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Halt Interventional Radiology Turf Wars

Joe Cantlupe, for HealthLeaders Media, September 5, 2012

This article appears in the August 2012 issue of HealthLeaders magazine.

It sounds like a conflict of epic proportions when you talk to some healthcare leaders. As David Levin, MD, former chairman of the department of radiology for the 969-bed Thomas Jefferson University Hospital in Philadelphia puts it, "There are turf wars, and there's been a big turf war between interventional radiologists and vascular surgeons."

Levin is referring to a longstanding healthcare issue: the disputes between interventional radiologists and other physician groups that center on which medical professionals should do certain procedures. Today, more health systems see the value in working to overcome the conflicts and finding ways to thrive in models where radiologists collaborate with physicians from different service lines.

Interventional radiologists' main focus is minimally invasive techniques that can produce improved outcomes, reduced infection rates, faster recovery time, and shortened hospital stays. But, as more cardiologists and vascular surgeons use interventional techniques—and as interventional radiologists move into the other physicians' territory—doctors and hospital officials see an increased need to manage a delicate balance of these relationships.

Hospitals are intently working to improve collaboration among physician groups. Experts say that team approaches are crucial for improved outcomes and more efficiencies of care. To that end, hospitals are ensuring that radiologists and other physician groups consult with one another and are working on programs that rotate their reading of x-rays and work with CT scans.

Interventional radiologists saw themselves years ago as among the first minimally invasive specialists; they were using their expertise in angioplasty and catheter-delivered stents to treat peripheral arterial disease. Soon, cardio and vascular surgeons increased their use of interventional techniques, which set the stage for territorial disputes.

"Historically, interventional radiologists have been doing catheter-based interventional procedures literally since 1963, when the first angioplasties were done," says Timothy Murphy, MD, medical director of the Vascular Disease Research Center at the 719-bed Rhode Island Hospital in Providence. "Surgeons for years denigrated the interventional procedures and wanted to operate on people. But then they had an epiphany, decided that surgery wasn't so great and they wanted to adopt interventional radiology procedures."

But the reverse was also true: Other specialties saw interventional radiologists infringing on their work.

"I think at one point in time interventional radiologists encroached on other people's turf," says Eric Russell, MD, FACR, a neuroradiologist and chair of the department of radiology for the 894-staffed-bed Northwestern Memorial Hospital in Chicago. "I don't see it as a unidirectional issue. We are trying to find a middle ground once conflicts have potential to rise, and try an approach that is good for the patient. It's hard when you are doing business, but ultimately that is what we have to focus on."

In recent years, interventional radiologists have expanded into new areas such as nonsurgical ablation of tumors to kill the cancer without harm; carotid artery angioplasty and stenting to prevent strokes; and treating liver tumors with intra-arterial yttrium-90 radioembolization, or tiny beads of radiation, to improve outcomes.

Some hospitals, such as the 960-bed Emory University Hospital in Atlanta, have launched cooperative vascular programs, involving vascular surgeons, interventional radiologists, and interventional cardiologists. Radiologists rotate in programs with other specialists and work in vascular clinics while consulting with other cardiovascular specialists, according to Kevin Kim, MD, director of interventional radiology and image-guided medicine and associate professor of radiology obstetrics and gynecology, hematology, and medical oncology and surgery at the Winship Cancer Institute of Emory University.

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