Pseudoexclusive Radiology Contracts: Our Downfall

To any medical student or resident reader of this blog, if you haven’t checked out the SIR Connect Forums, please do. There is so much incredible content from our society’s members. This post is a bit outdated, but at the time of writing there was a post regarding a job listing for an interventional radiologist being sought by an academic surgery group in Charleston, WV. From here, this thread took on a life of its own with so many comments regarding whether a potential IR should even be considering such a job. Some think doing so is a very slippery slope as this may result in “giving away our secrets to the enemy” as IRs sort of have done in the past. Others believe that IRs should be able to practice in a way which supports a clinical practice. This so-called notion of “Clinical IR,” is one that I explored in-depth on this blog.

As someone who left a group of radiologists to go work with a non-radiologist, you could imagine how I feel about this. Interventional radiologists should be able to practice however they would like! Unfortunately, this is not possible in many parts of our country. IRs don’t necessarily have a choice in how they’d like to practice. Their biggest obstacle is not interventional cardiology or vascular surgery. Sadly, the biggest hurdle are other radiologists. 

My story is one example of how radiologists can prevent our field from becoming truly clinical. I left my radiology group because my vision for a clinical IR practice was not shared by group leadership, including my IR partners. I had a better opportunity to practice the way I thought IR should be practiced by teaming up with a non-radiologist and working in an outpatient facility. Other than a strict non-compete with my former radiology group, nothing really kept me from moving on and striving to achieve my dreams. 

While I accomplished my mission of making it to the outpatient world, there was a huge void in my former OBL practice: caring for patients who cannot be safely treated in the outpatient setting. Knowing that I make more money and am happier in an outpatient setting, I wasn’t terribly bothered by this, but I had to come to terms with the fact that there were certain types of procedures I will likely never do again: portal hypertension interventions, acute clot of any sort, bleeders and even interventional oncology cases. Seeing as CLI, UFE, PAE and venous work are my areas of passion, I wasn’t terribly bothered by this. However, I was very frustrated by the fact that I couldn’t take care of my patients if they ever become hospitalized either related or unrelated to any procedure I may do for them in the OBL. 

So, why can’t I just apply for hospital privileges then? Well, you see I did this back in July 2020. My cardiology partner wanted me to have privileges because he still took hospital call which was a great way to bring patients to the OBL. Naturally, he wanted to split the call with me. Unfortunately, I was informed by medical staff services that I was denied privileges since the hospital has an exclusive contract with a local radiology group. This group by the way does not actively treat peripheral arterial disease since that is under the purview of the cardiologists and vascular surgeons who have privileges in the hospital. 

So if I wanted to round on a hospitalized PAD patient, or do a PAD case in the hospital for a high risk patient, I couldn’t. Thankfully I had a partner that was able to help me out if I needed to deal with the hospital in any way. More important for me was the fact that I was even able to practice in an OBL setting without hospital privileges or a hospital transfer agreement. 

The number one obstacle preventing interventional radiology from practicing independent of diagnostic radiologists is the presence of hospital contracts which in theory are supposed to be exclusive, but in reality they are not. These contracts are common with hospital based services including anesthesia, emergency medicine, pathology and radiology. The problem is they pretend to be exclusive, but they really aren’t, at least for radiology. The fact that a vascular surgeon can walk into an IR suite and do PAD cases, but the same group that allows this doesn’t allow an independent IR hospital privileges (which was the exact situation I faced), makes these contracts pseudoexclusive. 

Life isn’t always fair, and everyone wants to protect their bottom-line, but these contracts matter for one reason only: they can prevent an IR from opening a free-standing practice even if they want absolutely nothing to do with the hospital or the care of inpatients. While this wasn’t a problem for me (sheer luck based on my geography), this could in theory be a problem for many seeing that many states require hospital privileges or a transfer agreement to even open an outpatient practice. 

What bothers me the most, is that our professional organization (Society of Interventional Radiology) refuses to take a stance on this issue. It’s interesting, because if you look at the leaders in SIR, most of them are academic and hospital based! What a surprise. 

So there you have it. The wonderful OBL that you may not even get to start because of dinosaur politics and decades of inertia by the professional society you pay $950 a year to be a part of. Bet you they didn’t tell you this when you signed up for that fancy med student symposium. 

If you’re looking for more resources on this topic, reach out to me at linemonkeymd@gmail.com or on Twitter @linemonkeymd. If you want to join a society that will actually advocate for your interests in the OBL space, join OEIS. As always, leave a comment below.