Is IR the most competitive residency now?

[meister]

And if so, will IR residents mercilessly mock their DR brethren whilst wearing carefully fitted scrubs and leaded glasses? When can they start to make disparaging remarks about lesser specialties like derm or plastics? When will high school students start flooding this forum with questionable stories of how they've always wanted to be an IR since they were born???

Signed,

A lowly diagnostician

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[qxrt]

I know you speak half in jest, but it is something I've noticed among current medical students and residents interested in IR -- some of them seem to view DR as if it's below IR, that DR is "IR/DR lite," or that it's "easier" than IR, or at best, have no interest in DR. It's frankly a bad attitude to have. We are all colleagues who play complementary roles, and DR is a crucial component of IR/angiography (and vice versa). Even if we have preference for one or the other, those of us who are training in IR are responsible for knowing the imaging, yet DR is complex enough that those of us who only dabble in it will never be as good as those who devote themselves full-time to it. I really hope that IR/DR attracts people who understand this, not people who want "surgery lite" or claim that they are interested in IR but dislike DR.

I personally went into DR always intending to do IR, yet even if I didn't do IR, I would be happy with DR -- they are both awesome fields, and I come in to work every day in residency excited that someone is paying me to do this stuff, whether I am sitting in front of a monitor or standing in the angio suite.

 

[DrfluffyMD]

I know you speak half in jest, but it is something I've noticed among current medical students and residents interested in IR -- some of them seem to view DR as if it's below IR, that DR is "IR/DR lite," or that it's "easier" than IR, or at best, have no interest in DR. It's frankly a bad attitude to have. We are all colleagues who play complementary roles, and DR is a crucial component of IR/angiography (and vice versa). Even if we have preference for one or the other, those of us who are training in IR are responsible for knowing the imaging, yet DR is complex enough that those of us who only dabble in it will never be as good as those who devote themselves full-time to it. I really hope that IR/DR attracts people who understand this, not people who want "surgery lite" or claim that they are interested in IR but dislike DR.

I personally went into DR always intending to do IR, yet even if I didn't do IR, I would be happy with DR -- they are both awesome fields, and I come in to work every day in residency excited that someone is paying me to do this stuff, whether I am sitting in front of a monitor or standing in the angio suite.

I don't want to do 100% IR, but frankly the thought of more than 50% DR bores me to tears. I am one of those who went into DR to do IR and discovered along the way that I did not enjoy DR at all except when it's only ED cross sectional stuff.

I would have retrained in general or vascular surgery if I couldn't do IR.

The elephant in the room is that IR requires a very different mindset. I am on a mammo screener rotation right now and just fell asleep twice while reading....no disparage to my mammo colleages. I will never have the expertise to do mammo safely.

 

[radnonymous]

Things I've heard med students/applicants say about DR vs. IR:

"IR has a great lifestyle and is like surgery without rounding and clinic"

"Getting into any integrated IR/DR program is more competitive than top DR program"

"DRs can't/don't do any procedures"

"IRs spend a lot of time curing cancer"

"IRs read studies as good as fellowship-trained DRs so why wouldn't you get 2-for-1 training"

"DRs are going to get replaced by Watson/telerads or shipped overseas tomorrow so IR is the only way to have a job in rads"

And the best for application season: "Are you doing IR or 'just' diagnostic?"

 

[Light at end of tunnel]

I don't want to do 100% IR, but frankly the thought of more than 50% DR bores me to tears. I am one of those who went into DR to do IR and discovered along the way that I did not enjoy DR at all except when it's only ED cross sectional stuff.

I would have retrained in general or vascular surgery if I couldn't do IR.

The elephant in the room is that IR requires a very different mindset. I am on a mammo screener rotation right now and just fell asleep twice while reading....no disparage to my mammo colleages. I will never have the expertise to do mammo safely.

You should get that checked out!

 

[tco]

You should get that checked out!

It's called mammo-induced narcolepsy. I, too, am a sufferer.

 

[Light at end of tunnel]

It's called mammo-induced narcolepsy. I, too, am a sufferer.

What's the treament??

Swallow study BID?

 

[tco]

What's the treament??

Swallow study BID?

One week vacation and one week conference q rotation.

 

[DrfluffyMD]

One week vacation and one week conference q rotation.

I am fine working 30 hour straight on an IR shift. That would be the cure for me.

Rather live a surgical lifestyle and love 80% of it then live a 9-5 lifestyle but hate every second of that 9-5.

 

[tco]

I am fine working 30 hour straight on an IR shift. That would be the cure for me.

Rather live a surgical lifestyle and love 80% of it then live a 9-5 lifestyle but hate every second of that 9-5.

You can't work IR while on mammo, bro.

