One of the things that is so attractive about IR are the possibilities for the types of procedures performed. Interventional Radiology paved the way for almost every major imaging guided minimally invasive treatment modality in medicine. Pad, IR invented the balloon angioplasty (your welcome vascular surgery and most recently cardiologist), Stents, IR invented the stent which without cardiologist would still be left holding and empty bottle of nitro, Neuro IR, all pioneered by interventionist. I am not here to advocate that these specialists performing these procedures is wrong, I don’t think it’s wrong, so let’s make that clear right away. But what I will say is that we have a right to these procedures and we as interventional radiologists should be able to compete for these procedures without hospital administration coming down and saying for example “for now on all PAD goes to vascular surgery”, and this is happening. I don’t think that just because one specialty invented a procedure that specialty should be the only one to be able to perform it otherwise general surgeons would still be performing mohs surgery and I think we can all agree that is not a good thing. But where I take strong offense is when hospital administration says “sorry IR, stroke thrombectomy’s are only going to be done by neurosurgery and neurology from now on” that’s a monopoly on something you didn’t even invent and that is wrong. Medicine is becoming more and more secularized especially at major academic institutions in which everything is funneled for example: AAA’s all go to vascular surgery at “Blank” top 20 hospital. This concept of secularization works for almost every other specialty cardiology, neurosurgery, orthopedics, cardiothoracic surgery because they don’t have to cross as many specialty lines in order to get complete training in their field. That is simple not the case in IR if you are truly to cover the full spectrum of IR training. What does this mean for IR trainees? Well it means for a given year of training at what the public may consider one if the best academic medical institutions in the country you may perform as many PAD cases that a fellow at Miami Vascular performs in two days of their year of training (I do not work for or have any ties or disclosures of any kind with my use of Miami Vascular and I am simply using them in this example). Where the major academic institutions still dominate is in the procedures only performed by IR example; TIPS, Y90, TACE and any highly complex non traditional intravascular procedure in which Vascular Surgery, and Cardiology will be to scare to touch (no offense). How do we overcome this problem of secularization? We could just choose to give in and say “let them have it” but if we did that (and we would still be plenty busy) how long would we still be the foremost authority on complex endovascular procedures? My opinion is that we meaning IR need to take seats in the hospital committees and strive for the best relationships possible with the subspecialty’s performing these procedures so that trainees can do meaningful rotations with attending’s from vascular surgery, neurosurgery so they are capable of performing these procedures when they are done with training. That’s all for me today thank you for reading. I would love to hear other thoughts on this.
“Things have been both rewarding and at times frustrating. In the early days of transluminal angioplasty I had to accept a lot of unpleasant backbiting such as ‘He's a nut, you can't trust his uncontrolled, poorly documented case experience,’ and worse. I'm glad I was thick-skinned enough to stick with it and even more glad that there's so much still to be done and so many others to help do it”
Charles Theodore Dotter.
