Intern year, doubting radiology

[AndM17]

I matched into radiology last year but as I am going through my intern year I find that I enjoy medicine more than I expected. Obviously there are challenging times but I truly find myself deriving a lot of meaning from my work both inpatient and outpatient. More and more, I feel like I may not be able to give up on face to face encounters with my patients when it comes time to start my first year of radiology.

I was between radiology and internal medicine during medical school, and while my "passion" probably leaned toward internal medicine (esp a sub-specialty) I also did like my radiology rotations. I ultimately went against IM because some of the residents seemed unhappy and family members who were in IM (with experience in primary care, hospital medicine, and nephrology) said it was a terrible field that was thankless, underpaid, and heading down hill.

During my regular meeting with my current program director, I brought this up and they explained that it would be difficult to obtain a match waiver this late but that I would have plenty of opportunities to switch out if I started in radiology but found out it was not meant for me. This seemed fair to me; since my experience as an intern made me rethink my choices, maybe my experience as a radiology resident will be better (or worse) than that of a medical student in a radiology rotation and enlighten me even more. That being said, I am often regretful and wish I had just applied to IM straight out of medical school.

The questions I have for SDN is

1) Is it common to feel this way? Do many residents who stayed in radiology have doubts, or is it a sign I will probably end up switching out?

2) Is switching out as feasible as my PD made it sound? Do you know of any radiology residents who successfully switched out? From what I understand, applying as anything other than a senior medical student is a handicap.

If a similar situation has come up before in these forums, you can direct me to the post; I couldn't find any recent ones, though.

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[redoitall]

Dude as an intern I loved medicine, even the ICU. But in the end the amount of BS, the paperwork and all the social issues to deal with became overwhelming. The hours suck, the workload is terrible. Not that I don't like working, but the majority of my time was not medicine but writing notes, orders, dealing with paperwork...
I would have double boarded if it made any sense, but this would have been a waste of time.
Let me tell you that now, I am in love with rads. I am busy all the time, but time flies. There is a lot to learn and this is a bit of a "bummer". At the end of my intern year I felt pretty comfortable. Now in radiology, every month, I am clueless. Feeling as a new intern every month. That said, I am truly happy and I enjoy radiology so much.
You will find that more people switch into rad from other specialties, than out of it. Switching is always possible, and I think your chances are best staying in your current program. I remember my IM attendings keeping telling me that I should switch. It was an excellent feeling. And even now, I enjoy seeing them and saying hi. As long as you have good relations in IM, I am sure people will help you transition if this is your wish and I don't think you would have any majeure issue switching in IM (particularly if you are flexible geographically).
But what I did or what others do is irrelevant. I really enjoy rad, the only factor that perhaps could have tipped things the other way is length of training. But again, if you plan on doing a IM specialty then it is a moot point. Training for 3 years in IM and landing a hospitalist job 1 week on 1 week off at a decent pay is no bad deal.
I am very happy where I am now. All that matters is that you are happy as well. If it's IM, then it's IM. Just talk to second and third year residents to see how they feel about their choices, or hospitalists and discuss it with your PD.

 

[GadRads]

I echo the sentiments of @redoitall.

I would say the worst things about radiology are:

1) The volume of information to know, which is largely interesting, but still a lot. It is definitely impossible to know all of it, even if you read 24/7.

2) Call is super busy, non-stop and mentally tiring. Some images are suboptimal, some studies can be quite difficult to read, and the next study may be beyond the boundaries of your expertise. Your misses are also documented. Phone calls are also quite distracting when radiology requires constant focus and mental concentration for a 12 hr call shift. l believe many clinicians feel we just sit there and sip lattes with frequent restroom breaks, when in fact, we are times at reading at speeds that some people would consider dangerous.

3) Poor and at times horrible study indications from referrers.

There are probably more negatives. But overall, radiology still beats IM in my own opinion, since non-medicine type work is as minimal as possible.

At the end of the day, you have to do what you enjoy, assuming you can tolerate the most annoying things about that specialty.

 

[scootad.]

Re IM: It’s one thing to enjoy the intellectual challenge of making diagnoses based on patients history/physical exam/lab tests. It’s quite another to not be discouraged by non-complaint patients or patients with unreasonable expectations/demands, of which there are many.

During my IM rotation, I found many of those patient encounters draining and not at all enjoyable.

Only you can answer whether the 6 out of every 10 annoying patients don’t outweigh the 4 out of 10 patients who are reasonable.

The beauty about Rads is the computer doesn’t talk back. And those time limited patient interactions during procedures are a breeze, in comparison.

