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IR to DR
Hello all
Wanted to get peoples thoughts – weve had 3 of our IRs now express interest in transitioning over to full time DR over the past year. Our IR volume and call is not very bad (almost never get called overnight, 2-3 cases max on weekends), and theyre all younger in their careers (all less than 6 years out). Is this a common trend? Ive seen other posts on here about some people doing that, wanted to get a sense. Are people losing satisfaction from IR? -
58 Replies
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No. It is not a common trend unless they are 20 years out.
There should be more to the story or sometimes it may be just luck.
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Every radiology subspecialty thinks theirs is the hardest. Only IR is right.
The IRs in my group are not paid much more than DRs, which I suspect is similar to many groups. Our IRs are disgruntled to varying degrees, as they see us DRs sipping on espresso as we dictate ‘neg acute’ and play internet during the workday while they are sweating under lead and dealing with patient/clinician drama. All we can say is, “hey no one made you pick IR, you still living the dream?”-
The IRs in our group actually have the best gig, no RVU pressures or DR responsibilities during IR days, NP support. Cases are bread and butter. Maybe weird coincidence?
Anybody on here transition into DR and regret it?-
What is it they want from you ?
Its going to be one of three things:
– a few PAs to deal with the bullshit
– extra money
– not having to do DR to justify their income.-
Whats a good gig to IR could be counterintuitive to IRs and every IRs are different.
Are those 2-3 cases on the weekend all dump cases happening at 3AM? Are those the same type of cases that IRs do not see during day time? Are there any high end or interesting cases left?
If I am not doing high end cases I might as well be doing diagnostics. Well supported line service type of IR section rot ones brain and spirit.
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I would say that is a bit unisually most of my friend and myself who are IRs would give up Dx in a heartbeat.
I agree with the above its not the necessary the amount of case but the type of service lines you have. If they are doing lines all day and getting called into to do nephs and gi bleeds at night because Urology and GI work bankers hours that can get old. Personally I would rather do that then read ICU films and abdominal CTs from the ED.
While this doesnt seem to be the issue with your guys. A lot of times it has to do with dynamics of the IRs and DRs in the group of there is lack of support for build the practice or even working against it, it can lead to burnout.
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Point blank ask them why they are transitioning. There are lots of different personalities and desires in IR. The fact that 3 have asked to transition in your group; however, is cause for concern.
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Burnout can be high in IR. Most IR patients are palliative and near the end of their lives. Facing suffering everyday can be exhausting. Wonder if this may play a role?
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I and my colleagues in my group who are less than 5 years out of fellowship would all prefer more IR and less DR, not the opposite. We have a very active IR service spanning the full breadth of IR including interventional oncology, portal venous hypertension, PAD, neuro-IR/kyphos, etc, and yet we also have diagnostic responsibilities as well. Perhaps it is a self-selecting group that chooses certain practices over others?
Personally, I love IR and get burnt out by days when I am stuck predominantly doing DR. I love being able to do something about the findings I see on imaging. I love talking with patients, explaining procedures to them that they never imagined possible. Has nothing to do with the “coolness” factor of the procedure; I get satisfaction from each procedure that helps the patient, even the humble para/thora or the central venous catheter. Could never imagine giving all that up and going full DR.
I suspect that someone who was only lukewarm about IR and felt able to give it up early on would not be the type who would join my practice.-
Im IR and honestly its a dump job. Work harder, take overnight call with 30 minute response time expected, make same as DR, and DRs resent you because you earn less for the group.
IR is not as good a deal as DR period. Full stop.
The pandemic has made this even more apparent as DR reads more from home and often the only rads in the hospital are IR.
I think a lot of IRs are just over it, especially if youve been out >5 years.
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IR is not dump job. It can be very rewarding.
having said that people should have realistic expectations before entering IR.
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IR for sure is a dumping ground.
If there are procedures that dont pay anything and CAN be done with image guidance, they are dumped to IR.
This has accelerated to the point that many DRs no longer touch needles at all and often LPs and joint aspirations are dumped to IR let alone paras and thoras, because why not?
