IR is the greatest field of medicine

[nightflight]

If you are so crazy about IR, go to the community hospital across the street. You will see the Angio department. Introduce yourself and ask them whether you can shadow them for a day. You will see IR doctors are putting PICCs and draining abscesses, while vascular surgeons and cardiologists are doing EVAR or stenting carotid in the room next to them.

Wish you the best in your career in IR.

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[GroovyMed]

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[nightflight]

I am an R3. But even if I'm an MS4, still IR is putting PICC while others are doing high end procedures.

 

[MossPoh]

And the point of this post is.....?

 

[Interchange]

If you are so crazy about IR, go to the community hospital across the street. You will see the Angio department. Introduce yourself and ask them whether you can shadow them for a day. You will see IR doctors are putting PICCs and draining abscesses, while vascular surgeons and cardiologists are doing EVAR or stenting carotid in the room next to them.

Wish you the best in your career in IR.

"Putting PICCs?" In what country?

As a PGY-5 who can't wait to start IR fellowship, let me make something clear for any impressionable pre-meds, med students, junior residents who might give the above comment any credence: In IR, you can do absolutely anything you want to do. There is no other field in all of medicine that can make this claim. There is no field that is more versatile, has greater career opportunities, and has a higher substance:scut ratio, then interventional radiology. It is a FALLACY that procedures got "stolen" from anybody. For a field that depends on referrals, you earn your keep by building relationships. It's a simple equation. I made plenty of friends during med school and IM internship; they value the continued relationship, as I do, and they respect me as a physician. I asked flat out, whom would you rather refer your claudicants to--Cards, Vascular, or me? Guess who suddenly has a massive potential referral base for PAD work...

Look, IRs are chameleons. You want to do vascular, do vascular. You want to concentrate on onc, by all means do so. In addition, you can continue to pound out all the great PCN/PCNU for the urologists (who will love you for it), great chemo access for the med oncs (who will love you for it), great declots for the nephrons (who will love you for it), and the list goes on. The full complement of endovascular and percutaneous interventions--no other field can claim anywhere near that kind of versatility. And you can build whatever kind of niche practice you choose. You can do EVLAs and sclerotherapies in a primarily cosmetic practice, if that's your bag. You can be the go-to person for nasty, complicated (but extremely fun) TIPS and BORTO, building expertise in liver failure management. You can become a hybrid oncologist, participating heavily in (or even running) tumor boards, do tons of bland embo, TACE, SIRT, cryo, RFA, IRE, and who knows what's around the bend. Embolize pulmonary and peripheral AVMs, bronchial artery embo for CF patients, embo type II endoleaks, spleno-embos for trauma, mesenteric embos for bleeders, varicocele embo, UFEs, god the list just goes on.

So, when someone says that all an IR does is PICCs, paras, permacaths, drainages, that person is not in touch with reality. If that's all you want to do, then by all means go ahead. But IR is the most customizable field in medicine, and it will never stop being a phenomenal career choice. To you medical students: when a cardiologist or a vascular surgeon tells you IRs aren't really doing any interesting work, the reason is that they have no idea what an IR actually does all day. I don't mean that to slight either of those fields, and I have friends in both of those specialties whom I greatly respect. Remember--it doesn't have to come down to war. Just advocate for yourself, and make key alliances. That will be necessary no matter what profession you choose.

 

[davidjones]

Great post Interchange:

Just to add a caveat: IF you were so inclined to do PICCs, permcaths and tunneled caths all day, you could easily make a decent living.

I was curious what the reimbursement was for putting a tunneled cath, which even in a diabetic, dialysis patient with burnt out veins can be as short as 15 minutes, and if you do 4 of these a day, 5 days a week, and that's ALL you do, for 48 weeks a year, you could generate well over $1.5 million, assuming you get a fraction of that, subtracting cost of the angio suite, materials, and 1 nurse and 1 tech, you could take home between 200-300k, not too bad for what essentially amounts to an 1 to 3 hours of work a day with 4 weeks vacation a year. The reimbursement rates are available online, so I won't post them here.

