IR Residency Update Chuck Ray, MD, PhD

University of Illinois COM

Acknowledgement

Vicki Marx, M.D.

IRs as clinicians. • Perform inpatient consultations • Operate outpatient clinics • Admit patients • Provide focused clinical care

with longitudinal follow-up

Interventional Radiologist

IRs as specialists. • Interventional oncology • Women’s health • Venous disease • Peripheral arterial disease • Pediatrics

Evolution of IR

Imaging Procedures

Patient care

IR

2012 ABMS specialty status (IR)

Evolution of IR

ABMS ACGME

IR be recognized as a unique specialty …

with a unique training program

Approved 2012 Approved 2014

Evolution of IR

IR IR/DR

Clinical Care in IR

?

Clinical Care in IR

Periprocedural care Specific activities - Before, during, and - Outpatient clinic after procedures - Inpatient service - Focused care related - Admitting service to procedure - MutiD conferences

Clinical Care in IR

Smouse H. Seminars in IR 2006; 23; 305

Evaluation and Management (E&M) Coding

Clinical Care in IR

Evaluation and Management (E&M) Coding

Khan N. JVIR 2005; 16: 1753

Kwan S. JVIR 2012; 23:887.

Clinical Care in IR in the Age of Health Care Reform

How to provide clinical care: - Safely - Efficiently - With high quality

Clinical Care in IR in the Age of Health Care Reform

How to provide clinical care: - Safely - Efficiently - With high quality

High Quality Low Cost

Interventional Radiologist

• To facilitate optimal patient care in IR • To provide trainees with the tools they need to deliver this care - as imagers, proceduralists, and clinicians

Purpose

New training program

• Greater focus on clinical care: outpatient clinics, inpatient consultation and admission, and critical care • More time to master the procedural and clinical domains of IR (1 additional year) • New opportunity for trainees to enter into IR from medical school

Key Elements

IR Residency

• Maintain core competency in DR • Not extend length of training • Bring people in from medical school but also allow entry from DR • Do not leave any (many) programs behind

While at the Same Time …

IR Residency

• DR programs, PDs: big/small - with or without IR fellowship

• Department chairs • IR programs: big/small

- with or without DR - ratio of DR residents to fellows

Recognize Many Stakeholders

IR Residency

• All current IR training programs must convert to the new system • Within 5-7 years (2020)

Comply with ACGME Mandate

IR Residency

• Fortuitous advent of the new ABR exam paradigm

- Frees up the 4th year for electives Nevertheless, designing a system that meets the stated objectives and that will work for (almost) everyone has been a challenge.

IR Residency

RRC Tasks • Program Requirements • FAQs • Application Forms • Procedure Logs • Milestones

IR Residency

Site visits and review

Integrated Program - Medical school match - Internal DR transfer

Independent Program - DR graduate - ESIR 2nd year entry

Clinical Internship

IR Residency

ESIR

• DR programs wishing to provide residents with sufficient IR training to qualify for advanced entry into the 2nd year of an Independent IR residency must have prior approval from the RRC for their ESIR training program: −DR programs must specify the IR training that the ESIR

resident will receive in PGY2-5 (12 IR or IR-related rotations and 500 procedures)

−DR programs must have adequate IR facilities and personnel to provide IR training.

SlLIDE FROM Midwest Chairs 2016

Current ACGME Accreditation Status Integrated IR Residency Programs

• 62 applications for Integrated IR programs have been submitted to ACGME

• The RRC approved 8 programs during the Nov 2015 meeting – These are eligible to participate in the next NRMP

Match cycle (Match Day in March 2016)

• More program approvals will take place at the RRC meetings in Jan and April 2016

The approved integrated programs are: Brigham U Michigan U Pennsylvania U Kansas MGH Georgetown Washington U Vanderbilt

SLIDE FROM Midwest Chairs 2016

SLIDE FROM Midwest Chairs 2016

Current ACGME Accreditation Status Integrated IR Residency Programs • ACGME will begin consideration of applications

for Independent residency sometime in 2016 – date TBA

• Departments with approved integrated programs will submit a shortened application. – Site visits will be limited to programs that have not

been site visited for an integrated program • To ensure no gap in graduation of trainees after

June 30, 2020, it is recommended that applications be submitted by July 1 2017.

Current status of training programs Current training programs entering the match

Current status of training programs Current training programs entering the match

• 61 accredited programs entering the 2017 match • ~120 positions • ~40 ESIR programs

– Most plan on taking internal PGY 3-4 residents

• Handful of Independent programs applied for accreditation. None certified. All will launch simultaneously on July 1, 2020

Current status of training programs Current training programs entering the match – 2017 data • 558 applicants • 418 US medical grads • ~2/3 applying for both IR and DR

residency spots

What are our own data?

What are our own data?

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1

2

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4

5

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7

8

9

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Yes No Pending

10

4

2

Currently approved program?

What are our own data?

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1

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4

5

6

7

8

9

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Yes No

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0

Participating in 2017 Match

What are our own data?

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7

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9

#1 #2 #3

3

9

2

Positions per PGY5/6 year

What are our own data?

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Converted DR spots Converted DR and fellowshipspots

New GME funding New Dept funding

5

4 4

1

How will spots be funded?

What are our own data?

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7

2018 2018-2019 2019 2019-2020 2020 Unknown

1 1

2

1

7

2

When will fellowships be phased out?

What are our own data?

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2

4

6

8

10

12

Yes No Probably Unsure

11

2 1 1

Will you apply for independent residency positions?

What are our own data?

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8

9

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Yes Pending approval No

10

5

1

ESIR?

Interventional Radiologist

Thanks for your attention! About the picture…ask David