IR Competitiveness?

[rustymuffin]

I'm an MS2 and I've developed a recent interest in IR. From what I've seen (large academic system), IR has some crazy procedures and lots of tech/innovation going on. I've also heard from residents and attendings that the current job market is on fire and should only continue to increase in the future. All of these things make it a really attractive field to me and I'm trying to figure out if I should go all in on preparing my profile for it. I know it's an insanely competitive match for the integrated program but I read somewhere that the fill rate for the independent fellowships was <50% and I don't understand why it's so radically different. I know the independent path adds an extra year, but if it's such a great career then why is there so little interest from radiology residents? Do they know something about the downsides of IR that isn't obvious to med students?

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[qwerty89]

Do they know something about the downsides of IR that isn't obvious to med students?

Yes.

The IR Hospitalist: Hospital MVP or Glorified Trash Collector? – Line Monkey MD

linemonkeymd.com

It's not a bad job for what it is. But you have to have a realistic picture.

 

[scootad.]

That IR link should be required reading for IR applicants

 

[Kuratz]

For context I am an ESIR resident.

IR is great, I am very happy with my decision to pursue IR. But you have to be realistic with what the typical day of an IR looks like. Even at major tertiary academic centers a high portion of your workday will be "unsexy" procedures like lines, drains, ports and biopsies. Most days are certainly not filled with arterial and complex venous work at most places. If you like the basic stuff then IR is great, but many people paint IR as some wild west place where crazy procedures are being done daily. There is some of that, yes, but not the lions share and certainly not the case out in the community. IF you like being a Radiologist first and foremost and also like procedures then IR is awesome. But if you don't enjoy diagnostic radiology then I would sincerely question this route and consider something like vascular surgery instead.

The reason that the independent IR pathway is much less competitive is because most of the people set on IR have already self-selected into the integrated pathway leaving mostly people who would otherwise be doing DR. The total number of people interested in IR is about the same, however the number of spots in the independent pathway is relatively much higher. Your best bet is to match into a DR program with a strong ESIR pathway and go from there. That leaves the option of doing diagnostic if you find you enjoy it more. Frankly it's hard to sway DR residents because 8-5 lifestyle with no pager call and the opportunity to work from home making good money is very appealing.

 

[rustymuffin]

Thanks for all the feedback guys, really appreciate it. So what I'm hearing is that most IR's won't be able to build a practice solely around the high end procedures? Really disappointing to hear. Another one of the LineMonkey articles used the phrase "image-guided surgeon" which resonated with me a lot. I'm optimistic about the future of endovascular interventions and I'm pretty confident that I want to take my career in that direction. I assumed IR was the specialty driving innovation forward in that area but if not, what other fields would let me focus solely on complex endovascular work?

 

[efle]

I know it's an insanely competitive match for the integrated program but I read somewhere that the fill rate for the independent fellowships was <50% and I don't understand why it's so radically different.

The IR fellowship was never very competitive, even before integrated became an option. I asked some rads residents about this too. They said a big part of it is getting a taste of the "good life" in DR for several years before having to jump back into procedural training lifestyle for fellowship/attending practice. A lot of early 20s single med students feel like their career is priority in life and they're OK with grinding hard - waking up at 5am, going in 6 days/week, having middle of the night patient care responsibilities including emergent ones.

A lot less people come out of a cushy patient-free residency in their late 20s feeling the same way. They told me just wait until you have your medicine internship year followed by DR training as comparison, and I haven't even started the latter yet and I know they're right.

 

[DOVinciRobot]

Thanks for all the feedback guys, really appreciate it. So what I'm hearing is that most IR's won't be able to build a practice solely around the high end procedures? Really disappointing to hear. Another one of the LineMonkey articles used the phrase "image-guided surgeon" which resonated with me a lot. I'm optimistic about the future of endovascular interventions and I'm pretty confident that I want to take my career in that direction. I assumed IR was the specialty driving innovation forward in that area but if not, what other fields would let me focus solely on complex endovascular work?

“Image guided surgeon” sounds like something a premed would say. If you want to focus solely on highly complex endovascular cases then you should do vascular surgery. The the difference between IR and vascular is that vascular is true surgery and when the endo work doesn’t cut it, you can open and do a surgery instead of calling someone else.

To be frank, you shouldn’t pick a specialty based off of what the biggest and baddest procedures in that specialty are. Pick based off of the bread and butter. For IR it was mentioned above. For vascular it’s angiograms and vascular access work, etc. even the most bada** surgeons do a lot of bread and butter in their respective specialties