 

[Naijaba]

Any med student who thinks IR is the best specialty is...absolutely right! IR was the best-kept secret in medicine. Now the cat's out of the bag.
To quote myself from this post:

I think it's going to be incredibly competitive next year. Why? Med students know it exists now. IR has flown under the radar for the longest time. SIR has done a tremendous job in raising awareness at the med student level. Many schools now offer IR rotations or even sub-internships. IR provides what many med students want out of medicine:

1. Ability to work with specific populations. Women's health (UFEs / uterine artery bleeds / breast cancer mets to the liver ablation). Pediatrics (vascular/lymphatic anomalies, congenital biliary problems). Alcoholic / Hep C / NAFLD (TIPS). Diabetic population (dialysis fistulas). It's possible to make 50% of your work dedicated to one of these populations, at least at academic places. Or, you could do it all.

2. Innovation. More and more medical students have engineering backgrounds. Computer science in particular has surpassed biology as the most popular undergraduate major at many schools. IR docs invented angioplasty (Charles Dotter) and vascular plugs (Amplatzer). Recent developments include improvements in microwave ablation (NeuWave Medical - Fred Lee, Jr.), hydrophobic catheters (Cook Medical - William Cook was an IR srub tech) and laser-removal for IVC filters (Will Kuo). One reason why IR is so innovative is that the physicians frequently try new things intra-op to solve the problem at hand. This might include repurposing a neuro catheter for abdominal work or using an AngioJet for debridement (okay this one is a kinda expensive off-label use).

3. It is surgery, without the hubris. Think about the things that turn med students off to surgery: Getting yelled at by the scrub tech for improper sterile technique, having to stand up for 12-hours straight, endless retracting, poor visibility, waking up at 4:00 am, dressing up for Grand Rounds. The atmosphere of the IR suite is much more relaxed than the operating room. There's a collegial relationship between the nurses, scrub techs, fellows, and attendings. Albeit, the hours on IR can run longer than surgery and this might be a turn off to med students.

4. Compensation. It's no joke that 4 years of undergrad, 4 years of med and 6 years of residency is a long time, and that's if you go straight through. IR docs are in the top 5 specialities for compensation. They make essential the same as an interventional cardiologist. This is another fact that flies under the radar. Online lists of "well paid" specialties group IR with diagnostic radiologists, but IR docs earn substantially more (we're talking $50-$100K higher). You can reasonably expect to make $450,000 in the middle of your career

I should also mention that IR has a relatively easy residency. You can complete it by doing a transitional year + 3 years DR + 2 years IR. You don't have to do a prelim-surgery year, and you don't have to apply for fellowship afterwards. And the DR years are way easier than surgery and medicine.

 

[tco]

Any med student who thinks IR is the best specialty is...absolutely right! IR was the best-kept secret in medicine. Now the cat's out of the bag.
To quote myself from this post:


I should also mention that IR has a relatively easy residency. You can complete it by doing a transitional year + 3 years DR + 2 years IR. You don't have to do a prelim-surgery year, and you don't have to apply for fellowship afterwards. And the DR years are way easier than surgery and medicine.

BTW, the extra salary for IR is often because of the extra call compared to their DR colleagues.

 

[DrfluffyMD]

BTW, the extra salary for IR is often because of the extra call compared to their DR colleagues.

Here's is the thing, you can have extremely high compensation in IR by taking a lot of stroke calls. I have heard of neurosurgery level compensation with neurosurgery hours personally. That isn't my cup of tea but it happens to be possible in this specialty.

 

[weasel23]

i'll be applying to residency in the next few weeks, and I'm really torn between IR/DR and DR only. I love the idea of some IR time in my future, but really want to do a decent amount of DR and be good at it. With the setup of 3 years DR and 2 IR, wouldn't you be missing out on not only a neuro/msk/body fellowship, but the "mini-fellowship" year as well? Are you essentially losing (or rather not gaining) competence in not one but two subsections of DR when pursuing IR? That thought has me very conflicted

 

[irwarrior]

If you are torn between the two and want to do a fair amount of imaging , it may be best to go the route of DR and do the 2 year IR residency afterwards. This way you will have a strong background in DR and you can then choose whether you truly want to do IR . If you do the integrated IR residency the focus should be on being a strong clinician as that is what is currently lacking in IR training and hone your imaging and technical skills throughout. In my opinion the clinical and technical integration should not just occur at the last 2 years, but should instead occur throughout all 6 years. This will give you the best foundational skills in clinical medicine that are required to do IR well and compete for referral.s

 

[tco]

i'll be applying to residency in the next few weeks, and I'm really torn between IR/DR and DR only. I love the idea of some IR time in my future, but really want to do a decent amount of DR and be good at it. With the setup of 3 years DR and 2 IR, wouldn't you be missing out on not only a neuro/msk/body fellowship, but the "mini-fellowship" year as well? Are you essentially losing (or rather not gaining) competence in not one but two subsections of DR when pursuing IR? That thought has me very conflicted

It's ALWAYS a good thing to have options. I don't care what your girlfriend tells you. /joke

First, to answer your question, you're not really missing out on anything if all you want to do is IR. You'll get the basics of all the modalities during your first three years, and your mini fellowship will essentially be all IR, and then you'll do your fellowship. If you want to do diagnostics in addition to procedures, you'll never be as good as someone who does only diagnostics, but that's expected. You wouldn't expect them to be as good as you at putting in a line or doing a biopsy, would you?