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At least in our institution we have had some dumping of cases – surgery decided to take all permcaths and tunneled lines for a while during the COVID dry spell and has now dumped them back to us when their regular surgeries have picked back up. Our group really had no choice or say – surgery demanded it from the admins who said go ahead.
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Burn out. Dealing directly with patients during Covid. High income earners / Top carnivores in food chain want to take the least risk for making money/ kill. As simple. I don’t blame them. The response to Covid in US has been so shoddy that all healthcare providers, especially who take direct care of patients are at highest risk (of death) and bringing disease home to their loved ones.
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Like IR, but agree in my experience it is at least a bit of a dumping ground at most places. I also tend to get frustrated at how it seems like the stars always have to align to get a patient in and out of a room quickly. Nursing, floor, patient, and other random crap seems to usually have me waiting for start time longer than the actual procedure. Hoping others’ results vary for the positive.
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When I recertified for mammo, the room was full of grizzled IRs trying to (re)gain a skill that gives them a way back into DR.
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@fw
I bet most of them were 50-55+.A few years ago a badass 60 y/o neurosurgeon asked me about the possibility of doing neurorad.
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IR is tough and sometimes thankless work. The “cool” factor gets residents into it but then reality hits 5+ years into practice. I was planning to go into IR during residency but then an old IR staff member asked me if I’d still want to be strapping on lead at 50 y/o…. turns out DR was the right choice for me.
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+1 CoronaRad, same with me
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With the new IR training pathway, IR will take back a lot of lucrative procedures and won’t be a dump ground anymore. It will become its own clinical specialty.
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Quote from Hospital-Rad
With the new IR training pathway, IR will take back a lot of lucrative procedures and won’t be a dump ground anymore. It will become its own clinical specialty.
Lol.
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Whatll happen is that therell be two breed of IRs. One that likes doing high end procedures and clinical lifestyle.
Another that does dump cases and mostly do imaging working in PP, like other rad subspecialists that do mostly general.
Sucks that jobs like mine where you both do TIPS and read temporal bone maybe less going forward.
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As an IR I have seen both sides of this:
At prior hospital based job it was a total dumping ground. Oncology refusing to do bone marrow biopsies, neurologists dumping LPs. Dept getting overwhelmed with paras, thoras, lines, and biopsies. There was no incentive to try to build a practice because I was always working late and getting called in for cold legs, GIbleeds, neph tubes etc. I was consistently bitter at that job. my dreams at night mostly involved retirement. i was thoroughly burned out.
Now that I am an independent mostly outpt lab based IR I have never been happier. I still work hard, but I decide what type of work I want to do, what hours I want to work etc. I have only worked one weekend day this year (had to check a lysis catheter at the hospital), and 95% of the time I am back at home by 5 pm during the week. Although my vacation time is way less (by choice), I feel like i have waaay more free time. Its great having ‘normal people’ hours. I also love building my practice and watching it grow.
I cannot image doing anything else. -
Quote from Robotrad
As an IR I have seen both sides of this:
At prior hospital based job it was a total dumping ground. Oncology refusing to do bone marrow biopsies, neurologists dumping LPs. Dept getting overwhelmed with paras, thoras, lines, and biopsies. There was no incentive to try to build a practice because I was always working late and getting called in for cold legs, GIbleeds, neph tubes etc. I was consistently bitter at that job. my dreams at night mostly involved retirement. i was thoroughly burned out.
Now that I am an independent mostly outpt lab based IR I have never been happier. I still work hard, but I decide what type of work I want to do, what hours I want to work etc. I have only worked one weekend day this year (had to check a lysis catheter at the hospital), and 95% of the time I am back at home by 5 pm during the week. Although my vacation time is way less (by choice), I feel like i have waaay more free time. Its great having ‘normal people’ hours. I also love building my practice and watching it grow.
I cannot image doing anything else.
You decide what you do? LOL. I doubt it.
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Quote from Robotrad
As an IR I have seen both sides of this:
At prior hospital based job it was a total dumping ground. Oncology refusing to do bone marrow biopsies, neurologists dumping LPs. Dept getting overwhelmed with paras, thoras, lines, and biopsies. There was no incentive to try to build a practice because I was always working late and getting called in for cold legs, GIbleeds, neph tubes etc. I was consistently bitter at that job. my dreams at night mostly involved retirement. i was thoroughly burned out.
