IR Job Market?

[MouseChair]

Can anyone give some real world insight into IR job market?

I know there are lots of factors (academics, PP, hybrid etc, 100% IR vs IR/DR mix). Would like to hear all options (pay/vacation too) if possible.

thanks!

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[irwarrior]

Can anyone give some real world insight into IR job market?

I know there are lots of factors (academics, PP, hybrid etc, 100% IR vs IR/DR mix). Would like to hear all options (pay/vacation too) if possible.

thanks!

There are more DR jobs than IR jobs. Most jobs currently are mixed practices under radiology with around 50/50 split mostly doing minor procedures biopsies, vascular access and fluid management including paracentesis/thoracentesis etc. You will also se the occasional bleeder in these types of practices and occasional fibroid/prostate/oncology case. DR practices who hire IR provide great compensation and lots of vacation, but the DR subsidizes the IR salary. IR may be asked in these practices to do even minor procedures (arthrograms, lp, joint aspirations/injections, and some places GI Fluoro ).

The 100 pct IR jobs are growing in number and percentage, but challenges are that you have to have an office to see patients and a deeper understanding of clinical medicine than is currently taught at many IR training program. Also, to succeed in 100 pct VIR practices you need to get comfortable with PAD,dialysis work, varicose vein treatments , DVT/PE and spine work and potentially stroke work. Many IR training programs don't have those service lines covered and even those who do, the trainees don't have enough exposure to a true clinic (ie a consult clinic not pre-op /post op clinic) making it a challenge for graduates to go out and compete for those referrals.

These 100 pct IR jobs will often have far less vacation and compensation will be more similar to a procedural /surgical field (Cardiology/vascular surgery). If you have an ASC/OBL every week that is off is just cost (overhead costs/ staff ) and no revenue (no procedures/ no clinic visits) . Also, if you are not available to referring or patients the competition may change referral patterns during your absence.

It is harder to get hospital privileges for IR due to "pseudo"exclusive contracts where even if DR groups don't provide high end interventional services (PAD, DVT/PE,stroke, dialysis, spine interventions/fibroids/prostates/geniculars etc) they will prevent an independent IR from practicing in the hospital to prevent competition and risk to the DR contract.

Steps the SIR Can Take to Improve the Ability for Independent Interventional Radiologists to Obtain Hospital Privileges. – Line Monkey MD

linemonkeymd.com

 

[NDcienporciento100]

Agree with the above. Couple things I have noticed.
50/50 or less Jobs: these groups will want you to do as little IR as possible. They will tell you when you interview “oh yeah” “build it up the way you want it”. Translation: you are here for one reason and one reason only to check a box to keep are Hospital contract. You want to do IVC recanalization procedures. Sure! Just know we look at RVUs and IVC recanalization procedures don’t pay that much for 5 hours of work. You’re probably the only person in the group trained in modern IR. Your ir call will be split with a DR whose idea of IR is doing diagnostic aortograms to rule out aortic dissection when they were a radiology resident in 1995. They won’t want to learn how to do PE Thrombectomys or other complex things on call. That means the service will have no consistency and the referring providers will notice and not want to consult IR.

70/30 split jobs: it probably won’t be complete crap like the above. But probably no clinic. May or may not have consistency between your IR partners. Your DR partners will probably still hate you because you’re not making as many RVUs as they are. They will push you to read as much in between cases as humanly possible. You can probably build a service you’re interested in but that takes time, talking with referring providers and will not sound very appealing when you have a lot of pressure from your partners to read more. You will try to explain that if you take time to speak with referring providers that will pay dividends down the road but they won’t care.

>90% IR: There are a few power house groups still combined with DR that are like this. Northern Virginia group is one shining example and there are others. No surprise all these groups do highend work that pay higher RVUs. All the IRs in the group have the skill set to maintain consistency of the service. You will have a clinic +- OBL. You will be encouraged to build your practice. Your DR will likely be limited to vascular us and maybe CTA runoffs. Alternatively your in academics doing 100% IR is very common in academics and less pressure to produce RVUs. Or you’re in an OBl doing 100% IR. You better know PAD, Venous disease, pain management, Fibroids, PAE etc. You won’t have back up in many cases in an obl so you better keep your complications low. Better be extremely good with managing patients. You better be extremely good with working with referring providers.

Pick your poison wisely!

 

[NDcienporciento100]

Hospital employed IR. Not that common outside academia actually. But it is not that bad of a deal. The hospital will be incentivized to have you do higher end work because it makes them money. It will be easier to get clinic. The salary will be as good or better then for example a private equity job. Much more likely to give you 100% IR.

