IR job description, lifestyle, and procedures.

[Adrenaline Junky]

Hello, hope everyone is well. I used to search function and nothing about IR came up only DR however I was curious as to what Interventional Radiologists do procedure and non procedure wise as well as lifestyle and just a general job description.
Thank you for all your feedback!

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[irwarrior]

It depends on your practice. 100 percent clinical VIR practices are busy. I do about a day to 1.5 days of clinic and procedures a couple days of week. Mix of procedures including vascular/PAD/DVT/filters. Oncology TACE/Ablations. Fibroid therapy /UAE. Dialysis work (tunneled lines/fistula maturation/PD catheters). Biopsies and drainage procedures. When on call/inpatient do more of the gastrostomy tubes and abscess drains.

More of a surgical lifestyle with unpredictable hours . Early procedure times so round before procedures come in by 7 am or earlier. Stay as late as it takes to finish my cases or clinic patient charting (at least 6 or 7 pm and often later the days you are doing procedures). On call is busy given number of urgent/emergent cases. PE/DVT lysis, GI bleeding, traumas, hemoptysis, urgent cholecystostomy, urgent abscess drains, urgent chest tubes, urgent nephrostomy, urgent dialysis interventions and lines. Acute limb ischemia patients etc. Many peripheral IR are doing stroke work and the indications have expanded making them even busier. So, it has progressively become a busier and busier service with more emergency indications.

 

[Adrenaline Junky]

It depends on your practice. 100 percent clinical VIR practices are busy. I do about a day to 1.5 days of clinic and procedures a couple days of week. Mix of procedures including vascular/PAD/DVT/filters. Oncology TACE/Ablations. Fibroid therapy /UAE. Dialysis work (tunneled lines/fistula maturation/PD catheters). Biopsies and drainage procedures. When on call/inpatient do more of the gastrostomy tubes and abscess drains.

More of a surgical lifestyle with unpredictable hours . Early procedure times so round before procedures come in by 7 am or earlier. Stay as late as it takes to finish my cases or clinic patient charting (at least 6 or 7 pm and often later the days you are doing procedures). On call is busy given number of urgent/emergent cases. PE/DVT lysis, GI bleeding, traumas, hemoptysis, urgent cholecystostomy, urgent abscess drains, urgent chest tubes, urgent nephrostomy, urgent dialysis interventions and lines. Acute limb ischemia patients etc. Many peripheral IR are doing stroke work and the indications have expanded making them even busier. So, it has progressively become a busier and busier service with more emergency indications.

Thank you for your response it was extremely helpful, I apologize for my ignorance but is IR becoming more of an acute care setting vs chronic and scheduled procedures?

 

[irwarrior]

My outpatient clinic is where I see my patients that get scheduled elective procedures. I would say that for my personal practice it is 80 percent outpatient and 10 to 20 percent inpatient (mostly on my call weeks).

 

[Adrenaline Junky]

My outpatient clinic is where I see my patients that get scheduled elective procedures. I would say that for my personal practice it is 80 percent outpatient and 10 to 20 percent inpatient (mostly on my call weeks).

Thank you, I am definitely going to delve further into IR and look at its competitiveness. Thank you again for taking the time to educate me.

 

[qxrt]

IR is very busy. As a fellow, I have no time many if not most days to go to the cafeteria to get lunch (usually just skip or bring a granola bar), nor do I have time to answer personal phone calls or emails during the work day. This is the complete opposite to DR, where I would just take random walks around the hospital every hour or so just because I could. There is a reason most DR residents initially interested in IR ultimately decide not to do it. It's not conducive to a lifestyle where you can take a minute or two off any time to deal with personal business during the work day, nor as relaxing. That said, I would not change my subspecialty at all...I like the work and feel like I'm just playing video games in the angio suite each day.

