Quitting Rads

[Le chat noir]

I am about to enter the 2nd year in Rads residency, but I have never felt so tired of it. I am a bit unsecure about my future - and this means to me to drop Medicine -, but I guess it may helpful to share and get some input from you.


I came to realise that I really do not enjoy to sit in front of a screen long hours (about 10h a day as a resident), day after day... I barely see the light outside and, let s say, "normal" people!

The work becomes a routine and I really I feel unpatient for all those unclear clinical questions that come TOO OFTEN on the exam requisition form - how many times we are meant to call the IM jerk to provide decent info!

I start even to notice that my vision got worse from looking so close at computer screens day after day and, honestly, I do not feel my work is valuable. I did my internship year in Geriatrics and at least there was some kind of human interaction - even if I start to realise that it is a big flop "human interaction" in Medicine... a big lie.

I also came to realise how big it can be the legal pressure on us, radiologists, as well that I find a shame that we refer to the other colleagues as "your doctor will tell you how to manage our imaging findings... ****, are not radiologists doctors too?"

I find really hard to cope with the lack of variety in the way we do Medicine and I guess that money is the thing I may regret by leaving Rads. And that s why I do even think that most of us, docs, were wrong in our choices. We were told lies during our studies about being a doctor, a job that I increasingly find precarious nowadays...

It has been hard to accept this, but I never felt so close to drop this "miserable" work life. You may read well 95 per cent of your CTs but the very day you commit a mistake... ****, no one wil stand for you! Is this worth some many hours of study and work, so many pressures on our shoulders?

I do enjoy Apache Indian comments, they are so true for someone enjoying the field. Yet they can be misleading as well, if we dare to think of so many options out of Medicine, away from the Hospital...

Tired and without motivation to burn my eyes, I really feel my time is over in Radiology. Do you guys have similar feelings?

I am really thinking of having a break and study International Business somewhere, bang a nice girl, learn foreing languages and just forget this faked idea that docs are meant to be "good".

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[colbgw02]

It sounds like you might be thinking of leaving medicine completely. If so, and you have something in mind that you'd rather do and have the means to do it, then go for it. I know that I feel like I'm too invested in medicine to think about changing careers, but luckily I enjoy radiology.

If you're thinking of leaving radiology for another medical field, then the only compelling reason to do so in my mind is because you miss patient contact. That doesn't sound like the case, however. You may feel that your work in radiology is tedious and futile, but you'll most likely feel the same about another field, if not to a greater extent.

 

[freddydpt]

sounds like a troll

 

[C5toC9]

Interesting post from a year ago:

http://forums.studentdoctor.net/showthread.php?p=8555812#post8555812

 

[fun8stuff]

If you aren't happy with radiology, you won't be happy working any job... my advice would be to start playing the lotto! In reality, you have to get another job (outside of medicine) in order to fully appreciate how good rads have it.

 

[DrGregoryHouse]

I am about to enter the 2nd year in Rads residency, but I have never felt so tired of it. I am a bit unsecure about my future - and this means to me to drop Medicine -, but I guess it may helpful to share and get some input from you.


I came to realise that I really do not enjoy to sit in front of a screen long hours (about 10h a day as a resident), day after day... I barely see the light outside and, let s say, "normal" people!

The work becomes a routine and I really I feel unpatient for all those unclear clinical questions that come TOO OFTEN on the exam requisition form - how many times we are meant to call the IM jerk to provide decent info!

I start even to notice that my vision got worse from looking so close at computer screens day after day and, honestly, I do not feel my work is valuable. I did my internship year in Geriatrics and at least there was some kind of human interaction - even if I start to realise that it is a big flop "human interaction" in Medicine... a big lie.

I also came to realise how big it can be the legal pressure on us, radiologists, as well that I find a shame that we refer to the other colleagues as "your doctor will tell you how to manage our imaging findings... ****, are not radiologists doctors too?"

I find really hard to cope with the lack of variety in the way we do Medicine and I guess that money is the thing I may regret by leaving Rads. And that s why I do even think that most of us, docs, were wrong in our choices. We were told lies during our studies about being a doctor, a job that I increasingly find precarious nowadays...

It has been hard to accept this, but I never felt so close to drop this "miserable" work life. You may read well 95 per cent of your CTs but the very day you commit a mistake... ****, no one wil stand for you! Is this worth some many hours of study and work, so many pressures on our shoulders?

I do enjoy Apache Indian comments, they are so true for someone enjoying the field. Yet they can be misleading as well, if we dare to think of so many options out of Medicine, away from the Hospital...

Tired and without motivation to burn my eyes, I really feel my time is over in Radiology. Do you guys have similar feelings?

I am really thinking of having a break and study International Business somewhere, bang a nice girl, learn foreing languages and just forget this faked idea that docs are meant to be "good".

Apparently Jar Jar Binks teaches english classes...

 

[Goober]

I am about to enter the 2nd year in Rads residency, but I have never felt so tired of it. I am a bit unsecure about my future - and this means to me to drop Medicine -, but I guess it may helpful to share and get some input from you.


I came to realise that I really do not enjoy to sit in front of a screen long hours (about 10h a day as a resident), day after day... I barely see the light outside and, let s say, "normal" people!

