent your career. The clinic gives you long term relationships with patients and their families which is quite rewarding.

If you are focused on financial compensation and lifestyle issues and compare yourself to your DR colleagues you will simply be frustrated. IR is great and most suitable for those who are truly passionate about the field and where it is going.

 

[MedRad1990]

Agree. Some of it is just the individual's personality and are passionate about whatever they do. But, the beauty of IR is that it is constantly changing with the incorporation of completely brand new disease processes . ie BPH, knee pain, obesity, the whole pain intervention etc. The spectrum of IR is so broad and the impact factor is so great, it is hard not to get excited as you can continually expand and reinvent your career. The clinic gives you long term relationships with patients and their families which is quite rewarding.

If you are focused on financial compensation and lifestyle issues and compare yourself to your DR colleagues you will simply be frustrated. IR is great and most suitable for those who are truly passionate about the field and where it is going.

Sorry, I gotta inject a few words here.

The variety of procedures that IR can perform and will be able to perform is exactly why we will keep losing those procedures to clinicians.

The first thing to improve business efficiency is to industrialize it. Set up a workflow. When IR does some dozen different procedures, it’s hard to industrialize it and it increases cost significantly. That’s why IR in community will not thrive with those fancy procedures and all those fancy IR procedures should only be done in the major academic center where losing money is not too big an issue.

IR will be able to invent all kinds of new procedures but eventually lose a chunk of lucrative ones to clinicians. Look at the example of peripheral stent placement and you will know what I am talking about. Even if you go clinical and follow patients, you are not going to compete with cardiologists for referral base. Every patients with CAD will likely have PAD, those referral among cardiologist group are almost automatic. Not mentioning PMD will also not refer patients to IR to get ABI. Guess who owns those vascular lab? Cardiologist! Not to mention that IR will not be able to do medical management for those patients which is also quite important to prevent restenosis.

The ability to do a lot sounds really intriguing and attractive but in reality what matters is if you can get one thing done perfectly. I am sincerely feeling there are way too much medical student level of thinking here.

Anyway, I really think whoever chose to do IR knows what they are choosing and I praise all those who made informed consent and went into IR.

 

[NDcienporciento100]

Sorry, I gotta inject a few words here.

The variety of procedures that IR can perform and will be able to perform is exactly why we will keep losing those procedures to clinicians.

The first thing to improve business efficiency is to industrialize it. Set up a workflow. When IR does some dozen different procedures, it’s hard to industrialize it and it increases cost significantly. That’s why IR in community will not thrive with those fancy procedures and all those fancy IR procedures should only be done in the major academic center where losing money is not too big an issue.

IR will be able to invent all kinds of new procedures but eventually lose a chunk of lucrative ones to clinicians. Look at the example of peripheral stent placement and you will know what I am talking about. Even if you go clinical and follow patients, you are not going to compete with cardiologists for referral base. Every patients with CAD will likely have PAD, those referral among cardiologist group are almost automatic. Not mentioning PMD will also not refer patients to IR to get ABI. Guess who owns those vascular lab? Cardiologist! Not to mention that IR will not be able to do medical management for those patients which is also quite important to prevent restenosis.

The ability to do a lot sounds really intriguing and attractive but in reality what matters is if you can get one thing done perfectly. I am sincerely feeling there are way too much medical student level of thinking here.

Anyway, I really think whoever chose to do IR knows what they are choosing and I praise all those who made informed consent and went into IR.

IR’s are already practicing a wide variety of procedures in practices all over the country. Big hospitals could literally not function without them. PAD is the only place that IR has lost ground IR owns endovascular embolizations, endovascular venous work, and we have stolen from other specialty’s in areas like Kyphopkasty for example, IRs did not invent Kypho but tons of IRs do them.

 

[MedRad1990]

This guy does not know what the **** he is talking about. “Fancy procedures reserved for academics” it’s a ridiculous statement in so many ways. IR’s are already practicing a wide variety of procedures in practices all over the country. Big hospitals could literally not function without them. PAD is the only place that IR has lost ground IR owns endovascular embolizations, endovascular venous work, and we have stolen from other specialty’s in areas like Kyphopkasty for example, IRs did not invent Kypho but tons of IRs do them. Not sure what specialty you come from but you should go back.

Can’t argue with a verbally abusive dude.

But yeah. Have fun carrying out all your PAEs in the community with urologist referring them to you without eventually taking it back.

Every single procedure you mentioned above is emergency in-house procedure. Unfortunately, in the current reimbursement system, is not paid too well and unfortunately, you will have fun taking consults for those at 2 o’clock in the morning then grudging the next day to your colleague.

