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A New Era in Interventional Radiology - An interview with John A. Kaufman, MD, MS
  • 기사등록 2014-05-07 22:50:05
  • 수정 2014-05-07 23:49:41
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SEATTLE — A major shift is occurring in the United States in interventional radiology (IR) and how federal funding is allocated for it. IR is now being moved to a residency program and it is hoped that this change will lead to improved care, improved outcomes and a sea change in the field. IR was recognized as a subspecialty in diagnostic radiology, but that is no longer the case. Now, it is a true specialty and equal to surgery, psychiatry and other specialties. The U.S. government provides some support for primary specialty training, but none for sub-specialty fellowships. The new IR/DR certificate will change its stature within hospital hierarchy and interactions with payers.
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“It took 7 years to come up with this,” said John A. Kaufman, MD, MS, who is Director of the Dotter Interventional Institute and the Frederick S. Keller Professor of Interventional Radiology at Oregon Health & Science University Hospital, Portland, Oregon.
 
Dr. Kaufman, who has been instrumental in helping develop the new IR/DR certificate, said IR was recognized as a primary specialty of medicine in the U.S. in September, 2012, after many years of work by a joint task force of the American Board of Radiology (ABR) and the Society of Interventional Radiology (SIR). Dr. Kaufman said the new specialty will reside within the ABR as the fourth primary specialty under its supervision, joining Diagnostic Radiology, Medical Physics, and Radiation Oncology. The American Board of Medical Specialties (ABMS) is the umbrella group overseeing all of the specialty boards, and this change came about through the support of Diagnostic Radiology (DR) and the approval of other specialties.
 
Dr. Kaufman said this change in certification overtime will have a huge impact on IR and may potentially improve patient outcomes. It will affect local organizational issues so that at a local institution an interventional radiologist will be listed independently and next to surgery and medicine. “There are ramifications from this in terms of how federal dollars are allocated for training. It allows for people over time to specialize then in cancer and other areas within IR. We can stand on our own,” explained Dr. Kaufman.
 
He said although referred to as a "Dual Certificate" during the submission to the ABMS, it is now the "IR/DR Certificate", and the residency will be an IR residency. The Accreditation Council of Graduate Medical Education (ACGME) is currently preparing the program description and requirements. (Readers can find current information at the ABR, SIR, and ACGME websites.) The format of the residency will be one year of internship, three years of Diagnostic Radiology, and then two years of IR. Dr. Kaufman said during the three years of Diagnostic Radiology the trainees will be indistinguishable from all other Radiology residents, and will have to pass the same core certification examination after the third year. “The IR residencies will therefore likely all be within Radiology Departments, closely integrated into the Diagnostic Radiology residencies, and reporting to the same Chair of Radiology. Graduates will be competent as both diagnostic radiologists and interventional radiologists. It will not be possible to train only in IR, or be certified only in IR,” said Dr. Kaufman.
 
One of the key features of this change in curriculum is the emphasis on non-procedural patient care. Dr. Kaufman said this was the aspect of the proposed training (increased exposure through clinics, admissions to IR services, consult services, and an extra year) that all of the member boards of the ABMS found compelling in approving the change in training and status of IR from sub-specialty to its own specialty.
 
The changes in curriculum will be phased in over many years. Currently, there is concern that small DR residencies, which do not have IR fellowships, may be disenfranchised because of their inability to offer an IR/DR certificate training program. This is an issue to many institutions because one-third of all DR residencies fall into this category. Mechanisms to prevent this from being a problem and ensuring flexibility in program design and entry points are being carefully considered by the ACGME.
 
Dr. Kaufman said this is a very exciting time for interventional radiologists. He said the first generation of innovators helped develop the fundamental techniques and devices. “We are now in a refinement period. The specialty has been growing explosively. We now are developing more sophisticated approaches and combing devices with medicines. Our specialty has now become more about the disease as a whole,” said Dr. Kaufman.

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