Rads Offer ~Tough Decision~

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lovenhappiness

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I am currently a PGY -1 categorical resident at a well known top tier gen surg program several hours away from my hometown. Due to personal/family reasons I have considered pursuing a spot back home in radiology. Much to my surprise a spot became available in radiology (a field the I considered pursuing before choosing surgery). I still enjoy being in the OR but I am afraid that the demanding hours may not permit me to have the family life that I desire. My only concerns are as follows:

1. Is the radiology job situation going to be a persistent problem or is the field going to bounce back?
2. Is there a role for an independent practice in radiology at all? IR? NIR?
3. In the future will surgery provide more security and autonomy?

Thx!

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1- The job marker is tight, but not as tight as people say. At least this is my experience in my medical center with more than 20 fellows. Most can find a job. Now, if family ties are so important to you that you can not even do residency away from home, you may not be able find a job in your desirable location. Will the job market improve? Nobody knows, period.

2- Independent practice??? I don't think other than exceptional cases, these days there is any room for any field to practice independently.

3- Surgery vs radiology. I don't know which provides better security.

The way you choose your future career, your odds of being happy is 0.037 percent. I don't say which is better, which is worse, but you are choosing your future career based on family ties (important but ...) and your perceived tight job market in the other.
FYI, the job market for GS is not better than rads in general. I think Urology has better job market than both, so you can go for it.
 
how do you know the urology job market is better than both radiology and surgery? is this what you hear from current residents looking for jobs?
 
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Definitely switch to rads. Gen surg is a terrible field and surprisingly had a 12% salary cut this year (the highest cut of any field) despite already being paid next to nothing.

While shark is right nobody knows for certain, almost all of the issues leading to oversaturation are transient and will resolve by the time you graduate fellowship. This isn't just my opinion...I've spoken to people who are paid to track the rads job market.

Only switch to Rads if you like DR. If you are not DR type, stay with your surgery. Radiology is great, but for its personality.
 
Yeah, make sure you actually like radiology.
 
You guys need to stop BSing. How is it possible to know you "like" rads before doing it?

Bottom line: rads rules. derm and rad onc are good if you can tolerate histrionics/narcissists/body dismorphics/repulsive skin and the Kubler-Ross stages/BS journal articles, respectively. ophth is only good for retina or lasik. if you're not competitive for these, go into gas. Everything else is garbage.

I think you are being a little harsh. Rad onc is a great field I think, and it has potential for tremendous good, particularly for those who are research oriented. Derm is better in theory than reality, and has its own issues. Won't get into that! Gas has royal issues with CRNAs and things are getting hairy. I agree that these along with rads are probably some of the better fields in medicine though, but there are a number of fields that can also be great! I think heme/onc is a great field for example, with excellent pay and decent lifestyle, as well as GI. Uro, ortho, ENT also offer great compensation and pretty decent lifestyle for those who are into the surgical fields. Psych has a great lifestyle and decent pay especially if you go into pp.

Also for those who don't like rads, I think it can be extremely miserable of a specialty. You have to have a certain personality for rads, and not everyone has it.

OP needs to make sure he likes rads as others have also suggested.
 
I would say going to a vascular surgery fellowship is probably the better bet if you're already in a good surgery program and are interested in endovascular work.

It sounds like you want to stay procedural, and for better or worse they seem to be grabbing most of the endovascular stuff from IR anyway.
 
I think you are being a little harsh. Rad onc is a great field I think, and it has potential for tremendous good, particularly for those who are research oriented. Derm is better in theory than reality, and has its own issues. Won't get into that! Gas has royal issues with CRNAs and things are getting hairy. I agree that these along with rads are probably some of the better fields in medicine though, but there are a number of fields that can also be great! I think heme/onc is a great field for example, with excellent pay and decent lifestyle, as well as GI. Uro, ortho, ENT also offer great compensation and pretty decent lifestyle for those who are into the surgical fields. Psych has a great lifestyle and decent pay especially if you go into pp.

Also for those who don't like rads, I think it can be extremely miserable of a specialty. You have to have a certain personality for rads, and not everyone has it.

OP needs to make sure he likes rads as others have also suggested.

It is not only about Rads, it is about every field.

If you are not psych type, you can not do it.

If you are not surgical type you can not do ortho.

GI and urology need their own personality. Just imagine, 80% of you time deal with one orifice, either back or front, that is either bleeding or does not have output (= obstructed).

