This project sought to characterize the shifting professional values and concerns of interventional radiology (IR) fellows to allow educators to better shape the future role of the specialty. We compared the results of ethnographic interviews with fifteen 2015-2016 and twenty-eight 2017-2018 IR fellows at the beginning of their fellowships at the same 4 institutions. Fellows were asked about their journey to the specialty, what makes a “good” IR, their interactions with patients and providers, and the future of the specialty with probing for further detail. Interviews were transcribed verbatim and systematically coded for themes and trends by a single experienced qualitative researcher. Two-tailed t-tests were used to quantitatively compare interview theme frequencies between groups. Participating fellows (n = 43) were 32 ± 3 years old with 6 women and similar demographics between past and current fellows (p > 0.05). Both groups described similar pathways to IR with early interest in radiology or surgical fields. Fellows consistently valued working with their hands, thinking on their feet, and innovation. However, current fellows described ideal traits in much more clinically focused terms (p < 0.01), more consistently emphasizing the importance of understanding patients’ values and goals of care, rounding on patients, and follow-up clinics. Tension between diagnostic and interventional radiology was the primary inter-disciplinary concern of current fellows rather than competition emphasized by past fellows. IR fellows have become more clinically focused with better defined perceptions of IR’s clinical role, and the magnitude of this shift was surprisingly large. Tension between IR and DR rather than other specialties may be an important concern to address with the implementation of IR residency programs.