Typical IR hours?

[dinguskhan]

I know this has been discussed on several online sources, but I'm getting a lot of conflicting information on this. I think people online are saying they usually work from 7am to 5/6pm with call. However, I feel like my attending mentors are working way longer hours. One of my mentors called me one night and said he had been going home at 7pm every night for the past week. Maybe the hours are just worse in academia? I really like IR but I'm hesitant to work legit surgery hours. I'd appreciate it if anyone can shed some light on this matter. Thank you!

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[radapplicant920]

Entirely depends on the job/practice setting. 7a-5p sounds pretty typical for most jobs (when not on call) but this can very drastically. At a busy trauma center expect to stay later more frequently with busier call. At the VA, 8-4 is standard though this can vary from location to location. 100% outpatient jobs exist too which don't have call and can be 8-5 (but at a very fast pace). Private groups will expect you to stay and read diagnostic until the evening team takes over which may be 6p.

Having said all that, if lifestyle is an important consideration for you, think long and hard. I'm pretty happy with my job, but this commitment is not for everyone (and that's totally ok!) There are tons of burnt out IR's out there (but same can be said about most fields of medicine). Take time to know yourself before you take the plunge.

 

[dinguskhan]

Thank you so much for this detailed response! I'll definitely take this into consideration, but what you said was much more reassuring than what I had been anticipating.

 

[irwarrior]

Agree. Large number of VIR physicians who thought this would be easier than surgery tend to become disgruntled and burnout and wish in hindsight that they did DR and not get pigeonholed. The outpatient arena is the one area where the hours are consistent, but it is a large investment and if you take vacation (it comes out of the bottomline). The inpatient VIR world can be very variable, but it is the call that can be challenging as you will often get called in for bleeding and sepsis/infections. ie GI bleeds, nephrostomy, cholecystostomy, trauma embolizations, lp for meningitis, paracentesis for SBP rule out , vascular access when no one else is able to get it. So, the call can get pretty busy and unpredictable.

 

[dinguskhan]

Good to know, thank you very much for this insight. I guess I'll see if I can handle such a schedule in my surgery clerkship. Lifestyle isn't the priority for me, but I'm pretty hesitant to commit to surgery hours (although IR still seems to be less than surgery) and can see myself possibly regretting it while scrubbing in at 2 am in the future. I still want to love IR but really appreciate this perspective.

 

[dinguskhan]

Does anyone know if the hours are better in a ~50% DR job?

 

[irwarrior]

Potentially, depending on the facility or facilities that you cover. The challenge is you may be asked to cover several hospitals that the DR group covers on call and the geographic distance on call can be significant. Those are the challenges I hear faced by VIR . Those who are weary of the lifestyle can also do procedural specialties in DR such as MSK radiology and body imaging/intervention fellowships which can be procedure heavy.

 

[dinguskhan]

Good to know, thanks again for your insight!

 

[IRattending2021]

Agree. Large number of VIR physicians who thought this would be easier than surgery tend to become disgruntled and burnout and wish in hindsight that they did DR and not get pigeonholed. The outpatient arena is the one area where the hours are consistent, but it is a large investment and if you take vacation (it comes out of the bottomline). The inpatient VIR world can be very variable, but it is the call that can be challenging as you will often get called in for bleeding and sepsis/infections. ie GI bleeds, nephrostomy, cholecystostomy, trauma embolizations, lp for meningitis, paracentesis for SBP rule out , vascular access when no one else is able to get it. So, the call can get pretty busy and unpredictable.

you are in a pretty bad job if your call cases include vascular access when “no one else can get it”, paracentesis and LP.

in my last gig, i would do peds vascular access emergently. But when an adult hospitalist called me about those things I just tell them I do not offer vascular access services over the weekend and ask them if they would like to be responsible for bad outcome if I am tied up in a vascular access or paracentesis and there is a trauma happening.