If you are procedural type, nothing beets ortho. Good pay, relatively good life style, at least after a few years no nights and no emergencies, very brief pre-op and post-op encounter, if you stay away from spine.

Derm is next to perfect in medical fields. Lots of turf issues. If we have turf wars with specialists, they have turf wars with every family doctor and their mother. But at the end of the day, it has awesome options. First of all, its life style is next to nothing in medicine. If you want procedures, do MOHS which has great pay, very minimal hassle, is outpatient and elective and does not have turf wars. If you want sit on your *****, do Dermatopathology.

But you are missing the big picture. I totally agree that DERM and ORTHO are better gigs than Rads, But I would never change my job with Ortho and Derm. I would rather quit medicine than doing psych. It is not about what is better, what is worse. It is about personal preference.

And here I am not talking about money or hours or years of training. I am talking about my interest. I still enjoy most of what I do. There are days that I complain or nag to myself or there are aspects of my job that I dislike, but at the end of the day, I usually go home satisfied with what I do and I am 100% sure I can provide a decent life for my family and myself in the future.
 
It is not only about Rads, it is about every field.

If you are not psych type, you can not do it.

If you are not surgical type you can not do ortho.

GI and urology need their own personality. Just imagine, 80% of you time deal with one orifice, either back or front, that is either bleeding or does not have output (= obstructed).

If you are procedural type, nothing beets ortho. Good pay, relatively good life style, at least after a few years no nights and no emergencies, very brief pre-op and post-op encounter, if you stay away from spine.

Derm is next to perfect in medical fields. Lots of turf issues. If we have turf wars with specialists, they have turf wars with every family doctor and their mother. But at the end of the day, it has awesome options. First of all, its life style is next to nothing in medicine. If you want procedures, do MOHS which has great pay, very minimal hassle, is outpatient and elective and does not have turf wars. If you want sit on your *****, do Dermatopathology.

But you are missing the big picture. I totally agree that DERM and ORTHO are better gigs than Rads, But I would never change my job with Ortho and Derm. I would rather quit medicine than doing psych. It is not about what is better, what is worse. It is about personal preference.

And here I am not talking about money or hours or years of training. I am talking about my interest. I still enjoy most of what I do. There are days that I complain or nag to myself or there are aspects of my job that I dislike, but at the end of the day, I usually go home satisfied with what I do and I am 100% sure I can provide a decent life for my family and myself in the future.

Yes, I agree. My point is that there are a number of decent fields out there in addition to rads, and that the OP needs to LIKE rads in order to go into it. Like other fields, rads has its own personality, and if someone does not like it, they will be miserable doing it.
 
It is not only about Rads, it is about every field.

If you are not psych type, you can not do it.

If you are not surgical type you can not do ortho.

GI and urology need their own personality. Just imagine, 80% of you time deal with one orifice, either back or front, that is either bleeding or does not have output (= obstructed).

If you are procedural type, nothing beets ortho. Good pay, relatively good life style, at least after a few years no nights and no emergencies, very brief pre-op and post-op encounter, if you stay away from spine.

Derm is next to perfect in medical fields. Lots of turf issues. If we have turf wars with specialists, they have turf wars with every family doctor and their mother. But at the end of the day, it has awesome options. First of all, its life style is next to nothing in medicine. If you want procedures, do MOHS which has great pay, very minimal hassle, is outpatient and elective and does not have turf wars. If you want sit on your *****, do Dermatopathology.

But you are missing the big picture. I totally agree that DERM and ORTHO are better gigs than Rads, But I would never change my job with Ortho and Derm. I would rather quit medicine than doing psych. It is not about what is better, what is worse. It is about personal preference.

