A practice of a different color
By M. Victoria Marx, MD, FSIR Summer 2018
Recent discussions on SIR Connect underscore members’ ongoing questions about the clinical practice of IR. As Raj Pyne, MD, described in an article last year (Crossroads: The evolution and divergence of private practice IR. IR Quarterly. 5(3):14–22; bit.ly/2hqRPir), most of today’s IRs acknowledge that clinical practice is an integral component of IR and vital to the future of the specialty—but few agree on what shape that practice should take.
In some ways, these discussions about the clinical practice options available represent a tremendous step forward. After all, it wasn’t that long ago when IR leaders like Barry Katzen, MD, FSIR, and Robert White, MD, FSIR, were first urging IRs to evolve from a procedure-based model to the longitudinal care of patients. Today, IR is a primary specialty in its own right, clinical practice is a reality, and the American Board of Medical Specialties (ABMS) recognizes us as physicians who make decisions and not just do what other physicians tell them to. Drs Katzen and White probably think the change took too long but, in reality, the evolution of IR into its current model has been remarkably fast.
We are now each trying to figure out how to incorporate a clinical practice model into our existing businesses. Some IRs have found tremendous success in freestanding practices, performing 100 percent IR. Others have joined larger radiology groups within hospitals, performing procedures on an on-call basis amidst reading diagnostic studies. Still others have found ways to straddle the two worlds, establishing and growing a clinical practice within a supportive radiology group.
In parallel, the practice models of both DR and IR are undergoing significant changes, in part because of the IR Residency. It is likely that, over the next ten years, the clinical practice models of IR will be driven by the expectations and plans of physicians who graduate from the newly implemented IR residencies. There are also huge nationwide companies that hire DRs all over the country; they’re not part of a private practice—they’re all part of a big corporation, working remotely and removed from a patient’s location. It’s difficult to say how that trend will impact interventional radiologists, but DR groups may need IR groups to stay relevant in their local area. IRs have to be physically present!
Most of those who are succeeding in their pursuit of clinic-based IR, however structured, are rightfully proud of their accomplishments as clinicians. What may not be so clear is which of these models is “right” for IR—the approach that will best provide quality IR to the broadest group of patients.
In light of today’s economic realities, however, it’s likely unreasonable and unrealistic to believe that there is only one right answer. What works best for an individual IR will vary with the size of the community in which she practices, regional referral patterns, area health systems and, of course, her own preferences. That is, insisting that all IRs practice a certain specific way may decrease opportunities for IRs who practice in settings different from one’s own.
The 2018–2022 SIR Strategic Plan embraces a new philosophy in which there is no single best way or right answer. Instead, the society is working to help members like you succeed in the practice model of your choice. Regardless of whether you’re full-time or part-time IR, working in a hospital system or an OBL, academically linked or not, part of a radiology or nonradiology multispecialty group, the pathway to success may be more about these questions than about specific practice models:
- Are you doing as much IR (clinical and procedural) as you want?
- Are you meeting the population health needs in your community?
- Are you making the case of your value to your practice/your employer/your health system?
- And can SIR help you navigate your pain points?
In answering these questions together, and focusing on our commonalities, we will better allow our diversity to be a source of strength—not a liability.
In the meantime, know that we in SIR leadership are aware of all discussions on SIR Connect and that we’re working as always to meet SIR member needs. Watch this space and other SIR communication channels for more updates on what SIR is doing on your behalf, for your patients and your practice.