We spoke to Prof. Lee to learn more about his presentation at CIRSE 2022.
Recognition of IR as a specialty – challenges
Interventional radiology (IR) is unique in medicine, as it requires a triumvirate of competencies, which include imaging competency, procedural/surgical competency and competency in clinical care. As interventional radiology work practices have changed, new treatments have become available, knowledge has grown and the scope of practice including the aforementioned competencies, knowledge and skills have now become distinctly different to diagnostic radiology. There is no doubt that these changes in IR over the last twenty years, supported by major new concepts in IR science, new IR skills, advances in technology, new techniques and equipment as well as specialist continuing professional development and research, have transformed this area of medicine into a distinct practice deserving of specialty status.
Professor Colin Cantwell (Saint Vincent’s University Hospital Dublin) and I, along with other IRs, embarked on a process to achieve specialty status for IR in Ireland in 2020. The application process to the Irish Medical Council (the responsible body) is long, arduous and time consuming. We are currently at the end of stage one hoping to progress into stage two (Figure 1 a-c). The process is complex and a wide variety of consultations with post graduate training bodies, other faculties of medicine and surgery, the Dept. of Health and the National Training Programme Directorate are all necessary. Public engagement is also mandatory.
The main planks of our submission were:
Patient safety: The lack of 24/7 IR on-call services throughout the country is a significant risk to the public.
Equity of access: All patients should have access to interventional radiology for consultations regarding elective procedures.
Dedicated training programme: interventional radiologists and the public deserve to have a ring fenced training programme for appropriate training in imaging, clinical practice and IR techniques to develop the skills and competencies required to practice IR to the highest level. The IR training program should have both formative and summative assessment and should last a minimum of two years.
Workforce planning: A model of care (MOC) document for IR throughout Ireland was developed looking at the numbers of IRs andthe numbers of procedures and benchmarking those to numbers from other European countries. This model of care document allows us to benchmark our service against IR services in other countries and also to plan for the new posts required to support a countrywide 24/7 on call and replace retirees. The MOC is a vital piece of any application.
The challenges we face are many and are listed below:
- Limited formal recognition of IR as a specialty within other EC countries.
- Fragmentation of existing diagnostic radiology services from an on–call and DR workload point of view.
- Is there data detailing cost benefit analysis for IR? This is a difficulty, as there are limited studies on cost benefit analysis for IR.
- The recognition of IR as a specialty and any training programme must comply with article twenty-five of Directive 2005/36/EC on the recognition of professional qualifications and regulation.
- Lots of politics involved!
However, despite the above challenges, the most heartening outcome has been the immense support from surgical services, acute care services including critical care, anaesthesiology and emergency medicine as well as all the of the other medical faculties. Support also came from the Dept. of Health in Ireland, the NDTP (National Doctors Training and Planning, the body in charge of all of the medical and surgical training programmes in Ireland) and the health services executive. There was also wide engagement and support from patients and the public.
Although the challenges listed above can be overcome, there are certain key elements that one must have before embarking on this process, including:
- Support from the diagnostic radiology training body, who are the recognised body in charge of radiology training or equivalent in your country.
- A model of care document to outline workforce planning for the next ten to twenty years.
- A commitment from the national radiology training body in your country to support a dedicated curriculum based IR training programme for at least two years with formative and summative assessment.
- Letters of support from patient groups, other specialties, health authorities and training bodies
- There is an immense amount of writing and supporting documents to procure and collate, which takes time.
- A team of dedicated and enthusiastic interventional radiologists who will spend immense amounts of time on the project.
IR is now on the crest of a wave, and I believe there is immense goodwill toward IR form other specialties that we need to take advantage of and start the process of applying for specialty status. I will leave you with the words of Shakespeare from “Julius Caesar”:
“There is a tide in the affairs of men, which taken at the flood, leads on to fortune.
Omitted, all the voyage of their life is bound in shallow and in miseries
On such a full sea we are now afloat, and we must take the current when it serves
Or lose our ventures”.
Figures: Please click on the images to expand
RCSI University of Medicine and Health Sciences, Dublin/IR
Prof. Lee is currently a fellow of the Royal College of Physicians in Ireland. He graduated from medical school in Dublin in 1982 before discovering an interest in interventional radiology during his time as a trainee. He went on to pass the Boards of Radiology in both Ireland and the UK in 1989 and completed fellowships at Massachusetts General Hospital and at Harvard Medical School before returning to Ireland in 1995 as a Professor of Radiology.
Prof. Lee has published prolifically. He has written nearly 200 peer-reviewed publications and has edited or authored multiple chapters and textbooks. He has given more than 200 lectures around the world and is a committed educator, introducing an eight-hour IR teaching curriculum to the Royal College of Surgeons Ireland that ensures medical students are now taught about IR at an early stage in their career.
Prof. Lee has held many positions in national and international societies. Among many others, he was the first president of the Irish Society of Interventional Radiology and was President of CIRSE from 2011-2013. He was also a CIRSE Gold Medallist in 2016.