And here I am not talking about money or hours or years of training. I am talking about my interest. I still enjoy most of what I do. There are days that I complain or nag to myself or there are aspects of my job that I dislike, but at the end of the day, I usually go home satisfied with what I do and I am 100% sure I can provide a decent life for my family and myself in the future.


i'm not sure why you think that ortho is the "best" procedural/surgical field...i mean those guys can have a pretty bad lifestyle and can often be sued as a lot. plus ortho has become way too specialized these days where reconstructive guys only do hip/knee replacements, shoulder guys do shoulders only, etc...and thus if reimbursement rates are cut for such procedures, it won't be so good for them. but i do think its a good field if it's something that you enjoy and can see doing for 40+ years.

but i do think that other surgical fields are just as nice as ortho including uro and ENT. both of these fields have compensation similar to ortho and often have better lifestyles especially given that they both have medical aspects associated with them which allows ones to tailor his/her practice to being more surgical or more medical with smaller office procedures. and by saying that all you do is deal with one orifice and that's it really shows how short-sighted you are about these fields. in fact uro and ENT offer some of the greatest variety of any surgical field....what, ortho reconstructive guys only deal with osteoarthritis for their entire career... talk about repetitive.

so basically, i don't think that ortho is the only procedural field one should consider but rather realize that other fields offer just as much as ortho can and sometimes more. with all that said, i do believe rads is a great field too and honestly it is up to an individual to think about what they'll enjoy doing...but of course, it's not always that easy.
 
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i'm not sure why you think that ortho is the "best" procedural/surgical field...i mean those guys can have a pretty bad lifestyle and can often be sued as a lot. plus ortho has become way too specialized these days where reconstructive guys only do hip/knee replacements, shoulder guys do shoulders only, etc...and thus if reimbursement rates are cut for such procedures, it won't be so good for them. but i do think its a good field if it's something that you enjoy and can see doing for 40+ years.

but i do think that other surgical fields are just as nice as ortho including uro and ENT. both of these fields have compensation similar to ortho and often have better lifestyles especially given that they both have medical aspects associated with them which allows ones to tailor his/her practice to being more surgical or more medical with smaller office procedures. and by saying that all you do is deal with one orifice and that's it really shows how short-sighted you are about these fields. in fact uro and ENT offer some of the greatest variety of any surgical field....what, ortho reconstructive guys only deal with osteoarthritis for their entire career... talk about repetitive.

so basically, i don't think that ortho is the only procedural field one should consider but rather realize that other fields offer just as much as ortho can and sometimes more. with all that said, i do believe rads is a great field too and honestly it is up to an individual to think about what they'll enjoy doing...but of course, it's not always that easy.

Where did you find in my post saying uro or ENT are bad fields? Did I say that?
I said Uro needs its own personality. That's all. Like it or not, many do not like to do DRE left and right or deal with problems down there every day.

If you think Uro and GI are nothing but an orifice in pp, go and shadow them in pp. They basically do prostates or renal stones day and night and colonoscopies. Is it good or bad? I don't know, just needs its personality.

It seems you didn't get my point. I was not talking about money. But if you think ENT or Uro on average make as much as Ortho you are mistaken. I don't want to argue about salaries.

And you are talking BS. OK, the reimbursement for knee replacement may become half, but it is true for every field. In pp every field is dependent on 1 or 2 major procedures. If they decrease reimbursement for TURP, be sure that Uro income gets hit big time.

Good Luck. If you like ENT or Uro, go for it. Why you get so mad if I as a radiologist put some good words for Ortho. This was my experience after working with all of these people for while.
 
2. Is there a role for an independent practice in radiology at all? IR? NIR?

I've come across a couple of radiologists who worked solo. They had their own X-ray, ultrasound machines and CT scanners no MRI. They provided me with timely and cheap services. So I just ended referring every patient to them. Another radiologist I know of, had only X-ray machine and a radiographer next to busy medical centers. He stayed home reporting. So independent practice is do-able for diagnostic radiology. Don't know how much they make, but I suspect they don't starve. If you want proper full scope IR then I'd say hospital will be necessary.

Good luck with your decisions. You've got quite a few conflicting interests and it's going to be a tough decision. You can't have everything, but make it something you will regret the least in 30 years time.
 
Man, you are really pro-rads, anti anything else!

I must admit that I chuckled at your phrase, "Uro is a great choice if you're sublimating as a closet homosexual." I think both specialties are fine for those who like them. There is a need for every specialty. Repetition is part of what makes specialists experts in their respective specialty. Being in rads is also repetitive, just like every other specialty. If every specialist never saw the same thing more than once, they couldn't quite specialize/be experts in much of anything.
 
ahhahahah....someone clearly is insecure and upset about the field of medicine they're in...i take it you're in radiology. so u come on and bash all these fields...but then why are all of them (ortho, ENT, and uro) much much more competitive these days than rads if they're all "garbage."

hey man, just stick in the dark room reading the films ordered by all the above surgeons who actually can go and have an effect on someone's life directly. at the end of the day, those surgeons are who hospitals want to hire b/c they bring business/money into the hospital...radiologists can be replaced easily esp. given the fact that there are sooo many graduates a year and not as many jobs. but all i'm saying is that it's not hard to find something to say badly about any field....but only those who don't like the field they're in feel compelled to do so. sorry about that man.