 

[Cognovi]

A typical way to switch out is after doing a year at the advanced program and then returning to a PGY-2 position in the program of your intern year if the medicine program allows you. Because you would start as PGY-2 in a specialty that is accredited only to start at PGY-1, this is arranged outside the Match (ie, not subject to the All-In Policy) and is contingent on your program being able to create a position (financially and administratively). Such an arrangement would be made formally after you have completed 45 days of the advanced program (beyond which you do not require a NRMP waiver to quit your program). Don't make a move before 45 days because you risk getting blackballed with a flag on your NRMP profile, which may come up when you apply for fellowships in the Match in the following year.

If you don't want to do the same program you did intern year, you will probably have to enter the Match again, which means re-doing intern year. I have not heard of a categorical medicine program letting someone in as PGY-2 who did their intern year elsewhere; I think it is administratively difficult in terms of accreditation/certification/licensure or something.

 

[AndM17]

The common thread of @redoitall and @scootad are the frustrations of doing the "non medical" work of IM. One of the reasons I was doubting radiology is that I am finding the social side on IM to be less annoying than I thought it would be. I agree each specialty has its own advantages and disadvantages and it is ultimately a personal choice. Overall it is reassuring to know that many radiologists did like medicine and did enjoy their intern year.

@Cognovi I agree you should never do anything that would be considered a Match violation.

You will find that more people switch into rad from other specialties, than out of it.

I have heard this a lot before but as far as I know there is no meaningful data on "switchers". I have tried to research this but there are no recent studies or registries that measured the frequency with which residents switch.

Thank you for your input.

 

[radsisrad]

This is really up to you, all said and done. I used to think that I'd have gone for Rads even if it paid the same as IM, but when I see how commoditized and cannibalized the field is becoming, I'm much more disillusioned with radiology. IM isn't very intellectually demanding (with the exception of Heme/Onc, IMO), but it's much more emotionally fulfilling than plowing through study after study with the knowledge that senior partners or MBAs are scooping up income you're bringing in.

 

[patel1283]

From my R1 perspective,

I wasn't so sure about radiology when I applied but I am really glad I did it now that I'm 5 months in. I would just give it a chance and if you don't like it then consider switching back to IM. There's also other routes you can take after doing a diagnostic radiology residency that has more patient contact (IR, neuro IR, breast, palliative, and pain medicine).

ABR

 

[AndM17]

There's also other routes you can take after doing a diagnostic radiology residency that has more patient contact (IR, neuro IR, breast, palliative, and pain medicine).

Interesting, I have never heard of palliative care or pain medicine but I'm not sure if there are any real opportunities there for DR graduates in those fields. If you read the ABR website the accreditation are managed by other boards (Anesthesiology in the case or pain medicine, internal medicine in the case of palliative care); while qualifying DR graduates can apply they are listed as sub-specialties of radiation oncology. I haven't really heard on diagnostic radiologists in any of those fields.

Also note the VIR fellowship will be phased out and replaced with a two year IR residency. It remains to be seen how many of these will exist.

 

[Cognovi]

It's highly unusual but does exist.

"To obtain a subspecialty certification in hospice and palliative medicine, a radiologist needs certification by the ABR, an unrestricted medical license, 2 years of subspecialty training in hospice and palliative medicine, 100 hours of interdisciplinary hospice and palliative medicine team participation, active care of 50 terminally ill adult patients, and successful performance on the certification examination." An Error Occurred Setting Your User Cookie

Examples:
Sean Tutton, MD, FSIR | Medical College of Wisconsin
Robert A Hieb, MD, RVT, FSIR | Medical College of Wisconsin

 

[TCOM12]

I know of one person who switched from radiology to IM. He did half a year of R1 and didn't like it as much as he thought he would, found an open spot (or funding opened up, I can't remember) at the same institution he matched for radiology (different than his intern) and graduated 3 months late. He got an attending job at the place he did intern year. All in all, it worked out.

Most radiologists like patients. We just found a different way to care for people. As others have alluded to, a lot of IM and IM subspecialty burnout doesn't come from the medicine, it comes from the paperwork and endless social work involved.

And as nice as hospitalist life sounds, its feasible for 3-5 years of life for most (much like night time teleradiology).

Oh and R1 (and probably R2) year will be like beating your head against a wall because you'll feel like you're dumb most days. But once you gain confidence in yourself and the confidence of your peers (referrers, not fellow radiologists), the job is pretty easy.

Make the right choice (radiology).

Kidding... do what makes you happy. Don't break ACGME rules and switch when your contract allows. You're still young in the game and haven't seen how much life happens in medicine... switching residencies, taking a year off, getting fired, probation, etc etc. So if you decide to switch, life will likely work out fine.

