Radiology ideal for me?

[Gagan97]

I have been in between a few specialities mostly Im and a few subspecialties or radiology. I realised that I like talking but it doesn't have to be patients it can be other physicians too, quick procedures not too long, being a sort of an expert. I also have few hobbies that I would want to explore in the future like medical journalism and health economics. Right now I am trying to decide between Im with the intention of going into a subspecialty (this decision can wait) or radiology. Any advice?

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[brownman23]

Have you done rotations in both Radiology and IM?

What do you like about Rads? What do you like about IM?

Which specialty’s bread and butter would you rather do? Do you want to read CT Ab/Pelvis or manage a HF exacerbation?

 

[Gagan97]

I have done rotations in both.

Honestly I like the aspect of talking to patients in IM but I find the paperwork very draining. The amount of documentation seems insane. I will 100 percent subspecialize if I go into IM purely because I don't see myself in a primary care role. Like both GI and rheumatology

Radiology is really nice in that it's never boring. When you are on you are on. Your time off Is yours completely. Feels like I will be challenged daily. Love the relative peaceful environment

 

[Tiger100]

Do Rheumatology if you like talking to patients.

Do GI if you like to do repetitive procedures and don't mind smelling poops.

Do Radiology if you like the cerebral aspect of it with some quick procedures here and there.

Rheumatology has the best lifestyle but pays less than your other options at least for now.


Most medicine is boring and monotonous. Procedures become old very fast. Talking to patients is a mundane task for the most part with a few good encounters here and there and few terrible interactions.

Once you pass the age of 40 which is still considered early career in the world of medicine and especially if you have family, working evenings and weekends becomes really annoying and working nights becomes extremely hard.

 

[Gagan97]

Thank you. I agree. I also have a few buisness interests I would like to pursue. I just feel radiology fits the bill perfectly in that aspect allowing me time to work on these other ventures. Loved everything about the field during my rotations specially the ki. The hesitancy is mainly because I have seen so many specialists discourage me from radiology telling me about AI and teleradiology. Plus my mentor is gastroenterlogist who really thinks I will be great at it but Iam personally a little more inclined towards radiology because of the tech and control of schedule

 

[deleted379552]

so many specialists discourage me from radiology telling me about AI and teleradiology

I really don't understand why so many specialists outside of our field with very little knowledge of how the field operates have such strong opinions about our field. I've been man-splained (or whatever the equivalent is) what radiology will be by FM, ID, PMR docs, and even members of the random public... always random and unprompted (one time by a random ID fellow on a subway). Thx brahs, but no one asked you. Everyone is looking for a schadenfreude'ing moment for radiology (like maliciously hoping for its demise), which to me feels like your brother waiting for you to turn your back so he can shank you in the back and sleep with your wife. With the clinical world around us crumbling to ashes by the lost of physician autonomy (soon you'll need pre-authorization for Tylenol), midlevel encroachment, endless-mind-numbing paperwork, medicolegal minefield that is US healthcare, corporatization of healthcare (private equity takeover everywhere), and worsening lack of respect for physicians by the general public, folks are frustrated. Don't turn on your own physician colleagues tho.

 

[scoopdaboop]

I really don't understand why so many specialists outside of our field with very little knowledge of how the field operates have such strong opinions about our field. I've been man-splained (or whatever the equivalent is) what radiology will be by FM, ID, PMR docs, and even members of the random public... always random and unprompted (one time by a random ID fellow on a subway). Thx brahs, but no one asked you. Everyone is looking for a schadenfreude'ing moment for radiology (like maliciously hoping for its demise), which to me feels like your brother waiting for you to turn your back so he can shank you in the back and sleep with your wife. With the clinical world around us crumbling to ashes by the lost of physician autonomy (soon you'll need pre-authorization for Tylenol), midlevel encroachment, endless-mind-numbing paperwork, medicolegal minefield that is US healthcare, corporatization of healthcare (private equity takeover everywhere), and worsening lack of respect for physicians by the general public, folks are frustrated. Don't turn on your own physician colleagues tho.

Physicians invest in crypto and become AI experts!

