Abstract
The study by Dhatt et al provides a timely snapshot of interventional radiology (IR) distribution in Canada, revealing that nearly one-third of Canadians lack local access to a Canadian Association for Interventional Radiology (CAIR) physician. 1 Whilst the paper recognizes the limitations of using a CAIR database as a complete representation of IR in Canada, it provides food for thought when considering IR access at a national level. Using the 200 reported CAIR members, results in an IR-to-population ratio is 0.54 per 100 000. This is comparable to the United States, where nearly one-third of the population similarly lacks county level IR access and the ratio is even lower at 0.30 per 100 000.
For historical context, a 2007 survey of what was then called the Canadian Interventional Radiology Association (CIRA) identified 247 members—an IR-to-population ratio of 0.75 per 100 000. 2 Notably, there are fewer CAIR members now despite the significant interval population growth (approximately 25% growth) and the increasing reliance on IR within healthcare systems. Physician shortage was identified at that time as a barrier to IR growth. If CAIR membership is truly reflective of the subspecialty at large, this problem has only worsened.
Another significant finding is the concentration of members in urban areas, accounting for over 50% of CAIR membership. 1 Although one of the accomplishments since 2007 has been the positioning of IR as an independent clinical subspecialty,2,3 it remains a subspecialty that relies on its interdisciplinary position for the majority of more complex care we provide. While advanced IR procedures naturally cluster in larger centres, community-based basic IR services may not be captured in a simple review of CAIR membership. There remains however a clear bias toward urban centres with an underserved rural population, at least in part due to the significant geospatial challenges that Canada presents. The challenges are clear; in order to provide equitable access to IR services for over 40 million people across the vast Canadian geography, structural changes in how the specialty is organized may be needed.
Practical Steps Forward
Understanding and defining the problem remains an important first step. We welcome the authors’ recommendation for a national IR registry. This registry could track not just physician locations and experience levels but procedural volumes, case complexity, and available resources. Such a registry would illuminate Canada’s current IR landscape, identify genuine gaps in access, and provide the foundation for evidence-based strategies to address inequities. CAIR, as Canada’s only national IR organization, is uniquely positioned to lead this initiative. This registry could then be further utilized to build disease or device specific registries.
Recognizing that Canada’s geography means advanced procedures cannot and should not be offered by every centre or every IR physician, a formalized hub-and-spoke model could be the solution. Canada has already demonstrated this model to be effective in stroke thrombectomy, where stroke networks operate through a formal hub-and-spoke coordination.4,5 These networks succeed because comprehensive stroke centres maintain full neurointerventional capabilities while primary stroke centres perform rapid imaging and patient selection with pre-established transfer protocols. Relying exclusively on fellowship-trained interventionalists to serve 40 million Canadians is neither feasible nor necessary. Many essential interventional procedures—ultrasound-guided biopsies, abscess drains, nephrostomy tubes, basic vascular access—are already performed by diagnostic radiologists in community and rural settings. Integrating the full range of IR services within a given geographical region would allow for more efficient use of resources and establish formal support and referral relationships between larger centres and community or rural-based centres.
Third, coordinated planning at provincial and national levels is needed to develop and formalize this hub-and-spoke model. This requires transparent centre designation based on documented capabilities, pre-arranged transfer agreements, and integration with existing networks such as oncology, hepatology, vascular surgery, and critical care. Such coordination requires leadership which can be augmented by organizations like CAIR through advocacy, collaboration, and support of provincial and national health boards.
Finally, with less than 40% of people recognizing that IR is a medical specialty and only 200 CAIR members serving over 40 million Canadians, IR has a fundamental awareness problem. 1 Invisibility to the public translates to invisibility in healthcare planning. This, along with physician shortage, was recognized as a barrier to specialty growth in 2007 and remains a significant issue in 2025. While CAIR has conducted campaigns toward patient advocacy groups and encouraged direct referrals from primary care, continued efforts within the medical community and general population are still needed. 6
Canada’s challenge is not simply distributing 200 interventional radiologists differently, but building the systematic infrastructure that addresses IR shortages and Canada’s unique geospatial challenges to enable the subspecialty to serve 40 million Canadians effectively. Let’s not let another 18 years pass by while grappling with the same issues. The path forward is clear: decisive, coordinated action to meet these challenges—starting today.
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.