The work becomes a routine and I really I feel unpatient for all those unclear clinical questions that come TOO OFTEN on the exam requisition form - how many times we are meant to call the IM jerk to provide decent info!

I start even to notice that my vision got worse from looking so close at computer screens day after day and, honestly, I do not feel my work is valuable. I did my internship year in Geriatrics and at least there was some kind of human interaction - even if I start to realise that it is a big flop "human interaction" in Medicine... a big lie.

I also came to realise how big it can be the legal pressure on us, radiologists, as well that I find a shame that we refer to the other colleagues as "your doctor will tell you how to manage our imaging findings... ****, are not radiologists doctors too?"

I find really hard to cope with the lack of variety in the way we do Medicine and I guess that money is the thing I may regret by leaving Rads. And that s why I do even think that most of us, docs, were wrong in our choices. We were told lies during our studies about being a doctor, a job that I increasingly find precarious nowadays...

It has been hard to accept this, but I never felt so close to drop this "miserable" work life. You may read well 95 per cent of your CTs but the very day you commit a mistake... ****, no one wil stand for you! Is this worth some many hours of study and work, so many pressures on our shoulders?

I do enjoy Apache Indian comments, they are so true for someone enjoying the field. Yet they can be misleading as well, if we dare to think of so many options out of Medicine, away from the Hospital...

Tired and without motivation to burn my eyes, I really feel my time is over in Radiology. Do you guys have similar feelings?

I am really thinking of having a break and study International Business somewhere, bang a nice girl, learn foreing languages and just forget this faked idea that docs are meant to be "good".

Doesn't sound like you belong in radiology or maybe even medicine in general. Residency was great for me- 10X better than med school. If your aim is private practice radiology, you should know that radiology is one of the fields in medicine where being an attending is much more demanding than being a resident. It doesn't get easier- there are longer hours, more call and weekends.

 

[rad766]

I had very similar feelings beging year two of radiology residency.My issue became that I wanted more interaction and I wanted to get a sense of self worth through expressed appreciation from those I am working so hard to help. I felt totally out of place and useless my first year and felt that it would get better with time as I learned more radiology. I can tell you, it doesn't get better. If you hate it, quit.

 

[fun8stuff]

I had very similar feelings beging year two of radiology residency.My issue became that I wanted more interaction and I wanted to get a sense of self worth through expressed appreciation from those I am working so hard to help. I felt totally out of place and useless my first year and felt that it would get better with time as I learned more radiology. I can tell you, it doesn't get better. If you hate it, quit.

are you saying you felt appreciation during your intern year/med school? i know i didn't... the patient population i worked with felt like everything was owed to them.

 

[Holderlin]

I'm honored that my first post might be the only troll I've seen on a Med School forum. Thank you.

And for you efforts Sir,

 

[p53]

i dont agree with the trolls approach but there are some truths in their comments. Sure, interns and med students get no appreciation. The difference is that attendings in radiology get no appreciation or respect. In fact, next to Anesthesiologists I would say radiologists have the lowest prestige, respect, appreciation, and status among all physicians. Ask any nurse or people in the hospital what they think of radiologists. Lastly only 10% of the laypeople even know radiologists are physicians. Imagine working hard to become a radiologist and everyone you meet thibks radiology requires an associates degree from college. This is why the ones that hate rads go into IR. It is a way to correct ones mistake of going into rads.

 

[gonogo]

i dont agree with the trolls approach but there are some truths in their comments. Sure, interns and med students get no appreciation. The difference is that attendings in radiology get no appreciation or respect. In fact, next to Anesthesiologists I would say radiologists have the lowest prestige, respect, appreciation, and status among all physicians. Ask any nurse or people in the hospital what they think of radiologists. Lastly only 10% of the laypeople even know radiologists are physicians. Imagine working hard to become a radiologist and everyone you meet thibks radiology requires an associates degree from college. This is why the ones that hate rads go into IR. It is a way to correct ones mistake of going into rads.

But if you do IR you're still a radiologist. So I don't know how that would change people's perception. The layperson will always believe you didn't even go to med school.

 

[C5toC9]

Even more people don't know what IR is

 

[michaelrack]

Tired and without motivation to burn my eyes, I really feel my time is over in Radiology. ".

Before throwing away your career, you may want to consult an ophthalmologist. As a sleep specialist I spend a lot of time looking at sleep studies on a computer, and consulting an ophtho along with some eye drops helped me a lot.

 

[vicinihil]

Almost ALL specialties depend on Radiology to make a diagnosis. There are some no brainers, eg blatant hemorrhagic stroke, but for the most part most physicians in the hospital and private practice still depend on the final radiology read to make a final diagnosis. Doctors THINK they can read their own films, but they miss out on a lot of pathology that may be caught by a Radiologist. The good radiologist will also review patient's charts and essentially report a VERY narrow differential for the primary team. You're the doctor's doctor.

People who do not know what IR or Radiology is doesn't really matter. Your career doesn't depend on them. Doctors know who Radiologists are. Your paycheck will also speak for those that think you can get to it with an AS/AA from a community college.

 

[p53]

Tell that to the Pulmonologist that made management changes in the patient by reading his own portable chest xray before the radiologist even saw the film.

