DR market has exploded and it is very hard to keep up with DR volumes. There are simply not enough DR in its current state to read all of the imaging. This is not sustainable and either you train more DR, recruit DR from abroad or have others interpret imaging (Extenders/other physicians).
In the current state with IR doing mostly bread and butter in mixed groups ie biopsies, drains and lines it has to be subsidized for IR to maintain a semblance of the radiology salary and whether it be the hospital or the DR group or a mix of both is part of the contract.
The problem is that most IR in current training are trained to do IO and the evidence primarily exists in HCC which mostly goes to liver transplant centers /academics. In order to build a reasonable revenue stream as an IR you have to go out and build a patient panel and manage diseases which many IR are not trained to do. You have to be able to and willing to compete clinically with vascular surgery and cardiology. As an IR who wants to build service lines PAD, DVT/PE, fibroids, prostates, hemorrhoids, knee pain (GAE) etc you have to have weekly clinic and be comfortable getting an undifferentiated consult (which most IR in its current state of training are not). This will take a paradigm shift in training and jobs to enable this.
Another way for IR to achieve success would be outside the hospital in the OBL/ASC environment where you capture the globals but it requires a great deal of financial capital and overhead and you will be in the red for a few years (hard for most fresh grads with a large debt and families to navigate). The path of least resistance is to join a subsidized job where you are cleaning the list and doing the hospital IR work and cover call.
IR when done right with comprehensive vascular clinics including medical management /wound care, BPH clinic, knee and back pain clinics etc could be something that hospitals may seek out , but it is currently the exception rather than the norm. Hard to compete with cardiac (cardiac surgery/cardiology), Neuro (neurosurgery, spine, stroke) service lines that hospitals will seek out. Radiology, ER, path, anesthesia, shift workers (hospitalists (surgical/IM) ) are becoming commoditized. anesthesia has extenders to help lessen the burden, perhaps DR will ease the burden of imaging by doing the same. Currently imaging reimburses extremely well, but as volumes continue to rise that will likely take a hit as all high volume things in medicine eventually do.
It is best for IR and DR to continue to collaborate but they need to understand each other and their needs. DR needs to clean the list and provide quality imaging interpretation to their referring and IR needs a clinic and its incumbent overhead (office staff, billers, marketing, schedulers, EMR).