Nuclear Medicine

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Hi All:

It's nice to see a sub forum dedicated to nuclear medicine. I am a nuclear medicine physician, and would be happy to answer questions regarding this field.

Originally Posted by Imhotep

Hi All:

It's nice to see a sub forum dedicated to nuclear medicine. I am a nuclear medicine physician, and would be happy to answer questions regarding this field.

Two quick questions: How much money are you making? Why isn't nuclear medicine a popular career choice?

Salaries in private practice are quite nice....avg starting salary the past couple of years has been around 200k.

Reason for # 2 is lack of knowledge about the field.....a significant number of medical students seem to think that one needs to be a radiologist to do nuc med. Also, there are relatively few pure nucs people out there, so that perpetuates all sorts of misinformation ( e.g. from people who "know" someone who is a nuc med physician, or from those who have "heard" of this and that), several examples of which may be found on previous postings......

Dear IMHOTEP
thanks for writing!
My question is there enough scope for research in Nuc med?
people who do only nuc med residency(& not radiology) Do they get a fellowship easily?
I've heard from friends that NUc med fellowships are preferrably given to rads residents & not nuc med, is that TRUE?
Also, after fellowship are there decent jobs if one wants to work as a a faculty in any university?

Nuclear medicine fellowships are only available to those who have completed a diagnostic radiology residency. For those with pure nuc background, there are PET/CT fellowships. Currently there are about 15-20 programs offering these.

There are usually plenty of research opportunities during nuclear medicine residency. It is only limited by your level of interest (or lack thereof).

The job market for nucs in the past two years or so has been quite good. This is due to several factors. First, many of the older nucs people are retiring. Secodly, due to increasing clinical utilization of PET/CT, there is a need for adequately trained people. Thirdly, several larger radiology groups are beginning to hire pure nucs people due to a) advent of nighthawk and thus elimination of night call and b) Decreasing level of interest ( and training ) in nuclear medicine among recently graduating radiology residents. Recently, the required rotations in nuc med for rads residents have been decreased from 6 months to 4.

Imhotep - What do you think the future of the field is down the road? A noted individual told me that nucs is in its infancy and it can either go bust or reach for the stars. Your thoughts?

GuP

Your guess is as good as mine.

What's a day in the life of a nuclear med physician? How is it different from a radiologist? What are the pathways to Nuclear? What made you choose the field?

Thanks!

Day in life of a nuc med person: In private practice, there is usually higer volume work, its all about cranking out the studies, with the occasional lymphoscintigraphy and radioimmunotherapy. In academics, people get protected research time, some clinical work, and plenty (too many) meetings/conferences etc. In general, the hours mirror those of radiologists. Call is not as busy, again depending on where you are.

Pathways:
1. Diagnostic radiology + 1 year of nuc med fellowship.
2. Residency training in IM/FP/Path/Peds etc etc etc + 2 years of nuc med.
3. Prelim year/TY etc + 2 years of nuc med.

Please note however, that starting 2007, nuc med will change to a 1+ 3 residency. i.e. One year of prelim/TY/any other clinical year PLUS 3 years of nuc med. This is so that the residents have more formal training in cross sectional imaging such as MR/CT. However, if you are board certified in another specialty, you will only need 2 additional years or training. And if you are radiology trained, you will only need an additional year.

I got involved in "molecular imaging" research several years ago, and it kind of lead to nucear medicine. I am very happy with my decision.

Cool.

When you say high volume work in the above post - is that like reading films like radiologists? Does a nuc med doc read films just like a rads guy? Or is there anything different?

What is compensation like in the private and academic sector? Is it easier to get into a rads residency after a nuc med residency?

I guess you could call it reading "films". Bread and butter nuc med scans include myocardial perfusion studies, bone scans, Hepatobiliary, V/Q, MAG3 renal, thyroid, leukocyte, and PET/CT scans. Depending on where you practice, it may also include lymphoscintigraphy and treating thyroid cancer and lymphoma patients, along with palliative treatment for painful bone metastases from terminal cancer.

Salaries in private practice are higher, and the average private practice nuc med doc makes more than most of the primary care physicians.