 

[irwarrior]

you are in a pretty bad job if your call cases include vascular access when “no one else can get it”, paracentesis and LP.

in my last gig, i would do peds vascular access emergently. But when an adult hospitalist called me about those things I just tell them I do not offer vascular access services over the weekend and ask them if they would like to be responsible for bad outcome if I am tied up in a vascular access or paracentesis and there is a trauma happening.

I hate saying no. I have a pretty fun job with 1 to 2 days of clinic a week. Inpatient consult time. Book my elective cases 2 to 2.5 days a week. Scope and breadth of interventions are pretty broad. Get to admit my own patients. It was not easy to build and took a lot of hard effort, but it is very rewarding. Learn something new on a daily basis and want to continue to expand my clinical and technical expertise. Days are long but rewarding. Having the ability to personally impact so many patients is highly rewarding. Do what you love and it won't seem like work.

 

[IRattending2021]

I hate saying no. I have a pretty fun job with 1 to 2 days of clinic a week. Inpatient consult time. Book my elective cases 2 to 2.5 days a week. Scope and breadth of interventions are pretty broad. Get to admit my own patients. It was not easy to build and took a lot of hard effort, but it is very rewarding. Learn something new on a daily basis and want to continue to expand my clinical and technical expertise. Days are long but rewarding. Having the ability to personally impact so many patients is highly rewarding. Do what you love and it won't seem like work.

do you do vascular access and paracentesis in your job? If so, what’s the percentage?

do you do paracentesis and LP emergently as you seem to allude to?

 

[irwarrior]

YeS. mostly on my call weeks. During my noncallable weeks I do mostly elective cases booked from clinic. Call weeks I do mostly inpatient work including inpatient consults and cases (similar to acute care surgery). I am more than happy to help, but I triage my consults and procedures accordingly if there is a septic patient or bleeding patient I see that consult first and treat those patients first.

 

[IRattending2021]

YeS. mostly on my call weeks. During my noncallable weeks I do mostly elective cases booked from clinic. Call weeks I do mostly inpatient work including inpatient consults and cases (similar to acute care surgery). I am more than happy to help, but I triage my consults and procedures accordingly if there is a septic patient or bleeding patient I see that consult first and treat those patients first.

Do you think it’s a good idea to tie up resources that IR may use for trauma embo or stroke thrombectomy during call time to do an LP?

 

[irwarrior]

Neuro does LP , but triage your cases accordingly. Go see the consult and sort out what you think is most ill. If I am slammed on call I do the sickest patients first (bleeders, sepsis, acute limb ischemia, PE/DVT etc).

 

[IRattending2021]

Neuro does LP , but triage your cases accordingly. Go see the consult and sort out what you think is most ill. If I am slammed on call I do the sickest patients first (bleeders, sepsis, acute limb ischemia, PE/DVT etc).

so do you do paracentesis on call for SBP rule out? You seem to have a tendancy of dodging questions, so would appreciate your specific approach to this question.

 

[irwarrior]

I do but again if I am jam packed with more urgent cases, they will treat for presumed SBP or they will find a GI doctor or hospitalist or even intensivist to do it. If you feel I am evading your questions please send me a DM and I would be more than happy to talk to you personally and explain my practice with you.

 

[Broseiden]

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[irwarrior]

In general children are pretty healthy, unlike the aging population which have the bulk of disease. ie Stroke,CAD, CHF, DM, HTN, cancer, arthritis , osteoporosis etc. So, the complex pediatric interventions outside of cardiac / congenital heart disease (Peds IC) will not be that common. The bulk of complex Peds interventional is typically vascular/lymphatic venous malformations. The routine things are typically vascular access, enteric feeding tubes but there are increasing procedures at some of the children's hospitals. Some of the premier sites are Boston Childrens, CHOP in Philadelphia, Toronto Sick Childrens and Cincinnati . There has been a great deal of expansion in pedatric VIR and you should check out their virtual meetings. SPIR: Society for Pediatric Interventional Radiology Official Site

 

[dinguskhan]

Can someone please shed some light on what call is like (to be honest, I'm not really sure how call works in general)? It means you have to be ready with a pager at home for home call and you have to be present at the hospital for call call, right? Are IRs typically onsome sort of call for an entire week at a time? What makes weekend call different from weekday call? I know call depends heavily on practice type, but I was hoping to hear some typical example call schedules.

