Radiologists call for action on lack of 24/7 interventional services
Radiologists are calling for action on the worsening undersupply of 24/7 interventional services in North America and worldwide.
Members of the specialty made their case in an opinion piece published Wednesday. They highlighted recent research showing only 30% of hospitals with formal IR departments in the Canadian province of Ontario offer after-hours interventional services.
While the investigation—published in the Canadian Association of Radiologists Journal—focused on a small area, many U.S. experts agree the problem is global.
“Worldwide, hospitals are grappling with how to provide consistent, round-the-clock access for life-saving interventional procedures,” Francois H. Cornelis, MD, PhD, an IR specialist with Memorial Sloan Kettering Cancer Center in New York City, and co-authors wrote June 18.
“When minutes separate recovery from irreversible organ damage or death, geographic and temporal barriers to interventional care become unacceptable,” they added. “Whether a patient presents with active hemorrhage in rural France, acute stroke in metropolitan Tokyo, or sepsis requiring drainage in suburban Australia, the clinical imperative remains identical: prompt intervention saves lives and reduces morbidity.”
Overall IR demand rises along with the breadth of its procedures
For the original study, Blair E. Warren and colleagues surveyed 30 radiology department heads across Ontario during a six-week period in 2024 (for a response rate of 41%). Of those, two-thirds had formal interventional radiology divisions. A total of 70% (14 of 20) offered 24/7 IR care, and two of the hospitals without IR departments delivered on-call, nonvascular interventional procedures such as abscess drains. Nearly 93% of groups offering IR call services, meanwhile, said they were experiencing a year-over-year increase in demand.
“As the scope of IR continues to grow, the need for 24/7 access to procedures performed by IR may become more ubiquitous,” Warren, with the Division of Vascular and Interventional Radiology, University Health Network, Toronto, and co-authors advised. “Additionally, patients are increasingly older and medically complex, shifting the risk benefit ratio toward minimally invasive approaches offered by IR, especially for urgent or emergent conditions.”
Some department heads surveyed cited a lack of on-call stipends and resistance from radiologists as reasons for the scarcity of after-hours interventional options. Warren and colleagues believe this implies that financial support for IR on-call activity “could improve access for some.” Logistical challenges in preparing patients for late-night interventional procedures was identified as another barrier.
“Process improvements to facilitate communication and transportation of patients to and from IR could reduce critical time to treatment and administrative burden,” the authors added.
Going forward, demand for interventional radiology services is only expected to grow. Ontario, Canada’s most crowded province, saw its population grow 3% in 2023 and 2024. Meanwhile, the number of PGY-1 radiology training spots across Canada has remained “grossly stable” since 2014, a problem also seen in the States. Lack of IR-trained physicians and nursing staff are the two most reported barriers to implementation of after-hours IR services, the authors found.
A separate recent analysis from data firm Axuall found that interventional radiology is among the five specialties facing the greatest shortages in the U.S.
How to time-proof emergency IR services
In the June 18 commentary, Sloan Kettering radiologist Dr. Francois Cornelis and co-authors at the University of Toronto offered five suggestions on how the specialty can begin building “sustainable” emergency IR services:
1. Workforce planning: Increasing training positions for interventional radiologists while developing retention strategies for existing practitioners.
2. Procedural standardization: Establishing clear guidelines for which emergency procedures must be available within specific timeframes.
3. Network development: Creating formal regional networks with defined transfer protocols and real-time coordination.
4. Facility investment: Prioritizing hybrid interventional environments—combining CT, angiography and surgical capabilities in a single space—in regional centers.
5. Appropriate funding models: Developing reimbursement models that recognize the unique demands of emergency IR provision.
Without personnel to staff these models, however, such suggestions will offer little benefit.
A call for concerted efforts
The authors also detailed five “innovative workforce solutions” to address IR’s staffing demands today.
Their proposed strategies include (1) regional on-call pools serving multiple facilities; (2) hub-and-spoke models with telemedicine support; (3) cross-training of vascular surgeons and interventional cardiologists for select procedures; (4) international recruitment initiatives; and (5) expanded training programs with dedicated emergency IR rotations.
“Creating sustainable 24/7 IR access requires coordinated action among healthcare policymakers, hospital administrators and clinical leaders,” the commentators concluded. “The ultimate goal remains universal: ensuring that no patient’s outcome depends on when they fall ill or where they seek care, but solely on their clinical needs and the evidence-based interventions that modern interventional radiology can provide.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.