I would recommend against going into nuc med solely for the purpose of getting into radiology. While it is possible to do research and make great contacts during nuc med residency, as well as the possibility of getting upto one year of credit in rads for prior nuc med training, there are complex issues such as medicare only paying for one residency which should be kept in mind.

I encourage people to go into this field if they truly like it. Contrary to what others (who are not in this field, and rely on second or third hand info) may say, there ARE jobs in this field.

thanks Dear IMHOTEP! You have been really helpful! keep posting me more!!

The scans you mentioned above - can a radiologist read them after 5 years of training? Just curious b/c if they can then it would make it sort of a turf war.

Do nuc guys do interventional procedures? I see you mentioned treating cancer and palliative treatment - can you expand a little? Is this in the same arena as rad onc guys or something totally different?

You're welcome, Fedupme.

GuP: Radiologists can indeed read these scans. I don't really see it as a turf issue. You've got to remember that each year, only 50-60 pure nucs people graduate from residency. There are not nearly enough nuclear physicians around to read the ever increasing number of scans. I believe in increasing cooperation with diagnostic radiologists to fight off other specialties who are encroaching on imaging. i.e. Cards, neuro etc.

Nuc med physicians DO NOT perform interventional procedures. The above mentioned examples consist of treating these conditions with radioactive substances, which are given either in oral or IV form.

I really appreciate your input. Thank you for your time.

Can you speculate a range of salary for nuc physicians?

Originally Posted by Imhotep

Nuc med physicians DO NOT perform interventional procedures. The above mentioned examples consist of treating these conditions with radioactive substances, which are given either in oral or IV form.

The most invasive most nucs docs get is injecting some filtered sulfur colloid for lymphoscintigraphy with a 25ga needle.

There is one area where nucs docs at times become part of interventional procedures. And that is the administration of Ytrium microspheres for the treatment of HCC or liver mets (Therasphere or SirSpheres). The catheter is usually placed by a interventional radiologist. The person who pushes the button on the administration device has to be an 'authorized user' (by the nuclear regulatory commission) for Ytrium. Often, nucs and rad-onc docs have the required materials licenses already and become involved at the planning stage as well as the actual administration.

Originally Posted by GuP

The scans you mentioned above - can a radiologist read them after 5 years of training? Just curious b/c if they can then it would make it sort of a turf war.

Most radiologists will be comfortable interpreting the bread and butter studies like cardiac, ventilation/perfusion, hepatobiliary, thyroids, bones and PET-CT.

The area of treatment with open radionucleides (e.g. thyroid, lymphoma, bone mets) tends to be in the hand of people who have additional training (NM fellowship trained rads or nucs-only types). Also, there are lots of obscure tests that are rather infrequently done and you will often have only one or two centers per state who routinely do them.

GuP:

The academic salaries are around/slightly higher than what primary care physicians make. In private practice, there is an extraordinary amount of variability, but as I mentioned before, they are almost always significantly higher than those of primary care docs.

On the ABNM website, their rerequirements for board cert make it sound like you need to complete IM residency, not just a prelim/TY... Am I reading it wrong, or are you eligible for Nuc med after a prelim?

http://abnm.snm.org/index.cfm?PageID=5044&RPID=5043

E

Sorry, already been addressed. Must have missed in the thousands of posts in this sub forum

What is the difference between Nuclear Medicine and Nuclear Radiology?

Is the typical path a residency in Radiology, and then a fellowship in Nuclear Medicine? Are there multiple paths to get to the specialty?

Thanks!

Originally Posted by Asher2011

What is the difference between Nuclear Medicine and Nuclear Radiology?

One is only trained in nucmed (often after a internal medicine or FP internship/residency), the other is a radiologist with additional training in nuclear medicine (beyond the 4-6 months during a regular radiology residency).

Are there multiple paths to get to the specialty?

Yes.

Both do pretty much the same, the work environment might however be different.

'Nuclear radiologists' tend to be part of private practice radiology groups, and in addition to the nucmed work they often fulfill other roles such as general radiologist, mammographer or peds-rads for the rest of the day.

