Radiology Faculty--Answering Questions/"AMA"

[RadiologyPD]

I agree with you, of course. With how the algorithm works, it makes no sense for an applicant to rank B over A. But I always thought that applicants had an incentive to send programs the "you're my number 1" email

As I mentioned before, PDs love these "you're my number 1" notes from applicants. In my case, it doesn't influence me, but does makes me feel better. I can imagine it might actually help you with some other programs, who might be more concerned about their egos and what number they end up filling their program. Conceivably they could move you up to boost their pride in filling with low ranks. I can't conceive of how sending a program a "you're my number 1" could hurt anyone, as long as it is true. You definitely don't want to send that if not true--that PD will remember your name forever in a negative way if that program fills below you.

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[SDN]

Wasn't considering radiology but this thread may have put it on the map for me. Mods really outdid themselves with this one; really takes away most of the guess work and hearsay. @Lee Is there any way, any way at all, to get PDs for the other specialities to do the same? There is something to be said for the level of transparency here.

Yes, absolutely. We've had plenty of member-initiated AMAs over the years, but no structured program for it. Based on the member benefit of this AMA, I'd like to initiate PD AMAs as a regular feature across SDN.

 

[Light at end of tunnel]

Special shout out to @Winged Scapula who has worked tirelessly albeit behind the scenes to make this AMA happen!

 

[McNCheese]

Hi RadiologyPD! Do program directors find out match results on the same day as applicants? Do you get excited to look at the results? Do you ever get disappointed that an applicant didn't match at your program that you thought was an amazing fit? Just curious about the program's perspective on this life-altering day for applicants!

Thanks for all of your posts so far, this thread is already an incredible resource for future applicants.

 

[PL198]

Special shout out to @Winged Scapula who has worked tirelessly albeit behind the scenes to make this AMA happen!

ok chill with the sucking up...

 

[RadiologyPD]

Hi RadiologyPD! Do program directors find out match results on the same day as applicants? Do you get excited to look at the results? Do you ever get disappointed that an applicant didn't match at your program that you thought was an amazing fit? Just curious about the program's perspective on this life-altering day for applicants!

On Monday of Match week, Programs (PDs and PCs) get an email notification as to how many of the positions we have available filled through the Match. That happens around 11 am EST. The R3 system that NRMP uses is turned off for any program that filled--we can't go into the system at all. Only the programs that didn't fill still have access. The programs that did not fill then go through the SOAP process (you can review NRMP for details on how that works, not very familiar personally). PDs get the roster of matched applicants on Thursday afternoon, but we are obliged not to disclose this to anyone.

I try to send an email to our matched applicants in the late afternoon on Friday, after any Match Day festivities have finished so I can be assured that the applicants have already heard the news. All afternoon Thursday and throughout Friday, I'm constantly barraged by my residents and faculty to give them some clue as to how we did--so, yes, there is a bit of excitement. This year I'm thinking of throwing a happy hour at my house so our residents and selection committee can celebrate--but not sure I can compete with other St. Patrick's Day events.

As it turns out, we never get our consecutive top choices to fill the spots--we aim high, so we understand our top candidates have choices and the candidates who don't choose us usually end up at some impressive places. We don't get too upset when those longshots who we knew were going to go where ever they wanted don't end up with us--but there is a lot of disappointment and head-scratching when a candidate that we thought would definitely choose us ends up going somewhere that we don't think is as good a fit (unless the candidate was couples matching--then we usually presume it was due to the significant others choices).

Admittedly, the place one matches is "life altering" for the applicant. The class we end up getting is one we will have to work with for 4 years, one that we'll have to "own" for their entire careers, and will essentially help to define us as a program for future applicants--so we definitely also are anxious about the results.

 

[RadiologyPD]

Trying to knock out some more of the existing questions to date:

1. What are some things you see residents coming to learn toward the end of residency they wish they had known when they first started out residency training?

Agree completely with Radiology_Advisor's response.

1. Read, read, read

2. Dictate as many cases as possible--especially during the day! What I mean by this is that on all of our rotations (and I suspect most centers), there's no way the resident on the service can handle the volume of all the cases. There's going to be lots of work that the resident just can't get to, that gets done by the faculty. In our program, we keep track of resident dictated volume on a rotation basis using our radiology systems, and I get that data monthly. After correcting for time off the rotation, historically there is at least a 2 fold difference in the number of studies the most "aggressive" residents interpret compared to the most "passive". I don't mean aggressive in a negative connotation--some people just keep moving, click on the next case faster, etc. Others look at the news feed on their computers for a minute or two, take longer in the bathroom, etc.

Bottom line: when you are on service at work, make it count!

3. Be nice to everyone, especially the allied health staff--and the residents in other fields. In the middle of the night, it's too easy to get into a pissing match about some case, it always comes back to haunt you.

4. Act professional.

2. Does independent call during residency really make for better residents and overall better radiologist? What have you found to be the ideal call set up?

I think putting together complete dictations (not prelim reports) is useful, regardless of the time interval that the attending takes to review the study. If the attending is on site or even next to you, but you are charged with dictating a complete report that has reviewed all the necessary clinical data and concisely addresses the question as well as appropriately handles unexpected or incidental findings, that's fine. If the attending is at home, that's fine. It if it reviewed in 20 minutes or 2 hours or 12 hours, it's fine.

Ideally, you take more call and more challenging call as you progress. Assuming the amount of call that you take during your residency is a set amount, I think you should do less as an R2 than as an R4. That's not the way most programs are set up, but it makes the most sense from your development. In the past, I've seen fellows in our system come in after essentially not taking any call for a year and they had really lost ground. Our fellows take some general call along with our residents, and practically all of them tell me later that was the best preparation they had for their jobs (private or academic).

3. Job market is currently improving, but still has a way to go. How does the job market affect the dynamic of the residency program, if at all?

Perceptions of the job market obviously influence the number of applicants. I'm sure Radiology has lost some of the most accomplished students to other fields because of the job market.

4. Do resi fellowships enhance the overall learning experience for residents? Have there been unforeseen consequences of Resi-fellowships?

Depends on the program and how much choice you have. Obviously, you have to have enough volume of cases in any given discipline to give your fellows, resi-fellows, and residents enough experience. If everyone wanted to focus on MSK during their R4 year, it's not going to work. In our program, we actually tailor our fellowship recruitment for some of the most popular fellowship areas (currently breast, MSK, IR/procedures), based on what our residents tell us they want to do during their R4 year--we'll recruit fewer fellows in those areas if residents "commit" to doing a certain number of months during their R4 year. It is a problem of sorts, because the way fellowship recruitment works, we have to ask our R2s early in the R2 year how much MSK and Breast and Procedures rotations they are willing to commit to doing 2 years later.

5. What do you feel are the top 5 traits that make for a successful radiology resident?

I liked Radiology_Advisor's response

• Professionalism

• Empathy and kindness - you often see only the images of patient suffering, so even more important

• Knowledge - Lifelong learning - lots to read in radiology (similar to pathology)

• Work ethic and going the extra step

• Curiosity & Passion

 

[Waterskier15]

I read a bit earlier that you do not encourage away rotations because it is difficult to impress in a radiology rotation. Say you are interested in training and possibly starting a career in a state across the country from where you went to medical school, how would you convey this interest in order to get your foot in the door? Basically, how would you improve your chances of an interview at a program that is out of your region?

Also, thank you for your insight on this thread. It has been super helpful!

 

[Fedekz]

1.) From a PD point of view, do you have any recommendations for 1st/2nd year medical students interested in radiology?

2.) What sort of value do you put on pre-clinical grades?

