In the wake of overwhelming support from the British Society of Interventional Radiology (BSIR) membership, Raman Uberoi argues that interventional radiology (IR) should become a specialty in the UK. He enumerates the advantages of gaining specialty status, and outlines the necessary steps to achieving this goal.
IR practice has changed significantly from diagnostic radiology, and interventional radiologists are in practical terms image-guided surgeons. Within the Royal College of Radiologists (RCR), IR is almost identical to Clinical Oncology in terms of its pattern of practice: it is a predominantly procedural specialty, the main purpose of which is to offer treatment. Although imaging remains at the heart of IR, images are primarily for guidance rather than diagnosis. Interventional radiologists must have the confidence and ability to see patients before treatment in order to consent them appropriately and discuss all options with them; in order to do that well, they need to have sufficient clinical knowledge, including a good understanding of what other specialties have to offer for the same condition.
Interventional radiologists need to have the confidence and ability to take primary responsibility for the patient during the treatment episodes, and interventional radiologists need to follow up their own patients; if they do not things will go wrong. In order to do this, interventional radiologists require better training in clinical practice and procedures than is possible under the current system. As with surgery, interventional radiologists need training in clinical and interventional techniques. Currently, however, the training of interventional radiologists is patchy, and results in huge knowledge gaps that potentially compromise patient safety. We of course have stringent requirements about knowledge in imaging, but no formally defined comprehensive requirements for IR procedures. The focus of training and examinations for future interventional radiologists therefore still involves having to know the detailed characteristics of imaging for cases they will likely never see once they leave FRCR [Fellow of the Royal College of Radiologists], such as certain rare bone tumours, but does not necessitate having an intimate knowledge of clinical management, techniques, procedures, and equipment, such as microwave or radiofrequency equipment that the interventionalist may use several times per week.
Many trainees who might be considering a career in IR are put off applying as they still see radiology as predominantly an imaging specialty, particularly those with a surgical interest. Trainees spend much of their time in the first three years doing few or, in many cases, no IR cases at all.
An IR specialty would result in a better-defined training, assessment, and career path for interventional radiologists, and the College would be in a better position to define the numbers of interventional radiologists required in hospitals and regions. The benefit and success of an IR specialty has been shown in the USA, where it is the country’s most sought after specialty.
Specialty of course would not only improve individual training; it would also help workforce planning, and ultimately allow provision of a national 24/7 service. There are currently no defined IR numbers, so it is impossible to undertake workforce planning, with huge implications for providing 24/7 IR care. Approximately, only one in seven units is currently able to provide a comprehensive lifesaving out-of-hours service in the UK. Without a specialty, workforce planning is not possible, because there is no generally accepted definition of who is and who is not an interventional radiologist. This does not mean that radiologists who do not belong to the IR specialty would be precluded from performing certain procedures, in the same way that radiologists can do endoscopy without being gastroenterologists. Nobody would be disenfranchised, as long as they have the required skills. In fact, it is vital that interventional radiologists are available in all hospitals and settings. Drainages and biopsies will remain a core radiology procedure, with interventional radiologists also having additional training to undertake more complex and varied interventions.
The RCR is the natural home of IR, with key shared competencies and interests in patient care. With the overwhelming vote endorsing the proposal to set up an IR specialty at the annual scientific meeting of the British Society of Interventional Radiology (BSIR) in November 2019 (see above), we now have a mandate from members to approach the RCR in taking the next steps in the creation of a new specialty. The process for the creation of a new specialty is not going to be quick, easy, or straightforward. It will be necessary not only to get the full backing of the RCR, but to obtain four-nation support from various relevant bodies—for example: NHS Improvement, NHS Employers, Scottish Association of Medical Directors, Health Education England, NHS Education for Scotland, Health Education and Improvement Wales, Northern Ireland Medical and Dental Training Agency. With this support, we should then be able to get endorsement from the UK Medical Education Reference Group (UKMERG), and then submit an application with UKMERG endorsement to the Department of Health. The decision of course will ultimately be made by the privy council. There have already been some informal discussions with the General Medical Council (GMC) last summer, and more formal discussions are planned for early in 2020. To achieve specialty status, we will need strong support from many quarters, but ultimately a lot of time and hard work will be essential from many colleagues to succeed in completing this process and achieve specialty status.
Raman Uberoi is a consultant interventional radiologist and Honorary Senior Lecturer at the John Radcliffe Hospital, Oxford, UK. He is a past president of the British Society of Interventional Radiology, and is running for vice president of the Royal College of Radiologists in the UK.