Tell that to the Neurosurgeon when he is already in the OR for a hemmoragic stroke even before the radiologist sees the Head CT from the ER.

Let's face it 90-95% of radiology is bookkeeping. Subspecialists read their own xrays, CTs, and MRIs and manage their patients even before a radiologist reads them.

The value of a radiologist are to the primary care physicians, ER physicians, and Nurse Practitioners.

For the subspecialists, they read their own film and make management decisions long before a radiologist dictates a study.

As for the paycheck. It always come down to that doesn't it.

Here is an exercise. Go to google and type in reimbursement cuts in radiology for 2010. Money today is not the same as money in 2016.

In the 90's pathologists were banking and radiologists not as much.

The key is to go into a specialty out of sincere interest. And for a 4th year medical student to say he LOVES radiology after one month rotation of sitting behind a radiology resident is pure BS.

It is about the MONEY. The scary thing is that MONEY won't be there for the medical students going into radiology today.

Almost ALL specialties depend on Radiology to

make a diagnosis. There are some no brainers, eg blatant hemorrhagic stroke, but for the most part most physicians in the hospital and private practice still depend on the final radiology read to make a final diagnosis. Doctors THINK they can read their own films, but they miss out on a lot of pathology that may be caught by a Radiologist. The good radiologist will also review patient's charts and essentially report a VERY narrow differential for the primary team. You're the doctor's doctor.

People who do not know what IR or Radiology is doesn't really matter. Your career doesn't depend on them. Doctors know who Radiologists are. Your paycheck will also speak for those that think you can get to it with an AS/AA from a community college.

 

[gonogo]

I'd have to partially agree with p53. Ortho docs are better at reading MSK than most general radiologists. The same can be said about neurosurgeons and neuro films. Imaging has become an integral part of every medical specialty.

 

[MyNameIsOtto]

LOL, I'll second that...even as a medicine intern I make assessment and plans based on the clinical picture and what I interpret on the chest x ray...i generally save the dictated report for my discharge summary.

MRI's, CT Heads are a different matter.

 

[bronx43]

Tell that to the Pulmonologist that made management changes in the patient by reading his own portable chest xray before the radiologist even saw the film.

Tell that to the Neurosurgeon when he is already in the OR for a hemmoragic stroke even before the radiologist sees the Head CT from the ER.

Let's face it 90-95% of radiology is bookkeeping. Subspecialists read their own xrays, CTs, and MRIs and manage their patients even before a radiologist reads them.

The value of a radiologist are to the primary care physicians, ER physicians, and Nurse Practitioners.

For the subspecialists, they read their own film and make management decisions long before a radiologist dictates a study.

As for the paycheck. It always come down to that doesn't it.

Here is an exercise. Go to google and type in reimbursement cuts in radiology for 2010. Money today is not the same as money in 2016.

In the 90's pathologists were banking and radiologists not as much.

The key is to go into a specialty out of sincere interest. And for a 4th year medical student to say he LOVES radiology after one month rotation of sitting behind a radiology resident is pure BS.

It is about the MONEY. The scary thing is that MONEY won't be there for the medical students going into radiology today.

Too true. Medical students are like mosquitos that swarm towards the bright light. Hell, even rats know when to scurry off a sinking ship.
If you have genuine interest for radiology, then go for it, but don't think that its current reimbursement numbers are going to stay as is.

 

[naus]

I love the radio commercials from community colleges about becoming a certified "Radiographer" or "Radiologic Technologist" to "practice the booming field of Radiography."

I'd assume that's what the layman thinks of when you tell him you're a Radiologist.

 

[petyr_baelish]

I love the radio commercials from community colleges about becoming a certified "Radiographer" or "Radiologic Technologist" to "practice the booming field of Radiography."

I'd assume that's what the layman thinks of when you tell him you're a Radiologist.

Yep and they probably have an IQ of 100.

Is there a field out there that isn't misunderstood by a layman somewhere? Who are people trying to impress? The cashier? The 22 year old girl they are dating? Extended family members who are probably just asking so they can compare you to their immediate family?

I'd love to go into Rads so I can diagnose people on my ipad from Starbucks. Or go into IR and save people from ectopic pregnancy complications.

 

[C5toC9]

On some level, everyone wants to impress. It's natural.

 

[naus]

Yep and they probably have an IQ of 100.

Is there a field out there that isn't misunderstood by a layman somewhere? Who are people trying to impress? The cashier? The 22 year old girl they are dating? Extended family members who are probably just asking so they can compare you to their immediate family?

How about professional sports? Most laymen seem to have a pretty good handle on that.

I think people generally have an idea of what surgeons do or have some conception of a Wall Street banker's lifestyle. Rads is really not in the same league of misunderstanding.

 

[2012mdc]

Yep and they probably have an IQ of 100.

Is there a field out there that isn't misunderstood by a layman somewhere? Who are people trying to impress? The cashier? The 22 year old girl they are dating? Extended family members who are probably just asking so they can compare you to their immediate family?

I'd love to go into Rads so I can diagnose people on my ipad from Starbucks. Or go into IR and save people from ectopic pregnancy complications.

