The IR Residency: Past, present and future
By M. Victoria Marx, MD, FSIR Spring 2018
As you’ve heard by now, SIR experienced a highly successful Match Day while at the 2018 Annual Scientific Meeting, with 100 percent of the 136 spots filled—an increase from the 125 spots available in 2017. Congratulations to our newest class of residents, who are entering the specialty at an incredibly auspicious point in our history.
At the annual meeting, I gave a talk to medical students on the IR Residency, describing the difference between the integrated pathway (where you match out of med school) and the independent pathway (where you do a second two-year, IR-focused residency after completion of a DR residency). I was impressed by both their level of interest and the quality of questions I received. It was clear they understand what is at stake and recognize the current level of competition—as well as the value in having two options available to them.
That said, they also understandably had questions about what their future will hold—particularly since the independent programs will not enroll residents until 2020 and the number of available positions expected in the 2019 Match is not known with certainty. In addition, even though IR has evolved quite naturally into a primary specialty, medical students (as with all past generations) are facing some level of uncertainty about the IR job market. Will the demand for IR grow, remain the same or decline? Will the supply of IR physicians graduating from the new residency lead or trail the demand?
Recognizing the impact of this most recent change, SIR is making concrete strides to stimulate the market for IR and ensure that physicians can practice in their environment of choice.
- First, we are working to increase the number of residency spots available, by supporting and advocating for H.R. 1167, “The Enhancing Opportunities for Medical Doctors Act.” Residency training in the United States is primarily funded through Medicare. In the late 1990s, CMS (known then as the Health Care Financing Administration, or HCFA) put a cap on the amount of funding they would devote to graduate medical education of physicians. Since then, the number of residents has increased and hospitals are forced to pay for them without a corresponding increase in funding from Medicare.
Under President Obama, a one-time adjustment put hospitals’ unused residency spots into one bucket, which were then redistributed nationally to primary care and underserved areas. In the bill we’ve been advocating for, that one-time adjustment would be repeated, with new residencies (such as the IR Residency) also included in the redistribution. Our hope is to increase the number of positions in a nationally budget neutral way. Because of congressional turnover, it can be a long process, but with the support of Rep. Mia Love, R-Utah, we continue to present and re-present the bill before Congress.
- Second, we are working to establish a standard curriculum for IR residencies that covers the entire domain of IR, establishing a national consensus on what the medical knowledge of graduates should be. Such a curriculum would be useful both to trainees, giving them a broad (but appropriately focused) knowledge base, and to the individual programs by centralizing some of the development of educational materials and removing that burden from individual program directors.
The most important benefit of a standardized IR curriculum is that nationwide standardization of the IR knowledge base will increase patient access to the full spectrum of IR care. Regional/institutional variability in training will diminish. Residents will emerge from training with increased ability to practice in a wide variety of locales and practice models.
- Third, in an effort that extends beyond the new training paradigm, SIR is recommitting its efforts to help all IRs succeed across the variety of clinical settings that practices and groups may offer. Recent conversations on SIR Connect serve to illustrate the range of practice types that interventional radiologists currently participate in. The number one goal in our current strategic plan is to support and make it possible for IRs to practice in whatever situation suits them the best, which means that, as a society, we seek to remove common barriers rather than promote a single practice setting.
How IR is practiced in the future will to a large degree be driven by the career direction taken by people coming out of new training paradigm—IR residency. Future IRs will be as different from my fellowship-trained generation as we were to the physicians who first defined our profession! This is an exciting reality that the existing world of IR and the existing world of DR must embrace.
Stay tuned for more updates from Parag Patel and FAQs from the APDIR, which we’ll communicate on and publicize through SIR Connect.