Interventional work increasingly concentrated among smaller subset of radiologists

Interventional work is becoming increasingly concentrated among a smaller subset of radiologists, according to new Neiman Health Policy Institute research. 

Since IR’s formal recognition as a unique specialty in 2012, imaging stakeholders have debated the optimal practice model for the profession. Much of this discussion has centered around whether IR should function as an independent specialty or remain integrated within general radiology departments, experts write in JVIR. 

However, training for interventional specialists still occurs on a pathway integrated with diagnostics, and many IRs maintain mixed responsibilities that include both interpretation and procedural work. 

“Therefore, a clearer understanding of how IR work is distributed across radiologists is needed, including whether IR-related work is becoming increasingly concentrated among a smaller subset of radiologists rather than broadly shared across the radiology workforce,” Luke R. Wilkins, MD, an IR specialist and professor with the University of Virginia, and co-authors wrote June 17. 

This appears to be the case, according to an analysis of nationwide Medicare claims, spanning 2008 to 2023. The study used a 5% representative sample from fee-for-service beneficiaries, extrapolating the results across the U.S., with the final cohort including 46,533 unique radiologists. Those who were male, between the ages of 35 and 44 and in metropolitan areas were more likely to perform majority IR work (>50%). Same for physicians working in a multispecialty group or practice with less than 10 radiologists, the study found. 

The proportion of radiologists performing some (>0%) IR-related work declined from 70% in 2008 down to 50% by 2023. Among physicians delivering IR procedures, the proportion focused primarily on the specialty (>50% to 100%) increased from about 13% to nearly 19%. Meanwhile, the proportion of physicians with a super-majority of their time spent on IR work increased from 4% to nearly 9%. These trends were consistent across various radiologist and practice characteristics, the authors reported. Between 2020-2023, radiologists had higher odds of having super-majority IR workloads when compared to 2008 to 2011. 

“Together, these findings demonstrate a clear shift in the distribution of IR-related work toward a smaller subset of radiologists,” the authors noted. 

Wilkins and colleagues contend that the continued presence of mixed IR/DR workloads likely indicates that “integrated or hybrid models remain common and may continue to be appropriate in many practice settings.” Older radiologists appear less likely to have majority or super majority IR workloads in any given year. Meanwhile, younger rads showed the greatest growth in majority IR practice, potentially relating to the maturation of the IR/DR training pathway.

Experts believe these findings have implications for radiology training. 

“The IR/DR pathway was intentionally designed to preserve dual competency in imaging interpretation and procedural expertise,” they wrote. “The presented data suggest that this flexibility remains necessary as a substantial portion of radiologists performing IR-related work continued to practice in mixed IR/DR roles, indicating that this model remains common in real-world practice. These findings are evidence that workforce planning and training program should account for both predominantly IR-focused and hybrid IR/DR practice patterns.”

Other factors such as practice environment, institutional structures, diagnostic imaging demand, procedural coverage needs and market forces also may be contributing to these trends. The declining proportion of rads performing any IR work—dropping from 33% in 2008 to 50% in 2023—raises questions about procedural coverage, especially for low-volume treatments in smaller practices, the authors noted. Meanwhile, the greater concentration of IR work among fewer physicians may be associated with increased specialization, continuity of care and IR’s overall movement toward a clinically oriented specialty. 

“These potential benefits and risks are likely to vary substantially by practice setting,” the authors added. 

Read much more, including potential study limitations, in the Journal of Vascular and Interventional Radiology.