Choosing Fellowship Advice

[cecumbowels]

So after not liking radiology in the beginning, I ultimately decided to stick it out and now I am in my third year. I am going to be applying for fellowship soon and am honestly undecided on what fellowship I want to do. I have ruled out mammography and IR, but the other ones are fair game.

I am open to body, neuro, MSK, or even nucs. I honestly do not have a preference for one over the other, but I do enjoy body and nucs. However, I could see myself doing any of these. Anyone have any advice how I should pick one? Which one is the most laid back/chillest? I plan on beginning my career in private practice and then later possibly transitioning into academics.

Thank you everyone for the advice!

---

Members don't see this ad.

 

[MadRadLad]

Most laid back is probably MSK due to lack of acuity. Neuro and body have more urgent indications on call, but in private practice you will be reading everything on call. Some subspecialized larger practices could give you maybe 70-100% neuro as well due to the volume, also probably body. MSK is more variable because some places don't have the volume to support 100% MSK.

I would pick based on what you like the most. If you want to be an expert in rectal/pelvic/prostate MRI....small joint and congenital MSK stuff...peds neuro/head & neck/advanced neuro protocols. In PP you will end up doing a bit of everything but the hard cases or rarer stuff will get turfed to whatever you are fellowship trained in.

 

[Ole_Toe]

So after not liking radiology in the beginning, I ultimately decided to stick it out and now I am in my third year. I am going to be applying for fellowship soon and am honestly undecided on what fellowship I want to do. I have ruled out mammography and IR, but the other ones are fair game.

I am open to body, neuro, MSK, or even nucs. I honestly do not have a preference for one over the other, but I do enjoy body and nucs. However, I could see myself doing any of these. Anyone have any advice how I should pick one? Which one is the most laid back/chillest? I plan on beginning my career in private practice and then later possibly transitioning into academics.

Thank you everyone for the advice!

Nucs can give you a great career esp if you find a hybrid academic private setup. As long as you’re cool with being possibly <50% in your sub specialty. What I like about nucs is that it’s relatively lower volume more time per study and super interesting between the pathology and even therapeutics but ymmv. Can’t go wrong with body of you wanna keep your options open.

 

[vm26]

So after not liking radiology in the beginning, I ultimately decided to stick it out and now I am in my third year. I am going to be applying for fellowship soon and am honestly undecided on what fellowship I want to do. I have ruled out mammography and IR, but the other ones are fair game.

I am open to body, neuro, MSK, or even nucs. I honestly do not have a preference for one over the other, but I do enjoy body and nucs. However, I could see myself doing any of these. Anyone have any advice how I should pick one? Which one is the most laid back/chillest? I plan on beginning my career in private practice and then later possibly transitioning into academics.

Thank you everyone for the advice!

Unfortunately (or fortunately if you are looking at it from a point of job security), PP + any sub-specialty will likely not be chill/laid-back due to rad shortage, increasing volumes, increasing case complexity, and increasing demands from specialists asking for sub-specialty reads. In PP you will be reading outside your sub-specialty for a significant amount of time. I suppose picking one which gives you the broadest general skill set (?neuro or body) may make sense. However while most rads can read basic neuro MR, the same is not true for body or MSK. Also if you have any interest in procedures, this would also be a factor (more light IR in body than neuro/MSK). Can't really comment on NM. I think at the end of the day its a leap of faith and there is no right/wrong (at least prospectively!)

 

[cecumbowels]

Nucs can give you a great career esp if you find a hybrid academic private setup. As long as you’re cool with being possibly <50% in your sub specialty. What I like about nucs is that it’s relatively lower volume more time per study and super interesting between the pathology and even therapeutics but ymmv. Can’t go wrong with body of you wanna keep your options open.

Agreed. The person at my instution typically averages 10-15 studies per day about 5-8 PET scans.

Yeah the only thing is we get really good body training at my instution.