 

[RadiologyPD]

I read a bit earlier that you do not encourage away rotations because it is difficult to impress in a radiology rotation. Say you are interested in training and possibly starting a career in a state across the country from where you went to medical school, how would you convey this interest in order to get your foot in the door? Basically, how would you improve your chances of an interview at a program that is out of your region?

Keep in mind that being recognized by a program as "being local" or "having a local interest" is only really useful to distinguish you from other candidates that are equally competitive, because it means you are more likely to rank that program higher--so if the program is trying to decide who to interview, you may come out on top if the line is being drawn at around your credential level. If you are very competitive in the "pre-interview" part of the packet (USMLE and clinical grades, AOA status), you are probably going to get an interview at almost any place anyway. If you are in school in the southeast but have targeted an area in the west coast for future training/living, even then it can't hurt to send a short note to the PC/PD of the programs early in the application season but immediately after your applications are available to review that you are "interested in relocating to their location and please look at my application in that light." Just give the highlights of your situation in your note (USMLE scores, Clinical Honors, and AOA status if yes) if these are positive. Otherwise, just give a short one sentence legitimate reason for your local interest ("Due to my significant other's job prospects, I will be prioritizing interviews in (insert area of interest here).") Be honest here--if you say one thing to get the interview, but then it doesn't come through in your interview, that's a red flag. We once had a person say they were targeting our area due to a fiance's family in the area, but then didn't validate that when asked casually by one of my interviewers--looks bad.

1.) From a PD point of view, do you have any recommendations for 1st/2nd year medical students interested in radiology?

2.) What sort of value do you put on pre-clinical grades?

In addition to doing well in school (because the best training programs in radiology remain quite competitive), my simple advice would be to seek out opportunities to learn more about radiology, however that is possible at your school, including doing some research if possible. Don't worry about actually trying to "learn radiology" IMO-- anything you actually learn about interpreting images during medical school will not give you any significant advantage in being a good radiology resident--any knowledge advantage you've gained will be eclipsed by about the end of the first rotation, if not the first week. But it's always good to really be good at anatomy just for the future.

I don't have time to review pre-clinical grades. To the extent that these are reflected in your AOA status, and have helped you do well on USMLE Step 1, great. But so many schools have Pass/Fail for Years 1-2 that we don't even look at your first 2 years performance as it provides us with no comparative metrics (unless you failed a course, which typically gets highlighted in your Dean's letter). We rely on USMLE Step 1 to approximate your pre-clinical performance.

 

[Medic741]

When you are evaluating candidates from the PR schools, is there a bias against them similar to bias against IMG, or do PR MD grads have a 'level playing field' when it comes to how they are reviewed? This is somewhat a leading question... considering between DO and Ponce MD -- which would have better opportunities to match into strong residencies, such as rads or EM?

Thank you *so* much for your time!

 

[clockwerk]

For away rotations it seems it's necessary for students to apply to many schools in order to ensure a couple months have been filled. In the example of applying to 10 programs needing 2 away rotations, let's say I get accepted to 5. For the 3 that I inevitably have to turn down, am I destroying any chance of interviewing there? I like to think PDs would be understanding of the situation and necessity to over-apply

TL;DR - As a PD, do you auto reject those applicants that turned down an away rotation offer from your program? Do you even know which ones did so?

 

[RadiologyPD]

When you are evaluating candidates from the PR schools, is there a bias against them similar to bias against IMG, or do PR MD grads have a 'level playing field' when it comes to how they are reviewed? This is somewhat a leading question... considering between DO and Ponce MD -- which would have better opportunities to match into strong residencies, such as rads or EM?

Just to reiterate--isn't a "bias" against DO students. Each applicant gets evaluated on lots of stuff (see previous posts), including how helpful is this person going to be in recruiting the best candidates in the future. To the extent that there is a perception amongst applicants that a program with substantial DO students "couldn't attract" the best students, that hurts the DO applicant. PR MD grads less likely to be afflicted with this "bias".

As a PD, do you auto reject those applicants that turned down an away rotation offer from your program? Do you even know which ones did so?

No auto reject of applicants who ended up not doing rotation here. I probably would end up knowing that the person applied for rotation and did not do it with us, but I wouldn't care. Remember, n=1 on that answer.

 

[engineer16]

What can an applicant do on interview day to go from being a middling candidate to someone you're excited to rank?

 

[RadiologyPD]

1. Personality & Energy: shows sense of humor, optimism; is adaptable/flexible, humble, calm, confident, likable, mature; displays social intelligence, social grace, empathy, creativity, buoyancy, curiosity, and is thorough; displays energy, passion, enthusiasm, excitement, interest, ‘‘zing’’
2. Pleaser: will do what is asked, won't complain, steady, "nose to the grindstone", motivated, inquisitive, grateful
3. Self-reliance: Exhibits evidence of self-improvement; reflective, solicits feedback; understands strengths/weaknesses; shows awareness of needs, learning, and self-assessment; able to "figure out what to do"; "go getter"; doesn't need a lot of direction
4. Interpersonal: Is this someone you want to work with daily? Is this person a team player? Are other residents going to enjoy this colleague?
5. Pure Smarts (generalized--not specific to one area); test taking skills (consider board scores, shelf exams, etc)
6. Research: consider not what they've done or how many publications but why they did it; can they speak to intent?; how likely are they to continue to do in residency; beyond residency?; consider goals
7. LORs/Dean's letter comments (from rotations): how outstanding are they? (5 is average)
8. Intangibles: Is anything bugging you about the candidate (if so, score less than 5) Is anything compelling about the candidate (if so, score higher than 5). Leave at 5 if nothing positive or negative; use this score to emphasize special concerns or highlight special skills

See prior post (quoted above) for the components of the "personality score"--item 1, 2, 3, and 4--and the associated descriptors.

 

[rrxr]

First of all, thanks so much for this transparent and helpful thread!

How do you feel about letters from radiologists? I imagine many people don't have an amazing letter from a radiologist simply because of the nature of radiology electives, but would you want to see one anyway? I do research but my PI is a phd, would that be okay for a "radiology letter"?

My brain is telling me that no one cares about this stuff and there's no checkboxes for who you get letters from, but I can't help fretting about this anyway...

 

[RadiologyPD]

It's not that important to me (or my selection committee) to see that your letters are from radiologists. Years ago, I didn't have a good letter from a radiologist because I chose radiology late in the game. It does help to have a great letter from someone I know, and I know more external institutional academic radiologists than academic non-radiologists. It hurts you to have a really lack luster letter from a radiologist--I remember one candidate who chose the radiology dept chair to write his/her letter, and it started by saying "I don't know this candidate very well, but seems pretty good". The letter hurt that candidate.

Bottom line--get the best letters you can. If you can get a great letter from a radiologist who is academically connected, even better, but don't get one from that person if it's going to be a basic standard letter.

 

[rrxr]

That makes a lot of sense, thank you! I just got a little freaked out by seeing all these people online who say their PDs or clerkship directors write everyone a letter as a matter of routine, which I don't think people do at my school.

I wish my research was with an MD since I've done pretty well in it, but I've enjoyed it so no regrets.

 

[mTORC]

7. We do the same as #6 for DO candidates. We do interview a few every year (< 3), but we believe there is a penalty for our program in future applicants if we have a number of DO residents, mainly because there is the perception that we couldn’t attract the best MD candidates. It’s unfortunate for some DO students who are going to be great, but it is reality.

Do you take into account couples matching at all? The reason I ask is that I am couples matching with a DO also going into rads whereas I go to a top 5 allopathic med school (step >250 and >260 respectively)- would you consider the two to balance or is this unlikely to help? Otherwise, if you really wanted one of the two applicants, as a PD would you make calls to other local programs to try and match the other locally? Appreciate your insight.