The layman who doesn't know jack about medicine will be impressed that you are a doctor. People in the know will respect you for choosing one of the most intellectually difficult fields in medicine.

The lack of respect will come from the jack a.ss who thinks he knows more than he actually does about medicine and wouldn't respect/know about rads, rad onc, urology, ENT, derm, anesthesia etc.

Many people outside of medicine are ignorant about Rads but if they're educated they won't have preconceptions about the field and will be impressed once you explain all it entails

 

[ringhal]

Tell that to the Pulmonologist that made management changes in the patient by reading his own portable chest xray before the radiologist even saw the film.

Tell that to the Neurosurgeon when he is already in the OR for a hemmoragic stroke even before the radiologist sees the Head CT from the ER.

Let's face it 90-95% of radiology is bookkeeping. Subspecialists read their own xrays, CTs, and MRIs and manage their patients even before a radiologist reads them.

The value of a radiologist are to the primary care physicians, ER physicians, and Nurse Practitioners.

For the subspecialists, they read their own film and make management decisions long before a radiologist dictates a study.

I read 100-200 ICU films each week and I can tell you that the CXR's of unit players change very little day-to-day. Good pulmonolgists know this and make very few management decisions based on them. If they routinely saw films before me, I would never have to call the ICU about a Dobhoff catheter or endotracheal tube in the right mainstem bronchus, a subclavian line in the IJ or ventilator-induced pneumothorax. Since I have to call the ICU daily, I'm gonna disagree with you.

The overwhelming majority of hemorrhagic stokes are hypertensive and receive no invasive therapy. In my experience neurosurgery is only going to be involved if the patient develops increased intracranial pressure requiring a decompressive craniotomy or some sort of intracranial pressure monitoring. What sorts of things are neurosurgeons doing for patients with hemorrhagic strokes in your experience?

My day is certainly not 90% bookkeeping. Even if you consider dictating studies to be bookkeeping, it doesn't constitute 90% of my day since I do non-vascular procedures: fluoro and biopsies, as well as conferences (to teach those subspecialists who read better than I do...), patient consultations (wait, you mean radiologists actually talk to patients?) and talking to clinicians.

Folks love to bring up MSK radiology in ortho vs general radiology debates. What they fail to mention is that orthopods subspecialize, too. The knee surgeon may feel comfortable looking at knee MRI, but he's gonna come by the reading room to ask about a shoulder, ankle or spine. And no one is ever gonna mention getting a call from an orthopod asking if we can addend a report (or change it if it hasn't been finalized) to allow for a reasonable justification for surgical exploration. In plain terms: ortho doc misread the film, took patient to OR and found nothing; now he needs something to justify his exploration. If the radiology read comes back as negative, the unjustified surgery cannot be billed and leaves the surgeon open to litigation.

In some private practices, the orthopedic surgeons pretty much try to tell the radiologists what to dictate. Otherwise the surgeons will send their referrals elsewhere.

Your statements are shockingly different from my experience at the 12 or so hospitals I've worked at during my residency, fellowship and post-training career. They are different to the point that I would question what kind of radiology experience you actually have. If you have real-world or at least academic training-world radiology experience, it would be intellectually and ethically honest of you to frame your comments in the context of your rather limited experience.

 

[ericdopt]

Your statements are shockingly different from my experience at the 12 or so hospitals I've worked at during my residency, fellowship and post-training career. They are different to the point that I would question what kind of radiology experience you actually have. If you have real-world or at least academic training-world radiology experience, it would be intellectually and ethically honest of you to frame your comments in the context of your rather limited experience.


Spot on ringhal.

 

[colbgw02]

I read 100-200 ICU films each week and I can tell you that the CXR's of unit players change very little day-to-day. Good pulmonolgists know this and make very few management decisions based on them. If they routinely saw films before me, I would never have to call the ICU about a Dobhoff catheter or endotracheal tube in the right mainstem bronchus, a subclavian line in the IJ or ventilator-induced pneumothorax. Since I have to call the ICU daily, I'm gonna disagree with you.

The overwhelming majority of hemorrhagic stokes are hypertensive and receive no invasive therapy. In my experience neurosurgery is only going to be involved if the patient develops increased intracranial pressure requiring a decompressive craniotomy or some sort of intracranial pressure monitoring. What sorts of things are neurosurgeons doing for patients with hemorrhagic strokes in your experience?

My day is certainly not 90% bookkeeping. Even if you consider dictating studies to be bookkeeping, it doesn't constitute 90% of my day since I do non-vascular procedures: fluoro and biopsies, as well as conferences (to teach those subspecialists who read better than I do...), patient consultations (wait, you mean radiologists actually talk to patients?) and talking to clinicians.

Folks love to bring up MSK radiology in ortho vs general radiology debates. What they fail to mention is that orthopods subspecialize, too. The knee surgeon may feel comfortable looking at knee MRI, but he's gonna come by the reading room to ask about a shoulder, ankle or spine. And no one is ever gonna mention getting a call from an orthopod asking if we can addend a report (or change it if it hasn't been finalized) to allow for a reasonable justification for surgical exploration. In plain terms: ortho doc misread the film, took patient to OR and found nothing; now he needs something to justify his exploration. If the radiology read comes back as negative, the unjustified surgery cannot be billed and leaves the surgeon open to litigation.