Nucmeds more commonly work in academic departments or large radiology groups (rarely in independed nucmed groups) and do strictly nucs.

does anyone know if it will be an advantage to transfer
to rads from nucs now with internship plus 3 years rather
than 2, because of more residency funding carrying or is
that not a factor? Thanks, foxy

Originally Posted by foxymd

does anyone know if it will be an advantage to transfer
to rads from nucs now with internship plus 3 years rather
than 2, because of more residency funding carrying or is
that not a factor? Thanks, foxy

It's not the funding that is between you and your rads spot. It's the three disgruntled surgery residents with 250s usmle scores standing in line right in front of you.

If you decide to pursue nuc med from the 1+3 where you do 1 year transitional/med prelim/path, etc...is there any best option among these? I am interested in path, but am curious that perhaps I might also be interested in nuc med. If after a year of path I decide that maybe nuc med is for me, I'm just hoping that it won't be so difficult a road that perhaps I should have just done a transitional or IM prelim year instead.

Thanks!

hi!imhotep,
can u tell me about Brain SPECT and PET scan used for prognosis in cochlear implants pateints.

I have been thoroughyl impressed with the aid of our locate nuclear medicine physician. I just wanted to send a big thanks to you for this post and your continued work on these boards.

Merry X mas to you and all the readers here.

Osteo

hi imhotep.....

i am an IMG from india......i have completed my three yr NM residency from india this summer......further i want to specialize in US......

i have fairly good scores 99,95,88.....some research exp, awards, abstracts and publications.....

I applied for residency last yr, both for prelim and NM.....but was in a catch 22 situation.....cud not get many prelim calls and NM guys answered me saying that i need to be doing or completed internship for consideration.....so cud not get in last yr....

this yr i have applied again......but, now i have concentrated mainly on categorical IM coz of last years bitter experience with prelim spots......but, my passion is only in doing NM.....what is your advice on doin NM after IM...is it worth it.....or do i think of doing only NM.....

what r the options of doing fellowship in PET/CT directly with my previous exp......what r my chances....what r the prospects after fellowship without NM board certification?...when do i need to apply for it....

I have some offers on J1 visa......so, I would like to know of the probability of getting J1 waiver jobs in NM field....can i go for it or push for H1 visa.....

thanks for your replies and heartening to know a active NM forum......

I would say, land a spot in categorical medicine and scramle into Nucs somewhere after your first year.

Hi..
I was interested in applying to a NMT program. I am going to shadow a Nuclear Med physician at a local hospital and was wondering what kind of questions I should ask. Thanks alot.

hi i wanted to know if my 2 yr work experience(i.e diploma course) in nuc med in india is goin to help me choose it as a career option out there. and if yes how??? and how difficult is it for a fmg to pursue it there...zaq

Originally Posted by bvijaybabu

I have some offers on J1 visa......so, I would like to know of the probability of getting J1 waiver jobs in NM field....can i go for it or push for H1 visa.....

thanks for your replies and heartening to know a active NM forum......

I think the J1 visa is for training and you would have to go back to your home country after training for a minimum of 2 years before you could come back to the US.

As far as H1b, pure nucs is few and far between in private practice. That pushes most Nuc med grads into academics, so there is plenty of supply for relatively few academic jobs. Long story short-- I think it would be tough to secure an H1b visa for nukes.

hi bvijaybabu....glad to know theres an indian out here in this forum... i wanted to know the scope and prospects of nuc med in india and abroad if u hv got some info abt how to go ahead with it....

There are a lot of specialties out there. I'm currently shopping around.

I'm generally familiar with what a nuclear medicine physician does, but I want to know something no textbook could ever tell me: Why is it so awesome? I don't really care about money - if you have an M.D. and you are good at what you do, you will be loaded. What I want to know is how your choice of specialty contributes to your life. In your own words, what, if anything, makes you get up in the morning and think to yourself, "Hot damn, I really want to go do some nuclear medicine?"

Is the actual performance of the procedures invigorating? Is there an exceptional amount of intellectual stimulation you get from your chosen field?