I've always been 90% IR, and I'm going to end up matching IR this year, but I ranked UVA's VIR at the bottom of my match list (when I matched back in 2014, there were only a few integrated programs) because I wanted options. I went through my first two years of rotations, and enjoyed most of them, hated some of them...But I always had options. If you go to a big enough place, they'll have ESIR, and it's a total moot point about matching into DR/IR. Just do DR, actively LOOK for other careers that you'd enjoy (because you know you'd enjoy IR), and see what happens. The time is going to pass anyway. You shouldn't miss out on something you enjoy because you prematurely locked yourself into IR. If you do DR/IR, you'll have to hope for someone to switch with if you fall in love with another subspecialty. That might be easy...Might be hard. But if you are DR all the way, you won't have to worry about it.

 

[DrfluffyMD]

Agree with the posters above. DR IR is mostly only for people who cannot see themselves doing diagnostics.

 

[weasel23]

thanks for the advice! it was probably in line with my thinking, which was to do DR only at this point. it's kind of frustrating that they're moving to the integrated residency, but I'm sure it's great for the field and those that are in love with IR. that's a whole other topic though and unrelated to the thread

 

[harambe4ever]

thanks for the advice! it was probably in line with my thinking, which was to do DR only at this point. it's kind of frustrating that they're moving to the integrated residency, but I'm sure it's great for the field and those that are in love with IR. that's a whole other topic though and unrelated to the thread

One thing to keep in mind is the uncertainty of independent IR residencies. Nobody knows how many spots there will be. There could be 20 spots a year or 200. People just keep saying things like "it'll be fine" but not a single person has hard numbers. DR is still probably the best route for you as the others have explained, but don't expect getting an independent IR residency spot to be a cake walk because literally no one knows how it'll end up.

 

[Light at end of tunnel]

Why is there so much IR/DR residency uncertainty??

 

[Gadofosveset]

Agree with the posters above. DR IR is mostly only for people who cannot see themselves doing diagnostics.

The problem with this is that one doesn't really have a good idea what both fields entail as a medical student. There used to be more residents who came in strongly intending an IR fellowship switching to DR fellowship than the other way around. IR hasn't changed that much since then. Building in some leeway to move between the programs was wise.

I also fall asleep reading mammo, and although DR I'm more procedural than many of my colleagues... but my co-residents who did mammo fellowships are living better lives than me right now. It's important to make happiness projections over the short, medium, and the long term. If the only way one can get happiness is using the Seldinger technique to put plastic tubes in people's vessels, one might be psychotic or exaggerating to compensate for something. Or it's critical to one's ego to be seen as "one who works in an interventional suite". For some reason this division is really strong in med students going into IR and DR. There's an analogous division in specialty IM between interventionalists and noninterventionalists; from what I've seen they tend to work together rather than jockey for position. Some like to talk about how "surgical" IR is, but from what I've seen (community and major academic centers) the workday is much closer to being an interventional GI.

One of the best things about being an attending is that you know your skill set and your value. You stop worrying and comparing yourself with everyone (or do it much less). I know my DR skill set and my limitations. I know my IR friends' skill sets and their limitations. I know my surgeons' skill sets and their limitations when reading imaging. I causes me no anxiety. An attending general surgeon may be able to get 75-95% of a CT abdomen on his or her patient, but he or she can't roll immediately into reading three shoulder radiographs, reading a negative CT head, generating reports on these, then protocolling a pelvis MR for uterine anomaly, and then checking a sonographer's work, and finishing it all within 5-10 minutes. And filling in the 5-25% knowledge gap on the abdominal CT is value added. The majority of attendings work together. It's much easier that way for everyone. The juvenile attendings that trainees tend to like, the kind that like to cause a lot of friction with value judgments about others, just don't know or won't acknowledge their blind spots. And nobody really likes them much, either, besides trainees who are more swayed by personality than performance.

 

[recycledpaper]

Correct me if I'm wrong, but I always thought that if there is any doubt about whether you want to do DR or IR, the DR w/ ESIR route is the best path to take?

 

[Tiger100]

Having IR as a separate residency is a mistake.

 

[DrfluffyMD]

Having IR as a separate residency is a mistake.

How so?

 

[DrfluffyMD]

Actually I don't know any IR who felt that IR shouldn't be a separate specialty.

 

[recycledpaper]

IR as it has been historically practiced wouldn't make sense as its own specialty. But with the incorporation of clinical medicine, building your own patient base, etc, it makes sense to branch off and treat it more as a surgical subspecialty, which is vastly different from DR workflow.