In some private practices, the orthopedic surgeons pretty much try to tell the radiologists what to dictate. Otherwise the surgeons will send their referrals elsewhere.

Your statements are shockingly different from my experience at the 12 or so hospitals I've worked at during my residency, fellowship and post-training career. They are different to the point that I would question what kind of radiology experience you actually have. If you have real-world or at least academic training-world radiology experience, it would be intellectually and ethically honest of you to frame your comments in the context of your rather limited experience.

Hahaha. Awesome post. In the parlance of the internet, I believe this is known as pwnage.

 

[p53]

You are so clueless it is beyond hope. Do you honestly believe Pulmonolgists wouldn't be able to see an endotracheal tube in the wrong location OR a subclavian in the IJ? Here is news for you. The only reason you call is to CYA. Radiologists call physicians because they don't want to be sued for not relaying a critical finding. Why else would you stay on hold for 10 minutes when it doesn't really help your wallet? When you call they are being nice on the other end (i.e thanks for the finding). Inside they are thinking what an idiot. He does nothing all day except read studies in which 90% of the studies are normal and/or repetitive.

Subspecialists read better than you do because they have clinical history and clinical presentation. General radiologists read better than family physicians and ER docs but you do not read better than a subspecialist. You are merely a family doctor of radiology. Jack of all trades and master of none. Even the American College of Radiology agree with this premise. Why do you think there were changes in the board exam?

Patient consultations? Unless you are doing mammography, pediatric, or IR you are FOS. Plus, you don't get paid to talk to patients.

90% of the time you are dictating studies in which the management decisions have already been made. Yes, I am saying that dictating studies is bookkeeping. Consider the notion, how many times do you call a physician for a critical finding. One could argue those are the only cases during the day in which you made any difference in a patient. Furthermore, most of the time those phone calls are redundant because the subspecialist have already read the study. You are only calling to CYA.

Radiology is a good field don't get me wrong. But lets not make it sound like you make a profound difference every single day. Most of the day it is boring repetitive studies, fluoro studies, and sitting on your arse going through the same old chest xrays, follow up pulmonary nodules on Chest CT, normal Head CTs, and "Fatty Liver" on an Abdominal CT. Oh wait I forgot degenerative changes at L4-L5. YAWN!!!

I read 100-200 ICU films each week and I can tell you that the CXR's of unit players change very little day-to-day. Good pulmonolgists know this and make very few management decisions based on them. If they routinely saw films before me, I would never have to call the ICU about a Dobhoff catheter or endotracheal tube in the right mainstem bronchus, a subclavian line in the IJ or ventilator-induced pneumothorax. Since I have to call the ICU daily, I'm gonna disagree with you.

The overwhelming majority of hemorrhagic stokes are hypertensive and receive no invasive therapy. In my experience neurosurgery is only going to be involved if the patient develops increased intracranial pressure requiring a decompressive craniotomy or some sort of intracranial pressure monitoring. What sorts of things are neurosurgeons doing for patients with hemorrhagic strokes in your experience?

My day is certainly not 90% bookkeeping. Even if you consider dictating studies to be bookkeeping, it doesn't constitute 90% of my day since I do non-vascular procedures: fluoro and biopsies, as well as conferences (to teach those subspecialists who read better than I do...), patient consultations (wait, you mean radiologists actually talk to patients?) and talking to clinicians.

Folks love to bring up MSK radiology in ortho vs general radiology debates. What they fail to mention is that orthopods subspecialize, too. The knee surgeon may feel comfortable looking at knee MRI, but he's gonna come by the reading room to ask about a shoulder, ankle or spine. And no one is ever gonna mention getting a call from an orthopod asking if we can addend a report (or change it if it hasn't been finalized) to allow for a reasonable justification for surgical exploration. In plain terms: ortho doc misread the film, took patient to OR and found nothing; now he needs something to justify his exploration. If the radiology read comes back as negative, the unjustified surgery cannot be billed and leaves the surgeon open to litigation.

In some private practices, the orthopedic surgeons pretty much try to tell the radiologists what to dictate. Otherwise the surgeons will send their referrals elsewhere.

Your statements are shockingly different from my experience at the 12 or so hospitals I've worked at during my residency, fellowship and post-training career. They are different to the point that I would question what kind of radiology experience you actually have. If you have real-world or at least academic training-world radiology experience, it would be intellectually and ethically honest of you to frame your comments in the context of your rather limited experience.

 

[gonogo]

I believe p53 is partially right in the sense that most subspecialists know very well to read their subspecialty films. However, radiologists are still needed because in every film there isn't just one organ or organs concerning one subspecialty (i.e. a cardiologist can very well learn to read cardiac CT/MR but will fail to call anything in the adjacent lung, or the pneumologist will read the lung but will miss anything around it, etc... the same can be said of any subspecialty, if not, ask any subspecialists!). So in this way, radiologists are kind of bookkeepers, making sure that everything in the film is described and nothing is missed.

 

[goremachine]

Agree with p53. However, this is mostly true in academics, where I feel like he's right that radiologists are mostly bookkeeping and rarely affect management except for the ER and the unexpected critical finding. And yes, the clinician specialists read as well as the radiologist in most cases. In the complicated studies like MRI abdomens, etc. the radiologist prevails since clinicians see very few of those and truly have no idea how to read them but those are few and far between.

