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Evolution of Interventional Radiology Practice Phenotypes: Sedation, Clinical Integration, and Procedural Complexity
Amy R Deipolyi1, Adam M Belcher2
1West Virginia School of Medicine, Charleston Division, Charleston, WV, United States (A.R.D.); Interventional Radiology, Department of Surgery, Charleston Area Medical Center, Charleston, WV, United States (A.R.D.).
Rationale And Objectives:
To define longitudinal practice phenotypes within the interventional radiology (IR) workforce using procedural sedation and evaluation and management (E/M) billing patterns and evaluate their association with procedural complexity and workforce growth.
Materials And Methods:
A retrospective analysis of the Medicare Physician and Other Practitioners Public Use File was performed for 2013-2023. Physicians self-designated as interventional radiologists were classified into four practice phenotypes based on billing for moderate sedation and E/M services. Longitudinal trends in workforce composition, sedation billing, and procedure mix were assessed. Associations between practice phenotype and procedural complexity were evaluated.
Results:
The IR workforce increased from 1098 physicians (2013) to 2306 (2023). Moderate sedation billing rose from 25% to 69%, markedly increasing after the 2017 Current Procedural Terminology restructuring. Practice patterns diverged over time, with the "Moderate Sedation Only" group becoming the largest cohort (46.8% in 2023). Complex procedures were most frequently performed by physicians in the "Both" group, including embolization (20.4% vs 6.7%) and peripheral vascular intervention (13.3% vs 1.2%) compared to the "Moderate Sedation Only" group. The "Moderate Sedation Only" group maintained a predominantly routine procedural profile.
Conclusion:
The IR workforce is increasingly stratified into distinct practice phenotypes defined by procedural sedation and clinical integration. Complex IR procedures are predominantly performed by physicians who combine both elements, whereas workforce growth is concentrated in procedurally focused physicians performing routine care. Comprehensive IR practice, including participation in complex procedures, is most strongly associated with the combination of clinical integration and IR-directed procedural sedation.
