50 forward


The next IR frontier Small practices and rural deserts


W


hile medical systems everywhere are facing workforce shortages, there is more interest in


IR as a specialty than ever; the desire for IR training outmatches residency slots and job openings. However, as trained radiologists, minimally invasive specialists and all-around longitudinal physicians, IRs have an opportunity to fill an as-yet unmet need: providing care to rural, small and medically underserved areas. By utilizing new practice paradigms and technologies, IRs may be able to bring life-saving care to whole new populations.


IR deserts In the United States, many communities live in a healthcare desert, unable to access specialized care without substantial travel requirements. This includes IR services. According to a review of SIR membership data, only 15% of U.S. counties have at least one practicing IR. Looking at overall population distribution, that means approximately 30% of the U.S. population does not have access to an IR. Of the 487 counties with an IR presence, 141 of them only had one practicing IR. The same review found that most of the IR population is centered around large cities and counties with higher incomes and education levels.1


According to Elizabeth A. Ignacio, MD, FSIR, chair of the Small and Rural Practices Committee and president of the Hawaii Medical Association, this means that almost a third of the nation does not have easy access to minimally invasive IR therapies such as biopsies, drainages, vascular care, oncology and pain management.


In rural areas, this gap is even wider. About 82% of counties classified as rural are also considered “medically underserved.”2


“While there is a paucity of all medical specialists, IR physicians are often one of the first specialties to leave or the last to enter,” wrote Laura Findeiss, MD, FSIR, in her account of working in a rural IR desert in West Virginia.


According to Drs. Findeiss and Ignacio, there are multiple factors causing the workforce shortage in these areas: debt and training costs for IRs are high, and pay in these rural and small areas is low.3


The benefits of a smaller community Ava Star, MD, knew she did not want to pursue an academic research role, and instead wanted a hands-on, clinical position. She found an opening at a small practice in Olympia, Washington, which is close to Seattle, but situated in a small community. One of the hospitals her group covered had up to 400 beds, while another in the community was so tiny it only had 10 ICU beds.


“I really enjoyed rotating the smaller hospital,” Dr. Star said. “It was such a different atmosphere. At the larger hospital, administration wasn’t always as supportive of staff, so there was constant turnover.”


Alternatively, at the smaller hospital, Dr. Star met staff who had been in their roles for years.


Smaller hospitals have fewer beds,


meaning they have less funding to invest in subspecialty care.


There is also an awareness factor, according to Dr. Findeiss.


“It is not emphasized enough to trainees why they would want to consider practice in smaller communities, many of which offer a high quality of life,” she said.


2020 A healthcare challenge; VIRTEX creation


The COVID-19 pandemic forces many educational programs virtual, including the 2020 Annual Scientific Meeting. In response to the ongoing pandemic, SIR published toolkits, emerging health advisories and resources for members on the frontline.


Meanwhile, after years of development, the VIRTEX clinical data registry is launched. VIRTEX is designed to provide specialized clinical data for the IR field; in 2023, the first pilot healthcare organizations successfully completed their pilot phase.


irq.sirweb.org | 33


“The pace was slower, and everyone was so much more collegial,” she said. “It was such a great feeling, and everyone was so kind and appreciative, especially the patients and referring physicians.”


To Dr. Star, that feeling embodied the joy of working in a small community.


“The patients are able to receive a service they may otherwise have had to travel hours to receive—or not receive at all, because their income level doesn’t allow them to drive to a big city, get a hotel and have a family member come


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