Life of an IR

[werewethere]

For people who are in IR, whether attending, fellow, resident, or student:
How did you become or are becoming an IR?
What type of procedures do you do or have you seen done? What type of IR are you?
Do you have a favorite case to share?
Do you have clinic?
Do you do diagnostic radiology work as well?
How do you work with other clinicians?
How do you deal with turf battles?
Have you seen your SO or children recently?
How hard is it to get a good job in IR?
Are you worried about the radiation exposure leading to cancer and cataracts? Worried about being able to have children?
Most importantly, how does your back feel after a day with all that lead on?

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[Gvataken]

For people who are in IR, whether attending, fellow, resident, or student:
How did you become or are becoming an IR?

I became an IR through the traditiona path. 1 year of internal medicine , 4 years of diagnostic imaging and a year long fellowship. Then I joined a nurturing IR practice that gave me additional technical skills

What type of procedures do you do or have you seen done? What type of IR are you?

I have developed a primary interest in vascular disease (aortic interventions/percutaneous endografts for abdominal, thoracic, and iliac aneurysms; peripheral vascular disease including claudicants and critical limb ischemia (wound care/rest pain). I also do a fair amount of intervetional oncology including endovascular treatment of tumors and ablation of tumors (RFA/burning tumors; cryoablation/freezing tumors)

But,I do the bulk of general ir including biopsies, drains and venous access.

Do you have a favorite case to share?

There are so many; where to start.
well last week on monday I removed a fractured filter fragment that had migrated to the right ventricle.
Wednesday I treated and abdominal aortic aneurysm with a purely percutaneous approach using a new graft endologix which sits on the aorti bifurcation.
Saturday I had a patient with complete IVC thrombosis and femoral/popliteal thrombus with an IVC filter in situ. I was able to perform pharmacomechanical thrombectomy using a special device called the trellis device.

So I had a great week of fun cases which each had great impact on the patient.

Do you have clinic?
Yes. Usually a 1/2 day a week. Last week I had a day and a 1/2 of clinic for overflow. I see about 10-15 patients a week on average in clinic and have followed some of my patients for 4 or 5 years. You end up developing quite a strong bond with your patients and their families. Part of the practice I truly enjoy.

Do you do diagnostic radiology work as well?
Some, but as my IR practice has gotten busier I have had to cut down on diagnostics.

How do you work with other clinicians?
I get along with most of my clinical colleagues.

How do you deal with turf battles?

I feel it is just like multiple specialties doing plastics (derm, oculoplastics, plastic surgery and many fields doing botox etc)
Neurosurgery, ortho, pmr and anesthesia , and IR all doing some pain interventions and spine work.
Multiple specialties do vascular (vascular surgery, cardiology, vascular medicine, IR)

I think it is healthy to have competition and as many disciplines are involved it moves that field of disease foward faster. I have learned a great deal from my vascular surgery and cardiology colleagues.
To have a thriving practice you need to go build it.
Get your own patients. Give talks. Befriend primary care.

Teach your radiologists about IR. I got a consult for a AAA from one of my residents who I saw in the office on Friday and I got a referral for a pulmonary AVM from one of the other radiologists that I will see in the office.

Being available and affable is critical. Knowing your disease and being a solid clinician who takes care of the patient and that means seeing them in consult, admitting the patient to your own service and folllowing them longitudinally.

Have you seen your SO or children recently?
IR can be busy, especially as you start. I think it is far more like a surgical specialty. But, the key is to get like minded IR in your practice and make sure you have enough that you can split the call in a reasonble fashion. We have 7 IR in our call pool covering 2 hospitals so we have most weekends free.

How hard is it to get a good job in IR?
There are different practice models out there. Some are solo practitioners. Others are hospital employees. Others are in a pure IR group. THere are others who have joined cardiology or vascular surgey groups. Then the most common is those who have joined a traditional radiology practice.

Are you worried about the radiation exposure leading to cancer and cataracts? Worried about being able to have children?

You need to do everything to reduce radiation. wearing lead, using lead shields. Aprons. Radpads. And minimize your fluoroscopy time. Stay as far from the beam as possible. Also mix your week with clinic 1 to 2 days a week, CT and US guided procedures (rfa , biopsy etc) and then also varicose vein practice is another thing to consider . If you read CTA, MRA, and vascular ultrasound a day of week it would also help.
So, all in all I don't get too worried about it, but I do try to mix up my schedule so that I have longevity. Marathon not a sprint.

Most importantly, how does your back feel after a day with all that lead on?

