Would you choose radiology again?

[odyssey2]

If any specialty was open to you, regardless of competitiveness, would you still choose rads?

---

Members don't see this ad.

 

[Clean7795]

Yes.

Other specialties don't have the efficient work set-up we do or the established ability to WFH. Rads is also shorter in training length than the only other specialty I had any interest in.

 

[letmebe]

@odyssey2

Pick psych, I think it fits you based on your posts I seen. Just go to the most cush program.

 

[Dr_feelsbadman]

pleasantly surprised by the lack of "I wouldn't go into medicine"

maybe its me entering intern year this week, but many of me and several of my friends have had our doubts. Thanks for the uplifting poll SDN ill see you in 1 year radiology

 

[bronx43]

Medical sub specialist here who wishes daily that I had gone into rads…

 

[qwerty89]

Medical sub specialist here who wishes daily that I had gone into rads…

I thought you were enjoying the Rheum life.

 

[bronx43]

I thought you were enjoying the Rheum life.

It’s all relative, honestly. The hours are amazing (wouldn’t trade it for a call-based specialty) but clinical medicine is more or less glorified customer service. I probably suffer from a bit of grass is greener syndrome but my rads friends all seem more content than us clinicians.

Just when you think clinical medicine is tolerable, you get that patient who acts out in your office, or calls patient experience on you for “dismissive of their concerns” or “didn’t listen to me.”

 

[qxrt]

I would definitely go into IR again. Best field in medicine for me. If we're talking just diagnostic radiology without any IR, I would consider other specialties more strongly. I have no interest in spending 8-10 hours straight reading diagnostics every day, especially not on weekends.

The fact that diagnostic "call" is just a full shift on weekends or holidays on top of a full workweek really kicks it down a notch in terms of desirability in my opinion.

 

[SeisK]

One billion times yes.

We work with the coolest stuff in medicine. We deal with essentially no headaches plaguing modern medical burnout, and we are much closer to appropriate compensation than the vast swaths of the rest of medicine which is horrifically underpaid. We have the most controllable schedule of any specialty, bar none.

 

[voxveritatisetlucis]

I’m curious, do people think there is any risk of radiology going the way of path…ie. large companies like Quest buying all private practices.

Why are rads usually making double or triple a path? Or are the low(ish) salaries in pathology not related to consolidation at all.

 

[2brads]

I’m curious, do people think there is any risk of radiology going the way of path…ie. large companies like Quest buying all private practices.

Why are rads usually making double or triple a path? Or are the low(ish) salaries in pathology not related to consolidation at all.

I don't know all that much about path compensation, but my understanding is that it doesn't scale the way rads does; the volume in path hasn't exploded like rads, there aren't any efficiencies from things like PACS and path consolidation appears to be worse. In rads, there are a lot of "easy" cases that might take only a few minutes. I'm not sure there is a way to reduce the time for a read in path (i.e. a negative case and a complex case take roughly the same time to look at under the scope). I do think that consolidation is the greatest threat to top tier salaries in rads - the entire business model is to skim your billings, after all.

One thing I've always found fascinating about path is how they so readily send off cases they want a second opinion on. How does that work? It's obviously not free, so maybe that is also a drag on their salaries. It's pretty unheard of to send an imaging study to another rad for a formal second opinion. Usually, it's just one rad taking a screenshot and texting it to a buddy (or googling).

 

[guytakingboards]

I’m curious, do people think there is any risk of radiology going the way of path…ie. large companies like Quest buying all private practices.

Why are rads usually making double or triple a path? Or are the low(ish) salaries in pathology not related to consolidation at all.

The consolidation trend is certainly happening in radiology. I doubt it gets anywhere near as bad as pathology though. There are several reasons why it wouldn't happen.

1) The money in pathology was mostly off the value of the labs the groups owned and to a much lesser degree the professional fees. PE does buy capital-heavy radiology groups (i.e. those that own their own imaging centers) but the value/profit off of imaging centers seems much lower than path labs 20 years ago.