 

[qxrt]

Actually I don't know any IR who felt that IR shouldn't be a separate specialty.

Converting IR to a separate specialty would entail IR graduates no longer being certified to read DR studies (because otherwise, they are not really separate specialties). Even integrated vascular surgery programs are technically surgery residencies and fall under the surgery department. Given that the basis of IR and its advantage in turf battles is the knowledge of imaging, do you really think severing the connection to our main strength is a good idea?

 

[DrfluffyMD]

Converting IR to a separate specialty would entail IR graduates no longer being certified to read DR studies (because otherwise, they are not really separate specialties). Even integrated vascular surgery programs are technically surgery residencies and fall under the surgery department. Given that the basis of IR and its advantage in turf battles is the knowledge of imaging, do you really think severing the connection to our main strength is a good idea?

The IR DR graduates are dual boarded in both DR and IR. That's the whole point of separation. I gain a separate IR primary certificate. I wouldn't want to give up the DR cert.

 

[irwarrior]

Many other specialists are quite good at imaging. Ob physicians are very handy with an ultrasound, ER physicians are getting better, Neurologists and neurosurgeons are incorporating neuroimaging into their curriculum, vascular surgeons are running many of the vascular ultrasound labs, ICU are doing more point of care ultrasound and cardiology has done a great job in performing ultrasound/echocardiography, nuclear medicine, cardiac angiography, and cardiac CT/MRI.

The key for IR success is going out and giving talks, marketing, and going to multi-disciplinary tumor boards etc. Historically, IR physicians did not have a clinic or a formal consultative role and relied on specialists to order procedures and make clinical decisions while the IR physician played a pure technical role. The last 10 years have showcased more and more IR physicians taking on more clinical responsibility and marketing themselves more aggressively. The challenge has been that diagnostic groups often do not support the non procedural clinical activities of such an IR and often force the IR to read films. As someone stated this is a normal workflow for most of medicine, but unusual and atypical for diagnostic radiology divisions. In order for most IR to have true success, they likely need to establish 100 percent practices either within the domains of a radiology group or independently and a good portion of that will likely entail clinic work, marketing and educating other providers.

The IR residency seems to be a move in the right direction as it recruits directly from medical school and hopefully attracts a different type of student who actually desires patient contact and is excited about procedures. The other benefit of IR compared to many other specialties is the broad spectrum of diseases that we treat this enables us to do vascular procedures (PAD, aortic disease, varicose veins, DVT, PE, carotid disease, stroke), oncologic interventions (chemoembolization, ablations),palliative pain procedures, neurointerventions (aneurysms, avms), Spine interventions (vertebral augmentation), and manage a whole host of diseases.

The future is very bright for students who are highly motivated, hard working, want to take care of patients and are ready to go out and build a practice.

 

[meister]

Many other specialists are quite good at imaging. Ob physicians are very handy with an ultrasound, ER physicians are getting better, Neurologists and neurosurgeons are incorporating neuroimaging into their curriculum, vascular surgeons are running many of the vascular ultrasound labs, ICU are doing more point of care ultrasound and cardiology has done a great job in performing ultrasound/echocardiography, nuclear medicine, cardiac angiography, and cardiac CT/MRI.

What is your point here?

 

[Fab5Hill33]

It's only a mistake for DR. If you're IR, you're golden. Dual certificate in DR and IR? Please and thank you.

Having IR as a separate residency is a mistake.

 

[Tiger100]

It's only a mistake for DR. If you're IR, you're golden. Dual certificate in DR and IR? Please and thank you.

This topic has been discussed in another thread. It is not going to work for IR outside academic centers.

 

[DrfluffyMD]

This topic has been discussed in another thread. It is not going to work for IR outside academic centers.

Statement of absolute is rarely correct. Depends on referall pattern i say

 

[Tiger100]

Statement of absolute is rarely correct. Depends on referall pattern i say

What does that mean?

 

[DrfluffyMD]

What does that mean?

Well, in some areas, there is only one DR group and they have exclusive contract, so it would be hard for IR to survive without them. In other areas, there are multiple competiting rad groups and hospitals may have more leeway to give IR group priviledges and such without too much protest from DR geoup.

All I know is that DR has a history of losing exams and procedures to other specialities, even entire specialties like radonc. I have a hard time believing that history won't happen again.

 

[Tiger100]

Well, in some areas, there is only one DR group and they have exclusive contract, so it would be hard for IR to survive without them. In other areas, there are multiple competiting rad groups and hospitals may have more leeway to give IR group priviledges and such without too much protest from DR geoup.

All I know is that DR has a history of losing exams and procedures to other specialities, even entire specialties like radonc. I have a hard time believing that history won't happen again.

Other than certain exceptions, I don't know about any hospital that is covered by multiple DR groups. Usually it is one DR group. Otherwise, it will be a disaster.

