Addressing the Independent IR Residency Trainee Gap
By James B. Spies, MD, MPH, ABR Associate Executive Director for Interventional Radiology
2024;17(4):6
In recent years, the number of trainees applying for a five-year integrated interventional radiology (IR) residency has been increasing but with a corresponding decrease in the applicants for the independent IR residency. It appears that medical students committed to IR are showing a preference to match directly from school into integrated residencies, and a diminishing proportion of diagnostic radiology (DR) residents are applying for an IR independent residency.
Regardless of the reasons, the trend accelerated with this year’s independent IR residency match, with a dramatic decrease in the proportion of available positions filled. Of the 159 available positions, only 93 (58.5%) filled via the match. Of the 73 programs participating, only 28 (38.4%) filled via the match. Many training programs depend on independent residents during PGY-5 and PGY-6 and are now facing gaps in their trainee staffing.
As a result, the ABR has received inquiries from program directors about whether international medical graduates (IMGs) can be recruited to fill these open positions. While technically this may be allowable under ACGME rules, there are some potential pitfalls for IMGs who have no other U.S. or Canadian training. Perhaps the most important is that completing an independent IR residency alone does not result in eligibility for ABR interventional radiology/diagnostic radiology (IR/DR) board certification. For current trainees, the only pathways to ABR board eligibility in IR/DR are: (1) completion of an integrated IR residency, (2) completion of a DR residency followed by an independent IR residency, (3) completion of the five-year IMG IR alternate pathway, or (4) completion of a four-year IMG DR alternate pathway followed by an independent IR residency.*
Completion of an IR independent residency alone is not an option for either an American or international graduate. There must be appropriate DR training or experience as well, as the certificate qualifies the diplomate to practice in both disciplines. An independent IR residency does not provide diagnostic training.
It is also important to realize that the ACGME requires that DR training (either a DR residency or IMG DR alternate pathway) be completed before the independent IR residency. Therefore, if a program director offered an international graduate a two-year IR independent residency position without the requisite qualifying DR training, the IR training would not count toward eventual board eligibility. The DR training would need to be completed and the IR training then repeated to meet the requirement. Offering a two-year independent residency position without preceding DR training might be fine if the international graduate plans to return to their home country to practice. However, the program director would be doing a disservice to the trainee if the trainee’s eventual goal was ABR certification.
A better alternative would be to include the two-year independent residency in a five-year IR IMG pathway, with a three-year plan beyond that for additional training or faculty service. Candidates on this pathway are sponsored by the department, and the individual trainee’s plan must be approved by the ABR, but successful completion would result in the candidate’s board eligibility. An important prerequisite is that the candidate must be fully trained in their home country in radiology, including one year of IR training, and qualified to practice IR independently in that country. If that stipulation is met, the department can develop a training plan for the candidate that fits the mutual needs of the department and the candidate, with an eye toward ensuring that the individual will be capable of successfully passing the Qualifying (Core) and Certifying exams and practicing IR independently. The details of the requirements of the IMG pathway can be found here.
While at first glance the choices might seem confusing, all are directed toward a single goal: to ensure that those seeking ABR certification in IR/DR have sufficient training and experience to practice independently, competently, and safely. The ABR recognizes that there may be different paths to reaching that goal and has created options to allow candidates from a range of backgrounds to reach IR/DR certification.
* The ABR recently approved a limited two-year IMG pathway for IR that it is only open to those who successfully completed a four-year ABR IMG DR pathway. This is most applicable for IMG candidates who want IR/DR certification but are in a department without an accredited IR residency. An IR IMG alternate pathway can only be completed in a department with an ACGME-accredited IR residency. Inquiries regarding this limited pathway or the other alternative pathways should be directed to the ABR at 520-790-2900.
