Thoughts on ESIR vs IR/DR for this year's match?

[Zakley]

Hi all,

I'm planning on matching DR next month and am curious about what others think regarding being able to do IR fellowships when I'm finished. I'm not sure if the IR fellowships will actually disappear in 2020 like was laid out in the plan. I'd think the system needs a few more match cycles to work the kinks out. Anyway, at first I was thinking an ESIR program gives me the most flexibility (of fellowships and if I change my mind about IR). But I started to worry that there might not be enough independent spots so a program that has IR/DR seemed safest. What are others thinking?

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[badasshairday]

Hi all,

I'm planning on matching DR next month and am curious about what others think regarding being able to do IR fellowships when I'm finished. I'm not sure if the IR fellowships will actually disappear in 2020 like was laid out in the plan. I'd think the system needs a few more match cycles to work the kinks out. Anyway, at first I was thinking an ESIR program gives me the most flexibility (of fellowships and if I change my mind about IR). But I started to worry that there might not be enough independent spots so a program that has IR/DR seemed safest. What are others thinking?

Tough situation. How does ESIR work in terms of years of training? At first when I saw this thread I thought you were asking about endovascular surgical neuroradiology with that acronym.

 

[Zakley]

I'm sorry, I should have been clearer... Basically, ESIR is a designation one can get during their DR residency that says they did something close to 12 months of "IR related stuff." This entitles the resident to a voucher which lets them do only one year of fellowship rather than the newly instituted (in 2020) 2 years. The issue may be that there won't be enough independent spots for fellowship if all the places that used to have them now only fill internally with their integrated or DR residents.

 

[MNMD123]

This is an interesting dilemma which I could face, too. Tough luck with the timing of our match, and difficult to get enough exposure to IR in medical school to know. I'd also be interested to hear thoughts on whether the independent IR fellowships will actually phase out in 2020. Also, does anyone know of a list of programs that have ESIR as an option?

 

[wheewer]

Same boat here. I will be in the middle of my DR residency when the IR fellowships are phased out. But at the same time the number of integrated IR residency spots right now are incredibly limited. How safe is it to aim for IR but likely end up in DR if my goal is to do IR? I don't want a purely diagnostic career. I heard that even after 2020, IR fellowships will exist but just won't be ACGME approved. Is that a huge red flag or are those programs okay if there is no choice by that point in time?

 

[end of july]

Same boat here. I will be in the middle of my DR residency when the IR fellowships are phased out. But at the same time the number of integrated IR residency spots right now are incredibly limited. How safe is it to aim for IR but likely end up in DR if my goal is to do IR? I don't want a purely diagnostic career. I heard that even after 2020, IR fellowships will exist but just won't be ACGME approved. Is that a huge red flag or are those programs okay if there is no choice by that point in time?

I would get into the best DR program you can and go from there. You may realize that other fields of DR have procedures/clinic etc. without the difficult hours and call of IR. I expect there to be a lot of shuffling around in these next few years. If you end up deciding IR you will have 4 years to build up your resume.

 

[TheRealDrDorian]

I would get into the best DR program you can and go from there. You may realize that other fields of DR have procedures/clinic etc. without the difficult hours and call of IR. I expect there to be a lot of shuffling around in these next few years. If you end up deciding IR you will have 4 years to build up your resume.

I echo this sentiment, however would add that going to a strong DR program with a strong IR program would be the safest bet and open the most doors.

 

[Radz123]

There will likely still be spots mainly because of how long this whole process has been. I'd anticipate a new IR fellowship eventually being offered to DR Residents which will be two years instead of one.

 

[494110]

Not sure if the info is still needed but I'll comment since I have the answer. The current 1 year IR fellowships are supposed to be phased out by 2020. However, those fellowships are being replaced by what is called an 'Independent IR Residency' that is 2 years long and is ACGME approved, it is essentially a 'new and improved' IR fellowship. The Independent IR Residency will be available for all DR graduates. Completing ESIR within a DR program means that the graduate will only need to complete one year of the new Independent IR Residency to be IR board certified instead of 2 years. ESIR will take the same amount of time (6 years post med school) as Integrated IR to become IR board certified without the early commitment. Completing the Independent IR Residency will take a total 7 years post med school). The SIR created these programs to get more people into IR, not less.

TLDR; Not obtaining a spot in an integrated IR program or ESIR DR program will not keep you out of IR. You can still do the new 2 year fellowship (an extra year of training now) after completing a DR program.

 

[TheRealDrDorian]

Not sure if the info is still needed but I'll comment since I have the answer. The current 1 year IR fellowships are supposed to be phased out by 2020. However, those fellowships are being replaced by what is called an 'Independent IR Residency' that is 2 years long and is ACGME approved, it is essentially a 'new and improved' IR fellowship. The Independent IR Residency will be available for all DR graduates. Completing ESIR within a DR program means that the graduate will only need to complete one year of the new Independent IR Residency to be IR board certified instead of 2 years. ESIR will take the same amount of time (6 years post med school) as Integrated IR to become IR board certified without the early commitment. Completing the Independent IR Residency will take a total 7 years post med school). The SIR created these programs to get more people into IR, not less.

