R4 body fellowship - attending input

[entrepreneurMD]

I just matched my residency that advertises that I can complete a full body fellowship in my R4 year?

Would this be enough to say I did a fellowship and look for private practice jobs? What questions should I ask before doing this?

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[faruqster]

For a lot of jobs, probably yes. One of the practices I talked to when I was looking for jobs said they would be totally fine if I did 6 months neuro mini fellowship my R4 year to be one of their neuro guys. Would they actually give you some kind of certificate for completion of the fellowship?

 

[Tiger100]

Yes and No.

If you are looking to get a job in competitive market, there are definitely other applicants that have done a mini-fellowship during R4 in addition to a one year fellowship after. A "high quality job" always have options to choose from.

The last person that we hired did a body fellowship during his 4th year of residency in addition to a full year of MSK fellowship on top of that.

 

[entrepreneurMD]

For a lot of jobs, probably yes. One of the practices I talked to when I was looking for jobs said they would be totally fine if I did 6 months neuro mini fellowship my R4 year to be one of their neuro guys. Would they actually give you some kind of certificate for completion of the fellowship?

Yeah they would give me a certificate that says that I have completed my fellowship in Body Radiology just like the fellows get st my institution. It should count right?

 

[entrepreneurMD]

Yes and No.

If you are looking to get a job in competitive market, there are definitely other applicants that have done a mini-fellowship during R4 in addition to a one year fellowship after. A "high quality job" always have options to choose from.

The last person that we hired did a body fellowship during his 4th year of residency in addition to a full year of MSK fellowship on top of that.

I guess the question is what is a high quality job?

My desired locations are the following: Texas (Austin, Houston, Dallas, San Antonio) and Boston/Providence area. Are these competitive markets?

 

[meister]

It’s great that you have this opportunity. I would certainly do it. It’s a shame that most radiology programs cannot offer this.

 

[Cognovi]

Do you have a choice? Do you have other requirements (eg, mammo, nucs) during R4? Are you in the resident call pool or the fellow call pool?

 

[entrepreneurMD]

Do you have a choice? Do you have other requirements (eg, mammo, nucs) during R4? Are you in the resident call pool or the fellow call pool?

I have a choice. I can do the regular mini fellowships like everyone else but I don't really see the point when the offer on the table is to have a full fledge fellowship completion certificate just like the fellows? I would be n the fellow call pool and treated like a fellow. thoughts?

 

[Cognovi]

Just curious, what is the length of the regular mini fellowships? I don't know as I am not familiar with that process yet, but I would think it's not about whether you have a certificate of completion, it's being able to say something like, I've spent 9 months in subspecialty body imaging, during which time I interpreted 500 body MRs, including 75 prostate MRs, and am comfortable reading CT colonography.

 

[qxrt]

Does seem weird and inappropriate to give someone a certificate for fellowship for doing, say, an 8 or even 6-month mini-fellowship, the same as for someone who does a "complete" 12-month fellowship. I mean, it sounds like a race to the bottom, honestly.

 

[entrepreneurMD]

Does seem weird and inappropriate to give someone a certificate for fellowship for doing, say, an 8 or even 6-month mini-fellowship, the same as for someone who does a "complete" 12-month fellowship. I mean, it sounds like a race to the bottom, honestly.

1 year long like the regular fellowship. So it’s appropriate

 

[Radology]

You are not doing a body fellowship. You are doing a year long minifellowship. It’s a distinction with a difference. The body training may be the same, but Its coming at the expense of your general radiology skills. There is nothing wrong with marketing your 1 year body training, some groups will hire you for that without a formal fellowship. But If you claimed to do a body fellowship on your application I would view you as dishonest and would immediately throw your file out.

 

[txguy]

What about a mammo mini fellowship and full fledged body fellowship to follow? I would use the mini-fellowship opportunity in R4 to fill in any gaps in your training and get you ready for private practice. Its all about being a team player--the more you can do to help out the group, the more marketable you will be. This includes reading mammo, MSK MR, that pesky T-bone CT, OB US, etc.

 

[entrepreneurMD]

What about a mammo mini fellowship and full fledged body fellowship to follow? I would use the mini-fellowship opportunity in R4 to fill in any gaps in your training and get you ready for private practice. Its all about being a team player--the more you can do to help out the group, the more marketable you will be.