2) The supply of radiologists is way more highly constricted than pathology. In path, it's not uncommon to do 2 fellowships because there is so much competition in the market. It's much easier for that field to fall prey to consolidation because there aren't many job options relative to the supply. In radiology, that's exactly the opposite case. The supply is relatively tight, so it's no big deal to find a better job. People in radiology don't *have* to settle for mediocre jobs.

3) To the extent this is true or not I'm not sure but: people in radiology have looked at what happened in pathology/ER and what happened to the early groups that were bought out in radiology and concluded it's just bad business. A lot of the most successful radiology groups 10 years that took a buy-out are now heavily struggling to recruit/retain. Meanwhile the independent groups that weren't bought out now have a significant recruiting advantage in the tight market.

 

[DOFOSHO]

The consolidation trend is certainly happening in radiology. I doubt it gets anywhere near as bad as pathology though. There are several reasons why it wouldn't happen.

1) The money in pathology was mostly off the value of the labs the groups owned and to a much lesser degree the professional fees. PE does buy capital-heavy radiology groups (i.e. those that own their own imaging centers) but the value/profit off of imaging centers seems much lower than path labs 20 years ago.

2) The supply of radiologists is way more highly constricted than pathology. In path, it's not uncommon to do 2 fellowships because there is so much competition in the market. It's much easier for that field to fall prey to consolidation because there aren't many job options relative to the supply. In radiology, that's exactly the opposite case. The supply is relatively tight, so it's no big deal to find a better job. People in radiology don't *have* to settle for mediocre jobs.

3) To the extent this is true or not I'm not sure but: people in radiology have looked at what happened in pathology/ER and what happened to the early groups that were bought out in radiology and concluded it's just bad business. A lot of the most successful radiology groups 10 years that took a buy-out are now heavily struggling to recruit/retain. Meanwhile the independent groups that weren't bought out now have a significant recruiting advantage in the tight market.

what is it about a group that sold out that makes it so difficult to recruit/retain? Is the compensation a lot lower? Is there no camaraderie between partners who received buy package and new "partners" who didn't? Does the private equity group drive the practice into the ground?

 

[2brads]

what is it about a group that sold out that makes it so difficult to recruit/retain? Is the compensation a lot lower? Is there no camaraderie between partners who received buy package and new "partners" who didn't? Does the private equity group drive the practice into the ground?

It's hard for them to recruit because most PE buyouts require a vesting period for the partners. Once that vesting period is over, it is not uncommon to have the partners take their 7-figure buyouts and retire, leaving the new guys holding the bag (lower salaries and higher workloads).

 

[Steve_Zissou]

pleasantly surprised by the lack of "I wouldn't go into medicine"

maybe its me entering intern year this week, but many of me and several of my friends have had our doubts. Thanks for the uplifting poll SDN ill see you in 1 year radiology

Yeah, I’m staring down the barrel of a 1 year IM prelim and am a little concerned. July 1st is gonna be wild. 11 months and 21 days until I start rads.

 

[voxveritatisetlucis]

Does IM actually help for rads or is it just cheap labor?

 

[Gadofosveset]

The clinical year helps more than you realize. You actually understand what the clinicians need on the floors so it allows you to answer pitiful histories and indications since you have a better idea of what the clinical questions actually are. Much less of the “clinically correlate” nonsense. M3 does not get you to that point.

In fact as a rad (esp a subspecialist) the more you can toggle a “clinician mode” on and off, the better you are. I wouldn’t recommend years of working as a clinician — there are diminishing returns — but those who come to rads after a longer clinical experience seem to more accurately cut to the chase, IMO.

I see the difference when I get a chance to work with pathology trainees, who are lovely and intelligent people, but I notice they sometimes have trouble filling in the clinical gaps when questions arise.

 

[guytakingboards]

Does IM actually help for rads or is it just cheap labor?

I'm a big proponent of the intern year but it's excessive for what I find useful.

There's a ton of soft skills of "how to be a doctor" and "how to function in a hospital" environment that I think every rad needs. Some people may have gotten good experiences in those things in medical school. I personally did not. Things like learning to call (and receive) consults, interacting with other services, patient management, navigating the EMR, etc.... As someone who experienced low-volume clinical years, my intern year was also critical for setting the bar of work ethic and effort.

