Commentary on “Still So Far to Go” Plinio Rossi, MD I have read with interest the invited commentary by Kaufman in the November issue of JVIR, “Still So Far to Go” (1), which was a response to another commentary by Mezrich (2). I completely agree with the ideas presented by Kaufman regarding training for future interventional radiologists. When I began my residency in radiology in 1955 at Queens General Hospital in Jamaica, New York, and I performed vascular radiology procedures, still very primitive work, I already had 3 years of clinical training: 1 year in surgery at the University of Florence in Florence, Italy; 1 year in a general hospital in Formia, Italy; and 1 year of internship at Martland Medical Center in Newark, New Jersey. This initial experience gave me security in my practice, which I retain despite my not-so-young age. Regarding interventional radiology history and “the early champions of assuming responsibility for patient care” (1), the author is correct but probably he and many younger interventional radiologists now working are unaware that in 1967–1972, during the last few years of my 19-year period spent in the United States and in particular at St. Vincent’s Hospital in Manhattan, I was the chief of Cardio-Vascular Radiology, and I had the authorization to admit private patients to my service to perform all the diagnostic cardiovascular, coronary, and angiographic procedures just before the beginning of interventional radiology as a discipline in the late 1960s and early 1970s; I was considered among “the new breed of radiology.” In 1965 at St. Vincent’s Hospital, we were also able to initiate the “fee for service” for all the special procedures in neuroradiology (I was a cofounder of the American Society of Neuroradiology in 1962), diagnostic and interventional biliary procedures (still in its infancy), and angiography for the Department of Radiology. In Italy, the situation is different, and radiology represents a “service for the hospital.” Interventional radiologists

From Department of Radiology, Sapienza University, Rome, Italy. Received December 14, 2013; accepted December 15, 2013. Address correspondence to P.R., via Antonio Bertoloni n. 44, Rome 00197, Italy; E-mail: pliniorossi5@gmail. com The author has not identified a conflict of interest. & SIR, 2014 J Vasc Interv Radiol 2014; 25:495

have no authority to admit their own patients but need a cooperative surgeon or medical specialist to allow admissions to their service—with the exception of a few isolated hospitals, where limited admissions by interventional radiologists are permitted (ie, two to three beds). This situation is very constraining because the admitting chief of service must be aware of the interventional radiology procedure to be performed and must agree to it; this is almost impossible when one may offer interventions in competition with surgery. I do not see any way for improvement of the situation in Italy other than a change in status of interventional radiology from a subspecialty to a primary specialty with a different training program with the authority to admit patients, as already done by the American Board of Medical Specialties, provided that the interventional radiologist would assume full responsibility for patient care before and after the procedure until discharge from the hospital, exactly as suggested by Dotter. Although I understand this process is underway in the United States, it is not even considered by the Italian Society of Radiology. However, in my private practice, in hospitals not belonging to the National Health Service, I was able to admit patients in my name throughout my professional life and call consultants from different medical specialties when needed for the safety of the patients. I established a practice of interventional radiology that gave me great professional satisfaction. I hope that such a practice will evolve for all interventional radiologists.

REFERENCES 1. Kaufman JA. Still so far to go. J Vasc Interv Radiol 2013; 24:1669–1670. 2. Mezrich JL. Hospital admitting privileges in interventional radiology: how IR should reposition itself in the wake of one hospital’s policy change. J Vasc Interv Radiol 2013; 24:1667–1669.

Commentary on "Still so far to go".

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