 

[Ho0v-man]

I really don't understand why so many specialists outside of our field with very little knowledge of how the field operates have such strong opinions about our field. I've been man-splained (or whatever the equivalent is) what radiology will be by FM, ID, PMR docs, and even members of the random public... always random and unprompted (one time by a random ID fellow on a subway). Thx brahs, but no one asked you. Everyone is looking for a schadenfreude'ing moment for radiology (like maliciously hoping for its demise), which to me feels like your brother waiting for you to turn your back so he can shank you in the back and sleep with your wife. With the clinical world around us crumbling to ashes by the lost of physician autonomy (soon you'll need pre-authorization for Tylenol), midlevel encroachment, endless-mind-numbing paperwork, medicolegal minefield that is US healthcare, corporatization of healthcare (private equity takeover everywhere), and worsening lack of respect for physicians by the general public, folks are frustrated. Don't turn on your own physician colleagues tho.

I remember an outpatient psych NP in 3rd year telling me not to go into rads because of AI. Oh yeah, she definitely has a finger on the pulse of cutting edge imaging techniques despite the fact that she herself could be replaced with a benzo vending machine much quicker than any radiologist could ever be replaced by AI.


Its sad that physicians in other fields seem generally unappreciative of radiology’s contributions to patient care.

But honestly, no one really knows what’s going to happen in any field. You’d be laughed at 10 years ago saying ED and rad/onc would look bleak. But everyone KNEW rads was dead lol

 

[guytakingboards]

I really don't understand why so many specialists outside of our field with very little knowledge of how the field operates have such strong opinions about our field. I've been man-splained (or whatever the equivalent is) what radiology will be by FM, ID, PMR docs, and even members of the random public... always random and unprompted (one time by a random ID fellow on a subway). Thx brahs, but no one asked you. Everyone is looking for a schadenfreude'ing moment for radiology (like maliciously hoping for its demise), which to me feels like your brother waiting for you to turn your back so he can shank you in the back and sleep with your wife. With the clinical world around us crumbling to ashes by the lost of physician autonomy (soon you'll need pre-authorization for Tylenol), midlevel encroachment, endless-mind-numbing paperwork, medicolegal minefield that is US healthcare, corporatization of healthcare (private equity takeover everywhere), and worsening lack of respect for physicians by the general public, folks are frustrated. Don't turn on your own physician colleagues tho.

In psychology its called the "illusion of explanatory depth". Non-radiologists think they know the field of radiology better than they actually do. It's not particularly exclusive to radiology. Goodness knows I've muttered some unflattering things about some of those referring specialties and how their field works.

I've got my concerns about the field of radiology but those concerns are vastly different than the stuff that clinical services tell trainees.

 

[guytakingboards]

Its sad that physicians in other fields seem generally unappreciative of radiology’s contributions to patient care.

I've seen a few good lectures over the years from older rads that have talked about and contextualized the radiologists role in healthcare and how the appreciation for the field has gone down as it's been commoditized. In particular Paul Chang at UChicago has a great talk and anecdote about old school radiology and how the PACS ruined the hallowed role radiology used to have.

People used to queue up outside the radiology department to go over cases and time their morning rounds to involve a stop in the radiology dept.

Now radiology ordering is just a click on a screen and the reports and/or images can be pulled up on your phone in seconds, completely dehumanizing the radiologist involved. Current generation trainees basically have no context about radiology workflow and how a bill becomes a law/how an order becomes a report.

Though, its probably not any worse than PCP's dealing with patients thinking WebMD is as good or better than a real doctor.

 

[Taurus]

I actually don’t miss those days of clinicians queuing up in the morning to review radiology studies, which was a free courtesy service to them. Most of the time it’s a waste of my time plus it’s uncompensated time. 90% of the time the answer can be found in my report.

 

[odyssey2]

In psychology its called the "illusion of explanatory depth". Non-radiologists think they know the field of radiology better than they actually do. It's not particularly exclusive to radiology. Goodness knows I've muttered some unflattering things about some of those referring specialties and how their field works.

I've got my concerns about the field of radiology but those concerns are vastly different than the stuff that clinical services tell trainees.