 

[qxrt]

My group's call is so busy that we created a dedicated IR evening/overnight swing shift where one guy does all the after-hours cases and can sleep in the day time (or night if not called in). We were getting called in more than half of all nights. But I get the sense that our call is unusually busy compared to most other groups. For example, my last call weekend included an SVC recanalization, bronchial artery embo, GI bleed, two cold legs, splenic embo for trauma, in addition to the smaller stuff like nephrostomies, drains, venous access. That's a bit busier weekend call than I've seen at the large academic hospitals I trained at.

Many groups with less busy call will just have an IR on call who works routine daytime shifts in addition to overnight call. One of my co-residents is an IR attending at a pediatrics hospital - takes Q2 or Q3 call, but virtually never gets called in.

Nice thing about IR call is that you drive in to the hospital specifically to do a case. If there is no case, I just hang out at home.

 

[irwarrior]

Amazing cases qxrt, how many hospitals are you covering and how many beds. Are you doing thrombolysis or thrombectomy (penumbra etc) for your acute limb ischemics? For the SVC case was it malignant? If so did you thrombectomy/thrombolysis and stent? Saw some recent cases using Inari for SVC where my experience has been with thrombolysis / angioject/ penumbra.

So many variables that determine call frequency and how busy it is . How many VIR you have, how many hospitals you cover, how big are the hospitals (how many beds including number of ICU beds) . How complex are the services at the hospital (level 1 trauma, stroke center, transplant center). We got busier and busier so also had to add a later shift and that week we are supposed to primarily take care of inpatient and ER consults etc and it enables you to sleep in if you had a rough night. Working a full elective schedule of complex cases and then doing emergency cases and add ons can be challenging. Most of us in our group do a week at a time. Others, do it on a weekly basis ie every Monday and then split weekends .

Those friends of mine in the outpatient world (Office based labs) do not have call on the weekends as the lab is closed , so those patients go to to the hospitals for emergent procedures.

The variability in VIR is tremendous and you should get a flavor of all of these. It is such a new specialty and is in the verge of defining itself, which is what makes it very exciting for me.

 

[dinguskhan]

Thanks all for the insight. So if I were to join a group that has q3 call, every 3 weeks I'll have a week during which I work 8-5 mon-fri plus emergent cases at night? And also emergent cases some weekends? And if there are way too many nighttime emergencies the group would consider hiring a nightshift IR? Sorry for the ignorance, I'm a med student and I'm hesitant to have in-depth discussions about lifestyle with mentors.

 

[IRattending2021]

Thanks all for the insight. So if I were to join a group that has q3 call, every 3 weeks I'll have a week during which I work 8-5 mon-fri plus emergent cases at night? And also emergent cases some weekends? And if there are way too many nighttime emergencies the group would consider hiring a nightshift IR? Sorry for the ignorance, I'm a med student and I'm hesitant to have in-depth discussions about lifestyle with mentors.

It’s practice dependant.

one of my buddy is in a practice that sounds remarkably similar in setup to the Irwarrior’s practice with week long calls and covers PAD.

he/she find the call way too much.

I am in a big group and my call is more than q8 (specifics number would out me). It’s very do-able.

Also look at the compensation structure. While many people (including myself) enjoy big cases for what they are, a large reason why PAD have mostly gone to vascular surgery and cardiology is the financial compensation.

many IRs who do the “big cases” are not being compensated appropriately for the same type of work that VS and cards do.

i love PAD just as much as any other IRs but I would loath to do it if I would not get compensated appropriately.

also, when do you do it? If you only get cold leg at night and VS/cards take chip shot PAD cases during the day it gets old pretty quick.

