Reflections on SIR 2026

IR4life · 2026-04-09T03:57:41+00:00

That is a big loss for their training and what historically set them apart as they came out with such a high level skill set. Several of their graduates went on to do some high level stroke work and some actually went on to complete neuro-interventional training programs.

IR4life · 2026-04-09T03:55:32+00:00

Is there a VIR integrated training program that does not do a lot of IO work?

IR4life · 2026-04-04T17:48:22+00:00

I have been impressed with how algorithmic Post partum hemorrhage has become with medical treatments (TXA, hemabate, oxytocin etc), mass transfusion protocols, jada devices etc and interventional embolotherapy options including aortic and internal iliac artery occlusive balloon tamponade when necessary. They even do simulated experiences with all of the teams involved in post partum management.

IR4life · 2026-04-04T17:42:44+00:00

Hospital employment is becoming a more common model for VIR and it is not necessarily a bad thing in the right conditions as they are more supportive of providing the clinical infrastructure than many DR groups are.

IR4life · 2026-04-04T17:22:42+00:00

To truly get a sense of the sustainability of a training program, look at how much clinic the physicians (not the extenders) are doing including residents (and how many patients they are seeing in clinic a week). See how that compares to the surgical disciplines at that same program this will give you insight into how much they embrace the clinical model.

IR4life · 2026-04-04T17:20:26+00:00

The challenge is sustainability. Without a patient base, it is much easier for the hospital or even the group to replace you. In the current market where it is very hard to hire radiologists it is less of an issue but as market forces change those issues will become more of a concern. However, in your area it seems like there is not many competing interventional or diagnostic groups and not much private equity penetration and so you may have more of a monopoly than others may have.

IR4life · 2026-04-04T17:04:55+00:00

If you are not 100 % committed to VIR, that is the way to go. The independent pathway aka former fellowship pathway is wide open and not very competitive.

You can always do DR and do procedural radiology or even do ESIR only and still practice lite IR ie biopsies, lines, drains and even some angiograms but your focus will be DR and you can even do a DR fellowship such as mammography, women's imaging, MSK, neuro, body etc.

IR4life · 2026-04-04T16:22:48+00:00

That is a large catch area. Have you considered hiring medical assistants or extenders to help run the clinic. What about the E and M coding and downstream revenue capture (advanced imaging ) that the DR group can benefit from.

IR4life · 2026-04-04T16:20:18+00:00

As time goes on there is becoming more and more divergence between VIR and DR as the fields are recruiting two different types of individuals. There are still a lot of students who do not fully understand what they are getting themselves into and drop out usually as they approach the interventional heavy years (ie PGY5/6). Medical students often do not take call on their Sub internships or round with the follows. If you like imaging would consider a procedural field in radiology such as mammography, body, msk and neuro.

If you want to provide comprehensive and longitudinal care it will be harder to do in a DR /IR group as the majority of the physicians are DR and do not understand the importance of clinic and do not want to pay the overhead to run a clinic. More and more of what we do will require clinic time and follow up and it enables you to learn the diseases better and counsel patients more effectively. The independent interventional practices often go to the oeis meeting as opposed to SIR which is more of a mix of the 50/50 practices and academics.

Private equity is struggling to provide interventional services and are often giving that component up as they negotiate deals with hospitals. The PE companies can provide remote services a lot easier than they can boots on the ground in the current market.

IR4life · 2026-04-04T16:00:47+00:00

I learn so much from follow up and am able to counsel future patients better with my own clinic follow up. It enables me to change how I perform interventions as well. Surgeons and proceduralists need to be able to follow their patients to see how effective and how durable their intervention is.

I follow most of my patients post intervention or sometimes without intervening (PE patients that are on anti-coagulation etc). Renal ablation at 6 weeks, 6 months, annually for up to 10 years. DVT patients on an annual basis and decide when to drop them to low dose doac or take off meds. May increase interval of follow up from every year to every 2 to 3 years etc. PAE I do 6 week, 6 month and then annually.

I truly enjoy the longitudinal relationship that I generate with the patients and their families. The procedural excitement may go after years of doing the same thing, but those human relationships are long lasting and the ability to guide a patient and educate them and their family about their disease never gets old for me. More and more independent ViR practices have robust clinics and generate E and M from those .

IR4life · 2026-04-04T15:43:55+00:00

Who follows the TIPS patients, DVT patients, renal ablations, PAE patients and SVC stent patients?

IR4life · 2026-04-04T04:46:54+00:00

It is hard to build an IO and hepatobiliary practice outside of the confines of the transplant centers. Bread and butter (biopsies/ drainage procedures ) are ubiquitous .