>>Anyhow, it is not about getting privilege. Let's say IR has DR privilege. Now what?
- Are they capable of covering the hospital for DR 7/24?
- Are they capable of doing high end imaging (which has become the day to day practice of community radiology) like Neuro MR, CT Neck, MSK MR, MRI abdomen, even CT abdomen and pelvis for several reasons, HRCT?
- Are they capable of running breast service which is almost a department by itself and important to many hospitals?
- Are they capable of meeting the turn-around time for ER and stat inpatient?
- How can an IR group consisting of 3-4 IR doctors with 3 years of DR training compete with a sub-specialized DR group?

All of these questions should be answered in the current environment which DR is becoming more sub-specialized, All DR graduates have two areas of sub-specialization and DR groups are becoming big groups consisting of all sub-specialties even including chest and cardiac Imagers which in many places are covering hospitals 24/7?

Honestly it is more likely than DR group takeaway all non-vasuclar procedures (by hiring body imagers or even one or two IR doctors) from IR group rather than IR group taking aways some DR work.

>> Turf loss by DR is exaggerated. The areas of turf loss after 1980s has been cardiac echo (completely) and OB US (partly). Radiology swallowed the entire field of Nucs but then lost 80% of cardiac Nucs. However, IR has lost most of its PAD turf to the point that new fellows have hard time even finding a place to be trained in PAD.

This negative view of DR is something that is rampant among a lot of IR physicians and that is fine. But separating from DR is not going to solve their problems. It will add to IR problems.

I have worked in different settings. This DR certificate for new IR graduates will be only useful in interpreting chest Xrays, some vascular US and very few modalities here and there. And even in these cases, I don't know how they can find DR work. Diagnostic imaging studies will not come to your computer from nowhere WHEN you want them. It is a 7/24 service. A 3 year of DR training in between IR training will not make you a neuroradiologist, body imager, MSK radiologist, mammographer or even chest radiologist.

 

[Fab5Hill33]

Just another jealous and bitter diagnostic radiologist. I've been practicing IR and DR in private practice for over a decade. The new certificate will absolutely work. I read every modality on my DR days including some of what you consider "high end" and my turn around time is actually better than most of my DR colleagues because as an IR I don't suffer from the "hedge" syndrome that is prevalent among DRs -- and referring clinicians love me for it. They know I give practical advice and reads.

But keep posting @Tiger100... each post just shows you to be more bitter and reveals that you - a DR - just have an axe to grind on an IR discussion thread.

Other than certain exceptions, I don't know about any hospital that is covered by multiple DR groups. Usually it is one DR group. Otherwise, it will be a disaster.

>>Anyhow, it is not about getting privilege. Let's say IR has DR privilege. Now what?
- Are they capable of covering the hospital for DR 7/24?
- Are they capable of doing high end imaging (which has become the day to day practice of community radiology) like Neuro MR, CT Neck, MSK MR, MRI abdomen, even CT abdomen and pelvis for several reasons, HRCT?
- Are they capable of running breast service which is almost a department by itself and important to many hospitals?
- Are they capable of meeting the turn-around time for ER and stat inpatient?
- How can an IR group consisting of 3-4 IR doctors with 3 years of DR training compete with a sub-specialized DR group?

All of these questions should be answered in the current environment which DR is becoming more sub-specialized, All DR graduates have two areas of sub-specialization and DR groups are becoming big groups consisting of all sub-specialties even including chest and cardiac Imagers which in many places are covering hospitals 24/7?

Honestly it is more likely than DR group takeaway all non-vasuclar procedures (by hiring body imagers or even one or two IR doctors) from IR group rather than IR group taking aways some DR work.

>> Turf loss by DR is exaggerated. The areas of turf loss after 1980s has been cardiac echo (completely) and OB US (partly). Radiology swallowed the entire field of Nucs but then lost 80% of cardiac Nucs. However, IR has lost most of its PAD turf to the point that new fellows have hard time even finding a place to be trained in PAD.

This negative view of DR is something that is rampant among a lot of IR physicians and that is fine. But separating from DR is not going to solve their problems. It will add to IR problems.

I have worked in different settings. This DR certificate for new IR graduates will be only useful in interpreting chest Xrays, some vascular US and very few modalities here and there. And even in these cases, I don't know how they can find DR work. Diagnostic imaging studies will not come to your computer from nowhere WHEN you want them. It is a 7/24 service. A 3 year of DR training in between IR training will not make you a neuroradiologist, body imager, MSK radiologist, mammographer or even chest radiologist.

 

[Tiger100]

Just another jealous and bitter diagnostic radiologist. I've been practicing IR and DR in private practice for over a decade. The new certificate will absolutely work. I read every modality on my DR days including some of what you consider "high end" and my turn around time is actually better than most of my DR colleagues because as an IR I don't suffer from the "hedge" syndrome that is prevalent among DRs -- and referring clinicians love me for it. They know I give practical advice and reads.