Now that I am an independent mostly outpt lab based IR I have never been happier. I still work hard, but I decide what type of work I want to do, what hours I want to work etc. I have only worked one weekend day this year (had to check a lysis catheter at the hospital), and 95% of the time I am back at home by 5 pm during the week. Although my vacation time is way less (by choice), I feel like i have waaay more free time. Its great having ‘normal people’ hours. I also love building my practice and watching it grow.
I cannot image doing anything else.
“Building my own Patrice and watching it grow” does not go with “normal people hours and having waay free time [sec]” at all especially if you are in a procedural field with all sorts of emergencies and potential life threatening complications.
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I dont think you guys are understanding what he is saying. He has an outpatient lab. No call. No weekends. No dumping. Seems like a great option assuming you can get referrals to support it
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Why are we so critical?
They are hustling work for their outpt lab. They didnt say they make more money or have more vacation time, perhaps opposite on both fronts. But they have autonomy, are doing meaningful work, are building a referral practice.
They are no longer an anonymous name on a report. I suspect that is priceless to them.
Some Rad groups criticize IR for losing procedures while not supporting or freeing up the IRs to build a practice. They begrudge paying call or even acknowledging the different work…Its not perceived as lucrative enough, or not guaranteed enough.
That is shortsighted because a strong IR service is a clinical anchor for the dept.
So then, if not supported, they sometimes split off and take all the risk (but also the reward, job satisfaction, and prestige). This leaves the rest of the dept as a commodity with zero traction…so I guess that also ruffles feathers and independent IR are also begrudged!
Cant have it both ways.
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I agree with you ed.
IRs are starting to look much more out of the traditional model of being partnered with DRs and either open their own OBL (which can be very profitable I know some guys making 1M doing this but not all), have partnered with vascular surgery or cards, or even approach C suite suits and formed a separate IR division. While many practices still employ the do some dump cases, dont build profitable cases, and read hospital cases in your down time model. This is becoming less attractive especially as many younger IR no longer accept this traditional model. Times are they are a changin as they say.
I find it ironic that someone would laugh at the idea of someone saying they decided what they do. It is this very attitude from colleagues that drives many IRs to go independent in the first place. LOL
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IRs simply make at least 30-50% more than DRs regardless of the setting or location. They are also not a commodity unlike DRs unless they are below average and doing only low end procedures.
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The OBL/ ASC environment is becoming more and more popular for the vascular interventionalist as the person who owns and runs the outpatient lab has control of their schedule and is able to build their own practice. They do not deal with all of the red tape and issues that the hospital has. You are able to also collect the global fees (pro fees/technical fees). Peripheral arterial cases generate a fairly high global.
There are many ways to go out and build such a practice including marketing to podiatrists and wound care centers, working with dialysis centers, direct patient marketing for varicose veins and BPH and fibroids etc. You do not have emergency cases and you also rely on billing for your initial clinic consults and follow ups. -
An OBL/ASC sounds very appealing for these reasons. I am wondering though, what happens when you own the OBL/ASC and want to go on vacation? It must cost a fortune to pay staff while not taking in money. I would think it’s very difficult to do if you are a one-person shop. Must have at least one partner to do cases while you are on vacation?
Also, would it be a good idea for someone to finish fellowship and immediately be hired by an OBL? I am currently in training and have thought about it but would be worried about losing certain skills if I am at an OBL. I can’t imagine doing too many oncology cases, GI bleeds, trauma, hepatobiliary cases, etc. -
I think a lot of people do IR in a hospital setting first before transitioning into OBL.
There is a learning curve post fellowship. Some says it takes 2-5 years for an IR to iron out all the wrinkles.
Some new grads do not do well in OBL with less back up where complication can be catastrophic.
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Apparently we have two different practices of radiology. One happens in real life and the other happens in auntminnie.
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[link]https://oeisociety.com[/link]
This is a multi specialty society focused on OBL and ASC environment. A lot of practical pearls on how to set it up. Agree that it may not be a bad idea to stay in a busy academic center or a busy VIR hospital based practice for a few years post training and then once you gain clinical and technical confidence and develop a referral pattern and save enough money to consider setting up an OBL.
