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LOS ANGELES -- Interventional radiologists grappled with the prospect of striking out on their own as they imagined whether they would continue to practice alongside diagnostic radiology in 10 years here at the Society of Interventional Radiology (SIR) .

It may be a moot question as standalone interventional radiology practices or joint interventional-diagnostic radiology groups may well cease to exist in 2028, said Jason Levy, MD, of Atlanta's Northside Hospital, saying that every specialty is moving towards employment at a hospital.

New payment models (such as accountable care organizations and bundled payments) may be to blamed as they require institutions to push for quality and coordinate care at lower costs. Employment in hospital systems, Levy suggested, aligns with these new goals and payment systems.

"It's the entire medical community. I've seen it at my hospital. Instead of fragmenting, the surgeons join together," he said.

But the question remains: do interventional radiologists remain part of the radiology department or split off as radiation oncologists already have?

"I don't think they have anything in common," said William Julien, MD, of South Florida Vascular Associates in Coconut Creek, in the debate following Levy's remarks. "I don't think DR [diagnostic radiology] brings anything to IRs [interventional radiologists] ... DR pulls you down, makes you look bad so people don't think you're a serious physician. I've always wanted to distinguish from that."

Fellow panelist Raj Pyne, MD, of Rochester General Hospital in New York, said he agreed with the sentiment -- though he commented that inertia would likely stop a clean break from happening between the linked specialties.

"Ten years from now, I think major groups will have IR attached to DR on the academic and private practice levels. The two groups hopefully will be acting synergistically," Pyne said.

Recent data suggest that about one in five interventional radiologists practice either almost pure interventional radiology or almost none (the rest being diagnostic radiology), according to Raymond W. Liu, MD, of Boston's Massachusetts General Hospital.

"If you think about that, that's IRs -- SIR card-carrying members. How do we consider their future if we split off?" Liu asked, adding that these numbers are unlikely to change in the next 5 years.

As it stands, the current setup of a radiology group may have the two specialties working side by side with little actual day-to-day interaction, as is the experience of Michael Cumming, MD, MBA, of Center for Diagnostic Imaging Vascular Care in St. Louis Park, Minn.

"Me and my partner, we eat what we kill ... In the radiology group itself, every rat eats what he kills. The neuros only do neuro, the MSKs [musculoskeletals] only MSK. Whatever they make is what they make. There's no communism in the rat group," Cumming emphasized.

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