radiologists and radiology residents, I have a couple questions for you

[VoiceofReason]

I'm wondering if any residents, attendings, or practitioners would care to articulate their level of satisfaction with the intellectual stimulation in radiology. Are you satisfied with the depth and breadth of basic science you draw on daily (and thus master), or do you find that the reality of interpreting scans is less than, or too narrowly, thought-provoking? Do you feel like a detective, weighing possibilities, searching for clues, actually exercising your critical thinking capability? The material I'm reading pegs internal medicine as the "detective's" specialty, which is curious to me, because intuitively I'd think that specialties that focus mostly on diagnosis (path and rad) would be the "detective's" specialties. Lastly, how would you rate your satisfaction with the diagnoses you can make on average? Are you happy with the length of the differential list or do you hate the limitations of your diagnostic modality?

I'm trying to reconcile some results of my MBTI assessment as well as some other specialty asessment items. I came out INTJ and I largely agree with it, but for some reason pathology and internal medicine are on the list of specialties and not radiology. Since it is my understanding that radiology draws heavily on pathology and internal medicine, I can't understand why a list would have one but not the other.. Also, another asessment item correlated interest in biochemistry with the choosing of internal medicine, and interest in pathology and molecular biology with the choosing of pathology but not radiology. Anyone have any insight into why this is (I feel like there is a lot of overlap being overlooked)?

My favorite basic sciences are biochemistry, molecular biology, and physiology, and I'm lukewarm about anatomy. But I should clarify that I enjoy the knowledge and not necessarily the lab work/techniques associated with each. Therefore, although I like the idea of focusing entirely on diagnostics, I like the idea of using imaging technology much moreso than looking at slides playing with buffered solutions. Will the advent of molecular imaging make radiology perfect for me?

Thanks to anyone who reads this whole post, I realize it's a lot of effort so I thank anyone for any insight or advice no matter how small.

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[Bubblehead-to-MD]

My favorite basic sciences are biochemistry, molecular biology, and physiology, and I'm lukewarm about anatomy. But I should clarify that I enjoy the knowledge and not necessarily the lab work/techniques associated with each. Therefore, although I like the idea of focusing entirely on diagnostics, I like the idea of using imaging technology much moreso than looking at slides playing with buffered solutions. Will the advent of molecular imaging make radiology perfect for me?

Just another med student's opinion here, but if you're only lukewarm about anatomy, why the strong interest in radiology? Sure, you could end up doing molecular imaging, and yes, pathology is of significant importance, but I would think a detailed knowledge of anatomy is implicit to radiology.

 

[VoiceofReason]

I guess what I mean is I'm more intensely interested in the dynamics of the living system than in the spatial organization of its parts. Anatomy always seemed more like a foundation, or a framework/context, in which to discuss the real meat of biology (how it works). The idea that the dynamics is the real meat is of course just my opinion.

Thats not to say that I don't find it interesting, after all its eminently relevant, important, and integral to the biology. But I'm just more interested in the physiology from the molecular to the gross in most cases.

the interest in radiology, put real simply, is the interest in the diagnostic modality, the basic science (pathology and to a lesser extent anatomy), and the interest in diagnosing itself.

Edit: Now that I think about it, in a sense I find the anatomy very interesting. At the cellular level and at the molecular and biochemical level -- I enjoy the chemical "anatomy" of the cell very much. The gross is where I lose a little interest I guess. When someone tells me that this tissue is called this and such and this organ is called this and such I'm like "great but what's it made of and how does it work?" I guess I just hate memorizing names. Hope this helps.

 

[MrBurns10]

Why don't you wait until your 3rd year and see how you like the different rotations? You may be surprised at what you love and what you can't stand. Try a radiology elective and see if it's even a possibility for you...it's certainly not for everyone. And, this is just my opinion, I think not enjoying anatomy (except at the "cellular level") may indicate this isn't the field for you.

 

[Bubblehead-to-MD]

I guess what I mean is I'm more intensely interested in the dynamics of the living system than in the spatial organization of its parts. Anatomy always seemed more like a foundation, or a framework/context, in which to discuss the real meat of biology (how it works). The idea that the dynamics is the real meat is of course just my opinion.

