Establishing a standalone interventional radiology department: Finances and other key factors

Imaging leaders are detailing their experiences establishing what they believe is the first completely independent interventional radiology department in the country. 

The University of Miami undertook the three-year effort, spurred by the American Board of Medical Specialists making IR a separate specialty in 2012. This endeavor came with numerous barriers, including establishing financial independence, experts write in the Journal of Vascular and Interventional Radiology. 

Miami’s Robert M. Quencer, MD, and Govindarajan Narayanan, MD, believe standalone interventional radiology departments will be a growing trend in the years ahead. 

“As IR becomes more deeply involved and specialized in patient therapy and longitudinal patient care, independent departments of IR will become a reality in most large academic medical centers,” the two wrote in the March issue of JVIR. “Some would consider this need for secession as urgent, others as inevitable in the context of progressive medical specialization and explosive expansion of medical knowledge.”

University of Miami leaders started by formulating a multiyear plan, laying the groundwork for a new independent IR department. They were motivated by the added value interventional radiology provides to the hospital system and “recognized differences between IR and DR.” IR champions needed to overcome numerous barriers in the lead up to launch. These included demonstrating financial independence and stability, acquiring a dedicated outpatient clinic, gaining hospital admission privileges, recruiting faculty, and convincing other specialists of the endeavor’s merits. 

The IR department started establishing its worth about five years prior when separating its budget from diagnostic radiology, the authors noted. Billing for both the professional and technical components was handled by a central office at the university. 

“Continued growth and sustainability demonstrated that IR could stand alone financially, with no detrimental effect on DR,” the authors wrote. “Furthermore, equipment purchases and other necessities were supported by the hospital at the university sites, with decisions regarding equipment acquisition based on anticipated revenue generation and service demands.”

The University of Miami also needed dedicated space to interview and examine outpatients who might undergo IR procedures. At first, physicians took these meetings in their offices, gradually moving into shared clinic space in the Cancer Center. Finally, after years of growth, Miami created a “state of the art,” five-room clinic space for interventional radiologists, developed with funding from philanthropy and financial support from the university. 

Interventional radiology also gained “overwhelming” support for a new department following an open forum and electronic voting process. Key senior leadership at the university gave their “unequivocal and unanimous” blessing, too, with the department officially established in April 2016. The authors encouraged other institutions to explore IR-DR separation but acknowledged it may not work everywhere. 

“Profitable IR divisions may be financially coveted by the radiology department, some IR physicians may still perform clinical or administrative diagnostic radiology roles and retaining the word ‘radiology’ in our name may confuse those who are unfamiliar with the differences between specialties,” Quencer and Narayanan advised. “Formation of a separate IR department may not be achievable in many institutions because of a lack of prerequisites, namely a critical mass of faculty and trainees, a record of financial stability, a productive research arm, and appropriate administrative support. Hospital and university politics, patient and payer mixes, overhead, regulations, and other factors may all influence the critical number of faculty and trainees needed, or the financial goals achievable to establish a viable independent IR department.”

Read much more in JVIR, with the open-access article available for free.