But keep posting @Tiger100... each post just shows you to be more bitter and reveals that you - a DR - just have an axe to grind on an IR discussion thread.

It is interesting how you can't control your emotions when we are discussing some serious topic. Personal attacks go nowhere. You use personal attack because you don't have any other logic for your argument.

1- Your example is called anecdote. You may be better than every DR in the world but it doesn't mean that an average new IR/DR graduate with 3 years of DR is better than a neuroradiologist with 5 or 6 years of training in interpreting neurorad studies.

2- How does your IR skills to drain abscess or doing fistula work help you hedge less on neuro MRI, MSK MRI or Breast MRI or read them faster?

3- You don't understand the big picture. If you are doing DR, it is because you are part of a big DR group. If you and your IR colleagues separate from a DR group, there won't be enough manpower, enough leverage and enough skills to provide a comprehensive DR service.

4- It is very simple. With 3 years of DR and 2 years of IR you can't be as good as or as availabe as a well rounded DR group that has all subspecialties of radiology and doing it day in and day out.

Now I am getting familiar with a new concept. The new IR residency will make its graduates BETTER DIAGNOSTIC radiologists than the DR graduates with fellowship training. It is a true magic that only happens in IR world.

I don't expect any better argument from someone who is the jack of all trades and master of none. You don't know what you don't know. Nobody in the planet can be the best IR doctor and the best in every modality. Medicine is getting sub-specialized. But it is beyond the understanding of an IR doctor who does everything in the community except for high end IR since there is not enough IR work for him .

Now why don't you practice mostly IR? A healthy IR practice should have enough PAD work and other procedures to keep it busy. If your read every modality, it means that you do a lot of DR. Oh, I forgot. You don't do any real vascular work. In your practice, do vascular surgeons do it or cardiologists?

And since you started the personal attack, my answer is that you are stupid at best.

 

[DrfluffyMD]

It is interesting how you can't control your emotions when we are discussing some serious topic. Personal attacks go nowhere. You use personal attack because you don't have any other logic for your argument.

1- Your example is called anecdote. You may be better than every DR in the world but it doesn't mean that an average new IR/DR graduate with 3 years of DR is better than a neuroradiologist with 5 or 6 years of training in interpreting neurorad studies.

2- How does your IR skills to drain abscess or doing fistula work help you hedge less on neuro MRI, MSK MRI or Breast MRI or read them faster?

3- You don't understand the big picture. If you are doing DR, it is because you are part of a big DR group. If you and your IR colleagues separate from a DR group, there won't be enough manpower, enough leverage and enough skills to provide a comprehensive DR service.

4- It is very simple. With 3 years of DR and 2 years of IR you can't be as good as or as availabe as a well rounded DR group that has all subspecialties of radiology and doing it day in and day out.

Now I am getting familiar with a new concept. The new IR residency will make its graduates BETTER DIAGNOSTIC radiologists than the DR graduates with fellowship training. It is a true magic that only happens in IR world.

I don't expect any better argument from someone who is the jack of all trades and master of none. You don't know what you don't know. Nobody in the planet can be the best IR doctor and the best in every modality. Medicine is getting sub-specialized. But it is beyond the understanding of an IR doctor who does everything in the community except for high end IR since there is not enough IR work for him .

Now why don't you practice mostly IR? A healthy IR practice should have enough PAD work and other procedures to keep it busy. If your read every modality, it means that you do a lot of DR. Oh, I forgot. You don't do any real vascular work. In your practice, do vascular surgeons do it or cardiologists?

And since you started the personal attack, my answer is that you are stupid at best.

About to finish residency, the nature of academic DR training means that I feel very comfortable doing all those "high end" DR studies you mentioned. I have no interest to read those studies though. If I have to do another day of DR I rather quit. I enjoy reading images, but loath the idea of producing reports.

Also, I am not sure why you are so fascinated with PAD. A healthy IR practice can thrive despite no PAD. Just IO volume can sustain a regional IR practice.

The most laughable part of your post is that somehow the DR cert is only good for chest x rays...I will be completing an entire DR residency. Should you stop reading any CT abdomen and pelvis since you aren't body fellowship trained? Or noncon CT head since you aren't neuro trained? Silly.

 

[qxrt]

About to finish residency, the nature of academic DR training means that I feel very comfortable doing all those "high end" DR studies you mentioned. I have no interest to read those studies though. If I have to do another day of DR I rather quit. I enjoy reading images, but loath the idea of producing reports.

Training at a referral center with subspecialists within the radiology department, my initial instinct is similar to you. However, working at a referral center also exposes me to some of the more...questionable reads that some radiologists in the community practicing general radiology put out. We should never underestimate the impact that time has on its ability to atrophy our diagnostic skills. You may feel that you can read all the high-end studies available in DR...but we are senior residents who have just finished the core exam and are on the tail end of having rotated through every dedicated subspecialty in radiology. It is expected at this stage that we are at the peak of our game, and our level of knowledge should exceed that of the general radiologist, who has not typically been keeping up to date in all subspecialties. However, it is not realistic to expect that our diagnostic skills and knowledge will stay at the level that we are at as senior residents.