Thats not to say that I don't find it interesting, after all its eminently relevant, important, and integral to the biology. But I'm just more interested in the physiology from the molecular to the gross in most cases.

the interest in radiology, put real simply, is the interest in the diagnostic modality, the basic science (pathology and to a lesser extent anatomy), and the interest in diagnosing itself.

Edit: Now that I think about it, in a sense I find the anatomy very interesting. At the cellular level and at the molecular and biochemical level -- I enjoy the chemical "anatomy" of the cell very much. The gross is where I lose a little interest I guess. When someone tells me that this tissue is called this and such and this organ is called this and such I'm like "great but what's it made of and how does it work?" I guess I just hate memorizing names. Hope this helps.

Based on what you are describing in this post, I can see why pathology and internal medicine were high on your list.

While it may be lacking the diagnostic quality you are seeking, have you considered anesthesiology? I would think anyone that has a strong interest in chemistry and physiology would at least be intrigued by it.

 

[VoiceofReason]

Based on what you are describing in this post, I can see why pathology and internal medicine were high on your list.

While it may be lacking the diagnostic quality you are seeking, have you considered anesthesiology? I would think anyone that has a strong interest in chemistry and physiology would at least be intrigued by it.

I'm definitely considering gas as well to be honest. I like that you get to think critically in the planning stage and that you draw on pharm and physio. At the moment I'm considering radiology, internal medicine, pathology, and anesthesiology. In that order.

Like I said before, based on the sciences that I find interesting you'd think that path would be almost perfect. But the reality of the lab work, looking at slides and working with fluids really doesn't sound like fun to me. Its strange i know On the other hand I do find radiologic imaging to be pretty interesting.

Why don't you wait until your 3rd year and see how you like the different rotations? You may be surprised at what you love and what you can't stand. Try a radiology elective and see if it's even a possibility for you...it's certainly not for everyone. And, this is just my opinion, I think not enjoying anatomy (except at the "cellular level") may indicate this isn't the field for you.

Well to be clear it's not that I dislike it, and I'm not saying that that is what you were saying, I just want to be clear. I'm just lukewarm about it, its cool i just am fascinated by the dynamics a little more. I mean, it seems to me that you need to know it all pretty well in order to be a good diagnostician so I wonder how many radiologists actually enjoy anatomy, and physiology, and pathology on the exact same level.

 

[Whisker Barrel Cortex]

As a recently graduated radiologist, I can tell you what my view is of radiology as a diagnostic specialty.

As a radiologist, much of your focus is on understanding both the normal and abnormal anatomy of the organ or body part of interest. A big part of day-to-day radiology is simply differentiating the normal from the abnormal. Once at that stage (which in some cases is harder than it sounds given the limitations of imaging), the nature of the pathology is the concern.

During residency training and in fellowship, we learn differential diagnoses that could cause the imaging appearance. Some of this is very detailed and in depth. Others not so much. For our board examinations (of which there are three), we learn so much minute detail that it can be overwhelming. The information you are expected to know involves not only the possible pathology, but some of the management and prognostic factors (an example would be knowing that emphysematous pyelonephritis is an urgent finding that should be discussed with the team immediately while emphysematous cystitis is much more benign in its course). Some of the knowledge sticks for good, some of it just makes us aware of rarer entities so that, when an unusual case pops up, we have some level of recognition. This knowledge is essential in guiding clinicians, especially primary physicians and emergency room physicians, in their management. Most of the time you are an integral part of the diagnostic puzzle, but due to their knowledge of the patient, it is up to the clinician to complete the puzzle.

Now comes the unfortunate part. In private practice these days, the volume of imaging is extremely high. Many practices are reading in excess of 100-150 studies a day, which is a lot depending on the mix of cases and modalities. This fact is what results in some of the great incomes that rads currently enjoy. The unfortunate side effect is that there is less time for each case and less time to sit and think about the possible differential diagnoses, less time to look up labs and clinical history, less time to discuss with the clinical team, etc. In these extremely busy practices, much of the amazing breadth of knowledge possessed by the radiologist is seldom utilized and wasted. Your differentials are short and less helpful, you hedge more, etc. Fortunately, in most academic centers and in some less busy (and less well compensated) practices, this is not the case.