 

[MedRad1990]

This guy does not know what the **** he is talking about. “Fancy procedures reserved for academics” it’s a ridiculous statement in so many ways. IR’s are already practicing a wide variety of procedures in practices all over the country. Big hospitals could literally not function without them. PAD is the only place that IR has lost ground IR owns endovascular embolizations, endovascular venous work, and we have stolen from other specialty’s in areas like Kyphopkasty for example, IRs did not invent Kypho but tons of IRs do them. Not sure what specialty you come from but you should go back.

Once again, financially unsustainable for community practice.

 

[NDcienporciento100]

Can’t argue with a verbally abusive dude.

But yeah. Have fun carrying out all your PAEs in the community with urologist referring them to you without eventually taking it back.

Every single procedure you mentioned above is emergency in-house procedure. Unfortunately, in the current reimbursement system, is not paid too well and unfortunately, you will have fun taking consults for those at 2 o’clock in the morning then grudging the next day to your colleague.

Kyphoplastys don’t pay? Embolizations are all emergencies lol, Y90, TACE, liver and kidney ablations for cancer, vericose veins, I’m bored but I could keep going but the point is none are emergencies.

 

[NDcienporciento100]

Once again, financially unsustainable for community practice.

Should really clarify what you mean, are you talking some 100 bed hospital in a town of 5k? ok maybe but it is hard for any sub specialty in this scenario, it’s not unique to IR, but not hard for family med. but is you are talking about a 350-500 bed level 2-3, well then there are IR all over the country that a thriving in this scenario.

 

[MedRad1990]

Kyphoplastys don’t pay? This guy/girl literally has know clue. Embolizations are all emergencies lol, Y90, TACE, liver and kidney ablations for cancer, vericose veins, I’m bored but I could keep going but the point is none are emergencies. Get off my lawn.

You need to tell the difference between academic and community practice. Since when are varicose vein treatment handed to IR other than in big centers. As long as clinicians do not have the reflexive referral habit to IR, you are not going to get the cases. Vascular gets them all. As of 2019, I do know primary care still sees those cases vascular. They are ambulatory as well and not mentioning about the wound care aspect of vascular path which IR do not handle.

Y-90, TACE, Liver ablation, how many of those do you get in the community? Those patients are usually referred to major cancer center for potential trial evaluation from primary oncologist after failing 1-2nd line NCCN guideline treatment. Take a look at real community practice before you bark here.

 

[Splenda88]

Why not IR?

I was told they make 700k/yr without having the lifestyle of a neurosurgeon...

 

[JoshSt]

Why not IR?

I was told they make 700k/yr without having the lifestyle of a neurosurgeon...

Depending on where you're willing to live, you can make that much as a DR (although certainly not common). But, if you're hellbent on retiring early and making as much $ as possible or if it's in a place you'd like to live then it may be a nice fit. IRs make more than DRs and rightfully so. In my experience, the discrepancy is usually 50-100k (IRs making more than DRs).

Talking the big figure salaries is fine, but when you're a physician in a specialty that isn't horribly underpaid (e.g., family medicine or pediatrics), does making $400k vs $700k matter that much? It certainly does to some, but DRs and IRs both do well.

 

[irwarrior]

There is no reason that IR can not handle most vascular conditions similar to a cardiologist or vascular surgeon. The medical therapy is pretty straightforward (statin, ace I, anti platelet, cilostazol for claudicants). The CLI patients are usually referred by podiatrists and wound care centers. Varicose veins are very common and you can get PCP referrals and direct patient referrals (simply have to market aggressively).

Even BPH referrals won't be that challenging ie patient who has LUTS (check their IPSS score start on tamsulosin and finasteride). Check PSA, order uroflows. Discuss TURP/ MIST/Urolift. Discuss UK ROPE registry and trials and see if patient wants to consider treatment.

You simply have to be a strong clinician and have a clinic for long term follow up and market aggressively to PCP , ER , urgent care and to patients.

Agree oncology is tougher but not impossible to build in the community as most Hepatocellular cancers go to the transplant centers. Limited data on Y90/tace/ablation in metastatic disease.

 

[badasshairday]

Just so you know. Embolization codes are higher than stenting and angioplasty codes. So yes those emergency embolizations pay the Bills. Im at a community hospital traditional radiology group. I started getting referrals for PAD from hospitalists. I read the vascular imaging and have swooped in on cases before anyone else can. Sorry, @MedRad1990 but you are misinformed. Tunneled HD caths, ports, declots, embolizations of gi bleeds/trauma all are money makers. Even if I didnt do work on any gangrenous feet, I'm very busy. And I can get gangrenous foot work since I am so entrenched in taking care of renal patients. We have done BRTO, TACE, varicoele embos, stenting central veins, may thurners, arterial atherectomy and stenting, UAE, PAd, dialysis work galore and we are in a traditional radiology group in a major metro area without a clinic. With a clinic I would absolutely rock most of my "competetion" even more.... which is really only in PAD space.

