Yes.
i find it hard to believe a PCP will refer any patient with PVD to an IR doctor over an invasive cardiologist or a vascular surgeon -- i know i certainly wouldn't.
Well, that is the pattern that emerges in full-service IR only practices.
cards owns (or will own) every atherosclerotic-related problem below the jaw.
Actually, interventional cards sits at the end of a referral chain just like IR or VS.
At this time, many patients see cards first as they look at the pump (which tends to give out first) and manage to pick every fruit off the procedure tree (renals, carotids, iliacs, SFAs) before the patients have to go on to a CV or VS to receive actual treatment.
The wildcard in this is the advent of noninvasive coronary imaging. At this point, if one of my internists has an abnormal nuclear stress test, the patients have to go to cards for the coronary angio. Coronary CTA will allow general internists to triage their patients into the ones going to interventional cards vs the ones going to CV directly. Same in PVD, we can work up a claudicator or nonhealing ulcer to the point that they either go directly for an endovascular approach or to VS for a bypass. No cards required.
and vascular surgery training will incorporate IR-like training into it speciality, further taking away from the cut.
The PVD cake, none of the VS I know who do endovascular work will do TACE or any of the biliary/uro work.
patients, as dumb as they are, would rather go to a person wih extensive surgical training than in radiology.
Or a cardiologist with zilch surgical training
Patients go where their PCP sends them. And PCP send where they get something back usually respect, referrals and a sense of remaining involved in the patients care.
Here is the 'sociogram' for your typical higher level community hospital:
-- CV hates cards (for putting them almost out of business and leaving them with either the f-ed up endovascular failures or the multi-morbid multi-vessel poor surgical risks)
-- VS hates cards (for skimming off the cheap and cheerful TASC-A and B lesions and leaving them with the multi-morbid single-runoff rotting feet)
-- IM hates cards (for making oodles of money while being just another internist but mainly for holding on to their patients by having their PA do all the hypertensive and diabetes management afterwards)
-- FP hates everyone (because they buy into that thing that 99% of medical problems can be managed by a FP)
If you provide good service, back-referrals and a little bit of ego massage, you can carve out a lucrative niche in that setup.
i think IR can be sole proprietors of things like biliary stuff, chemoembolization, RF ablation, UAE...just not PVD stuff...
Nobody will be sole proprietor for PVD, and that is not what any area in medicine about. It is about competing for business and the people already doing clinical IR manage to hold on to their share of the PVD pie.
The currency in community specialty medicine are referrals, if you see the PVD patient first, do a diagnostic angio and decide that this patient is better served with a open fem-pop or fem-far, you send them to you favourite VS, if during their pre-procedure workup they turn out to have CAD, you send them direcly to your favourite CVS.
i hope i'm not hating on IR.
Well, maybe not hating, but probably a bit misinformed. Sounds like you spent too much time in bad company (around cardiologists).
but the fact remains not a lot of people want to do IR (be it for the lifestye or the turfwars).
Don't let the fact that the majority of IR fellowship positions remain unfilled make you believe that nobody goes into the field. The top fellowships consistently fill and there are more than enough graduates to fill the few full-time IR positions that come up every year.
and regarding canvassing PCPs for referrals, that's a turn off -- not really hope-inspiring!
So, who DO you want to canvass then ?
