Switching from IR residency into DR internally?

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Perpetually

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What have you all heard about the possibility of switching into DR if we decide a few years in to jump ship from the IR residency? This is certainly nobody's intention from the start, but things change...

I imagine it might be awkward at programs that only interviewed you for IR and not DR.

Thanks for sharing your perspective.

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At a few places (NYU comes to mind) they were OK with people transferring from IR to DR. However, I've heard that since IR is its own residency, you have to resign your residency with NRMP. I don't know if that constitutes a match violation and/or if there are any consequences.

I have one IR-only interview at a place where I applied DR and IR/DR. I initially thought it strange, but then I read that they don't have ESIR. If I matched there for DR, I would've had to do the independent residency for IR.
 
You may already know this, but just in case ...

Whether or not a program has ESIR, you still have to apply to an independent residency for IR. If a DR program has ESIR it just means that if you do the ESIR curriculum, then you'll get 1 year credit at wherever you end up for your 2-year independent residency. Doing ESIR doesn't guarantee you a career in IR. You still have to apply for and get accepted into an independent IR residency.

I have one IR-only interview at a place where I applied DR and IR/DR. I initially thought it strange, but then I read that they don't have ESIR. If I matched there for DR, I would've had to do the independent residency for IR.
 
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I'm sure it's possible, but you have to hope that someone from the DR program wants to do IR. Or that someone from the DR program quits to do another specialty.

Switching from IR to DR is like switching from general surgery to anesthesiology. Nobody can force you to finish your general surgery residency. But you can't just squeeze yourself into the anesthesiology residency at your hospital. There has to be a vacancy/opening.


What have you all heard about the possibility of switching into DR if we decide a few years in to jump ship from the IR residency? This is certainly nobody's intention from the start, but things change...
 
From my impression on the interview trail, it would be pretty easy to switch from IR/DR into a DR program if you change your mind. DR can expand to take a fourth year (you have passed the CORE and you can take independent call). In fact, I'm sure they would welcome it because it would mean less DR call for the other residents and more DR services will be covered by a senior.

I imagine going from DR to IR/DR integrated would be much tougher because of space limitations within IR training.
 
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This is incorrect. You can't just add a residency spot in DR (or any specialty for that matter). It has nothing to do with taking call.

Each residency program is approved by the government (ACGME) to train X number of residents. That number is based on several factors, like facilities, case volume, etc. A program is not allowed to increase that number on a whim. They would have to apply to expand their residency program, and I don't think that's something that can be done easily.

Just call up any of the programs you've applied to and ask them for yourself.

(Also passing the core has nothing to do with taking independent call. Even R2 residents can take independent call and they haven't even taken the core exam, let alone passed it.)


From my impression on the interview trail, it would be pretty easy to switch from IR/DR into a DR program if you change your mind. DR can expand to take a fourth year (which means you have passed the CORE and can take independent call) for one year. In fact, I'm sure they would welcome it because it would mean less DR call for the other residents.

I imagine going from DR to IR/DR integrated would be much tougher because of space limitations within IR training.
 
My apologies, I didn't mean to suggest that passing the CORE was required to take independent call. I meant that passing the CORE signifies that your interpretations are more informed, and therefore, more valuable to a DR program seeking senior coverage.

Switching was discussed by the PD at Dartmouth when I interviewed there. It appeared that she was very open to the idea of switching into DR after starting an IR/DR program. I do defer to your experience on the matter and what you mentioned above does make a lot of sense.

However, it does seem the content of fourth year in DR is very program dependent except a few mandatory requirements. BWH, for example, has options for residents to spend the majority of fourth year (6+ months) doing research or humanitarian efforts. Some Dartmouth residents were able to dedicate the majority of their fourth year learning informatics and getting second degrees (MBAs, certificates in health policy).

Given that, it would seem that switching from IR/DR to DR should not be as hard as say switching from surgery to anesthesiology. Your 3 DR years are secured in the IR/DR program and are identical to the DR residents. You'll essentially only be petitioning ACGME to complete fourth year as a DR resident.
 
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This is incorrect. You can't just add a residency spot in DR (or any specialty for that matter). It has nothing to do with taking call.

Each residency program is approved by the government (ACGME) to train X number of residents. That number is based on several factors, like facilities, case volume, etc. A program is not allowed to increase that number on a whim. They would have to apply to expand their residency program, and I don't think that's something that can be done easily.

Just call up any of the programs you've applied to and ask them for yourself.

(Also passing the core has nothing to do with taking independent call. Even R2 residents can take independent call and they haven't even taken the core exam, let alone passed it.)
Fab - in your discussions with your PD friends, what do you think the availability of 1 year residencies for current PGY2s (who did not have the option of applying to a residency back when we applied) that are doing ESIR? I know no one has applied to establish these residencies yet so it's thoeretical, but just curious.
 
I agree with what's already been said that on the interview trail this year, most PDs seem to think there will be quite a bit of switching back and forth, and that they will do what they need to try to make it happen. I would never bank on it, but I imagine if you match into IR, you would have a decent chance to go back to DR at most institutions.

Also, maybe I'm being naive, but I wouldn't listen to the doom and gloom of having a really tough road to get to IR if going the ESIR/Independent route. Just about any radiology resident who wants to do IR gets to a fellowship nowadays. If switching does happen within residencies internally, then everything will work out and the multiple paths will keep pumping out at least the same number of IRs a year as normal. The overall number of spots for IR is not decreasing, but will only increase. What might be harder is finding a program in your preferred area, since programs will be taking less independent residents compared to the traditional fellowships. I think if the average hard-working radiology resident wants to do IR, he/she will have at least just as much of a chance as before.
 
