Radiology Faculty--Answering Questions/"AMA"

[JDancing22]

@RadiologyPD Thanks for all the info you're giving. I am a current 4th year- 212/250 ( approx- don't want to give away actual numbers). I have 5 interviews- 1 from my home program and 2 from aways I did. Should I be concerned? I saw another individual matched DR/IR with lower scores than I did, but is that more of an anomaly? Thanks.

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[RadiologyPD]

A lot depends on the competitiveness of the places you've interviewed. The low USMLE Step 1 hurts you most in getting the interview to begin with, but the high Step 2 ameliorates that a lot in terms of wanting to make sure you don't have test-taking issues.

 

[barack_yomama]

....

 

[RadiologyPD]

@RadiologyPD How are (rads basic science) abstracts looked at compared to publications (obviously pubs count more, but I assume abstracts are still helpful)? How much can basic science research help overcome a mediocre Step1 (230s)?

See post #306 and #325

The quality of the research is most important ONLY for those candidates who are using research potential as "their hook". If you are selling yourself as a future "researcher", then it will be important to have a resume of good research.

For the vast majority of candidates, past research "checks a box". The research accomplishments of most candidates is often impossible to compare--as opposed to the Step scores. So your research helps you compared to other candidates with average Step scores if/when they haven't done any.

 

[andrewbobert]

@RadiologyPD When do you think is the best time to send the "you're my number 1" email to your top ranked program? Does it help at all to send the "I will rank you highly/I will rank you in the top 3" emails to those other programs? What are your thoughts on sending "you're my number 1" emails to your top 3-5 programs instead of your actual number 1 only?

Thanks for answering all of our questions and happy new year!

 

[redalert]

Dear @RadiologyPD, would it help to have one of the radiology letter writers or the PD at your home institution reach out to the program you're ranking #1 on your behalf? I feel that if they wrote a letter, they've already vouched for the candidate and an additional call would be unnecessary but I've heard different opinions. Thank you!

 

[proth]

@RadiologyPD thank you for all of your help! I really appreciate the advice and you taking the time to help us with this process. I had a question regarding preliminary years. I am applying for pediatrics in addition to medicine and haven't really seen anyone address a peds year. Does it matter for fellowship if you do a peds year vs the traditional medicine/surgery/TY? I am not particularly interested in IR at the moment, but obviously don't want to rule it out. Thank you so much for your help.

 

[RadiologyPD]

@RadiologyPD When do you think is the best time to send the "you're my number 1" email to your top ranked program? Does it help at all to send the "I will rank you highly/I will rank you in the top 3" emails to those other programs? What are your thoughts on sending "you're my number 1" emails to your top 3-5 programs instead of your actual number 1 only?

Best time is after you are done with interviews and know the answer. Now is good. Does not help to send the "really liked you a lot" letter--could hurt. Do not send #1 letter to more than one place--not good to develop a reputation as a liar. I have addressed this in a previous post, you'll have to search to find if you want more detail.

Dear @RadiologyPD, would it help to have one of the radiology letter writers or the PD at your home institution reach out to the program you're ranking #1 on your behalf? I feel that if they wrote a letter, they've already vouched for the candidate and an additional call would be unnecessary but I've heard different opinions. Thank you!

PD at your home institution?--absolutely yes, that is golden. Radiology letter writers?--if radiologists and they somehow have a connection to the PD, yes. If just some bozo, no.

@RadiologyPD thank you for all of your help! I really appreciate the advice and you taking the time to help us with this process. I had a question regarding preliminary years. I am applying for pediatrics in addition to medicine and haven't really seen anyone address a peds year. Does it matter for fellowship if you do a peds year vs the traditional medicine/surgery/TY? I am not particularly interested in IR at the moment, but obviously don't want to rule it out. Thank you so much for your help.

Peds if fine with me. n = 1. I'm not an IR PD and definitely do not have that snobbish "must be a masochist to be a good IR" attitude, so YMMV regarding IR.

 

[digoxin3443]

@RadiologyPD I was wondering if you could speak to the ROL a little bit. I saw on the match report that last year for DR, the average number of applicants ranked to fill the position was 8.3. I realize that this can be very variable due to factors like geography or the competitiveness of the program. I was wondering if in your experience you can kind of estimate how far down the rank lists programs may go that are in top 20-30 in terms of "reputation" on doximity and potentially in a highly sought after geography. I assume there will be some variability for each program in how far they fall each year, but maybe some ballpark number over the years.

I was also wondering about programs sending replies to letters. I read on an earlier post that you do not reply to anything other than questions. But do you think there are instances where a program director is telling applicants in some shape or form that they are "ranked to match" and then have no intention of ranking the applicant in a spot where they will definitely match assuming that is their desired program?

Thanks

 

[RadiologyPD]

@RadiologyPD I was wondering if you could speak to the ROL a little bit. I saw on the match report that last year for DR, the average number of applicants ranked to fill the position was 8.3. I realize that this can be very variable due to factors like geography or the competitiveness of the program. I was wondering if in your experience you can kind of estimate how far down the rank lists programs may go that are in top 20-30 in terms of "reputation" on doximity and potentially in a highly sought after geography. I assume there will be some variability for each program in how far they fall each year, but maybe some ballpark number over the years.

In all honesty, I don't know. In my own program, the spot at which we fill has varied a lot from year to year. Keep in mind that we don't try to game our rank list by putting people who we know "want us" higher. I think if a program did that, they would match at a lower number. It's pretty easy to guess that the more competitive programs will fill at less than 8.3 ranks/spot and the less competitive programs will fill at more than 8.3 ranks per spot. If I were to guess for the most competitive programs (not top 30 but top 5--if there is such a thing), I'd say they fill at 3-4 ranks/spot.

I was also wondering about programs sending replies to letters. I read on an earlier post that you do not reply to anything other than questions. But do you think there are instances where a program director is telling applicants in some shape or form that they are "ranked to match" and then have no intention of ranking the applicant in a spot where they will definitely match assuming that is their desired program?

I doubt it. For those programs that play this game (we do not), applicants might read into a message that they are "ranked to match" but are not. I do know there are programs that will tell you up front that you are "ranked to match"--if they use that term, I'd believe it. But who cares?--there's no special prize for candidates who match at their first choice. If you prefer Program 1 (who tells you nothing) but Program 2 tells you they really really love you and you are ranked to match, my advice is to put Program 1 first and Program 2 second.

 

[Ho0v-man]

Question: Is there any purpose in attending an ACR/RSNA conference at the end of third/beginning of fourth year if not presenting anything? I think it’d be kinda fun but I don’t have the money. My DSME is telling me to go and “network,” but I’ve never been to a conference so I’m unsure if there’s any real opportunity to do this at these things.