I was thinking about that but then I still have to do that extra year. I was trying to save a year since my program advertises it as a full fellowship and not a minifellowship.

I see that they are a hit or miss by some people on this thread as not a true fellowship. I still don’t understand what that means. Is it only a true fellowship if I have to take an extra year? Does that mean that since I finished al my 4 year undergrad requirements in 3 years that I don’t have a 4 year degree? The line seems thin

 

[entrepreneurMD]

You are not doing a body fellowship. You are doing a year long minifellowship. It’s a distinction with a difference. The body training may be the same, but Its coming at the expense of your general radiology skills. There is nothing wrong with marketing your 1 year body training, some groups will hire you for that without a formal fellowship. But If you claimed to do a body fellowship on your application I would view you as dishonest and would immediately throw your file out.

Is it a minifellowship if I end the residency with a completion of fellowship certificate? I think maybe if you say the institution that granted me this your opinion would change

 

[Cognovi]

In the neurosurgery world, this is known as an enfolded fellowship. Calling a year-long R4 subspecialty training a minifellowship I think cheapens it. Yes, there is the opportunity cost of general radiology training, but that's not to do with the fellowship training, it's to do with having essentially a 3-year residency program. We should call full-year experiences enfolded fellowships, and 3- or 6- month experiences mini-fellowships.

 

[maxxor]

Is it a minifellowship if I end the residency with a completion of fellowship certificate? I think maybe if you say the institution that granted me this your opinion would change

Radiology residency is 4 years.

If you take 1 year out to do GI/GU/Body/whatever, that time has to come from somewhere. Your other skills will be "lessened" relative to the imbalanced time you spend on GI/GU during the 4 years. It's not like you do less time in GI/GU and then "make it up" during the mini fellowship. You compared to someone else will have only spent 4 years in imaging training, versus someone who did 4 years + fellowship.

What you will have at the end of 4 years is residency completion with a dedicated 12 months of "Body Imaging". The fellowship certificate is "meaningless" in that it doesn't entitle you to any sort of CAQ from the ABR, but it allows a credentialing committee to say "hey, this guy completed the same curriculum as a body fellow".

The only Radiology subspecialty that the current mini fellowship "counts" in a way that "matters" is the 16 month NR/DR ABR training pathway, which allows for CAQ in Nuclear Radiology at the end.

The other CAQ specialties are Neuroradiology and Pedi radiology, neither of which will grant time from mini fellowship toward their CAQ.

 

[meister]

Sorry but in the days of IR/DR dual certs with IR people only doing three years of DR (probably less) it’s probably ok for someone actually committed to DR to be able to do three general years as well.

 

[Radology]

Is it a minifellowship if I end the residency with a completion of fellowship certificate? I think maybe if you say the institution that granted me this your opinion would change

No it wouldn’t change anything. A fellowship certificate is worth nothing more than the paper it’s printed on.

Your training is still that of a body fellow who is less experienced everywhere else in general radiology.

And you’d still be deceitful if you tried to claim it as actual fellowship. It is readily apparent from your CV, and you’ll look like a jackass explaining this on your interviews. Just be honest, you stand nothing to gain by embellishing the truth

 

[DrfluffyMD]

No it wouldn’t change anything. A fellowship certificate is worth nothing more than the paper it’s printed on.

Your training is still that of a body fellow who is less experienced everywhere else in general radiology.

And you’d still be deceitful if you tried to claim it as actual fellowship. It is readily apparent from your CV, and you’ll look like a jackass explaining this on your interviews. Just be honest, you stand nothing to gain by embellishing the truth

Not sure where the deceit is. This guy will be doing a one year fellowship? If you are tossing out his app in this job market, you are probably losing good candidates because programs that do enfolded fellowships are usually good ones.

 

[Radology]

Because it’s deceitful to market a built in mini fellowship, that comes at the expense of standard training, as a formal fellowship that is supplemental to a 4 year residency. I’m not sure what part you’re confused about. I mean, I don’t really care. OP can by all means try this, if he wants rural jobs or nighthawk jobs it won’t matter.

But As someone who interviews candidates, I would raise hell to make sure we didn’t hire someone pulling these shenanigans

 

[DrfluffyMD]

Because it’s deceitful to market a built in mini fellowship, that comes at the expense of standard training, as a formal fellowship that is supplemental to a 4 year residency. I’m not sure what part you’re confused about. I mean, I don’t really care. OP can by all means try this, if he wants rural jobs or nighthawk jobs it won’t matter.