For example, right now I am a biochemistry student. The reason I am a biochemistry student is because I get giddy from reading chemistry textbooks. When I read up on DNA and metabolic pathways and the like, I just think how ridiculously cool it is that such things were experimentally determined and are now being put to good use.

Do you get a similar invigoration from nuclear medicine?

Also, what sorts of research opportunities do you have? Are you in a position that affords you the opportunity to actively and creatively expand your field?

Furthermore, because of the machinery and substances required to perform nuclear medicine, it seems that nuclear medicine would require more in the way of equipment than most other fields, leading me to wonder if that might not affect and possibly limit your freedom of location. Is that true, or is my intuition mistaken?

in the surrent format, is nuc med an option after one year of pathology residency?
thanks.

I'm interested in NM and, I was wondering if you know any thing about St louis university program?

Hello out there my fellow colleagues. I wish to post this up on this forum as a gentle guide to anyone who is considering the Nuclear Medicine route. I had a very extreme circumstance that for me worked out well but in the meanwhile created an incredible level of stress for me, my family, and close friends. As we all know, Nuclear Medicine is a field not very well characterized by the medical resident community. There is no match and it is never really talked about much during medical school. I completed my intern year in Internal Medicine and did this training at a community hospital with a university affiliation. Wishing to increase my chances for obtaining a competitive fellowship, a university hospital would be the best way to go. After calling several GME offices, my alma mater institution called me back saying they only had a PGY-2 level opening but it was in Nuclear Medicine. After having an extensive discussion with the PD about my career goals I was told that if I came to his program that I would be able to double board certify in IM/NM and pointed to the ABIM website that outlined how this was done. I came to the program thinking that NM was the "admission ticket" to a big well recognized university hospital.

When I got there my schedule did not reflect our agreement and the director began to "promote" the 3-year version of the program. I told the director that this was not our original agreement. I then found out that the chair of Medicine had never even heard of my name. So what this program director did was lie to me and pulled a "bait and switch". His interest was to get a resident for 3 years and did this without any regard for what my professional aspirations. I was stuck in a field I knew nothing about and this person had essentially divorced me from my speciality. By the 2nd week he actually told me verbatim "Well it looks like you're kinda screwed then!" and told me he would not be a positive reference for me if I was to look for another program.

During July of 2007 by that second week I started using up almost every single morning to look for and call for senior Internal Medicine spots and would spend my nights and free time at the fax machine at Kinkos sending my CV, USMLE's, certificate of completion/passing of my PGY-1 Internal Medicine year, etc. My prior program director was absolutely shocked that I was lied to. I had finally landed a senior position at a very nice Internal Medicine program out in the east coast with a very presitigous university affiliation, a definite upgrade. The only catch was that this program was to start the following summer. I figured I may as well learn something and spend the rest of the year in Nuclear Medicine, and in fact now I really WOULD be able to double board should I decide to. (The training requirement now would only be 2 years since by the time I would decide to go back to NM, I would be board certified/elligible in IM).

Sounds like a wonderful way to resolve the situation, right? Wrong! When the program director found out I had signed a contract for July of 2008 in IM, he threatened to terminate me from the program! I was never put on probation and had no disciplinary actions ever taken on me. My only "sin" was missing several morning conferences during the first 2 weeks of July in order to search for an IM position. Since the director had no basis to terminate me this was not a viable option for him. However, the several months that proceeded were absolute hell. He began harassing me..keeping me late past hours to verbally attack/abuse me and would not mentor me on anything. It all became ego and mind games. Talk about a harsh work environment! He also told me not to record or document any of the studies I would do such as Nuclear Cardiology, thyroid therapies, and lymphoscintigraphies.

By mid-year I had decided to resign. The hospital even offered me a severence package which I had to turn down since he was not willing to sign that we BOTH could not bad mouth each other. What does this mean? He wanted a restriction that he could bad mouth me but that I could not defend myself. He had full plans to contact my new director to make life difficult for me. My file when I left was stuffed full of lies, exaggerations, and spin-doctoring. He essentially tried to destroy my medical career because I didn't go along with his lies. I denied this package and when I applied for a few months of unemployment benefits the department went out of there way to get me denied for that.