Hello, I am a Radiology PD who was asked by an SDN administrator who is friend of one of my former fellows to participate in this thread. My understanding is that there may be at least one other PD (by the handle of "Radiology_Advisor") who will participate for now. Here is the request I received:

We are looking to increase attending presence on the forums especially in those specialties, such as DR, where students may not get a lot of exposure during the premed and med school years. Our "AMA" (Ask Me Anything") threads are immensely popular and of course, having PD input benefits all users as your experience and insight is something that we feel would be invaluable and not easily accessible elsewhere. Would you be interested in participating?

For now I prefer to stay anonymous, but it may help to know a bit about me. I graduated from a big Midwest state medical school almost 30 years ago and did my internship/residency out West. I did not entertain the idea of becoming a radiologist until my M3 year, after doing an elective in Radiology that I chose in order to be more familiar with how to get films/reports on my patients prior to my subsequent Internal Medicine and Surgery rotations (in the old days, students were judged by how good they were at getting what you needed from the radiology records department before rounds!). A big part of the reason I chose radiology is because I enjoyed the one-to-one teaching interactions that I saw the academic radiologists doing more than what I saw the academic internists and academic surgeons doing, and I wanted to stay in academics if possible. I've only been at two academic centers in my career--staying at the institution I did my residency & fellowship as an attending for about 5 years, then moving to my present position, which is also out West. I was a Chief Resident and on the residency selection committee at my former institution, and have been a fellowship program director and more recently am the residency program director at my current institution. As a result, I've been involved with the training of many radiologists.

It might have made more sense to start this thread after the upcoming Match, as I'm sure this forum will be buzzing with the results of the Match for a while, but I'm forging ahead now as requested. Heads up, I'm not going to engage into conversations about which program is better, or "chance me" requests, other than to perhaps direct those sorts of inquiries into more a more general discussion of underlying principles. Nevertheless, feel free to ask whatever, and if I don't particularly feel like I should engage or if I don't have a good answer, I won't hesitate to say so. Also, I may not be able to be as responsive as others, but I'll do my best.

Ok, that's it for now. Good luck to all of you who are awaiting the upcoming Match results!

 

[RadiologyPD]

Question: Is there any purpose in attending an ACR/RSNA conference at the end of third/beginning of fourth year if not presenting anything? I think it’d be kinda fun but I don’t have the money. My DSME is telling me to go and “network,” but I’ve never been to a conference so I’m unsure if there’s any real opportunity to do this at these things.

You get the most networking value at those meetings if you have a faculty member who is "promoting" you. Generally, that requires you being on a project and that faculty member being affiliated with that project. I would not say it is a cost-effective thing to do as a medical student (while the meeting would likely be free as a "member-in-training", the travel and lodging expenses can be high), but it can be of value to open your eyes to the radiology world (RSNA is really big and overwhelming; ACR is smaller and focused on political/economic stuff). AUR is probably a better meeting that can be valuable for medical students to check out, but again best in the context of having an advisor/mentor with you, which works best in the context of a project/poster that is being presented.

I would not worry too much about networking on the national stage at the medical student level. Sure, there are a few students who manage to get contacts at this stage, but very few and usually these students are already competitive. Better to network locally with radiologists and residents in your school's department.

 

[Ho0v-man]

You get the most networking value at those meetings if you have a faculty member who is "promoting" you. Generally, that requires you being on a project and that faculty member being affiliated with that project. I would not say it is a cost-effective thing to do as a medical student (while the meeting would likely be free as a "member-in-training", the travel and lodging expenses can be high), but it can be of value to open your eyes to the radiology world (RSNA is really big and overwhelming; ACR is smaller and focused on political/economic stuff). AUR is probably a better meeting that can be valuable for medical students to check out, but again best in the context of having an advisor/mentor with you, which works best in the context of a project/poster that is being presented.

I would not worry too much about networking on the national stage at the medical student level. Sure, there are a few students who manage to get contacts at this stage, but very few and usually these students are already competitive. Better to network locally with radiologists and residents in your school's department.

Thanks a lot. That’s kind of what I was thinking but didn’t want to miss out due to ignorance.

 

[yanhoz]

Any idea how the changing of Step 1 to Pass/Fail will affect screening criteria for your program? Specifically the greater discrepancy between MD vs DO vs IMG, the greater emphasis on Step 2, prestige of your medical school, research, clerkship grades, and the new view on Step 1?

 

[r9too]

Any idea how the changing of Step 1 to Pass/Fail will affect screening criteria for your program? Specifically the greater discrepancy between MD vs DO vs IMG, the greater emphasis on Step 2, prestige of your medical school, research, clerkship grades, and the new view on Step 1?

This author has written extensively about this issue:

A Field Guide to USMLE Step 1 Apologists

In discussing whether USMLE Step 1 results should be reported pass/fail, I’ve gotten to take part in some lively debates. I’ve heard from many who – for one reason or another &#82…

thesheriffofsodium.com

 

[RadiologyPD]

Step 2 will become essential. There's no other standardized metric.

 

[yanhoz]

Do you like the decision? Do you see this benefitting any one Or any one group of students?

 

[RadiologyPD]

I take it that things have changed quite a bit since I was in med school, so I understand the rationale, because students were spending a butt load of time and money on Step 1 test prep. Having said that, I just got out of a meeting and it appears it is almost certain that the med school with which I am affiliated will juggle the schedule so that clinicals start earlier (instead of Step 1 test prep time) and then there will be Step 2 test prep time. So it seems to me that it results in only ONE high stakes exam--whereas previously there was this notion that you could make up for a lower Step 1 by doing really well on Step 2.

I personally would have preferred that Step 1 AND Step 2 both go to a "tiered" scoring system, i.e., perhaps "Fail" (rare), "Pass" (lowest 33%, excluding fail), "High Pass" (middle 33%), and "Honors" (top 33%). So students wouldn't have a number score, but just this high-level qualitative assessment. I suspect there would be less pressure with such a system but still some useful information for programs and applicants. For radiology, I am part of a multi-institutional group that has looked at how this might have worked in terms of predicting resident radiology Core examination outcome and performance, and it appears that it would have worked well. Radiology is one of those fields in which residents who are better "students" (better at studying, better at tests) seem to be able to master the breadth of clinical knowledge that is needed--there are a lot of books to read in Radiology, lots of material to know. In the data set I saw, radiology residents who were in the bottom 33% for Step 1 had a 45% chance of failing the Radiology Core exam on the first attempt, compared to 3% chance for radiology residents who were in the top 33%. That's a huge difference.

I'm also concerned that only students who have "connections" will be able to compete for highly sought residency spots (such as Derm, Ortho, etc)--already it seems that many people take full year gaps to make Derm connections doing research. At least with the Step scores, a student who just knocked the cover off the ball and still was personable and did some activities to show the she/he was capable of leadership/research/community service could compete.

