integrated IR/DR programs

[giguerex35]

had a couple questions about integrated IR/DR programs was hoping to find the answer to

are the integrated IR/DR programs all considered to be under the IR umbrella, because from the research of programs I have done it seems that most basically consider them IR programs with DR also included (rather than the opposite)

do these integrated programs require a TY?

how friendly are these programs to DOs?

just how competitive are the integrated programs compared to regular IR, I am a DO with step 1 = 245 and level 1 = 616, haven't taken step 2 yet, supposed to be starting radiology research in the upcoming weeks. Am i still in the running for integrated programs and any other advice would be recommended.

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[Cognovi]

are the integrated IR/DR programs all considered to be under the IR umbrella, because from the research of programs I have done it seems that most basically consider them IR programs with DR also included (rather than the opposite)

What do you mean by that?

It's 3 years of DR and 2 years of IR.
It's in a department of radiology, which includes both diagnostic and interventional radiology.
The PD of the DR program must be the APD of the IR/DR program.
You have to take the board certification tests for DR.
There is no IR "umbrella." IR is under the radiology umbrella.
IR/DR programs are just DR programs plus a fellowship you're locked into ahead of time.
IR/DR may advertise themselves as IR programs in writing or colloquially because they are trying to capture this sense of identity and commitment in the medical students ahead of time. This helps prevent people from dropping out during their DR years.

 

[giguerex35]

What do you mean by that?

It's 3 years of DR and 2 years of IR.
It's in a department of radiology, which includes both diagnostic and interventional radiology.
The PD of the DR program must be the APD of the IR/DR program.
You have to take the board certification tests for DR.
There is no IR "umbrella." IR is under the radiology umbrella.
IR/DR programs are just DR programs plus a fellowship you're locked into ahead of time.
IR/DR may advertise themselves as IR programs in writing or colloquially because they are trying to capture this sense of identity and commitment in the medical students ahead of time. This helps prevent people from dropping out during their DR years.

what i was getting at was what you mentioned in the last 2 sentences, in that programs advertise themselves as an IR program in writing (rather than DR even though it is both). I also asked it in the way I did because I was unsure of whether the match data for the integrated DR/IR programs would be included under IR or DR because there is no data for the IR/DR programs only that I know of at least.

 

[NDcienporciento100]

what i was getting at was what you mentioned in the last 2 sentences, in that programs advertise themselves as an IR program in writing (rather than DR even though it is both). I also asked it in the way I did because I was unsure of whether the match data for the integrated DR/IR programs would be included under IR or DR because there is no data for the IR/DR programs only that I know of at least.

So the first reply is mostly right. Some IR departments however are completely separate from DR for example University of Miami IR is as separate from DR as they are from Internal Medicine. Most places IR and DR are considered the same department but not all. In either case it doesn’t really matter that much. Yes the Integrated programs require an internship. The idea that SIR developed the IR Integrated Residence program to prevent people from dropping out is laughable and a theory I have heard many times. SIR developed an integrated Residency to capture a deferent type of candidate one that might normally go after Interventional Cards or GI in other words people that really want to perform high end procedures. Before the IR Integrated Residency people from DR would just stumble into IR. SIR felt that by doing an Integrated IR residence the core of IR would be overall stronger in the long run. I am an Integrated IR resident and can tell you I and my co residents have zero desire to back out of IR and go into DR. If anything we want to spend as much time in IR as possible. I personally don’t know a IR resident that regrets going IR and wants to switch to DR (Im Sure it’s happened somewhere but certainly not common). People that go into IR in general have a different mentality then DR colleagues. I highly respect my DR co-residents and attending’s. The DR we learn is essential to performing the wide range of procedures that we perform that truly does span from head to toe. Most of the first 3 years is dr with approximately 1-2 months a year of IR during that time depending on your program. When it comes to competitiveness look up the published data on the acgme regarding average scores etc. look up individual programs to see who the except. Good luck!

 

[Cognovi]

SIR developed an integrated Residency to capture a deferent type of candidate one that might normally go after Interventional Cards or GI in other words people that really want to perform high end procedures.