I thought the intern year was very helpful in understanding radiology's role in the practice of medicine. Anyone who's spent any time in clinicals understands that a lot of patient management relies on radiology and has seen how bad/hedgey reports can lead to bad medicine. We've all probably experienced the difficulty of getting IR to squeeze in XYZ procedure so the patient can go home on a Friday afternoon. It gives perspective to when we're on the otherside of the IR consult pager, shaking our heads.

This is all beyond the medical knowledge/procedural skills in medical and surgical prelim years that have their own inherent value.

 

[guytakingboards]

The clinical year helps more than you realize. You actually understand what the clinicians need on the floors so it allows you to answer pitiful histories and indications since you have a better idea of that the clinical questions actually are. Much less of the “clinically correlate” nonsense. Third year of med school does not get you to that point.

I see the difference when I get a chance to work with pathology trainees, who are lovely and intelligent people, but I notice they sometimes have trouble filling in the clinical gaps when questions arise.

There were a lot of alternate pathway fellows (who don't do clinical years stateside) in my residency program. I consistently saw problems with their reports being clinically relevant. It was pretty clear they hadn't had the experience of being on the other side of a crappy report. They also, similarly lacked clinical context to their reports.

EDIT* one of the best radiology lessons I got was to never put "clinical correlation recommended" into a report without saying what the clinician should actually do. I.e. if there are findings suspicious for discitis-osteomyelitis on a CT or non-MR lumbar spine, I'll say something like "suggest clinical correlation with serum WBC and ESR/CRP" or recommend post-contract MR imaging. It really makes you put on your clinician thinking cap and work through what options are available.

 

[Clean7795]

Does IM actually help for rads or is it just cheap labor?

Well the main purpose of most or all internships is definitely cheap labor... but you get out of it what you put in. It's pretty easy to autopilot the whole year away and not really learn anything.

As a resident clinical knowledge is helpful on call. Occasionally when I get a ridiculous request or something that will waste a lot of my time without affecting patient care, I give a hard no. Never had a complaint against me. Some of my colleagues approve these same kind of requests, because they're often unsure if the scan will change clinical management, which forces them to do it. The converse also happens where I see some unnecessary pushback on scans the patient needs.

It also helps with reporting for more complex scans or when there are multiple abnormalities.

 

[Tiger100]

Probably.

The other option that I would strongly consider are the Purely outpatient fields like Derm, Allergy-Immunology, Endo, Rheumato and psych if you have the personality (Ophtho and rad onc are oversaturated and I would avoid them). Being outside the hospital and not having to work evenings, weekends and holidays is awesome especially after a certain age and after you save some money. I still envy my friends who have an 8-5 schedule.

The grass is greener on the other side. Don't get me wrong. Rads is a great field but having to deal with hospital BS and working outside 8-5 gets annoying after a while and results in eventual burnout.

If you want to be happy in the long run, avoid the fields that medical students find attractive e.g. ER, ICU, Trauma surgery, etc.

 

[DoctorMD1]

I don't know all that much about path compensation, but my understanding is that it doesn't scale the way rads does; the volume in path hasn't exploded like rads, there aren't any efficiencies from things like PACS and path consolidation appears to be worse. In rads, there are a lot of "easy" cases that might take only a few minutes. I'm not sure there is a way to reduce the time for a read in path (i.e. a negative case and a complex case take roughly the same time to look at under the scope). I do think that consolidation is the greatest threat to top tier salaries in rads - the entire business model is to skim your billings, after all.

One thing I've always found fascinating about path is how they so readily send off cases they want a second opinion on. How does that work? It's obviously not free, so maybe that is also a drag on their salaries. It's pretty unheard of to send an imaging study to another rad for a formal second opinion. Usually, it's just one rad taking a screenshot and texting it to a buddy (or googling).

I am married to a path. they are doing ok. They bill insurance for a formal second opinion. They usually sent out some rare tumors.

 

[DoctorMD1]

Probably.