Anyway, Step 2 will become the important metric. At least I've been told the information tested may be more relevant to most fields.

 

[yanhoz]

Thank you for your insight! What a time we're in

 

[trimethylpurine]

With step 1 switching to P/F, do you see a shift of focus on other metrics for the class of 2021/2022 to get a better gauge on how the upcoming shift affects applicants?

 

[RadiologyPD]

More programs may start requiring Step 2 or look at Step 2 in anticipation of not having Step 1 in the future.

 

[digoxin3443]

@RadiologyPD at your program, do you tend to rank applicants you really like high in multiple tracks if they applied for them? For example, let’s say you like applicant A a lot and they applied IR/DR, will you put them number 1 in the IR list and then ahead of applicant B (a sole DR applicant) in the diagnostic list too? If so, is your experience that most other programs may be ranking the same way as your program?

 

[RadiologyPD]

We only have independent IR program, not integrated. We believe that is a better model.

 

[digoxin3443]

@RadiologyPD are you familiar with the ACGME funding rules at some programs where they have multiple quota? For example, if the ACGME and NRMP quota is 3 residents for the advanced normal track and then 1 for the physician only one where the applicant should have already finished their intern year, does this mean if the program doesn’t fill the one physician only quota, that the funding just disappears? Or do they get to still add an extra resident to normal track?

If the program can’t transfer that spot and essentially loses the chance to have that extra resident, what is the incentive for them in adding a physican track instead of an extra regular spot that can be used in the match each year?

 

[RadiologyPD]

In most cases, the R positions are "patches" when a program has a hole that occurs when someone drops out, or more unusually, when there is extra funding.

If a program is in the Match for an R position, that means they have have a need or an opportunity for an R1 starting in the July 3.5 months after the match (usually because someone dropped out, less commonly because they have a new program spot).

You can't fill an opening in July with any medical student who is graduating (that spot can't be filled by an A or C match in March). They also can't just fill the spot OUTSIDE the Match before the Match because the Match has this rule that if you COULD fill a spot in the Match, you HAVE TO use the Match--up until the day that quota spots were due (in late January, I believe), any R1 spot starting in July COULD be filled by using the Match by recruiting an R position in the Match, and so could not be filled outside the Match (unless the program isn't using the Match at all--practically never happens).

So the R position and the A positions aren't interchangeable. These programs don't want to wait until 15.5 months after the match to fill this spot, it's open now (meaning 3.5 months after the Match). If they find they can't fill the spot through the Match (with or without SOAP), or if the spot opens up AFTER the quota lists were due (so they can't get registered for an open R spot and fill it through the Match), then they will look to fill the spot with an individual OUTSIDE the Match:

APDR | Association of Program Directors in Radiology

The upcoming R1 positions at that site don't get listed until February 2020 and then typically go away soon after July--that's the window of opportunity for a program to fill an R1 spot outside the Match. This is when the spot will get filled by a disaffected surgery resident who decides to leave surgery (or other field) but didn't realize this in time to be in the Match.

So, the bottom line is that R positions don't get converted to A or C positions. Most R positions are readily filled through the Match (since there are relatively few), but if they don't, they go on the open market that starts immediately after the Match is over (when they realize they didn't fill) and ends shortly after July (perhaps August or September, when it becomes too late to get someone in). And if the program is really unlucky (or just bad and can't recruit someone), then an unfilled R1 position will get delayed and converted to another R position in the next Match.

 

[digoxin3443]

In most cases, the R positions are "patches" when a program has a hole that occurs when someone drops out, or more unusually, when there is extra funding.

If a program is in the Match for an R position, that means they have have a need or an opportunity for an R1 starting in the July 3.5 months after the match (usually because someone dropped out, less commonly because they have a new program spot).

You can't fill an opening in July with any medical student who is graduating (that spot can't be filled by an A or C match in March). They also can't just fill the spot OUTSIDE the Match before the Match because the Match has this rule that if you COULD fill a spot in the Match, you HAVE TO use the Match--up until the day that quota spots were due (in late January, I believe), any R1 spot starting in July COULD be filled by using the Match by recruiting an R position in the Match, and so could not be filled outside the Match (unless the program isn't using the Match at all--practically never happens).

So the R position and the A positions aren't interchangeable. These programs don't want to wait until 15.5 months after the match to fill this spot, it's open now (meaning 3.5 months after the Match). If they find they can't fill the spot through the Match (with or without SOAP), or if the spot opens up AFTER the quota lists were due (so they can't get registered for an open R spot and fill it through the Match), then they will look to fill the spot with an individual OUTSIDE the Match:

APDR | Association of Program Directors in Radiology

The upcoming R1 positions at that site don't get listed until February 2020 and then typically go away soon after July--that's the window of opportunity for a program to fill an R1 spot outside the Match. This is when the spot will get filled by a disaffected surgery resident who decides to leave surgery (or other field) but didn't realize this in time to be in the Match.

So, the bottom line is that R positions don't get converted to A or C positions. Most R positions are readily filled through the Match (since there are relatively few), but if they don't, they go on the open market that starts immediately after the Match is over (when they realize they didn't fill) and ends shortly after July (perhaps August or September, when it becomes too late to get someone in). And if the program is really unlucky (or just bad and can't recruit someone), then an unfilled R1 position will get delayed and converted to another R position in the next Match.

Thanks a lot for a thorough response. So to double check...A/C and R spots are not interchangeable. Are there any spots that ARE interchangeable? For example, A spot for DR vs A spot for DR/IMG/research/IR? Is there a way to make a revision where a program can just make their IMG or research track into an extra DR spot if they don’t like their applicant pool or the positions go unfilled?

 

[RealHumanBean1]

@RadiologyPD @Radiology_Advisor First of all, thank you for taking the time to answer our questions - your responses have been unbelievably enlightening and I really appreciate your time.

In short, I've received really mixed opinions regarding the utility of away rotations, and as such, wanted to ask:
Do you feel that an away rotation is helpful for "opening up" an entire region (not a specific school) to a candidate that has no ties there? ...especially if that candidate has been confined to one region/state for their entire lives?

I've heard, on one hand, that it could be helpful as it shows that I'm willing to move outside of my home state. On the other hand, I've been told by some PDs that it has no benefit, and in fact, increases their suspicion that the candidate is mostly interested in the school they did an away rotation at (thus making them feel it's even less likely the candidate would come to their school... i.e. increase chances at one school and decrease them everywhere else in that region).

If it matters, I'm very competitive in terms of Step 1 and clinical grades (260, all honors except Psychiatry)... and will be couple's matching with another very competitive applicant applying to a fairly uncompetitive outside specialty. Thank you again for your time!