 

[DOFOSHO]

More and more, I feel like I may not be able to give up on face to face encounters with my patients

You will lose the interaction that you have with patients as a clinician but that will be replaced with a huge impact that you have on many more patients' care as a radiologist. In my experience this has been way more rewarding.

 

[WeAreNotRobots]

You will lose the interaction that you have with patients as a clinician but that will be replaced with a huge impact that you have on many more patients' care as a radiologist. In my experience this has been way more rewarding.

another thing to consider: all medicine aside...on a fundamental level...are you more intrinsically or extrinsically motivated? at this stage in your life, you should have a solid handle on what drives you and how you derive self-worth. at the risk of over-generalizing, i’d say, in general, those driven more by intrinsic motivation are better suited for radiology. throughout my medical training (n=1 i know), i’ve found that the more “boring/lame” someone thinks radiology is, the more they are externally motivated. clinical medicine probably better suits those who are more externally motivated.

 

[JoshSt]

Also note the VIR fellowship will be phased out and replaced with a two year IR residency. It remains to be seen how many of these will exist.

Just FYI, unless the program you matched into does not have ESIR, you still finish in the same period of time if you matched into DR and your program has an ESIR program. It's still 6 years 1+4+1 years except you do nearly all IR in R4 (so 1+3+1+1). The only difference between IR residency and ESIR is that with ESIR you're not necessarily guaranteed the 1 year IR 'fellowship'/2nd year of residency. The 2-year independent residency will be for those that did not do ESIR.

All that being said, please give rads a chance. I absolutely loved patient contact and similarly had thoughts of switching out of rads during intern year and I couldn't be happier that I stayed in radiology. Radiology is so great in so many ways, being involved in nearly all specialties of medicine and participating in a high number of patients' care.

 

[AndM17]

I agree that radiology can be rewarding; I don't think it is "boring/lame". I feel my doubts stem from a lack of experience in radiology and good experiences in IM. That is why I agreed with my PD and did not push for a last minute match waiver. @WeAreNotRobots you make an interesting point about motivation I remember somewhere radiologists are more likely to self report being introverts (although I pretty sure it was a low quality study, like a MedScape poll). @JoshSt true IR has more patient contact and it is a field I can explore more; although the IR attending I met in med school was very much about it being a separate specialty and the independent residency being phased out this is not a universal opinion. Again, thanks for everyone's replies.

Thinking about this I feel that a large part of my regrets stem from my decision being driven by fear of burnout in IM; that is I would have likely gone into IM if I had not met several people who seemed unhappy in the field. During medical school, I felt that radiology was a good field, one that was very broad and intellectually stimulating and where I did not meet any unhappy physicians so I applied likewise and I will see if I want to continue in it.

The problem is that burnout in medicine is a complex interaction of personal and workplace factors (that is why duty hours, workplace yoga, mental health outreach, etc are not the answers in my opinion). You don't know if it will happen to you until you try.

 

[Radology]

You can justify it however you want. But no matter what, your decision is an uninformed one because You’ve never spent a day as a radiology resident. You shut that door, it’s not opening again. I’d personally wait until you start radiology, otherwise you’ll spend the rest of your life second guessing the decision (even if it ultimately is the correct one)

 

[CherryRedDracul]

I enjoyed IM during my intern (but hated the BS and paperwork that came along with it). I tolerated the social work aspect of it, but I did enjoy palliative discussions and working with a patient to come up with a treatment plan.

In my first week of radiology, I was hit with a pang of doubt as I wasn't seeing patients--as frequently--as I was before. I started to miss that and wondered, "Did I make a huge mistake?"

Fast forward to several months into radiology and I'm glad I'm not in IM. I see just enough patients on certain rotations to keep myself satisfied. With that said, if it wasn't radiology, it would have been pulmonary/critical care as I still get a hard-on for critical care medicine.

 

[AndM17]

You can justify it however you want. But no matter what, your decision is an uninformed one because You’ve never spent a day as a radiology resident. You shut that door, it’s not opening again. I’d personally wait until you start radiology, otherwise you’ll spend the rest of your life second guessing the decision (even if it ultimately is the correct one)

Agree, that is why I said that I will start my intern year and see how it goes (as opposed to using a match waiver and never starting radiology). It may just be that I will find something I love in radiology, similar to how I found my intern year to be more enjoyable than I thought.

 

[AndM17]

Thank you for your input. To try and help other people reading this, I will try and summarize what I think are the main points (both from comments and personal discussions).
1) Not all residents who enjoyed prelim year and had doubts about radiology end up disliking the field.
2) If you are a medical student choose your field carefully, don't let fear or what others might think govern your decision.
3) Changing specialties is doable, and is not stigmatized. There are multiple pathways for residents with an advanced (PGY2) position. Your PD is the best resource for navigating these. The major decision you would need to make in that situation is whether to return to the Match or to seek a position outside the Match.