Knock, on wood, I hve not had any back problems. It is important to get properly fitted light lead aprons and to work your core (ie abdominal musculature and obliques) to reduce the strain on your back. Again mixing your practice to include ultrasound and CT guided procedures and clinic as well as some admiinistrative tasks and imaging will also help with both radiaiton and back issues.

Hope that helps.

GV

 

[Gvataken]

were we there. We have a student resident fellow section of the Society of Interventional Radiology and at this years annual meeting we are going to have some focused events for trainees a question and answer panel will be there and those questions you have are some that we hope to answer. If you have interest in IR, hopefully we can meet at the meeting and you can learn much more about this exciting transformational field.

 

[MedManU]

What are the normal hours that typical interventional radiologists work? How many weekends do you work? How much call? I just want to get a good feel of the lifestyle of the field and how family friendly it is.

 

[Gvataken]

The IR work day varies depending on your practice style.

A IR in a Diagnostic group, is on call depending on the number of IRs in that group (usually 3 or 4). So every 3rd weekend etc. Sometimes, they will get some locums to cover some of the weekends. Else, some diagnostic radiologists cover some basic IR call and have IR backup the more complex cases. Some places will make the IR cover both IR and diagnostic call. The IR often are asked to read images between cases for RVU. This is a source of contention with clinically minded IR who want to establish high end practices. In fact a friend of mine recently left his conventional diagnostic practice to set up an independent IR practice.

Independent IR groups will have anywhere between 4 and 6 IR and they will be q4 to q6 and they split their practice between ir procedures, ir clinic and reading out vascular ultrasound, CTA and MRA etc. Sometimes the IR groups will split call with another IR group to lessen the weekend coverage.

When you are beginning to build a practice you have to work your tail of to build relationships and generate referrals. You will be happy to cover more call, spend longer hours and be available and affable, ad give talks. As your clinical practice grows then you can start to be more selective.

But, the lifestyle of a clinical IR is more reflective of a surgical specialty or subspecialty.

Hope that helps.

 

[IRpadawan]

Being a resident, I know I have a lot of training ahead of me including fellowship. Nevertheless, I have learned that an IR career is truly what you make of it. There are plenty of IRs in community based practices who practice IR from approximately 25-75 percent of the time. The rest of their workday is spent reading diagnostic studies such at CTs, MRIs, and radiographs. Procedures are usually basic and include a lot of venous access including dialysis access. Call is simple regardless of how much they take as these are not typically trauma centers. Nor are they cancer centers. I have worked with attendings who may take call for months at a time and get called in two or three times a month. Furthermore, these on-call cases may be as simple as an IVC filter.

That being said, the trend within IR is that of creating a clinical practice model. Full-time IRs are and should be considered clinicians. While the majority of them seem to be at academic centers, there is a huge impetus to develop an inpatient and outpatients practice with a clinical service and an outpatient clinic even out in the community. This takes time and effort and truthfully resembles a surgical specialty in dedication and diligence. However, just like a surgical specialty, you have to have a passion for IR to be good at it. Also, having a clinical practice is the only way to provide appropriate complete medical care for your patients and referring clinical physicians. Also, this is the best way to get the high-end, complex, really cool procedures.

 

[badasshairday]

Is it common for someone trained in IR to do DR as well? I know the attending above said he does a little bit of DR.

Is it possible to do something like 3-4 days a week of DR and 2-3 days of IR?

 

[Pontifex Maximus]

Very common in private practice. Most of the academic people I've interacted with do almost exclusively IR stuff though.

 

[badasshairday]

Very common in private practice. Most of the academic people I've interacted with do almost exclusively IR stuff though.

Thanks for the response.

I really want to go into something procedural, but I don't think I want to be a surgeon. IR seems like a really cool field, but I'll be honest, the radiation is pretty scary. I'd probably want to fall back on DR later in my career, if I became a radiologist.

 

[Gvataken]

The most successful IR practices are where the IR is primarily devoted to patient care responsibilities. It is very hard to have a successful IR practice, and do a lot of diagnostic radiology.

The successful private practice models include Riverside in Columbus Ohio, Baptist Cardiac and Vascular Institute in Miami, the Paridar and Malek group in Northern California. These groups are all clinic based and they may have physician extenders, but they work hard and have admitting privileges and the whole nine yards. The places that do "part time " IR are delegated to piccs, paras, thoras and biopsies or the rest of the stuff that no one else wants to do.

Modern day IR is much more like surgery. It is busy, very patient centered and highly rewarding.