 

[Adrenaline Junky]

IR is very busy. As a fellow, I have no time many if not most days to go to the cafeteria to get lunch (usually just skip or bring a granola bar), nor do I have time to answer personal phone calls or emails during the work day. This is the complete opposite to DR, where I would just take random walks around the hospital every hour or so just because I could. There is a reason most DR residents initially interested in IR ultimately decide not to do it. It's not conducive to a lifestyle where you can take a minute or two off any time to deal with personal business during the work day, nor as relaxing. That said, I would not change my subspecialty at all...I like the work and feel like I'm just playing video games in the angio suite each day.

Would you say IR is very fast paced with a mix of mostly high acuity patients along with scheduled procedures?

 

[qxrt]

I am at a large academic medical center. Less than half of cases tend to be semi-high to high acuity (iliocaval thrombus, GI/trauma/post-partum bleeds, pulmonary emboli, etc.), while the rest are composed of smaller cases like tunneled lines and nonemergent cases such as uterine fibroid embolization and liver tumor embolizations. At smaller hospitals, procedures probably skew even more towards non-urgent stuff. It is fast paced in the sense that experienced IRs can definitely get through numerous cases pretty quickly, with relatively little downtime between cases.

 

[Adrenaline Junky]

I am at a large academic medical center. Less than half of cases tend to be semi-high to high acuity (iliocaval thrombus, GI/trauma/post-partum bleeds, pulmonary emboli, etc.), while the rest are composed of smaller cases like tunneled lines and nonemergent cases such as uterine fibroid embolization and liver tumor embolizations. At smaller hospitals, procedures probably skew even more towards non-urgent stuff. It is fast paced in the sense that experienced IRs can definitely get through numerous cases pretty quickly, with relatively little downtime between cases.

Thank you for your response, it is greatly appreciated.

 

[UChicagoIR]

IR FAQ:

FAQ

 

[Adrenaline Junky]

IR FAQ:

FAQ

Thank you!

 

[SeldingerFan78]

Check out the Resident Fellow Student (RFS) section of SIR's website. I don't have link privileges yet, so just Google it. They have an introduction to IR, info on away rotations, IR residency application advice, et cetera.

 

[Adrenaline Junky]

Check out the Resident Fellow Student (RFS) section of SIR's website. I don't have link privileges yet, so just Google it. They have an introduction to IR, info on away rotations, IR residency application advice, et cetera.

Thank you

 

[meister]

The guys above who described 100% IR type jobs with tons of vascular are not really your average IR job. A private practice IR may do zero vascular work and spend days on dialysis interventions and biopsies/drainages/PCN. Smaller hospitals tend to be more like this. The job is almost entirely dependent on local referral patterns, hospital size and subspecialty presence. It is a very, very unique field in that sense. Academic jobs at big centers will usually be 100% IR.

 

[Adrenaline Junky]

The guys above who described 100% IR type jobs with tons of vascular are not really your average IR job. A private practice IR may do zero vascular work and spend days on dialysis interventions and biopsies/drainages/PCN. Smaller hospitals tend to be more like this. The job is almost entirely dependent on local referral patterns, hospital size and subspecialty presence. It is a very, very unique field in that sense. Academic jobs at big centers will usually be 100% IR.

Thank you for clearing that up, so I’m assuming like other specialities your day to day practice style varies on area and whether you’re private practice, community hospital, or academic.

 

[tco]

This can't be completely described in words because it's so variable.

The best way to think of it as a layperson is that we are imaging experts who are trying to establish ourselves in a clinical field by performing surgeries through a needle puncture. The surgeries can be as simple as putting in lines or drains, or as complex as recanalization of large vessels like the SVC, restoring blood flow to the lower extremities, or treating cancers by burning/freezing/or embolizing them. Some IR do a lot of diagnostic reading and a little interventions, some do a lot of interventions and a little diagnostics, some do no diagnostics. Some IR do a lot of PVD work, some do a little, and some do none. It's all so highly variable.

 

[qwerty89]

IR is very busy. As a fellow, I have no time many if not most days to go to the cafeteria to get lunch (usually just skip or bring a granola bar), nor do I have time to answer personal phone calls or emails during the work day. This is the complete opposite to DR, where I would just take random walks around the hospital every hour or so just because I could. There is a reason most DR residents initially interested in IR ultimately decide not to do it. It's not conducive to a lifestyle where you can take a minute or two off any time to deal with personal business during the work day, nor as relaxing. That said, I would not change my subspecialty at all...I like the work and feel like I'm just playing video games in the angio suite each day.