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Hospital-rad, didnt you have some trouble recruiting/retaining IRs? Maybe theyll gone to work at auntminnie
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Quote from irfellow2019
Hospital-rad, didnt you have some trouble recruiting/retaining IRs? Maybe theyll gone to work at auntminnie
One of them left our practice 2 years ago and joined a practice to do 100% IR. He called back a year later and was asking to join our practice again. We were already full staff and didn’t have a spot for him. IR job market is fine but not hot. So it is not hard to find a well qualified candidate to do a mixture of IR and DR if the DR group offers partnership track. -
So whats IR in real life to you and whats IR in auntminnie to you? What sets off your bullshit sensor then?
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IR do NOT make 30-50% more than DR. I’ve never heard of a group like that. Not once.
Usually IR make just SLIGHTLY more than DR. The money is actually a trivial amount, it’s more of a “sorry your job sucks more” type compensation. -
Quote from irfellow2019
So whats IR in real life to you and whats IR in auntminnie to you? What sets off your **** sensor then?
The reality is something in between.DR: It is a very good field unlike what people here on auntminnie describe. In Auntminnie DR is a terrible low paying job with terrible hours and a lot of stress. In reality it is not the cush job that makes million/y, but is a very good job that is well paid compared to most other medical fields and has a decent lifestyle.
IR: The reason I focus on IR is the recent movement in IR community which IMO is a radical movement. It is an extremist reaction like many other reactions. It is not like that in the community all IRs are super enthusiastic about doing all high end procedures and hate DR, but are doomed to do 50% DR and 50% IR because DR groups force them to do so. In many cases the exact opposite is true. I know a good number of mid career IRs who CHOOSE to do a lot of DR and some bread and butter IR with a few high end cases in between. And on the other hand, there are a good number of especially younger IRs who want to run their clinic and to do all high end cases.
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^^ It is just the energy and enthusiasm of youth….. which will fade after a decade or less of real world practice.
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I disagree with the above idea that a young IR just needs some years behind them and they will be tired of wearing lead too.
There has been a paradigm shift in IRs and IR training. Most IRs these days especially those entering the direct pathway have little to no interest in DR. The old IR model was wait around til someone sends you a case hence why many PP are line, bx, and drainage services. The younger guys (some older too to be honest) have realized the only way to have a successful practice is to be clinical and build the practice. Many of my friends and colleagues have looked outside of the traditional DR model for their practice whether it is in an OBL or join a multi specialty practice with Cards or VS. IMO the best step forward for many of these traditional DR practices may not be to fight the trend but to embrace it. A productive IR doing high end cases can be financially and politically beneficial to a group. At least that is my two cents.
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The more things change the more they stay the same. I am extremely pessimistic about this move by IR. Even worse, these new IRs can no longer fall back on DR if needed or desired later.
It has nothing to do with being sent cases – any clinician can take any procedure from IR they so desire and IR can do nothing about it. Thus, IR will by definition only get cases that are not wanted by other / not worth their time or effort. It doesn’t matter that the IR may be more skilled or know more clinical medicine than the clinician.
Direct referrals from PCP or wound care is possible but a difficult road. PCP much more likely to send that young woman with refractory HTN to a Cards over an IR. The Card will make the dx and then do the procedure himself unless they don’t want to for some reason. Similarly, most vascular patients will be referred to VS over an IR directly. VS doesn’t need IR “backup” and can switch to an open procedure if needed etc.
What is left? What they don’t want or after hours ER crap – lots of cold legs at 2am.
My opinion is this splitting of IR/DR actually hurts both and was not the best idea. Med students jumping at IR don’t have a clue as you would expect. All of this is an inherent weakness of being a radiologist, IR or DR. If someone wants to be a clinician they really shouldn’t pick radiology in any form or fashion imo.