Good question. I know some of the senior residents will still have the option of doing the traditional fellowship. I have not heard anything about how more junior residents will navigate the new system.

Fab - in your discussions with your PD friends, what do you think the availability of 1 year residencies for current PGY2s (who did not have the option of applying to a residency back when we applied) that are doing ESIR? I know no one has applied to establish these residencies yet so it's thoeretical, but just curious.



I don't know if I'd call it "doom and gloom" to get into IR via the independent route. But I do think it will be a little tougher and, at the very least, have more uncertainty than going the integrated route. If you're 100% committed to IR, there's no reason not to do IR/DR. If you're on the fence, I'd do DR.

Also, the number of IR spots -- by my guess -- will actually decrease. If a program needed 4 fellows to run the service before, they now only need 2 IR/DR residency spots because each resident stays in IR for 2 years.
 
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I disagree that the number of residents will decrease. True, you are in IR for 2 years, but they also have to staff IR residents out to ICU, Vascular, Transplant services, and many places finish nucs and mamm requirement in the R4 year. So yes, they will have 'twice' as many residents in the IR program, but will not have twice as many on the IR service. Once I get back to my interview notes I'll post some numbers for specific programs about total number of graduates per year.


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I think that would be very helpful to share, and I'd be curious myself to see the results from specific programs.

You make a good point about rotating in other services like ICU, vascular, etc. But I don't think (and I could be wrong) that you're spending a full year on those other services. It might just be a few months total. In which case, maybe you're going from 4 fellows to 3 IR/DR residents (6 total; 3 PGY5 and 3 PGY6 residents). So I would think that the total number of people accepted into IR each year would still decrease.

Check out this PDF from Northwestern that was presented at a meeting (it's dated 2015):
http://www.scardweb.org/uploadedFiles/Home/Meetings/2015/Russell-IR Large Program Northwestern.pdf
If you look at the last slide it says:

End result still results in cut in half of the number of IR trainees graduating each year in half, from 8 to4.
- This is a national problem with ramifications not fully addressed, regarding manpower needs in IR well into the future.
- Chairs must consider strategies to develop support for new or expanded independent programs through funding requests.


It sounds to me like this PD is worried there is going to be a decline in IR trainees graduating and he's making the argument that in order to balance it out, programs need to add independent programs.

Doesn't sound like an increase to me -- at least in the short term.


I disagree that the number of residents will decrease. True, you are in IR for 2 years, but they also have to staff IR residents out to ICU, Vascular, Transplant services, and many places finish nucs and mamm requirement in the R4 year. So yes, they will have 'twice' as many residents in the IR program, but will not have twice as many on the IR service. Once I get back to my interview notes I'll post some numbers for specific programs about total number of graduates per year.


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On my Upenn interview, one of the IR attendings told me they were reserving 4 ESIR positions for their DR people and would take them into the Independent residency. He also mentioned they want 1-2 from outside institutions through the independent residency. They are taking 2 in the integrated match I believe. This adds up to 7-8 IR positions graduating every year, and they are currently putting out 8 fellows a year if I remember correctly.

Caviat, my source was not the PD but he seemed to be very involved and knowledgeable with the process.

Caviat #2 There has been no accreditation of any Independent programs nationally. This is on purpose to allow for expediting the integrated and ESIR review process since those programs are filling now as opposed to several years from now. With that said, no one can say with 100% confidence that they know how many independent spots they will have, but I have to think that powerhouse programs like Upenn will be able to support that. They seem to be confident that they have all the numbers required, just a matter of completing the process.


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I didn't interview at Northwestern. Can anyone who did comment on the numbers and say if they are still implementing the program as the above paper details.


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just so you guys know - ESIR does not mean you end up doing IR final year at the same institution. ESIR preps you for a 1 year IR residency instead of 2 years. Some places will have ESIR spots but not all those spots will end up with the last year (ie akin to the fellowship now) at the same program
 
If you do ESIR, you can go to any program that has an independent residency, and whoever will take you. I'm guessing it could be NRMP match for that but haven't heard for sure. This means that you can apply for the independent spots at your home institution, and if they like you, I'm sure you would get it. The only possible downside is if there are more students in your class wanting to do an independent IR residency, than your home institution can take in. Most institutions love to show preference to their own but that can only go so far


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If you do ESIR, you can go to any program that has an independent residency, and whoever will take you. I'm guessing it could be NRMP match for that but haven't heard for sure. This means that you can apply for the independent spots at your home institution, and if they like you, I'm sure you would get it. The only possible downside is if there are more students in your class wanting to do an independent IR residency, than your home institution can take in. Most institutions love to show preference to their own but that can only go so far.

Several institutions I have interviewed at are only seeking the number of ESIR spots that they could eventually take in to an independent residency. Again, the caveat is that there have not been any independent residence is approved, so this is all under the assumption that things move forward as planned.

The flipside of the coin is that ESIR residents may prefer to go elsewhere for the last year, thus sleaving more independent spots open to other residents outside the institution.

Sorry for the editing issues and double post, phone is not working correctly.

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If only there were a way to put off the IR vs DR decision to later. Like some kind of combined residency where both applicants could all be in the same class, and then commit to one or the other after spending time in each field.
 
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