Also, there is room for molecular and cellular anatomy and physiology in radiology. However, at this time it is rather limited to nuclear medicine (which is practiced by both radiologists and nuclear medicine specialists; look up PET scans, SPECT, zevalin therapy) and to some of the up and coming applications of MRI (look up molecular imaging, MR spectroscopy). While radiology residents learn nuc med during residency (minimum of 4 months, usually a little more), there is an additional nuclear medicine fellowship that can be done after residency if this is of particular interest to you.

 

[Osteopathology]

"At the moment I'm considering radiology, internal medicine, pathology, and anesthesiology. In that order."

Sounds like you have a little more soul-searching to do, IMO.

 

[j dizzle]

VOR,

I'm an INTP, but I was borderline INTJ. I totally get where you're coming from. I have/had the same concerns. If I'm correct, it's not anatomy that you think is boring, it's LEARNING anatomy that you think is boring. That's because there's not a cool underlying principle that you can use to reason through and come up with the name of a structure - you just have to memorize it and it's location. Fortunately, radiologists (or any other physician) do not get paid to simply repeat the names and locations of structures. If anyone wants to know the answer to that question they can just look it up. Sure, radiologists have to study anatomy, but only for a limited time. Once you know it, you know it, and you can use that information to solve problems.

For example, it's no fun to learn that the right side of the heart pumps blood to the lungs and the left side pumps blood to the rest of the body. It could have just as easily been the other way around, but it's not, so you just have to memorize which side pumps to where. Once you know that, however, you can look at a hypertrophied left ventricle and hypothesize that the person had systemic hypertension, which is cool. (This particular example is obviously more applicable to pathology, but you get the point.)

Am I right?

 

[VoiceofReason]

yeah you're absolutely right. Thanks for that, I wasn't able to articulate it myself but i think what you wrote is spot on and pretty insightful. When you're tasked with learning something and the process feels more like memorization than thinking and arriving at an answer, its kind of boring.

 

[tum]

as a radiologist in training, i'll tell you what i wish apache indian were still around to explain.

i was originally an internal medicine resident. i switched because medicine became to boring and repetitive for me, and also it was physically very demanding (standing, running around, procedures, blah blah)

radiology -- the level of intellectual understanding of medicine required over when i was a medicine resident is phenomenal and uncomparable. you actually get to see the zebras because you're 'seeing' a far larger volume of patients. ya you'll get the borings, but you zoom past them. and you have to very intimately understand the diagnostic aspects of medicine, surgery, pediatrics, ob-gyn, neurology if you want to be a well rounded radiologist

 

[schan]

I can tell you I totally agree w/ tum and others. Radiology is very satisfying intellectually and personally. The level of understanding pathology and pathophysiology is very important in interpretation of images and managing patients.

You cover every area of medicine. You interact with physicians of all types/knowledge-base/interests. You help a huge variety of patients.

All in all, I am very happy.

I love my job. I can tell you more--please ask. And yes, there are unhappy radiologists too but you'd have to ask them why because I have no idea

as a radiologist in training, i'll tell you what i wish apache indian were still around to explain.

i was originally an internal medicine resident. i switched because medicine became to boring and repetitive for me, and also it was physically very demanding (standing, running around, procedures, blah blah)

radiology -- the level of intellectual understanding of medicine required over when i was a medicine resident is phenomenal and uncomparable. you actually get to see the zebras because you're 'seeing' a far larger volume of patients. ya you'll get the borings, but you zoom past them. and you have to very intimately understand the diagnostic aspects of medicine, surgery, pediatrics, ob-gyn, neurology if you want to be a well rounded radiologist

 

[drivesmecraazee]

as a radiologist in training, i'll tell you what i wish apache indian were still around to explain.

