M4 here -- would really appreciate any guidance on my dilemma between choosing EM vs Rads

[anon12380]

DO student here. 243 Step 1. Taking CK on October 2nd but likely to score 230-240 realistically. No red flags on my app, but my app has so far been EM-oriented as I have a SLOE and one LOR from an Ultrasound rotation ready. The thing is, lately I have been reflecting on my EM rotation and experience so far and worry about career longevity but also frankly how much of my attraction to working up "undifferentiated patients" in the ED may have been misplaced. To put another way, almost every single patient gets some form of imaging and the diagnosis can hinge on the imaging one way or another. I also found myself walking over to radiology for many stroke alerts and watched the radiologist scan and interpret the image. I would look up imaging later on Radiopedia on my own or even go looking for a quick YT video on topics. Maybe this is not unsual for EM bound students, but I definitely felt that perhaps my interest was starting to shift to Rads near the tail end of my EM rotations. FWIW, I got great feedback on my rotation and was told I would make an excellent EM resident wherever I go per the PD.

I've been doing a lot of research on Rads lately and I must confess, the idea of a relatively high-paying specialty, wide-breadth of DR, and the relatively -- compared to EM at least -- better lifestyle balance is appealing. I worry once I am in my late 50s EM will burnout. I think that is less so in DR. But as to the actual medicine, I honestly view Rads in a similar vein to EM in the sense that you really need to have a broad understanding of pathology and you are working up basically undifferentiated patients as well.

One issue I need help with which is entirely a superficial topic is my personal challenge with "feeling like a doctor". EM has appealed to me because it reminds me of what a doctor used to be -- jack of all trades. The skillset is practical probably moreso than most other fields. Before med school, I had thought of being a surgeon or even Cardiology but those went away quickly. The point is for many many years I thought of pursuing medicine and had an image of my career as such so my recent interest in Rads is at least challenging my own bias / preconceptions. It's vain. I know. I mean, no one in medicine cares and who cares what the public thinks, so this is definitely a me problem so to speak. Finally, I should mention I spent one whole day on a shadow shift with a neuroradiologist and I found his workflow just "meh". Maybe because I was just watching him and not doing anything but this was early third year. I almost want to reach out to other private practice radiologists and ask to shadow them to add some more datapoints to my experience.

Anyways, I am hoping to get some advice a) on how challenging it would be to apply to DR this late b) for anyone to maybe give their thoughts on this doctor vs not doctor feeling (which I know is shared by say Pathologists and Anesthesiologists at times), and c) do you feel fulfilled by your work ie "do you work to live" or "live to work".

Thank you for reading, hope this post was not offensive to anyone!

---

Members don't see this ad.

 

[anon12380]

@RadiologyPD hope you could provide your insight. I did not want to burden your thread with what could be viewed as a stream-of-consciousness post.

 

[RadiologyPD]

Anyways, I am hoping to get some advice a) on how challenging it would be to apply to DR this late b) for anyone to maybe give their thoughts on this doctor vs not doctor feeling (which I know is shared by say Pathologists and Anesthesiologists at times), and c) do you feel fulfilled by your work ie "do you work to live" or "live to work".

1. I don't think it is too late to apply for DR. Remember, I'm the person who didn't decide to do DR until early in M4 year.
2. Doctor vs. Not Doctor: You need to think deeply on whether this is actually a real question for you or not. I would say over 99% of rads do not have this in their minds at all--the fact that you do might be an issue. Over 30 years of training residents, the few that drop out always seem to have this in their minds, so if it is a serious thought, that is a negative predictor.
3. I would venture to say that I love my job. But I'm not in PP. I have friends in PP who really like their job (not sure anyone loves it). I have friends in PP who aren't that thrilled.

 

[deleted746658]

the advantage of EM over radiology is it is a 3 year residency and you are paid well when finished. in fact, with the recent CMS cuts the pay gap between EM and DR will be much smaller by the time you are done training

with EM, you don't have to "start over." with radiology, as soon as you're an R1, you literally start back at square 1 and learn a completely new and different field, one in which you have had very little exposure to as a student/ intern

i honestly think rads has about 10-15 years before AI starts making inroads and potentially decreases the need for humans.

with EM, your job will be more secure.

i vote EM

 

[medradthrowaway]

I foresee continued reimbursement cuts for radiology to be honest, especially in the coming political environment. Salary is important but I would say that EM is highly compensated and might even end up having a more stable career in the long haul. I'd say any specialty with a patient facing component will enjoy high demand and job security for the foreseeable future.

It sounds like you're having cold feet and are romanticizing your second choice. Like the other poster said, I would think long and hard about whether you want to be someone's "doctor" and to be acknowledged for your work. You will get little to none of this from your patients in radiology.

I'd say as for switching into DR right now, it shouldn't be an issue since there are a good number of programs out there.

