IRs-in-training By Jacob Fleming, MD


The need for IR subspecialty training


R has always been synonymous with innovation and an ever-expanding armamentarium of procedures, technologies and devices to support and improve patient care. This innovative legacy has only strengthened in recent years with developments in minimally invasive treatments for vascular, musculoskeletal and oncologic disease, among others. With the advent of the integrated IR Residency and IR’s transition to a primary specialty in the U.S. graduate medical education system, there has never been a more appropriate time to consider the benefits of subspecialization.


I Douglas P. Beall, MD, FSIR


What is IR subspecialization? Because IR is a broad field unified by medical imaging and minimally invasive techniques, its scope isn’t confined to a single organ system or pathology. Over time, both individual IRs and the specialty at large have developed specific focuses on certain body systems or groups of pathologies, resulting in subspecialties including interventional oncology, pediatrics, vascular disease, musculoskeletal IR/ interventional pain management and neurointerventional radiology (which exists more as a “sibling” specialty in the training paradigm than a direct subspecialty of IR).


By far, the most common path toward subspecialization in IR is focused practice development over time. This may include further education via residencies, intensive on-the-job training, shadowing other practices, or participating in society- or industry-sponsored courses. A focused subspecialty fellowship eases the burden of independent development and brings the various educational pathways together. However, IR subspecialty fellowships are currently uncommon.


30 IRQ | SUMMER 2021


advanced fellowship offers an accelerated path to additional skill sets that can benefit individual IRs, their communities and the specialty.


Evolution of training in parallel with evolution of techniques With the dizzying speed at which new techniques emerge in IR, education of trainees is crucial to further develop these competencies and keep pace in a field with many competitors. IRs working on the vanguard of the specialty are uniquely equipped to pass on such knowledge.


Douglas P. Beall, MD, FSIR, is a private practice IR who specializes in complex musculoskeletal interventions. After following an unconventional training path, Dr. Beall founded a comprehensive musculoskeletal practice and currently runs a musculoskeletal radiology fellowship predominantly focused on advanced interventions.


Kumar Madassery, MD


In contrast, dedicated fellowships exist in peripheral arterial disease for interventional cardiologists, and fellowships in interventional pain are available to graduates of anesthesia and physical medicine and rehabilitation programs. Graduating IR residents who are well qualified to learn and practice such techniques are not typically eligible for these fellowships. As a result, the question of subspecialization is also one of maintaining competitiveness in the marketplace.


While an additional year of training won’t appeal to all IR residents,


“A few years ago, when I was developing new techniques, a colleague told me I had a duty to pass on what I was doing to the future generation of clinicians. If I got hit by a bus, they said, a lot of the techniques and clinical information would be gone,” says Dr. Beall. “I was resistant, but an hour later, I picked up the phone and accepted a fellow. At this point in my career, I’m glad I did.”


Dr. Beall’s program allows fellows to explore the latest techniques and devices, often in the context of clinical trials, and become active participants in the advancement of the field. “Not only do I support physician collaboration with device and biotech companies, but I also believe this collaboration should be encouraged and fostered,” says Dr. Beall. “This collaboration is what will produce significant advancements in technology and techniques and should


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