i was originally an internal medicine resident. i switched because medicine became to boring and repetitive for me, and also it was physically very demanding (standing, running around, procedures, blah blah)

radiology -- the level of intellectual understanding of medicine required over when i was a medicine resident is phenomenal and uncomparable. you actually get to see the zebras because you're 'seeing' a far larger volume of patients. ya you'll get the borings, but you zoom past them. and you have to very intimately understand the diagnostic aspects of medicine, surgery, pediatrics, ob-gyn, neurology if you want to be a well rounded radiologist

Ive heard about this a thousand times: IM residents switching to rads because they didn't find in medicine what they were looking for, the reasons they had when they choose IM, such as diversity, intellectual stimulation, knowledgment requirements.
Is this true? Is medcine that repetitive? I always tought medicine forced people to think, if not, there's no way Im choosing it for a residency, I do like people, but the MOST important thing for me, my top priority is intellectual stimulation, if a job doesn't forces me to think Im not doing it, no way, I won't spend the rest of my life talking to people, doing paperwork and algorythms.

 

[MrBurns10]

Is this true? Is medcine that repetitive? I always tought medicine forced people to think, if not, there's no way Im choosing it for a residency, I do like people, but the MOST important thing for me, my top priority is intellectual stimulation, if a job doesn't forces me to think Im not doing it, no way, I won't spend the rest of my life talking to people, doing paperwork and algorythms.

Take this with a grain of salt as I'm still a med student, but I found medicine to be quite repetitive. Initially it was great, because everything was new to me and we did get a few zebras. Then, I spent part of my clerkship time at a community hospital associated with my school and 90% of the caseload I saw was comprised of COPD flare and rule-out chest pain. There's always an algorithm that you follow...the main thing that requires thinking is what studies to get and what antibiotic to choose, neither of which were that exciting to me. But that's just my opinion.

 

[drivesmecraazee]

But in medicine you get to see the patients evolving right? New signs and symptons appear, new complications that force you to think in order to keep up with the right treatment...I guess...I really don't know, sometimes it seems true, but sometimes I get the idea that the thinking part of medicine is totally overtated. Im still a MS2 so can't really tell right now, will have to waut til I get there.

Excuse my english, Im hispanic and I dont live in the US

 

[copacetic]

Ive heard about this a thousand times: IM residents switching to rads because they didn't find in medicine what they were looking for, the reasons they had when they choose IM, such as diversity, intellectual stimulation, knowledgment requirements.
Is this true? Is medcine that repetitive? I always tought medicine forced people to think, if not, there's no way Im choosing it for a residency, I do like people, but the MOST important thing for me, my top priority is intellectual stimulation, if a job doesn't forces me to think Im not doing it, no way, I won't spend the rest of my life talking to people, doing paperwork and algorythms.

all medicine gets repetitive after a while. trust me. thats what i've ehard from alot of attendings. this is aprt of the reason people go into academics. at least things stay interesting for a bit loner that way.

 

[tum]

Reviving an old thread because I think it has a lot of value. I am now a bit further into my training and basically here's my perspective:

As far as diagnostic understanding, I can't even compare the awareness of disease to my Internal Medicine training. Although IM has many theoretical intricacies, you still need to be aware of most of them for Radiology. I've found many times on call giving clinical advice to the interns as I call in my results. I feel with medicine training at one of the more rigorous programs in my history, and a confused intern on the other side of the phone, I don't mind sharing my two cents off the record.

I can't believe I get paid even a residents salary for what I do. It's easy, it's interesting, and your mind is usually the only thing limiting you -- not social work, not lab results, not blood draws, not consults -- just your mind. I find the pace of Radiology to be more interesting. I am a computer guy, I like sitting when I work, not standing or walking, so it suits me. Some of my co-residents find diagnostics not as appealing and go into IR. Some radiologists have careers heavily centered around fluoroscopy or specific types of procedures. The flexibility in radiology for choosing what type of career you eventually have is almost as wide as the flexibility before picking a field in general.

My current plans are along the lines of teleradiology. It's essentially inevitable -- economically and as far as what's best for the patient, as I see it. Seems equivocal as to its effects on academic radiology.

I can't imagine waiting to see if a potassium level goes up or down or a white blood cell count drops or an ANC count jumps as even remotely interesting. It's feels like I'm thinking in binary.