 

[dinguskhan]

I see, thanks for this info. I was wondering, then, what determines what kind of job you end up doing? I'm sure there's some degree of personal choice (how your CV is tailored for academia vs PP) and networking/luck involved, but to what extent are IRs free to choose their practice setting? Does pedigree/training or research matter?

 

[IRattending2021]

I see, thanks for this info. I was wondering, then, what determines what kind of job you end up doing? I'm sure there's some degree of personal choice (how your CV is tailored for academia vs PP) and networking/luck involved, but to what extent are IRs free to choose their practice setting? Does pedigree/training or research matter?

Job market is decent. I think when I looked, it was location, money, job satisfication (aka what you want to do), pick 2.

In general, it’s harder to get 100% IR jobs in non academic setting. It’s very difficult for new grad to start in outpt based lab right the way because new IRs may not have the experience to trouble shoot complications in that setting. People say it takes about 5 years to reach your maximal skill level.

It can be difficult to land jobs that allow you to do PAD or whatever else you want in the coast or in large populated cities due to competition from other specialists. It maybe impossible for you to build PAD or vascular practice in a large system due to entrenched referral patterns.

It’s much easier to do 100% IR or PAD in rural/underserved regions.

 

[dinguskhan]

Job market is decent. I think when I looked, it was location, money, job satisfication (aka what you want to do), pick 2.

Good to know, thanks! Choice over job satisfaction includes choice over work hours/call, right? Are employers usually upfront about work hours/call, or would I need to do my own investigating?

 

[dinguskhan]

Also, I must admit that I've recently started to consider GI because it seems like it has a lot of procedures (which may not be as exciting as those in IR) but probably less call/surgical lifestyle on average. Would anyone be able to share some insight as to why IR might be a more fulfilling field than GI overall?

 

[irwarrior]

GI does do some cool procedures especially advanced endoscopy. But, scope of practice is a bit more limited. hepatobiliary and enteric events. Liver, pancreas, biliary tree. esophagus, stomach, small and large intestines. Pathology limited to cancers of those organs and diseases impacting those organs . Emergency care is primarily GI bleed and biliary sepsis, the rare volvulus you may decompress. There are fellowships in GI including Hepatology, IBD, pancreatology and advanced endoscopy to name a few. There tend to be more GI docs per hospital so call is in general is not as frequent as they are doing a fair amount of clinic, upper and lower outpatient scopes, capsule interpretation etc.

 

[IRattending2021]

Also, I must admit that I've recently started to consider GI because it seems like it has a lot of procedures (which may not be as exciting as those in IR) but probably less call/surgical lifestyle on average. Would anyone be able to share some insight as to why IR might be a more fulfilling field than GI overall?

the beauty of IR is having options. The bread and butter of IR (aka things you don’t have to fight or build a practice for) are lines, tubes, biopsies, chemembolizations and gi bleed embolizations. The other stuff you may have to compete and build for it.

however, IR is far better lifestyle wise than surgical specialities because you have the options of practicing only light IR or even transition into diagnostic radiology where you would do no IR.

However, if you want to do cool cases, you must be prepared to work a more surgical lifestyle. I suppose you can do big cases in outpt center and do elective cases but you don’t get that handed to you on a platter. You have to build a reputation.

 

[Broseiden]

However, if you want to do cool cases, you must be prepared to work a more surgical lifestyle. I suppose you can do big cases in outpt center and do elective cases but you don’t get that handed to you on a platter. You have to build a reputation.

That's probably the best way I have heard this described. Seems reasonable. Do you feel this is still true for larger multidisciplinary groups like Sutter or Kaiser where everyone is salaried and less dependent on competing for RVUs, and therefore less likely to fight for referrals and "cool" cases? I know exposure to this model may depend on your geographic location.

I found this article that mentioned it, it seemed pretty ideal but I haven't heard much about the possibility IRL. Seems like a good mix of lifestyle control and "cool" cases while still having a close to median salary.