But As someone who interviews candidates, I would raise hell to make sure we didn’t hire someone pulling these shenanigans

UCSF and I think Duke both do this. I see their grads list enfolded fellowship just like OP would. I haven’t heard of any problem from them looking for jobs in Cali or other hot areas. You seem to be the minority here. Perhaps you are the rural job

 

[Radology]

You’re not seeing problems with them because most of them do a mini fellowship and a formal fellowship. THAT makes you a strong candidate and we love hiring these people because you can plug them in two subsections comfortably. If you cut out the formal fellowship part, the point of the mini fellowship is debatable and you’re weaker than what came out of the old style residency

And I’m on the Hiring committee of a coastal PP. I’m not gonna keep arguing about this. I haven’t said anything negative about the mini fellowship itself, just advising not to market it this way for a job because it’s misleading. But by all means, be my guest

 

[DrfluffyMD]

You’re not seeing problems with them because most of them do a mini fellowship and a formal fellowship. THAT makes you a strong candidate and we love hiring these people because you can plug them in two subsections comfortably. If you cut out the formal fellowship part, the point of the mini fellowship is debatable and you’re weaker than what came out of the old style residency

And I’m on the Hiring committee of a coastal PP. I’m not gonna keep arguing about this. I haven’t said anything negative about the mini fellowship itself, just advising not to market it this way for a job because it’s misleading. But by all means, be my guest

I assumed the OP will also do another fellowship.... you are correct in that if he just do the enfolded body he would not be employable

 

[Radology]

His second paragraph implies exactly that

 

[DrfluffyMD]

His second paragraph implies exactly that

My bad, I misread. This will not be adequate for any competitive pp jobs

 

[entrepreneurMD]

My bad, I misread. This will not be adequate for any competitive pp jobs

What are competitive pp jobs? Also are boston/Rhode Island and Texas jobs competitive?

I could care less of Cali or NYC

 

[Radology]

As I said before, You will basically limit yourself to nighthawk jobs and rural jobs without a formal fellowship. Saving one year of training is not worth a lifetime in a substandard position

 

[DrfluffyMD]

What are competitive pp jobs? Also are boston/Rhode Island and Texas jobs competitive?

I could care less of Cali or NYC

Boston/rhode island/Texas jobs are competitive. They cannot be gotten with just enfolded fellowships. If you just do what every other resident do, and get another fellowship, the enfolded fellowship will make you very marketable.

 

[entrepreneurMD]

Thank you so much attendings!

A final two question: is there a difference between if I did a research year my R4 year and a fellowship and just this enfolded fellowship?

Also any value to being dual certified in nucs ?

 

[DrfluffyMD]

Thank you so much attendings!

A final two question: is there a difference between if I did a research year my R4 year and a fellowship and just this enfolded fellowship?

Also any value to being dual certified in nucs ?

Research year is chill from what I’ve been told by my friends at top programs. However it’s only really useful for an academic career trajectory.

For example, you want to do IR but ended up in Joe Shmoe’s community IR fellowship, a research year prob won’t help you all that much since you prob won be able to academic IR regardless.

Dual cert in nukes can definitely open up unique opportunities in private practice. I say take that path.

 

[entrepreneurMD]

Research year is chill from what I’ve been told by my friends at top programs. However it’s only really useful for an academic career trajectory.

For example, you want to do IR but ended up in Joe Shmoe’s community IR fellowship, a research year prob won’t help you all that much since you prob won be able to academic IR regardless.

Dual cert in nukes can definitely open up unique opportunities in private practice. I say take that path.

Yeah I’ll consider the nucs then. If doing the body fellowship early doesn’t save me any time in terms of getting into a pp job early then why bother working hard? I’ll just do the nucs thing or a mix of chill minifellowship and “research”/ vacation and enjoy my life like the status quo before fellowship.

 

[Cognovi]

I have heard of multiple residents from top 10 programs who did enfolded fellowships and got a non-rural job without a true fellowship, in the last 2 years.

 

[DrfluffyMD]

I have heard of multiple residents from top 10 programs who did enfolded fellowships and got a non-rural job without a true fellowship, in the last 2 years.