 

[NDcienporciento100]

Private Equity: what I consider the worst thing for IR period. And DR as well really. Lose, lose, loser! The PE firm only cares about money and they make more of it when you are not doing IR. They want you to do the minimum to keep the hospital administrator that renews their contract happy. The hospital also does not care in many scenarios and in fact in some cases they don’t want you to build a practice. PAD for example if they employee IC or VS they will want those cases going to their employees. As said previously Lose, lose, loser! These are the worst IR jobs period in my opinion.

 

[irwarrior]

The key to sustainability for VIR is to manage diseases comprehensively in an outpatient clinic with referrals from primary care and diet patient marketing, this often requires an OBL/ASC so that you can book your cases electively. The challenge with the hospital is that you often are inundated with fluid management (paracentesis/thoracentesis/lp/joint aspirations), drains (abscess, gallbladder, chest tubes, g tubes) , biopsies ( that historically all radiologists would perform), diagnostic minor procedures (arthrograms/myelograms/ sometimes even GI fluoro). There are so many add ons to the IR schedule that is hard to schedule your elective cases. Things that you can get in the inpatient side include stroke, PE/DVT/ GI bleedres/ trauma . Even in the hospital setting it is key to get dedicated time to build your practice and give talks to physicians and grow your elective referral practice (AV fistula creation and maintenance/ PAD/ fibroids/ prostate / knee osteoarthritis/spine interventions). This requires a considerable amount of clinic time , clinic volume and infrastructure. Most radiology groups and even hospitals will not readily give that to the budding vascular interventionalist. Convincing the powers that be DR groups and private equity that clinic is important is very challenging. If you are a hospital employee or part of a multi specialty group (vascular surgery/cardiology/nephrology/podiatry etc) they are much more inclined to provide this as it is part of their culture. Current VIR training is limited in how much clinic you do, often the clinical work is delegated to extenders and the trainees don't learn any of it and are only able to do procedures and so when they graduate they struggle with knowing who to treat or why to treat and what perioperative management and follow up entails.

 

[Shunsui]

The key to sustainability for VIR is to manage diseases comprehensively in an outpatient clinic with referrals from primary care and diet patient marketing, this often requires an OBL/ASC so that you can book your cases electively. The challenge with the hospital is that you often are inundated with fluid management (paracentesis/thoracentesis/lp/joint aspirations), drains (abscess, gallbladder, chest tubes, g tubes) , biopsies ( that historically all radiologists would perform), diagnostic minor procedures (arthrograms/myelograms/ sometimes even GI fluoro). There are so many add ons to the IR schedule that is hard to schedule your elective cases. Things that you can get in the inpatient side include stroke, PE/DVT/ GI bleedres/ trauma . Even in the hospital setting it is key to get dedicated time to build your practice and give talks to physicians and grow your elective referral practice (AV fistula creation and maintenance/ PAD/ fibroids/ prostate / knee osteoarthritis/spine interventions). This requires a considerable amount of clinic time , clinic volume and infrastructure. Most radiology groups and even hospitals will not readily give that to the budding vascular interventionalist. Convincing the powers that be DR groups and private equity that clinic is important is very challenging. If you are a hospital employee or part of a multi specialty group (vascular surgery/cardiology/nephrology/podiatry etc) they are much more inclined to provide this as it is part of their culture. Current VIR training is limited in how much clinic you do, often the clinical work is delegated to extenders and the trainees don't learn any of it and are only able to do procedures and so when they graduate they struggle with knowing who to treat or why to treat and what perioperative management and follow up entails.

If you were a medical student today & knew everything you know now, would you still pursue IR?

 

[irwarrior]

Great question. Probably, as I do like the diversity and minimally invasive nature of the field and once you establish a clinic and have a referral stream it is great field. But, I may have chosen my training program differently and sought earlier mentorship from clinically driven VIR physicians with successful 100 percent practices earlier on as well.

 

[irwarrior]

Once you establish a clinic and gain deeper understanding of disease and follow patients longitudinally, the field gets even more interesting and exciting as you develop greatly as a clinician with outpatient clinics, admitting your own patients and doing formal consults as opposed to taking order entry. But, to achieve that a current trainee (given lack of clinical training integrated into the current residency) and graduate (lack of dedicated time to run clinics and clinical infrastructure) has to overcome a great deal of barriers and hurdles.