By Karan Patel, MD/MPH, PGY5/R4, Wayne State University, SIR-RFS Advocacy Committee Chair
Interventional Radiology (IR) is modern medicine at its finest and is paving the way to the future of personalized medicine. An Interventionalist assesses every clinical scenario in the context of the patient’s unique anatomy & physiology and subsequently tailors the treatment based on what the patient needs. By utilizing advanced imaging technologies such as (US, CTs, fluoroscopy, and MRIs) an interventionalist can treat a host of medical diseases that once required open procedures through catheters that are size of a straw. This has led the field to deliver cost-effective quality patient care by reducing hospital length of stay, minimizing complication rates, and ultimately improving patient’s quality of life.
It’s no wonder IR has quickly become extremely popular among medical students applying for residency. According to the 2017 NRMP Residency Match Data, there were only 124 total IR residency positions offered in the 2017 match and had nearly 3x-4x as many the total number of applicants for each position. Just to put things in perspective, super competitive specialties like dermatology, otolaryngology, orthopaedics and plastics traditionally see about 1x-1.5x the total number of applicants for each position. This by far has made IR the most competitive primary specialty out there and I am certain medical students everywhere felt the uncertainty of matching into the field this year.
So why aren’t the residency programs just increasing the number of training spots to meet this growing demand? Certainly, it’s safe to assume as the baby boomers’ population in the US continues to age, this demographic will benefit from IR’s minimally invasive approach in treating various medical conditions and hence there will be even a greater demand for Interventionalists in the future.
The crux of the matter lies in understanding that there isn’t enough dedicated graduate medical education (GME) funding to train more Interventionalists. Let me provide some background on this issue– Any medical residency GME funding comes from Center for Medicare and Medicaid Services (CMS). CMS has not increased the cap on GME funding since early 1990s which limits more doctors from being trained in the US. In 2012, American Board of Medical Specialties approved and granted IR, its own primary medical specialty designation, but it did not promote the establishment of medical residency training programs for IR. So, if a program wants to increase number of slots to train more interventionalist, it has two options; A) reduce slots in another residency program or B) operate the new program with partial or no Medicare GME funding. Bottom line, IR has to secure its own GME funding in order to train more interventional radiologists.
So where does the current funding for the newly established IR residency come from you ask? The before mentioned 124 total IR residency spots that were offered in the 2017 match, got most of their ACGME funding from diagnostic radiology. As an example, a diagnostic radiology program would have to reduce one of its diagnostic spots and give the funding to IR in order to train an interventionalist. Meaning, IR currently does not have its own ACGME funding and predominantly gets it’s funding from elsewhere.
But not all is lost! Here comes HR. 1167 to the rescue. The proposed house bill was introduced by Rep. Mia Love of Utah and is currently referred to the Subcommittee of Health. Also known as the “Enhancing Opportunities for Medical Doctors Act of 2017,” this budget neutral bill would not only help train more interventionalists but would address the need to train more doctors in the US. It would reallocate existing, but unused, government-funded residency positions, put them in a pool, and allow for newly approved primary specialties to apply for those unused slots and use them towards training more physicians. The redistribution was first authorized under the Medicare Modernization Act (MMA) of 2003 and then again under the Affordable Care Act (ACA) of 2012. With the last redistribution under the ACA, approximately 1300 slots were redistributed and roughly 3,000 slots under the MMA. That’s a lot of spots to be taken and certainly would help address the need to train more Interventionalists.
How can you help in making sure this vital house bill gets passed? SIR provides several ways to get involved at the grassroots level. You can explore the opportunities in SIR’s Advocacy Toolkit (visit the toolkit at bit.ly/2tjfkPD), which provides valuable resources on contacting your local congressman, visiting a member of Congress to share IR success stories or holding a congressional site visit/fundraiser at your institution. You can take part in the Annual Grassroots Leadership Program, which allows Interventionalists face-to-face interaction to members of Congress as they consider future legislation. Chances are you have already played a part in the advocacy process – if you have ever explained what you do to a relative or shared a few work stories during a dinner with friends, you have already helped raise awareness and advocated for IR.
More importantly, you can support SIRPAC, SIR’s nonpartisan political action committee which represents the needs of interventional radiologists as critical decisions are made on Capitol Hill. Think of them as our “guardian angels”. While we are busy performing procedures in our angiosuites, they are the ones out advocating on our behalf to members of Congress, doing their best to ensure that IR doesn’t go out of business. Thanks to SIRPAC efforts and the support of SIR leadership, IR has not seen a specific reimbursement cut since 2008 due to SIRPAC’s involvement and enacting key legislation.
Given the capricious political climate, we all need to take an active role in shaping our specialty’s future or risk losing what we value most – practicing IR and making a genuine difference in our patients’ lives. I highly encourage all of you to give what you can to SIRPAC and help strengthen our specialty by furthering our access to members of Congress and their legislative staffs.
For more details on SIRPAC, visit bit.ly/2tjQ7Vz. To donate to SIRPAC, visit bit.ly/2uBa6iO. Please follow the SIR-RFS Advocacy Committee on Twitter: @iradvocacyrfs for more updates regarding HR 1167.