 

[RadiologyPD]

Do you take into account couples matching at all? The reason I ask is that I am couples matching with a DO also going into rads whereas I go to a top 5 allopathic med school (step >250 and >260 respectively)- would you consider the two to balance or is this unlikely to help? Otherwise, if you really wanted one of the two applicants, as a PD would you make calls to other local programs to try and match the other locally? Appreciate your insight.

We do note who is couple matching. Generally the partner isn't going into radiology, but occasionally when the couple are both interested in radiology, if one is "awesome", it does help the other. If only one person meets our target criteria and that person is "pretty good", that person gets an interview invitation--in that case, the other person is considered on his/her own merit. There are a number of residencies in our geographic area so it's possible that we interview one but don't ask the other, and the other person gets an interview at one of our local alternative radiology programs. However, if one person is awesome, we will give high consideration to the other person--remember, we don't really think there is a magic set of performance criteria that accurately sorts out our "average" candidates and predicts which person in that group is going to be a fantastic radiology resident vs. who is going to be a very good radiology resident vs. who is going to be an adequate radiology resident. We know there are going to be some fantastic radiology residents who come out of the "average" pool. We are just playing the odds. So if one person of the couple has a lot of favorable characteristics and a higher likelihood of being "awesome" (by our guess), then the other person could be "average" and he/she gets bumped up for the interview.

When it comes time to rank, we don't feel that the two candidates have to be "back-to-back". Again, this is because there are some other options in our geographic area.

We don't call other radiology residencies to try to get the person in the couple who scores lower in our spreadsheet a position in the local area. Likewise, I've never been called from another radiology residency program that is geographically close for that same request. It just doesn't happen.

What does happen more commonly is for a PD in my institution to call me about the partner of a candidate that they are interested in for a different specialty. We practically always give preferential treatment to interview the partner in that situation, if for no other reason as to be a good institutional citizen. We've also asked that of other PDs when we have a strong candidate whose partner is interested in another specialty. In a weird sort of way, we like the "alliance building" that occurs when one of our residents has a partner who is in another residency at our institution. It's good for relationships between departments.

 

[mTORC]

We do note who is couple matching. Generally the partner isn't going into radiology, but occasionally when the couple are both interested in radiology, if one is "awesome", it does help the other. If only one person meets our target criteria and that person is "pretty good", that person gets an interview invitation--in that case, the other person is considered on his/her own merit. There are a number of residencies in our geographic area so it's possible that we interview one but don't ask the other, and the other person gets an interview at one of our local alternative radiology programs. However, if one person is awesome, we will give high consideration to the other person--remember, we don't really think there is a magic set of performance criteria that accurately sorts out our "average" candidates and predicts which person in that group is going to be a fantastic radiology resident vs. who is going to be a very good radiology resident vs. who is going to be an adequate radiology resident. We know there are going to be some fantastic radiology residents who come out of the "average" pool. We are just playing the odds. So if one person of the couple has a lot of favorable characteristics and a higher likelihood of being "awesome" (by our guess), then the other person could be "average" and he/she gets bumped up for the interview.

When it comes time to rank, we don't feel that the two candidates have to be "back-to-back". Again, this is because there are some other options in our geographic area.

We don't call other radiology residencies to try to get the person in the couple who scores lower in our spreadsheet a position in the local area. Likewise, I've never been called from another radiology residency program that is geographically close for that same request. It just doesn't happen.

What does happen more commonly is for a PD in my institution to call me about the partner of a candidate that they are interested in for a different specialty. We practically always give preferential treatment to interview the partner in that situation, if for no other reason as to be a good institutional citizen. We've also asked that of other PDs when we have a strong candidate whose partner is interested in another specialty. In a weird sort of way, we like the "alliance building" that occurs when one of our residents has a partner who is in another residency at our institution. It's good for relationships between departments.

Thank you! That is incredibly helpful.

 

[bauhinia123]

In light of the 240 step1 as the threshold for interview invites, would I have a chance matching into an academic program in the South/north/anywhere on the east coast with a ~235 step 1 and 20 points higher step 2 score and mix of H(30%)/HP(70%) clinical grades?

 

[RadiologyPD]

Yes. Not sure where you see the 240 step 1 threshold. 240 is around the average Step 1 score for radiology applicants/residents. That means a whole lot of people are below 240.

 

[harambe4ever]

Personal statement. Important or just need to put something generic down that doesn't come off weird? Anything we should particularly say or not say? What about modifying a personal statement to a particular program?

 

[Jfandango]

Many thanks to the both of you for taking the time to answer our questions. I'm a US IMG with a USMLE step 1 score of 238. Considering what you said about DOs/IMGs, should I even bother applying to extremely competitive/academic institutions (eg anywhere in California, except for maybe Hemet program)? Taking that a step further: I've been looking at program websites and seeing where their residents are from. Some schools have IMG and DO residents, so these would clearly be good places to apply to, but what about programs who have DO residents but no IMG residents, or programs that might be considered "mid-tier" but have only US allopathic residents? I'm planning on applying broadly, but applications are expensive so I'm trying to be realistic. Should I bother applying to IR residencies as well, or just try to focus on DR programs that are ESIR? I know that's several questions, but any type of insight you could provide would be appreciated.

 

[DrfluffyMD]

Many thanks to the both of you for taking the time to answer our questions. I'm a US IMG with a USMLE step 1 score of 238. Considering what you said about DOs/IMGs, should I even bother applying to extremely competitive/academic institutions (eg anywhere in California, except for maybe Hemet program)? Taking that a step further: I've been looking at program websites and seeing where their residents are from. Some schools have IMG and DO residents, so these would clearly be good places to apply to, but what about programs who have DO residents but no IMG residents, or programs that might be considered "mid-tier" but have only US allopathic residents? I'm planning on applying broadly, but applications are expensive so I'm trying to be realistic. Should I bother applying to IR residencies as well, or just try to focus on DR programs that are ESIR? I know that's several questions, but any type of insight you could provide would be appreciated.

I have been involved with resident recruitment. For you, I would only apply to DR at this moment and try to get to a better IR independent residency as DR/IR is very competitive and the few place you have a shot may not be the IR training you want (right now the DR/IR match could be inflated in competitiveness).

As for DR, former DO residencies (like the Hemet one) is fine, but I would apply to university programs outside of competitive areas only.

 

[RadiologyPD]

Personal statement. Important or just need to put something generic down that doesn't come off weird? Anything we should particularly say or not say? What about modifying a personal statement to a particular program?

The personal statement (PS) probably won't be a factor in whether or not an individual gets an interview--since programs receive so many applications for the number of spots, it's just too hard to review all the PS in the filter process and most do not stand out. I don't read the PS during the "select to interview" process for candidates that hit all the right metrics (see earlier post on what I look for during the select to interview process). For candidates with metrics that don't make them no-brainers for interview (good metrics that a lot of people have), I will review the PS. A really good or great personal statement helps at that point, and is an advantage during the interview process--if memorable in a positive way, it helps the candidate stand out. It can be useful to "steer" the interviewer to ask about interesting or unique aspects of a candidate's application, which then make the interview "effortless" and serves to increase the likability of the candidate. But don't be weird just to be unique--an off color or weird PS is offputting to the interviewer.