The other option that I would strongly consider are the Purely outpatient fields like Derm, Allergy-Immunology, Endo, Rheumato and psych if you have the personality (Ophtho and rad onc are oversaturated and I would avoid them). Being outside the hospital and not having to work evenings, weekends and holidays is awesome especially after a certain age and after you save some money. I still envy my friends who have an 8-5 schedule.

The grass is greener on the other side. Don't get me wrong. Rads is a great field but having to deal with hospital BS and working outside 8-5 gets annoying after a while and results in eventual burnout.

If you want to be happy in the long run, avoid the fields that medical students find attractive e.g. ER, ICU, Trauma surgery, etc.

you can easily find remote day job 8-5.

 

[odyssey2]

you can easily find remote day job 8-5.

In radiology you mean?

 

[DoctorMD1]

In radiology you mean?

Yes!

 

[Tiger100]

Remote 8-5 jobs are not stable jobs.

 

[2brads]

you can easily find remote day job 8-5.

I don’t know about “easy” but they exist. The problem is they will drop you like a hot potato when/if they find someone willing to be in house. When the market swings the other way (and it will), watch out.

 

[odyssey2]

Probably.

The other option that I would strongly consider are the Purely outpatient fields like Derm, Allergy-Immunology, Endo, Rheumato and psych if you have the personality (Ophtho and rad onc are oversaturated and I would avoid them). Being outside the hospital and not having to work evenings, weekends and holidays is awesome especially after a certain age and after you save some money. I still envy my friends who have an 8-5 schedule.

The grass is greener on the other side. Don't get me wrong. Rads is a great field but having to deal with hospital BS and working outside 8-5 gets annoying after a while and results in eventual burnout.

If you want to be happy in the long run, avoid the fields that medical students find attractive e.g. ER, ICU, Trauma surgery, etc.

Why would you probably still choose rads over those fields?

 

[voxveritatisetlucis]

I thought that optho kept a close eye on the number of residency spots so I’m surprised that it is saturated

Probably.

The other option that I would strongly consider are the Purely outpatient fields like Derm, Allergy-Immunology, Endo, Rheumato and psych if you have the personality (Ophtho and rad onc are oversaturated and I would avoid them). Being outside the hospital and not having to work evenings, weekends and holidays is awesome especially after a certain age and after you save some money. I still envy my friends who have an 8-5 schedule.

The grass is greener on the other side. Don't get me wrong. Rads is a great field but having to deal with hospital BS and working outside 8-5 gets annoying after a while and results in eventual burnout.

If you want to be happy in the long run, avoid the fields that medical students find attractive e.g. ER, ICU, Trauma surgery, etc.

 

[SeisK]

When the market swings the other way (and it will)

Given enough time anything will happen that can, but this won’t happen for a while (a decade at earliest). I just don’t see how it could.

 

[2brads]

Given enough time anything will happen that can, but this won’t happen for a while (a decade at earliest). I just don’t see how it could.

A decade? I bet it will be sooner than that. Rads job cycle seems to correlate with overall economy in my experience. Just delayed by a year or so.

 

[SeisK]

A decade? I bet it will be sooner than that. Rads job cycle seems to correlate with overall economy in my experience. Just delayed by a year or so.

Well the reason for that wasn’t falloff of demand for radiologists or imaging services. It was because there was room for radiology practices to tighten the belt when needed as a result of retirement funds disappearing and reimbursements cutting. Demands are so high now and reading paces maxed out that even with the demand OR REIMBURSEMENT fall off brought about by a huge recession, I just don’t see practices being able to tighten the belt to adjust to enough of an extent that the job market approaches anything close to what it was from ‘08-‘14.

 

[2brads]

I think there’s more wiggle room than is apparent now. People said the same thing about rads in the 90s (too much work, reading pace too high, insta partner, etc) and then it fell off a cliff. Radiology isn’t a physically taxing job, so older rads who have, say a 30-40% drop in their retirement savings will strongly consider delaying retirement or going to part time rather than full retirement. There are two in our group right now who could swing either way depending on how the broader economy does. They’d be more than fine either way, but there’s the psychology of retiring into a down market that is hard to overcome.

But we shall see. Start the clock. The receipts are here.