 

[qwerty89]

the advantage of EM over radiology is it is a 3 year residency and you are paid well when finished. in fact, with the recent CMS cuts the pay gap between EM and DR will be much smaller by the time you are done training

with EM, you don't have to "start over." with radiology, as soon as you're an R1, you literally start back at square 1 and learn a completely new and different field, one in which you have had very little exposure to as a student/ intern

i honestly think rads has about 10-15 years before AI starts making inroads and potentially decreases the need for humans.

with EM, your job will be more secure.

i vote EM

The worst thing for any field is oversupply. Just look at RadOnc today. Those poor PGY-5s are begging for jobs.

Radiology has, somehow, actually not oversaturated its field to the same extent like many others.
ACGME has a website with the total number of residents in any given academic year (i.e. for rads this would be R1 + R2 + R3 + R4)

ACGME - Accreditation Data System (ADS)

Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years!

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years.

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years.

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years!

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Reimbursement decreases mean even more when you are in an oversupply. Posts of EM talk about Denver EM jobs paying as little as $140/hr to new grads. The days of ~350-500/hr locums rates in bumblef**k Texas are also over.

 

[odyssey2]

Not saying salary and job security aren’t really important, but I think OP should focus more on what he likes about the jobs themselves when making this decision. The day to day of EM and rads are so different

 

[Clean7795]

i honestly think rads has about 10-15 years before AI starts making inroads and potentially decreases the need for humans.

with EM, your job will be more secure.

i vote EM

The idea that there is some 'far away threat' always makes me laugh, especially when certain specialties are not only under attack but have already been transformed by midlevel pressure (primary care, ER, hospitalist medicine). If you go to an urgent care or ER right now, chances are you will see a midlevel. Jobs are there right now but a combination of over-training and midlevel expansion is putting its own downward pressure on ER pay.

Same thing with corporatization which gets rads riled up... ER is a specialty where corporate has already far penetrated into and ingrained itself. Most of the worries you read and hear about from radiologists about radiology, has already significant impacted ER.

Anyways, I am hoping to get some advice a) on how challenging it would be to apply to DR this late b) for anyone to maybe give their thoughts on this doctor vs not doctor feeling (which I know is shared by say Pathologists and Anesthesiologists at times), and c) do you feel fulfilled by your work ie "do you work to live" or "live to work".

It is rare to find people who live to work in either radiology or ER.

The doctor vs not doctor feeling fades quickly for the vast majority. You will feel needed and essential in radiology when you realize that most medical specialties rely on you to make the majority of the important ER diagnoses (trauma, stroke, etc.). Even surgical specialists who look at their own imaging will call you for your opinion or to ask you to look at a study outside the 5-10 diseases they're comfortable with. Eventually it will get to the point where it will annoy you, but these sort of things are also the things that keep radiology safe from intrusion.

I've been doing a lot of research on Rads lately and I must confess, the idea of a relatively high-paying specialty, wide-breadth of DR, and the relatively -- compared to EM at least -- better lifestyle balance is appealing. I worry once I am in my late 50s EM will burnout. I think that is less so in DR. But as to the actual medicine, I honestly view Rads in a similar vein to EM in the sense that you really need to have a broad understanding of pathology and you are working up basically undifferentiated patients as well.

I agree, except keep in mind that radiology does ER work and non-ER work (inpatient/outpatient), while a ER physician doesn't have the option to do outpatient primary care or be a hospitalist.

 

[medradthrowaway]

The worst thing for any field is oversupply. Just look at RadOnc today. Those poor PGY-5s are begging for jobs.

Radiology has, somehow, actually not oversaturated its field to the same extent like many others.
ACGME has a website with the total number of residents in any given academic year (i.e. for rads this would be R1 + R2 + R3 + R4)

ACGME - Accreditation Data System (ADS)

Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years!

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years.

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years.

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years!

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Reimbursement decreases mean even more when you are in an oversupply. Posts of EM talk about Denver EM jobs paying as little as $140/hr to new grads. The days of ~350-500/hr locums rates in bumblef**k Texas are also over.

Lol what are you even saying? You know radiology is notoriously known for having periods of oversaturation and supply glut right?

Radonc isn't a good example. Not every hospital can afford a multi-million dollar accelerator and ancillary staff.

 

[sloh]

You should also read this thread to get a more accurate idea of the day to day practice of radiology


What contributes to burnout in Radiology?

What contributes to burnout in Radiology?

Genuinely curious - what are the big factors that contribute to Radiology burnout? Is it mostly because of high volume or are there other factors I don't understand as a non-radiologist? Thanks in advance.

forums.studentdoctor.net

 

[anon12380]

1. I don't think it is too late to apply for DR. Remember, I'm the person who didn't decide to do DR until early in M4 year.
2. Doctor vs. Not Doctor: You need to think deeply on whether this is actually a real question for you or not. I would say over 99% of rads do not have this in their minds at all--the fact that you do might be an issue. Over 30 years of training residents, the few that drop out always seem to have this in their minds, so if it is a serious thought, that is a negative predictor.
3. I would venture to say that I love my job. But I'm not in PP. I have friends in PP who really like their job (not sure anyone loves it). I have friends in PP who aren't that thrilled.

