September 2012

To IR or Not to IR? — That Is the Question
By Jim Knaub
Radiology Today
Vol. 13 No. 8 P. 4

It’s neither new nor secret that differences between diagnostic and interventional radiology (IR) practice often cause conflict within a group. Plenty of diagnosticians think the time and resources needed to build an interventional clinical practice would be more profitably used in the reading room earning revenue for the group rather than subsidizing IR. Interventionalists want to follow their chosen career path and develop their practices by properly serving their patients. They also point out that their services bring real value to the group because interventional radiologists frequently are among the top procedure and admissions referrers for their hospitals.

With so much incompatibility between the two groups, should interventional radiologists pursue their own clinical practices separate from their diagnostic radiology colleagues? Such separation is trending upward, according to Beth W. Orenstein’s reporting on page 26. But if your group faces that question, should the diagnostic radiologists graciously show interventional radiologists the door or block the exit?

Those on the separatist side contend that each group can better focus on the different things they do and that interventional radiologists should establish their clinics as separate practices. Diagnosticians argue that building an excellent, efficient subspecialized diagnostic radiology group creates the best chance to succeed in imaging in the coming years. Interventionalists desire the latitude to develop their clinical practices without backlash from the group. That requires considerable time outside the IR suite and the reading room in addition to the resources and space required to see patients.

One key argument for staying together is that united radiology is stronger than divided radiology. If the hospitals you work with place a high value on IR, it makes good business sense to maintain that service as part of a radiology group’s offerings. And if the IRs don’t have a full-time interventional caseload, reading studies provides economic security.

Some opponents of splitting see a more clear and present danger: They worry that interventional radiologists forming or joining some other entity to provide their services to a hospital make diagnostic radiology groups more vulnerable to being displaced by teleradiology-driven competitors. That may be a new valid argument for IR’s value to a group.

When IR services are not part of your radiology group, those former colleagues could form an independent IR group, join with local interventional cardiologists and/or vascular surgeons, or be hired as hospital employees. I’m not convinced any of those arrangements is better for diagnostic radiologists in the long term.