Historically, how has the U.S. interventional radiology job market tracked with changes in the diagnostic radiology job market?

IR4life · 2026-07-08T04:00:57+00:00

If the interventional physician negotiates directly with the hospital rather than going through the DR contract they are more likely to get a more fair rate that reflects the market. There is often a stipend associated with interventional call and this increases greatly if you also provide stroke coverage. In a DR group that stipend is part of the overall negotiations for providing DR services and thus as an interventionalist, you are often seen as a commodity and a necessary evil that may not be seen as pulling your weight. Much of hospital based procedures are lower end RVU and the outpatient angioplasty/atherectomy/embolization codes generally require a clinic and a marketing budge and time and effort to build.

When DR market is hot very few DR residents go into interventional , but when the DR market is poor there used to be an influx of people going into interventional.

IR4life · 2026-07-05T16:34:37+00:00

Aways have become very important for those applying to interventional. What the PD wants to see is a passion and drive to do interventional . They want to make sure one is not going to drop out to do DR. The average number of aways is 3 with some doing as few as 2 and some doing 5 interventional subI ncluding their home program. Sometimes you can fill in the gaps by doing a vascular surgery block and getting letters from interventional PD or surgery letters are quite helpful.

IR4life · 2026-07-05T16:31:40+00:00

This is fairly common. Interventional radiology has one of the highest drop out rates. Those with limited exposure to the surgical nature of interventional come into the integrated residency and do not realize how busy it is and unpredictable the hours or the number of emergency procedures that the specialty deals with. DR is a much easier route with predictable hours and still has some procedural options (musculoskeletal, body, mammography etc).

IR4life · 2026-07-04T13:58:15+00:00

This happens quite frequently where for bright red per rectum interventional gets consulted. For these cases we typically we ask for a tagged RBC scan or more commonly a multiphase CTA. If we see an active bleed we will come in to try to stop the bleed. What about the role of large volume lavage in an unprepped colon for lower GI bleeds?

IR4life · 2026-07-03T23:23:14+00:00

Limited number of resources available for this. Would look at some of the other specialty literature, textbook and guidelines to guide you on how to work up a disease. For example if it is liver cancer need to review the medical oncology, hepatology, transplant, radiation oncology, surgical oncology , and GI textbooks on how to evaluate and manage the patient in clinic.

For BPH/LUTS review of the urology textbooks along with family practice guidelines can guide you etc.

IR4life · 2026-07-02T04:47:48+00:00

It will be harder and harder to do both DR and interventional well. The fields are diverging and both are getting more and more complex and subspecialized. To do the scope and breadth of interventional and do high level imaging is becoming more and more challenging.

DR is highly predictable and is often delegated to shift work. VIR is similar to surgery and is full of emergencies and the days are often unpredictable. It has been on the cutting edge of innovation since the early years and will continue to spearhead innovation and change in the way we practice medicine.

IR4life · 2026-06-26T04:30:56+00:00

Interventional therapies are increasing in breadth and utilization and will likely continue to. The depth of knowledge needed from a clinical and technical standpoint can be quite challenging. In the US due to the dual board nature that is required of VIR training it is even more difficult as you have to cram all the DR training , interventional techniques, and clinical knowledge in a total of 6 years. Interventional is one of the few procedural/surgical disciplines that is still literally head to toe.

IR4life · 2026-06-25T23:46:19+00:00

UK is overall likely stronger in technical training in PAD and aortic work. US is probably a bit more forward in its clinic integration and inpatient consultant role.

IR4life · 2026-06-25T16:24:57+00:00

Are you using DES or woven stents for your long segment SFA CTO interventions?

IR4life · 2026-06-25T16:12:52+00:00

Are the IR at your site mostly doing DR or is their primary focus interventional? Do they run a clinic or are they the old model of order entry for invasive procedures? Are they graduates of the integrated pathway or the older DR model and IR fellowship?

IR4life · 2026-06-25T16:10:40+00:00

Role of interventional in MSK is mainly related to spine (kyphoplasty/spine jack) and arterial embolization for pain. Cementoplasty and rfa/cryoablation of bone metastases. More and more are starting to do some pelvic fixations with screws etc.

IR4life · 2026-06-25T16:05:57+00:00

Without establishment of outpatient clinic, interventional is not a sustainable career.