 

[RadiologyPD]

Thanks a lot for a thorough response. So to double check...A/C and R spots are not interchangeable. Are there any spots that ARE interchangeable? For example, A spot for DR vs A spot for DR/IMG/research/IR? Is there a way to make a revision where a program can just make their IMG or research track into an extra DR spot if they don’t like their applicant pool or the positions go unfilled?

I think your question is quite specific, and to my knowledge only applicable to one institution.

By mentioning "IMG" and "research", I get the sense that you are referring to the unusual positions at UCSD that seem to be set aside for IMGs and for research track. I am not the PD at UCSD and I don't know anything about those programs, but my guess is that here is how they might work--those codes all are "A" codes in the NRMP system (the DR one is called A0, the research is A1, and IMG is A2). My guess (again, my program doesn't use these unusual ancillary codes) is that UCSD has it set up with NRMP to consider the A1 and A2 lists as secondary to the DR A0 list, with spots that "revert" back to the A0 list if unfilled.

I'm not exactly sure what order these tracks are set to run in the Match--meaning I don't know if the computer fills the A0 list first or the A1 or A2 list first. But here is one scenario of how it might work assuming A0 got filled last (after A1 and A2).

The Match looks at the A1 list, where UCSD has ranked all the candidates they really liked as research people. IF it turns out that UCSD has an unfilled A1 "research" spot or spots, because everyone on UCSD's research list actually ended up preferring to go elsewhere and matched elsewhere, then the unfilled spots "revert" to the A0 list--meaning that those spots get added to the A0 number. Same is true for the people that UCSD puts on the "IMG" list--so UCSD only has to put in the stellar IMGs that they are interested in, and any unfilled spots in their A2 IMG list will "revert" back to their A0 list. Then the computer matches up the A0 list with the number of designated spots (5) + reverted spots (possibly 0, but up to 4).

It's a little complicated, but actually quite clever, because UCSD can choose to only rank the best and brightest IMGs in their A2 IMG list, and the most attractive research people on their A1 research list, without worrying about what to do if their chosen candidates don't Match--because those spots "revert" back to the A0 list.

Click on "Program Tracks" below to review a brief blurb from NRMP that mentions that programs with these "tracks" set up a "reversion in the R3 system, if necessary, to guard against the program being unfilled".

Program Tracks

So, don't worry about UCSD. They will fill their research/IMG spots.

Now, if your question is about IR and DR--those are 2 different residencies, so they don't have a "reversion" system for that. Currently this isn't an issue for IR programs--did any not fill in the past? I haven't looked closely at that, but I suspect not.

 

[RadiologyPD]

In short, I've received really mixed opinions regarding the utility of away rotations, and as such, wanted to ask:
Do you feel that an away rotation is helpful for "opening up" an entire region (not a specific school) to a candidate that has no ties there? ...especially if that candidate has been confined to one region/state for their entire lives?

I've heard, on one hand, that it could be helpful as it shows that I'm willing to move outside of my home state. On the other hand, I've been told by some PDs that it has no benefit, and in fact, increases their suspicion that the candidate is mostly interested in the school they did an away rotation at (thus making them feel it's even less likely the candidate would come to their school... i.e. increase chances at one school and decrease them everywhere else in that region).

If it matters, I'm very competitive in terms of Step 1 and clinical grades (260, all honors except Psychiatry)... and will be couple's matching with another very competitive applicant applying to a fairly uncompetitive outside specialty. Thank you again for your time!

I don't believe doing an away rotation "opens up a region" because I can't for the life of me remember when I looked at a transcript to see that a student was doing an away "in my region". The only way it could possibly help as evidence of your interest in a region is if you purposefully signaled to the PD through your application or other communication that you are "interested in the region" by way of an email or in your personal statement (which you can tailor for that program). But then you could do that without actually doing the away.

Review my comments previously on "signaling" that you are interested in a region.

It helps most if you are an outstanding candidate that is so interested in a region that you would consider a mediocre program in that region that is "below you" in terms of prestige/reputation/etc. That program may not interview you because they assume they can't get you--and don't want to waste an interview slot on you because you are a "long shot". In such a case, by all means you should signal your desire to go to the region and will rank that program higher than they might expect. So, using a real world example, this strategy fits you if you are in med school at Hopkins and have no connections to the Southwest but absolutely want to be in SoCal and so would be willing to match at Cedars even though you have 260+ USMLE, all honors, and are captain of the med school football team, such that MGH is begging you to go there. By all means, send Cedars an email expressing your sincere desire to live in LA, and that your SO is probably going to match around Cedars, etc. Cedars would be dumb not to consider you.

It also helps if you are a competitive candidate but not outstanding candidate for a program in an area that wouldn't know of your interest in that area based on your record. So, again using real world examples, let's say you and your SO are considering Albuquerque but are from Boston. UNM is a relatively small program so only interviews a relatively small number of people and you might not make the cut because they think you aren't serious about them--again, make it clear to the program in advance of interview selection that your circumstances are such that you are strongly considering Albuquerque-- again, with your numbers, the PD would be dumb not to consider you.

It does NOT help you if you are an average candidate looking to go to a popular area. If you are average, doing a rotation at Stanford doesn't help you get an interview at UCSF because it somehow signals an intention to be in the Bay Area. For outstanding programs in popular places, the "signaling" isn't very effective.

 

[digoxin3443]

I think your question is quite specific, and to my knowledge only applicable to one institution.

By mentioning "IMG" and "research", I get the sense that you are referring to the unusual positions at UCSD that seem to be set aside for IMGs and for research track. I am not the PD at UCSD and I don't know anything about those programs, but my guess is that here is how they might work--those codes all are "A" codes in the NRMP system (the DR one is called A0, the research is A1, and IMG is A2). My guess (again, my program doesn't use these unusual ancillary codes) is that UCSD has it set up with NRMP to consider the A1 and A2 lists as secondary to the DR A0 list, with spots that "revert" back to the A0 list if unfilled.

I'm not exactly sure what order these tracks are set to run in the Match--meaning I don't know if the computer fills the A0 list first or the A1 or A2 list first. But here is one scenario of how it might work assuming A0 got filled last (after A1 and A2).

The Match looks at the A1 list, where UCSD has ranked all the candidates they really liked as research people. IF it turns out that UCSD has an unfilled A1 "research" spot or spots, because everyone on UCSD's research list actually ended up preferring to go elsewhere and matched elsewhere, then the unfilled spots "revert" to the A0 list--meaning that those spots get added to the A0 number. Same is true for the people that UCSD puts on the "IMG" list--so UCSD only has to put in the stellar IMGs that they are interested in, and any unfilled spots in their A2 IMG list will "revert" back to their A0 list. Then the computer matches up the A0 list with the number of designated spots (5) + reverted spots (possibly 0, but up to 4).

