"The elevation of interventional radiology to a specialty level with its own distinct residency program places IR on the same level as surgery, pediatrics, and internal medicine," says one proponent.
A radiology sub-specialty is emerging as distinct medical specialty, separate from the traditional revenue-generating imaging-based model of service.
Two years ago, the American Board of Medical Specialties elevated interventional radiology from a subspecialty of radiology to a primary medical specialty.
The Accreditation Council for Graduate Medical Education is currently developing the residency program requirements for the new dual interventional radiology/diagnostic radiology (IR/DR) certificate that will replace the vascular interventional radiology (VIR) subspecialty certificate.
Accreditation of the first IR residencies for the new IR/DR specialty is likely to begin in July 2015.
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As the final details are getting worked out, the President of the Society of Interventional Radiology, James Spies, MD, FSIR, and an interventional radiologist and chair of the radiology department at MedStar Georgetown University Hospital and professor of radiology at Georgetown University Medical Center in Washington, D.C., says the move will give interventional radiologists more visibility among fellow physicians and patients.
"The elevation of interventional radiology to a specialty level with its own distinct residency program places IR on the same level as surgery, pediatrics, and internal medicine in the ABMS hierarchy and brings recognition and validation to a specialty that has had a hugely positive impact on the practice of medicine."
While interventional radiologists have been an important and significant part of clinical care teams, they are still relatively unknown to patients, and even physicians.
"Our roots are in diagnostic radiology," says Mahmood Razavi, MD, director of clinical trials and research center at Orange, California-based St. Joseph Vascular Institute & partner at Vascular & Interventional Specialists of Orange County (VISOC). "The reason the public doesn't quite understand is we deal with so many disease entities and so many body parts, it is hard to brand us."
Revenue Generators
Interventional radiologists pioneered angioplasty and stenting, mainstream procedures today. Now, their vein and vascular clinics are widespread. Therapies for those diseases are clinics' bread and butter, but Razavi says the interventional radiology procedure he sees the most growth potential for is treating primary and metastatic liver cancer tumors with yttrium-90 radioembolization (Y-90).
Y-90 radioembolization therapy uses radioactive beads that are tiny—about the width of five red blood cells. Like other interventional radiology procedures, a small incision is made for a catheter that delivers the Y-90 beads to the tumor vessel, killing the cells.
Razavi says nationwide, the use of Y-90 has grown by 20—30%, but at VISOC, growth rate is even higher. "At our practice, the growth of Y-90 is closer to 50%. Y-90 will continue to grow unless the emerging research turns out to be negative or the payers take a different approach, but that scenario is unlikely… The growth is only limited by the epidemiology of the disease."
While not a cure for primary or metastatic liver cancer, Y-90 radioembolization allows for higher doses of radiation to be delivered since it is a targeted therapy. Patients benefit by having a better quality of life.
Another key component to interventional radiology procedures is imaging, but it's the imaging procedures that have also contributed to patient and physician confusion about what an interventional radiologist does.
Razavi says interventional radiologists are experts at reading x-rays, CT scans, and MRIs, but more importantly, the treat the disease they're seeing on the images.
To distance itself from imaging, Razavi's practice does no imaging.
"We use the local diagnostic imaging centers and the diagnostic radiologists to refer our patients to," he says. "We're not part of them."
VISOC's model is unique because imaging is a revenue generator, but Razavi says omitting imaging services reinforces the interventional radiologists as a clinical partner and physician rather than an image reader.
"Those interventional radiologists who still do imaging part of the time, say 2–3 days a week or the same day, that is the model that is going to fade away," Razavi predicts. "The full-time interventional radiology practices, such as ours, are financially successful. It is a viable model."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.