Radiology Faculty--Answering Questions/"AMA"

[xxxxxxxxxxxxxxx]

Dear @RadiologyPD , what was your experience from this year's match?

I'd like to piggyback off of this a little bit... Were there any common pitfalls or patterns that you noticed in applications this round that turned you off from said candidates? What are some of the red flags that you were looking for during the interviews? What are your thoughts on the relative competitiveness of the field as compared to previous years? Is it getting more or less competitive, or staying about the same? Have you noticed any trends as far as DO students having a decent shot at matching going forward?

I know that's a lot, so any input at all is greatly appreciated.

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[RadiologyPD]

Our program had a very effective match. We filled below 4 ranks/spot which is one of our best results ever.

There were no consistent "pitfalls" that I noticed in applications, and no special red flags--obviously, some applications did have pitfalls and red flags that were unique to the individual.

I'm the PD of a DR program and a number of our top candidates ended up matching at IR programs. Remember that I don't particularly care about "optics" regarding how far down our match list we go, we rank candidates based on our assessment of their potential in our program. But clearly for these IR focused individuals, our program looks to have taken a back seat in the ranking process because we were DR, even though I think the pathway for doing IR through our program (with ESIR) is fairly robust.

I looked at the match outcomes for all candidates who applied to our program. Most of the reasonably competitive DO candidates who applied to our program (based on USMLE scores) ended up matching in Radiology, and some at reasonably good programs it seemed to me.

 

[gilaze]

Our program had a very effective match. We filled below 4 ranks/spot which is one of our best results ever.

There were no consistent "pitfalls" that I noticed in applications, and no special red flags--obviously, some applications did have pitfalls and red flags that were unique to the individual.

I'm the PD of a DR program and a number of our top candidates ended up matching at IR programs. Remember that I don't particularly care about "optics" regarding how far down our match list we go, we rank candidates based on our assessment of their potential in our program. But clearly for these IR focused individuals, our program looks to have taken a back seat in the ranking process because we were DR, even though I think the pathway for doing IR through our program (with ESIR) is fairly robust.

I looked at the match outcomes for all candidates who applied to our program. Most of the reasonably competitive DO candidates who applied to our program (based on USMLE scores) ended up matching in Radiology, and some at reasonably good programs it seemed to me.

What about IMGs?

 

[alchemist123]

@RadiologyPD, when looking at research, do you count publications from undergrad? Also, do you look at the impact factor of the journal and use that as a metric as well?

 

[RadiologyPD]

What about IMGs?

I have no special insights here.

@RadiologyPD, when looking at research, do you count publications from undergrad? Also, do you look at the impact factor of the journal and use that as a metric as well?

Our program tries to look at research as a measure of academic motivation (how interested in an academic career, and what type of academic career). So undergraduate research really isn't that important, since typically that's done as a checklist item to get into medical school. To be honest, the quantity of research isn't that important to us--we try to understand why the person chose to do research instead of other useful stuff (leadership, volunteering, etc.). If we get the sense that the person isn't really all that interested in academics, that's perfectly fine--but then we discount the research stuff (it's just a check box then). We don't penalize the person for having done research, but it doesn't really help them any more than concentrated effort in other activities as a demonstration of being able to "get things done" and "being committed". You'd be surprised at how many PhD candidates we've had in which we felt the person was unlikely to go into radiology academics--for them, the research activity "checks the box".

When research just "checks the box" as an activity, we don't spend any time looking at the journal impact factor, etc.

 

[DrfluffyMD]

Our program had a very effective match. We filled below 4 ranks/spot which is one of our best results ever.

There were no consistent "pitfalls" that I noticed in applications, and no special red flags--obviously, some applications did have pitfalls and red flags that were unique to the individual.

I'm the PD of a DR program and a number of our top candidates ended up matching at IR programs. Remember that I don't particularly care about "optics" regarding how far down our match list we go, we rank candidates based on our assessment of their potential in our program. But clearly for these IR focused individuals, our program looks to have taken a back seat in the ranking process because we were DR, even though I think the pathway for doing IR through our program (with ESIR) is fairly robust.

I looked at the match outcomes for all candidates who applied to our program. Most of the reasonably competitive DO candidates who applied to our program (based on USMLE scores) ended up matching in Radiology, and some at reasonably good programs it seemed to me.

Do you program have a DR/IR program? Can you comment on how far that program have go down to fill?

 

[jfxs20180312]

@RadiologyPD, thank you very much for keeping this channel alive to help us. I didn't match this year. My first question is, is it true that Rad. programs don't rank applicants without CS score? I saw examples of people matched without CS in SDN. I didn't have CS when ranking due, I applied DR only and ranked 15+ of it. My next question is, my interview invitation yield is OK, without considering CS factor, does that mean I am OK on paper to those programs? Or programs would go through paper carefully only when they rank, so decent IV yield doesn't mean you don't have red flags on paper to them. I have this feeling because most of my invitations came early, I doubt programs had time to go through everything carefully. Thank you in advance for your help.

 

[sired]

Dear @RadiologyPD , what do you think about residents swapping or moving to another institution during their residency training?

 

[JoshSt]

You'd be surprised at how many PhD candidates we've had in which we felt the person was unlikely to go into radiology academics--for them, the research activity "checks the box".