Thank you for a quick and thoughtful response. My mother is actually a pathologist and it literally does not bother her at all so I recognize the Doctor vs Not Doctor thing is frankly all in my head. It may even be a sign of immaturity, I don't know, but I concede that is possible. I mean, really no one will care what I do -- it's not like the public or family friends have an understanding of how medicine works in general. I guess I wrote that because I just had this image of what my career would look like as an EM doc and only in the past few weeks as I have been ruminating on possibly attempting to apply DR that suddenly my idea of what my future could look like is a lot more intimidating given the wholly unique day-to-day work of Radiologist. That is, it is easy I think for most medical students to envision what being a EM doc or surgeon would feel since we have opportunities to actually participate. When I shadowed the neuroradiologist, while he was really nice, I couldn't attempt my own search pattern or look for pathologies -- but that could also be because as you have noted before that it is frankly learning a new language and way of thinking. I wonder if the fact that I did not feel like Cupid's arrow struck me while in that dark room means perhaps I don't have some visceral love for Radiology. Could that also be a negative predictor?

In addition, I don't think I can get a DR LOR before ERAS opens, but instead immediately after it opens. Instead, I've been watching a few Radiology lectures online, reading up interesting cases on Radiopedia, and even listening to Sarel Gaur about the business and life of PP radiology -- and of course trying to read as many threads on this forum too!

 

[anon12380]

You should also read this thread to get a more accurate idea of the day to day practice of radiology


What contributes to burnout in Radiology?

What contributes to burnout in Radiology?

Genuinely curious - what are the big factors that contribute to Radiology burnout? Is it mostly because of high volume or are there other factors I don't understand as a non-radiologist? Thanks in advance.

forums.studentdoctor.net

Yup, I was reading that this morning with my coffee. I believe the recent Medscape survey though put Rads as Top 5 in terms of career choice (ie would you pick the same specialty again), so I think that must be the case for a reason(s)?

 

[anon12380]

Not saying salary and job security aren’t really important, but I think OP should focus more on what he likes about the jobs themselves when making this decision. The day to day of EM and rads are so different

This is fair observation. And I know I stated lifestyle and salary upfront, but I do of course want to enjoy what I do otherwise what's the point, right? I think my challenge is that I have experienced the day to day of an EM doc and I liked it. Not love, but liked it (at least better than anything else). The day to day of a Radiologist is hard to get a feel for as a medical student I feel since it is highly specialized and basically hard to understand. Similar to anesthesiology in that a student mostly stands around since a lot of what anesthesiologist do is cerebral and of course that is basically Rads in a nutshell.

 

[deleted746658]

The worst thing for any field is oversupply. Just look at RadOnc today. Those poor PGY-5s are begging for jobs.

Radiology has, somehow, actually not oversaturated its field to the same extent like many others.
ACGME has a website with the total number of residents in any given academic year (i.e. for rads this would be R1 + R2 + R3 + R4)

ACGME - Accreditation Data System (ADS)

Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years!

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years.

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years.

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years!

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Reimbursement decreases mean even more when you are in an oversupply. Posts of EM talk about Denver EM jobs paying as little as $140/hr to new grads. The days of ~350-500/hr locums rates in bumblef**k Texas are also over.

IIRC, in the not so distant past rad residents were doubling down on fellowships... 7 years of training! yikes!

us young trainees need to make hay while the sun shines, and committing 6 years to train in a field with a hazy future is not in most med student's best interest

and, if AI makes delivers on even half the hype, there will undoubtedly be a period (maybe 10-15 years from now?) where senior rad residents are firing up ERAS to switch fields.

 

[qwerty89]

Lol what are you even saying? You know radiology is notoriously known for having periods of oversaturation and supply glut right?

Radonc isn't a good example. Not every hospital can afford a multi-million dollar accelerator and ancillary staff.

The last period of oversupply was during and immediately after the great recession. THAT period is a result of residency expansion that took place in the years PRIOR to that. Let me give you numbers.

Year 2000 using NRMP match data https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2013/08/resultsanddata2000.pdf
= 814 combined PGY-1 and 2 spots. Multiplying that by 4 to give us a crude measurement of total number of residents at any one time = 3364
2001-2002: 3805
2003-2004: 4134
2005-2006: 4303
2007-2008: 4427

In 8 years from 2000 to 2008 total resident numbers had exploded from 3364 to 4427. Which is a 31.5% increase.