 

[IRattending2021]

That's probably the best way I have heard this described. Seems reasonable. Do you feel this is still true for larger multidisciplinary groups like Sutter or Kaiser where everyone is salaried and less dependent on competing for RVUs, and therefore less likely to fight for referrals and "cool" cases? I know exposure to this model may depend on your geographic location.

I found this article that mentioned it, it seemed pretty ideal but I haven't heard much about the possibility IRL. Seems like a good mix of lifestyle control and "cool" cases while still having a close to median salary.

read between the lines in that article. Multiple people talked about IR losing turfs.

it’s an unfortunately situation but occurs because we are a tertiary referral service. Even in a multidisciplinary group, losing turf can be inevitable.

Take PAD. 20-30 years ago VS are far less skilled than IRs in PAD. Today, I would say that an average vascular surgery residency new grad is at par or far more skilled than an average new IR grad at PAD and much much more skilled than an average new Ir grad at aortic stenting. It’s now their turf, with them driving the research and development of new technologies. IRs that are competing in this space still have some advantage in endovascular techniques but it’s laughable to suggest that clinical training gathered during Ir/dr residency can be comparable to clinical training in a surgical program.

in that article, multiple IRs alluded to constantly moving to new frontiers because the old ones are taken. That is true. The thing in article that resonates a lot with me is that “I wont know what I will do the next day, all I know is that my board will be full”.

 

[irwarrior]

If my fellow angiographers prove unwilling or unable to accept or secure for their patients the clinical responsibilities attendant on transluminal angioplasty, they will become high-priced plumbers facing forfeiture of territorial rights based solely on imaging equipment others can obtain and skill still others can learn.
—Charles Dotter
American College of Surgery meeting in 1968

The above statement was discussed by the founder of VIR specialty.

I have seen much of this at training programs and in private practices and my goal in training and beyond was to develop a sustainable practice in the various conditions I wanted to treat and I realized early on it required a solid understanding of the disease that I wanted to manage and not just technical proficiency.

The key is to go to a training program where you will learn how to compete for referrals. This also requires dedicated time to see patients in the office, admit them and follow them longitudinally. If you want to learn PAD , learn the basics of vascular disease Keep HBa1c<7, high intensity statins, antiplatelet trials (CAPRIE) ; Voyager and COMPASS. Go to primary care, podiatry, nephrology and endocrinology , wound care centers and offer them your skill set. Be willing to admit the patient and start them on iv antibiotics if they develop a foot infection.

Expecting specialty referrals to come into your lap is transient and not sustainable. Need to also be able to market directly to patents and follow patients longitudinally, much of what we do needs repeat interventions (PAD vessels restenose, aneurysm repairs develop endoleaks, fibroid symptoms recur post UAE (EMMY 10 year data) , and retrospective data from BPH shows recurrence (Pisco et al).

There are certainly surgical and medical specialties who can gather interventional skills and already offer these therapies and it will be up to you to go and compete with them for these referrals. The difference is they may have already developed a natural referral service and like a new company coming into a space you will have to change referral patterns. It is no different than a new car company coming in and competing with historically well recognized brands such as Ford, GM, Toyota, Honda, BMW and Mercedes. If you are interested in building a spine practice (you will have to compete with others who provide such care (ortho; neurosurgery; pain anesthesia; PmNR, neuro IR; MSK rads etc) . You will have to garner knowledge of the differential of back pain, conservative therapy for back pain, natural history of osteoporosis, imaging interpretation , interventional treatment and follow up of these patients.

 

[IRattending2021]

If my fellow angiographers prove unwilling or unable to accept or secure for their patients the clinical responsibilities attendant on transluminal angioplasty, they will become high-priced plumbers facing forfeiture of territorial rights based solely on imaging equipment others can obtain and skill still others can learn.
—Charles Dotter
American College of Surgery meeting in 1968

The above statement was discussed by the founder of VIR specialty.

I have seen much of this at training programs and in private practices and my goal in training and beyond was to develop a sustainable practice in the various conditions I wanted to treat and I realized early on it required a solid understanding of the disease that I wanted to manage and not just technical proficiency.