 

[cecumbowels]

Unfortunately (or fortunately if you are looking at it from a point of job security), PP + any sub-specialty will likely not be chill/laid-back due to rad shortage, increasing volumes, increasing case complexity, and increasing demands from specialists asking for sub-specialty reads. In PP you will be reading outside your sub-specialty for a significant amount of time. I suppose picking one which gives you the broadest general skill set (?neuro or body) may make sense. However while most rads can read basic neuro MR, the same is not true for body or MSK. Also if you have any interest in procedures, this would also be a factor (more light IR in body than neuro/MSK). Can't really comment on NM. I think at the end of the day its a leap of faith and there is no right/wrong (at least prospectively!)

Yeah honestly the volumes scare me the most about private practice. LIke I have head stores of people averaging 100-150 studies per work day. That honestly just sounds like a grind. Many people will will counter and say that the cases in private practice are relatively easier and you get through them faster. However, hypothetically speaking if you are reading 50 body CTs in a day that is approximately 10 minutes per study in an 8 hour work day without taking any breaks.

 

[vm26]

Yeah honestly the volumes scare me the most about private practice. LIke I have head stores of people averaging 100-150 studies per work day. That honestly just sounds like a grind. Many people will will counter and say that the cases in private practice are relatively easier and you get through them faster. However, hypothetically speaking if you are reading 50 body CTs in a day that is approximately 10 minutes per study in an 8 hour work day without taking any breaks.

I was considered a slow resident and am able to keep up in a semi-busy PP so I wouldn't get too concerned. You will adapt. Case complexity in PP is variable. I used to work community semi-rural hospital which was pretty tame as anything mildly complex would get shipped out (trade off was wide skill-set needed: light IR, breast, read most types of modalities etc). Now at level 1 trauma and stroke center so cases can get complex but again you figure things out...On a side note 50 body CTs would yield about 85-90 wRVUs for the shift which I would guesstimate is >95th% or so for PP volume.

 

[GadRads]

I was considered a slow resident and am able to keep up in a semi-busy PP so I wouldn't get too concerned. You will adapt. Case complexity in PP is variable. I used to work community semi-rural hospital which was pretty tame as anything mildly complex would get shipped out (trade off was wide skill-set needed: light IR, breast, read most types of modalities etc). Now at level 1 trauma and stroke center so cases can get complex but again you figure things out...On a side note 50 body CTs would yield about 85-90 wRVUs for the shift which I would guesstimate is >95th% or so for PP volume.

Agree. 50 body CTs is a ton. If the majority are complex, it is difficult to read that volume properly in 8 hrs.

 

[guytakingboards]

Yeah honestly the volumes scare me the most about private practice. LIke I have head stores of people averaging 100-150 studies per work day. That honestly just sounds like a grind. Many people will will counter and say that the cases in private practice are relatively easier and you get through them faster. However, hypothetically speaking if you are reading 50 body CTs in a day that is approximately 10 minutes per study in an 8 hour work day without taking any breaks.

50 body CT's is a lot no matter where you go. I doubt there's many groups where people read 50 body CT's per day shift consistently.

PP definitely benefits from a faster resident/reader but 100-150 studies isn't crazy depending on the case mix and case complexity. Particularly just hitting 100 studies.

That day could look like 25-35 CT, 10 MRI, 15-20 US and 30-40 PF's.

If you've taken call before you know its not uncommon to get a trauma pan scan with 5-8 CT's and maybe a few entire extremity PF's (e.g. hip/femur/knee/tibfib/ankle/foot). In the community setting, those are usually negative or have mono-pathology.

It's also not difficult to get a bunch of negative neuro CT which is easy to fly through.

It's all intimidating until you realize how many studies in the community are negative and what level read is expected. Most of my partners on MSK PF's limit it to "no fracture or dislocation" for findings and impression.

 

[Neopolymath]

My partners on MSK PF's limit it to "no fracture or dislocation" for findings and impression.

Wow. No mention of the calcaneal enthesophyte?! Tsk tsk.

 

[GoPelicans]

I am doing an MSK fellowship currently. I wasn't really super passionate about anything and I would've skipped fellowship altogether if I felt I could've gotten away with it. My fellowship is about half procedures which I think has been a nice change from just sitting in the reading room all day every day. At worst it is helping the year go by faster.