As I showed before, the expansion from 2007-2008 to 2020-2021 is only 11.5%.

Meanwhile EM had a total of 1118 PGY1 and 2 spots in the match in 2000. Multiply that by 3 and you get 3354 spots. Multiply it by 4 and you get 4472 spots. The real number is somewhere in between closer to 3 since most EM programs are 3 years.

But you guys do what you want.

 

[qwerty89]

IIRC, in the not so distant past rad residents were doubling down on fellowships... 7 years of training! yikes!

us young trainees need to make hay while the sun shines, and committing 6 years to train in a field with a hazy future is not in most med student's best interest

and, if AI makes delivers on even half the hype, there will undoubtedly be a period (maybe 10-15 years from now?) where senior rad residents are firing up ERAS to switch fields.

Is going into EM, a hospital based field dominated by CMGs, is supposed to be better? The number of freestanding ERs has been declining.

If this is a serious concern pick a field like Psychiatry where you have little overhead and aren't tied to a hospital. Do what you want.

But picking EM over Rads because you think the future is hazy?

Well. You might be on to something. The future in EM isn't as hazy. The future sounds like decreased pay with worse staffing ratios (i.e. supervising more midlevels) all while dealing with the constant circadian rhythm disruption. So yeah the future of rads is definitely more hazy than that. AI? Who knows when and how it will impact rads. But the future of EM is pretty clear to me.

 

[medradthrowaway]

The last period of oversupply was during and immediately after the great recession. THAT period is a result of residency expansion that took place in the years PRIOR to that. Let me give you numbers.

Year 2000 using NRMP match data https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2013/08/resultsanddata2000.pdf
= 814 combined PGY-1 and 2 spots. Multiplying that by 4 to give us a crude measurement of total number of residents at any one time = 3364
2001-2002: 3805
2003-2004: 4134
2005-2006: 4303
2007-2008: 4427

In 8 years from 2000 to 2008 total resident numbers had exploded from 3364 to 4427. Which is a 31.5% increase.

As I showed before, the expansion from 2007-2008 to 2020-2021 is only 11.5%.

Meanwhile EM had a total of 1118 PGY1 and 2 spots in the match in 2000. Multiply that by 3 and you get 3354 spots. Multiply it by 4 and you get 4472 spots. The real number is somewhere in between closer to 3 since most EM programs are 3 years.

But you guys do what you want.

I'd say radiology suffered a massive supply glut from 08 all the way to 2015. Since then it has started to come back ,but now COVID has taken volumes down dramatically again. While I don't doubt volumes will come back eventually, the issue is that radiology is still graduating 1000 residents a year and any disruption in demand (whether it be COVID or incremental improvements in AI) will set the job market dramatically back.I don't doubt the grads from Hopkins and Harvard will have any trouble landing a gig but it will be tough for the rest. You'd be hard pressed to find a job in a good city without a fellowship these days.

Also, the corporatalization of healthcare is not unique to EM and don't be surprised when I tell you that radiology is going through the same thing right now with huge entities buying out small PP.

 

[AnxietyMonster]

IIRC, in the not so distant past rad residents were doubling down on fellowships... 7 years of training! yikes!

us young trainees need to make hay while the sun shines, and committing 6 years to train in a field with a hazy future is not in most med student's best interest

and, if AI makes delivers on even half the hype, there will undoubtedly be a period (maybe 10-15 years from now?) where senior rad residents are firing up ERAS to switch fields.

I see your posts on here often about the same topics (AI and such). That's totally fine that you think that and I think it's a valid concern. I'm just curious if you're a radiologist or in another specialty or like me a med student considering rads. I'm just trying to frame your thoughts and wondering why you're hanging around the rad board.

 

[qwerty89]

I'd say radiology suffered a massive supply glut from 08 all the way to 2015. Since then it has started to come back ,but now COVID has taken volumes down dramatically again. While I don't doubt volumes will come back eventually, the issue is that radiology is still graduating 1000 residents a year and any disruption in demand (whether it be COVID or incremental improvements in AI) will set the job market dramatically back.I don't doubt the grads from Hopkins and Harvard will have any trouble landing a gig but it will be tough for the rest. You'd be hard pressed to find a job in a good city without a fellowship these days.

All this talk about fellowships miss the point. Radiology has gotten more and more complex (as has the rest of medicine). Fellowship trained musculoskeletal radiologists, neuroradiologists, and even body imaging radiologists add a lot more to their knowledge base with their extra training. How many recent graduates feel super comfortable reading post op H&N tumor cases or temporal bone or wrist MR. Many dont feel comfortable with bread and butter MSK MR including shoulders and knees.

On a separate note. You might be surprised at how many Ortho and ENT residents are doing fellowships these days. At most university programs in large metropolitan areas it is well over 50%. Those are fields which have not had crazy residency expansion.