So where am I now? I'm a senior IM resident and am having an amazing time. My evaluations and clinical performance are very high and in the "excellent" category. When I was team leader for the wards and did it well I honestly felt joy to the point of tears. I am doing what resonates perfectly with my heart and soul I have my self respect back and I am around a completely different calibar of people who are in medicine for the right reasons. Life has continued and I am happy that I was able to get out of the clutches of this horrible angry person.

What is happening with this gentleman? The ACGME knows everything that happened and the program is under investigation for several counts of professional misconduct.

Nuclear Medicine honestly....is an extremely interesting field and is best done when conducted with people who are kind and progressive and are attentive to the core principles of what being a physician really means. Honestly, integrity, colleagiality, and a commitment to lifelong learning and healing towards others it the real reason we all entered the field of medicine regardless of the subspecialty. I wish not to even mention which program this is and who the director was...badmouthing has no role here.

The story however holds a great deal of value and I wish that any of you who want to pursue this field to make sure to know who and what you are getting involved with. It would break my heart to think this would happen to anyone else.

My suggestion to you all is get a primary care speciality done FIRST. This way you are are more marketable, have definite job security, shorten your training time by an entire year, and have something to fall back on which would prevent a situation like this from ever occurring. It would even make you improved at Nuclear Medicine as you would know and appreciate the full clinical context of the imaging modality.

Best of luck to all of you and g-d bless.

Hello out there my fellow colleagues. I wish to post this up on this forum as a gentle guide to anyone who is considering the Nuclear Medicine route. I had a very extreme circumstance that for me worked out well but in the meanwhile created an incredible level of stress for me, my family, and close friends. As we all know, Nuclear Medicine is a field not very well characterized by the medical resident community. There is no match and it is never really talked about much during medical school. I completed my intern year in Internal Medicine and did this training at a community hospital with a university affiliation. Wishing to increase my chances for obtaining a competitive fellowship, a university hospital would be the best way to go. After calling several GME offices, my alma mater institution called me back saying they only had a PGY-2 level opening but it was in Nuclear Medicine. After having an extensive discussion with the PD about my career goals I was told that if I came to his program that I would be able to double board certify in IM/NM and pointed to the ABIM website that outlined how this was done. I came to the program thinking that NM was the "admission ticket" to a big well recognized university hospital.

When I got there my schedule did not reflect our agreement and the director began to "promote" the 3-year version of the program. I told the director that this was not our original agreement. I then found out that the chair of Medicine had never even heard of my name. So what this program director did was lie to me and pulled a "bait and switch". His interest was to get a resident for 3 years and did this without any regard for what my professional aspirations. I was stuck in a field I knew nothing about and this person had essentially divorced me from my speciality. By the 2nd week he actually told me verbatim "Well it looks like you're kinda screwed then!" and told me he would not be a positive reference for me if I was to look for another program.

During July of 2007 by that second week I started using up almost every single morning to look for and call for senior Internal Medicine spots and would spend my nights and free time at the fax machine at Kinkos sending my CV, USMLE's, certificate of completion/passing of my PGY-1 Internal Medicine year, etc. My prior program director was absolutely shocked that I was lied to. I had finally landed a senior position at a very nice Internal Medicine program out in the east coast with a very presitigous university affiliation, a definite upgrade. The only catch was that this program was to start the following summer. I figured I may as well learn something and spend the rest of the year in Nuclear Medicine, and in fact now I really WOULD be able to double board should I decide to. (The training requirement now would only be 2 years since by the time I would decide to go back to NM, I would be board certified/elligible in IM).

Sounds like a wonderful way to resolve the situation, right? Wrong! When the program director found out I had signed a contract for July of 2008 in IM, he threatened to terminate me from the program! I was never put on probation and had no disciplinary actions ever taken on me. My only "sin" was missing several morning conferences during the first 2 weeks of July in order to search for an IM position. Since the director had no basis to terminate me this was not a viable option for him. However, the several months that proceeded were absolute hell. He began harassing me..keeping me late past hours to verbally attack/abuse me and would not mentor me on anything. It all became ego and mind games. Talk about a harsh work environment! He also told me not to record or document any of the studies I would do such as Nuclear Cardiology, thyroid therapies, and lymphoscintigraphies.

