Integration or Independence: New Models for Organizing Interventional Radiology
Changes in training, practice and patient care are reshaping how IR is organized
While both diagnostic and interventional radiology (IR) are experiencing a period of significant change, the specialties are evolving in different ways. As IR becomes increasingly clinical and patient-facing, some leaders are asking whether it still belongs within a traditional radiology department.
On the diagnostic side, clinical practice is being transformed by AI—a technology that has had less impact on IR. Instead, IR is becoming an increasingly surgical specialty.
“As interventional radiology becomes more complicated due to clinical consultation, hospital admissions and inpatient rounding, it requires more patient-facing clinical exposure to trainees—a fact that is reflected in the creation of a distinct IR residency straight out of medical school,” explained Stephen Solomon, MD, an interventional radiologist and chair of the Department of Interventional Radiology at the University of Miami Miller School of Medicine and the University of Miami Health System (UHealth).
The two fields also have a very different looking work environment, with diagnostic radiology largely moving away from in-person settings and towards remote, volume-focused work. “Since the COVID-19 pandemic, most diagnostic radiologists have increased the amount of time they spend working from home,” Dr. Solomon said.
An interventional radiologist’s workday, on the other hand, is much more patient-centric, requiring them to go to the hospital, meet with patients, discuss treatment options, perform procedures and manage recovery plans.
Medicare further distinguishes the specialties through the Provider Enrollment, Chain, and Ownership System (PECOS). Diagnostic radiologists are classified under specialty code 30, while interventional radiologists are classified under specialty code 94, which permits billing for certain patient evaluation and management services.
The IR classification permits physicians to bill Medicare for certain patient evaluation and management services that are not billed in the same way under the diagnostic radiology classification.
“The practice of radiology is changing. There are clinical, billing, technology, educational and identity-driven factors that differentiate us quite substantially,” said Julius Chapiro, MD, PhD, a diagnostic and interventional radiologist at Yale School of Medicine in New Haven, CT.
But do these differences mean interventional and diagnostic radiology should become different departments?
According to Dr. Solomon, the answer is ‘yes’.
“The structure of what I do and what my diagnostic colleagues do are diametrically opposed,” he explained.
This, in part, is why he decided to move to UHealth, where the Department of Interventional Radiology functions independent of the hospital’s Department of Diagnostic Radiology. “I feel this structure gives interventional radiologists a seat at the table, where we—as an independent specialty—can ensure our needs are fully represented,” he said.
However, that seat could come at a cost.
The Benefits of Staying Together
One of IR’s key differentiators is the fact that its procedures, training and knowledge are based on an intimate knowledge of imaging. “Our surgical skills are not necessarily better than those of other minimally invasive specialists, but our outcomes are achieved because we are highly trained in image interpretation,” Dr. Chapiro said.
Giving up the affiliation with radiology could make IR less competitive. “We lose the one defining strength that makes us better than those surgical specialists who are not trained to understand and use advanced imaging,” Dr. Chapiro added.
It also risks losing the financial backing of a strong diagnostic radiology department that often subsidizes IR divisions. As a result, IR could become much smaller and thus vulnerable to competition from surgery and minimally invasive specialties like endoscopy and interventional cardiology.
“Our ability to negotiate for new equipment, new privileges and more resources is much stronger when we’re part of a department with 100 people than it would be as a small unit with maybe 10 faculty,” Dr. Chapiro said.
Yet, as Dr. Solomon points out, this advocacy depends on the department understanding IR’s specific needs. “The majority of departments are led by diagnostic radiologists who, because they might not fully understand what interventional radiologists do, don’t always represent what’s in our best interest,” he explained.
A New Approach to Integration
Although she understands Dr. Solomon’s concern, Maureen Kohi, MD, an interventional radiologist who currently chairs the Department of Radiology at the University of North Carolina (UNC) Chapel Hill and will soon become the chair of the Department of Radiology at the University of Pittsburgh Medical Center in October, believes the issue can be resolved not by separating, but by changing how the two specialties are integrated.
As Dr. Kohi explains, UNC’s IR program is successful because it’s positioned as a highly autonomous clinical service within a fully integrated radiology department. “I see the importance of giving interventional radiology the support they need to establish an independent clinical identity as well as a strong outpatient clinic and inpatient service,” she said.
Dr. Kohi also strives to maintain a shared vision towards research, education and enterprise imaging strategy. “This ensures that as the diagnostic side of our department has grown across the system, so too has the interventional side,” she said.
It could be argued that UNC is an exception, being one of only a handful of departments headed by an interventional radiologist. Yet there are diagnostic-led departments where IR thrives.
“These successfully integrated departments recognize that modern IR requires more than just procedural space and provides them with dedicated clinics, appropriate staffing, efficient scheduling, multidisciplinary partnerships and support for longitudinal patient care,” said Jeffrey Chick, MD, MPH, division chief of interventional radiology at the University of Southern California’s Keck School of Medicine.
To further improve integration, Dr. Chick notes that diagnostic-led departments may do a better job identifying patients who could benefit from intervention, developing disease-specific imaging pathways, and including interventional radiology in strategic planning. “Integration should provide a foundation for clinical growth, not limit it,” he said.
Set the Emotions Aside
Whether IR should become a separate department is a question that evokes strong opinions both for and against. According to the experts, decisions about departmental structure require setting emotions aside and focusing instead on measurable effects on patient care, clinical growth, academic performance and workforce stability.
“You really need to ask whether an integrated department provides IR with the autonomy, resources and strategic influence it needs to thrive as a clinical specialty while also preserving the advantages of our shared imaging expertise and innovation,” Dr. Kohi said. “If the answer is yes, then stay integrated; if not, then maybe IR would be better off separating.”
“Regardless of whether one opts to stay integrated or become independent, the decision should ultimately be driven not by the organizational chart, but by a mission to improve patient care,” Dr. Chick concluded.
For More Information
Read previous RSNA News stories on interventional radiology:
- Addressing the Interventional Radiology Shortage
- Training Interventional Radiologists in East Africa
- Interventional Radiologists May Benefit from Dedicated MRI Safety Guidelines