It's a little complicated, but actually quite clever, because UCSD can choose to only rank the best and brightest IMGs in their A2 IMG list, and the most attractive research people on their A1 research list, without worrying about what to do if their chosen candidates don't Match--because those spots "revert" back to the A0 list.

Click on "Program Tracks" below to review a brief blurb from NRMP that mentions that programs with these "tracks" set up a "reversion in the R3 system, if necessary, to guard against the program being unfilled".

Program Tracks

So, don't worry about UCSD. They will fill their research/IMG spots.

Now, if your question is about IR and DR--those are 2 different residencies, so they don't have a "reversion" system for that. Currently this isn't an issue for IR programs--did any not fill in the past? I haven't looked closely at that, but I suspect not.

I have likewise seen tracks at Maryland, Penn, and Emory, although UCSD seems to have every track possible, so makes for a complicated situation like you nicely explained above. My confusion and curiosity actually started after seeing which programs “SOAPED” on this website Match Data. I was shocked to see some of the names on there and I thought there has to either be something faulty with the website or some sort of shifting is taking place with the spots. Not sure what you make of that.

In either case, I assume they can still rank a research candidate (or IMG) on both lists as high as they want with no real consequence? For example, applicant A listed as first both on the research and the regular A0 list if they happen to really like that person? Can there be crossover between the lists if they really want a certain person regardless of a track? I would think some places do this with IR/DR too, but I guess it depends on each program. Maybe some have completely different applicants ranked on each list.

As for unfilled IR spots, I think I saw a few around the country, but I cannot recall what year it was.

 

[RadiologyPD]

Can there be crossover between the lists if they really want a certain person regardless of a track?

Yes, that's common. Programs will put applicants into multiple tracks if they have multiple tracks, assuming they've instructed the candidates to rank multiple tracks. For example, I know that some programs have both "A" positions and "C" positions, and I'm sure that they basically put their applicants into both lists. So if you rank their A position first and their C position 2nd, you would match to their A position if there is still one available when the computer gets to you, but if there isn't and a C position is still available, then you'd match to their C position--BUT ONLY IF YOU RANKED BOTH.

I hope this makes sense. Seems like we are spending a lot of time on these minor variations.

 

[cuddy316]

@RadiologyPD

I know it's a bit early to tell, but do you anticipate any changes in how you (or other PDs) evaluate residency applications this upcoming cycle in the wake of the current pandemic? In particular, will you have any changes to how you view Step 2CK, given that more students will be struggling to complete the test before their application submission?

 

[yanhoz]

Also regarding changes to this application cycle, what are you hearing in regards to how interview season will play out? Will it be virtual? Do you think less weight will be put into These interviews?

 

[RadiologyPD]

I know it's a bit early to tell, but do you anticipate any changes in how you (or other PDs) evaluate residency applications this upcoming cycle in the wake of the current pandemic? In particular, will you have any changes to how you view Step 2CK, given that more students will be struggling to complete the test before their application submission?

My guess is that since Step 1 is still available, it will still be used but programs will try to correlate more with Step 2. Some programs that previously did not require or ask for Step 2 may start doing so in anticipation of migrating to the new environment when Step 1 won't be available.

Also regarding changes to this application cycle, what are you hearing in regards to how interview season will play out? Will it be virtual? Do you think less weight will be put into These interviews?

Still too early to say for sure. Our program interviews in January, and it's possible that more programs will set up for a later interview season. Programs may allow for a virtual interview, but as I've said before, programs want to "sell you" on the program as much as you want to sell them--so my guess is that if travel is allowed/feasible, most candidates will want to visit their top choices. One unforseen potentially positive benefit is that candidates may be more selective in how many applications they actually put out--I don't know the stats off hand, but lots of competitive candidates match in their top 3, so it makes no sense for these people to submit applications to more than 10 places if selected with thought.

 

[Cognovi]

potentially positive benefit is that candidates may be more selective in how many applications they actually put out--I don't know the stats off hand, but lots of competitive candidates match in their top 3, so it makes no sense for these people to submit applications to more than 10 places if selected with thought.

Can you explain why you think candidates will be more selective with applications? I think it can go the other way. With virtual interviews, there will no longer be a hard (time and financial) limit on interviewing if you don't have to factor in traveling. Each candidate will be able to do more interviews, and each program will be able to afford to interview more candidates. Competition will increase. Programs and candidates will go down deeper on their rank list.

 

[SeisK]

Can you explain why you think candidates will be more selective with applications? I think it can go the other way. With virtual interviews, there will no longer be a hard (time and financial) limit on interviewing if you don't have to factor in traveling. Each candidate will be able to do more interviews, and each program will be able to afford to interview more candidates. Competition will increase. Programs and candidates will go down deeper on their rank list.

Assuming travel-interviews are still a thing: If it’s still relatively dangerous to travel, people will only choose the places they ”truly want” to go to. I think this is incorrect because it assumes that many candidates will casually spend hundreds of dollars per interview for lackluster interest, when in reality it’s hedging their bets on their future career.

People will think “to hell with this virus, small price to pay to decrease the risk of not landing my dream job.”

 

[RadiologyPD]

Can you explain why you think candidates will be more selective with applications? I think it can go the other way. With virtual interviews, there will no longer be a hard (time and financial) limit on interviewing if you don't have to factor in traveling. Each candidate will be able to do more interviews, and each program will be able to afford to interview more candidates. Competition will increase. Programs and candidates will go down deeper on their rank list.

Yes, maybe just wishful thinking on my part that candidates will be more selective in interviewing. Assuming that travel is allowed, but that residencies make an accommodation to also do virtual interviews, my contention is that candidates will generally travel to the programs they are most interested in or most curious about, relegating virtual interviews to those places they see as "safeties" or are intrinsically less interested in.

But I don't think the total number of interviews for each program is going to go dramatically up--your contention that "each program will be able to afford to interview more candidates" doesn't resonate with me. I'm not actually sure whether programs have the capacity to significantly increase the number of people they interview even if they do it virtually--these interviews take time for faculty. Unless the faculty are "donating" their time (meaning, doing it on their vacation time or PTO), the time a program allocates to having faculty do interviews is time that faculty isn't producing any work. When I spend the day interviewing, I can't do anything clinical. So even if it costs less for the candidates to interview because they do some virtually, it doesn't change the cost structure for the program--each interview has a cost, virtual or in-person, and for most programs, the cost of an interview is almost entirely the cost of the faculty person not doing clinical work--not the catered lunch.

