Huge Effort and Extraordinary Results: Interventional Radiology’s Official Recognition

Marshall HicksAfter countless hours and almost 10 years of Herculean effort from Society of Interventional Radiology (SIR) members and the American Board of Radiology (ABR), the American Board of Medical Specialties (ABMS)—the organization that oversees the 24 recognized medical-specialty boards—approved the ABR’s application for a dual primary certificate in interventional radiology and diagnostic radiology. This action sent a clear signal that the interventional-radiology skill set is a unique combination of expertise in imaging, technology, and patient care. It 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.

The ABMS announcement comes after significant behind-the-scenes activities by dedicated individuals, both within and outside SIR, who have worked to promote training and professional education as distinct to the specialty—and of paramount importance to the delivery of expert patient care. Indeed, after a prior application for a single certificate in interventional radiology was rejected in 2009, John A. Kaufman, MD, FSIR, chair of the SIR/ABR Dual Certificate Task Force, led members back to work on a new application. As interventional radiology becomes an increasingly complex discipline, it makes sense for its training to remain rooted in radiology, leading to the application for a dual certificate in diagnostic radiology and interventional radiology.

This new certificate will provide all future patients with an ample supply of well-trained interventional-radiology specialists and will ensure that board-certified interventional radiologists are trained and qualified to deliver nothing less than the highest level of care. The inclusion of periprocedural care as an integral competency (along with interventional radiology’s technical and imaging competencies) reinforces this action. The new dual primary certificate in interventional radiology and diagnostic radiology will be the fourth primary certificate for the ABR and the 37th overall in the United States. The other three ABR certificates are in diagnostic radiology, radiation oncology, and medical physics.

Moving to a primary certificate, as opposed to a subspecialty certificate, designates interventional radiology as a unique and distinct area of medicine, rather than an area of focus within an existing specialty. This elevation to a specialty level, with its own distinct residency program, places interventional radiology/diagnostic radiology on the same level as surgery, pediatrics, and internal medicine in the ABMS hierarchy.

What’s Next

The ABR will seek the approval of the Accreditation Council for Graduate Medical Education (ACGME) for accreditation of interventional-radiology residency programs. Once ACGME approves the plan to accredit programs in the new specialty, the Diagnostic Radiology Residency Review Committee will draft the residency training program’s requirements. These will be subject to a public comment period of 45 days and will then be reviewed by the ACGME Committee on Requirements. Once approved, programs can begin to apply for accreditation.

It is unlikely that even the earliest programs accredited will be able to enroll any interventional radiology/diagnostic radiology residents before July 2015. Even after all of these steps, the process of conversion of vascular and interventional radiology fellowships to interventional-radiology residencies will take several years. All existing vascular and interventional radiology subspecialty certificates will be converted to interventional radiology/diagnostic radiology primary certificates through a special maintenance-of-certification pathway to interventional radiology/diagnostic radiology certification.

Partly as a result of this pathway and partly as a result of future newly minted interventional-radiology residency graduates obtaining interventional radiology/diagnostic radiology certification, several years from now, the vascular and interventional radiology subspecialty certificate will cease to exist. Patients benefit from well-trained specialists, and only one credential should become the new standard: the interventional radiology/diagnostic radiology certificate. Although we will not get there quickly, or all at once, we must remain committed to getting there.

The joint SIR–ABR task force that developed the dual primary certificate in interventional radiology and diagnostic radiology was a true collaboration between radiology’s two branches—diagnostic and interventional—in the fullest sense. The task force noted that although it was the specific qualities of interventional radiology that prompted the SIR and ABR decisions to apply for primary specialty status, competency in diagnostic imaging is of great benefit when using imaging to guide an intervention. I would be remiss if I did not note that this would not have been possible without the dedicated volunteers on the task force and from the ABR, the combined leadership of both societies, and many more members and staff too numerous to mention. Many associations, representing all branches of organized radiology, supported the effort.

Marshall E. Hicks, MD, FSIR, is president of the Society of Interventional Radiology and head of the division of diagnostic imaging at the University of Texas MD Anderson Cancer Center, Houston.