 

[yungspleen]

I am doing an MSK fellowship currently. I wasn't really super passionate about anything and I would've skipped fellowship altogether if I felt I could've gotten away with it. My fellowship is about half procedures which I think has been a nice change from just sitting in the reading room all day every day. At worst it is helping the year go by faster.

Can I ask why you didn't feel you could've gotten away with not doing a fellowship?

 

[MadRadLad]

Can I ask why you didn't feel you could've gotten away with not doing a fellowship?

Can't speak for the person you asked specifically, but competitive markets/groups that are more subspecialized will usually require fellowship because of some combination of their referrers, branding, and having enough applicants that they can get away with it. The more rural or smaller PP you go, the less a fellowship will be required. When the job market tightens, people without a fellowship will be hit the hardest unless they have some other skillset (admin, list crusher, good schmoozer etc) and have good relations with group leadership.

Fellowship isn't mandatory, but it does decrease your options and the jobs available to you. For some people this doesn't and will never matter. For some, it limits their career trajectory and what they want to do in a day-to-day setting. And once you're a real attending making money, hard to go back. Best middle ground is to do a chill fellowship where you can moonlight on the side for a PP, you can make 200k+ and still get your certificate.

 

[Warped Apostle]

Wow. No mention of the calcaneal enthesophyte?! Tsk tsk.

I literally made the call while on call last night....lol

 

[redoitall]

Can I ask why you didn't feel you could've gotten away with not doing a fellowship?

I personally felt I could, and I didn't go through fellowship. I was hired by a small PP in a rural setting during third year with a nice stipend. I made the decision to skip fellowship a few days before list were due. I felt that psychologically it was too much to ask. Tired of the BS, along with the lifestyle at the time, which was essentially ratrace, big city, traffic, hours a day on the road and so one.
There a plenty of jobs out there even without fellowship.

Can't speak for the person you asked specifically, but competitive markets/groups that are more subspecialized will usually require fellowship because of some combination of their referrers, branding, and having enough applicants that they can get away with it. The more rural or smaller PP you go, the less a fellowship will be required. When the job market tightens, people without a fellowship will be hit the hardest unless they have some other skillset (admin, list crusher, good schmoozer etc) and have good relations with group leadership.

Fellowship isn't mandatory, but it does decrease your options and the jobs available to you. For some people this doesn't and will never matter. For some, it limits their career trajectory and what they want to do in a day-to-day setting. And once you're a real attending making money, hard to go back. Best middle ground is to do a chill fellowship where you can moonlight on the side for a PP, you can make 200k+ and still get your certificate.

I think poster above is spot on.
Before doing a fellowship one needs to know how one sees his/her career. I personally believe that doing a fellowship because everybody is doing one is the wrong answer. Location, setting, type of job you want etc... are very important. Many elect to do teleradiology and salaries I am hearing are absolutely insane in the field. No fellowship required.

I will simply add a few things:
- The notion that a fellowship protects you in a rough market may be true, but I would say that it would depend to the same extent that a fellowship may be needed to find a job or not. Perhaps in the biggest groups and most desirable locations. The market has been excellent for rads the last few years, and I am not seeing any slowdown anytime soon. In fact the market continues to be more favorable to rads. That does not mean that this will continue. Also keep in mind that because of the market, you are more likely to become more and more a generalist who will read more outside of his/her specialty than the other way around. In my opinion, you are likely to be more interesting to a group if you have well rounded skills, with nuc/mammo and procedures. Just an opinion without numbers/facts to back this up. At least it is the case in my group (but this is because of our setting).
- Doing a fellowship is a serious financial cost as well (in my case it would have resulted in 450K of lost income in todays money, more if you invest it obviously). Is it worth it?
- One of my partner is a generalist with a lot of experience. He is a specialist in absolutely everything including IR. Not kidding, by far the best radiologist I have ever worked with. Absolutely crazy.
- Today I am a partner in my group, while my co-residents who did a fellowship are starting their attending position, as associates. Not doing a fellowship was the best decision I could have made. At least in my own case and for now. This would not be true for everyone, but I believe many who do one end up in a situation where they could have ended up without a fellowship.