What are your concerns?

 

[guytakingboards]

What are your concerns?

Some of it's radiology-related. some of the concerns are more healthcare in general.

On the radiology side, the field has been and continues to be ripe for reimbursement slashing. Radiology is often on the top of the chopping block, while the primary care specialties have actually seen pay bump recently. That means less money for the same work, which is total horse**** when you consider that inflation goes up every year.

Only new technologies buffet that downward pressure on salaries. Tomosynthesis was a relatively recent but decent bump in RVUs but there's no way the reimbursement for those will remain high. Theranostics *may* be extremely lucrative until reimbursements are cut and too many players enter the market. Every other specialty is chomping at the bit to steal lucrative studies/procedures from radiology and for the most part, we can't stop them.

We're currently not training enough radiologists. There's a nation-wide radiologist shortage but everyone is scared to death to go the way of EM/Rad-onc and overproduce rads so everyone is short-staffed. A lot of people i know in the field right now feel overworked and/or burned out. Some of the older partners in my group saying they're working as hard as they ever remember and are making considerably less than their heyday.

But do i spend time worrying about AI? Heck no.

 

[recycledpaper]

Some of it's radiology-related. some of the concerns are more healthcare in general.

On the radiology side, the field has been and continues to be ripe for reimbursement slashing. Radiology is often on the top of the chopping block, while the primary care specialties have actually seen pay bump recently. That means less money for the same work, which is total horse**** when you consider that inflation goes up every year.

Only new technologies buffet that downward pressure on salaries. Tomosynthesis was a relatively recent but decent bump in RVUs but there's no way the reimbursement for those will remain high. Theranostics *may* be extremely lucrative until reimbursements are cut and too many players enter the market. Every other specialty is chomping at the bit to steal lucrative studies/procedures from radiology and for the most part, we can't stop them.

We're currently not training enough radiologists. There's a nation-wide radiologist shortage but everyone is scared to death to go the way of EM/Rad-onc and overproduce rads so everyone is short-staffed. A lot of people i know in the field right now feel overworked and/or burned out. Some of the older partners in my group saying they're working as hard as they ever remember and are making considerably less than their heyday.

But do i spend time worrying about AI? Heck no.

All subspecialties are getting reimbursement cuts. I believe recent efforts by ACR have postponed some of those cuts as well as reduced them, but we can expect those reimbursement cuts to keep coming. If you are as concerned as you make it out to be, I recommend getting involved with those efforts. There are a lot of people doing thankless jobs in order to maintain appropriate reimbursement for radiologists. Truly, we owe these folks a lot.

Either way, the points you made are hitting almost all aspects of medicine. We, as in physicians, are no longer in the drivers seat. The older docs relinquished that to admin many years ago and it may be too late to take it back.

 

[guytakingboards]

All subspecialties are getting reimbursement cuts. I believe recent efforts by ACR have postponed some of those cuts as well as reduced them, but we can expect those reimbursement cuts to keep coming. If you are as concerned as you make it out to be, I recommend getting involved with those efforts. There are a lot of people doing thankless jobs in order to maintain appropriate reimbursement for radiologists. Truly, we owe these folks a lot.

Either way, the points you made are hitting almost all aspects of medicine. We, as in physicians, are no longer in the drivers seat. The older docs relinquished that to admin many years ago and it may be too late to take it back.

Yes, the recent cuts got significantly neutered and/or delayed. The net effect is a 0.75% cut on Medicare rates starting Jan 1 and the continued possibility of a phased in additional rate cut in April if more legislation isn't passed.

I support the organizations like ACR and my local state ACR chapter that are fighting for radiology. Don't necessarily want to be in the fight myself but my dues support the groups that are fighting the fight.

While there is an overall downward pressure on healthcare spending/reimbursement, I rarely if ever hear my primary care colleagues complaining about their salaries being cut. True those fields are starting at a lower place than radiology, but they're not at the top of the list of targets for rate cuts. If anything their salaries have gone up lately.

 

[guytakingboards]

I have done rotations in both.