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I disagree with your assertion that an IR cannot out compete their competitors for good (well paying) cases just cause they are IRS. Is it a disadvantage yes but not impossible. I personal have got cases over those said specialities because the podiatrist, wound care centers, and PCPs saw that I provided better care and better outcomes for their patient over my competitors. I have no problem visiting their offices, giving presentations, or round on my patients on the floor. Plenty of times Ive been told by these providers theyve never seen a rad out of the reading room. Or when I left my last job two different providers who referred me PAD cases (5 or so a month each) said they wouldnt send them to the group anymore because they didnt trust the other IRs in the group to care for their patient properly. Or I get called to do kyphos over the Ortho and pain specialist in my hospital all the time now because I do a better job (referrers words).
IMO it is about the effort you put in. If you act like you cant compete and are just bottom feeder than that is how youll be treated by other docs. One last point most of the gate keepers in medicine are looking for the easiest way for their patient to get the care they need if you put up a wall, which frankly man rads do they will look elsewhere.
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That sounds like an incredible pain in the @ss though to me personally. If one wants to work like this why mess with Rads, why not just go into surgery / vascular or become a Cardiologist? They do many cool minimally invasive cases, many of which are beyond the scope of IR also. I understand DR can get boring but why become a Radiologist just to later desire to become a Surgeon Jr.
i commend you Vanilla, however, to your work ethic and dedication to IR and wish you well. -
I think vanilla com is right on. To me there has not been a more exciting time for VIR. We are recruiting exceptional candidates who are motivated to take care of patients and are not afraid of competition and in fact many embrace it. The technology continues to rapidly evolve.
If you want to simply do coronary and structural and PAD you could argue IC is a reasonable route.
If you want to do carotids, dialysis, peripheral / CLI, aortic work, venous disease and also do open surgeries, vascular surgery is a reasonable route.
The exciting thing about VIR, is the head to toe options and various service lines.[b]Vascular:[/b] Dialysis including PD catheter placements, endovascular av fistula formation , dialysis catheters, av fistula and graft maintenance.
DVT and PE work especially with the clottriever and flowtriever and lighting CAT12 , jeti etc. IVC filter retrievals with forceps and lasers and IVC reconstructions with venous dedicated stents.Varicose vein scelotherapy, clarivein, evlt
carotid stenting, stroke thrombectomy etc
Refractory htn is more likely to be due to hyperaldosteronism as RAS (unless young patient 40 or less with FMD) is not likely the source. ASTRAL trial, STAR and CORAL all did not show benefit from renal stenting.[b]Oncology[/b]: Liver directed therapy (TACE, Y90, DEB TACE, bland) microwave, rfa , cryoablation, ire
Lung ablation (Cryo /rfa/microwave)
Bone: ablation/ cementoplasty and fixations even (dechampes et al)
Kidney (cryoablation/ rfa/ microwave)
Thyroid: rfa/ PEI/ TAE
[b]GI/GU/Reproductive:[/b] Varicoceles; pelvic congestion syndrome; BPH and PAE ;Fibroids and adenomyosis and UAE and tubal recanlizations etc.
nephrostomy; nephroureteral stents; PCNL; gallstone removal using scopes; feeding tubes; Gi bleeds; TIPS/ BRTO/CARTO/PARTO
[b]MSK/Pain/Palliative: [/b]Indwelling pleural darinage catheters (malignant ascites/ effusions); epidurals ; facets; rhizotomy; vertebroplasty; kyphoplasty; spinejack; osteocool; celiac blocks/ hypogastric nerve blocks etc. ablation of osseous metastases with adjunctive cementoplasty; pelvic fusions
The scope and breadth of what we can offer is now unparalleled and with the much needed most recent clinical integration in the VIR residencies, the VIR graduates are finally getting the critical clinical acumen they were sorely lacking in the prior training paradigm.
What is the biggest challenge is will the graduate be able to get the following which requires expensive overhead
1) clinic time (not doing procedures or imaging)
2) clinic space (outpatient space to see and counsel patients)
3) staff (schedulers; nurses/ medical assistants; scribes etc)
DR is an amazing specialty as you learn in great detail anatomy and diseases throughout the human body with rapid advancements in technology as well. The DR physician is very well compensated and they have reasonable hours and decent amount of time off. The VIR physicians may often have buyers remorse when they realize they have to work much harder compared to the DR colleagues, and have to go out and actively compete to get referrals .
