In a new report, a joint task force of the American College of Radiology (ACR) and the Society of Interventional Radiology (SIR) highlights the need to improve access to interventional radiologists (IRs) in small and rural areas (J Am Coll Radiol 2022; https://doi.org/10.1016/j.jacr.2022.08.004). Access to an interventional radiologist's care “can be the difference between life and death,” stated Parag J. Patel, MD, FSIR, Professor of Radiology at the Medical College of Wisconsin and SIR President.
Patel pointed out that millions of Americans in rural communities do not have access to the image-guided treatments that IRs perform. Indeed, patients in rural areas “tend to be older, to be poorer, to have more chronic health conditions, to have higher rates of tobacco use and obesity, and to live farther away from health care services than those in urban areas,” according to the report, citing a 2019 study highlighting the link between lack of access to medical specialists and mortality and preventable hospitalizations of rural Medicare beneficiaries (Health Aff (Millwood) 2019; doi: 10.1377/hlthaff.2019.00838).
That same 2019 analysis showed a 31 percent lower supply of medical specialists, with an associated higher rate of preventable hospitalizations and a 23 percent higher annual mortality rate, compared with urban areas. Given such disparities, the ACR/SIR task force was formed to explore strategies for the recruitment and retention of interventional radiologists in small and rural areas, “which have the greatest challenges with access to interventional radiologic care.”
Focusing on improving training opportunities, creating templates to help radiology practices and hospitals provide interventional radiology services in small and rural communities, and developing appropriate financial models to recruit IRs to these areas and retain their services, the task force's report outlines suggestions that it hopes will help practices attract IR talent and expand interventional radiology services where they are often most needed.
Composed of delegates from SIR and the ACR's Commission on General, Small, Emergency and/or Rural Practice and the Commission on Interventional and Cardiovascular Imaging, the task force was established to address a number of issues specific to smaller and more rural practices, such as:
- the value proposition to radiology practices of providing more access to IR services, along with the value proposition to interventional radiologists of partnering with radiology practices to provide these services;
- critical workforce and community characteristics that can establish where better recruitment and retention efforts are needed;
- the impact of interventional radiology on hospital and health systems and communities, such as population-based patient outcomes, costs of care delays and the cost of leakage of patients for care, as a basis to negotiate partnerships with hospitals for recruitment of interventional radiologists; and
- alternative interventional and diagnostic radiology contracting models that address root causes of instability of recruitment and retention of interventional radiologists.
“Our first task was to address who can do what, when, and where,” said Catherine J. Everett, MD, MBA, FACR, a managing partner at Coastal Radiology Associates in New Bern, NC, and a co-author of the report. “Advanced IR procedures cannot be done in many communities because of equipment, support staff, and operator constraints.”
The group also attempted to assign levels of procedures based on consensus of the task force. “Our consensus thought is that certain procedures should be within the skill set of diagnostic radiologists, and we defined those. Others should be done only by IRs and in staffed and equipped locations,” she said, adding that the task force also analyzed various practice models and how they provided such coverage.
Ultimately, the task force produced a consensus document of image-guided procedures tiered according to three levels of complexity. Level 1 procedures, for example, are those that most diagnostic radiologists should feel comfortable performing regardless of their subspecialty training, according to the ACR, which called out a number of additional key points to emerge from the report, including the following.
- Limited data suggest that diagnostic radiology residency programs may not provide adequate training for the performance of level 1 procedures.
- There are multiple successful models for providing IR services in small and/or rural communities that can be used as templates for practices or IRs who wish to establish sustainable IR services. Wide variation in practice models and hospital environments mandate development of locally sensitive solutions for the implementation and sustainability of a successful IR practice.
- Appropriate financial models must be developed to recruit and retain IRs into smaller, more rural community hospital-based radiology practices.
Mark McGraw is a contributing writer.