SALT LAKE CITY - While it may seem like nothing less than setting up shop with a competitor, inviting a vascular surgeon to become a part-time member of the interventional radiology staff does have its advantages, according to a speaker at the Society of Interventional Radiology conference.
"We know that this profound change is going on in interventional practices based on turf issues. There’s a considerable (amount) of literature out there about the philosophy of who should do what and why, and who should be training people," said Dr. Timothy McCowan in a talk he gave on Saturday. But there is little documentation on what practices have done to address these turf issues, added McCowan, who is from the University of Arkansas in Little Rock.
The goal of McCowan’s study was to compare interventional radiology procedure volume and distribution a year before, and after, the incorporation of vascular surgery into the practice. The procedure volume was corrected for percentage of full-time employment (FTE) of university hospital staff, McCowan explained. The four interventional radiologists do not spend all their time at the hospital, as it is also an academic facility, he said.
The vascular surgeon is one of three doctors in that department, and works in the IR unit one day a week. Before joining the team, the surgeon had done a three-month endovascular training course at another institution, McCowan said. The interventional radiology department covers a portion of the surgeon’s salary. All billing for the surgeon’s day in the IR is handled by interventional radiology, he said.
According to the study results, the number of IR procedures increased by 21%, from 3,361 to 4,074, during a one-year period after the surgeon came on board. Meanwhile, the total number of vascular procedures (arterial diagnosis, venous diagnosis, and dialysis) increased by 20%. The total number of nonvascular procedures (gastrointestinal, genitourinary, biopsy) also increased by 23%. Venous treatment services (mainly venous access) increased by 39% per FTE interventional radiologist.
The top five category increases were:
- Biopsy --132%.
- Gastrointestinal -- 82%.
- Arterial thrombolysis -- 78%.
- Venous access -- 73%.
- Arterial stenting -- 64%.
The interventional radiology fellow saw an increase in total services by 41% during a three-month period; similarly, the vascular surgery fellow was able to do 39% more arterial diagnosis procedures.
But it wasn’t all great news. Although the total procedures per FTE interventional radiologist increased by 7%, there was a significant change in procedure distribution, with a 25% drop in arterial diagnosis and a 46% decrease in arterial treatment, McCowan said.
"The distribution changed, with a significant shift (of work) to the vascular surgeon," he said. However, McCowan said that he felt the new spirit of collaboration was more productive than unbridled competition. "Given the realities of medicine, this has been a superb outcome for us. Having had him on board has increased our diagnostic business."
In answer to various audience questions and comments, McCowan acknowledged the following:
- The current arrangement is based on an honor system; there is no contingency plan that would prevent the surgeon from taking his newfound interventional radiology knowledge and transferring it back up to his own department or even a private practice. But McCowan said he hoped that the chance to work together would outweigh the benefits of becoming rivals. "(The vascular surgeon) is not someone else anymore. He’s one of us," he said.
- There is a bias in referral patterns, as the surgeon is more likely to refer cases from the vascular clinic to interventional radiology on the day that he works. However, because the surgeon is only there one day a week, the number of cases he can handle is limited, McCowan said. The remaining vascular surgeons are referring cases to the other interventional radiologists.
- As the interventional radiology department does not do much CT or MR angiography, McCowan said he wasn’t too concerned that the surgeon would express an interest in reading imaging studies.
- The swap has given the interventional radiologists greater access to the vascular lab. This has been particularly useful for the interventional radiology fellow.
- This model may work best at an academic institution where teaching is a primary goal. Whether it can be done at a private practice would require further exploration, McCowan said.
By Shalmali Pal
AuntMinnie.com staff writer
March 31, 2003
Copyright © 2003 AuntMinnie.com