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I still feel the optimal set up is to be supported in Radiology rather than a split. So some time spent doing cases, some practice building / clinic and some time spent reporting.
The key is not to try to squeeze out every possible drop of reporting or the practice building cannot happen.
Also building it has to be incentivized somehow… most traditional rad groups dont….Not sure how…
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Agree, ideal to be supported by global radiology. But, the overhead is high and hard for many to support as the return on investment can take several years and the first few years will often be in the red. The VIR physician may not be seen as productive when they are doing floor work, spending time talking to patients or referrings and that time sink is an opportunity cost of getting the DR list read.
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The new IR paradigm and working with VS and cards is more of a wishful thinking. It will definitely hurt both DR and IR but IR more. I am also very pessimistic about those who choose to do 100% IR early in their career.
Hint: My brother is an interventional cardiologist. He and many of his friends dropped or significantly decreased the interventional part after a 10-15 years of practice and now do mostly clinic and imaging.
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I don’t have a dog in this fight and I respect our IRs. The field of IR does cool stuff, but as a physician, if I wanted to do procedures for a living, owning the patient as a surgeon would have been the way to go, IMO. Trying to do that as an IR is like being the bat in Aesop’s tale of the Bat, Birds and Beasts. In for a penny, in for a pound.
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I chose VIR because I did not like the prolonged recovery and how ill patients got after open surgery and liked the minimally invasive nature of the specialty with rapid recovery and the broad spectrum of diseases treated. There are very few things in medicine that can give me this degree of breadth in procedures. The challenges that had to be overcome are poor clinical training (which is changing) and the need to educate referrng physicians of what we can offer (takes time but is very doable) and now patients are requesting many of these services.
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Yes it is hard to build an independent practice, but it was the one of the most rewarding things Ive done in my life (second to wife and kids). Luckily a well run OBL can be quite rewarding financially. Its also amazing that even the mundane dump cases become not so bad when you are getting decently paid for it at a decent hour.
I still occasionally go to a hospital to do an Elective EVAR on one of my pts or a PAD consult. It always serves as a good reminder of the bureaucratic chaos I left behind. My cases almost never start on time there (getting pushed back due to hospital emergencies, staff lunch breaks, pts getting lost in the massive hospital/parking garage, mounds of paperwork they have to fill out, etc).
I find that most pts prefer getting there case done at the outpt lab (better parking, less paperwork, usually in and out of office much quicker). They get to know and become friends with my staff. Another huge benefit is getting to hire and fire your own staff. I also chose to pay good people well to get them to stay. Having a friendly staff at the front desk and phones goes a long way for pt retention.
I feel that Having training in IR is advantageous for the OBL compared to to vascular surgery or cardiology. I do everything they can do in an OBL ( pad and veins – arguably better then them ;). I also can build other well paying service lines for my lab ( Prostate embo, UAE, chemo embo, Y90, kypho etc).
Even the little cases ( para, Thora, LP, tube changes, biopsies) pay well in the office and can help to pay the bills and fill in the gaps in the day. The good news is that you CAN do these little cases, but dont have to Schedule them if you dont have time or desire to do them.
A lot of insurance companies, HMOs, and capitulated care companies prefer their pts to go to an OBL for their care due to the decrease in costs compared to the hospital.
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Quote from Robotrad
Yes it is hard to build an independent practice, but it was the one of the most rewarding things Ive done in my life (second to wife and kids). Luckily a well run OBL can be quite rewarding financially. Its also amazing that even the mundane dump cases become not so bad when you are getting decently paid for it at a decent hour.
I still occasionally go to a hospital to do an Elective EVAR on one of my pts or a PAD consult. It always serves as a good reminder of the bureaucratic chaos I left behind. My cases almost never start on time there (getting pushed back due to hospital emergencies, staff lunch breaks, pts getting lost in the massive hospital/parking garage, mounds of paperwork they have to fill out, etc).
I find that most pts prefer getting there case done at the outpt lab (better parking, less paperwork, usually in and out of office much quicker). They get to know and become friends with my staff. Another huge benefit is getting to hire and fire your own staff. I also chose to pay good people well to get them to stay. Having a friendly staff at the front desk and phones goes a long way for pt retention.
