By Alok Bhatt, MD
Chair, SIR-RFS

It is exceedingly rare for organized medicine to acknowledge a group of physicians with a skill set so unique, that it recognizes the birth of a brand new medical specialty. That is exactly where we are with the American Board of Medical Specialties’ (ABMS) recognition of IR as the 37th primary specialty in medicine. Following the ABMS’ announcement, the Accreditation Council for Graduate Medical Education (ACGME) explicitly stated the following:

“Over the past 20 years IR techniques have increased dramatically in sophistication and diversity…Over this same period, clinical care has become an integral and essential part of interventional care. Interventional radiologists must now take primary responsibility for peri‐procedural outpatient and inpatient care, and consultative services. Interventional Radiologists are now clinicians who must perform inpatient consultations, run outpatient clinics, admit patients, and provide focused clinical care with longitudinal follow-up. ABMS has recently acknowledged these evolutionary changes in the practice of IR and has recognized IR as a primary medical specialty. Accordingly, ABR has created a new certificate (IR/DR). Trainees will become certified in both IR and DR.”

This represents a seismic paradigm shift in interventional radiology and requires contextualization. In a 2005 Seminars in Interventional Radiology article, Drs. Soares and Murphy compare the evolution of interventional radiology to the evolution of general surgery and the transformation of the “barber-surgeon” to a surgeon and clinician. To quote the article:

“From the very earliest period of the development of general surgery until the early 20th century, surgeons were perceived as skilled artisans or technicians and were not afforded the same respect as the physicians (internists) of their time. A paradigm shift occurred after this time, which altered the societal perception of surgeons as technicians requiring physicians to oversee and in many cases approve their treatment to an acceptance of them as the patient’s primary caregiver. The circumstances that allowed this transition are not isolated to the early 20th century and more importantly are not unique to the evolution of general surgery.”

They go on to say:

“The technological advances of antisepsis and anesthesia allowed the possibility of more complex surgical procedures with higher success rates. Consequently, the surgeon needed to evolve from lancer and bloodletter to skilled operating physician. In a similar fashion, the explosion of technological innovations in catheter and image-guided therapies has propelled the practice of IR from its roots as a collection of diagnostic imaging ‘‘procedures,’’ or tests, to its current state. Technical advances in interventional devices and techniques have mandated a change in the role of interventional radiologist from diagnostic radiologist, dabbling in invasive ‘‘special procedures,’’ to that of the treating physician… The development of ‘‘modern,’’ or more appropriately, clinical, IR is an accelerated repetition of the evolution of ‘‘modern’’ clinical surgery. The resistance or in some cases delay of some to fully accept IR as a clinical specialty is a duplication of the resistance to accept surgery as a clinical specialty by medicine in general. Unfortunately, as noted by the physicist Max Planck ‘‘Innovation rarely makes its way by gradually winning over and converting its opponents. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the [new] idea from the beginning.”

The remarkable transformation of surgery from a technical to clinical entity can and should be the goal for interventional radiology. As surgeons are consulted for a clinical problem, so too should interventional radiologists be consulted for hepatocellular carcinoma rather than TACE and for GI bleeding rather than TIPS. The article concludes with a message each aspiring IR should take to heart— “History shows us that perseverance is imperative if the resistance of the traditional clinician of the day is to be overcome. As the surgeon did in the past, the interventional radiologist must refuse all pressures to shirk his ultimate responsibility to the patient.”

Read Drs. Soares and Murphy’s entire article titled “Clinical interventional radiology: parallels with the evolution of general surgery” here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036259/

Categories: Chair's Blog