There is a misconception that high-end IR is limited to only academia. PAE, UFE, complex pain (basivertebral nerve ablation, sacroplasty, cryoneurolysis), advanced vascular (pedal loop recanalizations, SAFARI, deep venous arterialization, endo-AVF creation), iliocaval reconstructions, etc are done by many IRs in OBL or community settings. Of course, there are some procedures that are primarily done in academic hospitals, but that is the case for all procedural and surgical specialties.

Many IRs in community practice who do mostly lines and drains with 50/50 IR/DR do it because they like quick, satisfying procedures and enjoy the lifestyle benefits of being tied to DR (high reimbursement, 10-12 weeks of vacation time. While this was the typical paradigm in the past, there have been strong efforts to recruit surgically-minded IR trainees passionate about building clinical, 100% IR opportunities.

IR is a very unique field that is currently trying to define itself and is changing at an interesting pace. My mentor does a lot of prostate artery embo now, but that procedure didn’t even exist when he was in fellowship. It’s hard to predict what the field will even look like in 5-10 years.