Indeed, we have a mammo attending here who actually used to be a body CT radiology attending at UCSF back in the day, decades ago, before he switched to mammo. Now? He hardly knows how to read a body CT, even though he still occasionally sees one when covering the ED for lunchtime coverage. This will happen to all of us who do not spend regular dedicated time reading any specific study. If you do not read, for example, follow-up MRI brain for post-treatment GBM routinely as an attending, you will one day realize that you no longer know how to read it, even if you once could, back in residency.

In this line, the more time you dedicate specifically to IR, the more you will realize that eventually, you cannot read DR studies the way you used to be able to.

 

[Tiger100]

About to finish residency, the nature of academic DR training means that I feel very comfortable doing all those "high end" DR studies you mentioned. I have no interest to read those studies though. If I have to do another day of DR I rather quit. I enjoy reading images, but loath the idea of producing reports.

Also, I am not sure why you are so fascinated with PAD. A healthy IR practice can thrive despite no PAD. Just IO volume can sustain a regional IR practice.

The most laughable part of your post is that somehow the DR cert is only good for chest x rays...I will be completing an entire DR residency. Should you stop reading any CT abdomen and pelvis since you aren't body fellowship trained? Or noncon CT head since you aren't neuro trained? Silly.

So you are saying that a group of 5 IR people who do mostly IR and do some DR on the side is better or as good as a group of 20 DR who have all subspecialties of radiology and many of them have done another fellowship in their 4th year and they do DR day in and day out? Do you know what you are talking about? Do you know what is radiology?

As I mentioned above, it is not only about being able to read certain studies by the end of residency. Learning is an ongoing process. If you are the best at the end of residency and don't do it for 5 years you will lose the skills. I read CT abdomen and pelvis as good or better than a recently body fellowship trained graduate because I have done it for 15 years day in and day out. But if I wanted to do IR most of my time and just dabbled in reading a few CTs here and there, my skills would be worse than a second year resident.

Anyway, that is not the main problem. The main problem is the logistics. Let's say an IR group obtain the privilege to read non-con head CTs No What? Just think about it. Can you read ED studies within 20 minutes? Can you read inpatient stroke codes in a timely manner? Who will read the head CT that is ordered at 3 am? You can do it only and if only you have enough people to do it round the clock and they do only DR on those certain days. From practical purposes, it means that your practice will be a combination of IR and DR? Honestly, what is the difference between this scenario and the current model of practice?

And NO. You are absolutely wrong. IO volume can sustain an academic practice. But it can not give you enough work in private practice. IO volume is peanuts in private practice compared to PAD. I know that someone will come here and will give me an anecdotal example of an IR who is making a killing by doing IO somewhere in private practice somewhere in this country. But that is not the norm. Believe it or not you can make more money in an AVERAGE private practice by doing thryoid FNAs or breast biopsies than IO. IO has very limited indications and does not exist in many private practices. The biggest turf loss in the history of medicine of the turf loss of PAD and IR guys say it is no big deal. What a joke.

This is another problem with academic Gurus and almost all residents and fellows in all fields. The realities of community practice are very different from how things are in your tertiary care center.

 

[Tiger100]

Training at a referral center with subspecialists within the radiology department, my initial instinct is similar to you. However, working at a referral center also exposes me to some of the more...questionable reads that some radiologists in the community practicing general radiology put out. We should never underestimate the impact that time has on its ability to atrophy our diagnostic skills. You may feel that you can read all the high-end studies available in DR...but we are senior residents who have just finished the core exam and are on the tail end of having rotated through every dedicated subspecialty in radiology. It is expected at this stage that we are at the peak of our game, and our level of knowledge should exceed that of the general radiologist, who has not typically been keeping up to date in all subspecialties. However, it is not realistic to expect that our diagnostic skills and knowledge will stay at the level that we are at as senior residents.

Indeed, we have a mammo attending here who actually used to be a body CT radiology attending at UCSF back in the day, decades ago, before he switched to mammo. Now? He hardly knows how to read a body CT, even though he still occasionally sees one when covering the ED for lunchtime coverage. This will happen to all of us who do not spend regular dedicated time reading any specific study. If you do not read, for example, follow-up MRI brain for post-treatment GBM routinely as an attending, you will one day realize that you no longer know how to read it, even if you once could, back in residency.

In this line, the more time you dedicate specifically to IR, the more you will realize that eventually, you cannot read DR studies the way you used to be able to.

Exactly.

In reality, the job opportunity for an IR graduate in private practice is very limited if he/she is not a part of a DR group. Unfortunately, many IRs don't understand or don't want to accept this reality.

