Impact of the IR/DR Primary Specialty Certification on Scientific Research in the Field.

Research is essential to the development, maintenance, and success of interventional radiology (IR) as a primary specialty. IR physicians must embrace a more sophisticated research approach toward the procedures we perform and the diseases we treat to accompany our elevated status. Identifying impactful research needs and directing a comprehensive research portfolio will anchor our position as an essential specialty within a thriving health care system. Doing so will ensure that this historic opportunity is maximized for the benefit of IR physicians, IR trainees, and, ultimately, IR patients.

A Review of Professional Liability in IR: Sweeping the Mines.

Medical professional liability (MPL) is becoming a substantial issue in interventional radiology (IR), with both impact on health care costs and negative psychological effects on physicians. MPL presents special challenges within IR because of the field's complex and innovative therapies that are provided to a diverse group of patients and complicated by the off-label use of devices and drugs that is pervasive in the field. This review discusses the principles and practices to avoid and manage MPLs that are specific to the field of IR.

Establishing a pediatric interventional radiology inpatient consult service.

OBJECTIVE: To delineate pediatric interventional radiology (IR) inpatient consult growth and resulting collections after implementation of a pediatric IR consult service. METHODS: An inpatient IR consult process was created at a single academic children's hospital in October 2019. IR consult note templates were created in Epic (Epic Systems Corporation, Verona, Wisconsin) and utilized by 4 IR physicians. Automatic charge generation was linked to differing levels of evaluation and management (E&M) service relating to current procedural terminology (CPT) inpatient consult codes 99251-99255. The children's hospital informatics division identified IR consult notes entered from the implementation of the consult service: October 2019 to January 2022. The university radiology department billing office provided IR service E&M charge, payment, and relative value units (RVU) information during this study period. A chart review was performed to determine the IR procedure conversion rate. Mann-Whitney and a two-sample t-test statistical analyses compared use of the 25-modifier, monthly consult growth and monthly payment growth. P-value < 0.05 was considered statistically significant.  RESULTS: Within this 27-month period, a total of 2153 inpatient IR consults were performed during 1757 Epic hospital encounters; monthly consult peak was reached 5 months into the study period. Consult level breakdown by CPT codes: 99251-8.7%, 99252-81.7%, and 99253-8.8%. 69.7% of IR consults had consult-specific billing with payments in 96.4% resulting in $143,976 new revenue. From 2020 to 2021, IR consult volume trended upward by 13.4% (P =0.069), and consult-specific payments increased by 84.1% (P<0.001). IR consult procedure conversion rate was 96.5%. CONCLUSION: An inpatient pediatric IR consult service was quickly established and maintained by four physicians over a 27-month study period. Annual IR consult volume trended upward and consult-specific payments increased, resulting in previously uncaptured IR service revenue.

Workforce Diversity of Interventional Radiology Physicians in North America: Reflections on the U.S. Experience.

Achieving parity in representation within the field of Interventional Radiology (IR) across women and specific subsets of minority groups has been a challenge. The lack of a strongly diverse physician workforce in gender, race, and ethnicity suggests suboptimal recruitment after, during as well prior to IR training. There is a dearth of studies which effectively characterize the national demographic trends of the evolving IR workforce. This has prevented an accurate appraisal of continuing efforts to narrow the gaps in physician workforce diversity across the field of IR. To support these needs, this article illustrates historic trends while providing contemporary data that canvasses the status of diversity within the current IR physician and IR trainee workforce. It highlights the representation of those individuals historically underrepresented in medicine as well as women. It also highlights current obstacles to achieving equity, diversity, and inclusion within the field of IR as well as existing efforts that have been employed to mitigate this gap.

Reductions in Reimbursement and Relative Value Units for Interventional Radiology Procedures: Trends from 2011 to 2021 Compared with Those for Other Physician Specialties.

