Future Proof Detour - Why Interventional Radiology?

Yours Truly - Dressed for action. M-I-Z!!!

Yours Truly - Dressed for action. M-I-Z!!!

Welcome to another Future Proof Detour post.  Every once in awhile I like to talk about something other than money.  I shared with you previously about How I Became a Radiologist.  Now let me tell you how I decided that Interventional Radiology (IR) is the career for me.  Fair warning - this one is a bit longer than my usual post.

IR - The Newest Medical Specialty

For those unfamiliar, Interventional Radiologists are physicians who specialize in minimally invasive image-guided procedures.  The breadth of IR procedures is rivaled only by the specialty's relative obscurity.  If a procedure is 1) minimally invasive and 2) image-guided, you can bet you'll find an IR doc who can do it.  In fact, many image-guided procedures now commonly performed by interventional cardiologists, endovascular surgeons and interventional nephrologists were pioneered by interventional radiologists.  Here is a short video from the British Society of Interventional Radiology explaining what we do - man I wish I had that accent!

Vascular and Interventional Radiology (VIR) has been recognized as a radiological subspecialty by the American Board of Medical Specialties (ABMS) since 1994.  However, as the complexity of imaging and image-guided interventions evolved, it became apparent that the skillset required of an interventional radiologist is fundamentally different from a diagnostic radiologist, and the traditional 1 year subspecialty fellowship training may not be sufficient to provide the best clinical care.  From 2012-2014, the American Board of Radiology (ABR), American Board of Medical Specialties (ABMS) and Accreditation Council for Graduate Medical Education (ACGME) sequentially approved the proposal for IR to become the newest primary medical specialty.  You can find more information on the IR residency at the Society of Interventional Radiology (SIR) website.  Here is a video primer on the IR Residency by Dr. Parag J. Patel:

Becoming the newest primary medical specialty - the 37th to be exact - affirms the uniqueness of the interventional radiology practice.  However, it also brought with it some serious side effects.  Take the 2017 main residency match for example, 563 medical students applied for a total of 125 positions.  Of those, 119 successfully matched.  Translation: if you were a medical student applying for IR in 2017, you had an 80% chance of NOT matching - Yikes!!!  This has lead to Sarel Gaur MD to post this video on Top 3 Reasons It's OK You Didn't Match into Interventional Radiology.

My Path to IR

IR was the original reason I decided to go into Radiology as a career.  However, once I started residency, I wasn't so sure anymore.  I won’t lie, there were times during my training when I could imagine myself becoming a body radiologist or a neuroradiologist.  I loved diagnostic radiology, and I still do.  I love piecing clues together to form a coherent explanation of a patient’s complaints; there were more interventional procedures in many other subspecialties than I previously thought; and who doesn’t like going home at a set time?!  Furthermore, my first IR rotation was crushing - I was incompetent, mostly due to a lack of preparation and translatable skills from other radiology rotations.  Almost all of the knowledge in diagnostic radiology can be obtained by an excessive amount of reading.  That wasn't the case for IR.  Think of it this way - you can learn what it looks like to ride a bike by watching others, but you sure can't ride one until you do it.  

Lucky for me, I had great role models who were patient and encouraging.  By my second IR rotation, I was starting to see why I was so attracted to IR in the first place - the patients and the variety of procedures.  I loved seeing patients, talking to them, listening to their stories, sharing in and helping lessen their pain.  I enjoyed looking up the medical record, piecing together the clinical puzzle and finding out exactly what we as IR can do to help.  The variety of procedures performed by IR is nothing short of dazzling.  On a single day, you can place a central venous catheter/port, IVC filter, lyse a pulmonary embolus, recanalize an occluded AV fistula, drop a gastrostomy/nephrostomy/biliary drain, bust up some cancer cells with either TACE or Y90, fix an acute GI bleed, shut down an endoleak... and I haven't even started on CT or US guided procedures!!!  By the end of my third rotation, I was able to perform many procedures independently.  The days were long but I always finished the day feeling proud of what I’ve accomplished and learned.

When I entered third year of residency training, I had a real decision to make - it has come down to body radiology vs. IR.  In order to make up my mind, I requested for an additional IR rotation.  The first day I was back on service, all doubts evaporated and I started wondering why I ever thought I could do anything other than IR.

Where I Go From Here

While the future is always uncertain, I do want to share with you something that's fairly certain in the short term.  June 14, 2017 was the date when I found out where I will go to continue my fellowship training in 2018 and I am proud to announce that I matched into IR fellowship at Miami Cardiovascular Institute (MCVI) - a storied institution and a pioneer in the new clinical model of IR.  I cannot be more excited.

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Future Proof, MD

Dr. Bo Liu is an aspiring radiologist-in-training and the founder and editor of the White Coat Money Blog.  He has an interest in interventional radiology and helping his medical colleagues get ahead in this mad world of medicine and money.  When he's not crushing the list at the PACS station or typing up your next favorite blog post, you can usually find him at the local badminton club, movie theater or the most recently opened restaurant.