Interventional Rad

[OHMAN0125]

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Just wondering why IR is always losing the turf battle on minimally invasive procedures. I mean, radiologists developed them and the next thing you know cards, vasc surg, neurosurg, has basically taken all the procedures. I'm gonna guess that surg onc will take the oncology procedures eventually as well. This is disheartening since I really like IR but I don't want to go into a field that will lose their procedures all the time.
My theory is that IR is a demanding specialty (lifestyle wise) similar to a surgeons or inv cards. Thus most radiologists won't give much of a fight to let those procedures go since they are sitting on 400k/year doing DR and enjoying their 9-5 jobs. Another reason why IR really isnt that popular for rads residents in the first place.

 

[f_w]

Just wondering why IR is always losing the turf battle on minimally invasive procedures.

One concept: Ownership of patients.

Once the VS or cards has the patient in his fangs, he will of course extract all the procedural revenue he can get. He might or might not be the best person to do those procedures, but as long as a buck is to be made, he will do them. IR practices depending on referrals from those specialists will in fact loose all their referrals eventually.

IR practices that take ownership of patients (by taking direct referrals from primary care and building referral relationships with the respective surgical and medical specialties) are thriving and drowing in work. But that requires running an office/clinic, marketing and outstanding customer service.

 

[werewethere]

One concept: Ownership of patients.

Once the VS or cards has the patient in his fangs, he will of course extract all the procedural revenue he can get. He might or might not be the best person to do those procedures, but as long as a buck is to be made, he will do them. IR practices depending on referrals from those specialists will in fact loose all their referrals eventually.

IR practices that take ownership of patients (by taking direct referrals from primary care and building referral relationships with the respective surgical and medical specialties) are thriving and drowing in work. But that requires running an office/clinic, marketing and outstanding customer service.

And a backbone.

 

[DrPunk]

IR Runs my hospital... Ridiculous amounts of PROCEDUREs: Biopsies, Drainages, Tubes, Lines, Catheters, Vascular Accesses, Interventional NeuroRadiology runs the Stroke Team, LPs, Even heard of IR doing AAA repairs now, wtf? everybody at my hospital is blown away by how busy IR is...and a little pissed that theyre so busy they cant get to some procedures until the next day....

 

[f_w]

IR Runs my hospital... Ridiculous amounts of PROCEDUREs: Biopsies, Drainages, Tubes, Lines, Catheters, Vascular Accesses, Interventional NeuroRadiology runs the Stroke Team, LPs, Even heard of IR doing AAA repairs now, wtf? everybody at my hospital is blown away by how busy IR is...and a little pissed that theyre so busy they cant get to some procedures until the next day....

Sounds like a typical IR service.

The easier you make access to procedures, the more the skills in the other services atrophy. I did my residency and fellowship at a places where the senior IM residents where incapable (and unwilling) of placing a central line. If you offer fluoro guided LPs, within a year or two, nobody except anesthesia and peds will be able to do a LP with less than 5 sticks. If you offer thora-, paracentesis or G-tubes no questions asked, in no time you will corner the market on those. They are dull and boring, but heck if you run a tight ship, they pay their way pretty well.

For the higher end stuff (angio work, onc work), you need to take ownership of the patients.

 

[maxheadroom]

The issue in my community has always been that Cards and Vascular are always happy to take a consult and see a patient in the middle of the night, on weekends, on Christmas, or during their best friends' wedding (OK, that might be a stretch). Getting IR to do anything at my hospital takes something near an act of God.

I've heard multiple community primary docs say, "When Dr. Vascular does an intervention on my patient, HE TAKES CARE OF THE PATIENT while they're in the hospital and sees them back in clinic." When IR does a procedure in our town somebody else has to admit the patient, manage the patient, and follow up the patient. Why not refer to your friendly Interventional Cardiologist or Vascular Surgeon?

Most of the Rads residents that I know will say that while they enjoy interventional procedures that they aren't willing to make the sacrifice of taking IR call.

It's about taking care of patients and fostering good relationships with referring physicians. If you do a procedure, but don't take care of the patient, why would someone send their patients to you?

 

[f_w]

I've heard multiple community primary docs say, "When Dr. Vascular does an intervention on my patient, HE TAKES CARE OF THE PATIENT while they're in the hospital and sees them back in clinic." When IR does a procedure in our town somebody else has to admit the patient, manage the patient, and follow up the patient.

That just means that your local IRs haven't caught up the new paradigm yet. I bet they are biotching that everyone takes 'their cases'. Today, if you want to be busy, you have to admit some of your patients and 'be available'. Yes, that means the occasional 11pm dialysis catheter that could have either been done in the afternoon or early the next morning, but that is the price you pay to keep your referrers captive.

If you do a procedure, but don't take care of the patient, why would someone send their patients to you?

If
- they can't do it themselves (e.g. onc or IM placing chest ports or biopsieing stuff)
- it's more convenient to send the patient to IR (e.g. for neurosurg getting a g-tube into one of their gorked wrecks so they can be turfed to the long-term care facility)
- it's politically convenient to do so (e.g. CT surg sending their peripheral work to IR rather than cards or VS so those don't pluck other fruits off the procedure tree)

- GASP the IR is the best or only person to perform the procedure. Many cards or VS have no experience to work in visceral arteries (e.g. transplant artery stenosis). I have seen referrals from endovascularly working VS or cards for the really tricky stuff (not to ME, to the people who taught me).