 

[sloh]

The concern about AI and radiology seems like a red herring. From that thread I posted above about Radiology burnout:

“Improved technology in radiology has led to MORE work most of the time. We have doubled our resolution on many scans and now have multiplanar reformats and high resolution reconstructions become the norm, which on average is at least 2-3x more work now compared to 'the old days' of the 16 slice non-contrast head. This hasn't happened for most other specialties.”

 

[CallMeBigJeff]

@cosine89 Why are you so obsessed with fear-mongering Rads? Aren't you an IM resident?

 

[deleted746658]

@cosine89 Why are you so obsessed with fear-mongering Rads? Aren't you an IM resident?

fear mongering? i'm just trying to force people to pause and think before they commit 6 years (maybe 7 in a bad market) to a field that has the potential to be disrupted by machine learning.

it's not fear mongering. the tech is already here. you saw the mammo nature paper, no? you're in denial if you refuse to believe this tech won't be transformative. they're not just designing tech to count and measure pulm nodules.

 

[anon12380]

The worst thing for any field is oversupply. Just look at RadOnc today. Those poor PGY-5s are begging for jobs.

Radiology has, somehow, actually not oversaturated its field to the same extent like many others.
ACGME has a website with the total number of residents in any given academic year (i.e. for rads this would be R1 + R2 + R3 + R4)

ACGME - Accreditation Data System (ADS)

Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years!

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years.

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years.

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years!

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Reimbursement decreases mean even more when you are in an oversupply. Posts of EM talk about Denver EM jobs paying as little as $140/hr to new grads. The days of ~350-500/hr locums rates in bumblef**k Texas are also over.

I have been reading up on the expansion of EM programs. EM residents and docs have told me, though, that the market is still favorable and now EM leadership is getting involved apparently to stop the expansion of residencies. It would be disingenuous for me not to say that I have kept such factors into consideration. From your previous posts, seems radiology was perfect for you since you dislike patient contact. Maybe it's the wide-eyed medical student in me, but my experiences with patients have been net positive, but I am weary things could/will change once I am resident and actually have responsibility. I mean, the million dollar question for me is knowing what signs indicate that I could get burnt out from patient contact. But, suffice to say posts like yours make me anxious and provide an objective data point to pursue radiology. As an aside, I am not worried at all about AI.

 

[AnxietyMonster]

@cosine89 Why are you so obsessed with fear-mongering Rads? Aren't you an IM resident?

1. I don't think it is too late to apply for DR. Remember, I'm the person who didn't decide to do DR until early in M4 year.
2. Doctor vs. Not Doctor: You need to think deeply on whether this is actually a real question for you or not. I would say over 99% of rads do not have this in their minds at all--the fact that you do might be an issue. Over 30 years of training residents, the few that drop out always seem to have this in their minds, so if it is a serious thought, that is a negative predictor.
3. I would venture to say that I love my job. But I'm not in PP. I have friends in PP who really like their job (not sure anyone loves it). I have friends in PP who aren't that thrilled.

This is absolutely fascinating. I don't have much to add but I appreciate this information.

FWIW, I think I used to be more interested in being "the doctor" but as i've changed through medical school it has lost importance. Now I see some level of appeal in when saying I'm a radiologist (in the future), many people will think I am the person who takes the xrays. I find myself to be an interesting person outside of medicine and am so sick of talking about medicine at parties and with friends/relatives.

 

[AnxietyMonster]

fear mongering? i'm just trying to force people to pause and think before they commit 6 years (maybe 7 in a bad market) to a field that has the potential to be disrupted by machine learning.

it's not fear mongering. the tech is already here. you saw the mammo nature paper, no? you're in denial if you refuse to believe this tech won't be transformative. they're not just designing tech to count and measure pulm nodules.

You've been raising AI fears in rads and a little bit in anesthesia since 2016. I spent some time reading your post history and went down that rabbit hole because, well, god knows why. But if you were a rad resident turned IM why did you go into rads in first place if you've been significantly concerned since 2016?

I don't think your fears are baseless but I certainly don't totally line up with your thoughts. Mostly, I'm just personally fascinated in the psychology of coming to the rads board as a non-rad to disseminate this information. You say to prevent people from making bad/ill-informed decisions, I'm not sure I see it. Perhaps your time would be better spent convincing various single parents from signing up for MLM schemes since you're so attracted to dissuading folks from making poor decisions online? Maybe you could do some work with those considering Scientology?

Just some thoughts on other ways you can spend your time!

You seem like a smart fellow and perhaps you should be honest with yourself about your motives, whatever they may be.

 

[anon12380]

This is absolutely fascinating. I don't have much to add but I appreciate this information.

FWIW, I think I used to be more interested in being "the doctor" but as i've changed through medical school it has lost importance. Now I see some level of appeal in when saying I'm a radiologist (in the future), many people will think I am the person who takes the xrays. I find myself to be an interesting person outside of medicine and am so sick of talking about medicine at parties and with friends/relatives.

