IR Residency - Outlook in 2020

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JPSmyth

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Society of Interventional Radiology- IR Residency

It seems from browsing the SIR site that once these new changes are implemented in 2020, hopefully IR residencies and ESIR+IR residency/fellowships will become less competitive? Apparently the most recent match had 300 people applying for 100 IR spots which is insane.

Any current residents/attendings, do you think that more IR spots will open up within the next 4 years? How does the future look for IR spots in your projections?

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There will not be more IR spots opening up. The current number fellowship match has around 250 applicants for 240 spots. However, once the ultimate IR training becomes 1.8 years (current R4 plus IR year) rather than just IR year (my fellowship year), you no longer have capacity to train the same amount of trainees.

For example, say Man's greatest hospital has 8 spots per year right now each year, but now suddenly has a residency, and 14-16 residents need to rotate on IR each year (R4 and IR year), there won't be enough cases to support the original 8 per year quota. So instead of 8 per year there will be 4 per year since there will be 8 resident total now per year on service.

I personally think we'll end up with around 150 integrated spots and 30-50 independent residencies.

My year will probably be the last year where match rate remains higher than 90% (92% this year).
 
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There will not be more IR spots opening up. The current number fellowship match has around 250 applicants for 240 spots. However, once the ultimate IR training becomes 1.8 years (current R4 plus IR year) rather than just IR year (my fellowship year), you no longer have capacity to train the same amount of trainees.

For example, say Man's greatest hospital has 8 spots per year right now each year, but now suddenly has a residency, and 14-16 residents need to rotate on IR each year (R4 and IR year), there won't be enough cases to support the original 8 per year quota. So instead of 8 per year there will be 4 per year since there will be 8 resident total now per year on service.

I personally think we'll end up with around 150 integrated spots and 30-50 independent residencies.

My year will probably be the last year where match rate remains higher than 90% (92% this year).

Ah thanks for explaining. So IR will be become and remain hyper competitive for the foreseeable future, comparable to derm ortho ENT neurosurg plastics etc?
 
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Ah thanks for explaining. So IR will be become and remain hyper competitive for the foreseeable future, comparable to derm ortho ENT neurosurg plastics etc?

Hard to say. It will have to do with reimbursement and job market opportunities.

I do think our leadership is correct in maintaining the subspeciality as a competitive one.

Just a few years ago, the field was so forgotten that places like UPMC shut down its fellowship and even Mt Sinai couldn't match a USMD graduate when I was a visiting student there.

Keep our specialty competitive, and the smart people will come. They will in turn make our specialty even more attractive.
 
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Hard to say. It will have to do with reimbursement and job market opportunities.

I do think our leadership is correct in maintaining the subspeciality as a competitive one.

Just a few years ago, the field was so forgotten that places like UPMC shut down its fellowship and even Mt Sinai couldn't match a USMD graduate when I was a visiting student there.

Keep our specialty competitive, and the smart people will come. They will in turn make our specialty even more attractive.

I understand the logic, but just concerned that I won't be able to match when the time comes. I'll see how step 1 goes and re evaluate. Thanks
 
I understand the logic, but just concerned that I won't be able to match when the time comes. I'll see how step 1 goes and re evaluate. Thanks

No need to worry just yet. IR value interest and connection a lot more than many other specialty do. What you can do now is to look into participating in the resident fellow student section of society of interventional radiology and do IR research.
 
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Just a few years ago, the field was so forgotten that places like UPMC shut down its fellowship and even Mt Sinai couldn't match a USMD graduate when I was a visiting student there.

Hmm...you do realize that Mt Sinai matched a Caribbean IMG just this past match (Don't take my word for it, check the St. Luke's Roosevelt radiology residents page)? As well as places like MUSC and BID matched DOs recently? There were still many more fellowship spots than USMD applicants even during the most competitive match years. There's only slightly more applicants than positions if you include all comers, including USMDs, DOs, IMGs, and FMGs.
 