The only reason I post that is that people realize that even if you're relegated to vascular access you can make a great living, it's not exactly intelectually stimulating, and most people don't spend 15+ years of training to put in glorified IVs, but if your bag is to make lots of money than here you go;

No IR anywhere will want that however, the days of being a procedure monkey are over, especially with all the onc stuff.

Furthermore, cards is getting torn up by reimbursement cuts just like radiology is, because they do essentially the same thing, i.e. imaging and intervention; except that they have no room to maneuver and we do; IRs are the first to accept new technology, and patients gravitate towards novel treatments; and with 350,000,000 people in the US and only 4000 IRs in the country I guarantee anyone going into IR is going to be just fine.

The real reason to go into IR is this: it's the newest field in medicine, and it is very rare to be able to be a pioneer in medicine in this day, and you pretty much do that every day; On the way to work today I thought of at least 3 new devices I could come up with; there are guys still practicing today who have catheters and devices named after them.


The only thing the douche at the top of this page is correct about is that radiology isn't a cake walk; call is hard, at a lot of places it's harder than any other call, you're often the only rad, or one of two rads in the entire hospital, and in a hospital full of residents and no attendings at night, you are the go to person, so it's stressfull, especially because you can't possibly be prepared for every eventuality; but that kind of call has been part of radiology since the field began, it's not like it's new; so again, not sure what his problem is.

 

[badasshairday]

Yup, IR is the best field in medicine. Everyone else is just a biter and copycat. By the time another specialty adopts an IR modality, it is old news and IR is doing something new. lol.

 

[Doctor4Life1769]

IR = biggest set of whiny b!tches ever.

 

[davidjones]

IR = biggest set of whiny b!tches ever.

really anesthesia? aren't you guys currently fighting a losing battle with nurses? and also whining about it? best stick with the gas passing, and in your own forum. Don't like getting all confrontational, but you're going to get that if you come into someone else forum and start talking ****.

lots of love

 

[nightflight]

Radiology is 10 times a better filed than anesthesiology.
You can become a nurse by going to nursing school for 4 years. I don't undestand how come people do 4+4+4= 12 years of education to become a glorified nurse (Anesthesiologist) ?

Currently CRNAs can charge medicare for running Operating room, without supervision from Anesthesiologists. Soon we will see a wave of replacement of Gas by CRNAs. I don't say Anesthesiologists will be jobless, but they will get a very bad hit. While you can pay a CRNA 150-200K to do the job, why you should pay an Anesthesiologists 400K ?

We constantly do Image guided biopsies and many patients need some level of conscious sedation and monitoring. We also sometimes need it for taking MRI to reduce motion artifact. In our academic center, our department has two CRNAs hired by Department of Radiology who take care of most stuff. We never call Anesthesiology residents even for very complicated cases. Guess what was the routine 20 years ago? Those days even CT scanners were very slow (were not MDCT) and for many sedations that our attending didn't feel comfortable giving, they had to call the Anesthesiologist.

Anesthesiologists killed their own specialty many years ago by giving too much responsibility to the mid levels. In radiology, despite all turf issues, never sonographers want to read the studies. WHY? Because Radiology is a very high skill job that even PCPs and internists do not infringe the turf ( They have a lot of skills that I do not have and I respect them a lot), but anesthesiology is no brainer. You have to memorize a list of medications and be able to run a code.

Anesthesiology is done. It is over dude.

 

[Interchange]

Agree with you, DJ, that you can certainly make a decent living doing nothing but the dreaded "P Cases." However, I hope that prospective IRs are more ambitious than that, because the new guard is all about heightened visibility and embracing leadership roles in medicine, at institutional as well as regional and national levels. That doesn't have to mean becoming president of SIR or even running your hospital's IR section. It simply means making a point to become a known commodity in your hospital; making conspicuous rounds on your patients, helping out your referrings by seeing their patients in your clinic and appropriately following them up; becoming heavily involved in tumor boards, interdisciplinary conferences, grand rounds, etc; and generally raising awareness of what IR does through effective outreach. That, to me, is the most appealing challenge of IR, awesome procedures notwithstanding.

