Congratulations! A Pivotal Moment for IR

By Marshall E. Hicks, M.D., FSIR

SIR President 

Congratulations—to the many dedicated individuals both within and outside SIR and the American Board ofRadiology (ABR) whose herculean efforts over countless hours and almost 10 years laid the groundwork that lead to a pivotal moment in advancing the value of our specialty!

On Sept. 11, the American Board of Medical Specialties (ABMS)—the organization that has oversight of the 24 recognized medical specialty boards—approved ABR’s application for a new Dual Primary Certificate in Interventional Radiology and Diagnostic Radiology. The ABMS announcement came after significant behind-the-scenes activities by dedicated individuals to promote IR training and professional education as distinct to the specialty and of paramount importance to the delivery of expert patient care. This change in IR training will ensure that interventional radiologists will deliver care to patients with the requisite combination of clinical, procedural and interpretive skills. 

IR has a primary specialty certificate—one that has been elevated and now exists alongside diagnostic radiology (rather than as a DR subspecialty) and on the same level as surgery, pediatrics and internal medicine in the ABMS hierarchy. The IR/DR dual certificate—an essential feature of the growth and evolution of modern scientific medicine—will be the fourth primary certificate for ABR (joining Diagnostic Radiology, Radiation Oncology and Medical Physics) and the 37th overall in the United States. With its decision, ABMS and its member boards confirmed the benefit to patients of the unique interventional radiology skill set comprised of competency in diagnostic imaging, image-guided procedures and periprocedural patient care.

Moving to a primary certificate as opposed to a subspecialty certificate designates IR as a unique and distinct area of medicine, rather than an area of focus within an existing specialty. With increased attention to the length and kind of training interventional radiologists will receive under this new dual certificate, those who will benefit most will be our patients. This action—our turning point—affixes a publicly visible imprimatur on the specialty ensuring that it will receive the recognition from peers, legislators and the public that it so richly deserves. This news was hailed not only in the United States; our colleagues attending CIRSE greeted the news as a global IR success.

I predict that the demand for and complexity of image-guided interventions will continue to increase every year—and that we will need a lot more highly trained IRs. This new certificate will provide patients with an ample supply of well-trained IR specialists by ensuring that board-certified IRs are trained and qualified to deliver the highest level of care available today and demanding that this same quality be made available to all future patients. 

ABMS has stipulated that there will be a transition from Vascular and Interventional Radiology (VIR) fellowships to IR residencies as the new residencies are approved. The details and timeline for that process will be developed with significant input from ABR, SIR, APDIR, APDR, SCARD and other key stakeholders. The proposal will proceed carefully through the Accreditation Council for Graduate Medical Education (ACGME), with great attention to the needs and concerns of the IR and DR community. More information, as it becomes available, will be provided.

Thank you! The ABMS decision would not have been possible without the continued strong support from the dedicated volunteers on the SIR/ABR Dual Certificate Task Force (particularly John A. Kaufman, MD, MS, FSIR, chair) and from ABR (including Gary J. Becker, MD, FSIR; Matthew A. Mauro, MD, FSIR; Jeanne M. LaBerge, MD, FSIR; and Anne C. Roberts, MD, FSIR), the combined leadership of both societies, colleagues from supporting organizations and many more SIR members and staff too numerous to mention here. (See related story, p. 1.)

For now, this is our time to celebrate; this is our turning point—our future.

 Question

What do you think of the ABMS decision to approve the IR/DR primary certificate? Please post your comments, questions or concerns to me about this seminal event for IR.

Good News: The IR World Is Flat

By Susan E. Sedory Holzer, MA, CAE
SIR Executive Director

News—especially good news—travels fast. The recent ABMS decision to approve the American Board of Radiology’s application for a new Dual Primary Certificate in Interventional Radiology and Diagnostic Radiology—was the talk of the CIRSE meeting in Lisbon. Attendees congratulated me and SIR members in attendance about this significant turning point for IR. I traveled to Portugal, the nation that launched the global age of discovery, and found our news to be as relevant and exciting there as it was at home. The dual certificate approval generated deep curiosity and recognition across the global IR community.

The historical parallels got me thinking. Just as Magellan’s circumnavigation of the world ushered in a century of global exploration and discovery, what future will be made by the increasingly global specialty of IR? In his popular book The World Is Flat, Pulitzer-prize-winning journalist Thomas Friedman details how the processes of discovery, research, design, development and marketing are globally networked. No single nation or group possesses all of the creative knowledge to succeed independently. 