In residency, both my own and mingling with other programs, I've been very surprised at the proportion of MD/PhDs that go into private practice. It's fine, but sheesh that's a lot of extra schooling when just doing regular med school would have done the trick. People's priorities in life change of course and I imagine people get burned out in research.

 

[RadiologyPD]

Do you program have a DR/IR program? Can you comment on how far that program have go down to fill?

I can't comment as I have no information on DR/IR program stats.

My first question is, is it true that Rad. programs don't rank applicants without CS score?

Not true for our program. Can't say for others.

My next question is, my interview invitation yield is OK, without considering CS factor, does that mean I am OK on paper to those programs? Or programs would go through paper carefully only when they rank, so decent IV yield doesn't mean you don't have red flags on paper to them. I have this feeling because most of my invitations came early, I doubt programs had time to go through everything carefully.

I've elaborated extensively in my past posts regarding how once you get to the interview stage, factors other than USMLE scores and clinical clerkship scores come into play. Since clinical clerkship scores are not standardized, some programs don't even use that very much after the "invitation" stage. You know your application better than anyone, so you should be able to get a sense as to whether or not you have a "red flag" in your "paper" application. Truth be told, I get the sense that English may be your second language in the way you phrase certain sentences, and so it's possible (only guessing here) that your communication skills may not be "as slick" as some, and that could hurt you. If I've guessed incorrectly, I apologize, but my mental picture right now is that you have great/good enough USMLE scores (which secures your invitation) but you may be getting dinged a bit based on the interview.

Dear @RadiologyPD , what do you think about residents swapping or moving to another institution during their residency training?

To be honest, swapping is a crazy concept, in my opinion. Does it really happen? I've seen an occasional post on SDN and Aunt Minnie from individuals looking to do this, but it sounds like such a long shot that both programs would be fine with this--frankly, a little crazy. I do know that some residents do seek to move to another program for personal reasons, and I know it does happen infrequently (outside of the situation when the resident is underperforming/failing) when the resident has a compelling need that is readily understood by the program that the resident is leaving. Usually the resident just leaves and the "hole" in the program that the resident is leaving is filled in other ways (increase incoming resident class, advertise for someone, etc).

 

[manu23]

Dear @RadiologyPD. How are you? I was wondering if I can get some advice regarding radiology application. Thanks.

 

[RadiologyPD]

I don't have the bandwidth to get into the weeds on any one particular set of circumstances.

The gist of your question is whether it is possible to match in radiology with a 225 Step 1 and relatively low prestige DO school background.

It is difficult but not impossible. You will need what is referred to as "a hook". This can be research with a particular faculty who has pull with a particular program, or an exceptional clinical rotation at a particular program, or "sidestepping" into a program by being in a different residency at that place, impressing the heck out of the radiologists, and then grabbing any open spot that may develop or matching into the residency later. Even with relatively low step 1 and sub-par osteopathic school background, a very high step 2 score may help you get into the less competitive residencies.

 

[GANCPA740]

@RadiologyPD

I was hoping you could provide some insight on my situation.

Currently, I am a PGY-2 (RO-1)Radiation Oncology resident and am wanting to switch to DR and eventually pursue IR fellowship.

My question is where would I even start? I have not mentioned anything to anyone in my program. I work hard, get along with everyone and continue to publish with faculty. I know no one in my program would have any clue this was coming. In your opinion what should my first step be? I would love to discuss specifics of my application with a radiology PD to see how competitive I would be if I were to switch and to see if any program would even be interested in matching me given that I am leaving my current residency.

I have never been in this situation before and for the first time since starting medical school have no idea what steps I should take next.

Any advice would be greatly appreciated.

 

[DrfluffyMD]

@RadiologyPD

I was hoping you could provide some insight on my situation.

Currently, I am a PGY-2 (RO-1)Radiation Oncology resident and am wanting to switch to DR and eventually pursue IR fellowship.

My question is where would I even start? I have not mentioned anything to anyone in my program. I work hard, get along with everyone and continue to publish with faculty. I know no one in my program would have any clue this was coming. In your opinion what should my first step be? I would love to discuss specifics of my application with a radiology PD to see how competitive I would be if I were to switch and to see if any program would even be interested in matching me given that I am leaving my current residency.

I have never been in this situation before and for the first time since starting medical school have no idea what steps I should take next.

Any advice would be greatly appreciated.

First you gotta ask yourself, why IR? And why not radonc?

If your concern is primarily due to the job market, the IR job market can be just as limiting, if not more so, than radonc, depends on what you like to do.

 

[GANCPA740]

First you gotta ask yourself, why IR? And why not radonc?

If your concern is primarily due to the job market, the IR job market can be just as limiting, if not more so, than radonc, depends on what you like to do.

Thanks for the prompt reply.

Honestly, it is not the job market but more the nature of the work. My wife and I have agonized over this decision for some time and we have arrived (for many reasons which are to numerous to post here) that I think I would be happier and enjoy day-to-day work more in IR. Unfortunately, I had no exposure to IR until my prelim year and had I been exposed during medical school I may have primarily pursued this as a career.