I heard of the same thing, except people usually are fine to consider a candidate with enfolded fellowship plus separate fellowship as dual fellowship trained but significant controversy exist when the candidate has only done an enfolded fellowship. Some do not consider them fellowship trained.

 

[maxxor]

Sorry but in the days of IR/DR dual certs with IR people only doing three years of DR (probably less) it’s probably ok for someone actually committed to DR to be able to do three general years as well.

This is why the whole mini fellowship nonsense is stupid.

IR people get IR/DR while only doing 3 years.

DR people have to do

I have heard of multiple residents from top 10 programs who did enfolded fellowships and got a non-rural job without a true fellowship, in the last 2 years.

This is usually limited to Mammo.

 

[entrepreneurMD]

I heard of the same thing, except people usually are fine to consider a candidate with enfolded fellowship plus separate fellowship as dual fellowship trained but significant controversy exist when the candidate has only done an enfolded fellowship. Some do not consider them fellowship trained.

That logic doesn’t make any sense though.. you know

 

[Radology]

It makes complete sense, especially for a body mini fellowship.

Take one resident who is only offered a 3-6 month mini fellowship.

He has built into his residency curriculum 1 month of body ct, 1 month of body mr, and 1 month of ultrasound, both in his R3 and R4 Years. That’s 6 months in the last two years of residency doing body. Granted, this varies program to program but it’s still typically 3-4 months minimum. Meanwhile, he can do a mini fellowship in mammo or msk mri, and then go on to a full year body fellowship. Very marketable.

Now take you.

You reshuffled your mammo, nucs and other mandatory rotations into your third year to accommodate your fourth year schedule. Since you’re doing body 4th year, you can skip those third year body rotations and cover the other services.

Yes, you did a full year, But you really have 4-6 less months of body training than your colleague when all is said and done.

And yes while you technically have 12 consecutive months, you are entering your “fellowship” at the level of a junior resident in terms of knowledge base, and your colleague is entering as a seasoned upper level. While I’m teaching your colleague how to read an MR elastography, I’m teaching you the differences in contrast agents.


So, I agree with the mentality of not really considering this scenario truly fellowship trained.

 

[entrepreneurMD]

It makes complete sense, especially for a body mini fellowship.

Take one resident who is only offered a 3-6 month mini fellowship.

He has built into his residency curriculum 1 month of body ct, 1 month of body mr, and 1 month of ultrasound, both in his R3 and R4 Years. That’s 6 months in the last two years of residency doing body. Granted, this varies program to program but it’s still typically 3-4 months minimum. Meanwhile, he can do a mini fellowship in mammo or msk mri, and then go on to a full year body fellowship. Very marketable.

Now take you.

You reshuffled your mammo, nucs and other mandatory rotations into your third year to accommodate your fourth year schedule. Since you’re doing body 4th year, you can skip those third year body rotations and cover the other services.

Yes, you did a full year, But you really have 4-6 less months of body training than your colleague when all is said and done.

And yes while you technically have 12 consecutive months, you are entering your “fellowship” at the level of a junior resident in terms of knowledge base, and your colleague is entering as a seasoned upper level. While I’m teaching your colleague how to read an MR elastography, I’m teaching you the differences in contrast agents.


So, I agree with the mentality of not really considering this scenario truly fellowship trained.

Ah ok so the smart answer here is just to do a 3 month mini fellowship in body, maybe another 3 months in MSK or neuro or whatever and then 3 months to just do BS research or vacation months. That or do the nucs dual certification which I have also heard is a hit or miss. I have 0 problems taking extra vacation ESPECIALLY if it means I'm more marketable in the end.

Of course, this depends on the competitiveness of the pp in the area. DrM said that Texas and Boston/RI are competitive markets but I'm confident that its not nearly as competitive as NYC, SF and SoCal

 

[Radology]

I think you’re misinterpreting me. There’s a ton of value in a 12 month body minifellowship. It just doesn’t exactly equate to a real fellowship, and absolutely must be followed by a formal fellowship in something else.

Boston is arguably as competitive as Manhattan and California but yea Texas and RI should be average

 

[JoshSt]

There’s some misconception and truths in this thread.
1. The program can truly give a 1 year real fellowship that’s not a minifellowship. The requirements for DR residency are fulfilled in 3 years, that’s why programs can do the integrated nucs training, some of the research residency tracks without extending the 4 year residency and it’s a basis for IR residency and ESIR.
2. As others have pointed out and by the myriad of minifellowship comments, this would simply not be understood by employers. Additionally, it would cut into elective time like strengthening yourself in breast, msk mr, etc.