The PS is a tough one--if you just "mail in" a generic one, it becomes obvious to the interviewer. If you try to be too cute, it can come off wrong. But if you nail it, it really helps to make you memorable. I would definitely have others that you trust review what you write to see if it rubs anyone the wrong way. If you try and it ends up being generic, that's ok. Most of them fall into this category. If you don't try at all and it is obvious that you just wrote down a bunch of cliches, that isn't a great impression. It won't hurt you if your metrics are great, but won't help you if you are in the mix with a bunch of other candidates with the same metrics.

My personal bias is that I want to know a bit more about the applicant in the PS, not why they think radiology is a great field. I find it somewhat irritating if you spend the PS telling me why radiology is a great field--I know it is, I'm a radiologist. I'd rather you highlight experiences in your CV or in your life that give you some "color" or that you think set you apart or that give me an indication of what you find important in your career. If you are passionate about caving, tell me about that in the context of what that says about you, the challenges you've faced, and the direction you are headed. Tie that into your interest in radiology or medicine in general, and you have the makings of a PS that gives me some insight into you--or at least is something I can talk to you about during your interview.

 

[RadiologyPD]

Many thanks to the both of you for taking the time to answer our questions. I'm a US IMG with a USMLE step 1 score of 238. Considering what you said about DOs/IMGs, should I even bother applying to extremely competitive/academic institutions (eg anywhere in California, except for maybe Hemet program)? Taking that a step further: I've been looking at program websites and seeing where their residents are from. Some schools have IMG and DO residents, so these would clearly be good places to apply to, but what about programs who have DO residents but no IMG residents, or programs that might be considered "mid-tier" but have only US allopathic residents? I'm planning on applying broadly, but applications are expensive so I'm trying to be realistic. Should I bother applying to IR residencies as well, or just try to focus on DR programs that are ESIR? I know that's several questions, but any type of insight you could provide would be appreciated.

I agree with DrfluffyMD. You've got a good approach in terms of looking at current resident backgrounds. Your board score doesn't set you apart as a US IMG. It's a reasonable score for success as a radiologist, but recognize that it is below the average for all radiology applicants--and probably well below average for US IMGs that match into radiology. You will need a hook to get a mid tier program with that score as a US IMG.

 

[plasmodium]

I agree with DrfluffyMD. You've got a good approach in terms of looking at current resident backgrounds. Your board score doesn't set you apart as a US IMG. It's a reasonable score for success as a radiologist, but recognize that it is below the average for all radiology applicants--and probably well below average for US IMGs that match into radiology. You will need a hook to get a mid tier program with that score as a US IMG.

Hi @RadiologyPD, thanks for answering all of these questions.

How are students looked upon whose scores either don't improve or fall on Step 2 CK after scoring 260+ on Step 1 (hypothetically let's say they remain >240)?

 

[RadiologyPD]

How are students looked upon whose scores either don't improve or fall on Step 2 CK after scoring 260+ on Step 1 (hypothetically let's say they remain >240)?

The scenario you describe is rare--it didn't happen last year in my experience. I went back to my database and for last year's applicants, of about 400 applicants who had submitted both Step 1 and Step 2 scores, there were only 11 applicants whose Step 2 scores were 15 or more points lower than step 1.

Here are those score pairs (step 1 first, step 2 second):
255-215, 264-230, 251-220, 229-199, 248-225, 238-215, 250-229, 235-216, 252-235, 233-218, 231-216

To be honest, if someone dropped 25-30 points from Step 1 to Step 2, my thoughts would be that the person spent more time prepping for Step 1, or just was innately more adept at basic science facts. If Step 2 was 240+, no big deal.

Just FYI, there were 80 applicants whose Step 2 was 15 or more points higher than Step 1.

 

[qxrt]

The “Interview” score is combined with the “USMLE” score and the “Clinical” score (the 3rd year core clerkships) to determine the overall score. We constantly tweak the relative percentage that each score contributes to the overall score, but for the most part, the interview score is about 50%, the USMLE score is 25%, and the Clinical score is 25%.

...

In the end, our “overall score” does not predict the exact ranking. Last year, our top 10 candidates (in order) had the following “overall score” ranks: 2-9-14-19-3-4-8-7-11-6. The number 1 person on the "overall score" ended up being ranked 11th.

So, there you have it!

Thank you for all the insight into this process! I was a bit puzzled by the part I quoted above, where you talk about how the final ranking is made. How did someone who got the number 1 "overall score," which includes both the application and interview scores, end up so relatively far down the final list? Does this imply that there is some other criteria that you took into account? Or perhaps it was an unbalanced "overall score," where their application (or vice versa with the interview score) disproportionately bolstered their overall score, and the final ranking took that into account? Conversely, would that account for how someone with a "14" or "19" overall score rank got boosted so high?

And another question about the same step in the process: I know that you've said that you personally select the applications that go on to get an interview. But after the interview stage is over, much of a relative impact do you have (as program director) in terms of the final ranking compared to the other faculty members who have interviewed the candidates? Do you get a disproportionately high say in the final ranking, or is everyone on the ranking committee given an equal say in how any applicant gets ranked?

 

[RadiologyPD]

How did someone who got the number 1 "overall score," which includes both the application and interview scores, end up so relatively far down the final list?

Yes, interesting. The way this happens is because we don't blindly accept our "formula" for combining the interview score, the USMLE score, and the clinical score. Let's review what characteristics we want to recruit, as I posted before (in quotes below):

“Will we enjoy working with this person, can we trust them to do the best job possible for our patients, can we be confident in their ability to interact with our clinical colleagues, will this person help us recruit great residents in the future, will we be excited to see this person at a meeting after they graduate, are they on a career trajectory that could inspire future residents and maintain our brand?

• Enjoy working with: obvious
• Trust them to do the best job: potential for developing excellent clinical skills, demeanor, motivation
• Interactions with clinical colleagues: If the most arrogant surgeon comes down to review a case, will this person be able to handle it well?
• Help us recruit: are they likeable, present themselves well, will they pursue the best possible fellowships
• Excited to see: obvious
• Inspiring career trajectory: Leadership (private practice, organized radiology, or academics), Academics, Community service."

As I mentioned in that post, the selection committee jots down a score for "Leadership" which gets at a combination of research/academic ambitions and inspiring career trajectory. We review this score as we look at the candidates and use it to move up or down. But it doesn't actually fit into a "formula".

The person who had the #1 "overall" score based on our mathematical formula that combines the interview score, USMLE score, and clinical score was an individual who went to a large mid tier medical school out west which we know well, who got all honors at that school where honors was only given to 15-30% of individuals (so relatively good discriminator of performance), and who scored over 265 on step 1 and step 2 (doing better on step 2 than step 1). On the interview score, the person did fine but the feeling was the person had modest career ambitions. That person went to undergrad at the same institution as medical school, was probably going to settle in that area, and we perceived that person to have little true desire for academics or leadership, based on historical activity and interview impressions. The committee had this assessment:

• Enjoy working with: YES!
• Trust them to do the best job: YES!
• Interactions with clinical colleagues: YES!
• Help us recruit: Very likeable, but probably would do fellowship at same institution the person came from to eventually practice in that area. That institution is fine but not really a "name".
• Excited to see: YES!
• Inspiring career trajectory: Looked to us like this person will be a great colleague in a private practice in the area that person grew up.

So based on that, we dropped that person to #11. We just didn't think that in the end this person was going to have an inspiring career trajectory THAT WOULD BE READILY APPARENT TO APPLICANTS. In other words, the person might in fact be very inspiring on the local level that he/she chooses to be at--but hard to point to that person to our future applicants and say, "Look at this graduate, he/she is practicing in a community practice in a mid-size area where he/she grew up--isn't that inspiring!".