This characterization is better than the one I made. The commonality, however, is that the point of the integrated residency is primarily of marketing. SIR wants to manufacture a professional identity that medical students buy into from the start rather than one that develops during radiology residency. This attracts more surgical and procedurally minded students who otherwise would not have considered a pathway leading to IR because the idea of "radiology" didn't immediately strike their fancy (maybe too cerebral, passive, or disconnected from the smell of body fluids, who knows). The outward image and inward professional identity of "radiologist" are dominated by the diagnostic activities, for good reason: you spend more time training on the diagnostic side than the interventions, and there are many more diagnostic jobs than interventional jobs (with 100% interventional jobs being less common). This was problematic for the aspirations of IR to be a separate clinical field, so the marketing has to march ahead of the reality. All I'm saying is, med students considering IR should really think about whether they tolerate or like diagnostic radiology because it is an inseparable part of the training and typical career of an IR.

 

[Cognovi]

I was unsure of whether the match data for the integrated DR/IR programs would be included under IR or DR because there is no data for the IR/DR programs only that I know of at least.

Ah yes, where the marketing gets confusing. The "IR/DR" nomenclature came from the ABMS (and its subservient board the ABR), who when deciding to make this a primary specialty (rather than a subspecialty), called it Interventional Radiology and Diagnostic Radiology, probably to appease the radiology leaders who felt that detaching IR altogether would be too drastic for now. The "IR - Integrated" nomenclature has evolved in the ACGME sphere for accreditation purposes. There is a problem with the ACGME nomenclature though: because IR/DR is now a "primary specialty", an independent IR program is called a "residency" even though it has DR residency as a prerequisite. The NRMP is sane and uses the terms residency and fellowship in the colloquial sense (based on prerequisite training), not based on how ABMS defines specialties.

For the purposes of NRMP match data, the integrated IR residencies (ie, IR+DR) are called "Interventional Radiology" or "Interventional Radiology (Integrated)" in the Main Residency Match. The independent IR programs (ie, IR only but require prior DR residency) are called "residencies" by ABMS but are still considered equivalent to fellowships by the NRMP, so those data are included in the NRMP Specialties Matching Service (SMS).

To be clear:
The data on the NRMP reports on this webpage for the main residency match that are labeled Interventional Radiology pertain to what the ACGME calls integrated IR residencies: Main Residency Match Data and Reports - The Match, National Resident Matching Program

The data on the NRMP reports on this webpage for the fellowship specialties matching service that are labeled Interventional Radiology pertain to what the ACGME calls independent IR residencies: Fellowship Match Data and Reports - The Match, National Resident Matching Program

An integrated IR residency includes 3 years of DR residency. An independent IR residency requires the completion of a DR residency. Both require a non-radiology clinical year (internship).

Both pathways lead to eligibility to take the ABR's IR/DR Certifying Exam, which labels you in the eyes of the ABMS as board-certified in the specialty of "Interventional Radiology and Diagnostic Radiology". Both take the ABR's Core Exam, which is the same exam but called the DR Core Exam and the IR/DR Core Exam depending on your residency program.

 

[Cognovi]

do these integrated programs require a TY?

No, but I think your question reveals a misunderstanding.


A categorical program (starting PGY-1) includes a clinical year (PGY-1 internship).
An advanced program (starting PGY-2) requires a clinical year (PGY-1 internship).
A transitional year is a PGY-1 program spent in multiple specialties.
A preliminary year is a PGY-1 program spent in one specialty (medicine, surgery, or rarely pediatrics or ob/gyn).

The term "integrated" just pertains to the PGY-2 through PGY-6 levels. An integrated program can be either categorical or advanced.

Therefore, no, an integrated program does not necessarily require a TY. A categorical integrated program could INCLUDE a TY OR any other configuration of a clinical year (usually as PGY-1, usually mostly surgical), or it could REQUIRE EITHER a TY or preliminary year to be arranged separately. Because advanced programs match separately from PGY-1 programs, it would be difficult for an advanced program to require their applicants to only match to TYs.

 

[giguerex35]

Ah yes, where the marketing gets confusing. The "IR/DR" nomenclature came from the ABMS (and its subservient board the ABR), who when deciding to make this a primary specialty (rather than a subspecialty), called it Interventional Radiology and Diagnostic Radiology, probably to appease the radiology leaders who felt that detaching IR altogether would be too drastic for now. The "IR - Integrated" nomenclature has evolved in the ACGME sphere for accreditation purposes. There is a problem with the ACGME nomenclature though: because IR/DR is now a "primary specialty", an independent IR program is called a "residency" even though it has DR residency as a prerequisite. The NRMP is sane and uses the terms residency and fellowship in the colloquial sense (based on prerequisite training), not based on how ABMS defines specialties.

