IM before IR?

[dapple]

Hi everyone,

I'm a new 4th year med student with a very strong interest in IR. I met recently with the director of IR at a large well known hospital affiliated with my med school and he surprised me by his recommendation that I consider doing not just a medicine internship but an internal medicine residency. Basically his point was that as IR is seeking to become more clinical, IR will always be at a disadvantage with their medical/surgical colleagues who seek to take over their procedures until the specialty had incorporated clinical training that is deemed equivalent. I know that Society for Interventional Radiology (SIR) has been pushing strongly for more clinical training for radiologists interested in IR by advocating for the DIRECT and Clinical Pathways for IR. However, it appears that the future and validity of these pathways is still in flux as IR is seeking to define itself among the other medical specialties. I realize that doing an entire IM residency may be overkill, but after giving it some thought, I have started to entertain the idea. I actually like the idea of learning how to be a clinician first. I think it would give interventional radiologists more credibility and and also knowledge to create new innovative therapies. Any thoughts out there from current residents and/or attendings? Do you know anyone that has taken this path?

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[DrBowtie]

So you want to do 3 years IM, 4 years DR, then 1 year IR fellowship?
Seems way overkill to me even after attending this most recent SIR meeting.

 

[Radonkulous]

So you want to do 3 years IM, 4 years DR, then 1 year IR fellowship?
Seems way overkill to me even after attending this most recent SIR meeting.

Why do you say that? It's as long as IC training and 1 year longer than the traditional VS training.

 

[DrBowtie]

Why do you say that? It's as long as IC training and 1 year longer than the traditional VS training.

2 additional years before 4 years of straight DR is going to atrophy.
If you were going to do it, it would be most helpful in a DIRECT or truly integrated model. I think doing 3 years of gen surg would also be more helpful in terms of pre/post procedure inpatient care and a more surgical model of clinic.

I believe one of the SUNY programs is more geared towards full physicians in other specialties making the switch (sorry can't remember which one from SIR). If you can find that info out and make contact it might be helpful.

 

[Radonkulous]

Did any hope come out of SIR this year with regards to the future of IR?

 

[IRGuru]

Did any hope come out of SIR this year with regards to the future of IR?

I don't understand this sentiment..."is there any hope?"... It's not a matter of hope, things are already improving. Read the other threads on this site or speak with rising IR attendings. Anytime I do the latter, especially at SIR, they all say IR is about to blow up in terms of our role in patient care and what we can offer patients...The problem is getting entitled older IRs to come around to realizing that the old way is dead...younger IRs don't have that problem which is why IR is on a decidedly upward trajectory

To the OP, I thought really REALLY hard about doing an IM residency first (so much so I applied to and interviewed IM programs as well...I also actually ranked medicine programs about several radiology programs)...I decided to go the radiology route for a lot of reasons but especially since I'll get at least 2 and almost 2.5 years of clinical medicine anyway in my DR residency (true internship- not an easy TY- and 12-16 mo of IR during residency)...I'll do year of fellowship and a year of vascular medicine where I'll end up with all the knowledge/skills I want and need. As an adjunct, I'll also moonlight in clinical medicine throughout my residency (ED/urgent care etc.). However I could understand if you decided to do a medicine residency and then tried to match into the DIRECT pathway (which btw, is 4 years for both DR/IR and does NOT require an extra fellowship year). Lots of excellent IRs have done that. One new attending at PENN trained in gen surg and in his fourth year, joined the DIRECT pathway. Here's another example:

http://www.rt-image.com/Famous_Last...nal/content=8504J05E489E928040969676448080441


Despite the path you take, bottom line is be a clinician. Keep reading, keep learning, keep seeing patients. IR is really a great field for those who don't hem and haw about seeing patients outside the angio suites.

 

[Gvataken]

I think that it is reasonable to get dual boarding. IR has a tremendous range of diseases that we tend to treat. As many have noted the field is becoming far more clinical. Many of us are admitting our own patients to the IR service.

You have to have a solid foundation in basic medicine. This includes diabetes and hypertension management. The concepts and treatment of atrial fibrillation, dvt and pe management, chest pain evaluation, stroke and TIA management etc. This involves a deep understanding of anticoagulation meds, thrombolytics, antiplatelets etc.

Internal medicine training gives you a reasonable foundation.

The thing about IR is the scope of our practice continues to expand and though we have great catheter and technical skills , the required deep understanding of clinical medicine and decision making is challenging. We learn alot about the pathologic conditions in the diagnostic imaging and you have the ability to develop strong technical skills and imaging skills during residency and fellowship, but the clinical skills will take additional time to obtain. The new paradigms of training such as the Clinical pathway and the new radiology boards format give the motivated individual nearly 40 clinical months(12 months of internship (surgical/internal medicine); 7 months of variable clinical rotations (vascular surgery, hepatology, stroke neurology, surgical oncology, vascular medicine, cardiology consults , ICU etc); 21 months of IR rotation (9 during residency and 12 during fellowship year) and 32 diagnostic imaging months in a 6 year period of time. The way to integrate the clinical training varies from program to program.

I have a few highly motivated trainees who are doing additional IR months and clinical training during their residency and are following their own IR clinic patients during the course of their residency. I have noted that the residents that I am training in this fashion are more advanced clinically than many of the PGY6 IR fellows. As the scope of IR continues to increase many of the power groups in IR are even developing niches for each IR.

1. Neuro-interventional (including aneurysms and stroke therapy)
2. Vascular interventional
3. Women's therapy (fibroids , pelvic congestion syndrome etc)
4. Interventional Oncology
5. Pediatric interventional
6. GI and GU interventions


Those who want to have successful IR practices, will have to realize you have to be a strong clinician and have a great deal of patient care responsibilities. This entails a deep understanding of disease (pathophysiology, physical exam and history (signs and symptoms), lab evaluation, prognosis, treatment options (medical , surgical , and interventional) and a follow up algorithm.

IR is an exciting field and has constant challenges. The rapid evolution of technology, the minimally invasive nature of the field , innovative aspecdts, and the ability to have a global understanding of disease keep it challenging and exciting.