Honestly I like the aspect of talking to patients in IM but I find the paperwork very draining. The amount of documentation seems insane. I will 100 percent subspecialize if I go into IM purely because I don't see myself in a primary care role. Like both GI and rheumatology

Radiology is really nice in that it's never boring. When you are on you are on. Your time off Is yours completely. Feels like I will be challenged daily. Love the relative peaceful environment

Seems like a pretty glamourized view of radiology. I'm 3 years out of fellowship and I can say at this point: there are plenty of days that are boring. Depending on the type of job your take, it could be VERY boring. Sitting in the outpatient neuro seat and reading degen spine MRIs , sinus CT's and stable cancers follow-ups all day is not super interesting. Can't imagine how it'll feel after another 20 years.

In terms of the "your time off is your time off", that's definitely not universally true in radiology. My group has pager call, a few call pools actually. I can be called to jump on the list from home and help the group catch up if they're drowning. Definitely been woken up at 2am for that. I can be called in to do an emergent procedure overnight, like an LP. These instances aren't common (maybe a few times a year), but i definitely take pager call.

The whole peaceful environment is also heavily circumstantial too. When I read outpatient neuro from home, sometimes zero interruptions or calls. When I sit in certain outpatient clinic rotations, the phone's ringing off the hook with tech and provider questions... multimodality techs are coming in and showing me cases... there are procedures to be done... It can be an extremely unpleasant day where it seems crazy to get any work done.

The day-to-day of radiology can look very different in different jobs and settings. just like any other specialty.

As was said earlier in the thread, figure out if the day-to-day of radiology is more interesting to you than the day-to-day of the other specialties. After a while every one of them will become monotonous in some way or another.

 

[recycledpaper]

Seems like a pretty glamourized view of radiology. I'm 3 years out of fellowship and I can say at this point: there are plenty of days that are boring. Depending on the type of job your take, it could be VERY boring. Sitting in the outpatient neuro seat and reading degen spine MRIs , sinus CT's and stable cancers follow-ups all day is not super interesting. Can't imagine how it'll feel after another 20 years.

In terms of the "your time off is your time off", that's definitely not universally true in radiology. My group has pager call, a few call pools actually. I can be called to jump on the list from home and help the group catch up if they're drowning. Definitely been woken up at 2am for that. I can be called in to do an emergent procedure overnight, like an LP. These instances aren't common (maybe a few times a year), but i definitely take pager call.

The whole peaceful environment is also heavily circumstantial too. When I read outpatient neuro from home, sometimes zero interruptions or calls. When I sit in certain outpatient clinic rotations, the phone's ringing off the hook with tech and provider questions... multimodality techs are coming in and showing me cases... there are procedures to be done... It can be an extremely unpleasant day where it seems crazy to get any work done.

The day-to-day of radiology can look very different in different jobs and settings. just like any other specialty.

As was said earlier in the thread, figure out if the day-to-day of radiology is more interesting to you than the day-to-day of the other specialties. After a while every one of them will become monotonous in some way or another.

Your group needs to figure out a solution to all those distractions. Surely that cannot be the only option? There are many inefficiencies in your daily workflow and it should be addressed.

 

[Gagan97]

Seems like a pretty glamourized view of radiology. I'm 3 years out of fellowship and I can say at this point: there are plenty of days that are boring. Depending on the type of job your take, it could be VERY boring. Sitting in the outpatient neuro seat and reading degen spine MRIs , sinus CT's and stable cancers follow-ups all day is not super interesting. Can't imagine how it'll feel after another 20 years.

In terms of the "your time off is your time off", that's definitely not universally true in radiology. My group has pager call, a few call pools actually. I can be called to jump on the list from home and help the group catch up if they're drowning. Definitely been woken up at 2am for that. I can be called in to do an emergent procedure overnight, like an LP. These instances aren't common (maybe a few times a year), but i definitely take pager call.

The whole peaceful environment is also heavily circumstantial too. When I read outpatient neuro from home, sometimes zero interruptions or calls. When I sit in certain outpatient clinic rotations, the phone's ringing off the hook with tech and provider questions... multimodality techs are coming in and showing me cases... there are procedures to be done... It can be an extremely unpleasant day where it seems crazy to get any work done.