In every way the default choice to finish RO is easier. I am at a good program that has great job placement, I would lose less time etc.. However, I don't know if I am passionate about it. I could elaborate further.

However, if I do pursue switching, from a practical standpoint, any thoughts/advice on first actionable steps in the process?

 

[colbgw02]

Thanks for the prompt reply.

Honestly, it is not the job market but more the nature of the work. My wife and I have agonized over this decision for some time and we have arrived (for many reasons which are to numerous to post here) that I think I would be happier and enjoy day-to-day work more in IR. Unfortunately, I had no exposure to IR until my prelim year and had I been exposed during medical school I may have primarily pursued this as a career.

In every way the default choice to finish RO is easier. I am at a good program that has great job placement, I would lose less time etc.. However, I don't know if I am passionate about it. I could elaborate further.

However, if I do pursue switching, from a practical standpoint, any thoughts/advice on first actionable steps in the process?

Does your hospital have a DR program? I would seek information there first, even if it's through back channels (e.g. other residents). Best case scenario is that they have an opening or R position, meaning you could potentially avoid moving or spending time outside of training. I mention using back channels because, if you're trying to keep things from your PD, I wouldn't trust that a sit-down the DR PD would remain a secret.

I know you're here for practical advise, but are you running from RO or to IR? Because if it's the former, then you don't want to find yourself feeling the same about IR in a few years. Do you believe you've had sufficient exposure to IR to be sure you'll like it?

Also, forget passion. That stuff is for personal statements and appeasing the med school admission committee. I mean, I think radiology is great, but I wouldn't say I'm passionate about it. It's a job - I don't hate it enough to quit and it pays well. I'm just wondering if you've set too high of a bar for what you're expecting out of your field.

 

[DrfluffyMD]

Thanks for the prompt reply.

Honestly, it is not the job market but more the nature of the work. My wife and I have agonized over this decision for some time and we have arrived (for many reasons which are to numerous to post here) that I think I would be happier and enjoy day-to-day work more in IR. Unfortunately, I had no exposure to IR until my prelim year and had I been exposed during medical school I may have primarily pursued this as a career.

In every way the default choice to finish RO is easier. I am at a good program that has great job placement, I would lose less time etc.. However, I don't know if I am passionate about it. I could elaborate further.

However, if I do pursue switching, from a practical standpoint, any thoughts/advice on first actionable steps in the process?

My understanding is that RO is only 3 years plus an intern year? Have you ever thought about finishing RO, then go back for 5-6 years of training for radiology?

The con of that is basically time. Instead of finishing in 5-6 years counting this year, you will take an extra 2 years to finish RO.

The pro of that is you gain a specialty certification. Basically can walk from rads whenever if you decide that you don’t like it, and be in a position to do some truly cool, cool stuff (like Y90 permeated SVC stent that’s currently done in Korea) and be a superacademic attending at an elite center.

 

[sired]

how easily can someone switch specialties, given the medicare funding restrictions?

 

[GANCPA740]

My understanding is that RO is only 3 years plus an intern year? Have you ever thought about finishing RO, then go back for 5-6 years of training for radiology?

The con of that is basically time. Instead of finishing in 5-6 years counting this year, you will take an extra 2 years to finish RO.

The pro of that is you gain a specialty certification. Basically can walk from rads whenever if you decide that you don’t like it, and be in a position to do some truly cool, cool stuff (like Y90 permeated SVC stent that’s currently done in Korea) and be a superacademic attending at an elite center.

RO is 4 + 1. So it is 5 total years. I have thought about finishing but the road seems so long its difficult to see any light at the end in that scenario. Thanks for the thoughts! I know there are many barriers to switching but it seems difficult to complete 3 additional years of RO and then start Rads training.

All else equal, from a program standpoint would I have a huge "red flag" if I tried to switch and enter the match for Rads? There is a paper published in the surgical literature than approximately 20% of general surgery residents will quit or switch during residency to a different specialty so this has to be somewhat common.

Thanks for you help.

 

[DrfluffyMD]

RO is 4 + 1. So it is 5 total years. I have thought about finishing but the road seems so long its difficult to see any light at the end in that scenario. Thanks for the thoughts! I know there are many barriers to switching but it seems difficult to complete 3 additional years of RO and then start Rads training.

All else equal, from a program standpoint would I have a huge "red flag" if I tried to switch and enter the match for Rads? There is a paper published in the surgical literature than approximately 20% of general surgery residents will quit or switch during residency to a different specialty so this has to be somewhat common.

Thanks for you help.

First I just want to say sorry for “hijacking” rad pd’s thread. Again I am just a graduating resident.

I think when RO say they have one of the greatest job in medicine, they mean it. As a result, it’s competitive. I am sure you won’t have trouble getting to a radiology program, possibly also IR as well (it’s more realistic to bank of fellowship though), so 5-6 more years of training.

The issue though, is sometimes grass look greener on the other side. What is about RO that you don’t like?

Is it “boredom” or “this is too routine”? Is it “I don’t get to do surgery?” I had this “I want to do surgery itch” for awhile. I still do. But I also recognize that people prefer radonc to IR to surgery for a reason. When you have a lot of free time, it’s easy to imagine what could be. But after rotating in IR for the last 9 month, I can tell you, I definitely don’t want to do surgery realstically. The highs just doesn’t worth the low.

