Abstract No. 359 - Why vascular surgeons and interventional radiologists collaborate or compete: A look at endovascular stent placements

Abstract

To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision-making and inter-specialty relationships. Endovascular stent procedure data was collected from 3658 procedures performed in a single hospital system between Jan. 2005 and Dec. 2015, using CPT codes. Aggregate counts were divided by provider specialty for each year and trends were assessed via correlation coefficients. This data was supplemented with a historical analysis of the two specialties and 26 conversational interviews with IRs and VSs about their approaches to patient care, views of their specialty and others’, and solutions to any expressed concerns. Interview transcripts were systematically coded according to constructivist grounded theory, a well-validated method for exploring social processes. Key themes were compared across specialties and practice environments in terms of frequency and emphasis. During the 11-year period studied, endovascular stent placements were primarily performed by IR and VS with roughly equal division but some variability from placements by cardiology. However, IR’s share of these procedures slowly but significantly increased (r = 0.7, p = 0.02). Both historically and presently IR and VS have shared icons, training, and procedural territory. IRs tend to lay claim to treatments as masters of procedures whereas VSs base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived inter-specialty tension was most associated with specialists’ awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement. In general, IRs and VSs viewed each other’s claims to shared territory more favorably than other specialties, e.g. cardiology. Understanding cultural differences between specialties is imperative for fostering better collaboration. As relatively small specialties with close histories, it is likely best for IRs and VSs to grow their shared territory together rather than competing for the same slice of the pie.