The day-to-day of radiology can look very different in different jobs and settings. just like any other specialty.

As was said earlier in the thread, figure out if the day-to-day of radiology is more interesting to you than the day-to-day of the other specialties. After a while every one of them will become monotonous in some way or another.

I guess I never really looked at it from that perspective. when I was shadowing the attending was going through such a varied list i was actually pretty much in awe. But I guess in private practice everything becomes routine. Inspite of the calls I still felt radiology was relatively peaceful compared the other specialities where you can focus on your work and pretty much forget everything else. The 2 am thing is a shocker. I always thought they had no nights and overnight telerads covered that after residency

 

[guytakingboards]

Your group needs to figure out a solution to all those distractions. Surely that cannot be the only option? There are many inefficiencies in your daily workflow and it should be addressed.

Hah. It sounds nuts and it is. I think that particular seat is **** by design. A bunch of more senior partners once upon a time dumped an outsized amount of crap responsibilities on that seat cuz they weren't sitting there. I rarely cover that rotation, so i just take it on the chin for a day or two and go back to my more pleasant rotations. I have way more WFH shifts with zero interruptions than shifts at that crap site.

I guess I never really looked at it from that perspective. when I was shadowing the attending was going through such a varied list i was actually pretty much in awe. But I guess in private practice everything becomes routine.

Hah don't let my cynicism derail you. What radiologists do on a daily basis is pretty cool when you stop to think about it. But there are gonna be days when its just "get through the list" and you want things to be less interesting rather than the other way around. If I get a few cases where i need to take 10-15min extra and consult some colleagues, that's great. If i get 20 of those, it's a pretty bad day.

Inspite of the calls I still felt radiology was relatively peaceful compared the other specialties where you can focus on your work and pretty much forget everything else.

At base, you are correct. Radiologists do spend more time doing radiology than other specialties spend doing theirs. In most places these days, you will not lack cases to read and could probably sit and read cases for 8hr straight provided you didn't need to pee or eat.

That being said, it's often a nice break to do a minor procedure or talk to referring clinician about an interesting case. And we do very little mindless paperwork.

The 2 am thing is a shocker. I always thought they had no nights and overnight telerads covered that after residency

It really depends on what type of group/practice you join, PP/VA/academics/etc... Even academics attendings where I trained had pager call where they could be called to review a case in the middle of the night, or come in and do a procedure if the call resident wasn't comfortable with it.

VA jobs are commonly 8a-5p M-Fr with no evenings/overnights/weekends. There are definitely outpatient tele gigs with a similar schedule. Mammo gigs can be mammo-only (no general work) during weekday business hours too.

My group (a large subspecialized group with both inpatient and outpatient presences) covers our evening and overnight shifts internally. We send very little out to telerads. I'd suspect alot of PP groups cover some amount of their evenings/overnights/weekends internally.

 

[Tiger100]

If you have practiced radiology for more than 5 years and with the exception of 2-3 cases per day, you find the cases challenging there is something wrong. The most challenging task in the world becomes Mundane after doing it more than 200 times.

 

[Matthew9Thirtyfive]

I've seen a few good lectures over the years from older rads that have talked about and contextualized the radiologists role in healthcare and how the appreciation for the field has gone down as it's been commoditized. In particular Paul Chang at UChicago has a great talk and anecdote about old school radiology and how the PACS ruined the hallowed role radiology used to have.

People used to queue up outside the radiology department to go over cases and time their morning rounds to involve a stop in the radiology dept.

Now radiology ordering is just a click on a screen and the reports and/or images can be pulled up on your phone in seconds, completely dehumanizing the radiologist involved. Current generation trainees basically have no context about radiology workflow and how a bill becomes a law/how an order becomes a report.

Though, its probably not any worse than PCP's dealing with patients thinking WebMD is as good or better than a real doctor.

We actually did radiology rounds where I rotated for peds during my inpatient weeks. Almost every day, we went down to radiology to discuss one or two of the cases. It was very educational.