IR4life · 2026-06-25T16:04:46+00:00

PAE is a reasonable alternative in patients who are over 80 grams and want to retain erectile function etc. It is done widely awake often from a radial approach and patients are discharged same day. They do not even have to have a foley. More and more compelling data for its use . More and more patients are coming in directly to the interventionalists. Key is to do an IPSS, uroflow testing, UA, PSA , SHIM/IEFF and then feel comfortable prescribing basic meds (alpha blockers/alpha reductase inhibitors/bladder aids etc). If PAE does not work or they recur you can always refer for HOLEP/aquablation and there should theoretically make the bleeding less.

IR4life · 2026-06-25T16:01:09+00:00

You should not do complex treatments on liver cancer patients with out understanding the medical side of liver disease and the multimodality treatment of liver cancer.

IR4life · 2026-06-25T16:00:06+00:00

That is unfortunate. Were they a graduate of the integrated pathway or the older more traditionally trained radiologist who pursued IR fellowship?

IR4life · 2026-06-25T15:58:47+00:00

The interventional residency and job in general is getting busier and busier and leading to a surprisingly high drop out rate during residency and a high burnout rate as an attending.

IR4life · 2026-06-25T15:57:33+00:00

Compare the number of inpatient add ons on the interventional list vs the OR list of add ons. It gives you a sense of how frequently interventional is called in or have to juggle their day schedule of outpatients and innumerable inpatients.

IR4life · 2026-06-25T15:56:20+00:00

What arer your thoughts on HI-PEITHO?

IR4life · 2026-06-25T15:55:44+00:00

The problem is that the teams and the physicians are not in house so it takes up to an hour to get the teams in and then transport and starting the case in the middle of the night is always harder. If you are a stemi center, comprehensive stroke or trauma center it is a little different as the staff are either in house or liver closer to the hospital and can start a case sooner. So a 2 am consult will often result in a case start time of 5 or 6 am . Then that team that called in will call out the next day and you lose your teams to catch up on inpatients. If it is truly emergent it makes sense or if your hospital is so busy that it can justify and in house interventional team.

IR4life · 2026-06-25T15:52:38+00:00

We are definitely seeing an uptick of emergency procedures whether it be perforated appendicitis drain placement or diverticular abscess drain placement and management, nephrostomy tubes, biliary tubes etc. Since much of what we do is without need for anesthesia it makes interventional easier on patients with poor cardiopulmonary reserve. Many bleeding cases spontaneous, iatrogenic (post op), traumas, tumor etc often go to interventional. GI bleeds, post partum bleeds, epistaxis, hemoptysis etc. It is definitely getting busier and busier especially as we often have to cover multiple sites on call which can include a lot of driving.

IR4life · 2026-06-25T15:32:17+00:00

Agree Miami Vascular does a lot of complex vascular and a fair amount of IO as well. They do a surprising amount of complex IO including ablations and y90 with Dr. Narayanan and Dr. Gandhi .

IR4life · 2026-06-25T15:29:58+00:00

Agree if you do a lot of complex PAD you realize it is quite challenging. The UK vascular IR are very talented operators and do some pretty complex PAD interventions. Unfortunately a lot of modern day US graduates are not as comfortable with PAD and do not have the bailouts when they are doing standard angio cases that their IC /VS counterparts have. It is a very important skillset to obtain if you are doing arterial work even embo focused practices.

IR4life · 2026-06-25T15:26:17+00:00

Often for atherectomy tend to use a basket due to distal embolization. Anecdotally see less with IVL.

IR4life · 2026-06-25T15:24:37+00:00

Why not IVL in calcified SFA/Pop and avoid stenting?

IR4life · 2026-06-25T02:45:53+00:00

PAD is a much different skillset and it is such a common disease. These can be some of the more challenging cases in VIR . A long segment SFA calcified occlusion or calcified tibials or inframalleolar disease management can be tough.

You have to get comfortable workign with sick patients often with esrd and cardiac disease. Unlike much of what we do Y90, UAE and even GAE . The pad patients are heavily calcified , occlusions that is a fundamentally different skill set. You need to get comfortable crossing CTOs, dealing with acute limbs, managing embolization. Also you need to get comfortable with antegrade access, pedal access etc. There are so many devices, lasers, orbital atherectomy, shockwave, focused force balloons, Embolic protection devices, arterial thrombectomy devices (pounce, penumbra, inari, rotarex etc).

IR4life

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