New accreditations may fend off competing specialists. From MedPage Today.
This article first appeared March 9, 2017 on MedPage Today.
By Nicole Lou
WASHINGTON -- Sweeping changes are coming for interventional radiology (IR), and an expert panel discussed the challenges to carving out a niche for a field that's currently fighting a turf war against other specialists, like vascular surgeons and cardiologists.
"Graduating numbers are going to be a little less in the future than they are now because of the job market. A quarter of practicing IRs do very little IR -- less than 5%. The solution is not to graduate more people. The solution is to have them do more," said Saher S. Sabri, MD, of the University of Virginia in Charlottesville, during a session at the Society of Interventional Radiology (SIR) annual meeting.
"If you come out [to the job market] knowing how to do transplants, but not venous disease and PAD [peripheral artery disease], you're going to be stuck. We need to be training them for the right things they'll need in the future. We just have this superb training program with what's in it but when they're in private practice, they don't have what they need to tackle what's out there," he added.
What's more, "now there's a new Society of Interventional Oncology with a mission that's similar to ours," said Charles E. Ray, Jr., MD, PhD, of the University of Illinois Hospital and Health Sciences Center in Chicago.
He asked the audience at SIR: "Do people think we're at the point where we need to have subspecialty societies? Are we at the point where we, as a society, are meeting the needs of all vascular specialists and venous specialists?"
"What everyone agrees on is that a defined set of core procedural competency that every IR fellow comes out with would be needles, catheters, and wires," Ray stated. "There is not a procedure I do now that I did as a fellow or trainee. So IR is rapidly evolving; what you know now may be obsolete in 10 years."
John A. Kaufman, MD, of the Dotter Interventional Institute at Oregon Health & Science University in Portland, agreed.
"You're not going to learn all the skills you'll need the rest of your life in your fellowship. You're really learning a set of competencies, and you'll juggle them, and mix, and use them in new ways. You're always adding new skills once you're in practice."
You have to go to meetings, talk to people, and get yourself proctored if you have to," he urged.
For Kaufman, if procedures are only performed once or twice a year, they may not be something trainees need to learn. "Think about how many diagnostic pulmonary angiograms we have done – maybe a lot during early training and now it's gone."
On the flip side, however, when learning does have to occur, it will need to be overhauled, according to Sabri.
"Most of us in IR, we're not as good at managing [surgery unit] patients. Others need to train us in procedural areas depending on what it is. Most people are going to rely on other specialists to teach us. It's better for us as a society to train each other," he stated. "It's an opportunity to include the private sector in training our trainees. It should be considered a significant project that we work on over the next couple of years, how we reach out to private practice."
In 2012, the American Board of Medical Specialties bumped interventional radiology up from a subspecialty of radiology to a primary medical specialty, beginning a 10-year process from decision to implementation.
Starting in 2020, two new IR training pathways will be offered: the independent IR residency and a shorter alternative ("Early Specialization in IR") that requires completion of 12 IR rotations during the diagnostic radiology (DR) residency. Graduates will take the IR/DR exam from the American Board of Radiology. Those who pass will be certified to practice both DR and IR.
"Patient care is really critical to IR, and IR is part of DR. We need the support to make this happen," Kaufman emphasized.
The current track to IR -- an integrated IR residency followed by a vascular/IR (VIR) fellowship -- will cease then, to be replaced by the independent IR residency.
Fears of disenfranchising all of VIR made this a controversial topic even in the 1990s, when IR fellowships first received accreditation from the Accreditation Council for Graduate Medical Education, according to Kaufman.
In a worst case scenario, he said, "we would be in a situation where people can't do neuro; can't do peds if they don't have the certificate. It's worked out that people managed to do that. There's been no increase in the scope of procedures going from the VIR certificate to IR/DR. What was added was the extra time in IR training to have a clinical care component."
"History so far has been on the side of everyone being able to do what they want to do in the appropriate environment. I have DR people doing some drainages. It's a matter of how you organize it," he noted.
Sabri and Kaufman disclosed no relevant relationships with industry.
Ray disclosed serving as editor-in-chief of Seminars in Interventional Radiology. He disclosed relevant relationships with BTG, Medtronic, Gore.