People who did a procedural heavy DR fellowship, eg MSK or body

[GoPelicans]

How much of your procedural skills do you actually get to use in practice? Some MSK fellowships are almost 50% procedural, does this seem overkill to you? I just assumed most guys would be doing close to 100% dictating once they were actually in practice. Is this amount of procedures just something seen at academic medical centers?

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[maxxor]

How much of your procedural skills do you actually get to use in practice? Some MSK fellowships are almost 50% procedural, does this seem overkill to you? I just assumed most guys would be doing close to 100% dictating once they were actually in practice. Is this amount of procedures just something seen at academic medical centers?

Depends where and how much you want to do.

I did a 50% procedure msk fellowship. Now I mostly practice Nucs but still read in the msk division.

I would only build a procedure heavy practice if you have the team to support it: scheduler, great techs, dedicated machines. Otherwise, you are fighting a losing battle because most of radiology is not designed for that.

You need a place with a weak pain division (or ortho referrers who love to add on patients and you have wide open availability. That’s the only way radiology can compete).

Most abdominal divisions are ceding CSIR to regular IR because the pipeline of people willing to do the procedures is drying up.

 

[guytakingboards]

How much of your procedural skills do you actually get to use in practice? Some MSK fellowships are almost 50% procedural, does this seem overkill to you? I just assumed most guys would be doing close to 100% dictating once they were actually in practice. Is this amount of procedures just something seen at academic medical centers?

Not a body/MSK guy but I work in a large, multi-specialty practice and generally know what my MSK/body colleagues do. We cover a spectrum of hospitals from 450 bed lvl 1 centers to 75 bed lvl 4 centers.

MSK: Maxxor's post is spot on from what I've seen. This procedure service line is not an easy one to build up because it puts you in direct competition with your referrers (pain and ortho) and may be a marginal revenue source. Because image-guided MSK interventions pay so poorly, an MSK rad's time is almost certainly better spent reading the list. As also mentioned, it's somewhat capital/resource intensive to do it well as you need extra resources above the regular radiology workflow. My group does 1 day a week of US-guided MSK interventions but that's really only because they promised it to a guy coming out of a procedure-heavy MSK fellowship a few years back. The service line never grew past 1 day (his day) of work and other younger MSK rads in his section chose not to do those procedures.

Body: Really runs the gamut. Our hospital "body slots" can be covered by a body-trained person or overflow from other sections (IR,MSK, etc...). We have a large hospital footprint, so body intervention requirements vary widely. Smaller hospital manned by 1 rad total? Sometimes zero non-thora/para procedures. Larger community tertiary referral center? Sometimes upwards of 10 procedures a day including 6-7 CT/US biopsies/drains and a handful of thora/paras. For example, a day with a CT-lung bx, 2-3 CT-bone marrow biopsies, 1 US-random liver bx, 1-2 drains (plus a few thora/para's) is uncommon but does happen. Not every body/general rad can handle that seat and the VIR and/or mid-level has to help out.

In my opinion, a DR comfortable with the full spectrum of body CT/US interventions is super useful to any group with a decent hospital presence. Doesn't have to be body-trained specifically. It really helps with group flexibility, as it means an IR doesn't have to cover that site (if small) or can focus more on endovascular work (at bigger sites with multiple seats).

 

[GoPelicans]

I ask becasue I applied MSK - if I wanted to find a job that gets my butt out of the chair a few times a week to do a para/thoro, biopsy, joint injection, etc etc would this be hard to find? Especially if I am limiting myself geographically to a specific state. I ask because I recently reached out to three recent MSK alums from my program and they all do jobs which are 100% DR, and said this is the vast majority of jobs out there. In residency I feel I just go insane on rotations where all I am expected to do is dictate at a fast pace all day.

 

[guytakingboards]

I ask becasue I applied MSK - if I wanted to find a job that gets my butt out of the chair a few times a week to do a para/thoro, biopsy, joint injection, etc etc would this be hard to find? Especially if I am limiting myself geographically to a specific state. I ask because I recently reached out to three recent MSK alums from my program and they all do jobs which are 100% DR, and said this is the vast majority of jobs out there.

That's kind of surprising to hear that. Short of doing boutique outpatient only work, I'd expect a PP MSK rad to have some procedure responsibilities.

I'd say ask some more people and furthermore reach out to groups you might be interested in and ask what they need/expect from incoming rads.

Another possibility is taking the time to mold whatever job you take into what you want. In my experience, the job can and will vary a lot. The job I signed up for is not the job I did my first year and is similar but still different than what I do now in my 3rd year. Part of that is me molding the job to be what I want it to be. Unless there's particular logic/resistance, I'd imagine a group would be flexible if not welcoming of a MSK rad who wanted to do more of the basic stuff like thora/para/LP/joint injections and take that off an IR's hands.... provided the IR could also help read studies while you are doing procedures.

In residency I feel I just go insane on rotations where all I am expected to do is dictate at a fast pace all day.

In residency, you probably are dictating closer to your max speed (at the time) then you will be after a few years in practice. It completely makes sense that procedures in residency help break up tough rotations.

A few years out of training, I have a very different opinion of procedures than I did in your shoes. Most of my junior colleagues feel the way same. We all wanted the procedure heavy/action packed rotations as first years. A few years later almost every single one of my colleagues is happy to a have a procedure free day. Our day work is more like 50% effort, not like the max speed effort of call or what it felt like as a trainee.

 

[MouseChair]

If you don’t mind me asking, I think I saw posts from you before stating you were ESIR. Why the switch?

-R1 (very) interested in IR but has vague doubts.

 

[odyssey2]

If you don’t mind me asking, I think I saw posts from you before stating you were ESIR. Why the switch?

-R1 (very) interested in IR but has vague doubts.

Switches from IR to DR are pretty common. Residents get a taste of the diagnostic lifestyle and don't look back

 

[vm26]

Switches from IR to DR pretty common. Residents get a taste of the diagnostic lifestyle and don't look back

I get it. With this said, DR lifestyle in todays PP is not cush, particularly when the group covers overnights internally etc..

 

[GoPelicans]

If you don’t mind me asking, I think I saw posts from you before stating you were ESIR. Why the switch?

-R1 (very) interested in IR but has vague doubts.

Had to go into work one too many times at 3am. It was a difficult decision becasue I love procedures a lot more than looking at scans. But I have a family now which became +1 in the past year and I looked ahead at attending life and saw they were still taking a ton of call. So lifestyle is the answer to your question. If I could go back back in time maybe I would've done anesthesia instead since their call is a bit more accomodating and the residency is shorter. Hard to say. You make the bets decisions in life with the information you have at the time.