The recent vote by the European Union of Medical Specialists (UEMS) shows how interventional radiology has moved from a technical discipline to a true clinical discipline, which marks a real milestone – the official birth of a new medical specialty in Europe. CIRSE president, Jim A Reekers, said European standards for training in interventional radiology can now be implemented, which would result in the improvement of quality of care for patients
The last issue of Interventional News carried a report by CIRSE on how the European Union of Medical Specialists (UEMS) had voted positively on the establishment of an interventional radiology division in Europe. In this issue, Interventional News has gone deeper, and asked several prominent interventional radiologists in Europe what this significant decision means for the discipline.
CIRSE president, Jim A Reekers, The Netherlands, highlighted that this vote strengthens the perception of interventional radiology going from being a ‘professional hobby’ to a specialty. He said, “Interventional radiology was already recognised by the European Society of Radiology as a subspeciality of radiology for many years, but this is still recognition within your own group.
“For the outside world, a radiologist and an interventional radiologist were still more or less the same – an interventional radiologist being a radiologist who did some interventions on the side, like a professional hobby. Now, by the positive UEMS vote, interventional radiology is officially recognised in Europe as a true medical subspecialty, although still closely connected to diagnostic radiology. European standards for training in interventional radiology can now be implemented,” he said.
Andy Adam, UK, one of the editors-in-chief of Interventional News, emphasised that, “The recognition by UEMS is an important step in changing interventional radiology’s status from a technical discipline to a true clinical discipline, in charge of its own destiny.”
“Very simply, becoming a medical specialty means a lot,” said Marc Sapoval, France, CIRSE chairman of the scientific programme committee, “This decision is a very important step in the sense that it shows the way. From now on, no one can say ‘what is interventional radiology – who are these guys?’”
Riccardo Lencioni, Italy summed it up: “The UEMS decision is a milestone. It is the official birth of a new medical specialty in Europe. For several years interventional radiologists were facing the paradox of playing a key and well-defined role in patient care, but in the absence of a formal recognition as distinct medical specialists by several authorities. This decision marks the change in that.”
The UEMS decision also impacts other factors. Reekers says, “By being an official subspecialty in Europe, interventional radiology in all countries can now develop further to become a clinical specialty with direct patient referrals and clinical logistics. This is the next logical step.”
Training, skill certification and standardisation
Prominent interventional radiologists also feel that the decision will expedite the establishment of a training curriculum. It will enable a definite European skill certification and help in setting standards for quality.
Sapoval said, “This decision paves the way for a better definition of the training, capabilities, work organisation, and position among other specialties. Very likely it will help allow interventional radiologists to define themselves, set out what they need to develop, how to do it, at which pace and in which order.”
“The European skill certificate (interventional radiology examination) will be a fact in 2010. This examination will be based on the European interventional radiology training curriculum. And will be a huge step forward in standarisation of interventional radiology quality throughout Europe,” said Reekers.
Lencioni added, “CIRSE’s planned European Certificate of Interventional Radiology will represent a recognised common European qualification in interventional radiology. The UEMS decision has created a solid basis for this important and timely project, as well as for any other future initiative aimed at standardising training and expertise in interventional radiology across Europe.
Thomas Pfammatter, Swizerland, puts it in context for the country:
“The establishment of a European training curriculum is pivotal, particularly for a multilingual, small country such as ours, where many interventionalists are from abroad, and where several locally trained radiologists have undergone subspeciality training in Europe or the US. For a small national society the creation of our own training and quality control programmes would represent a huge effort. Therefore, the help of an international society, such as CIRSE, is definitely needed.”
Attracting young radiologists
“Subspecialty status will lead to designated interventional radiology posts in most hospitals and will ensure the future of this discipline. This will make interventional radiology more attractive and boost recruitment,” said Adam.
Lencioni said, “Recognition of interventional radiology as a distinct medical specialty will be instrumental in attracting young MDs. The cosmos of medicine is moving towards technology-assisted, minimally invasive approaches. UEMS’ decision makes it clear to the many young MDs who are interested in this exciting and ever-growing field of patient care, that there is one specialty for image-guided interventions, and this specialty is interventional radiology.”
Sapoval clarified some difficulties that young interventional radiologists have faced so far. “They have been in the fog for a long time. Now, they can see the way, what will be needed in terms of training, who will play for them, and who will guide and support them. As an example the SFICV (French Cardiovascular and Interventional Radiology Society) have been developing a specific training programme for young interventional radiologists that has proven to be very successful; more than 200 young interventional radiologists have entered the process in just four years.”
Pfammatter shares his views on some of the challenges facing recruitment. “Currently, a career as an interventional radiologist can be perceived as not an attractive one for young radiologists. This is because we are perceived as those constantly being exposed to turf battles, as those taking night calls until the end of their professional life and as those practicing in a field with an insecure job market. The recognition of a specialty status might help take care of a part of these problems,” he feels.
Different countries and scenarios
According to Lencioni, the UEMS decision will have a great impact on a national basis. “National authorities cannot disregard the UEMS decision and shall give national accreditation to interventional radiology. It will likely take a considerable amount of time to translate the decision into actual changes in the national regulations. But in the end, all European countries shall be aligned,” he says.
Referring to how the UEMS decision would affect the UK, Adam said, “The Royal College of Radiologists is seeking formal subspecialty status for interventional radiology in the UK. The UEMS decision will help in this effort.”
Sapoval adds, “The positive influence will be huge. In France, for instance, it will result in a strengthening of the Federation de Radiologie Interventionnelle, and influence the need for a specific training pathway managed by the “College des Enseignants de Radiologie de France (CERF).”
In Switzerland, discussions on the status of interventional radiology within radiology departments and on its current or future role in percutaneous imaging-guided therapies within the community of competing proceduralists has been going on over the last ten years or so. “Unfortunately, no consensus has been reached, and in 2009 interventional radiology is still practiced throughout the country according to local agreements and habits. There is no guarantee that it will survive. This decision might empower interventional radiology and represent an additional argument when it comes to defend or even enhance its status in Switzerland,” said Pfammatter.
Similarly, Jose Ignacio Bilbao, Spain, says “I´m not sure about the impact of this decision in Spain. People probably know that the administration here has decided that radiology is a four-year training specialty. We do not have any recognised programme of subspecialty fellowships and most of our specialised working places are not focusedon attaining this. It means that we, the spanish radiologists, have a lot of inner management to improve the situation. It is needless to say that any additional help from Europe will be very welcome.”
He believes that Spanish interventional radiologists and the Spanish Ssociety of IR (SERVEI), as well the Spanish Ssociety of Radiology (SERAM), will use this important decision to improve the situation.
“The UEMS decision is not only important for interventional radiology but also for the accessibility of minimal invasive procedures for patients and through this for the improvement in the quality of care,” said Reekers.
So what lies ahead? According to Adam it is a clarion call to employers. “The next step is to ensure that employers recognise the importance of interventional radiology in modern medicine and the many advantages it offers for patient safety. They need to fund posts in IR, and provide the appropriate infrastructure for clinical practice.”
Johannes Lammer, Austria, adds, “Interventional radiology including vascular and non-vascular interventions as well as emergency treatments are an important part of state-of-the-art medical services today. Therefore it was important that interventional radiology is recognised as a medical subspecialty.
As a next step, it is important that in every European country interventional radiology is recognised as subspecialty as well.