Members of the British Society of Interventional Radiology (BSIR) have voted overwhelmingly in favour of interventional radiology (IR) becoming a specialty in the UK. Of 350 votes cast, 80% (279) were in favour, and 20% (71) were against.
BSIR members had 24 hours to vote on the motion “Should interventional radiology become a specialty?” during the society’s 2019 annual scientific meeting (13–15 November, Manchester, UK). The society’s annual general meeting (AGM) took place during this voting window, and allowed participants to discuss the ramifications of voting for or against granting IR specialty status.
Whether or not interventional radiology will become a specialty is still under the auspices of the Royal College of Radiologists (RCR), explained BSIR vice president Philip Haslam (Freeman Hospital, Newcastle-Upon-Tyne, UK), but he said that the results of this vote “give us [BSIR] a mandate now, from our members, to take this forward with the college of radiologists, with the General Medical Council (GMC), and hopefully achieve our aims”.
IR became a specialty in the USA in 2014 and, by 2018, was the most sought after specialty amongst medical students. While the healthcare system differs between the USA and UK, proponents of IR becoming a specialty in the UK argued that “there is much to learn” from this US success. The Royal Australian and New Zealand College of Radiologists (RANZCR) have recently published a white paper looking to develop an IR specialty in Australasia. In continental Europe, the German Society of Interventional Radiology and Minimally Invasive Treatment (DeGIR) have their own exam, which implements a modular system for training. France and The Netherlands are currently exploring options for IR to become a specialty.
What happens next?
“This is the start of a long and slightly painful process,” Raman Uberoi (Oxford University Hospitals NHS Foundation Trust, Oxford, UK) told BSIR delegates, “because it is tricky to become a specialty”.
BSIR will begin talks with the RCR, and then jointly with national training bodies, including the GMC, the clinical oversight group (COG), and the UK Medical Education Reference Group (UKMERG), to make the case for IR becoming a specialty. This decision will ultimately come from the Privy Council, but Uberoi emphasised that “the message needs to come from the bodies to say that it is vitally important that IR becomes a specialty”.
The Privy Council is a formal body of advisers to the Sovereign of the UK, and is responsible for some of the affairs of the GMC. Following an initial, positive reaction from the GMC, Uberoi reported that the Privy Council were not supportive of IR becoming a specialty (“Their knee-jerk response is ‘no’ to any new specialty,” he said). However, he added that the case had never been made directly to the Privy Council, and that BSIR needed to work with the RCR and GMC “to make the arguments cogent” before making the final submission to the body.
This process may take “many years”, he said. Specifically addressing the BSIR members, he urged: “A lot of us will need to go into the college, a lot of us will need to be involved in the creation of the specialty and actually delivering for the future.
“Ultimately, this is about quality and patient safety, and improving outcomes,” he continued. “That means, we have to have better training, we need better access to clinics, and to occupy those clinics, and then to get better workforce planning for the future. But this needs buy in from all interventional radiologists, because this is not something that Council or a small group of people can take forward. We all need to push for this and we all need to believe in this project, because it will take some time. It will not impact on any consultants working today. This is the future; this is next generation of interventional radiologists that we are looking to. So we are looking at something that is going to take eight or nine years before we see the full benefits. We need to be doing other things besides, but I think this is vital for the future survival of IR, and more importantly, it is going to give us high-quality, focused care.”
Graham Plant Lecture advocates for IR to become a specialty
In his Graham Plant Lecture at the annual meeting, entitled “Interventional Radiology: A 21st century specialty”, Uberoi took the opportunity ahead of the vote to make the case in favour of IR gaining specialty status. “We have become integral to the management of not all, but a large number of patients in virtually every specialty in the hospital setting,” he said. “We play a key role in their treatment in nearly every sense that I can think of.”
However, he continued: “I think there is a problem. […] This issue that Charles Dotter [founder of interventional radiology] himself identified, and others after him identified, is the role of clinician versus technician. It is really about who is clinically responsible for the patient? Who is clinically responsible for the patient has huge connotations: the hospital management team, NHS England, the Trust, really focus on those individuals, supporting them with infrastructure and resources. They are seen as the primary clinician managing that patient. I argue that many of us are still behaving very much as technicians; the responsibility lies with surgeons or physicians. They are seen as the specialist clinician and, not unreasonably, a lot of organisations will focus their attention and their resources on those areas.”
Speaking in advance of the BSIR membership vote on the matter, Uberoi said, “I think it is vitally important that we consider becoming a specialty. I am not one for doing things just for the sake of it; I really believe this is crucial for our future development and survival. We can carry on sculling, keep doing the same things that we have been doing for the last 20 years, but I can tell you that, yes, it has given us some benefit, but I do not think that we can do much more.” Listing what he saw as the potential benefits, he enumerated:
- Improved provision of 24/7 IR services, quality of IR training and patient safety throughout the UK
- Improved IR workforce planning by matching training to need
- More defined career path for IR
- Widen the pool of doctors considering a career in IR
- Strengthen the voice of the RCR nationally by creating a three-specialty college—both therapeutics and diagnostics
Uberoi did mention concerns his IR colleagues had raised with him over the last few months about becoming a specialty, though, which he hoped to alleviate in his Graham Plant Lecture. Firstly, he said, some people worried that becoming a specialty may adversely impact the number of doctors joining IR. Addressing this concern, he said: “I think we are in a poor place [with recruitment]; I think we can only get better.”
Furthermore, he said there is “a lot of confusion” about what happens with diagnostic radiologists who currently do IR. “This does not stop anybody from doing IR. On the contrary, it gives greater guidance and support for their practice in their roles from the specialty, which will ensure the quality standards that we need to adhere to,” he explained. “Similarly, those who do diagnostic radiology (DR) and IR will be able to continue doing so. DR is key to what we do, it is what distinguishes us from other surgeons. We need imaging, and we can and should continue to do DR, as long as we adhere to the RCR quality standards and look to our patient’s needs. We will continue to be trained in imaging, and we will continue to do imaging.”
This concern was discussed further by BSIR members after the Graham Plant Lecture, before voting closed. In particular, congress attendees asked about the RCR’s attitude towards IR becoming its own specialty, with one audience member flagging that the college may view this as taking numbers away from DR. “I do not think they are overjoyed,” Uberoi conceded, “because I think this is an unnecessary, from their perspective, headache, and it is a real problem for them.” However, he went on to counter: “Yes, we will be taking numbers from DR initially, but of course, these would reflect for trainees who are currently going into IR. Over time, I think we will increase IR numbers not at the expense of DR.”
Uberoi described the RCR’s stance towards designating IR specialty status as “lukewarm”, in his opinion, and announced his intention to run for vice president of the college once nominations open, as he believes it is important for the IR voice to be represented. “My intention is to do this from within the college. I think we can only do this with full college support. I think we need to make people understand why we want to do this: it is not a backlash against DR, it is about our future, the future survival of our specialty.”
Following dialogue with RCR, BSIR president Ian McCafferty (Queen Elizabeth Hospital Birmingham, Birmingham, UK) was positive about the college’s response: “They [RCR] also understand that we cannot stay where we are. They know we have to evolve in some shape, way, or form.”