 

[medgator]

Well, in some areas, there is only one DR group and they have exclusive contract, so it would be hard for IR to survive without them. In other areas, there are multiple competiting rad groups and hospitals may have more leeway to give IR group priviledges and such without too much protest from DR geoup.

All I know is that DR has a history of losing exams and procedures to other specialities, even entire specialties like radonc. I have a hard time believing that history won't happen again.

Hardly a loss. More like a fork in the road. The work between rads and RO is completely different.

In all likelihood, IR is another fork just further down the timeline of the specialty. IR is more akin to surgery where imaging is utilized to perform the procedure

 

[DrfluffyMD]

Hardly a loss. More like a fork in the road. The work between rads and RO is completely different.

In all likelihood, IR is another fork just further down the timeline of the specialty. IR is more akin to surgery where imaging is utilized to perform the procedure

To someone like myself, it's a fork, to others, it's a loss.

Honestly, the commonality of myself and DR ends at the ability to interpret images. Just like how medicine docs and surgeons take H&P and see patients but their commonality ends there.

 

[medgator]

To someone like myself, it's a fork, to others, it's a loss.

Honestly, the commonality of myself and DR ends at the ability to interpret images. Just like how medicine docs and surgeons take H&P and see patients but their commonality ends there.

It's a gain to medical practice in the country and overall patient care though imo....

For example, in the UK, clinical oncologists give radiation and chemo but the skill set between the two treatments is completely different. I think a dedicated RO gives better radiation and a med onc stays up to date better on chemo/immuno/targeted therapy than a dual chemo/xrt doc in the UK

In RO, we spend more time with patients and we have the luxury of examining them and correlating things to imaging. I've found new bone mets that a DR (who's getting paid less per scan and has to crank through more volume per hour) missed on a scan because a patient was symptomatic and I had the luxury of examining them and pulling up their scans at the same visit....and then setting up the radiation to take care of the problem

Sent from my SAMSUNG-SM-N910A using Tapatalk

 

[irwarrior]

There is some truth that it is hard to build a 100 percent outpatient or community IR practice without doing either interventional pain, PAD, dialysis interventions and venous disease. There is an element of disconnect from most academic centers and the community IR practices. If you look at most independent successful IR practices they are incorporating a moderate amount of PAD, veins, fibroids, dialysis interventions, stroke interventions , DVT, PE, bleeders (GI etc). IO can certainly be developed but there is limited evidence at this juncture. The RCT data is coming but is not quite there yet and we will ultimately need RCT overall survival to push the field further from an oncologic standpoint. Tertiary centers with liver transplant can develop a fairly robust IO practice based on hepatocellular cancer alone, but without transplant it can be done but is much more difficult.

 

[meister]

It's funny how people finish residency and assume they're the best...largely likely related to not being overread constantly by a subspecialist.

 

[Tiger100]

Things I've heard med students/applicants say about DR vs. IR:

"IR has a great lifestyle and is like surgery without rounding and clinic"

"Getting into any integrated IR/DR program is more competitive than top DR program"

"DRs can't/don't do any procedures"

"IRs spend a lot of time curing cancer"

"IRs read studies as good as fellowship-trained DRs so why wouldn't you get 2-for-1 training"

"DRs are going to get replaced by Watson/telerads or shipped overseas tomorrow so IR is the only way to have a job in rads"

And the best for application season: "Are you doing IR or 'just' diagnostic?"

Two mistakes in your post:

1- It is not only medical students. As you see in the above post, an IR attending (self claim) with 10 years of practice experience who does mostly IR, claims that he reads studies much better than DR.

2- Again, the same person claims that he does it better. So you statement that says "as good as" is wrong.

 

[Tiger100]

And if so, will IR residents mercilessly mock their DR brethren whilst wearing carefully fitted scrubs and leaded glasses? When can they start to make disparaging remarks about lesser specialties like derm or plastics? When will high school students start flooding this forum with questionable stories of how they've always wanted to be an IR since they were born???

Signed,

A lowly diagnostician

I don't blame the medical students. The above posts are good proof of the mindset that you are describing.

As you can see above, an IR attending with more than a decade of practice experience calls "Just another jealous and bitter diagnostic radiologist".

This mindset has become very rampant among IR guys. Many of them think that DR is responsible for their turf loss. It is an immature defense mechanism but it is already out there.

 

[DrfluffyMD]

I don't blame the medical students. The above posts are good proof of the mindset that you are describing.

As you can see above, an IR attending with more than a decade of practice experience calls "Just another jealous and bitter diagnostic radiologist".

This mindset has become very rampant among IR guys. Many of them think that DR is responsible for their turf loss. It is an immature defense mechanism but it is already out there.

The moment a DR colleague puts "5.5cm AAA, recommend vascular surgery and/or IR consultation" rather than "AAA, refer to vascular" is when I stop blaming some of them for turf loss.