The Reading Room

What Charlotte Radiology wants you to know about interventional radiology

by Erin Lane

This is part of a weekly series on conversations we had with interventional radiology (IR) leaders who represent programs in a variety of settings, including health systems, children’s hospitals, AMCs, cancer centers, and more. Make sure you’re subscribed to follow along.

For the third post in this series, we sat down with Dr. Eric Wang, Vice Chief of Radiology for Carolinas Medical Center and Charlotte Radiology, to discuss his experiences as an interventional radiologist.

Overview of Charlotte Radiology's IR program

Setting: Large, multi-hospital health system

  • IR program type: Offers a diverse range of procedures with a focus on interventional oncology at the main hospital, an 874-bed level 1 trauma center
  • Program oversight: Department of Radiology
  • Physician staffing: Independent radiology group that includes 14 interventional radiologists covering 6 hospitals and 3 outpatient vein clinics in the Charlotte metropolitan area
  • Dedicated IR space: Main hospital has 3 IR procedure rooms, 1 PICC line room, a dedicated waiting area, and an on-campus outpatient clinic for new patients consults and follow-up clinical care visits and evaluation

Employed staff: More than 20 physician assistants (PAs) are employed by the radiology group for both diagnostic and interventional radiology coverage at multiple hospital sites. The PAs allow the interventional radiologists to maximize the number of patients IR can evaluate for consultations, procedures, and follow-up care.

Typical daily volumes: Varies depending on procedure mix, but on average 7-8 slots per day per IR suite, and an additional 1-2 slots held for add-on and emergency cases.

Top opportunities for growth: All minimally invasive interventions, such as peripheral vascular disease/chronic limb ischemia procedures and management of thromboembolic disease, are great opportunities for IRs to provide longitudinal care of patients. Most notable is interventional oncology (IO) and liver directed procedures which makes up over 50% of Carolinas Medical Center’s clinical case mix.

Dr. Wang’s take on IR opportunities and challenges

Q: Charlotte Radiology’s IR program has a large focus on interventional oncology, with over 50% of your clinic patients per month being oncology patients. What is it that continues to drive your service offerings toward oncology?

Dr. Wang: Interventional radiology plays a key role throughout cancer care, from cancer detection and diagnosis through interventional procedures such as CT or ultrasound guided biopsies, to advances in treatment options such as radioembolization, chemoembolization, and microwave ablation. IRs today have an unique opportunity—and responsibility—to be an essential part of the hospital’s oncology decision-making team.

We attribute the overall IR service line growth to 3 factors: IR expertise and skill-sets, growth opportunities benefiting our hospital partner, and building our clinical practice through key referring provider relationships.

These same three factors apply to our IO practice growth. Several of our IRs, myself included, are passionate about interventions specific to oncology, which subsequently has lead to new service offerings for both our hospital partner and community. Relationship building is critical for clinical growth, and we continue to advocate IO options and maintain our presence during important oncology discussions and multi-disciplinary conferences.

Q: Your clinic space is directly next to the interventional suites where you perform procedures. Why did you decide to co-locate your clinic and procedure rooms, rather than having an off-campus clinic?

Dr. Wang: Two key reasons. Efficiency and visibility.

First, having the clinic in close proximity to the IR suite allows our team to see patients in clinic during the downtime between procedures. IR physician “free time” during room turnover (the time between 1 procedure ending and the start of the next) is approximately 30 minutes. This window allows enough time for our IR coordinators and PAs to help facilitate new patient or follow-up clinic visits for the MDs. Our physician assistants begin and end each clinic visit for our patients to optimize both clinic workflow and the overall patient experience.

Secondly, locating our clinic within the hospital allows IR the visibility we would never achieve off the hospital campus. There is often a misconception among referring providers and hospital administrators as to the role IR plays in the continuum of patient care.

Many are unaware that we see patients in the clinic setting; not only are we well-trained proceduralists, but diligent clinicians as well. Having that clinic visibility at the hospital is an important constant reminder.

Q: Increasing measured productivity, such as RVUs, is a common concern we hear from interventional radiologists. How do you address that challenge at your organization?

Dr. Wang: A common challenge interventional radiologists face is efficiently using downtime between procedures, especially for smaller programs. Our diagnostic radiology counterparts optimize their productivity by steadily reading exams at the workstation. If measuring productivity in RVUs, interventional radiologists can sometimes appear less productive than diagnostic radiologists. And although our workflow is different, we’re regularly held to the same productivity standards, so interventional radiologists must make up that RVU deficit somehow. Most IRs read diagnostic imaging exams between procedures to supplement those RVUs.

By placing the clinic in close proximity to our IR procedure rooms, we can also use clinic visits to contribute to and improve our productivity. Interweaving our busy IR procedure days with patient clinic visits ensures that we are caring for the maximum number of patients and providing timely patient access.

Q: Thinking about your growth strategy, what is Charlotte Radiology’s IR program prioritizing this year?

Dr. Wang: Interventional radiology is an ever-evolving specialty that is often viewed as only providing non-therapeutic services such as biopsies, drainages, and venous access. Today, Interventional radiologists are not only leading the charge in non-surgical minimally invasive treatment options, but also providing care for patients before, during, and after their procedures. Currently, we are focusing our efforts on educating patients and physicians that Charlotte Radiology IR can effectively provide that longitudinal care.

Our dedicated PAs and IR coordinators are essential in helping us work towards that goal; this is especially important with the increases that we have seen in clinic visits associated with the success of our many different IR service lines and procedures including chronic limb ischemia/peripheral vascular disease (PVD), uterine fibroid embolization, thromboembolic disease, IO, and chronic venous insufficiency.

In case you missed it, view our previous blogs in this series on MedStar Georgetown and Children’s Healthcare of Atlanta.

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