Unfortunately, NRMP provides a lot of data but not the most meaningful data. As a candidate, what you'd really like to know is how high on the rank list did most people who "look like you" go on their list. Obviously there is so much individual variability in that based on how ambitious someone is compared to their "metrics". But, looking just at US MD seniors, NRMP says that as a group for all specialties in 2020, 49.2% matched at rank 1, 16.4% matched at rank 2, 10% matched at rank 3, 6.8% matched at rank 4, and only 17.6% needed to go above rank 4. Let's assume those numbers apply for US MD seniors going into Diagnostic Radiology--no good reason to think they would not, since US MD seniors going into DR match at a really high rate (only Peds, Internal Medicine, and Neurology match at higher rates). IF you give careful consideration of your personal "metrics" and include some "safeties", I suspect that many US MD seniors going into DR apply to way more programs than they need to. Obviously, if you have some weaknesses in your application, you need to apply more broadly, but the numbers suggest that even strong applications don't effectively whittle down their lists prior to sending out applications and accepting interviews.

The data isn't out for 2020, but if you look at 2018, of the 621 US MD seniors who ranked radiology programs, the median number of ranks was 13. Only 143 of the 621 US MD seniors ranked less than 10 radiology programs--and there were 151 US MD seniors going into radiology with Step 1 scores over 250, with about 100 US MD seniors who were AOA going into radiology. My point is that if you are AOA or have a really good application, you should not need to interview at more than 10 places, unless you have some personality gaps.

There are many very good residency programs--what makes a program great (the so called "dream" job) is usually more about location for most people, and you don't need to interview to know where a program is located. The recent publication about Core passage rates being almost entirely a function of STUDENT ability (as measured by Step scores) rather than actual residency program or curriculum should tell people that they can be well-trained at many places. In that study, there was NO DIFFERENCE between 13 different programs (which varied widely by reputation) in the observed Core pass rate vs. the expected Core pass rate based on Step scores.

https://www.jacr.org/article/S1546-1440(20)30238-6/fulltext

While it won't happen soon, at some point this whole ERAS process needs a major overhaul. We need to have an "early action" system to get maybe 33% of the applicants tucked away "early".

Improving the Residency Application and Selection Process—An Optional Early Result Acceptance Program

This Viewpoint proposes an early result match program for applicants to postgraduate training programs, much like early decision programs at undergraduate colleges, as a means to address the rise in number of residency applications and to ensure better fit between trainees and programs.

jamanetwork.com

 

[owenwilsonwoah]

@RadiologyPD

if programs will not be able to interview more applicants, then what will happen if applicants apply to more schools due to this being an online interview season?

will schools simply pick the top candidates, which would harm middle of the road or weaker applicants? or will schools still try to interview applicants based on historical match data ( some superstars, average ppl, les competitive ppl) so that the program rank list is on par with previous years?

 

[RadiologyPD]

It's not that difficult to figure out what happens if ALL students apply to more programs. Use the NFL draft as a thought exercise.

Let's say there are 32 OUTSTANDING candidates, 64 EXCELLENT candidates, 64 GREAT candidates, and 64 GOOD candidates, with 32 programs. Each program gets 7 candidates, and can ordinarily interview 70 people.

The absolute disaster scenario is that each of the 32 OUTSTANDING candidates and each of the 64 EXCELLENT candidates decide to apply to each of the 32 programs. Which coach will have the gonads to actually TURN DOWN the request to interview from these 96 OUTSTANDING or EXCELLENT candidates? So we all decide to figure out how we can boost the number of people we can interview so we can interview these 96 candidates who said they might be interested in our program, and go into our war rooms and figure out our rank list for these 96 players. In the end, some programs get 7 of these OUTSTANDING or EXCELLENT candidates, some get 0. Not a problem--some of the greatest radiologists were GREAT or GOOD med students, and some of the worst radiologists were OUTSTANDING or EXCELLENT.

The only problem is that the Great and Good candidates have less of a chance to get considered by the program in which they are most interested.

When the candidates who have stellar records (whatever that means) OVERAPPLY and OVERINTERVIEW, all it does is reduce the number of interviews that the Great and Good candidates get. Every team CANNOT interview every player.

And the impact is greatest on the programs, not the Outstanding and Excellent candidates. So, to answer your question, since we never get to the DISASTER scenario, all that happens when "programs will not be able to interview more applicants" is that programs go down on their rank list--applicants without red flags or application gaps tend to get the interviews they need to match SOMEWHERE.

I literally became a meme on the interview trail last year because our program made the decision to interview late and I purposefully kept in touch with applicants all year asking them to really consider if they really were interested in our program--it got so old that blogs were full of people complaining that I overcommunicated. I didn't care. The honest truth is that we had about 30-40 people who we ordinarily WOULD HAVE interviewed in our old system of interviewing early who ended up realizing that they had plenty of interviews in the geographic locations that they preferred, and respectfully declined further consideration for our late interview--which basically opened up 30-40 interview spots for the GREAT and GOOD candidates. From my constant contact with candidates, I could tell that a number just weren't as interested in our program as other programs, and they had OUTSTANDING or EXCELLENT credentials.

My most straightforward advice is to make an honest assessment of your application, and if you have an OUTSTANDING or EXCELLENT application, give serious thought to where you actually might want to do your residency and apply there, with a few safety programs thrown in for good measure. If you have real gaps or issues with your application, by all means apply broadly. If you are AOA, you have no reason to interview at more than 10 places.

 

[owenwilsonwoah]

It's not that difficult to figure out what happens if ALL students apply to more programs. Use the NFL draft as a thought exercise.

Let's say there are 32 OUTSTANDING candidates, 64 EXCELLENT candidates, 64 GREAT candidates, and 64 GOOD candidates, with 32 programs. Each program gets 7 candidates, and can ordinarily interview 70 people.

The absolute disaster scenario is that each of the 32 OUTSTANDING candidates and each of the 64 EXCELLENT candidates decide to apply to each of the 32 programs. Which coach will have the gonads to actually TURN DOWN the request to interview from these 96 OUTSTANDING or EXCELLENT candidates? So we all decide to figure out how we can boost the number of people we can interview so we can interview these 96 candidates who said they might be interested in our program, and go into our war rooms and figure out our rank list for these 96 players. In the end, some programs get 7 of these OUTSTANDING or EXCELLENT candidates, some get 0. Not a problem--some of the greatest radiologists were GREAT or GOOD med students, and some of the worst radiologists were OUTSTANDING or EXCELLENT.

The only problem is that the Great and Good candidates have less of a chance to get considered by the program in which they are most interested.

When the candidates who have stellar records (whatever that means) OVERAPPLY and OVERINTERVIEW, all it does is reduce the number of interviews that the Great and Good candidates get. Every team CANNOT interview every player.