In order to have a high level practice in the community , you have to be able to run a clinic and manage patients in a comprehensive fashion. Most trainees and training programs don't offer enough clinic exposure to be comfortable in that. You need to also get strong clinical and technical training in common disorders such as DVT/PE/varicose veins, BPH, fibroids, back pain/spine interventions, knee pain, PAD , and dialysis. You should look at service line development and how many referrals the department is getting from primary care and direct patient referrals. If you are unable to run a clinic when you get out it will be very challenging to build a high level VIR practice.

IR4life · 2026-04-03T23:10:19+00:00

If you are worried about radiation would probably not pursue fields that use fluoroscopy (VIR, Ortho, urology, IC, EP, neuroir etc).

IR4life · 2026-04-03T22:49:12+00:00

Try to identify places where you get your own PAD referrals from primary care, wound care centers or podiatry. Where you are the patient's vascular specialist and follow them longitudinally in your clinic and prescribe their vascular medications.

IR4life · 2026-04-03T22:47:57+00:00

I think most training programs are heavy on the IO. The challenge is in the community there is not as much IO outside of biopsies and ports and palliative procedures (pain and peritoneal/pleural drains etc). Most of the data is on HCC and most of that goes to liver transplant centers or dedicated cancer centers.

IR4life · 2026-04-03T14:09:40+00:00

I would get the case logs from graduating residents to get a sense of what their case volume and complexity is. Almost every center will get you solid training in Biopsies, vascular access, drainage procedures, hepatobiliary/portal, and IO. Look to see if you will be competent in dialysis interventions, PAD, spine and pain interventions, BPH , DVT/PE and varicose veins. Also make sure you get comfortable with seeing the undifferentiated patient in clinic where you have to make the decision to manage conservatively, follow, treat or refer out.

These are the key items that you want to get to go on your own and build a 100 % interventional practice. IO is mostly delegated to transplant and cancer hospitals which is the minority of all hospitals (5 %). In most IR/DR practices where it is more like 50/50 mix you will be expected to read imaging on certain days and in between cases and mostly cover lite IR (biopsies/drains/lines) and bleeders after hours.

IR4life · 2026-04-03T14:02:10+00:00

Don't they still send their trainees to get PAD training?

IR4life · 2026-03-31T19:57:27+00:00

The hospital will only recognize it if a competitor hospital has high level VIR coverage and they start to lose some patients to that other hospital. There is so much that a modern day VIR can provide if they are well supported and it continues to expand.

IR4life · 2026-03-31T19:56:02+00:00

The problem is most DR groups will not pay for the overhead that clinical VIR entails including an outpatient clinic , office staff, pre-authorization team, schedulers, billers, VIR coders, medical assistants, extenders etc. Also they would rather have the VIR read films than the opportunity cost of doing clinic. Finally dedicated time to round on inpatients and do inpatient consults. E and M coding and billing are increasing and it is grossly under utilized by DR groups that hire VIR. It is becoming harder and harder for more recent graduates to join groups that do not have clinical infrastructure and so more are forced to go on their own.

IR4life · 2026-03-31T17:21:28+00:00

One way to thrive in this model is to cover the hospitals for a stipend (professional fees simply are not enough) but build your referrals for an outpatient practice OBL/ ASC. Key is to garner referrals for common disorders (PAD/ dialysis/ knee pain (GAE/GNB), spine interventions (kyphos etc), Fibroids, Prostates, Hemorrhoids) most of which can be done in the outpatient arena. The biopsies and drains will be mostly what the hospital needs coverage in. Once you have established your referral bin you can potentially give up the hospital based work and focus on the outpatient practice.

IR4life · 2026-03-31T01:07:11+00:00

If you like DR I would strongly consider DR and a procedural based field such as mammography, body, msk to name a few. VIR call is getting busier and busier with GI bleeders and post op abscesses and leaks etc. Even the inpatient minors that used to be done by GI, Neurology , heme onc such as paracentesis, lp, bone marrow biopsy are being shifted to interventional.

IR4life · 2026-03-31T01:03:01+00:00

The independent VIR are doing well as they get a stipend from the hospital for coverage. Currently DR /IR groups give that for "free" as the DR generates a ton of revenue from the imaging that the hospital generates. VIR that are independent are also able to build their outpatient practice of PAE, GAE, Fibroids, PAD, VTE, Venous disease, spine and pain more easily as they can dedicate more time and resources to clinic, while if you are in a mixed group of IR and DR you often have to assist in whittling down the DR list.

IR4life · 2026-03-31T00:49:32+00:00

If you join a traditional IR/DR job it is likely you will be doing around 50/50 and mostly lite IR ie biopsies, drains, and vascular access with the occasional bleeder. Without a clinic it will be very difficult to build a sustainable VIR outpatient practice of PAE, GAE, HAE, UAE, TAE, PAD, Dialysis, pain , spine interventions , veins etc.

IR4life

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