The generic line you hear (even from people with NO medical training) is that "You sit in a dark room all day and speak into a microphone". Yes, but that room will be in my house. I will be reading in my pajamas. And I will leave that room with plenty of daylight left to enjoy.

As I look at it, while I appreciate the other fields of medicine, there is nothing logically or emotionally that connects with me about them. The only way for you to know ANYTHING about your preference in career will be by doing it. And even then you can't be sure.

I definitely wasted a crap load of time on these forums before starting training trying to figure out what field I liked.

It's useful to a degree, but man just going out into private and academic settings and shadowing would have been so much easier.

 

[sestamibi]

Even a guy like me who is pretty much obsessed with money, easy women, and fast cars... when I'm alone pounding out studies at home or onsite somewhere, from time to time I will come across a case that will make me stop and say WHOA COOL. And I forget about the money and the women and the cars, and I actually get into it and start looking up the clinical info on the patient, Googling the pathology, reading up on it.

That's not the the ApacheIndian I know

 

[IheartCaffeine]

And it's a whole heckuva lot better than the mental masturbation the fleas do all day long.

i like you apache. ive read a lot of your posts and you seem like an honest, cool guy. but please don't call them fleas. it's not easy work they do and no one can argue that they don't play an important role in the hospital. if we don't respect them, they won't respect us.

 

[PeepshowJohnny]

i like you apache. ive read a lot of your posts and you seem like an honest, cool guy. but please don't call them fleas. it's not easy work they do and no one can argue that they don't play an important role in the hospital. if we don't respect them, they won't respect us.

Not that I disagree with you...but we are not exactly respected now. Radiologists get crap all the time (sometimes in jest, sometimes maliciously) from docs in all types of fields. Why can't we be allowed to give it back a little bit, especially if we're playing larger than life like Apache?

Personally, I don't because I prefer the Kung Fu master approach to things. This week I ran into a guy who I'd been paired with last year on Surgery when I was a third year and he was an intern. Nice enough guy, but totally in love with the prestige of being a surgeon. He gives me all the usual crap when he finds out I'm doing Rads ("So you gave up on being a real doctor" "How hard is it to say correlate clinically" "We read all our films better than the radiologists").

And you know what I said? Nothing much. Smiled and let him get it off his chest. If he was secure enough in his decision about his field, he wouldn't give one damn about what field I chose. But I know because I worked with him last year, on some level, he's struggling as his idealized view of being a surgeon is losing some of its luster and so he takes shots. It's okay. I'm a big boy, I can handle it.

 

[IheartCaffeine]

Not that I disagree with you...but we are not exactly respected now. Radiologists get crap all the time (sometimes in jest, sometimes maliciously) from docs in all types of fields. Why can't we be allowed to give it back a little bit, especially if we're playing larger than life like Apache?

Personally, I don't because I prefer the Kung Fu master approach to things. This week I ran into a guy who I'd been paired with last year on Surgery when I was a third year and he was an intern. Nice enough guy, but totally in love with the prestige of being a surgeon. He gives me all the usual crap when he finds out I'm doing Rads ("So you gave up on being a real doctor" "How hard is it to say correlate clinically" "We read all our films better than the radiologists").

And you know what I said? Nothing much. Smiled and let him get it off his chest. If he was secure enough in his decision about his field, he wouldn't give one damn about what field I chose. But I know because I worked with him last year, on some level, he's struggling as his idealized view of being a surgeon is losing some of its luster and so he takes shots. It's okay. I'm a big boy, I can handle it.

im glad you decided to go with the kung fu master approach. i hope ill have the patience to do likewise.

it just seems to me that every specialty talks crap about every other specialty. the hospital would be a much more tolerable place if we were all civil with each other.

and apache...dude. i have no idea where to begin in response to your rebuttal...so you win. internists will be replaced by computers.

 

[Copralith]

I agree Iheartcaf...the above word vomit from apache is precisely why as physicians as a whole we are being screwed by Washington. We need to band together like the dentists and uphold our profession as a whole, not just radiologists or IMs etc... but as doctors. I really enojoy the frank comments apache, but come on name calling should be beneth you.