Strategies to Reduce Disparities in Interventional Radiology Care
In order to help address the geographic, racial, and socioeconomic barriers that limit patient access to interventional radiology (IR) care, these authors recommend a variety of measures ranging from increased patient and physician awareness of IR to mobile IR clinics and improved understanding of social determinants of health.
Interventional radiology (IR) procedures have been shown to improve patient outcomes but disparities in access to IR care remain a significant concern.1 Geographical limitations, particularly the uneven distribution of interventional radiologists, pose challenges for patients in rural areas compared to those in urban regions. The impact of these limitations is evident in studies showing that patients in rural regions with conditions such as pulmonary embolism undergo fewer interventional procedures than those who reside closer to academic medical centers.2
Furthermore, variations in procedural access have been observed among different demographic groups. For instance, certain populations, including Black and Hispanic patients, are less likely to receive IR procedures, such as uterine artery embolization (UAE) and transjugular intrahepatic portosystemic shunt (TIPS) creation, in comparison to more invasive surgical alternatives.3 Additionally, these groups have been reported to have poorer outcomes after interventional procedures.3 Socioeconomic factors also play a role as patients who are uninsured or covered by public insurance programs tend to undergo fewer IR procedures than those who are privately insured.2
As advancements in IR continue to emerge, differences in access to interventional care have become more pronounced. Addressing these disparities requires targeted and coordinated efforts. Accordingly, let us take a closer look at strategies to mitigate geographic, racial, and socioeconomic barriers to IR care.
How to Overcome Geographic Barriers
Interventional radiologists are predominantly concentrated in urban areas with fewer than one-sixth of U.S. counties having a practicing Society of Interventional Radiology (SIR)-registered physician.4 This unequal distribution limits access to IR procedures for patients in rural and underserved regions. Several strategies can help bridge this gap, including increasing awareness of IR among patients and referring primary care providers, expanding telehealth services, and exploring mobile IR clinics and remote robotic interventions.
Despite increasing public interest in IR, as reflected by a rise in related Internet searches over the past decade, awareness of the specialty remains limited.5,6 A 2023 study found that only 39.8 percent of surveyed individuals recognized IR as a distinct medical specialty.5
Enhancing public and provider awareness of IR is essential to reducing geographical barriers. One approach is the dissemination of high-quality educational materials to patients. This strategy is especially important given that public understanding of the specialty is likely limited by the poor quality of online resources regarding specific IR procedures.6 Additionally, improving understanding of IR among primary care providers can facilitate more informed discussions about interventional treatment options, ultimately increasing referrals for appropriate procedures. Studies have shown that structured educational interventions — such as online resources for patients and a targeted lecture series for referring physicians — can significantly enhance both patient and provider knowledge of IR.7-9
While education is fundamental, leveraging technological advancements, such as teleradiology, can further improve access to IR care. Expanding the use of telehealth for IR consultations may enable patients in remote areas to explore minimally invasive procedural options without the burden of travel. Additionally, many rural patients face logistical challenges, including financial limitations, time constraints, and transportation barriers, that can make it more difficult for them to seek in-person IR care. Implementing telehealth for pre- and post-procedural visits can help mitigate these challenges and enhance accessibility.
Another innovative approach to addressing geographic barriers is the use of mobile IR clinics. Mobile health units have been successfully employed in other medical specialties to deliver care directly to underserved communities. In São Paulo, Brazil, mobile IR units have demonstrated the feasibility of transporting procedural equipment for travelling interventional radiologists to use at various public hospitals.10 Introducing similar programs in the United States could improve access to IR care in under-resourced areas.
In addition to mobile clinics, tele-operated robotic interventions present a potentially promising long-term solution for addressing geographic barriers to IR care. These devices would enable interventional radiologists to perform procedures remotely, reducing the need for patient and physician travel. However, challenges remain, including concerns related to Internet connection stability, cybersecurity risks, and the substantial financial investment required for implementation of this technology.11 Further research is required to evaluate the safety and feasibility of remote robotic IR procedures before widespread adoption can be considered.
Key Steps to Help Mitigate Socioeconomic and Racial Barriers
Geographic, socioeconomic, and systemic factors often overlap, furthering gaps in access to IR care. For example, Black, Hispanic, and other underrepresented groups are disproportionately represented in lower socioeconomic communities.12 Similarly, rural communities tend to have lower average incomes than their urban counterparts.13 Given the intersectionality of these factors, reducing barriers to IR care requires a multifaceted approach, combining the previously mentioned geographic-based tactics with efforts to expand insurance coverage for IR procedures, addressing systemic variations in health care delivery, and promoting workforce diversity.
Addressing gaps in insurance coverage for IR procedures is critical to improving the accessibility of IR care. Many patients rely on insurance to afford interventional procedures. However, obtaining prior authorization for more cutting-edge IR procedures remains challenging with some insurance payers. These restrictions disproportionately affect patients from lower socioeconomic backgrounds, contributing to disparities in IR care.2 Advocacy efforts should focus on persuading insurers to broaden coverage for IR procedures by highlighting their clinical benefits, cost-effectiveness, and innovative capacity.1 Additionally, further research is needed to provide robust data on the long-term benefits of interventional procedures to strengthen the case for comprehensive insurance coverage.14
Beyond financial barriers, systemic factors in health care delivery can limit patient access to IR procedures. Modern medical education has placed greater emphasis on understanding social determinants of health and enhancing structural competency. However, continued efforts are necessary to address variations in care delivery at both individual and institutional levels. One potential strategy is the integration of patient facilitators, health care professionals who provide individualized guidance and assist patients in navigating available treatment options. By contributing to more personalized patient care, these facilitators may help improve access to IR care and reduce gaps in health care delivery.
Furthering workforce diversity in IR is another essential step in enhancing access to IR care. Research indicates that a diverse physician workforce may enhance patient trust and improve health-care experiences for diverse populations.15 Furthering efforts to expose medical students to IR early in their training could help achieve this aim. Educational initiatives, social media outreach, and structured mentorship programs can improve awareness, particularly for students from diverse backgrounds. Furthermore, expanding opportunities for students to participate in IR clerkships and shadowing experiences may foster greater interest in the specialty and contribute to a more representative workforce.
In Conclusion
While health-care disparities are observed across many medical specialties, IR faces unique challenges that contribute to a lack of access to care in certain populations. Geographic, racial, and socioeconomic factors all contribute to variations in access to IR care, underscoring the need for targeted interventions to curtail them. Strategies such as increasing awareness of IR, expanding telehealth services, implementing mobile IR clinics, advocating for broader insurance coverage, and fostering diversity within the specialty are essential to addressing these disparities. By prioritizing efforts to reduce barriers to IR care, the field can advance toward ensuring that all patients — regardless of location, socioeconomic status, or background — have equitable access to cutting-edge, minimally invasive procedures when clinically indicated.
Dr. Makary is a vascular and interventional radiologist. He is an associate professor of radiology and director of the interventional radiology clerkship at the Ohio State University Wexner Medical Center in Columbus, Ohio.
Ms. Umapathy is a medical student at Ohio State University.
References
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February 11th 2022Richard Duszak, MD, and Mina Makary, MD, discuss a number of issues, ranging from demographic trends and NPRPs to physician burnout and medical student recruitment, that figure to impact the radiology workforce now and in the near future.
