The Changing Landscape of Interventional Radiology: Growth in Nonprocedural Services and Market Dynamics

Objective: To evaluate the evolution of interventional radiology (IR) practice patterns from 2013 to 2022, focusing on longitudinal growth in evaluation and management (E&M) services among actively practicing IR physicians. Methods: Using the Medicare Physician and Other Supplier Public Use File, we retrospectively identified “actively practicing IR physicians” based on a minimum 10% threshold of annual procedural and clinical work relative value units derived from IR-specific procedural codes. For each calendar year, we tallied the number of actively practicing IR physicians, total E&M claims, and mean E&M claims per IR physician. A two-step decomposition was then performed to quantify how much of the change in total E&M services was attributable to fluctuations in physician count versus changes in per-physician E&M billing. Results: From 2013 to 2022, total E&M claims rose from 149,481 to 201,825 (+52,344, +35.0%, P < .05). The number of IR physicians billing ≥11 E&M claims per annum rose 12.9% from 1,347 in 2013 to 1,522 in 2022. Mean E&M claims per clinically active IR physician increased 19.8% from 111 to 133 (P < .05). The number of actively practicing IR physicians declined from 12,483 in 2013 to 11,585 in 2022 (−7.2%). Decomposition analysis revealed that, absent the drop in IR physician count, E&M claims would have been higher by 10,776. However, an additional 62,559 E&M services stemming from increased per-physician billing offset this effect, yielding a net growth of approximately 52,000 E&M claims. Conclusion: IR physicians markedly expanded their E&M activities during the past decade. This growth is primarily driven by a rising fraction of “active-clinical” IRs who are growing in number and intensifying their clinical workload. These findings underscore IR's accelerating transition toward comprehensive patient care, with significant implications for training, practice management, and the specialty's role within the broader health care landscape.