Why Vascular Surgeons and Interventional Radiologists Collaborate or Compete: A Look at Endovascular Stent Placements.

Purpose: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision making and inter-specialty relationships.

Methods: Twenty-four conversational interviews were conducted 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 analyzed to identify and compare key themes according to the constructivist grounded theory and content analysis using NVivo 10 software. These data were supplemented with a retrospective analysis of 3658 endovascular stent placements performed at a large medical academic center over 11 years. Aggregate counts were divided by provider specialty, and trends were assessed via correlation coefficients.

Results: Endovascular stent placements were relatively equally divided between IR and VS over 11 years with some variability from placements by cardiology. 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 competition was most associated with specialists' awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement.

Conclusions: Understanding cultural differences between IRs and VSs is imperative for fostering better collaboration to grow shared territory rather than competing for the same slice of the pie.