Where radiologists really are valued are in the private sector, which is where most of medicine is practiced. And most radiologists do end up in private practice, and there your reads really do make a difference. The only exceptions would be orthopods who generally ignore the reads. MSK rads read better than orthopods but it rarely makes a difference, and orthopods definitely read better than general rads. But most other docs will defer to the radiologists read -- and most docs are not in academia just like most rads are not in academia.

 

[housemd]

I feel you OP. I am having the same thoughts, I don't know if I can sit and read CT after CT, film after film for the rest of my life. I really under estimated how much I liked talking with patients, people even. Wondering if I made the right choice after day after day, hope it gets better.

 

[jake2]

p53 ain't a troll, he's been around for too long and makes a lot of valid points. He's just provocative. There are definite trolls here and on AuntMinnie, though I'm relatively convinced he ain't one of them.

That being said, I'm not sure where you're practicing man, but it's worlds different than my experience, almost 180 degrees. I feel like I call someone up at least once an hour to give a critical finding and get the following response, "What? Where's the pneumo? O crap". And on every service the phone's going off the hook with internal meds/specialty med, gen surg, peds, the ED, etc calling for reads. I get the sense some days I'm managing the whole damn hospital. The question of "do we make any impact" seems odd to the point of me thinking your statements must be sarcastic. And I'm at a pretty fancy tertiary care academic center.

Ortho can definitely read their own plain films, but most people getting plain films don't present to ortho, they present to the ED and I've never run into a PA or ED resident yet that knows what a nutrient channel is. Super-subspecialized orthos can read their own respective joint MRs, but not most of them.

Some of the neuro, both surgeons and neurologists, can hang with the general rads, but they are the minority and only in their little niches. And they know who the best neuro-rads are and all come down to get reads on complicated cases before doing anything. That T2 hyperenhancing may well be an aneurysm and it wouldn't look good if you tried to resect it!

That being said, the patient consultation thing is silly. Once in a blue moon (excluding on IR, mammo, fluoro, or before a biopsy), a patient will get my number or sneak into the reading room making for an awkward interaction. That isn't the norm though.

You are so clueless it is beyond hope. Do you honestly believe Pulmonolgists wouldn't be able to see an endotracheal tube in the wrong location OR a subclavian in the IJ? Here is news for you. The only reason you call is to CYA. Radiologists call physicians because they don't want to be sued for not relaying a critical finding. Why else would you stay on hold for 10 minutes when it doesn't really help your wallet? When you call they are being nice on the other end (i.e thanks for the finding). Inside they are thinking what an idiot. He does nothing all day except read studies in which 90% of the studies are normal and/or repetitive.

Subspecialists read better than you do because they have clinical history and clinical presentation. General radiologists read better than family physicians and ER docs but you do not read better than a subspecialist. You are merely a family doctor of radiology. Jack of all trades and master of none. Even the American College of Radiology agree with this premise. Why do you think there were changes in the board exam?

Patient consultations? Unless you are doing mammography, pediatric, or IR you are FOS. Plus, you don't get paid to talk to patients.

90% of the time you are dictating studies in which the management decisions have already been made. Yes, I am saying that dictating studies is bookkeeping. Consider the notion, how many times do you call a physician for a critical finding. One could argue those are the only cases during the day in which you made any difference in a patient. Furthermore, most of the time those phone calls are redundant because the subspecialist have already read the study. You are only calling to CYA.

Radiology is a good field don't get me wrong. But lets not make it sound like you make a profound difference every single day. Most of the day it is boring repetitive studies, fluoro studies, and sitting on your arse going through the same old chest xrays, follow up pulmonary nodules on Chest CT, normal Head CTs, and "Fatty Liver" on an Abdominal CT. Oh wait I forgot degenerative changes at L4-L5. YAWN!!!

 

[ringhal]

Based on your thread here, you took the USMLE in 2005. At that point I was junior faculty at the academic center where I'd done my fellowship. I've spent the last 3.5 years in private practice. So I was finished with my post-graduate training before you started yours. And you feel comfortable calling me clueless? Where did you say you trained and on what are you basing your strong opinions?

Your ad hominem attack exposes the weakness of your actual comments. I will address your comments not for your benefit - from this thread and your posts in other threads I gather that you are not open to other individuals' radiology experience. I participate in this and other medical student forums because they are full of bad information. There are students lurking on this forum who might otherwise believe what you are writing.

My opinion, based on my experience as a practicing radiologist on both coasts, is that you are dangerously wrong. The more you write, the more ignorance you reveal. I have already demonstrated this in your comments about neurosurgical treatment of hemorrhagic stroke. I will further illustrate your malignant ignorance by addressing this last post.

You are so clueless it is beyond hope. Do you honestly believe Pulmonolgists wouldn't be able to see an endotracheal tube in the wrong location OR a subclavian in the IJ? Here is news for you. The only reason you call is to CYA. Radiologists call physicians because they don't want to be sued for not relaying a critical finding.