The one major issue I have had with not doing a fellowship is the certification exam that I just took last month. A fellowship is a tremendous benefit is passing the exam. I did not do too well but I will find out soon enough. It is not that big of a deal as it can be retaken multiple times. But still, to have acquired skills in a particular field is definitely a big plus to pass it. Again, not worth 1 year of my life and certainly not 450K.

Whatever you decide, I wish you the best of luck.

 

[Tiger100]

I personally felt I could, and I didn't go through fellowship. I was hired by a small PP in a rural setting during third year with a nice stipend. I made the decision to skip fellowship a few days before list were due. I felt that psychologically it was too much to ask. Tired of the BS, along with the lifestyle at the time, which was essentially ratrace, big city, traffic, hours a day on the road and so one.
There a plenty of jobs out there even without fellowship.


I think poster above is spot on.
Before doing a fellowship one needs to know how one sees his/her career. I personally believe that doing a fellowship because everybody is doing one is the wrong answer. Location, setting, type of job you want etc... are very important. Many elect to do teleradiology and salaries I am hearing are absolutely insane in the field. No fellowship required.

I will simply add a few things:
- The notion that a fellowship protects you in a rough market may be true, but I would say that it would depend to the same extent that a fellowship may be needed to find a job or not. Perhaps in the biggest groups and most desirable locations. The market has been excellent for rads the last few years, and I am not seeing any slowdown anytime soon. In fact the market continues to be more favorable to rads. That does not mean that this will continue. Also keep in mind that because of the market, you are more likely to become more and more a generalist who will read more outside of his/her specialty than the other way around. In my opinion, you are likely to be more interesting to a group if you have well rounded skills, with nuc/mammo and procedures. Just an opinion without numbers/facts to back this up. At least it is the case in my group (but this is because of our setting).
- Doing a fellowship is a serious financial cost as well (in my case it would have resulted in 450K of lost income in todays money, more if you invest it obviously). Is it worth it?
- One of my partner is a generalist with a lot of experience. He is a specialist in absolutely everything including IR. Not kidding, by far the best radiologist I have ever worked with. Absolutely crazy.
- Today I am a partner in my group, while my co-residents who did a fellowship are starting their attending position, as associates. Not doing a fellowship was the best decision I could have made. At least in my own case and for now. This would not be true for everyone, but I believe many who do one end up in a situation where they could have ended up without a fellowship.

The one major issue I have had with not doing a fellowship is the certification exam that I just took last month. A fellowship is a tremendous benefit is passing the exam. I did not do too well but I will find out soon enough. It is not that big of a deal as it can be retaken multiple times. But still, to have acquired skills in a particular field is definitely a big plus to pass it. Again, not worth 1 year of my life and certainly not 450K.

Whatever you decide, I wish you the best of luck.

I agree with some of your points.

But one thing to consider. If you are fellowship trained, you will become someone whom the group depends on your "quality of work" for certain things which can be breast MRI biopsy or MSK protocols or MRI Prostate or may just be marketing to the oncologists, neurosurgeons or urologists. But without fellowship the group depends on "your quantity" of work.

Now, saying that you know one radiologist who did not do fellowship but reads MSK better than all fellowship trained MSKs may be a correct statement but is an exception that can not be generalized. For the most part, fellowship trained radiologists read and protocol studies better than non-fellowship trained ones. More importantly they say "perception is reality".

In other words, for the rest of your career THEY always see you as jack of all trades master of none. If you don't care, that is fine. When the politics is low, you will be fine. When the politics is high or when the market is tight, you will have your own challenges. So don't get surprised that if the fellowship trained body imager misses a small pancreatic head mass on MRI, they attribute it to motion artifact but if you miss it, they may say you missed it because you did not have enough training. Or you may read a lot of MSK MRIs for 6 years in your group but after 6 years they want you to stop reading them because the new hire of the group has done an MSK fellowship and wants more percentage of MSK MR.

 

[redoitall]

Tiger
I do agree with you as well on the points you make.
And you are on the money when you speak of being a jack of all trades master of none. This is my personal goal. I chose the appropriate setting for this. It all worked out for me. It could have not worked out. But it did.