PURPOSE: To compare recent trends in Medicare reimbursement and relative value units (RVUs) for interventional radiology (IR) procedures similar to those performed by non-IR specialties. MATERIALS AND METHODS: Data from the Centers for Medicare and Medicaid Services Physician Fee Schedule for facility reimbursement and RVU component values for 23 commonly performed single Current Procedural Terminology IR procedures were compared with similar procedures or procedures for similar indications performed by non-IR specialties between 2011 and 2021. RESULTS: The work RVU component decreased in 18 of 23 (78.3%) IR procedures compared with 6 of 23 (26.1%) similar procedures performed by non-IR specialties. The largest change in single RVU component was a 19.2% reduction in practice expense RVU for IR compared with a 16.5% reduction for similar procedures performed by non-IR specialties. CONCLUSIONS: As a specialty, IR experienced a disproportionately greater reduction in reimbursement and RVU valuation for a range of comparable procedures performed by non-IR specialties.

Gender representation within radiology conferences in the UK in 2021.

AIM: To examine the gender representation and equality within academic meetings and society conferences within the UK radiology conferences. MATERIALS AND METHODS: UK-based subspecialty radiology meetings organised by major radiological associations and societies (online and in-person) from 1 January 2021 to 31 December 2021 were included. Speakers and chairs were documented with reference to their gender, years on General Medical Council (GMC) register, academic publications, and h-index. Data were analysed using SPSS v27 (IBM, Armonk, NY, USA). RESULTS: Of 298 sessional chairs, 105 were female (35.2%). Of 639 speakers, 212 (33.2%) were female. Three subspecialties (interventional radiology, uro-radiology, and nuclear medicine) had a higher proportion of female speakers than the percentage of female consultants with specialist interest. Of the 71 invited international speakers, 28.2% (20/71) were female. Online conferences had a significantly greater proportion of female speakers (43.2% versus 24.1%, p<0.001) and chairs (48.7% versus 20.4%, p<0.001) compared to in person. Male speakers had a higher median number of publications (31 versus 12, p<0.0001) and median h-index (11 versus 4, p<0.001). CONCLUSION: This study demonstrates that women are under-represented in radiology society meetings, particularly within certain subspecialty groups. Radiological societies should actively encourage a more balanced gender representation at conferences with online conference shown to improve female representation.

Clinical Practice Patterns of Interventional Radiologists by Gender.

OBJECTIVE. Given recent specialty attention to workforce diversity, we aimed to characterize potential gender differences in the practice patterns of interventional radiologists (IRs). MATERIALS AND METHODS. Using Medicare claims data, we identified IRs on the basis of the distribution of their billed clinical work effort and descriptively characterized practice patterns by gender. RESULTS. Women represented 8.2% (241/2936) of all IRs identified nationally. Female representation varied geographically (≤ 2% in nine states, ≥ 20% in three states) and by career stage (9.4% among early-career IRs and 6.4% among late-career IRs; 18.8% among early-career IRs in the Northeast). For both female IRs and male IRs, interventional case mixes were similar across service categories (e.g., venous and hemodialysis access, arterial and venous interventions, biopsies and drainages) and by procedural complexity (e.g., 5.7% vs 4.3% for low-complexity procedures and 59.5% vs 61.3% for high-complexity procedures). Average patient complexity scores were also similar for female (2.7 ± 12 [SD]) and male (2.8 ± 12) IRs. Female IRs spent slightly lower portions of their work effort rendering invasive services (66.5% vs 70.0%, respectively) and noninvasive diagnostic imaging (19.0% vs 22.2%) than male IRs but spent more time in evaluation and management clinical visits (14.5% vs 7.9%). Both female IRs and male IRs rendered a majority of their services to female patients (53.4% vs 53.1%). CONCLUSION. Although women remain underrepresented in interventional radiology, female IRs' interventional case composition, procedural complexity, and patient complexity are similar to those of their male colleagues. Female IRs' higher proportion of evaluation and management clinical visits supports the specialty's increased focus on longitudinal care so that interventional radiology will thrive alongside other clinical specialties.

Medical Malpractice Primer for Practicing Interventional Radiologists.

Medical professional liability (MPL), also commonly referred to as medical malpractice, is a costly issue in health care today, accounting for roughly 2.4% of total health care expenditure in the United States. Almost all physicians currently in clinical practice will either be subject to a lawsuit themselves or work with someone who has. Given a lack of formal structured education about MPL in medicine for trainees, this review aims to define and discuss the relevant concepts in MPL as a reference for early career interventionalists to understand the current medicolegal environment and learn best practices to avoid litigation.