You should add the disclaimer that DR residency is generally easier than the typical private practice job. Diagnostic radiology generally gets harder as you move from resident to attending which is the opposite of many other fields.
On the flip side I doubt the average Miami Vascular fellow will work as many hours a week as an attending as they did a fellow.

 

[Adrenaline Junky]

You should add the disclaimer that DR residency is generally easier than the typical private practice job. Diagnostic radiology generally gets harder as you move from resident to attending which is the opposite of many other fields.
On the flip side I doubt the average Miami Vascular fellow will work as many hours a week as an attending as they did a fellow.

What's the reasoning behind DR becoming harder when you become an attending?

 

[qwerty89]

What's the reasoning behind DR becoming harder when you become an attending?

Significantly higher volume, at least for private practice. No attending checkouts or noon conference. Just read scans at a fast pace all day +/- intermittent procedures.

 

[tco]

You should add the disclaimer that DR residency is generally easier than the typical private practice job. Diagnostic radiology generally gets harder as you move from resident to attending which is the opposite of many other fields.
On the flip side I doubt the average Miami Vascular fellow will work as many hours a week as an attending as they did a fellow.

The average Miami Vascular fellow isn't the average fellow.

 

[Adrenaline Junky]

The average Miami Vascular fellow isn't the average fellow.

Agreed

 

[badasshairday]

I have to agree with meister. Quite variable esp in pp. As a new attending in pp we cover a small community hospital and a large one. At both hospitals most of the cases are straightforward. In the small hospital i read and do procedures in between (para, thora , drain, biopsies, pcn, occasion venous access, rare IVC filter, rare visceral/mesenteric angio). Mostly biopsy and drain 90% of the cases. At the larger hospital i do 100% IR and no diagnostic duties because it is much busier and I'm often jumping between angio , us, ct procedures (lines, PAD, acute limb ischemia, gi bleed angio, ivc filter lots of biopsies, drains, UAE, fistulas, and now we are starting ablations and Tace).

 

[Adrenaline Junky]

I have to agree with meister. Quite variable esp in pp. As a new attending in pp we cover a small community hospital and a large one. At both hospitals most of the cases are straightforward. In the small hospital i read and do procedures in between (para, thora , drain, biopsies, pcn, occasion venous access, rare IVC filter, rare visceral/mesenteric angio). Mostly biopsy and drain 90% of the cases. At the larger hospital i do 100% IR and no diagnostic duties because it is much busier and I'm often jumping between angio , us, ct procedures (lines, PAD, acute limb ischemia, gi bleed angio, ivc filter lots of biopsies, drains, UAE, fistulas, and now we are starting ablations and Tace).

Thank you for the insight I appreciate it.

 

[TCOM12]

Non IR in a private practice, but had a decent interest in it as a resident before I chose neuro. Most of the IR people I know went into private practice.

The IR people here (880 bed hospital in a midwest catch area and the nearest academic center is 3-4 hours away) do mostly filters, declots, embolizations, trauma. They also do CT guided ablations. Some do TACE and Y90. They also do kyphos (which some places don't train IR to do... at my former institution, the spine work was done by neurosurgery). In addition to whatever procedure work, they read some general diagnostic stuff-- radiographs, body and extremity CTA, etc.

What isn't always understood is that private practices usually have to subsidize IR because their RVU production is lower (some cases take forever...). We have a multiplier to make them look like they produce as much. It's generally fair, though, since they take a lot more call.

In DR, the volume gets higher as you transition to attending status. But that's the point of building a good search pattern and seeing a lot of cases in residency so your eye picks up on things. I read 150-180 cases per day, up to 80 cross sectional, over 7 hours.

If procedures are your thing, you can go to a private practice where you do a lot of procedures that are non-vascular or basic vascular (ports and the like) as a DR. Mammo also has a lot of procedure work and patient care if that's what you're looking for.