 

[UChicagoIR]

Questioning someone's decision to pursue IR over DR on the basis of income difference is foolishness. Additionally, having worked in both a community practice and in academics I can say that some of the comments above are misinformed. Rather than argue with anyone on this thread (there's been too much of that already), I would be happy to answer any questions re: IR via private message.

One more thing: if you're chasing money you've entered the wrong profession. Most of my friends in finance or tech startups have retired by their late 30s - early 40s with eight-figure net worths. If you're committed to a career in medicine and are still chasing money, you're also far better off in other specialty where you're not a hospital commodity and can build a business beyond just your daily medical practice.

 

[Tiger100]

Being right or wrong is a different story. But cursing at someone because their opinion is different than yours is a different story.

It has become a common behavior that if something is said about IR that doesn't appeal to IR docs, some posters (not all) become extremely angry and curse at the poster left and right.

 

[Norick13]

Being right or wrong is a different story. But cursing at someone because their opinion is different than yours is a different story.

It has become a common behavior that if something is said about IR that doesn't appeal to IR docs, some posters (not all) become extremely angry and curse at the poster left and right.

They have to shun the non-believers.

IR is cool, so's DR.

As an aside I always smile at the posts that talk about how you can just flip from IR to DR once you're old and tired, but bring up doing IR as a DR and it is madness.

Sure, you' spend a longer time in residency doing DR, but if you take time focusing on only IR, say like in fellowship and early career, your DR skills will atrophy as well.

In my opinion, all that mindset does is undermine the actual skill and acumen it takes to be a successful DR.

 

[NDcienporciento100]

What gets me is when people speak things that are completely false. Take microwave/RFA for kidney an liver lesions they are literally one of the most common procedures that IR does in private practice but there are people on this thread that say it’s only for academics. And there are more examples of this on this thread, I don’t mind if you have a different opinion but don’t say things that are false.

 

[badasshairday]

What gets me is when people speak things that are completely false. Take microwave/RFA for kidney an liver lesions they are literally one of the most common procedures that IR does in private practice but there are people on this thread that say it’s only for academics. And there are more examples of this on this thread, I don’t mind if you have a different opinion but don’t say things that are false.

Most common procedures are para/thora and venous access. Ablations are not super common imo. We do them occasionally.

 

[badasshairday]

They have to shun the non-believers.

IR is cool, so's DR.

As an aside I always smile at the posts that talk about how you can just flip from IR to DR once you're old and tired, but bring up doing IR as a DR and it is madness.

Sure, you' spend a longer time in residency doing DR, but if you take time focusing on only IR, say like in fellowship and early career, your DR skills will atrophy as well.

In my opinion, all that mindset does is undermine the actual skill and acumen it takes to be a successful DR.

You can smile all you want. But it's not uncommon for IR people to transition to DR only/mostly late career. Most of us in PP do read a good amount of DR while being IR. We are radiologists after all.

 

[irwarrior]

Renal ablation may be fairly common (older patients who have small lesions and the options are active surveillance vs ablation), but liver ablation is not as common, unless your hepatobililary surgeons are not that aggressive as the standard treatment is resection if technically and clinically feasible. HCC has some disease free survival and overall survival equivalence when compared to ablation , but most of these are done at transplant hospitals. However, it is pretty challenging to build a consistently high end VIR practice without a dedicated clinic (not impossible but certainly more difficult).

 

[Tiger100]

You can smile all you want. But it's not uncommon for IR people to transition to DR only/mostly late career. Most of us in PP do read a good amount of DR while being IR. We are radiologists after all.

Most private practice IR jobs is a combination of DR and IR. Probably 60%- 40%.

This was whay I exactly said in another thread and one poster started cursing as though doing DR is a crime.

 

[Tiger100]

I agree that there are false information going around and many people especially academic IRs and fellows don't have a good understanding of private practice radiology including private practice IR.

While there are some IRs out there who have clinic and many IRs who are practicing 100% IR, it is not the majority.

Most IRs docs in private practice do 60% IR and 40% DR. And the IR part is a combination of bread and butter cases and high end cases Probably 1-2 big cases a day and the lines, drains, tubes, biopsies, thoras and paras.

 

[irwarrior]

The rise of the office based lab is starting to change the landscape of private practice IR. OEIS | Outpatient Endovascular and Interventional Society. As more go into dedicated IR training, they will want and look for dedicated IR jobs. Though they are certainly not the majority, it is a growing sector of the VIR community. The clinical and the technical skillsets of the modern IR trainee are different when compared to their predecessors. Also, the modern integrated IR residents won't have the same DR training as the predecessors. It will certainly be exciting and interesting times. The biggest challenge to be faced is the "exclusive" contracts and restrictive trade covenants that will be a huge hurdle to overcome.