Now, to be fair, based on the combination of the size of our program and history, and because we always interview and rank our candidates based purely on our metrics and don't worry about our "rank to fill" number (in other words, as I mentioned before, I will rank people highly who I sense would rather be somewhere else geographically), we have never filled all of our positions in the top 15 choices. So ranking this person #11 meant the person was still going to match with us if he/she ranked us first, unless somehow we magically got all of our top choices--which never happens.

The person ended up matching at the same institution that he/she did undergrad and med school at--I expect he/she will be in one of the big "super-practices" that we know that operate in that geographical area (at which some of our graduates currently work). It's where that person grew up, chose to stay for undergrad, chose to stay for med school, and chose to stay for residency. I would be very surprised if that person doesn't do his/her fellowship there.

Applicants can't be easily distilled into "numbers". We use scores and numbers to help guide our thinking and keep us honest (it's a way to combat unconscious bias which is hard to recognize). But we aren't beholden to the scores and numbers if the consensus is that the candidate has some special appeal or is less of a good fit for us.

And another question about the same step in the process: I know that you've said that you personally select the applications that go on to get an interview. But after the interview stage is over, much of a relative impact do you have (as program director) in terms of the final ranking compared to the other faculty members who have interviewed the candidates? Do you get a disproportionately high say in the final ranking, or is everyone on the ranking committee given an equal say in how any applicant gets ranked?

I'm passionate about our residency and the selection process, so objectively I would say that I probably advocate forcefully for a particular outcome--but my selection committee is used to me and there are other passionate voices, and others who are quietly effective at shaping group consensus. We work well together and know each others' blind spots and preferences. In the end, if I'm the outlier, I'm overruled. Where I hold the most power as PD and chair of this selection process is when the selection committee is fairly equally split about a candidate. If half love someone, and the other half are "meh", then it really does matter where I stand since I usually break that tie.

 

[DrfluffyMD]

Yes, interesting. The way this happens is because we don't blindly accept our "formula" for combining the interview score, the USMLE score, and the clinical score. Let's review what characteristics we want to recruit, as I posted before (in quotes below):

“Will we enjoy working with this person, can we trust them to do the best job possible for our patients, can we be confident in their ability to interact with our clinical colleagues, will this person help us recruit great residents in the future, will we be excited to see this person at a meeting after they graduate, are they on a career trajectory that could inspire future residents and maintain our brand?

• Enjoy working with: obvious
• Trust them to do the best job: potential for developing excellent clinical skills, demeanor, motivation
• Interactions with clinical colleagues: If the most arrogant surgeon comes down to review a case, will this person be able to handle it well?
• Help us recruit: are they likeable, present themselves well, will they pursue the best possible fellowships
• Excited to see: obvious
• Inspiring career trajectory: Leadership (private practice, organized radiology, or academics), Academics, Community service."

As I mentioned in that post, the selection committee jots down a score for "Leadership" which gets at a combination of research/academic ambitions and inspiring career trajectory. We review this score as we look at the candidates and use it to move up or down. But it doesn't actually fit into a "formula".

The person who had the #1 "overall" score based on our mathematical formula that combines the interview score, USMLE score, and clinical score was an individual who went to a large mid tier medical school out west which we know well, who got all honors at that school where honors was only given to 15-30% of individuals (so relatively good discriminator of performance), and who scored over 265 on step 1 and step 2 (doing better on step 2 than step 1). On the interview score, the person did fine but the feeling was the person had modest career ambitions. That person went to undergrad at the same institution as medical school, was probably going to settle in that area, and we perceived that person to have little true desire for academics or leadership, based on historical activity and interview impressions. The committee had this assessment:

• Enjoy working with: YES!
• Trust them to do the best job: YES!
• Interactions with clinical colleagues: YES!
• Help us recruit: Very likeable, but probably would do fellowship at same institution the person came from to eventually practice in that area. That institution is fine but not really a "name".
• Excited to see: YES!
• Inspiring career trajectory: Looked to us like this person will be a great colleague in a private practice in the area that person grew up.

So based on that, we dropped that person to #11. We just didn't think that in the end this person was going to have an inspiring career trajectory THAT WOULD BE READILY APPARENT TO APPLICANTS. In other words, the person might in fact be very inspiring on the local level that he/she chooses to be at--but hard to point to that person to our future applicants and say, "Look at this graduate, he/she is practicing in a community practice in a mid-size area where he/she grew up--isn't that inspiring!".

Now, to be fair, based on the combination of the size of our program and history, and because we always interview and rank our candidates based purely on our metrics and don't worry about our "rank to fill" number (in other words, as I mentioned before, I will rank people highly who I sense would rather be somewhere else geographically), we have never filled all of our positions in the top 15 choices. So ranking this person #11 meant the person was still going to match with us if he/she ranked us first, unless somehow we magically got all of our top choices--which never happens.

The person ended up matching at the same institution that he/she did undergrad and med school at--I expect he/she will be in one of the big "super-practices" that we know that operate in that geographical area (at which some of our graduates currently work). It's where that person grew up, chose to stay for undergrad, chose to stay for med school, and chose to stay for residency. I would be very surprised if that person doesn't do his/her fellowship there.

Applicants can't be easily distilled into "numbers". We use scores and numbers to help guide our thinking and keep us honest (it's a way to combat unconscious bias which is hard to recognize). But we aren't beholden to the scores and numbers if the consensus is that the candidate has some special appeal or is less of a good fit for us.



I'm passionate about our residency and the selection process, so objectively I would say that I probably advocate forcefully for a particular outcome--but my selection committee is used to me and there are other passionate voices, and others who are quietly effective at shaping group consensus. We work well together and know each others' blind spots and preferences. In the end, if I'm the outlier, I'm overruled. Where I hold the most power as PD and chair of this selection process is when the selection committee is fairly equally split about a candidate. If half love someone, and the other half are "meh", then it really does matter where I stand since I usually break that tie.

Thank you for your valuable insight.

In your experience, how often do you call candidates before rank list is due (if you do) and where are those folks typically ranked?

 

[RadiologyPD]

We do not communicate with candidates after interview other than to send some of information that I present during the interview in a written form to ALL candidates as a reminder (so they don't have to take notes). We also answer any questions. We do not give anyone "rank to match" or "hey, we're interested in you" calls or letters.

Some of my selection committee feel this is a mistake. I've always held the position that candidates should rank places as they see fit and it should not matter if your #1 choice hasn't sent you a rank-to-match communication. I still do not understand why someone would rank their #2 choice that sent them a love note over their #1 choice that didn't when that #1 choice told them up front that they wouldn't send any notes.

Someone told me a few weeks ago that there is actually now research that shows that med students unconsciously or consciously will alter their match lists based on rank-to-match communications. Perhaps there is some data to suggest that you look more favorably on a place that you feel "really wants you"--if you can trust those communications.

So looks like I'm probably wrong--but we aren't going to change our policy.

 

[DrfluffyMD]

We do not communicate with candidates after interview other than to send some of information that I present during the interview in a written form to ALL candidates as a reminder (so they don't have to take notes). We also answer any questions. We do not give anyone "rank to match" or "hey, we're interested in you" calls or letters.

Some of my selection committee feels this is a mistake. I've always held the position that candidates should rank places as they see fit and it should not matter if your #1 choice hasn't sent you a rank-to-match communication. I still do not understand why someone would rank their #2 choice that sent them a love note over their #1 choice that didn't when that #1 choice told them up front that they wouldn't send any notes.

Someone told me a few weeks ago that there is actually now research that shows that med students unconsciously or consciously will alter their match lists based on rank-to-match communications. Perhaps there is some data to suggest that you look more favorably on a place that you feel "really wants you"--if you can trust those communications.