Now, is the high of IR worth the low of another 5-6 yrs of training minimum, when your coresidents are attendings half way through your rad years working 4 days a week making bigger salary than IRs? At some point all work becomes routine and you just wanna go home.

This is not to mention the turf war in IR. What if you end up in a position to only do “light IR” like paras and thoras? What if you end up with a 10% IR job, mostly DR that’s busier than RO, ****tier lifestyle, for less pay?

A lot to think about.

 

[GANCPA740]

Does your hospital have a DR program? I would seek information there first, even if it's through back channels (e.g. other residents). Best case scenario is that they have an opening or R position, meaning you could potentially avoid moving or spending time outside of training. I mention using back channels because, if you're trying to keep things from your PD, I wouldn't trust that a sit-down the DR PD would remain a secret.

I know you're here for practical advise, but are you running from RO or to IR? Because if it's the former, then you don't want to find yourself feeling the same about IR in a few years. Do you believe you've had sufficient exposure to IR to be sure you'll like it?

Also, forget passion. That stuff is for personal statements and appeasing the med school admission committee. I mean, I think radiology is great, but I wouldn't say I'm passionate about it. It's a job - I don't hate it enough to quit and it pays well. I'm just wondering if you've set too high of a bar for what you're expecting out of your field.

Hey,

Thanks for the reply. Practical advice is exactly what I am after. My initial thoughts were similar to yours. I don't think a sit down with the Rad PD at my program would be kept secret. And I know the second I do that and it gets out I would be done with RadOnc given how small a field it is and my institutions department can be quite prideful. I think maybe talking with a trusting Rads resident would be the first way to go. It would be great to get a spot where I am at if possible through an opening or some how in the next years match class or through a research year.

Your second point, I think I am seeking out IR not running from RO. RO is still a great field for lots of reasons already mentioned on this thread. I just don't know if it is for me.

Thanks again, any additional thoughts are welcomed.

 

[RadiologyPD]

In general, medical students who successfully matched into a mid tier or better Rad Onc residency will be competitive for DR spots. I honestly can't say how competitive you will be for integrated IR spots, since some of those spots want people to do a surgical internship and you presumably have not. My guess is that there may be some integrated IR spots that won't be as receptive.

The change of heart shouldn't really impact your competitiveness for DR and open-minded IR programs, assuming you can genuinely speak to the reasons. DR with/without ESIR followed by the senior year of an independent residency is a fine option for the person interested in IR training. Even for IR programs, since IR is so heavily involved with oncologic care, I think you can make a compelling case in which you articulate how your interest in oncologic care migrated from Rad Onc to IR.

The current period (after Match rank lists are in and before the new academic year begins) is special for people looking to switch into radiology because IF an R1 spot opens up for July, the program does NOT have to fill that open spot through the Match. Of course, the number of spots for an R1 starting in July that open up this late is quite limited, and I might think would be nearly nil for "integrated IR" spots. I would review AuntMinnie.com "Residents Digital Community" forum daily for any possible opening that might get listed...but be prepared for no position to open up.

For an R1 spot that would start July 2019 (again, much more likely to be DR than IR), programs MUST fill through the Match since the opening is so far away that the program COULD fill it through a match (the Match has rules on this). The program that finds itself with such an opening must first do some paperwork with NRMP, then fill the "R" position through the Match. You will find these through the usual NRMP listings that show the number of postions and types of positions for each program. There are some but not many R positions.

Otherwise, you are looking at starting Radiology in July 2020.

As for "how to start", once you have definitely decided to move forward, clearly decision 1 is figuring out what your plan is for July 2018-July 2019 in terms of income/support. It's ok if you are fully engaged in moonlighting with whatever skills you have (wound care is something that some people do), you don't have to do "research" but if you have some time, then I would try to secure something with a program that you are interested in matching (they may not have any paid positions, probably won't). Of course, you'll have to resign from your Rad Onc program (try to be nice and give enough notice, so soon if possible), sign up for the Match, and go through the Match process.

If you want to "talk about" your situation with the Radiology PD at your institution, what you might do is talk to one of the chief residents and tell them you want to stay anonymous. Have the chief talk to the PD to see how receptive the PD is to talking to you.

Good luck. Others have done it. It does mean a few extra years before you are "done" with training. It is worth it if you are convinced that it is the right move for you.

 

[GANCPA740]

Thank you for this information. This is exactly what I was searching for. I will keep an eye out for any open R1 spots through the resource you have listed as that would be a great option.

I am also glad to know I would not be disadvantaged because I am switching spots. That was one of my biggest concerns when I first started thinking about making this transition. I agree that finding an IR spot may be difficult and I figured my best option would be DR with ESIR as you have pointed out. I did a medicine prelim year not surgical as you have mentioned.

Do you feel a research year may be a positive for my application? I am trying to optimize what the best way to spend the upcoming year would be that would both pay the bills and prepare me to apply into Rads. I did a dual degree and already have a fair amount of publications so if the year would not add value to my application I would rather find another way to spend this time. I have also considered just doing another year in RO while I apply but then I have no idea how I would gather new LORs.