 

[Tiger100]

The rise of the office based lab is starting to change the landscape of private practice IR. OEIS | Outpatient Endovascular and Interventional Society. As more go into dedicated IR training, they will want and look for dedicated IR jobs. Though they are certainly not the majority, it is a growing sector of the VIR community. The clinical and the technical skillsets of the modern IR trainee are different when compared to their predecessors. Also, the modern integrated IR residents won't have the same DR training as the predecessors. It will certainly be exciting and interesting times. The biggest challenge to be faced is the "exclusive" contracts and restrictive trade covenants that will be a huge hurdle to overcome.

The exclusive contract will do nothing. It didn't do anything for vascular surgery or cardiology or any other specialty who wanted to do endovascular procedures or wanted to interpret imaging studies.

I disagree with your comment about exclusive contract. If a separate IR group wants to get credentials, they can.
But the biggest challenges will be followings:

1- They have to give up DR part or at least limit their DR work to vascular ultrasounds and may be CTAs. Even in that case scenario, due to turn-around time, vascular studies from ER or probably inpatient will be interpreted by DR group.

2- They may end up competing with DR group for bread and butter procedures or even vascular procedures. In a very unscientific survey, I asked 5 IR people in our group about clinic and 100% IR job. 3 of them said that they want their current set up (combined DR and IR) and even if the hospital hires a separate IR group they will continue to do what they do now. One of them said he likes to do only IR and the other one said he does it only and if only his paycheck goes up significantly (which will probably won't happen at all especially giving the fact that it takes time to get there).

For example right now in our practice the lionshare of IVC filters are done by IRs but vascular surgery and cardiology are both credentialed and do a few filters here and there. Now if you add a separate IR group, don't get surprised if DR group get some of those cases (if they have IR people).
It happens like this (and in fact this is the way that our IRs get them before other services): The ICU doctor or the hospitalist calls radiology to see whether there is a PE or not and if there is a PE they ask whether we can through a filter or not ASAP.

Separating from DR will lose some of IR referrals. Whether they can make up for it by clinic and rounding is a different story.

My last point: I think some people take radiology department for granted. It is one of the biggest departments in the hospital that is constantly in touch with most services.

 

[Norick13]

You can smile all you want. But it's not uncommon for IR people to transition to DR only/mostly late career. Most of us in PP do read a good amount of DR while being IR. We are radiologists after all.

You're exactly right - it's not uncommon coming from the current practice model for IR, and seems to work OK.

But I thought, based on most of the responses in this thread and others from the IR Brigade, that young IR attendings are coming out doing 100% IR regardless of practice size, with independent clinic, and lots of PAD work leaving little time for DR.

On the ground in training, there's already a clear schism among DR and IR residents with many of the IR residents already thinking they're above the DR portion of their programs (showing up late, ducking out to do/steal cases from others on their IR rotations). There are now 2 PDs both of whom jockey for control of the first 3 years of residency. Separate WhatsApp groups, separate call pools, basically anyway to fractionate IR from DR is occurring. This is based upon my and others I am close to experiences in a large east coast city at university-based residencies. Is it right? of course not, but that's how the wind is blowing at least in residency. Its hard to see how this isn't going to continue on into practice. The, "We are radiologists after all," sentiment is nice and all but seems to less applicable as time goes on and the schism in training widens.

 

[irwarrior]

If you read SIR connect posts and talk to those in the SIR private practice council, their biggest concern is that in a hospital that IR is not doing all of the endovascular procedures they prevent other independent IR practitioners from going out and getting hospital privileges. This is one of the biggest topics discussed by many private practice IR.

Historically those who went into IR were more of the ROAD mentality and we are starting to see a shift of that mindset and mentality to a surgical type A personality. This transition is likely occurring due to the ability to apply directly out of medical school. Also, the competitive nature of the ESIR and the independent residency has also led to residents competing for a limited pool of spots. Historically radiology fellowships have not been ultra competitive and IR was not competitive in the mid 2000's when the diagnostic radiology market was wide open. Now, the IR student and resident should strive to be the best resident on whatever service they are on and try to learn the most they can.

The excitement of IR amongst students has been largely due to the much needed embracement of clinical medicine as well as the explosion of the various service lines in interventional radiology. The challenge will be that the current job market are mostly in DR groups that may not be willing or able to offer dedicated office hours to see patients. But, the scope breadth and complexity of what we do requires follow up and at some point it will be considered itinerant surgery/abandoment if we do not provide that degree of care to patients. IVC filters are a prime example in where poor IR follow up led to some serious adverse events. The FDA, lawyers and Joint commission have all caught wind of this and have been looking at IR more closely. The whole process of IR in the hospital has become far more similar to surgery. Where consents can be obtained and by whom (ie avoid coercion). The time out process has become more rigorous. Also, the sterile technique has also come under scrutiny. Interventional procedures are starting to come under the jurisprudence of preoperative services at many hospitals and it is likely that trend will continue.