I guess since I am in the thick of medical school, right now my identity is certainly tied to being a physician. I don't think that makes me lame or anything lol -- it's been a goal to be where I am since 2010.

I guess I have not changed that much through medical school; probably have become a bit more boring due to all this studying, but I enjoy the medicine that I am learning (not surgery though, that I can happily do without). I guess that is something I am seeing on this thread and elsewhere -- lots of radiologist don't tie their identity to their career but I've met quite a few EM docs who actually say their identity is closely intertwined (but they stress they love their private lives outside of the ED). It may be sappy to say, but it almost seems that a good chunk of EM docs are doing so because it was a calling despite all the evidence on how it is bad for your health, burnout, etc. I wonder if such emotional desires to pursue Radiology exist? I mean it must, I just don't know any Radiologists in my personal life. I suppose this is what the crux of my post is about.

 

[AnxietyMonster]

I guess since I am in the thick of medical school, right now my identity is certainly tied to being a physician. I don't think that makes me lame or anything lol -- it's been a goal to be where I am since 2010.

I guess I have not changed that much through medical school; probably have become a bit more boring due to all this studying, but I enjoy the medicine that I am learning (not surgery though, that I can happily do without). I guess that is something I am seeing on this thread and elsewhere -- lots of radiologist don't tie their identity to their career but I've met quite a few EM docs who actually say their identity is closely intertwined (but they stress they love their private lives outside of the ED). It may be sappy to say, but it almost seems that a good chunk of EM docs are doing so because it was a calling despite all the evidence on how it is bad for your health, burnout, etc. I wonder if such emotional desires to pursue Radiology exist? I mean it must, I just don't know any Radiologists in my personal life. I suppose this is what the crux of my post is about.

Oh just a quick point, no offense to those who do tie their identity to medicine or their career. I don't think it'd make you lame by any means. I, personally, am just sick of it and would rather talk about kayaking or something. My comment on the "i'm interesting outside of medicine" is just me poorly expressing that I wanna talk about other stuff. Sorry if I stated that poorly earlier and hope I didn't offend.

I think you could find both in both fields, but I'm sure you're right that more EMs are like that than radiologists. Personally, rads is just a means for me to do something that's intellectually satisfying, helpful, provides an income, and is involved in science. So in a more abstract way I think the field really draws passion from me. Plus images are pretty ****ing cool, in a non abstract way.

I think you're sounding more like an ER doc to me, but truly you know best!

 

[anon12380]

Oh just a quick point, no offense to those who do tie their identity to medicine or their career. I, personally, am just sick of it and would rather talk about kayaking or something. Sorry if I stated that poorly earlier and hope I didn't offend.

I think you could find both in both fields, but I'm sure you're right that more EMs are like that than radiologists. Personally, rads is just a means for me to do something that's intellectually satisfying, helpful, provides an income, and is involved in science. So in a more abstract way I think the field really draws passion from me. Plus images are pretty ****ing cool, in a non abstract way.

I think you're sounding more like an ER doc to me, but truly you know best!

You may be right. I guess coming across so much #FOAMed Radiology has opened my eyes to what I previously thought was a rather mundane specialty and the more I read the more I think that, yeah, images are pretty cool. Do you have any recommendations, readings, or podcasts that could help elucidate whether or nor Rads is a good fit? It's funny because this time last year I was enamored with IR and was told not to even consider IR if one does not like DR -- which at that time I thought was as boring as watching paint dry -- and now I've completely flipped by way of my EM experience.

 

[qwerty89]

I have been reading up on the expansion of EM programs. EM residents and docs have told me, though, that the market is still favorable and now EM leadership is getting involved apparently to stop the expansion of residencies. It would be disingenuous for me not to say that I have kept such factors into consideration. From your previous posts, seems radiology was perfect for you since you dislike patient contact. Maybe it's the wide-eyed medical student in me, but my experiences with patients have been net positive, but I am weary things could/will change once I am resident and actually have responsibility. I mean, the million dollar question for me is knowing what signs indicate that I could get burnt out from patient contact. But, suffice to say posts like yours make me anxious and provide an objective data point to pursue radiology. As an aside, I am not worried at all about AI.

Fair enough. Good luck. But never forget that at the end of the day its just a job. I think many docs like to tie their identity around "being a real doctor" because it helps them justify why they spent hundreds of thousands and years of your life on this path. Otherwise you are just left with the reality that you lost a decade and gained, at best, a decent job out of it. And that's a depressing thought for many.