Another thing to think about is that most of the cool things in any niche field are done in academics, so you have to be okay with that.

My thoughts on residency choices...don't do direct IR. Go to a good place with ESIR and a strong IR program or take the extra year and do the fellowship. I'm not saying don't do IR. I'm saying that things may change and you may like DR better or maybe not think IR is as cool as a trainee as you did as a medical student. If you do the direct path and don't like it, you have to switch residencies (different ACGME funding for a separate residency). A lot of the kinks of that haven't really been seen since the new direct pathway hasn't really encountered that problem yet.

Good luck choosing a subspecialty. IMO you've already made a step in the right direction thinking of playing around with XRays (whether at the PACS station or the fluoro suite).

 

[Adrenaline Junky]

Non IR in a private practice, but had a decent interest in it as a resident before I chose neuro. Most of the IR people I know went into private practice.

The IR people here (880 bed hospital in a midwest catch area and the nearest academic center is 3-4 hours away) do mostly filters, declots, embolizations, trauma. They also do CT guided ablations. Some do TACE and Y90. They also do kyphos (which some places don't train IR to do... at my former institution, the spine work was done by neurosurgery). In addition to whatever procedure work, they read some general diagnostic stuff-- radiographs, body and extremity CTA, etc.

What isn't always understood is that private practices usually have to subsidize IR because their RVU production is lower (some cases take forever...). We have a multiplier to make them look like they produce as much. It's generally fair, though, since they take a lot more call.

In DR, the volume gets higher as you transition to attending status. But that's the point of building a good search pattern and seeing a lot of cases in residency so your eye picks up on things. I read 150-180 cases per day, up to 80 cross sectional, over 7 hours.

If procedures are your thing, you can go to a private practice where you do a lot of procedures that are non-vascular or basic vascular (ports and the like) as a DR. Mammo also has a lot of procedure work and patient care if that's what you're looking for.

Another thing to think about is that most of the cool things in any niche field are done in academics, so you have to be okay with that.

My thoughts on residency choices...don't do direct IR. Go to a good place with ESIR and a strong IR program or take the extra year and do the fellowship. I'm not saying don't do IR. I'm saying that things may change and you may like DR better or maybe not think IR is as cool as a trainee as you did as a medical student. If you do the direct path and don't like it, you have to switch residencies (different ACGME funding for a separate residency). A lot of the kinks of that haven't really been seen since the new direct pathway hasn't really encountered that problem yet.

Good luck choosing a subspecialty. IMO you've already made a step in the right direction thinking of playing around with XRays (whether at the PACS station or the fluoro suite).

Thank you so much for the feedback!

 

[deleted674723]

Non IR in a private practice, but had a decent interest in it as a resident before I chose neuro. Most of the IR people I know went into private practice.

The IR people here (880 bed hospital in a midwest catch area and the nearest academic center is 3-4 hours away) do mostly filters, declots, embolizations, trauma. They also do CT guided ablations. Some do TACE and Y90. They also do kyphos (which some places don't train IR to do... at my former institution, the spine work was done by neurosurgery). In addition to whatever procedure work, they read some general diagnostic stuff-- radiographs, body and extremity CTA, etc.

What isn't always understood is that private practices usually have to subsidize IR because their RVU production is lower (some cases take forever...). We have a multiplier to make them look like they produce as much. It's generally fair, though, since they take a lot more call.

In DR, the volume gets higher as you transition to attending status. But that's the point of building a good search pattern and seeing a lot of cases in residency so your eye picks up on things. I read 150-180 cases per day, up to 80 cross sectional, over 7 hours.

If procedures are your thing, you can go to a private practice where you do a lot of procedures that are non-vascular or basic vascular (ports and the like) as a DR. Mammo also has a lot of procedure work and patient care if that's what you're looking for.

Another thing to think about is that most of the cool things in any niche field are done in academics, so you have to be okay with that.

My thoughts on residency choices...don't do direct IR. Go to a good place with ESIR and a strong IR program or take the extra year and do the fellowship. I'm not saying don't do IR. I'm saying that things may change and you may like DR better or maybe not think IR is as cool as a trainee as you did as a medical student. If you do the direct path and don't like it, you have to switch residencies (different ACGME funding for a separate residency). A lot of the kinks of that haven't really been seen since the new direct pathway hasn't really encountered that problem yet.

