Utilization of a key class of interventional procedures has swelled in recent years as corresponding surgical volumes plummet. But cardiologists appear to be grabbing a much larger piece of the pie than radiologists, with implications for practice management.
That’s according to a new analysis of Medicare data, published Nov. 10 in the Journal of Vascular and Interventional Radiology . The use of superficial venous disease treatment leapt 58% in this patient population between 2010 to 2018, driven largely by increasing popularity of minimally invasive treatment methods. At the same time, delivery of surgical alternatives for such vein diseases fell 66%, experts noted.
Analysis showed that endovascular procedure volumes surged across most specialties. However, cardiology recorded the biggest gain at 427%. That’s compared to a 125% uptick among radiologists, to an 11% market share by the end of the study period.
“Historically, surgeons and radiologists have dominated [superficial venous disease] interventions. Recent trends reveal a significant shift as cardiologists have embraced treatment of venous disease, as they had previously with peripheral arterial disease,” Darshan Parikh, MD, an interventional radiology resident at Thomas Jefferson Hospital in Philadelphia, and co-authors advised. “Although radiologists’ market share increased, their growth was not as robust as that of cardiologists…This ongoing trend highlights the need for discussion regarding the diversification of specialties in SVD patient care.”
As of 2021, there were 4,011 interventional radiologists, 4,736 interventional cardiologists and 4,039 vascular surgeons across the U.S. New fellows/trainees, meanwhile, totaled 358, 354 and 224, respectively, across the three specialties. Such parity, alongside a larger IR trainee pool, signals that “underlying factors likely drive the substantial utilization rate differences.”
Cardiologists and surgeons benefit from larger practices and referral bases, increasing their treatment opportunities, Parikh et al. noted. Interventional radiologists, meanwhile, rely heavily on referrals while public awareness about the specialty remains low, both potentially limiting access to this patient pool.
“Traditionally, interventional radiologists have emphasized inpatient care, hindering establishment of an outpatient patient base. However, recent years have seen a shift towards a clinically oriented specialty, through expanded training paradigms with the advent of the IR Integrated residency in 2014,” the authors noted. “The competency of newly trained interventional radiologists now encompasses longitudinal patient care, such as formulation of plans, follow-up care, and nonprocedural clinical activity, practice-building education, and interdisciplinary collaboration. Recent trends emphasize the need to refocus efforts towards local advocacy and practice- building to sustain and grow interventional radiology. While we may be observing early effects, the national movement toward more clinical IR practice is too recent to be significantly reflected in this study.”
Read more about the study’s results, including procedure types that have seen the greatest growth over the past 10 years, in JVIR at the link below.