 

[AnxietyMonster]

You may be right. I guess coming across so much #FOAMed Radiology has opened my eyes to what I previously thought was a rather mundane specialty and the more I read the more I think that, yeah, images are pretty cool. Do you have any recommendations, readings, or podcasts that could help elucidate whether or nor Rads is a good fit? It's funny because this time last year I was enamored with IR and was told not to even consider IR if one does not like DR -- which at that time I thought was as boring as watching paint dry -- and now I've completely flipped by way of my EM experience.

Hopefully some more experienced folks can help you. For me, my interest was tickled when I heard radiologists talk about the field. "oh it's not just looking at images and spitting out info? It's actually something that requires you to process tons of information in a very cerebral way?" This was sort of the nidus that grew the interest. From there, just talking to more radiologists about what they like and dislike and then looking at images while on rotations (even though I have essentially no diagnostic skills) helped me grow. Admittedly, it's quite boring to watch someone think if they're not expressing all the thoughts with words.

It was a lot of ruling things out as well. I like a lot of patient contact, but generally feel that this is going to wane for me. Moreover, the "bad" patients who take energy from you do a lot more harm for me than the "good" patients who give me energy. Think the IVDU who is drug seeking or someone annoyed at you for something you can't control vs. the patient you connect with on a personal level. I worked in the ED for some time, and I didn't want to turn jaded by the time I was 50 like many of the docs. Please, take these with a grain of salt. These are how I arrived at my decision but to use these you have to feel the same way and be of a similar constitution as me.

 

[sloh]

Hopefully some more experienced folks can help you. For me, my interest was tickled when I heard radiologists talk about the field. "oh it's not just looking at images and spitting out info? It's actually something that requires you to process tons of information in a very cerebral way?" This was sort of the nidus that grew the interest. From there, just talking to more radiologists about what they like and dislike and then looking at images while on rotations (even though I have essentially no diagnostic skills) helped me grow. Admittedly, it's quite boring to watch someone think if they're not expressing all the thoughts with words.

It was a lot of ruling things out as well. I like a lot of patient contact, but generally feel that this is going to wane for me. Moreover, the "bad" patients who take energy from you do a lot more harm for me than the "good" patients who give me energy. Think the IVDU who is drug seeking or someone annoyed at you for something you can't control vs. the patient you connect with on a personal level. I worked in the ED for some time, and I didn't want to turn jaded by the time I was 50 like many of the docs. Please, take these with a grain of salt. These are how I arrived at my decision but to use these you have to feel the same way and be of a similar constitution as me. I'm a weird person generally and have enough idiosyncratic worldviews that you should not let me project my ideas onto you without hesitation.

I originally considered EM but ended up specializing in PM&R to avoid these”draining” patients and still, I find that patients are—more often than not—exasperating

 

[slowthai]

On a separate note. You might be surprised at how many Ortho and ENT residents are doing fellowships these days. At most university programs in large metropolitan areas it is well over 50%. Those are fields which have not had crazy residency expansion.

Yep, 95%+ of ortho residents do a fellowship.

 

[Dave1980]

One issue I need help with which is entirely a superficial topic is my personal challenge with "feeling like a doctor".

Does EM feel like a doctor? I always thought it felt more like a glorified charge nurse.

IMO the radiologist is one of the most important people in the hospital in terms of treating patients correctly. The only good thing about EM>rads is that it is half the training so you make an extra 900k during those 3 extra attending years.

 

[AvacadoToast]

You may be right. I guess coming across so much #FOAMed Radiology has opened my eyes to what I previously thought was a rather mundane specialty and the more I read the more I think that, yeah, images are pretty cool. Do you have any recommendations, readings, or podcasts that could help elucidate whether or nor Rads is a good fit? It's funny because this time last year I was enamored with IR and was told not to even consider IR if one does not like DR -- which at that time I thought was as boring as watching paint dry -- and now I've completely flipped by way of my EM experience.

Try listening to the podcast "The Undifferentiated Medical Student." I haven't listened to it myself, but there are a few topics on IR, DR, DR-MSK.

 

[scoopdaboop]

Also interested in both specialties, but M2. How does vacation time work in rads? So if you have 12 weeks vacation a year, can you schedule that up for 2-3 week blocks 4-6 times a year? Or is it like 3-4 day chunks if you're on call every 3-4 days?

Also, because fellowship is required, can't you do the 2 yr IR fellowship to alleviate the AI worrying, if there is anything to worry about. I mean it's 7 instead of 6, which in the long run is pretty mute, because I imagine you can moonlight a lot in IR fellowship.

Also, what is this CMS 0 percent rule? So let's say in 2021 they release their next (for 2022) CMS reimbursements increases/decreases, because it's a 0 percent change across the board, radiology could get a 5 percent bump say in 2022, and another specialty takes the hit right.

 

[Dave1980]

Also interested in both specialties, but M2. How does vacation time work in rads? So if you have 12 weeks vacation a year, can you schedule that up for 2-3 week blocks 4-6 times a year? Or is it like 3-4 day chunks if you're on call every 3-4 days?