IN your experience as a PD have you had a resident transfer from one specialty within your hospital into Rads? I was hoping I may be able to transfer "horizontally" into the program I am already at. I already know the hospital, research avenues, etc and it seems it would make sense but I am unsure if this is common.

Thank you again for the information!

 

[RadiologyPD]

I've mentioned before that our committee tries to understand research experiences in the context of future career plans. If the person is doing research because he/she clearly has a trajectory toward an academic career, then an extra year helps, particularly if you can articulate how it improved your research skill set. If not, it doesn't help. We see that as just a person "checking the box"--doesn't hurt, doesn't help-- especially once the box has been checked previously. Having said that, research AT THE INSTITUTION where you most highly want to match is helpful because you meet people and then they like you and then you have a leg up on other applicants.

Yes, it is common for programs to match applicants into the program after completing 1-2 yrs in another program at that institution. It clearly helps the radiology program when there is a last minute opening, but even through the regular match, there's an advantage to the internal candidate who is well-liked/successful but who just has a change of heart in terms of specialty. That's why it pays to be as nice as possible to the Rad Onc program that you are in and give them as much heads up as possible. I don't think that Rad Onc program is going to want you to stay an "extra year" when you don't plan to finish the residency, since almost all residency programs get the most "value" out of their most senior residents--they will want to replace you earlier, not later.

 

[radioactive_pheonix]

Thank you for all your replies, RadiologyPD. The amount of detail you go into is incredible. The effort you put into normalizing clerkship grades just shows how much you care about the process, even when you know it can all flip during the final review. I enjoyed all the bits of humor you include in your posts. I also think it's amusing there is an online chatroom for radiology PDs. Enough kissing ass, here is my question.

In previous posts, you said that not matching is NOT a red flag and that switching career trajectory from another residency is also ok. Does not matching in itself and then pursing radiology (assuming there are solid motivations for now pursuing radiology) ever discussed in your selection committee in a negative or positive light? There are several reasons for re-applicants to feel insecure. Stigmatization of not matching. No program/field wants to be seen as a sloppy second / not a field of (initial) choice. Programs might wonder why this applicant didn't match and start digging for negative traits, etc.

 

[RadiologyPD]

I should clarify that not matching into competitive fields does happen and those applicants seem to do fine.

Remember, I conclude every match year by recording on my spreadsheet where all of the applicants who applied to our program ended up matching. We have interviewed a number of applicants over the years who did not match into Ortho (mostly) as well as some scattered other competitive fields (Neurosurgery, ENT, Dermatology). They seem to end up matching, many at very good places.

Our committee understands that things sometimes don't work out--often there is a letter from a person in that person's originally intended field that expresses shock that the candidate didn't end up matching in their field. We try to understand if the person has a reasonably good understanding of radiology and take them at their word that they are interested in radiology--we aren't butt-hurt that they had a different interest first.

We have a healthy self-esteem in our department and on our selection committee--basically Radiology is the best field in our eyes, and so we don't see ourselves as "sloppy seconds". Some of our residents in our history started out in other fields--they consciously abandoned original plans and moved to Radiology, at the cost of doing extra years of training.

Of course, any applicant who doesn't match will get careful scrutiny. If the person didn't match in a less competitive field, then it does make you wonder about that person's judgement (if they didn't rank programs effectively) or their record. Likewise, if they didn't match in Radiology initially, that is also a concern--in the recent past, it hasn't been that hard to match into Radiology somewhere if you are a US medical graduate. Perhaps that will change.

 

[ejay19955]

Do you ever expect DR to bounce back up to the 90's - 00's competitiveness? I pretty much knew I wanted to do radiology when I entered medical school, and around that time (I believe 2015 match?) radiology had like 180 unfilled spots, which honestly made me happy because the competitiveness tanked. Now, with emergence of IR, DR seems to have gotten much more competitive.

 

[SpartanWolverine]

Do you ever expect DR to bounce back up to the 90's - 00's competitiveness? I pretty much knew I wanted to do radiology when I entered medical school, and around that time (I believe 2015 match?) radiology had like 180 unfilled spots, which honestly made me happy because the competitiveness tanked. Now, with emergence of IR, DR seems to have gotten much more competitive.

It was definitely a competitive year and I can say that my N=1 experiences on the interview trail pointed to a lot of it driven by an interest in IR from those who would have otherwise gone for a non-radiology procedural specialty.

The Match report for 2018 though the increase in competition was remarkable enough to make the following note in the initial summary page:
"Radiology-Diagnostic offered 125 categorical positions and 944 advanced positions. All categorical positions (100%) and 99.5 percent of the advanced positions were filled, both among the highest on record."

 

[ypeter999]

@RadiologyPD

I really want to go to California for residency and I've heard that there is a big location bias, especially for someone from Texas. (I'm from Texas, went college in the east coast, and then came back to Texas for med school). I wanted to know how I can get a California school like yours to even give me the chance to interview especially considering that I have no connections whatsoever to California (no family, significant other's family, away rotation, etc.). My grades and extracurriculars shouldn't stop me from interviewing at some California schools but I'm worried that they won't believe I actually want to go to California or rank them highly.