And one more thing that I neglected to mention in the versatility tirade: if you burn out, or become physically incapable of doing procedures all day, you're still a radiologist by training. Imagine--if for some reason you no longer want to practice IR full time, you get to fall back on DR, which in itself is a richly rewarding career. I repeat: No one in medicine enjoys this kind of versatility.

 

[badasshairday]

IR = biggest set of whiny b!tches ever.

I got respect for anesthesiologist, but honestly, those who live in a glass house shouldn't throw stones.
At least in the turf issues with radiology, it is with other highly educated and highly skilled PHYSICIANS that the turf is over... not a mid-level.

 

[badasshairday]

Agree with you, DJ, that you can certainly make a decent living doing nothing but the dreaded "P Cases." However, I hope that prospective IRs are more ambitious than that, because the new guard is all about heightened visibility and embracing leadership roles in medicine, at institutional as well as regional and national levels. That doesn't have to mean becoming president of SIR or even running your hospital's IR section. It simply means making a point to become a known commodity in your hospital; making conspicuous rounds on your patients, helping out your referrings by seeing their patients in your clinic and appropriately following them up; becoming heavily involved in tumor boards, interdisciplinary conferences, grand rounds, etc; and generally raising awareness of what IR does through effective outreach. That, to me, is the most appealing challenge of IR, awesome procedures notwithstanding.

This is what IR does at my program. IR is very active and is very visible and plays a huge role in the hospital. They are seen rounding, are part of onc board, vascular board, as well as a sarcoma board. Patients and physicians know IR here, and it was by the active role the IR department has played. It has gone from an ancillary service to a full on consult service with it's own admitting privileges. Guess who is doing the carotid, aortic, extremity, and renal stents here? IR.

 

[IRneuroIR]

Unless you are viewed as a valuable consultant who takes care of patients, nobody will refer you complex/high-end cases for you to simply do a procedure. It takes time to establish yourself as a reliable and knowledgeable clinician but once that is in place, the cases will come. As a resident, I have worked hard over these past several years to build my own reputation and now I often get paged/consulted directly regarding potential IR cases. Once I am done with my training, I am planning to return to this area and will already have a solid referral base in place and feel very confident that I will continue to get "good" cases based on my reputation amongst referring physicians. There's the saying "affability, availability, and ability" and the first two are certainly the most important.

 

[Interchange]

Unless you are viewed as a valuable consultant who takes care of patients, nobody will refer you complex/high-end cases for you to simply do a procedure. It takes time to establish yourself as a reliable and knowledgeable clinician but once that is in place, the cases will come. As a resident, I have worked hard over these past several years to build my own reputation and now I often get paged/consulted directly regarding potential IR cases. Once I am done with my training, I am planning to return to this area and will already have a solid referral base in place and feel very confident that I will continue to get "good" cases based on my reputation amongst referring physicians. There's the saying "affability, availability, and ability" and the first two are certainly the most important.

Exactly--relationships are key. You can't hope to steer great cases your way if you remain anonymous and antisocial, stick needles and tubes into an unspecified number of people, and peace out at 5pm every day. The same goes for DR, by the way, which is why I rail against the "sitting in a darkroom all day" cliche. The last time I did night float, the trauma surgeons asked if I would be on the following week, and were disappointed to find out that I would not. This dynamic reflects how referral patterns develop, and it didn't come about because of any special talent. It was the result of good communication and efficient work. Agree with above--affability and availability far outweigh ability, though of course you don't want to be incompetent.

 

[fiatlux]

anyone going to SIR in SF this year?

 

[SteadyEddy]

Pure rubbish. I am a senior vascular fellow and I find that collaboration with other interventionalists is helpful. Those fellows are pretty skilled at the diagnostic interventional stuff and have taught me a thing or too. If you up and comers cant figure out how to collaborate and have other doctors backs, you will end up making 150k while some yahoo with an associates degree is making the big bucks. Peace