And the impact is greatest on the programs, not the Outstanding and Excellent candidates. So, to answer your question, since we never get to the DISASTER scenario, all that happens when "programs will not be able to interview more applicants" is that programs go down on their rank list--applicants without red flags or application gaps tend to get the interviews they need to match SOMEWHERE.

I literally became a meme on the interview trail last year because our program made the decision to interview late and I purposefully kept in touch with applicants all year asking them to really consider if they really were interested in our program--it got so old that blogs were full of people complaining that I overcommunicated. I didn't care. The honest truth is that we had about 30-40 people who we ordinarily WOULD HAVE interviewed in our old system of interviewing early who ended up realizing that they had plenty of interviews in the geographic locations that they preferred, and respectfully declined further consideration for our late interview--which basically opened up 30-40 interview spots for the GREAT and GOOD candidates. From my constant contact with candidates, I could tell that a number just weren't as interested in our program as other programs, and they had OUTSTANDING or EXCELLENT credentials.

My most straightforward advice is to make an honest assessment of your application, and if you have an OUTSTANDING or EXCELLENT application, give serious thought to where you actually might want to do your residency and apply there, with a few safety programs thrown in for good measure. If you have real gaps or issues with your application, by all means apply broadly. If you are AOA, you have no reason to interview at more than 10 places.

thanks for the reply. Idk if its possible but could you give examples for the various "tiers" of applicants in regards to step scores, research, clinical grades, school rank?

 

[greatboardgod]

It's not that difficult to figure out what happens if ALL students apply to more programs. Use the NFL draft as a thought exercise.

Let's say there are 32 OUTSTANDING candidates, 64 EXCELLENT candidates, 64 GREAT candidates, and 64 GOOD candidates, with 32 programs. Each program gets 7 candidates, and can ordinarily interview 70 people.

The absolute disaster scenario is that each of the 32 OUTSTANDING candidates and each of the 64 EXCELLENT candidates decide to apply to each of the 32 programs. Which coach will have the gonads to actually TURN DOWN the request to interview from these 96 OUTSTANDING or EXCELLENT candidates? So we all decide to figure out how we can boost the number of people we can interview so we can interview these 96 candidates who said they might be interested in our program, and go into our war rooms and figure out our rank list for these 96 players. In the end, some programs get 7 of these OUTSTANDING or EXCELLENT candidates, some get 0. Not a problem--some of the greatest radiologists were GREAT or GOOD med students, and some of the worst radiologists were OUTSTANDING or EXCELLENT.

The only problem is that the Great and Good candidates have less of a chance to get considered by the program in which they are most interested.

When the candidates who have stellar records (whatever that means) OVERAPPLY and OVERINTERVIEW, all it does is reduce the number of interviews that the Great and Good candidates get. Every team CANNOT interview every player.

And the impact is greatest on the programs, not the Outstanding and Excellent candidates. So, to answer your question, since we never get to the DISASTER scenario, all that happens when "programs will not be able to interview more applicants" is that programs go down on their rank list--applicants without red flags or application gaps tend to get the interviews they need to match SOMEWHERE.

I literally became a meme on the interview trail last year because our program made the decision to interview late and I purposefully kept in touch with applicants all year asking them to really consider if they really were interested in our program--it got so old that blogs were full of people complaining that I overcommunicated. I didn't care. The honest truth is that we had about 30-40 people who we ordinarily WOULD HAVE interviewed in our old system of interviewing early who ended up realizing that they had plenty of interviews in the geographic locations that they preferred, and respectfully declined further consideration for our late interview--which basically opened up 30-40 interview spots for the GREAT and GOOD candidates. From my constant contact with candidates, I could tell that a number just weren't as interested in our program as other programs, and they had OUTSTANDING or EXCELLENT credentials.

My most straightforward advice is to make an honest assessment of your application, and if you have an OUTSTANDING or EXCELLENT application, give serious thought to where you actually might want to do your residency and apply there, with a few safety programs thrown in for good measure. If you have real gaps or issues with your application, by all means apply broadly. If you are AOA, you have no reason to interview at more than 10 places.

Thank you for being so helpful on this website and I really appreciate the time you put in to help applicants.

I discovered that I had a medical condition that affected my sleep, mood and concentration during my 2nd year. It was well documented in my school medical facility. I struggled really hard to get through my 2nd year with 4 fails. I was better after they put me on medication. I was able to pass all 4 classes during my 3rd year and graduate with my class without delay.

My cGPA is below 3.0 (my school calculates the 4Fs in the cumulative as well as the repeated classes). I understand it is very low but I do have a legitimate reason for it. Is there anything I can do to offset my low GPA and to prove that I can handle the residency?

Thank you for your time in advance!

 

[yanhoz]

With AAMC discouraging away/sub-i rotations but allowing those without a home program to go, will it be viewed negatively to PDs/residencies to go on more than 1 away rotation this cycle?

 

[RadiologyPD]

thanks for the reply. Idk if its possible but could you give examples for the various "tiers" of applicants in regards to step scores, research, clinical grades, school rank?

I suppose the easiest thing to consider is:
AOA: outstanding
Class rank top 25% but not AOA: excellent
Class rank 50-75%: great
Class rank 25-50%, with Step 1 or 2 above 50th percentile: good
Class rank < 50th % and Step 1 or 2 below 50th percentile: ok

 

[RadiologyPD]

Thank you for being so helpful on this website and I really appreciate the time you put in to help applicants.

I discovered that I had a medical condition that affected my sleep, mood and concentration during my 2nd year. It was well documented in my school medical facility. I struggled really hard to get through my 2nd year with 4 fails. I was better after they put me on medication. I was able to pass all 4 classes during my 3rd year and graduate with my class without delay.

My cGPA is below 3.0 (my school calculates the 4Fs in the cumulative as well as the repeated classes). I understand it is very low but I do have a legitimate reason for it. Is there anything I can do to offset my low GPA and to prove that I can handle the residency?

Thank you for your time in advance!

You need a hook. This could be relationship (successful rotation, faculty advocate) or special skill (programming, research, leadership).

With AAMC discouraging away/sub-i rotations but allowing those without a home program to go, will it be viewed negatively to PDs/residencies to go on more than 1 away rotation this cycle?

No. No one cares about where you do sub-i's--we don't have time to get to that detail. The purpose of the away rotation is to develop a relationship with the away program--doesn't help you or really hurt you with other programs, in my opinion. We would hardly notice--I don't have time to look through your transcript.

 

[Brill4]

Thank you so much for this thread @RadiologyPD. This is extremely helpful for us Radiology hopefuls.

