The transition of interventional radiology from diagnostic radiology subspecialty into a primary specialty is well underway and gaining momentum.
A lot of that momentum is coming from the growing residency training programs as IR gains its place as its own primary medical specialty. Friday was the third match day for medical students applying for integrated interventional radiology residencies.
Applications for IR residency started four years ago. In that time, the number of accredited integrated residency programs has increased to 75. On Friday, 136 integrated IR training spots were offered, and 136 spots were filled. That’s an increase from 125 integrated IR training spots in 2017, with the competition for those spots becoming even more competitive, said SIR President-elect M. Victoria (Vicki) Marx, MD, FSIR, member of the Radiology Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME), former chair of the IR Residency Task Force and associate director of the IR residency program at the University of Southern California.
“This is a very exciting development,” she said. “It’s rare for the American Board of Medical Specialties to approve a new primary specialty — very rare. So that’s a major evolution in the thought process of how medicine is practiced in the United States.”
Instead of focusing four years on diagnostic radiology, followed by a one-year fellowship, residents in integrated IR residency training will spend five years integrating diagnostic and interventional radiology and clinical care.
Another residency option, the independent residency, will allow a resident who completes a four-year diagnostic radiology residency to follow with two years of IR training. The independent residency, which will be offered starting July 1, 2020, could be an option for those who don’t initially match into IR or for DR residents who decide midway through residency they want to become interventional radiologists.
Another pathway, the Early Specialization in Interventional Radiology (ESIR), involves a curriculum that can be incorporated within the diagnostic residency program that allows a person to matriculate into an independent IR residency with advanced placement.
“This sounds very complicated, but the complexity is a byproduct of the desire to make entry into this specialty flexible and available both to medical students and to physicians who decide later in their training path that they want to pursue a career in interventional radiology,” Dr. Marx said.
While the full complement of integrated and independent residencies won’t be active until the 2020-21 academic year, projections suggest that most fellowship programs are converting to residencies, with some increasing their numbers of trainees. Overall, Dr. Marx said, it looks like the same graduation volume will be maintained once all of the IR residency programs are up and fully running.
This major change in the IR training paradigm has driven comprehensive changes for the training programs and the organizations that oversee them. The Association of Program Directors in Interventional Radiology (APDIR) has evolved in three years from a small group gathering once a year to discuss issues related to their programs to a more formal body with an organizational structure, board of directors and standing committees so they can address the complexities of the training transition.
Kelvin Hong, MD, FSIR, associate program director of the IR fellowship at Johns Hopkins, who has led APDIR for the past three years, credits the strong communication among the program directors and other groups to go from one fellowship version to three versions of residency.
“We haven’t really had a huge problem that we haven’t either anticipated or mitigated,” Dr. Hong said. “That’s fairly unusual, I think. Most thought there would be some major area that we would come across that we hadn’t anticipated and introduced. This implementation has been surprisingly smooth.”
Each new IR residency program had to go through a rigorous application process to gain accreditation from ACGME.
“We have undergone tremendous change to meet the needs of the new training programs, and certainly there are still a lot of unknowns, but I think it’s gone much better than we actually had envisaged. We’ve managed to group all the stakeholders together to make it all work.”