TLDR; Not obtaining a spot in an integrated IR program or ESIR DR program will not keep you out of IR. You can still do the new 2 year fellowship (an extra year of training now) after completing a DR program.

Completely agree, and great summary. I will add that most of the med students I mentor I will say:

If you 100% know you want to do IR (which is hard at the med student level; you can still do procedures as a DR): Match in an integrated IR residency with strong DR training (level 1 trauma, transplant, major referral center) or a DR program with ESIR and strong current IR fellowship.

If you are on the fence of IR: Do a DR program with ESIR and strong current fellowship

The Integrated IR Residencies are extremely competitive from what I hear. It is still uncertain how competitive the Independent IR Residencies will be as DR residents start applying for them. ESIR provides the most flexibility.

 

[494110]

Completely agree, and great summary. I will add that most of the med students I mentor I will say:

If you 100% know you want to do IR (which is hard at the med student level; you can still do procedures as a DR): Match in an integrated IR residency with strong DR training (level 1 trauma, transplant, major referral center) or a DR program with ESIR and strong current IR fellowship.

If you are on the fence of IR: Do a DR program with ESIR and strong current fellowship

The Integrated IR Residencies are extremely competitive from what I hear. It is still uncertain how competitive the Independent IR Residencies will be as DR residents start applying for them. ESIR provides the most flexibility.

Definitely agree with this. I'm a very interested M3. I'm more keen on doing DR with ESIR since it offers the most flexibility and would end up being as long as the integrated IR programs. The only downsides I can think of are (1) an ESIR grad may not be guaranteed a spot in the IR fellowship at their DR program and (2) it isn't clear how competitive ESIR positions are at the DR programs.

It seems like most DR programs offer 2-4 spots for ESIR. Any idea how sought after they are? Additionally, if an applicant wanted to go the route of DR with ESIR or DR followed by the 2 year fellowship would you still recommend getting into a strong DR program with a strong IR department (this seems like it is always the goal).

 

[TheRealDrDorian]

Definitely agree with this. I'm a very interested M3. I'm more keen on doing DR with ESIR since it offers the most flexibility and would end up being as long as the integrated IR programs. The only downsides I can think of are (1) an ESIR grad may not be guaranteed a spot in the IR fellowship at their DR program and (2) it isn't clear how competitive ESIR positions are at the DR programs.

It seems like most DR programs offer 2-4 spots for ESIR. Any idea how sought after they are? Additionally, if an applicant wanted to go the route of DR with ESIR or DR followed by the 2 year fellowship would you still recommend getting into a strong DR program with a strong IR department (this seems like it is always the goal).

To your proposed downsides of doing DR with ESIR:
Agree completely with your points. Try to have as many conversations with senior trainees and attendings working to try to get further insight.

To your questions:
(1) I have no idea how sought out the ESIR spots are, but at the same point it's not the end of the world if you really want to do IR. Yes it may be frustrating to do 7 instead of 6 years of training, but in the grand scheme of things if it's truly the field you want to do, that's a small investment.

(2) I can't emphasize enough the importance of DR training in an IR's training. It's hard to gauge as a med student what exactly you need to know in DR, and a large portion of it is management of everything you "see." That is, any mass in any organ that you see, you must be able to recommend further imaging, correlate with physical exam and labs, and know the normal pathogenesis of disease (e.g. pattern of spread of specific cancer). The "procedural" skills are comparatively easier to pick up during later training, in my humble opinion.

Particularly for IR, you really want to be able to see the pre- and post-operative imaging of disease processes IRs deal with regularly. These include pancreaticobiliary disease and portal hypertension (e.g. major referral centers for pancreatic cancer/HCC, cirrhosis, liver transplant) and embolization in trauma patients. These are the same scans you're going to be expected to review when you're on IR.

Hope this helps. Feel free to PM with any specific questions.

 

[494110]

To your proposed downsides of doing DR with ESIR:
Agree completely with your points. Try to have as many conversations with senior trainees and attendings working to try to get further insight.

To your questions:
(1) I have no idea how sought out the ESIR spots are, but at the same point it's not the end of the world if you really want to do IR. Yes it may be frustrating to do 7 instead of 6 years of training, but in the grand scheme of things if it's truly the field you want to do, that's a small investment.

(2) I can't emphasize enough the importance of DR training in an IR's training. It's hard to gauge as a med student what exactly you need to know in DR, and a large portion of it is management of everything you "see." That is, any mass in any organ that you see, you must be able to recommend further imaging, correlate with physical exam and labs, and know the normal pathogenesis of disease (e.g. pattern of spread of specific cancer). The "procedural" skills are comparatively easier to pick up during later training, in my humble opinion.

Particularly for IR, you really want to be able to see the pre- and post-operative imaging of disease processes IRs deal with regularly. These include pancreaticobiliary disease and portal hypertension (e.g. major referral centers for pancreatic cancer/HCC, cirrhosis, liver transplant) and embolization in trauma patients. These are the same scans you're going to be expected to review when you're on IR.

Hope this helps. Feel free to PM with any specific questions.

Thank you so much for the advice! Rads is the most excited I've been about a specialty since starting third year so this has been very helpful.