I feel that Having training in IR is advantageous for the OBL compared to to vascular surgery or cardiology. I do everything they can do in an OBL ( pad and veins – arguably better then them ;). I also can build other well paying service lines for my lab ( Prostate embo, UAE, chemo embo, Y90, kypho etc).
Even the little cases ( para, Thora, LP, tube changes, biopsies) pay well in the office and can help to pay the bills and fill in the gaps in the day. The good news is that you CAN do these little cases, but dont have to Schedule them if you dont have time or desire to do them.
A lot of insurance companies, HMOs, and capitulated care companies prefer their pts to go to an OBL for their care due to the decrease in costs compared to the hospital.
What is your mechanism to admit the occasional one-off patient that you can’t send home after a procedure ? Do you have any cooperators (e.g. pain) who use your facility for their cases ?
I assume you are just a ‘doctors office’ from a licensing perspective or are you considered a single-room ASC ? In some states, one of the things that hampers the development of OBLs is the CON process that allows the local hospital to effectively veto the development of any OBLs and ASCs in their area.
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Re pts needing admission: you are required to have hospital privileges at a nearby place to practice in an OBL (different states have different distances). Additionally you need to use best judgement about what cases to do in office vs the hospital. Things that likely need lysis are better done in hospital.
It is incredibly rare that we have had to send a pt to hospital after a Procedure. For the most part, an IR has the toolkit and know how to tackle most complications. Need to keep embo coils and covered stents on shelf. Full code cart needed.
CON does not apply to OBLs in my state. ASCs are more expensive and more regulated. There are some procedures we cant do (or get paid for) in an OBL that you can do in an ASC. Some procedures pay better in an OBL, others pay better in an ASC.
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This is why its better for new IR trainee to get their complications out of the ways in a supportive environment.
Having an unfortunate bad complication / death where you did everything you can as a new grad is unfortunate but having such a death in your OBL and you cant figure out how to deal with it will be career ending.
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Quote from irfellow2019
This is why its better for new IR trainee to get their complications out of the ways in a supportive environment.
Having an unfortunate bad complication / death where you did everything you can as a new grad is unfortunate but having such a death in your OBL and you cant figure out how to deal with it will be career ending.
The best place to get your procedural kills out of the way is as junior faculty at ‘mecca’. Because you always have the excuse that ‘the disease did it’ and ‘nobody in the community would have touched him’ 😉
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Quote from Robotrad
Re pts needing admission: you are required to have hospital privileges at a nearby place to practice in an OBL (different states have different distances). Additionally you need to use best judgement about what cases to do in office vs the hospital. Things that likely need lysis are better done in hospital.
Do you admit to your own service at the hospital or are you cooperating with the hospitalists ? Are your privileges at the hospital limited to IR procedures and E&M only ?
I have just never practiced in a setting where we had a OBL that also admitted to the hospital. We had a independent IR group when I was a resident, they did cases at several local hospitals as a carve-out in the respective contracts. In a setting where the group covering the hospital has their own IR service, I could see a lot of potential for ‘bad blood’ and envy if there is a local OBL that ‘steals their cases’ (not realizing that those wouldn’t be ‘theirs’ but probably in the hands of VS or cards). -
I can admit, but usually do not. There are several independent IM docs at my hospital that are happy to get the business to admit my pts. There is a radiology group with IRs at the hospital I go to. We really dont compete as they dont do PAD or aorta work. I bring my own pts to hospital and very rarely get consults from podiatry at the hospital. One VS complained that I was doing cases at his hospital, but the CV surgeon i work with (he is my backup on aorta cases, gets paid well to be available) put him in his place. I try not To do many cases there as it is quite annoying (always delays, supply issues, unmotivated staff).
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Quote from irfellowship2020
An OBL/ASC sounds very appealing for these reasons. I am wondering though, what happens when you own the OBL/ASC and want to go on vacation? It must cost a fortune to pay staff while not taking in money. I would think it’s very difficult to do if you are a one-person shop. Must have at least one partner to do cases while you are on vacation?
You hire a locums, usually someone from the VA or .mil who wants the extra cash.
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