Apologies if this question has been asked already but didn't see it in the few pages that I read through. I developed an interest in Radiology pretty early in med school, and discovered IR around my 2nd year. Since then I have been gearing my application towards the integrated IR track (research, scheduling electives, etc), but have been having second thoughts as of late. Assuming the COVID situation doesn't mess this up any more than it already has, I will likely be doing two IR electives in the fall. However, if I at some point I decide that integrated IR isn't for me and instead apply only DR, would my application be looked down upon by PDs once they see all the IR stuff on my app? I've heard that DR PDs can tell when an applicant is mainly interested in IR and may not offer interviews to reserve spots for those more interested in DR. There's also a chance that I mix and match my rank list rather than place all IR integrated programs first, in which case I wouldn't want to be docked as someone who's only going for IR. Thank you!

 

[greatboardgod]

You need a hook. This could be relationship (successful rotation, faculty advocate) or special skill (programming, research, leadership).

RadiologyPD: Which programming language would you recommend? Thank you in advance!

 

[RockyFord]

I'm not an IR PD, but as the DR PD in our program that has ESIR, I'm involved in vetting the DR residents who want to do IR in our program. I doubt it would matter that much in terms of securing your ESIR spot anywhere; it doesn't for us. Your ability to get an ESIR spot will be based on your relative strength as an "IR person" to the IR decision-makers based on your performance as a DR resident

So with this in mind: what factors go into an applicant being a strong “IR person”, especially if one develops an interest in IR later? At what point in residency do you select people for ESIR? How much stock should applicants put into a program saying that they prioritize internal candidates for the independent IR positions post-ESIR?

Also somewhat less related and I apologize if you have already touched on this already but I didn’t see it addressed: how much do you suppose diagnostic skills atrophy during the 2 years of dedicated IR training? I would like to practice both DR and IR (rare breed based on this forum I guess) and not being able to provide value reading some general diagnostic is my biggest concern.

Thanks in advance

 

[RadiologyPD]

Apologies if this question has been asked already but didn't see it in the few pages that I read through. I developed an interest in Radiology pretty early in med school, and discovered IR around my 2nd year. Since then I have been gearing my application towards the integrated IR track (research, scheduling electives, etc), but have been having second thoughts as of late. Assuming the COVID situation doesn't mess this up any more than it already has, I will likely be doing two IR electives in the fall. However, if I at some point I decide that integrated IR isn't for me and instead apply only DR, would my application be looked down upon by PDs once they see all the IR stuff on my app? I've heard that DR PDs can tell when an applicant is mainly interested in IR and may not offer interviews to reserve spots for those more interested in DR. There's also a chance that I mix and match my rank list rather than place all IR integrated programs first, in which case I wouldn't want to be docked as someone who's only going for IR. Thank you!

If and when you apply and decide to just do DR, or target a mix of IR and DR programs, to some degree your success in obtaining the DR interviews will be a function of how serious those programs think you are about going to that program. Typically programs only have so many interview slots, and they are not really interested in wasting interview slots on individuals looking for back-up programs. So if your application comes across like someone who is looking at DR spots purely as a backup, you may not get as many DR interviews as your record would justify.

Having said that, now that it is clear that the next interview cycle is not going to be normal, in that it will be largely virtual, it is hard to know whether programs will spend the same resources on each interview candidate as they have in the past. As a result, programs may decide to interview more individuals if they decide that only two-to-three faculty will interview any individual candidate. In this scenario, they could indeed interview more people and will be less concerned about filling interview slots with individuals who may preferentially rank IR spots.

The bottom line is that you should aim to tailor your application to each DR program to ensure that the program sees you as being serious about DR and their program--consider tailoring the message in the personal statement. If you can convey that message, then you will be fine.

 

[RadiologyPD]

RadiologyPD: Which programming language would you recommend? Thank you in advance!

Sorry, can't help you with this one. Not in my sphere of knowledge.

 

[RadiologyPD]

So with this in mind: what factors go into an applicant being a strong “IR person”, especially if one develops an interest in IR later? At what point in residency do you select people for ESIR? How much stock should applicants put into a program saying that they prioritize internal candidates for the independent IR positions post-ESIR?

Also somewhat less related and I apologize if you have already touched on this already but I didn’t see it addressed: how much do you suppose diagnostic skills atrophy during the 2 years of dedicated IR training? I would like to practice both DR and IR (rare breed based on this forum I guess) and not being able to provide value reading some general diagnostic is my biggest concern.

In my experience, some radiology residents just have a knack for procedures, some are all thumbs, and most can do fine with training. In all fairness, as a resident, the IR team is not looking for the resident to be the procedural expert. The IR radiologists are not going to turn to you and say "Bob, I'm really having difficulty getting the catheter to where I want -- can you please give it a try for me?"

What do the IR rads picking residents want? They want residents who are compulsive but fast, residents who will catch the pre-procedural problems in the chart but don't spend all day reading the chart, residents who get the dictations done fast, residents who can consent a patient quickly, residents who effectively complete the scut work on the service, residents they can trust to check the INR. The best potential IR resident to the IR team is not necessarily the person who has the best "IR skills", it is the resident who is punctual, accurate, compulsive, fast, and pleasant.

In our program, we select residents for ESIR at the beginning of the 3rd year of residency. So far, everybody in our program who has wanted to do ESIR has done ESIR because we have a relatively high number of ESIR spots for the number of our DR residents--so frankly we've never turned anyone away. But we've had a number of residents who self-ejected from the IR path during the first two years, realizing that they actually prefer the diagnostic work with "IR light" activities that are ubiquitous in many DR subspecialties.

I would absolutely believe a program that says that they prioritize internal candidates for any independent IR positions that they have--they'd be stupid not to. For most residencies, an internal candidate is gold--already up to speed on the nuances of the institution and department and EMR, ready to go. They know the system, they know the attendings, and the attendings know them. In our program, we essentially rank our internal candidates "to match" but help them explore other opportunities if they want, because we realize that there is value in diversity of clinical experience (especially if we want to recruit that person back to our practice later).

With respect to the other question about atrophy of skills, obviously if you do not do something you never did very well, you will lose skills--but much depends on your aptitude for that activity and how good you are at it. For example, in my residency, neuroradiology was heavily emphasized. Our residents were really good at neuroradiology, even if we didn't go into it. Therefore, even after spending 5 years not doing any neuroradiology, there was a short period when I became the backup neuroradiologist person in my new practice until we could hire more neuroradiologists. For a full year, I did about 20% diagnostic neuroradiology, never working alone but helping knock out the cases, even after having not done it for 5 years. I wasn't great but I knew enough to get the easy and average stuff done, and ask for help for the hard stuff--I didn't hurt anyone. You will find that what you do in radiology practice 10 years after training may have nothing to do with what thought you'd be doing after radiology residency or fellowship. So after doing IR for 2 years, your ability to do non-IR stuff will really depend on how well you learned the basics, your aptitude for the non-IR work, and your ability to learn and polish new skills.