I would just reiterate that many would say that a fellowship is mandatory. I do not think it is the case. Each residents needs to know the pluses and minuses of both options, and understand the implications of whatever choice.

To all of you who are undecided, If you happen to read this thread, I do wish you all the success you deserve.

 

[scootad.]

Bottomline, its probably fine for the right person in the short term. Long term though (if you want to change jobs down the road in 5-10 years, no longer want to do telerads, if the job market tanks, etc), it may limit your opportunities.

 

[MadRadLad]

I agree with some of your points.

But one thing to consider. If you are fellowship trained, you will become someone whom the group depends on your "quality of work" for certain things which can be breast MRI biopsy or MSK protocols or MRI Prostate or may just be marketing to the oncologists, neurosurgeons or urologists. But without fellowship the group depends on "your quantity" of work.

Now, saying that you know one radiologist who did not do fellowship but reads MSK better than all fellowship trained MSKs may be a correct statement but is an exception that can not be generalized. For the most part, fellowship trained radiologists read and protocol studies better than non-fellowship trained ones. More importantly they say "perception is reality".

In other words, for the rest of your career THEY always see you as jack of all trades master of none. If you don't care, that is fine. When the politics is low, you will be fine. When the politics is high or when the market is tight, you will have your own challenges. So don't get surprised that if the fellowship trained body imager misses a small pancreatic head mass on MRI, they attribute it to motion artifact but if you miss it, they may say you missed it because you did not have enough training. Or you may read a lot of MSK MRIs for 6 years in your group but after 6 years they want you to stop reading them because the new hire of the group has done an MSK fellowship and wants more percentage of MSK MR.

My god you're so correct in that last paragraph. I know some extremely good rads who weren't fellowship trained (or had a different fellowship) that had to drop reading MSK/neuro MRI even though they were very experienced and good. Ortho and neurosurg wanted fellowship trained reads exclusively as a point of marketing for their own clinics.

The politics angle holds true as well. As a fellowship trained rad you are part of that subspecialty group in a bigger practice. As a generalist you are sometimes without a home from that political angle, as you are not as tied into any of them and it can cause some issues if you are not as socially integrated.

Lots of exceptions here of course. @redoitall is definitely correct that fellowship is not mandatory, especially in this job market, if you are willing to be a jack of all trades and work in smaller groups, more rural practices, etc.

 

[guytakingboards]

Great posts from Tiger and MadRadLad. Agree with both of them.

 

[vm26]

Great posts from Tiger and MadRadLad. Agree with both of them.

Unless you are academics or in a mega-PP (eg. >50 rads) you will have to be both sub-specialist and generalist. You will have to be productive/efficient in both scenarios in PP.

I would recommend fellowship. Job market will eventually change and despite the rad shortage, referring physicians are asking for sub-specialist's reads. Breadth/depth of knowledge required in our field is ridiculous I could not function with internet resources)...past few days I've read prostate MR, other body MR such as enterography/female pelvis, CTA/CT perfusion, all sorts of neuro-MR, US renal transplant, pan-scan CT poly-trauma from ER, screening tomo, and performed GI fluoroscopy. Others in my group ( around 30) have broader range but these guys are seasoned/old school. Interesting times in our field.

 

[Neopolymath]

Unless you are academics or in a mega-PP (eg. >50 rads) you will have to be both sub-specialist and generalist. You will have to be productive/efficient in both scenarios in PP.

I would recommend fellowship. Job market will eventually change and despite the rad shortage, referring physicians are asking for sub-specialist's reads. Breadth/depth of knowledge required in our field is ridiculous I could not function with internet resources)...past few days I've read prostate MR, other body MR such as enterography/female pelvis, CTA/CT perfusion, all sorts of neuro-MR, US renal transplant, pan-scan CT poly-trauma from ER, screening tomo, and performed GI fluoroscopy. Others in my group ( around 30) have broader range but these guys are seasoned/old school. Interesting times in our field.

How many rads in your group?

 

[vm26]

How many rads in your group?

Around 35