Also, because fellowship is required, can't you do the 2 yr IR fellowship to alleviate the AI worrying, if there is anything to worry about. I mean it's 7 instead of 6, which in the long run is pretty mute, because I imagine you can moonlight a lot in IR fellowship.

Do you think vacation time in radiology is standardized across the whole US?

 

[scoopdaboop]

Do you think vacation time in radiology is standardized across the whole US?

No, I was just curious what the norm is. I mean, the reason i'm considering radiology is one - IR, and 2- the vacation time, 3- the money.

 

[Dave1980]

Well obviously vacation time will work differently in every practice. 12 weeks is probably generous these days. I'd expect 7-10 weeks.

IR is only 7 years if you are bad at planning. It should only take 6 years now.

 

[scoopdaboop]

Well obviously vacation time will work differently in every practice. 12 weeks is probably generous these days. I'd expect 7-10 weeks.

IR is only 7 years if you are bad at planning. It should only take 6 years now.

yeah as a DO, im preparing for the worst. IR match is like high 60s, but regular DR is 92 percent.

 

[scoopdaboop]

Well obviously vacation time will work differently in every practice. 12 weeks is probably generous these days. I'd expect 7-10 weeks.

IR is only 7 years if you are bad at planning. It should only take 6 years now.

But how do you take vacation? Are you able to schedule 2-3 week chunks?

 

[CyrusHabs7695]

@cosine89 Why are you so obsessed with fear-mongering Rads? Aren't you an IM resident?

I see your posts on here often about the same topics (AI and such). That's totally fine that you think that and I think it's a valid concern. I'm just curious if you're a radiologist or in another specialty or like me a med student considering rads. I'm just trying to frame your thoughts and wondering why you're hanging around the rad board.

I think he usually gets pretty bored when writing notes and dealing with social work all day on the weekends, so he hops on here to rip apart radiology

 

[scoopdaboop]

 

[AnxietyMonster]

But how do you take vacation? Are you able to schedule 2-3 week chunks?

Same as any other job in any other industry. It depends on where you work.

 

[qwerty89]

Locums: The Big Canary in the Emergency Medicine Coalmine

So for the med students out there interested in the aforementioned “doomed specialities” (EM and anesthesia for me), what specialities are NOT doomed? Surgery? Primary care? Also, is ACEP just propaganda? Their salary numbers this year still seem high and the number of FM/IM doctors working in...

forums.studentdoctor.net

 

[Cognovi]

No, I was just curious what the norm is. I mean, the reason i'm considering radiology is one - IR, and 2- the vacation time, 3- the money.

These are not the right reasons.

 

[808s&heartbreak]

All this talk about fellowships miss the point. Radiology has gotten more and more complex (as has the rest of medicine). Fellowship trained musculoskeletal radiologists, neuroradiologists, and even body imaging radiologists add a lot more to their knowledge base with their extra training. How many recent graduates feel super comfortable reading post op H&N tumor cases or temporal bone or wrist MR. Many dont feel comfortable with bread and butter MSK MR including shoulders and knees.

On a separate note. You might be surprised at how many Ortho and ENT residents are doing fellowships these days. At most university programs in large metropolitan areas it is well over 50%. Those are fields which have not had crazy residency expansion.

Knowledge isn't confined to fellowships. Anyone who is motivated to learn can learn, especially with resources like radiopedia which are wayyyyy better than my attendings.

There really isn't much to fellowships aside from formality and interventional skills - those are hard to emulate. Others you can pick up from casestacks, pacsbin, etc etc, without doing the scutwork.

 

[medradthrowaway]

Knowledge isn't confined to fellowships. Anyone who is motivated to learn can learn, especially with resources like radiopedia which are wayyyyy better than my attendings.

There really isn't much to fellowships aside from formality and interventional skills - those are hard to emulate. Others you can pick up from casestacks, pacsbin, etc etc, without doing the scutwork.

Agreed. All this push to self-policing ourselves and cornering us into a PGY6 and PGY7 and possibly PGY8. Where does it end? Now, you have mid-levels that can practice whatever straight out of school. Why are we doing this to ourselves? Say no to endless fellowships. Life is short, dont spend a whole decade being a slave to the system.

 

[patel1283]

Current rads resident. To answer the OP question, if my body could tolerate whacky schedules I would do EM given the short residency. You can have more stable hours in radiology but the training is doubled. Obviously, pick something you're more interested in but hard to tell as a medical student. If I had to do it all over again, I probably would have done EM. But radiology is great just long training length. I dunno how AI , corporate radiology, and NP/PA intrusion will impact us but we're not the only field facing these challenges.

 

[Dave1980]

In my group we only let chest fellowship trained ppl read pre op chest x-rays.

 

[r9too]

In my group we only let chest fellowship trained ppl read pre op chest x-rays.

Seriously?