These comments are self-defeating. I would not need to CYA and there would be no lawsuits for delayed diagnosis if the critical care physicians saw all of the malpositioned lines and tubes. In my real-life experience, many low ETT's are actually adjusted by the respiratory therapist. He or she is often the first person to see the film. Not me or the critical care clinician. Sometimes when I call up there with the finding, they tell me they've already adjusted the tube. Most of the time they have not. The reason I tend to see them first is because if I’m reading plain films that particular day, I’m sitting at the workstation; as soon as the rad tech loads it, the portable film shows up on my unread films list. The only delay is the number of films ahead of it on my list – and that’s gonna vary – usually anywhere between zero and maybe fifteen. Call me "clueless" but this is my experience.

Why else would you stay on hold for 10 minutes when it doesn't really help your wallet? When you call they are being nice on the other end (i.e thanks for the finding). Inside they are thinking what an idiot.

A few years ago, one of our hospitals had a lawsuit in the hospital because of a central line in the carotid of an ICU patient. I read the afternoon chest film and called the ICU. The next day the unit clinician ordered a neck ultrasound to verify line placement. I read that study, too, and confirmed the arterial line. Later that day, the ICU doc ordered a neck CT for further confirmation. The patient stroked after the CT, before vascular surgery consult. Maybe I am an idiot, but I was not named in that lawsuit.

He does nothing all day except read studies in which 90% of the studies are normal and/or repetitive.

The reality behind this comment would be self-evident to you if you had actual medical experience. Are you actually doing a residency? A huge amount of the studies I read are normal, but that is the fault of the clinicians ordering them - think CYA. Yesterday a clinican ordered an abdominal MRI for a patient with resolving pancreatitis. We called and asked why she wanted to order a $4000 exam. This afternoon, a clinician ordered a non-contrast CT abdomen for pyelonephritis. First, CT is not indicated for uncomplicated pyelonephritis. Second, the radiologic signs are based on IV contrast – so that was another $4000 wasted.

Subspecialists read better than you do because they have clinical history and clinical presentation.

This is a straw man argument. That’s 2 logical fallacies so far; we’ll see how many more you have for us. Someone with more information is usually going to arrive at a more concise diagnosis than someone with less information. Set me at a PACS station next to your vaunted subspecialist with a set of studies and the typical clinical information we get from them and let’s see who arrives at more accurate diagnoses.

Another thing you’d know if you were actually involved in the day-to-day practice of medicine is that subspecialists are increasingly using imaging as an additional barrier to their overbooked clinics. That means the neurologist won’t even take the consult from the PCP until the MRI has been done. So there’s no way the subspecialist sees the film before me. This is in outpatient and inpatient settings.

Even the American College of Radiology agree with this premise. Why do you think there were changes in the board exam?

I addressed this in another thread recently. The change in the board exam is geared to decrease the disparity between academic and private practice radiologists by creating more radiologists who are automatically subspecialized and feel less comfortable doing all modalities – thus more likely to stay in the ivory tower. This format is okay in large academic places. However, it doesn’t work elsewhere, i.e. where most medicine in the US is actually practiced because most places do not have sufficient volume to support people only reading one modality. Like I alluded to in my other post with the orthopaedic surgeons, the knee orthopod is gonna be doing hips, shoulders and maybe some spine, too. The board changes are about academic radiologists trying to preserve their way of life.

Patient consultations? Unless you are doing mammography, pediatric, or IR you are FOS. Plus, you don't get paid to talk to patients.

Well genius, I do mammography, pediatric radiology and non-vascular IR – also hysterosalpingograms, barium enemas and several other procedures where communicating to patients before and/or after the procedure is appreciated – or is the standard of care. Do I get paid for it? No. But you seem to be the only one talking about money. I call it good patient care. Maybe one day you will learn it.

90% of the time you are dictating studies in which the management decisions have already been made. Yes, I am saying that dictating studies is bookkeeping. Consider the notion, how many times do you call a physician for a critical finding. One could argue those are the only cases during the day in which you made any difference in a patient. Furthermore, most of the time those phone calls are redundant because the subspecialist have already read the study. You are only calling to CYA.

Burden of proof fallacy – logical fallacy number three. The most obvious way I can demonstrate this being an ignorant assertion is that clinicians in the hospital are typically too busy to know exactly when a patient has an imaging study performed. Because of this, he or she will not know when it is completed. I am usually near the scanner or sitting at the PACS and have access to it as soon as it is done. For a management decision to be made before I dictate the study, it would have to have been made without taking it in to consideration. Again, if you were in real training, you would know this.

Radiology is a good field don't get me wrong. But lets not make it sound like you make a profound difference every single day. Most of the day it is boring repetitive studies, fluoro studies, and sitting on your arse going through the same old chest xrays, follow up pulmonary nodules on Chest CT, normal Head CTs, and "Fatty Liver" on an Abdominal CT. Oh wait I forgot degenerative changes at L4-L5. YAWN!!!

Based on these comments and the number of posts you make about radiology, I am going to assume that you applied and did not match. That is the best explanation for your attitude.

 

[mrmandrake]

Thanks ringhal for taking the time to post. I am back and forth in terms of rads and surgery and your posts are very informative.