The key is to go to a training program where you will learn how to compete for referrals. This also requires dedicated time to see patients in the office, admit them and follow them longitudinally. If you want to learn PAD , learn the basics of vascular disease Keep HBa1c<7, high intensity statins, antiplatelet trials (CAPRIE) ; Voyager and COMPASS. Go to primary care, podiatry, nephrology and endocrinology , wound care centers and offer them your skill set. Be willing to admit the patient and start them on iv antibiotics if they develop a foot infection.

Expecting specialty referrals to come into your lap is transient and not sustainable. Need to also be able to market directly to patents and follow patients longitudinally, much of what we do needs repeat interventions (PAD vessels restenose, aneurysm repairs develop endoleaks, fibroid symptoms recur post UAE (EMMY 10 year data) , and retrospective data from BPH shows recurrence (Pisco et al).

There are certainly surgical and medical specialties who can gather interventional skills and already offer these therapies and it will be up to you to go and compete with them for these referrals. The difference is they may have already developed a natural referral service and like a new company coming into a space you will have to change referral patterns. It is no different than a new car company coming in and competing with historically well recognized brands such as Ford, GM, Toyota, Honda, BMW and Mercedes. If you are interested in building a spine practice (you will have to compete with others who provide such care (ortho; neurosurgery; pain anesthesia; PmNR, neuro IR; MSK rads etc) . You will have to garner knowledge of the differential of back pain, conservative therapy for back pain, natural history of osteoporosis, imaging interpretation , interventional treatment and follow up of these patients.

that’s all well and good, but are you able to do bypass? What happens when your pt fail venous arterilization or whatever your skillset allow before that? Can you offer the true one stop shop package for arterial disease?

it’s also hilarious that you compare IR to a new car company. I am sure you are well aware that IR was the original owner of the PAD space.

lastly, can you comment on how much help will a training program like you described help a new IR grad getting PAD referrals if he takes a job at Stanford or NYU?

 

[irwarrior]

that’s all well and good, but are you able to do bypass? What happens when your pt fail venous arterilization or whatever your skillset allow before that? Can you offer the true one stop shop package for arterial disease?

it’s also hilarious that you compare IR to a new car company. I am sure you are well aware that IR was the original owner of the PAD space.

lastly, can you comment on how much help will a training program like you described help a new IR grad getting PAD referrals if he takes a job at Stanford or NYU?

I would urge you to go to some of the talks at AMP, VIVA, ISET, NCVH and go check out some of the labs that are doing PAD work. The need for bypass is pretty rare given modern day endovascular tools. I would urge you to check out some of the busy VIR and IC labs doing pad and if you want DM me I can guide you a slew of centers near you doing it and I can show you the cases we have done as well.

NYU hired a VIR to build their PAD practice and Stanford VA also hired someone to build their PAD practice as well. Again, please send me a message and I would love to talk to you offline as well.

 

[irwarrior]

Tim Clark who was fomer VIR head at NYU built a pretty robust CLI pad practice there. He left there and subsequently has built a busy practice for CLI in Philadelphia at UPenn. In fact he was referenced in this Dotter lecture by Trerotola.

 

[IRattending2021]

I would urge you to go to some of the talks at AMP, VIVA, ISET, NCVH and go check out some of the labs that are doing PAD work. The need for bypass is pretty rare given modern day endovascular tools. I would urge you to check out some of the busy VIR and IC labs doing pad and if you want DM me I can guide you a slew of centers near you doing it and I can show you the cases we have done as well.

NYU hired a VIR to build their PAD practice and Stanford VA also hired someone to build their PAD practice as well. Again, please send me a message and I would love to talk to you offline as well.

No thanks. I already go to those conferences and have experience doing those cases. Chance is you already know me offline.

some folks in SIR are very gungho about PAD, practice building, etc. I know we want to recruit the best and brightest medical student but it’s imperative for them to know the reality of IR, which is that your service line can be taken away at the drop of a hat despite years of experience and given to a surgeon or cardiologist with minimal experience completely with no possibilities of getting it back doesn’t matter how you build your practice.