Good luck choosing a subspecialty. IMO you've already made a step in the right direction thinking of playing around with XRays (whether at the PACS station or the fluoro suite).

With integrated residencies for IR, aren't the vast majority of IR fellowships closing? Is it still possible if applying in the next couple years to do DR residency with the possibility of an IR fellowship?

 

[TheRealDrDorian]

You will be able to apply to IR "fellowships" through a DR residency, but they are now referred to as "Independent IR Residencies."

More information: Society of Interventional Radiology- Independent IR residency

 

[kouzasmith]

It depends on your practice. 100 percent clinical VIR practices are busy. I do about a day to 1.5 days of clinic and procedures a couple days of week. Mix of procedures including vascular/PAD/DVT/filters. Oncology TACE/Ablations. Fibroid therapy /UAE. Dialysis work (tunneled lines/fistula maturation/PD catheters). Biopsies and drainage procedures. When on call/inpatient do more of the gastrostomy tubes and abscess drains.

More of a surgical lifestyle with unpredictable hours . Early procedure times so round before procedures come in by 7 am or earlier. Stay as late as it takes to finish my cases or clinic patient charting (at least 6 or 7 pm and often later the days you are doing procedures). On call is busy given number of urgent/emergent cases. PE/DVT lysis, GI bleeding, traumas, hemoptysis, urgent cholecystostomy, urgent abscess drains, urgent chest tubes, urgent nephrostomy, urgent dialysis interventions and lines. Acute limb ischemia patients etc. Many peripheral IR are doing stroke work and the indications have expanded making them even busier. So, it has progressively become a busier and busier service with more emergency indications.

Hi,
I am a radiologist graduated over seas, I have 2 years experience in IR, I want to ask you about mistakes, and complication that sometimes happened during procedures, often are unpredictable, other times are due to burnout. In my home country, patient rarely tend to file a lawsuit, pursuits, how is the trend here in the U.S?
thank you.

 

[19pieces19]

Non IR in a private practice, but had a decent interest in it as a resident before I chose neuro. Most of the IR people I know went into private practice.

The IR people here (880 bed hospital in a midwest catch area and the nearest academic center is 3-4 hours away) do mostly filters, declots, embolizations, trauma. They also do CT guided ablations. Some do TACE and Y90. They also do kyphos (which some places don't train IR to do... at my former institution, the spine work was done by neurosurgery). In addition to whatever procedure work, they read some general diagnostic stuff-- radiographs, body and extremity CTA, etc.

What isn't always understood is that private practices usually have to subsidize IR because their RVU production is lower (some cases take forever...). We have a multiplier to make them look like they produce as much. It's generally fair, though, since they take a lot more call.

In DR, the volume gets higher as you transition to attending status. But that's the point of building a good search pattern and seeing a lot of cases in residency so your eye picks up on things. I read 150-180 cases per day, up to 80 cross sectional, over 7 hours.

If procedures are your thing, you can go to a private practice where you do a lot of procedures that are non-vascular or basic vascular (ports and the like) as a DR. Mammo also has a lot of procedure work and patient care if that's what you're looking for.

Another thing to think about is that most of the cool things in any niche field are done in academics, so you have to be okay with that.

My thoughts on residency choices...don't do direct IR. Go to a good place with ESIR and a strong IR program or take the extra year and do the fellowship. I'm not saying don't do IR. I'm saying that things may change and you may like DR better or maybe not think IR is as cool as a trainee as you did as a medical student. If you do the direct path and don't like it, you have to switch residencies (different ACGME funding for a separate residency). A lot of the kinks of that haven't really been seen since the new direct pathway hasn't really encountered that problem yet.

Good luck choosing a subspecialty. IMO you've already made a step in the right direction thinking of playing around with XRays (whether at the PACS station or the fluoro suite).

Why did you decide against IR? I'm a med student very interested in the field.