Overall, agree with others that it would not replace the need for a formal post residency fellowship year in something and would not be super attractive by itself. It might be helpful and marketable with a true post residency fellowship, but ppl won’t simply get its billing as a real fellowship as opposed to an R4 minifellowship

 

[Radology]

Not to mention the variability from place to place. There are no hard and fast curriculum rules for body.

A small program could market a 1 year integrated “body fellowship.”

As 3 months body ct/mr
2 months ultrasound
1 month nucs/pet
2 month chest ct/x ray
2 months msk mr/x ray
1 month fluoro
1 month elective

That would technically count for a body fellowship, but it’s really just a 4th year standard curriculum without peds and mammo

 

[DrfluffyMD]

I agree. A year of mini is still a mini. I am doing 10 month of IR myself but I am definitely not representing that as a fellowship. I just called focused subspecialty experience.

 

[entrepreneurMD]

I guess the consensus is that a true body fellowship = 12 month mini fellowship in eyes of employers so I still have to do a fellowship after i.e 6 years of total training instead of 5. Based on this feedback, I would much much much rather take it a bit easy R4 and have like 3 or 6 months of vacation/light research since there is no real added benefit to just work 12 months hardcore vs 6 months hardcore mini fellowship (diminishing marginal returns of work).

What are the thoughts on the nucs dual certification? Value or nah?

Thank you so much for the responses!

 

[colbgw02]

What are the thoughts on the nucs dual certification? Value or nah?

I wouldn't get a certificate just to get it. If you want to focus on nucs in your practice or you really enjoy it, then go right ahead. If you intend to practice general radiology or prefer to practice in your fellowship's subspecialty, then I wouldn't bother.

 

[DrfluffyMD]

I guess the consensus is that a true body fellowship = 12 month mini fellowship in eyes of employers so I still have to do a fellowship after i.e 6 years of total training instead of 5. Based on this feedback, I would much much much rather take it a bit easy R4 and have like 3 or 6 months of vacation/light research since there is no real added benefit to just work 12 months hardcore vs 6 months hardcore mini fellowship (diminishing marginal returns of work).

What are the thoughts on the nucs dual certification? Value or nah?

Thank you so much for the responses!

Body fellowship is fine. Issue is when u just do 4 yrs of rad residency and pretend u got a fellowship

 

[entrepreneurMD]

Body fellowship is fine. Issue is when u just do 4 yrs of rad residency and pretend u got a fellowship

I guess my program advertises it as a true fellowship instead of a 12-month mini fellowship thats why I thought but consensus here is that its not so I'd rather incorporate more of a balance in my R4 year with some 3 month mini fellowships + vacation months.

 

[TCOM12]

Nucs dual certification is becoming more and more desirable as less people are nucs and jobs are opening up. One of the reasons I’m being hired at the new job is because I’m right out of training and am comfortable reading nuclear medicine studies...
PET/CT is 3.0 rvus per exam. For reference, a mri brain without and with is 3.1.

 

[Radology]

Which is funny, because a pet ct with priors takes 3x as long to read than brain mri with and without

 

[scootad.]

You don't need a nucs certficate to read PET CT or most nucs studies. Anyone who did a rads residency should be able to read those.

 

[JoshSt]

I guess the consensus is that a true body fellowship = 12 month mini fellowship in eyes of employers so I still have to do a fellowship after i.e 6 years of total training instead of 5. Based on this feedback, I would much much much rather take it a bit easy R4 and have like 3 or 6 months of vacation/light research since there is no real added benefit to just work 12 months hardcore vs 6 months hardcore mini fellowship (diminishing marginal returns of work).

What are the thoughts on the nucs dual certification? Value or nah?

Thank you so much for the responses!

You haven’t done nucs yet, when you do, you’ll see why many people don’t choose to go into it. It may have some mild PP recruitment advantages with another formal fellowship, but I wouldn’t recommend it. As others have said, you’ll be comfortable reading any nucs study.

It’ll take away from elective rotations, which are valuable as a pseudo-refined post core R4.

If you want to go into academics and practice in two different sections and do tracer research, it might worthwhile.

TLDR; no, don’t do it. Just do a normal rads residency.