The 2017 Integrated IR Residency Match: Results of a National Survey of Applicants and Program Directors.

PURPOSE: To characterize and compare the experiences of matched applicants and program directors (PDs) participating in the first large-scale integrated interventional radiology (IR) residency match. MATERIALS AND METHODS: Survey questionnaires were distributed nationally to integrated IR applicants who matched in the 2017 Match cycle and PDs. Both groups were questioned regarding their experiences with the application, interview, rank, and match processes as well as applicant-specific and PD-specific information. Summary and descriptive statistics were applied to responses, and comparison of Likert scale responses was performed by two-sample t test. RESULTS: Sixty-one matched applicants (51.3%) and 34 PDs (55.7%) responded to the survey. Regarding the match process, applicants believed United States Medical Licensing Examination (USMLE) Step 1 score (P = .002) and connection to a program's geographic location (P = .006) were significantly more important than PDs did, whereas PDs ranked grades (P = .049), class rank (P = .011), academic awards (P = .003), additional degrees (P < .001), and USMLE Step 2 Clinical Skills score (P < .001) as significantly more important factors than applicants did. Additional information regarding demographic data, medical school experiences in IR, application strategies, interview experiences, rank lists, the intern year, and match results are reported. CONCLUSIONS: The completion of the first large-scale integrated IR match represents a paradigm shift in the way in which IR practitioners are recruited and trained. This study provides valuable benchmark data and analysis that can be used to improve efforts to match the best-fitting applicants into the integrated IR residency and improve future match cycles for applicants and PDs alike.

Current Clinical Practice Patterns of Self-Identified Interventional Radiologists.

OBJECTIVE: The purpose of this study was to assess patterns of procedural, clinical evaluation and management (E/M), and diagnostic imaging services rendered by self-identified interventional radiologists (IRs) across the United States. MATERIALS AND METHODS: Recent Medicare Physician and Other Supplier Public Use and Physician Compare national downloadable files were linked. IRs were defined as physicians self-identifying interventional radiology as their primary specialty on Medicare claims or as a specialty during Medicare enrollment. The primary outcome measure was percentage of work (in work relative value units [WRVU]) attributed to interventional services (both procedural and E/M) per IR. Secondary outcome measures included sociodemographic factors per interventional WRVU quartile and percentage of E/M service units per IR. Statistical analysis included chi-square and t tests and logistic regression. RESULTS: Overall, 3132 physicians nationally self-identified to Medicare as IRs. The distribution of WRVU attributed to interventional services was strongly bimodal. Procedures and E/M together accounted for ≥ 91% and ≤ 5% of total work for the most and least intervention-oriented quartiles, respectively, but were widely distributed in the middle two quartiles. The most intervention-oriented self-identified IRs were more likely out of medical school ≤ 30 years (odds ratio [OR], 2.5; p < 0.0001), men (OR, 2.2; p < 0.0001), and in academic practice (OR, 4.3; p < 0.0001). E/M accounted for only 1.4% of all billed services. CONCLUSION: Although most self-identified IRs perform both interventional and diagnostic imaging services, the subspecialty distribution is strongly bimodal, one-quarter each focusing ≤ 5% and ≥ 91% of work on interventional services. Despite ongoing emphasis on clinically focused interventional radiology, E/M services remain rarely reported.

Are Standardized Video Interviews Useful for Selecting Integrated Interventional Radiology Residents?

The objective of this project is to evaluate the usefulness of the asynchronous or standardized video interview (SVI) for selecting integrated interventional radiology residents. All selected interviewees were asked to provide a brief recorded video answering 2 standardized questions. The applicants were interviewed in the virtual real-time format by 8 interviewers and ranked by group consensus. The SVIs were independently reviewed by a separate group of 4 interviewers and ranked by group consensus. These consensus ranks were compared to each other to determine similarities and differences in rank order. The results show that the SVIs are not statistically reliable as compared to the real-time interviews. There was a trend for an agreement for the lowest tiers in ranking; however, this was not statistically significant. The asynchronous interview is not equivalent to the virtual real-time interview and would not represent an equivalent replacement. However, the SVI may be useful for screening applicants to interview.