Thank you for your help!

 

[RadiologyPD]

If you have a competitive application, being from Texas won't stop you from getting interviews in California. California is a popular place for young people who understand the higher cost of living is part of the deal--programs understand this popularity. The "location bias" is a bigger issue for programs in other less popular areas. I think some students think there is a "location bias" when they don't get an interview at a California program, but the truth is that it is more likely that the application wasn't really all that different from others (meaning not particularly competitive).

 

[RadiologyPD]

See posts #60, #141, #176. A letter of interest can be useful if it is genuine and articulates a reason to consider the candidate as especially likely to rank the program highly. Best to send in late September, I think.

 

[RadiologyPD]

There is hope. You almost certainly would have to start as an R1 somewhere, with no credit for your completed R1 year, given the time lapse.

You will have to be convincing regarding resolution of your issues that led to delays and detours in your training to date. Nevertheless, if you have a compelling application (metrics, track record/letters, potential to make the program "proud"), you have a chance.

See post #92 regarding potential funding restrictions for some programs.

 

[Epicurusall]

Unsure if this has been asked or not yet, and if it has I apologize.

In evaluating an applicant, is a higher step 1 score or higher class rank in Dean's letter more important?

For example, 240 step 1 and ~70-80th percentile class rank vs 250 step 1 and ~50-60th percentile class rank

 

[SpartanWolverine]

I'd say almost universally a higher Step is more important. It's one of the primary initial screening factors and the best standardized measure to stratify applicants. In a closer review a higher class rank may hold some weight if from a good school, but that's if you get beyond the initial screen. Again, though, almost certainly the higher Step score would be more important. Being within vs above 1 standard deviation from the national mean is meaningful. Being 75th percentile vs 55th percentile from one school less so unless the reviewer is familiar with the inner working of the program.

 

[RadiologyPD]

I don't agree with SpartanWolverine on this one.

If 2 students from the same school had the metrics you define, with only a 10 point difference between Step 1 scores (both at or above 240) and a 20% difference in class rank (with one in the 2nd to top "quintile", the other in the middle "quintile"), and ALL OTHER FACTORS were the same (which is impossible), then the student with the higher class rank is more likely to have the "right stuff" for our program.

 

[Epicurusall]

I don't agree with SpartanWolverine on this one.

If 2 students from the same school had the metrics you define, with only a 10 point difference between Step 1 scores (both at or above 240) and a 20% difference in class rank (with one in the 2nd to top "quintile", the other in the middle "quintile"), and ALL OTHER FACTORS were the same (which is impossible), then the student with the higher class rank is more likely to have the "right stuff" for our program.

Thank you!

 

[RadiologyPD]

For you, your competitiveness for radiology will depend on (in no particular order):
1. Your academic metrics: the standard board score, medical school rank, clinical grades, etc.--all as a proxy for how easy it will be for you to impress the staff and pass the Core exam
2. The quality of your Nuclear Medicine training and what you've done with it in the 5 yrs since you finished residency.
3. The intangible personal stuff you bring to the table--how impressive do you come across in a job interview? Do people love working with you?
4. The demonstrated resolution of whatever issues led you to leave radiology in the first place
5. A letter from your prior radiology program director saying they loved you and were so sorry you had to leave due to medical issues.
6. Will the program see you as "brand enhancing"--your presence will help recruit future applicants, your career trajectory will bring pride to the program, you're a no-brainer star, faculty are going to love being out at dinner while you handle the call cases superbly and they won't be dealing with fixing reports all night/weekend
7. Your personal connections with the program

To the extent that a PET/CT fellowship or any clinical experience facilitates one of the above 7 items, go for it. Otherwise, no point. "Refreshing clinical skills" makes it seem like you haven't being doing any work for 5 years since finishing Nucs, which would be a big issue. It's ok if you don't know anything about radiology--if you don't remember anything about medicine, it's a problem.

 

[howdysang]

@RadiologyPD I am a MS4 applying this cycle. How acceptable would it be to obtain a LOR from a graduating resident from a non radiology specialty? I am certain that the letter will be glowing and top notch. Thank you!

 

[RadiologyPD]

probably won't be well received, to be honest

 

[RadiologyPD]

Good evening:

Thank you for your reply.

While the quality of my training was excellent, I have NOT practiced since graduating from my nuclear medicine residency (nearly 5 years) due to my severe endometriosis and infertility. Only after I finished NM was I able to attempt to have a family. Between the endless failed IVF treatments, trials, multiple miscarriages, and attempts with gestational carriers, I could not at that time commit to a position in NM.

Though I first sat for my NM boards in 2015, 2 1/2 years after residency and was certified by the ABNM, I made several more attempts at starting a family; however, I finally decided that I had tried long enough and thus had a full hysterectomy and peritoneal stripping, a final and drastic step towards ending my disease.

I realize that not practicing may be seen as a "RED FLAG." However, I was attempting literally every procedure, medication, etc. to improve my health and to try to have a family. It saddened me daily that I wasn't working in my chosen field.

I simply want a chance.

What would you advice?

Lastly, I thought that a PET/CT fellowship would allow me to return to clinical practice in NM after being away for so long. Maybe radiology residency directors, after receiving positive feedback from my fellowship attendings, might realize that I could be of value to their residency programs (even with a 5 year gap).