By mid-year I had decided to resign. The hospital even offered me a severence package which I had to turn down since he was not willing to sign that we BOTH could not bad mouth each other. What does this mean? He wanted a restriction that he could bad mouth me but that I could not defend myself. He had full plans to contact my new director to make life difficult for me. My file when I left was stuffed full of lies, exaggerations, and spin-doctoring. He essentially tried to destroy my medical career because I didn't go along with his lies. I denied this package and when I applied for a few months of unemployment benefits the department went out of there way to get me denied for that.

So where am I now? I'm a senior IM resident and am having an amazing time. My evaluations and clinical performance are very high and in the "excellent" category. When I was team leader for the wards and did it well I honestly felt joy to the point of tears. I am doing what resonates perfectly with my heart and soul I have my self respect back and I am around a completely different calibar of people who are in medicine for the right reasons. Life has continued and I am happy that I was able to get out of the clutches of this horrible angry person.

What is happening with this gentleman? The ACGME knows everything that happened and the program is under investigation for several counts of professional misconduct.

Nuclear Medicine honestly....is an extremely interesting field and is best done when conducted with people who are kind and progressive and are attentive to the core principles of what being a physician really means. Honestly, integrity, colleagiality, and a commitment to lifelong learning and healing towards others it the real reason we all entered the field of medicine regardless of the subspecialty. I wish not to even mention which program this is and who the director was...badmouthing has no role here.

The story however holds a great deal of value and I wish that any of you who want to pursue this field to make sure to know who and what you are getting involved with. It would break my heart to think this would happen to anyone else.

My suggestion to you all is get a primary care specialty done FIRST. This way you are are more marketable, have definite job security, shorten your training time by an entire year, and have something to fall back on which would prevent a situation like this from ever occurring. It would even make you improved at Nuclear Medicine as you would know and appreciate the full clinical context of the imaging modality.

Best of luck to all of you and g-d bless.

I am happy that everything has turned out well for you. But I want to suggest you change the title of the post as it implies that you are discrediting NM as a specialty. I am sure most of your angst is directed at the unfair treatment that you had to deal with at that certain residency.
I am in a similar position as you were in. I will be completing my Pediatrics residency in June 2009 and I am looking for a NM position. I have applied an received some interviews from the so called "top schools". After reading your story, I am apprehensive. My eventual goals are to pursue a pediatric cardiology fellowship then specialize in cardiac imaging. It seems like being a resident/fellow would never end for me. Since there are so few programs offering NM , it will be more than likely that I may run into the PD that you mentioned. If you don't mind , can you mention the name of the hospital/university so that it would save a lot of innocent people from the wrath of a dishonest,conniving and conspiring PD.
Also while you wre a NM resident did you find out about the job prospects after NM residency. I heard bad things aboout the job scenario. Wgat do you make of it?

Rick.

Originally Posted by Imhotep

Hi All:

It's nice to see a sub forum dedicated to nuclear medicine. I am a nuclear medicine physician, and would be happy to answer questions regarding this field.

lol i have a few questions..

1. What is the distinction between Nuclear Medicine and the fields of Radiation Oncology and Radiology?

2. Are there rotations in this specialty?

3. Is this one of the specialties that would be an 'uphill climb' for a DO?

4. Would an MD/PhD be a good route to this field (the PhD being in either Medical Physics, Nuclear Engineering, Health Physics, or Physics)

Thanks!

I am nuclear medicine residency in thailand.
I have to rotate in radiology and radiotherapy in first year.
and next 2 year I will stay in nuclear medicine only.
There is not much work load for every nuc docs here.
But I think it will much improve in future....

Don't be fools, guys. Let me say this once and let it sink in:

ABNM stands for American Board of No Marketability

Originally Posted by Hedgeman

Don't be fools, guys. Let me say this once and let it sink in:

ABNM stands for American Board of No Marketability

Actually you said it 17 times. Troll? Bot?