 

[fun8stuff]

Thanks ringhal for taking the time to post. I am back and forth in terms of rads and surgery and your posts are very informative.

really? do you like doing things out of the hospital? if you do, the choice should be pretty obvious.

 

[mrmandrake]

I'm an M2 so I hope you can understand where I'm coming from. I'm leaning towards rads right now but I don't have the exposure to make the definite choice. I think my personality fits rads pretty well and I really don't want to deal with too many patients. Working with my hands during surgery is also appealing but I think the novelty will wear off. Only time will tell.

really? do you like doing things out of the hospital? if you do, the choice should be pretty obvious.

 

[fun8stuff]

I'm an M2 so I hope you can understand where I'm coming from. I'm leaning towards rads right now but I don't have the exposure to make the definite choice. I think my personality fits rads pretty well and I really don't want to deal with too many patients. Working with my hands during surgery is also appealing but I think the novelty will wear off. Only time will tell.

oh yeah i know where you are coming from... i wanted to do heme/onc until ms3.

 

[dopetown]

the fact that p53 has not disclosed his experience and exposure to radiology just supports the fact that he's misinformed.

everyone should easily be taking ringhal's word over p53's at this point.

 

[Long Dong]

Go derm.

 

[Ableton]

the fact that p53 has not disclosed his experience and exposure to radiology just supports the fact that he's misinformed.

everyone should easily be taking ringhal's word over p53's at this point.

I believe he's a resident at a very good radiology program (assuming he goes to the one I am thinking of).

 

[psychforme]

I believe he's a resident at a very good radiology program (assuming he goes to the one I am thinking of).

Are we talking top 10 or top 20?

It makes a difference.

 

[C5toC9]

What are the radiology program rankings anyway? Are you just going off of USNWR for med schools?

 

[The Dark Knight]

1. If you drop out of the program won't your visa be rovoked requiring you to go back to your home country (I'd assume India).
---This assumption is based on your grammar. I'm not the grammar police but I think anyone that reads your post can see the classic errors made by people who don't speak english as a first language. Your spelling is fine, it's just how you put sentences together.

2. Are you serious? I think a growing trend is seeing IMGs flood SDN message boards to post messages about how sh*$*ty a certain specialty is to try and scare of US students from applying.
----basically its a numbers game. The odds Le Chat is going to scare away 1,000 students is rare but even if he scares of 10 or 20 it ups his chance even by 1% and what narcissistic medical student won't take that extra 1% chance. So yes.. I'm implying Le Chat is not a resident but basically..

An Indian citizen, graduated from a foreign medical school, wants to go into Radiology to live the American dream $$$$$$$$$, and would greatly appreciate it if none of you all would apply.

 

[The Dark Knight]

Interesting post from a year ago:

http://forums.studentdoctor.net/showthread.php?p=8555812#post8555812

AHHHHH!!!!! I guess this but I didn't read your post til a few mins later. Sorry! I doubt he's from Europe though. Le Chat is pretty french though although I could change my username to El Darko Knighto and that won't make me Mexican.

 

[The Dark Knight]

Yep and they probably have an IQ of 100.

Is there a field out there that isn't misunderstood by a layman somewhere? Who are people trying to impress? The cashier? The 22 year old girl they are dating? Extended family members who are probably just asking so they can compare you to their immediate family?

I'd love to go into Rads so I can diagnose people on my ipad from Starbucks. Or go into IR and save people from ectopic pregnancy complications.

k... so you equally love:

Option A - put on your sweat pants and flip-flops, walk down to starbucks at 10 am, order a coffee and just diagnose people on your ipad

Option B - scrub in and work in the IR suite as an actual doctor

Yeah makes sense. More like you're debating if 300k + no respect will be fine with you as long as you can get a nice cup of coffee everyday versus 400K + doing IR work actually helping people, in the event you're not content with the whole starbucks workday plan. Good job guy

 

[gonogo]

k... so you equally love:

Option A - put on your sweat pants and flip-flops, walk down to starbucks at 10 am, order a coffee and just diagnose people on your ipad

Option B - scrub in and work in the IR suite as an actual doctor

Yeah makes sense. More like you're debating if 300k + no respect will be fine with you as long as you can get a nice cup of coffee everyday versus 400K + doing IR work actually helping people, in the event you're not content with the whole starbucks workday plan. Good job guy

Unfortunately option A does not exist.

 

[Substance]

1. If you drop out of the program won't your visa be rovoked requiring you to go back to your home country (i'd assume india).
---this assumption is based on your grammar. I'm not the grammar police but i think anyone that reads your post can see the classic errors made by people who don't speak english as a first language. Your spelling is fine, it's just how you put sentences together.

2. Are you serious? I think a growing trend is seeing imgs flood sdn message boards to post messages about how sh*$*ty a certain specialty is to try and scare of us students from applying.
----basically its a numbers game. The odds le chat is going to scare away 1,000 students is rare but even if he scares of 10 or 20 it ups his chance even by 1% and what narcissistic medical student won't take that extra 1% chance. So yes.. I'm implying le chat is not a resident but basically..

An indian citizen, graduated from a foreign medical school, wants to go into radiology to live the american dream $$$$$$$$$, and would greatly appreciate it if none of you all would apply.

bingo!