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Time for Interventional Radiologists, Surgeons to End Turf War?

— A look at two areas of contention: stenting, IVC filter implants

MedpageToday

WASHINGTON -- Despite anecdotes claiming otherwise, interventional radiologists didn't bear the brunt of inconvenient weekend inferior vena cava (IVC) filter placements, a study of Medicare data found.

And in a separate single-center analysis, stenting duties were shared equally between vascular surgeons and radiologists.

Across the board, surgeons, cardiologists, and radiologists alike were placing 90% of their IVC filters on weekdays and 10% on weekends (P=0.41), reported of Emory University School of Medicine in Atlanta, at the annual Society of Interventional Radiologists meeting here.

"Anecdotally, many radiologists report competitors preferentially seeking services at convenient hours, disproportionately burdening radiologists with on-call weekend procedures," he and his colleagues found. "However, overall, specialties equally share in weekend call placements of IVC filters nationally."

The was based on claims records from a 5% random sample of Medicare beneficiaries. In the dataset there were 9,172 IVC filters placed from 2012 to 2014 by radiologists (59.8%), surgeons (30.0%), and cardiologists (8.7%).

Whitmore did mention other areas of overlap that are still of interest: central venous access, dialysis access/fistula, and arterial revascularization.

Curiously, the most popular day for IVC filter placements -- at least numerically -- was Friday (19.7%).

A separate found that endovascular stenting procedures were roughly split between vascular surgeons and interventional radiologists at one center.

There were 3,658 stenting procedures in the 2005-2015 period included in the study. , of Northwestern University's Feinberg School of Medicine in Chicago, and colleagues also conducted 26 conversational interviews with interventional radiologists and vascular surgeons.

What they found: "Both historically and presently interventional radiology and vascular surgery have shared icons, training, and procedural territory. Interventional radiologists tend to lay claim to treatments as masters of procedures whereas vascular surgeons base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived inter-specialty tension was most associated with specialists' awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement.

"In general, interventional radiologists and vascular surgeons viewed each other's claims to shared territory more favorably than other specialties -- e.g., cardiology. Understanding cultural differences between specialties is imperative for fostering better collaboration. As relatively small specialties with close histories, it is likely best for interventional radiologists and vascular surgeons to grow their shared territory together rather than competing for the same slice of the pie."

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    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine.

Disclosures

Whitmore and Keller disclosed no conflicts of interest.

Primary Source

Society of Interventional Radiology

Whitmore M, et al "Weekday versus weekends: are radiologists disproportionately placing off-hours inferior vena cava filters?" SIR 2017.

Secondary Source

Society of Interventional Radiology

Keller E, et al "Why vascular surgeons and interventional radiologists collaborate or compete: a look at endovascular stent placements" SIR 2017.