So looks like I'm probably wrong--but we aren't going to change our policy.

Appreciate the valuable insight!

Two more questions.

If you can travel back in time, to yourself as a medical student, knowing what you know now about radiology, which one of the following attribute would you prioritize? Assuming you are still trying to achieve your current career trajectory of being an academic radiology PD.
- location
- reputation of the institution to lay people / reputation of the undergrad associated with the program
- reputation of the institution to other medical professionals / reputation of the radiology residency (For example, Wash U/MIR vs. Dartmouth)
- Cost of living
- Salary and benefits
- Actual training provided by the program
- and other factors.

And knowing what you know now, would you chose the same career trajectory again?

 

[RadiologyPD]

Will answer 2nd question first: Same career trajectory?

Absolutely. For me, academic radiology has been great. I was always a fairly fast radiologist, and reasonably good at lots of areas, so I'm sure I would have done fine in private practice from a "bang out the work" perspective. In the first few years of academic practice, I had a few job offers from former co-residents and private attendings who I worked with in residency (they stopped asking after a while when my career path was set). Some of them have fantastic practices in terms of equipment, great hospitals, great pay--but I like my job better. Keep in mind, though, that I had to be willing to leave the highly desired geographical area that I trained at to get the best academic job for me. Not that where I currently live isn't great, but not as popular as the area where I trained.

Which attribute of residency to prioritize?

See my prior post:

What should applicants be looking for in a residency?

I believe the most important question an applicant should consider is whether or not he/she feels the program can inspire them to be the best version of what that person wants for himself/herself and also help him/her achieve those goals, while at the same time keeping him/her emotionally happy and mentally engaged. This is a highly personal calculation and requires some serious introspection.

I didn't realize how important it would be to put myself in a situation where I would find inspiration in the faculty or peer group, to nurture what I wanted to do with my career when I started residency (for me, that was to be involved in teaching and some research and work at an academic center)--and my ability to tap into those mentors. To be honest, the "tapping into the mentors" didn't happen for me during residency itself--with a big residency and a big faculty, it was easy to "go with the flow", and the flow was definitely geared toward private practice in the area I trained. It turned around for me during my fellowship at the same institution where there was a smaller group of faculty to deal with and so more opportunity for them to know me and me to know them. That's when I reconfirmed my interest in academics. I would say that about 2/3rds of the residents with whom I trained began their residencies truly thinking they might end up in academics (with 1/3rd saying they might but not really believing it), and in the end only 1/4 actually did, partly because they didn't get that interest nurtured, and it was just natural to "go with the flow". So if you are serious about pursuing an academic path, I think it is important to consider the way the residency is geared to facilitate mentorship and generate inspiration. That actually might be #1 for the person who is seriously interested in an academic career.

After that, or you don't have that particular ambition, then the important things in my opinion would be:

1. Subspecialty instruction--not "lectures", but really at the viewbox. Lectures are fine but you can get those on the internet, or read the facts.

Subspecialty means that your faculty are often just doing one thing--i.e., Neuro does neuro, MSK does msk, Chest does chest, Abdomen does abdomen, Ultrasound does ultrasound, etc. (Parenthetically, I think the departments in which Ultrasound is subsumed entirely within Abdomen and does not have a true set of faculty champions results in relatively poor ultrasound training since it gets relegated to second fiddle). If your cases on call are being read out by a "generalist" or a subspecialist required to occasionally read out call stuff outside their area of expertise, the readouts will be quick and less instructive.

Instruction means that they give you feedback on cases regularly. If you are blasting through cases on call or during the day and they aren't really instructing you, you just get very fast at missing things. In this respect, volume is your enemy, not your friend as everyone assumes, if the volume is leading to less opportunity for the faculty to instruct. Furthermore, if the faculty are world renowned but disinterested instructors, you don't benefit (even though you will score in terms of brand--see #2). You are better off with a fantastic fellow instructing you than a world-renowned lecturer/researcher who wants to go write a paper instead of instructing you. You are best off with a highly skilled and respected faculty member who teaches you via direct and indirect instruction (you'd be amazed at how much you absorb when you review prior reports generated by experts as you are figuring out the case you're reviewing).

By far and away, this is the most important thing in terms of how clinically good you will be as a radiologist.

2. Brand

Brand is essentially reputation, for the residency/department/organization--at the radiology level. Brand opens doors later--in both academics and private practice. Remember, though, that you can augment brand at the fellowship stage if you have the support to get there (see #4).

3. Your well-being.

Geography can play a big role here, as can other quality of life issues. If you absolutely can't tolerate driving in traffic, don't go to Emory. If you get depressed in the fog, don't go to UCSF. If you must own property, don't go to Stanford. If you just can't stand the desert, don't go to Mayo AZ. If you absolutely hate snow, don't go to Mayo Rochester.

It's ok to not be in your favorite area as long as it doesn't really hurt your well-being--you can live in LA for 4 years even if you dream of living in Denver so you can ski on weekends. Same is true of cost of living, salary/benefits, etc--gauge how much this is really going to impact your well-being. If you have kids or have other factors and absolutely must moonlight in order to make ends meet, then factor in moonlighting. Otherwise, don't worry about moonlighting as a way to make significant money (you can make an argument that it is a good learning experience, as long as you are legally protected). The amount you make moonlighting will be a drop in the bucket later.

4. Support

Professional, emotional, personal. If you feel unsupported, you will become cynical. If the PD plays favorites or the department isn't supportive of the collective group, it can be a drag. It's easier to succeed when the faculty are supportive and willing to go to bat for you to write letters of rec, etc.

 

[plasmodium]

Could be one of the greatest threads in SDN history.

I'll piggyback the previous question regarding career trajectory - when you were a medical student, did you always want to be a Radiologist? or were you torn between more than one field and ultimately made the decision to pursue Rads? If the former, why? If the latter, what helped you make the final decision?

 

[RadiologyPD]

Everyone has their own story, so nothing about mine would apply exactly to anyone else--but there may be some universal themes.

In my case, I took a year off between M2 and M3 years to do Howard Hughes research in Bethesda at NIH. I was setting myself up for an academic internal medicine career--I thought perhaps in Immunology, so I did T cell activation research. I hit it off in the lab I was at in NIH, and the head of the lab said he'd make a few calls and get me into MGH for internal medicine residency which would allow me to do my 3rd year back at NIH in the lab. The head of the lab had magnetic personality and huge coattails--he eventually became a huge figure at NIH. The program I was in at NIH allowed me to personally have wine and dinner with some really famous basic scientists.

So I went back to M3 year with a plan, but my real interest in academics was balanced between investigation and teaching. To be honest, I was also a little nervous about competing for NIH grant funding for basic science research projects as an MD against PhDs. Despite the "path" that had been laid out for me by my mentor with the magnetic personality, I had some doubts about academic internal medicine. I wasn't trying to be a Nobel Prize winner in science--I really just wanted an interesting job that would gratify my sense of personal accomplishment but also be meaningful at an "academic" level--wasn't interested in having a successful small business (i.e., my own practice).

So, as I mentioned in a previous report, I chose to do a Radiology elective early in M3 year with the sole purpose of being more familiar with radiographs on my patients and knowing "the system" at the hospital, which would enable me to be a better med student on IM. During the rotation, I just loved the ACR/UCSF teaching file (a relic of the past, for those of you in med school now--it was a uniform set of cases that most academic centers had, with films in jackets that you'd pull out and look at, which a short paragraph of findings and impressions on the jacket), going through case after case quickly, and I really liked the one-on-one teaching at the viewbox that I observed. Contrasting that to the role of the academic internist for the team during rounds (which I also hear is a relic from the past these days, with the advent of the EMR), where the faculty person spends a few hours at most with the team and then takes off, it became obvious to me what academic role I liked better.