BTW, most IR in the VA system does PAD, I was referring to the stanford main campus. What’s your thoughts on IR and PAD there?

 

[irwarrior]

Stanford had a powerhouse of Dake , Razzavi and Kee. Dake, developed thoracic aortic interventions. Razzavi went to VISOC and has recruited Khalsa there. Kee, built up the UCLA VIR program. Unfortunately they all left and were in a system of rebuilding, but have done quite well with other service lines including venous disease and IVC filter retrievals with Hoffman, Kuo , Kothary and others. Not sure what their current PAD volumes are.

The biggest challenge is if you go in solely to do a "procedure" but not have a foundational understanding of the disease or can comprehensively manage the disease none of the service lines are sustainable.

In my opinion , you need a clinic to see patients with a disease for a disease and not for a "procedure" but to manage their disease. You need to follow patients longitudinally otherwise much of what we do will be transient.

 

[IRattending2021]

Stanford had a powerhouse of Dake , Razzavi and Kee. Dake, developed thoracic aortic interventions. Razzavi went to VISOC and has recruited Khalsa there. Kee, built up the UCLA VIR program. Unfortunately they all left and were in a system of rebuilding, but have done quite well with other service lines including venous disease and IVC filter retrievals with Hoffman, Kuo , Kothary and others. Not sure what their current PAD volumes are.

The biggest challenge is if you go in solely to do a "procedure" but not have a foundational understanding of the disease or can comprehensively manage the disease none of the service lines are sustainable.

In my opinion , you need a clinic to see patients with a disease for a disease and not for a "procedure" but to manage their disease. You need to follow patients longitudinally otherwise much of what we do will be transient.

They currently hanear zero PAD volume outside of VA. Is it because their faculties don’t have fundamental understanding of arterial disease or unable to comprehensively manage arterial disease? Or is it perhaps they have no clinic? Or is it perhaps because they don’t practice build hard enough? Hmm.

Do you know WHY those people left Stanford?

It’s misleading to suggest to medical students that they can do PAD or other service lines wherever and however they want just by going to certain training programs and practice build. This create the false impression that some IR programs are not good enough. But more over, those students are better served by the knowledge that if their interest is predominantly peripheral arterial disease, vascular surgery and cardiology are the appropriate specialty choice.

further more, the suggestion that one just have to “build the practice” and if you lose the service line it’s because you aren’t being clinical enough is straight up condescending for a majority of academic, PP and independent clinical IRs who saw their PAD service line taken away by people that were technologically inferior and sometimes clinically inferior as well. It was a political situation that you seem to never mention.

It’s not impossible to do some PAD as an IR. I do some PAD myself. But it’s absolutely not a guarantee. JVIR paper shows about 10% IR practicing this service line. It’s available but it’s just happen to be something IR can do sometimes.

 

[irwarrior]

They currently has near zero PAD volume outside of VA. Is it because their faculties don’t have fundamental understanding of arterial disease or unable to comprehensively manage arterial disease? Or is it perhaps they have no clinic? Or is it perhaps because they don’t practice build hard enough? Hmm.

Do you know WHY those people left Stanford

 

[qxrt]

My understanding is that Stanford IR doesn't even do much if any dialysis interventions, let alone PAD. Academic center IR groups are good at pushing boundaries and getting really good at a specific niche (e.g. complex filter retrieval or venous work), but also have large deficiencies in other subsets of IR because there's competition from other aggressive boundary-pushing specialties. Private practice ranges from groups that only stick to drains, venous access, and the occasional GI bleed, to those like mine that do everything, including PAD, IO, transplant, etc. Out in the community, other competing specialties like vascular surgery and cardiology tends to be less aggressive than their academic counterparts. If you really want to do everything in IR, your better bet is to focus on those certain private practice groups that have managed to keep their toes in almost every subset of IR. They are out there.