This issue of Seminars in Interventional Radiology focuses on aspects of IR that many of us know little about, perhaps care nothing about, and largely ignore whenever possible. The topics included in this issue have nothing to do with our ability to diagnose or treat disorders, describe nothing flashy or novel, and for the most part won't get one invited to give a lecture at a meeting of much significance. Or, if lucky enough to be invited, expect to be giving the lecture at the last session of the last day to three other speakers, two meeting attendees who had to check out of their hotel room and had no place else to go for three hours, and two housekeepers. Trust me—I know.

However, these nonclinical drivers of our practices are vital to our survival. Very few people want to get into the weeds on issues such as how the RUC works, or how payments are determined and made (or denied) for services rendered, or the importance of disparities in our field. Issues such as this seem boring to some and in some cases even somewhat distasteful. We would far rather be doing interesting cases, delivering care in helping a patient with advanced or early disease, developing a novel technique or using an established technique in a different pathology or organ system, or training the next generation to push the envelope even further to provide care that is faster, better, and less costly than what is currently available. Isn't that what we are in this game for, after all?

I would anticipate that 98% of you reading this editorial (although that would require 50 people reading this, which is laughable) have no interest in becoming experts like those writing articles for this issue have. It takes a certain skill set as well as interest in becoming authorities in payment policies, advocacy, delivery of IR to underserved regions, health services research, etc, etc, etc. To be blunt, and with the understanding that like most physicians I have an ego that would choke a horse, I have come to realize that those individuals who have a firm grasp on these nonclinical drivers likely contribute more to the sum total of IR patients than I ever will in my entire lifetime of clinical practice. If Krol is not educating on the RUC process, Englander advocating for those changes on the floor of organized medicine, Talenfeld providing us with an argument regarding the value we bring to patient care, and Findeiss trying to guarantee we get paid for what we do—where would we be?

There is a major push right now in getting more physician leaders into health care systems. This is a topic that seems to wax and wane over time, and currently the tide is turning back toward having more leaders with clinical acumen sitting around the table as decision makers regarding the business of medicine. While that is generally good news for the physician community as a whole, it may or may not be the best thing for IRs. What we do is highly contributory to patient care, and we know what worth we bring to the table. However, not everyone shares that view, and particularly in times of scarce resources (meaning always) we can be thought of as reckless and expensive. Personally, I'm not certain that it is necessarily any better for IR to have to ask for resources from another physician who may not fully buy into what we are selling than it is in asking for the same from a businessperson. The answer to be found between this rock and a hard place is clear—we need more IRs in these nonclinical spaces to be able to make those arguments in a cogent, meaningful, and decisive way. However, that involvement will only get us as a field to the starting line—to complete the circle, we must be willing and interested in having these experts educate us so that we can make the case succeed locally.

All good initiatives for you the reader's practice must be homegrown. While the organized IR community such as our society may help set the table, it is incumbent on all of us as individuals in our own groups to be able to make these arguments, to convince the decision makers, and to prove our value in our own local environment. We can, should, and must learn these lessons from one another in order to best compete for scarce resources and to provide optimum care for our patients.

I'll look forward to seeing you at the next meeting. Thursday at 5:30 PM—walk past the guy with the vacuum cleaner and sit up front.

Article published online:
02 November 2023

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