Medical discovery and advances originate all over the world. And our global IR community is just the kind of mutually reinforcing network that supports Friedman’s “world is flat” vision. The opportunity to easily cross oceans, devices, protocols, treatments, disease states, practice environments and cultures and debate new ideas and medical advances enables all to stay on the cutting edge of medical developments and improve care to patients. 

Congratulations to CIRSE President Michael J. Lee and other leaders for providing an exceptional educational program. With representatives from more than 80 countries, CIRSE’s successful meeting benefits the global IR specialty. 

Having returned home, I found your leaders, staff and volunteers busily preparing for SIR 2013. The theme of our AnnualScientific Meeting this year is “IR Reaching Out,” providing another dynamic opportunity to collectively learn from the broadest possible range of international and domestic attendees. And we are so excited to be returning to New Orleans, Louisiana, a city that has proudly recovered from the aftermath of Hurricane Katrina by holding onto its cultural economy and universal charm. Laissez les bons temp rouler in Crescent City—and sample its unique culture in a selection of videos.

In other developments, SIR’s new International Task Force is working to positively “flatten the world of IR” by reaching out to colleagues outside the United States through new programs and a new quarterly International Leadership Update e-newsletter. We are excited to offer for its second year our International Scholarship Program, which will foster (and fund) professional networking at SIR 2013, together with focused programming and possible visiting observerships, as a way to build key relationships with future international IR leaders and strengthen the developing international IR movement. SIR will also collaborate and participate in upcoming international IR meetings of the Chinese Society of Interventional Radiology (CSIR) and the Indian Society of Vascular and Interventional Radiology (ISVIR). Looking far ahead, SIR has already begun working with the Canadian Interventional Radiology Association (CIRA) leaders for SIR 2016, which will be held in Vancouver, British Columbia, Canada.

Just as the news of the U.S. IR/DR primary certificate advances the specialty globally, I am reminded that our name, “Society of Interventional Radiology,” was never intended to be bound by geographical divisions—and neither are the advances that we can dream and accomplish together. Let’s keep flattening the world of IR learning. Registration is open for SIR 2013; we look forward to meeting you in a few months!

Question

Tell SIR: What do you look forward to doing at SIR2013, the Society’s Annual Scientific Meeting?

Recovering From Hurricane Sandy

By Marshall E. Hicks, MD, FSIR

SIR President

Dear Colleagues,

We hope this email finds you safe and well. Hurricane Sandy caused unprecedented devastation across multiple states throughout the Mid-Atlantic and Northeast portions of the United States. Thank you for your patience and support as we re-opened the society’s Washington, D.C., area office and got back up and running.

Millions have been impacted by the storm, including many of our colleagues. SIR is here to serve you. If there is information that you would like to share, please let us know at membership@SIRweb.org. You may also connect with the society on the SIR website, on our IR Uncut blog, and on Facebook and Twitter (SIRspecialists, SIRmembers).

Please know that our hearts and thoughts are with you and your loved ones, especially those dealing with the added challenges of evacuating from homes and property damage. We wish you a safe and swift recovery.

Your Assistance Needed: Proposed IAC Vascular Testing Standards Ignore IR Expertise, Please Submit Opposing Comments by Nov. 5

By Marshall E. Hicks, MD, FSIR
SIR President

Dear Colleagues,
The Society of Interventional Radiology needs your assistance: I encourage you to oppose proposed Intersocietal Accreditation Commission (IAC) Standards and Guidelines for Vascular Testing Accreditation. The proposed standards recommend the Registered Physician in Vascular Interpretation (RPVI) credential or American Society of Neuroimaging (ASN) credentialing process over other training options—ignoring IR’s unique training and skill set. 

I ask that each SIR member copy and paste the below comments to the IAC review website or provide an opinion in your own words by the Nov. 5 review deadline. Please note: SIR is conveniently providing comments on the proposed standards because responses are limited to 1,500 characters (with spaces). 
****************************************************************************************************************
I strongly object to the comment that the RPVI credential or ASN credentialing process is recommended over all other training options.