Thank you so much for your help, it is genuinely appreciated.

Sorry to hear about your struggles but it seems you are moving forward, which is great.

As I said, "To the extent that a PET/CT fellowship or any clinical experience facilitates one of the above 7 items, go for it." In your case it seems it would help.

Given your situation of not having done any clinical NM, if you can get a PET/CT fellowship, I think it augments #2 for you. It could also help with #7 if it is at a place that also has a DR residency to which you might apply. Obviously, if you are able to get positive feedback during the fellowship, it helps with #2 and #3. Doing a great job in the fellowship helps with #4, and is a proxy for #5. For any DR program that has strong NM faculty, your candidacy could also bolster #6. Getting involved with research during your fellowship and being successful would also help #6

Item #1 still is quite important and will help if positive.

So yes, go for it if you can find the right spot. If not and you are considering other options, consider how it impacts the "checklist" in your favor.

Good luck.

 

[RadApp]

Sorry to hear about your struggles but it seems you are moving forward, which is great.

As I said, "To the extent that a PET/CT fellowship or any clinical experience facilitates one of the above 7 items, go for it." In your case it seems it would help.

Given your situation of not having done any clinical NM, if you can get a PET/CT fellowship, I think it augments #2 for you. It could also help with #7 if it is at a place that also has a DR residency to which you might apply. Obviously, if you are able to get positive feedback during the fellowship, it helps with #2 and #3. Doing a great job in the fellowship helps with #4, and is a proxy for #5. For any DR program that has strong NM faculty, your candidacy could also bolster #6. Getting involved with research during your fellowship and being successful would also help #6

Item #1 still is quite important and will help if positive.

So yes, go for it if you can find the right spot. If not and you are considering other options, consider how it impacts the "checklist" in your favor.

Good luck.

It was so very kind of you to reply. Your advice is much appreciated.

 

[soulcity]

Dear PD,
I will be applying for DR match this September. I have time for one AI elective before my application goes out.

1. Is there a specific AI you like to see? At my school IM is very popular so many students do not get to do an AI in IM before September. My other choices at this point include EM AI and General Surgery AI. Is there any advantage to doing one versus another? (i.e. getting letter from EM physician vs surgeon?)

2. I am currently ambivalent about pursuing IR fellowship after DR residency. I don't have a strong desire to do so but it is something I would like to explore during residency. Is it acceptable to express possible "interest" in IR fellowship in my DR application (in personal statements/ in LORs- my letter writers wanted to know)? Or would this make my application less desirable?

Thank you!

 

[RadiologyPD]

1. Is there a specific AI you like to see?

Don't really care. We tend not to look at the 4th year rotations since these vary so much between candidates. Doesn't matter if you have a letter from EM physician or surgeon.

I am currently ambivalent about pursuing IR fellowship after DR residency. I don't have a strong desire to do so but it is something I would like to explore during residency.

This is fine, but be careful about the words you choose to use. "Ambivalence" sounds like you don't care, whereas you'd be better off saying you're "undecided". Remember, procedures are part of many radiology subspecialties, and you will interview with subspecialists who do procedures who are not interventionalists. You don't want to come off as someone who is scared of procedures (this is not as uncommon as you might think)--not because there isn't a place for radiologists who detest procedures, but PDs like to see individuals who aren't scared of doing things.

Above all, be honest, but if it is true you might say something like "I've realized that procedures can be part of many radiology subspecialties--breast, MSK, neuro, abdomen--and since I'm inclined toward a rich diagnostic career, I'm undecided as to whether my procedural interests will demand an interventional career or whether I'd be better off marrying my strong diagnostic interests with subspecialty procedures in one of these areas, or simply focusing on being the best diagnostic radiologist I can be without having to do any procedures. I'm most interested in a DR pathway that will allow for any interventional aspirations to grow if they blossom during the DR residency."

 

[halfwaycrooks]

Thank you @RadiologyPD for the thread. I'm going radiology after pursuing a surgical subspecialty for the majority of med school. How much of a red flag would it be to have a letter from a surgeon in this specialty? Will they assume rads is a backup and my app will be thrown out?

 

[RadiologyPD]

Thank you @RadiologyPD for the thread. I'm going radiology after pursuing a surgical subspecialty for the majority of med school. How much of a red flag would it be to have a letter from a surgeon in this specialty? Will they assume rads is a backup and my app will be thrown out?

Of course not.

Radiology residency selection committees do not want you to have letters only from radiologists. Many will want one from a radiologist, but as I've mentioned previously, this is not a requirement for my program.

 

[xxxxxxxxxxxxxxx]

Our program had a very effective match. We filled below 4 ranks/spot which is one of our best results ever.

There were no consistent "pitfalls" that I noticed in applications, and no special red flags--obviously, some applications did have pitfalls and red flags that were unique to the individual.

I'm the PD of a DR program and a number of our top candidates ended up matching at IR programs. Remember that I don't particularly care about "optics" regarding how far down our match list we go, we rank candidates based on our assessment of their potential in our program. But clearly for these IR focused individuals, our program looks to have taken a back seat in the ranking process because we were DR, even though I think the pathway for doing IR through our program (with ESIR) is fairly robust.