 

[Fbdags144]

I matched into radiology last year but as I am going through my intern year I find that I enjoy medicine more than I expected. Obviously there are challenging times but I truly find myself deriving a lot of meaning from my work both inpatient and outpatient. More and more, I feel like I may not be able to give up on face to face encounters with my patients when it comes time to start my first year of radiology.

I was between radiology and internal medicine during medical school, and while my "passion" probably leaned toward internal medicine (esp a sub-specialty) I also did like my radiology rotations. I ultimately went against IM because some of the residents seemed unhappy and family members who were in IM (with experience in primary care, hospital medicine, and nephrology) said it was a terrible field that was thankless, underpaid, and heading down hill.

During my regular meeting with my current program director, I brought this up and they explained that it would be difficult to obtain a match waiver this late but that I would have plenty of opportunities to switch out if I started in radiology but found out it was not meant for me. This seemed fair to me; since my experience as an intern made me rethink my choices, maybe my experience as a radiology resident will be better (or worse) than that of a medical student in a radiology rotation and enlighten me even more. That being said, I am often regretful and wish I had just applied to IM straight out of medical school.

The questions I have for SDN is

1) Is it common to feel this way? Do many residents who stayed in radiology have doubts, or is it a sign I will probably end up switching out?

2) Is switching out as feasible as my PD made it sound? Do you know of any radiology residents who successfully switched out? From what I understand, applying as anything other than a senior medical student is a handicap.

If a similar situation has come up before in these forums, you can direct me to the post; I couldn't find any recent ones, though.

let me give u some advice...as someone who has been trying to switch out of rads its actually quite difficult if you want a decent university program in a loosely geographical area (northeast and california for me - as I have family in both. my family is transitioning to the west coast). there were very few spots this year for IM to transfer to. the best chance you will have to switch is either 1) your intern year program will take you back or 2) your PD in rads will be supportive enough to help you get a spot in your rads institution if a spot opens. You can DEFINITELY get a spot to transfer but just remember it will more likely than not be a downgrade to a community program. let me know if you have any Q's. I was unlucky enough that my rads PD would not write a LOR as he doesn't want me to leave.

 

[IRrads10]

let me give u some advice...as someone who has been trying to switch out of rads its actually quite difficult if you want a decent university program in a loosely geographical area (northeast and california for me - as I have family in both. my family is transitioning to the west coast). there were very few spots this year for IM to transfer to. the best chance you will have to switch is either 1) your intern year program will take you back or 2) your PD in rads will be supportive enough to help you get a spot in your rads institution if a spot opens. You can DEFINITELY get a spot to transfer but just remember it will more likely than not be a downgrade to a community program. let me know if you have any Q's. I was unlucky enough that my rads PD would not write a LOR as he doesn't want me to leave.

what has left you dissatisfied with rads as a career choice? not a good fit? or is there another field you now realized better suits your skill set and interests?

 

[Fbdags144]

what has left you dissatisfied with rads as a career choice? not a good fit? or is there another field you now realized better suits your skill set and interests?

hey! i just dont think its a good fit. i dont like being in the dark for such an extended amount of time. when i was in med school, it was more social as several of us would rotate in rads together so being in the dark wasnt too shabby. but now being alone in that dark room.....its just not for me. i also really miss the teamwork and camaraderie of IM.

 

[AndM17]

@Fbdags144 sorry to hear about your experience, especially with your PD. From a PD's perspective, what would they have to gain by forcing a resident to stay on in field they dislike? My understanding is that a dissatisfied resident can be worse than no resident. Maybe things have changed and it has become harder to switch specialties, or maybe fewer residents are leaving IM. Is the culture in IM less open to "switchers" than radiology? If any of these are true this is disheartening because residents can have a bona fide change of heart about specialty choice and feel there should be opportunities to switch.

If you are looking for empty IM spots (which I assume based on the way you worded your post) perhaps more will pop up as time goes on (due to residents switching out, dropping out or taking leaves of absence). I wish you the best.

You make a good point about the large difference between academic versus community programs in IM, a wider gulf than there is in radiology. Being at an academic program would open up opportunities in academic medicine and fellowship opportunities in IM. Perhaps returning to the Match can offer more choices in terms of location and program type, although that would mean restarting as a PGY-1.

I guess at the end of the day the question everyone has to ask themselves "What sacrifice am I willing to make to switch?" The sacrifice may mean repeating intern year, moving away from your family, or going to a less prestigious program.