The biggest struggle I had in eventually choosing radiology was the feeling that I was "selling out"--to my NIH mentor, to my medical school peers, to some faculty that viewed radiology as something not worthy of my skills. I'm glad I got over that, because having now been in the medical world for 30 years, I honestly don't think I would have been happy doing anything else.

I submitted my application to Radiology with only 1 letter from the clerkship director of my M3 elective, who didn't know me from Adam. I ended up with a "High Pass" in Radiology instead of "Honors" because that clerkship director had this ridiculous grading system in which much of your grade depending on the difference between your preclerkship score and your post clerkship score, and I am a good test taker so my preclerkship score was high. Her system assumed that a student did not work as hard on the rotation as others if his/her score didn't go up as much as others--of course, since I was gone for a year, I didn't know the other students in my class as well and wasn't "in the know" for this early elective--no one clued me into this ridiculous system--they all tanked the pretest. Whatever. I took no other Radiology electives during med school. So you can see the seeds of why, as PD, I don't really care if your best letter isn't from a Radiologist and I really don't care if you have only a little Radiology experience.

 

[LeoMessi10]

Question for the gracious PDs that is admittedly very specific and one I am having difficulty finding concrete answers to. I am on the verge of completing my 2nd year of neurosurgical training with plans to resign at the end of the month. I will be re-entering this match in hopes of finding a radiology position. I know there are categorical and advanced positions and the advanced positions will not start until July 2019. I plan to apply to both types of programs.

My question is this: As I completed 2 years of a 7 year program will I have issue regarding ACGME funding if I were to complete another intern year prior to beginning an advanced position (if I do not initially match into categorical). My home GME dean advised against this as they felt I would not have to "re-do" another intern year and if I did it may cause programs issue regarding my ACGME funding as they were under the impression I would have only 5 years (vs 7) available. Does anyone out there know the details of how this works? Regardless of whether I would have to complete another intern year or not it is my preference so I am busy and employed for the July 2018-2019 before starting an advanced position in 2019. I suppose worst case scenario is I go a year in residency without salary due to running out of ACGME allotted years if I am in fact not already approved for 7 from when I matched neurosurgery.

Apologies for the length but any clarity on this would be greatly appreciated as we approach this next application cycle.

 

[Cognovi]

Question for the gracious PDs that is admittedly very specific and one I am having difficulty finding concrete answers to. I am on the verge of completing my 2nd year of neurosurgical training with plans to resign at the end of the month. I will be re-entering this match in hopes of finding a radiology position. I know there are categorical and advanced positions and the advanced positions will not start until July 2019. I plan to apply to both types of programs.

You should apply to the 'R' (Physician) positions, which would start at the PGY-2 level in July 2018. This past year, there were 37 such spots in the Match. These are often not advertised.

 

[JPSmyth]

I am an MS1 very interested in radiology, and I have a few questions that I was hoping some people on here might be able to answer.


From my research on SDN it seems that most DR residencies have a typical day of morning conference 7-8, reading from 8-12, 12-1 lunch didactic, 1-5/6 reading.


During those reading times, are they broken up by leaving the reading room to do procedures? How many procedures does an average resident do per week? I'm sure this varies from program to program and the rotation you're on but any insight would help.


If you had to give a ratio of time spent reading / time spent doing procedures what would you say that is? 80/20? 70/30?


Since I am interested in doing procedures/seeing patients on occasion would it be best for me to look into IR residency/fellowship which would lead to dual board certification so I can split my practice into some days spent reading other days spent in clinic?


Thanks so much!

 

[RadiologyPD]

Sorry for the delay in response. I was away on vacation. I'll hit the last 2 posts:

My question is this: As I completed 2 years of a 7 year program will I have issue regarding ACGME funding if I were to complete another intern year prior to beginning an advanced position (if I do not initially match into categorical).

Your ability to occupy a position in any given radiology residency will depend on whether or not the program relies exclusively on federal funding for all of the spots. This is a complicated issue and if you didn't want to waste your time/money/effort on an application that will be summarily rejected, you will have to ask each program you are considering applying to whether or not they would consider you for a spot.

Cognovi is correct that the "R" positions are well-suited for your situation. For these spots, the program will essentially let you start the residency in July 3.5 months after you match with them in March. There are not many R spots.

Many programs are fully funded by federal dollars to the institution--this is particularly true in the Northeast. The federal government sets limits on how many years of funding they will provide for any one individual, depending on the specialty. For those programs, my understanding is that you would probably be summarily rejected because your entire residency would not be eligible for federal funds, and if the programs relies exclusively on federal funds, they'd basically be losing money on you compared to another candidate.

Other programs have a variable fraction of their spots funded by federal dollars (with some of the newer programs not receiving any funding). In general, spots that were created (either added by a program or newly developed) since around 2000 would rely less on federal funding. You would qualify for those programs.

For the categorical spots, you'd have to re-do the internship year.

For the advanced spots, you would generally have to "sit out" a year, since these programs have you start as an R1 resident 15.5 months after matching (start in the 2nd July after you match in March). You could do locums or research or whatever during that year prior to starting residency.

Please note that no program will allow you to be a resident "without salary". That happens for a few rare Radiology fellowships (in MSK on the West Coast, it seems), but your comment that you might end up in a program in which you wouldn't get paid for a few years is not possible. The program just wouldn't rank you if there was an issue for them. If you are a resident in an ACGME-accredited program, you have to get paid.

I am an MS1 very interested in radiology, and I have a few questions that I was hoping some people on here might be able to answer.


From my research on SDN it seems that most DR residencies have a typical day of morning conference 7-8, reading from 8-12, 12-1 lunch didactic, 1-5/6 reading.


During those reading times, are they broken up by leaving the reading room to do procedures? How many procedures does an average resident do per week? I'm sure this varies from program to program and the rotation you're on but any insight would help.


If you had to give a ratio of time spent reading / time spent doing procedures what would you say that is? 80/20? 70/30?


Since I am interested in doing procedures/seeing patients on occasion would it be best for me to look into IR residency/fellowship which would lead to dual board certification so I can split my practice into some days spent reading other days spent in clinic?

One of the biggest misconceptions for medical students is that all procedural work in radiology falls under the "IR" umbrella, and that all radiology departments are organized the same way. What you see being done at your institution as a medical student may not be the way it is done at any other place and may not be the way it will be done in your practice.

For most practices, breast imagers do all the breast interventions, MSK radiologists do the MSK interventions (sometimes the spine work), Neuroradiologists do the Neuro interventions (LP, spine work, angio). At some practices, Abdomen imagers or Ultrasound (US) imagers do US-guided and CT-guided "body" procedures--this could include thyroid/lymph node FNA/biopsies, paracentesis, thoracentesis, solid organ lesion FNA and core biopsy procedures.

Some practices have hired PAs and have carved out the paracenteses and thoracenteses and have PA's doing that work.

You'd be surprised, there are practices in which RF and microwave ablation procedures in the liver/kidneys/etc are done by "body imagers", not the VIR Division

While there are some practices in which all the procedures are done by group of "IR" rads, I wouldn't say this is the norm.

So your question doesn't have a straightforward answer. When you are on the Chest rotation, you probably won't be doing any procedures during the day. It will be non-stop diagnostic work. When you are on US, if you are at a place where most things that are done with US-guidance are done by the US group, you could be doing procedures all day. When you are on Breast, the number of procedures you do interspersed between mammograms/ultrasounds will depend on whether you are doing the screening rotation or the diagnostic rotation or the procedure rotation, etc.

