"Interventional radiology covers a wide spectrum of disease, from peripheral vascular to spine disease to cancer therapies, you name it," says Kim. "Our field is a young field, but it has advanced substantially in light of imaging technology advances and is making image-guided interventional therapies less invasive and more efficient and cost effective.
"I cannot say there is no turf war even in our system, but when it comes to liver cancer, for instance, all the specialists come together with their own expertise and evaluate the patient. The patient comes in and everybody literally sits together. The patient gets the benefit of opinions, and the expertise of the multiple specialties in the same visit," Kim adds. "We work hand in hand in collaboration," which also means sharing in reimbursement.
Interventional radiologists grapple with one overriding issue: their relatively low profile to the public. "A major obstacle is that people aren't familiar with interventional radiology as a name. It has low recognition compared to something like cardiology, which is a chronic problem for interventional radiology as a whole. We just have to get the message out there that we have a lot to offer patents," says Dan Brown, MD, director of interventional radiology at Thomas Jefferson
Interventional radiology—a recognized medical specialty by the American Board of Medical Specialties, which certifies these specialists—also has trouble commanding respect within the larger physician community. Murphy expresses concern that other physicians besides radiologists have been able to obtain interventional privileges without proper training. "The problem is the board of examination process," he says. "There should be a higher bar to get privileges, not a lower one."
Success key No.1: Team concepts
Russell, the chairman of the department of radiology for Northwestern Memorial Hospital, years ago began to look around the landscape of interventional radiology at his hospital and saw it was changing immensely. For one thing, vascular surgeons were performing procedures that interventional radiologists had handled for many years. "You lose control of the situation to some degree; that is a common theme," he says.
It was important for the radiologists not just to lose control, but also to initiate cooperation, he says. As a result, Russell began a cooperative program with other specialists that led to improved working relationships among physicians, while delivering more efficient patient care. The hospital started seeing so much improvement in patient outcomes, in fact, that vascular surgery and interventional radiology departments combined resources and shared expenses to form a vein center within the Northwestern Medical Faculty Foundation. The center provides treatment for patients with varicose veins, spider veins, and vein-related pain. Performing minimally invasive procedures is a cornerstone of the program.
"We have had collaboration, so as turf issues developed, that helped to overcome any problems," Russell notes. "We had institutional backing throughout the hospital to keep things balanced. Now we have a shared practice in cardiac-specific imaging, so we've been able to avoid any real conflict." Interventional radiologists are seeing increased volume related to other interventional procedures, primarily interventional oncology, he says. "We also have taken on the responsibility of taking over interventional radiology programs at smaller, local hospitals," he says. It was important, too, for interventional radiologists to become involved in cancer therapies. "That's a key program for us," he adds, noting that interventional radiologists can't simply rely on vascular procedures to generate income. If that was the case, "we would have suffered a drop in overall procedure volume if we didn't have new avenues," he adds.