Hmm...you do realize that Mt Sinai matched a Caribbean IMG just this past match (Don't take my word for it, check the St. Luke's Roosevelt radiology residents page)? As well as places like MUSC and BID matched DOs recently? There were still many more fellowship spots than USMD applicants even during the most competitive match years. There's only slightly more applicants than positions if you include all comers, including USMDs, IMGs, and FMGs.

Well, supposedly one of the FMG who matched to one of the top IR fellowship is the president of SIR RFS section and have multiple big names calling for him.

SLR have mt sinai IR attendings rotating with them.

Like I said, who you know is very important in IR. I have pretty good step 1 and research but I matched far better than my friend who has more research them me, probably partly due to some influential people who knows me.
 
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Yep...it's interesting. Probably no better way to become an IR fellow at MCW or Rush than being a radiology resident there and making those direct connections...yet probably much harder to match to a DR residency at the "bigger names" in town like UWisconsin or Northwestern than the aforementioned's DR residency counterparts. It will be interesting to see how the integrated IR/DR residency will change how med students decide to rank these programs. I predict an upswing in competition for brand names where a traditionally strong DR residency can boost the associated IR program, since they are now tied together. And since it is generally common wisdom to do fellowship where you want to practice in most cases, those brand names in desirable locations will benefit the most.
 
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Yep...it's interesting. Probably no better way to become an IR fellow at MCW or Rush than being a radiology resident there and making those direct connections...yet probably much harder to match to a DR residency at the "bigger names" in town like UWisconsin or Northwestern than the aforementioned's DR residency counterparts. It will be interesting to see how the integrated IR/DR residency will change how med students decide to rank these programs. I predict an upswing in competition for brand names where a traditionally strong DR residency can boost the associated IR program, since they are now tied together. And since it is generally common wisdom to do fellowship where you want to practice in most cases, those brand names in desirable locations will benefit the most.

I agree. Was talking with my buddy the other day and we agreed the current king for the best of both world is U Penn.

It's interesting that in IR the best training and the best name recognition currently don't intersect. Words on the street is that BWH/MGH and UCSF are not the best in training nor are the programs with the best training like Rush or MCW biggest names.
 
@DrfluffyMD one more quick question about ESIR programs. It says on the SIR site that the DR residency will have 12 IR-related rotations mixed in and the resident will do >500 procedures. How long are rotations in residency usually, 1 month? 2 weeks? 2 months? I'm sure it varies but would you be able to give an example of some specific IR rotations that you did/will do?
 
@DrfluffyMD one more quick question about ESIR programs. It says on the SIR site that the DR residency will have 12 IR-related rotations mixed in and the resident will do >500 procedures. How long are rotations in residency usually, 1 month? 2 weeks? 2 months? I'm sure it varies but would you be able to give an example of some specific IR rotations that you did/will do?

So as a DR resident right now, we do 1 month of IR a year. I will do an additional 9 month of IR this year to satisfy the ESIR requirement though it is not mandated for my class.

To fit the ESIR requirement the residency must be large enough to support an R4 in doing 9 month of IR, which preclude smaller programs from achieving that certification.

As far as 500 procedures, the current ACGME requirement for an IR fellowship is 500 procedures in one year. Most IR fellowship go above 700, the busier ones over 1500 (my future fellowship is one of those).

Things I did durig residency include Tips as an assistant, cholecystostomy, percutaneous nephrostomy, suprapubic cath placenent trauma embolization, abscess drainage, ultrasound and CT guided biopsy, central line placement, mediport placement and g tube placement.

I think the technical ability a resident should strive for is to be able to independently do everything with the exception of IO procedures such as tace/Y90, PAD work including women's interventions, dialysis work, and complex heptobiliary work.

This means you should be able to independently do (with attending outside)
- lines
- mediport
- simple biopsy
- CT guided biopsy or drain in a straight forward case
- gastrostomy tube
- suprapubic cath
- nephrostomy

Perform with attending guidance from control console
- venous work including central venous angioplasty
- femoral artery access
- initial part of the TIPs before you start making the porto-systemic tract
- IVC filter deployment

This is a nonexhaustive list of course, but I think those technical skills are preferred for someone entering fellowship now days.
 
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