1. Interpretation of vascular studies is already part of the training and board certification of radiologists. Radiologists have didactic and practical training in ultrasound and its interpretation, including vascular ultrasound, as well as formal extensive training in ultrasound physics and theory. Because this training includes vascular evaluation as well as evaluation of the end organ integrating multiple imaging modalities, one could argue that DR board certification is the superior alternative.

2. While the prerequisites for the RPVI and ASN include some of the elements in the IAC standard, there is no independent validating evidence that passing either exam qualifies one to interpret vascular studies.

3. By recommending the RPVI/ASN credentialing process without including board certifications in its list of physician credentials, the IAC vascular testing board is essentially creating a monopoly and abandoning the original multispecialty philosophy of ICAVL. This sort of recommendation (with or without the stated goal of eventually requiring the RPVI or ASN) will only lead to further division in the various physician specialties.

If IAC wants to strengthen the training and experience requirements for medical directors, radiology board certification must be clearly acknowledged as adequate for credentialing in this guideline.
*************************************************************************************************************** 
Here's how to submit comments on the proposed IAC Standards and Guidelines for Vascular Testing Accreditation.  

• Go to the IAC review website.

• Scroll down to the section for IAC Vascular Testing Standards and Guidelines Available for Comment.

• Select 1.1.1.4A and 1.3.1.4A: Medical Director and Medical Staff Section/ Changed.

• A window will expand with the description of the standard and the proposed change on the left.

• On the right, fill in your name and comment in the boxes provided. Comments on the proposed standards are limited to 1,500 characters with spaces.

• Hit Submit.

We are a small society, and—with your help—we can continue to make a big footprint on modern medicine. Thank you in advance for supporting the IR community on this important matter!

Resource
Download the IAC vascular testing standards.

Take a SIR-vey: Proposed IAC Vascular Testing Standards
SIR would like to know: Please indicate if you commented or will comment on the proposed IAC vascular testing standards.

Politically in Tune

By Marshall E. Hicks MD, FSIR
SIR President

Competing to be heard among the chorus of presidential candidates, parties, issue groups and their advertising blitz this election year is difficult. While small when compared to other national health care associations, SIR still can pack a solid punch when it comes to defending and promoting interventional radiology—but we need your continued help to strengthen IR’s voice with key decision makers.

Through SIRPAC—the Society’s nonpartisan political action committee dedicated to advancing the interests of SIR members, their practices and patients before Congress—we can help elect or re-elect political candidates who may help advance the Society’s public policy mission and legislative initiatives. As the election approaches, your contributions become even more critical to the success of IR. Your contribution helps us support candidates who focus on medical reimbursement, drug shortages, medical malpractice reform, appropriateness and accreditation standards, scope of practice, and medical research and funding.

SIR continues to meet with members of Congress to share its ideas about policy reform since Congress and the administration have made it no secret that they intend to revamp the current Medicare fee-for-service system and replace it with an alternative payment system. Delivery system model reform will be one of the key driving forces behind overall health care reform as we approach the next Congress and presidency.  SIR has introduced and educated Congress about its efforts to promote quality and efficiency, as Congress and CMS look for new payment reform models that move away from the traditional fee-for-service system. SIR has offered input into key legislative issues, such as medical malpractice reform and drug shortages. Most recently, SIR provided comments on efforts to improve health care outcomes and efficiency in the Medicare program to members of the Health Subcommittee of House Ways and Means Committee, an influential body charged with writing tax legislation and bills affecting Social Security, Medicare and other entitlement programs. SIR’s response will be used to review value-based measures and practice arrangements for improving outcomes and efficiencies in Medicare and reforming the sustainable growth rate.

Ensure representation: I want to thank all members who helped Save Our Seat on the AMA House of Delegates by joining or renewing memberships. For 20 years, SIR held an AMA seat, allowing us to send advisers to both the CPT Editorial Panel meetings and the RBRVS Update Committee (RUC). These are the only venues where new CPT codes are vetted and then receive a physician work value that is forwarded to CMS. By keeping our seat, your AMA membership ensures that IRs will defend IR. I know that many physicians disagree with many AMA policies; however, those who joined or renewed understand that our aim was not simply to maintain our seat and keep the status quo but to seize this opportunity to be an instrument of change—to promote progress and reform from within.