Bottom line: You don't have to do IR to do many straightforward or subspecialty-specific procedures. The amount of mixing of diagnostic and procedural work will vary substantially based on institution and practice-specific organization.

 

[JoshSt]

These are great perspectives, thank you.

I'm a junior radiology resident and about 80-90% certain I want to do academics. Research, teaching environment, working in a subspecialty with subspecialty referring clinicians, ability to train residents, and try and promote radiology as a specialty to med students are my big reasons.

Couple of questions:
1. Is there anything you ever regret either in being or choosing academic radiology? It sounds like you're very happy and again I'm 80-90% sure about academics. It just seems like at least half or more of who I would consider our 'top notch' residents go into private practice. Obviously, there is typically more money, more vacation stress typically paired with more stress and a higher volume (although not always true). What keeps you fueled and excited about academic radiology?

2. I only have a few places that I would like to work in academics. The main one is where I train, and I suspect that's where I would probably end up. There are a couple of other specific places I'd be interested in. Once I near the end of my training how aggressive should I be at interviewing at these other places?

 

[RadiologyPD]

JoshSt

1. I don't regret my choice of academic radiology. At the 5 year mark, when I left my first academic practice to go to where I currently am, I had an opportunity to move to private practice into a highly respected group with one of my good friends who was a former co-resident in what would have been a "better" location for me on balance than my current location. I probably would have been personally happy there too, but professionally my career could not have been better.

What do I enjoy about academic radiology?--see prior posts for some details. In brief, the ability to be truly subspecialized, develop expertise in my field, make and publish observations that help other radiologists do their jobs, have connections with many other radiologists in other academic centers throughout the country, talk to medical students during rotations and during interviews, develop relationships with new residents and fellows yearly, and have input with vendors and organizations are some of the major reasons I enjoy what I do.

2. If you are focused on a particular geographic area, your statement about there only being a few places you would like to work in academics makes sense. Otherwise, you might be limiting yourself unnecessarily. If you want to end up where you currently are, you have an inside track to making that happen. If there are other places you've also targeted, you should "aggressively" (but not obnoxiously) make connections at those places. You may not be able to "interview" at every place you are targeting because they may not have a position for you. Be prepared to look outside your initial list of places in order to make the transition LATER to one of those places, should there not be a position for you initially.

Along the lines of making connections, here's a piece of advice for any resident or fellow, interested in academics or private practice: Always aim to impress. It's not important for me to impress anyone--there's a 99% likelihood that I'm at my final job. When you are a resident or fellow, you should aim to legitimately impress everyone--the PD, the attendings, the other residents, the other fellows, the program coordinator, the schedulers, the allied health staff--everyone. By "legitimately" impress, I mean doing so in a genuine fashion--not sycophantic behavior. Be nice--smile--be likeable--do your work the first time and do it right--go the extra mile--etc.

You get opportunities from positive impressions.

 

[recycledpaper]

Can you give some specific examples of what impresses you? I'm about to start a slew of aways and would love an idea of what impresses and what annoys.

 

[questionsmaster]

Thank you RadiologyPD for your illuminating answers.

I have a more somber question. I have a misdemeanor that was expunged, all prior to medical school. How will this affect my competitiveness for Radiology residency? Will I be screened out / dinged for interviews in any way?

If possible, feel free to PM me privately if you feel that is more appropriate. Thank you for your help!

 

[RadiologyPD]

Can you give some specific examples of what impresses you? I'm about to start a slew of aways and would love an idea of what impresses and what annoys

It has to be organic, so don't put on a show that isn't really you--but some examples of what impresses me:
-demeanor traits I mentioned above: Be nice--smile--be likable--show respect
-preparation: doing your homework. If you are starting the Chest service on Monday, figure out what you need to do before Monday--look at the goals/objectives, ask other residents how it works, figure out a reading plan/learning plan for the month and ask the education director on Monday if it makes sense. If you are starting the US service on Monday, look up the sonographers' names/pictures and memorize them before you walk in the door.
-over-deliver: go the extra mile. Let's say you have a 4 pm education conference and the service is getting killed--of course, you need to go to conference, and the attending usually mops up. Generally the residents take off after the conference--consider checking back into the service to see if there's anything you can do to help clean up.
-knowledge: I'm always impressed when residents really know their s**t
-"good eye": often a sequella of knowledge, since you "see what you know"--so work on it by reviewing as many case examples of disease processes as possible

Don't annoy
-don't quote me my research out of context
-don't kiss my ass
-don't be too familiar until the familiarity is deserved
-don't be argumentative--it's ok to probe
-don't make my job harder

I have a more somber question. I have a misdemeanor that was expunged, all prior to medical school. How will this affect my competitiveness for Radiology residency? Will I be screened out / dinged for interviews in any way?

Can't speak for everyone, but if it's only one misdemeanor a while ago, I eventually get over it. You can't get past the fact that it is a "ding" that can be a source of embarrassment, but I see it all the time so not new. Often alcohol related during college--"open container" infraction, DUI, other stupid things. If you have an opportunity in the interview to address it briefly, it can help.

If there are 2 of the same thing over time, it's going to require some finesse. That suggests you don't learn from your mistakes.

 

[DrfluffyMD]

Another question: Can PD see where applicants he ranked end up? What about applicants he interviewed but did not rank?

Some follow up on the question I asked about being called: I was called by one of my top program to ask if I needed more info, I matched there.

However a friend of mine fell through 3 programs where PD reached out to him, so PD call is by no mean a done deal in fellowship land.

 

[RadiologyPD]

Another question: Can PD see where applicants he ranked end up? What about applicants he interviewed but did not rank?

Anyone with access to the R3 system (Registration, Ranking, and Results system of NRMP) can check on the outcome of any applicant, and the database goes back many years. All Program Directors have access.

To search, at a minimum, you have to know the last name and 2 letters of the first name, but it works better if you just enter the AAMC ID number. You can batch enter numbers, which is what I do--I enter in all the numbers of everyone who applied to us who we didn't outright reject, regardless of whether or not we actually asked them for an interview. Of course, I'm most interested in the following 3 categories:
1. Those we interviewed
2. Those who we asked to interview but who decided not to accept the invitation.
3. Those who we decided not to interview but who were reasonably competitive.

I'm interested in #3 because I want to see how well our selection for interview criteria capture individuals who eventually match to a program we consider competitive--I review those candidates who seem to have ended up at places we consider our academic competition who we didn't ask to interview to determine what we might have missed.

It's all part of the QA process!

 

[plasmodium]

How much importance do you place on radiology letters of recommendation? would you recommend getting a letter from the biggest name possible, or would a small community program director be as good if they wrote a good letter?

• Clinical letters are more important - where you can show your strengths more easily than in radiology, i.e., by shadowing and having a solid knowledge and participation in conferences in radiology. That said a a letter from a research mentor is important. If going into IR, should get an IR letter and DR letter - if one is also a research mentor, it makes it easier. So 1-2 clinical, 1-2 DR/IR, 0-1 research (whether radiology or not)
• Good personal letter more important big name who doesn't know you

To follow-up this response, I have a bit more of an individualized question:

I'm interested in IR, but still have a very strong interest in imaging and diagnostics. If I happen to match DR I do not intend to just coast through DR as a means to get to IR. I intend to be a highly productive resident. In terms of applications, I'm going to apply to both. Under these circumstances, if I applied to DR with strong letters from 2 IRs and a clinical letter, and was open about my interest in both IR and DR, how would it be perceived by the DR programs if I applied DR without a DR letter?