I looked at the match outcomes for all candidates who applied to our program. Most of the reasonably competitive DO candidates who applied to our program (based on USMLE scores) ended up matching in Radiology, and some at reasonably good programs it seemed to me.

I'd like to ask a follow-up question...is a 'reasonably competitive USMLE score' 245+ ? I'm hoping 245-249 could land me in at least an average DR program, even with coming from a largely unknown DO school.

Also, I'm afraid that coming from a med school that is NOT in the general region I want to apply will hinder me. If I want to apply to programs in my home state (not near the state I go to school in), would PD's still count me into the pile of a 'student with a regional tie' since I lived there basically my whole life?

 

[JRY6788]

I am wondering how DR program directors view applicants applying to both IR and DR programs (I am sorry if this question has already been addressed but I couldn't find anything in the forum). I am a current M4 who will be applying to DR programs (and possibly some IR programs) this upcoming cycle. Do DR program directors tend to shy away from (or limit) extending interview offers to applicants who seem more interested in IR? And following up on that question, if the aforementioned applicants are extended interviews to PD programs, are they given less consideration in the rank process?

 

[RadiologyPD]

I'd like to ask a follow-up question...is a 'reasonably competitive USMLE score' 245+ ? I'm hoping 245-249 could land me in at least an average DR program, even with coming from a largely unknown DO school.

Also, I'm afraid that coming from a med school that is NOT in the general region I want to apply will hinder me. If I want to apply to programs in my home state (not near the state I go to school in), would PD's still count me into the pile of a 'student with a regional tie' since I lived there basically my whole life?

I'm not sure that 245-249 USMLE from a DO school will do the trick for an "average DR program" since the "average DR program" doesn't usually fill with DO candidates. Radiology is currently more competitive. There are some programs that have a history of taking DO candidates, and though some may be great, they are not the "typical" DR program (i.e., the "average DR program"). You will need a hook for the "typical DR program", I believe. Possible hooks include super strong USMLE scores, personal connections to a program (by way of time spent there or familiarity with program leadership), significant research of interest to the program, leadership history of interest to the program, selection in merit based societies (such as Psi Sigma Alpha or Sigma Sigma Phi), etc. Remember, the "regional tie" thing is only if the region isn't super popular--if your "home state" is California, the fact that you are from California doesn't help you at all. But if the region you want to go to isn't very popular (or even better, is unpopular), then the regional tie thing helps you a lot.

 

[RadiologyPD]

I am wondering how DR program directors view applicants applying to both IR and DR programs (I am sorry if this question has already been addressed but I couldn't find anything in the forum). I am a current M4 who will be applying to DR programs (and possibly some IR programs) this upcoming cycle. Do DR program directors tend to shy away from (or limit) extending interview offers to applicants who seem more interested in IR? And following up on that question, if the aforementioned applicants are extended interviews to PD programs, are they given less consideration in the rank process?

The fact that a candidate is applying to both IR and DR programs really should not affect the way a program ranks you ONCE THEY HAVE INTERVIEWED YOU. They really should not care if you have 5 other programs ahead of then on your rank list--if they liked you best of all candidates, they should rank you first. Again, that's the way I see it.

Having said that, the fact that a candidate is applying to both IR and DR programs may very well AFFECT THE LIKELIHOOD OF YOU GETTING AN INTERVIEW. Remember, the number of interview slots is finite--and programs get 10 or more applicants for every interview slot they have. If they don't have a robust pathway to IR training (through relatively high percentage of DR residents who can do ESIR and an independent IR residency in which they indicate they will give preference to internal candidates), then these programs know that they are "second fiddle" to the applicant who indicates a high likelihood of going into IR. They may limit the number of excellent candidates who they perceive as being more interested in IR just to make sure they don't ONLY interview IR candidates and risk not filling through the Match. In practical terms, what these programs might do is reserve a certain percentage of their interview slots for candidates who they somehow feel are more interested in DR--though it remains to be seen how they would really know that. I guess some individuals might expressly state that in their application materials, which could be strategically advantageous if it is really true. The really savvy programs will understand that there are going to be many outstanding IR candidates also interested in DR who won't match into IR, and so it hurts them to not interview these candidates--but not all programs are savvy.

 

[gilaze]

I'm not sure that 245-249 USMLE from an unknown DO school will do the trick for an "average DR program" since the "average DR program" doesn't usually fill with DO candidates. Radiology is more currently more competitive. There are some programs that have a history of taking DO candidates, and though some may be great, they are not the "typical" DR program (i.e., the "average DR program"). You will need a hook for the "typical DR program", I believe. Possible hooks include super strong USMLE scores, personal connections to a program (by way of time spent there or familiarity with program leadership), significant research of interest to the program, leadership history of interest to the program, selection in merit based societies (such as Psi Sigma Alpha or Sigma Sigma Phi), etc. Remember, the "regional tie" thing is only if the region isn't super popular--if your "home state" is California, the fact that you are from California doesn't help you at all. But if the region you want to go to isn't very popular (or even better, is unpopular), then the regional tie thing helps you a lot.

What do you call "super strong" USMLE scores?