Continue appropriate value: SIR continues to have a strong presence at coding and reimbursement venues. For 2013, new CPT codes for carotid angiography, chest tube procedures and thrombolysis will be introduced. Thank you to our volunteer members who spearhead the work in this process and invest countless hours to ensure fair valuation for IR procedures. If we don’t participate aggressively in these forums, the consequences would be detrimental to our specialty.

Make a difference: Finally, I want to ask that you consider serving your Society. Volunteers don’t get paid—not because they’re worthless, but because they are priceless. During this election year, please consider volunteering for an elected or appointed position or as a member on our diverse committees.

If we’re politically in tune, we can strengthen IR’s voice. Please consider helping: As you can see, the common element to success in these efforts is you.

Please Note

SIRPAC’s ability to support key leaders is directly dependent on your generous support. If you have not done so in the past, please consider contributing to SIRPAC. If you have contributed in the past, we sincerely appreciate your contributions and hope you will consider donating again. 

Get Schooled: Smart SIR Tips

By Susan E. Sedory Holzer, MA, CAE

SIR Executive Director

Just as readying a daughter or son for a new school year takes more than new clothes and a shiny apple, so does preparing yourself for the rigors of treating patients in a health care environment that continually asks you to know more, do more and be more. How can you enhance your clinical practice skills? After hitting the stores for kids’ notebooks and pens, it’s a great time for you to take advantage of SIR’s valuable resources. 

1.     Register for SIR 2013: Your unique educational needs will be met—indeed exceeded—April 13–18 in the vibrant city of New Orleans at our Annual Scientific Meeting, which will feature a re-imagined up-close-and-personal format and collaborative theme of “IR Reaching Out.” Nearly 400 scientific presentations and posters covering the newest trends in IR research will be presented to more than 5,000 attendees—but we can’t provide research outcomes without you—so please consider submitting your original IR research.

2.     LEARN to keep PAD practice strong: This four-day course September 27–30 in Chicago is designed for physicians with training and experience in the fundamentals of vascular medicine, endovascular therapy and clinical management of PAD and AAA who seek to upgrade their knowledge and skill base.

3.     Find CLOTS: This perennial favorite is the most comprehensive stroke training course available worldwide. The five-day training course Oct. 21–25 in Dallas covers stroke pathophysiology, clinical neurological evaluation and the NIHSS, neurocritical care, multimodal neuroimaging, techniques of catheter-directed stroke care, patient-specific decision-making and more.

4.     Visit SIR Learning Center: Here’s where you can access educational activities on-demand. Current offerings include meeting proceedings, Webinars and JVIR CME tests. The site provides professional education on a wide array of clinical topics, including PAD, IO, stroke care, coding and billing and overall IR patient care. Register now for new IO, PAD and Venous Service Line Webinars.

5.      Get coding: Don’t forget that the 2012 Coding Update is available for free download to SIR members. Have coding questions? There’s also a convenient coding question form.

6.     Listen to JVIR podcasts: JVIR has launched audio (or video) podcast discussions with authors regarding current journal articles. These short, focused interviews delve into study rationale and design and implications of results for current practice and future research.

7.     Shop for you: The IR Store for everything to help you build and grow your clinical practice—from learning to set up and run an office-based clinical practice (with a sound business plan) to getting outfitted in the best back-to-school scrubs, caps and tees.

8.     Engage patients: Need to explain a treatment to a patient? SIR has easy-to-understand patient info brochures with detailed medical illustrations that give a good understanding of IR treatments and your special training. Add your business info to the back flap and market your practice.

9.     Get social: Don’t be anti-social: Tell us your successes and patient stories and/or follow us on Facebook, Twitter, YouTube or LinkedIn.

10.   Volunteer: Giving your time helps to make SIR stronger! Nominations for elected and appointed positions are being accepted. Or, work on practice guidelines, assist with a new task force, recruit medical students or help with coding. We need your help.

11.   Make due(s): SIR develops and delivers programs and services that bring measureable value to you and your patients. Thank you for submitting your membership fees by July 1! If you haven’t, there’s still time so you can take advantage of all an SIR membership has to offer.

12.   Find change: Are you looking for different? Career HQ, SIR’s dedicated job center for IR professionals, provides access to our specialized niche for job seekers or employers (interventionalradiologyjobs.sirweb.org/home/).

SIR has something for everyone when you’re in the “back to school” spirit; visit our website to learn more.

Originally published in SIR's September/October IR News

Question

What SIR educational product or service best meets your clinical practice needs?