IR in a small town

[long]

Hey guys. I've recently been looking into IR and it looks like something I could really enjoy doing but I have a couple questions.

First of all, I would like to eventually go back and practice in my hometown, which is a town of 25,000 and the hospital has a catchment of about 60,000. Is that a big enough area to have a successful IR practice? And what kind of breadth of procedures should I expect to be able to take on in this kind of situation?

Also, does anyone know if the number of DIRECT programs will be increasing, and how difficult it is to get these positions? I like the bigger clinical focus these programs seem to have, and I think I'd rather go that route than 4 years of rads and then a fellowship.

I'm sure there some other questions I have that I've forgotten, but I'll post them later if remember. Thanks!

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[MossPoh]

I can kind of answer the first part.

I grew up in a similar sized town with similar population, but maybe a slightly larger area. My dad was a radiologist with a cardiovascular fellowship (before they had IR). We moved from a large area where his daily work was almost exclusively IR. The area was not generating enough to do it full time. He even told me that he felt he was losing some of his skills by the end and didn't feel comfortable doing the things he did in the past. He was good for the bread and butter along with scattered other things, but he had to shift over to much more diagnostic radiology once we moved to the small town. It isn't impossible, but most groups will probably want a mix of diagnostic and interventional. Now, if you can somehow lobby yourself to hospital administration and pick up some other vascular work, it may be possible but the variety would still be limited. I think you need 100k+ population for the area for it to be more doable.

 

[officedepot]

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[shark2000]

Disagree with above.
The wrong mindset in radiology is having an established practice waiting for you at the very first day of your job. You have to establish the practice yourself.
If you want only do vascular work, you can not do it in a 25K town. It does not have enough volume. The same is for CT surgery or Neurosurgery.

However,
You can not compare the scope of radiology practice (including IR )with CT surgeon. And also radiology in 2012 is a whole lot different from the time of your father. CT surgery scope of practice is very limited, though very high end. Radiology in 20-30 years ago was not as broad as today. These days radiology has changed into a 24 hour service to almost all medical groups from PAs and NPs to neurosurgeons.

The key to establish a high end practice is to start from day to day, bread and butter stuff.
Carotid angioplasty may not be day to day work of a small rural hospital in a small town. It also is not emergent and can be turfed to big cities. As a result Vasc surgeons may not be able to establish practice there. BUT biopsies, Joint aspirations, drains, chest tubes, thora, para, LPs, abcess drainage, biliary work, nephrostomies and .... are day to day work of a rural small hospital. They usually can not and are not turfed to big cities. Rather than sending Mr. Peter 300 miles away to a neurosurgeon for back pain, you can read his MRI and see him in you pain clinic and inject the diseased facet joint.Once you establish yourself as a minimally invasive problem solver in the hospital, then higher end cases start to come. Once people trust you, you can broaden your practice to vacular work. Besides you can do mammo and all biopsies. Soon you will be busier than you can imagine.

In summary if you want to do only one or two limited procedures (like CT surgery or only vascular work) you do not have enough volume in a small town. You have to broaden your practice scope. You will have enough volume for 1-2 days of work. You can do variety of other procedures on the other days (vasc work 1-2 days, biopsies one day, pain work one day, biliary work one day, ... ). This is the greatest thing about radiology (both DR and IR).
A rural hospital can handle 90% of its patients with an ER doctor, hospitalist, General surgeon and a radiologist. On the other hand, only vary few patients need neurosurgeon, vac surgeon and other sub-specialists. It does not have the volume for their full salary.

 

[MossPoh]

I think you're kind of blurring together posts. If you're referring to me, he was doing procedures until about 6ish years ago and he most certainly did not join some solid established practice, nor did he limit himself to just vascular. In the end, the mix worked out well though. There were other docs soaking up much of the other stuff and people preferring to go to a bigger hospital about an hour or so away.