For the purposes of NRMP match data, the integrated IR residencies (ie, IR+DR) are called "Interventional Radiology" or "Interventional Radiology (Integrated)" in the Main Residency Match. The independent IR programs (ie, IR only but require prior DR residency) are called "residencies" by ABMS but are still considered equivalent to fellowships by the NRMP, so those data are included in the NRMP Specialties Matching Service (SMS).

To be clear:
The data on the NRMP reports on this webpage for the main residency match that are labeled Interventional Radiology pertain to what the ACGME calls integrated IR residencies: Main Residency Match Data and Reports - The Match, National Resident Matching Program

The data on the NRMP reports on this webpage for the fellowship specialties matching service that are labeled Interventional Radiology pertain to what the ACGME calls independent IR residencies: Fellowship Match Data and Reports - The Match, National Resident Matching Program

An integrated IR residency includes 3 years of DR residency. An independent IR residency requires the completion of a DR residency. Both require a non-radiology clinical year (internship).

Both pathways lead to eligibility to take the ABR's IR/DR Certifying Exam, which labels you in the eyes of the ABMS as board-certified in the specialty of "Interventional Radiology and Diagnostic Radiology". Both take the ABR's Core Exam, which is the same exam but called the DR Core Exam and the IR/DR Core Exam depending on your residency program.

you have been quite helpful as i was getting confused with the terminology you just explained. much appreciated

 

[NDcienporciento100]

you have been quite helpful as i was getting confused with the terminology you just explained. much appreciated

IR is extremely broad in terms of the types of procedures we can perform. Just as broad are the types of jobs out there. They range from drains, biopsy’s And lines plus 80% DR to high end PAD, IO, hepatobiliary, stroke, MSK interventions, trauma, 100% IR.

 

[pmcojm]

Therefore, no, an integrated program does not necessarily require a TY. A categorical integrated program could INCLUDE a TY OR any other configuration of a clinical year (usually as PGY-1, usually mostly surgical), or it could REQUIRE EITHER a TY or preliminary year to be arranged separately. Because advanced programs match separately from PGY-1 programs, it would be difficult for an advanced program to require their applicants to only match to TYs.

How is the clinical year "arranged separately"? Does the student have to "match" into both the PGY-2 program and a PGY-1 program?

 

[Cognovi]

How is the clinical year "arranged separately"? Does the student have to "match" into both the PGY-2 program and a PGY-1 program?

Yes, it is a match into both the PGY-2 program and PGY-1 program. When you enter your program preferences, you submit one rank list that contains your PGY-2 programs, and for each PGY-2 program you submit a supplemental rank list of PGY-1 programs. The NRMP first matches the PGY-2 program independent of your PGY-1 preferences, and then matches your PGY-1 preferences separately according to the supplemental rank list corresponding to that PGY-2 rank.

 

[pmcojm]

Yes, it is a match into both the PGY-2 program and PGY-1 program. When you enter your program preferences, you submit one rank list that contains your PGY-2 programs, and for each PGY-2 program you submit a supplemental rank list of PGY-1 programs. The NRMP first matches the PGY-2 program independent of your PGY-1 preferences, and then matches your PGY-1 preferences separately according to the supplemental rank list corresponding to that PGY-2 rank.

Thanks. That's very helpful. One more question. Are the matches into the PGY-1 programs separate from the matches into the regular four-year programs in each place? For example, is there a separate match into a PGY-1 surgery program or internal medicine program at, say, NYU, that is separate from the match into the regular four-year residency programs in those things?

Also, do you apply for and interview for PGY-1 spots separately?

 

[Cognovi]

Thanks. That's very helpful. One more question. Are the matches into the PGY-1 programs separate from the matches into the regular four-year programs in each place? For example, is there a separate match into a PGY-1 surgery program or internal medicine program at, say, NYU, that is separate from the match into the regular four-year residency programs in those things?

Also, do you apply for and interview for PGY-1 spots separately?

I think the answer to your first question is the same as my prior answer. The match into the PGY-1 surgery program should be put into the supplemental rank list, which is matched separately from your primary rank list. The primary rank list would include the four-year (PGY-2 start, 'advanced') program. If you included a PGY-1 prelim program in your primary rank list, it should go at the bottom because it would mean you did not match a PGY-2 (advanced) program and doing a prelim only is your backup.

You apply for PGY-1 spots separately. Usually but not always you interview for the PGY-1 spots separately.