LOL...just saw this. Ortho can def be repetitive but it's not without a tinge of irony. Have fun sticking your finger up men's asses 10,000 times (not an exaggeration) during ur Uro career. You'll repeat DREs so many times that you could stick your d*ck up their ass and tell them about their prostate.
Uro is a great choice if you're sublimating as a closet homosexual.

ENT is garbage too...those orifices are about as disgusting as GI. At least once you get burnt out in ENT (as every ent surgeon does) after dealing with mucus, ear wax, halitosis, and 15 hour head and neck dissections, you can slow your roll to a nice boring allergy clinic
 
Only switch to Rads if you like DR. If you are not DR type, stay with your surgery. Radiology is great, but for its personality.

Can you expand on this a little bit?

I know there's a stereotype of Radiologists but how much of that is true? When I tell residents or attendings that I've worked with that I wanna do Rads, I usually get confused looks. I like the quickness of the work, I like interpreting images, I like that I can sit down all day after hitting quads the day before (just being honest). But at the same time, I'm a social creature... I like working with other residents, I like talking things through, I like moving around a little bit.. all things that have been pointing me a little more towards EM lately. Two totally different fields, I know, but they each have their own pros and cons for me that I would be GLAD to get into for some help.
 
Can you expand on this a little bit?

I know there's a stereotype of Radiologists but how much of that is true? When I tell residents or attendings that I've worked with that I wanna do Rads, I usually get confused looks. I like the quickness of the work, I like interpreting images, I like that I can sit down all day after hitting quads the day before (just being honest). But at the same time, I'm a social creature... I like working with other residents, I like talking things through, I like moving around a little bit.. all things that have been pointing me a little more towards EM lately. Two totally different fields, I know, but they each have their own pros and cons for me that I would be GLAD to get into for some help.
Personalities within radiology are as diverse as in any field. I'm as social as they come, and my evaluations in med school, intern year, and so far in residency have tended to highlight my people skills (rather than, say, knowledge base)...and I am very happy in radiology. You still get people contact, it's just that those people tend to be other doctors and the communication tends to come over the phone. But there's plenty of patient contact during procedures and relationships you form with other employees (other doctors, techs, nurses, sonographers). It's a great field for both the extroverts and the introverts alike :)
 
Personalities within radiology are as diverse as in any field. I'm as social as they come, and my evaluations in med school, intern year, and so far in residency have tended to highlight my people skills (rather than, say, knowledge base)...and I am very happy in radiology. You still get people contact, it's just that those people tend to be other doctors and the communication tends to come over the phone. But there's plenty of patient contact during procedures and relationships you form with other employees (other doctors, techs, nurses, sonographers). It's a great field for both the extroverts and the introverts alike :)

Truth! I absolutely cannot wait to move onto rads from med school.
 
ahhahahah....someone clearly is insecure and upset about the field of medicine they're in...i take it you're in radiology. so u come on and bash all these fields...but then why are all of them (ortho, ENT, and uro) much much more competitive these days than rads if they're all "garbage."

hey man, just stick in the dark room reading the films ordered by all the above surgeons who actually can go and have an effect on someone's life directly. at the end of the day, those surgeons are who hospitals want to hire b/c they bring business/money into the hospital...radiologists can be replaced easily esp. given the fact that there are sooo many graduates a year and not as many jobs. but all i'm saying is that it's not hard to find something to say badly about any field....but only those who don't like the field they're in feel compelled to do so. sorry about that man.

We are really lucky to have a dentist coming to our forum and open our eyes to the true nature of our field.
Thanks a bunch for opening my eyes. I am going to switch to Urology.

A just a question: Have you ever been to a "dark reading room" in your life?
 
ahhahahah....someone clearly is insecure and upset about the field of medicine they're in...i take it you're in radiology. so u come on and bash all these fields...but then why are all of them (ortho, ENT, and uro) much much more competitive these days than rads if they're all "garbage."

hey man, just stick in the dark room reading the films ordered by all the above surgeons who actually can go and have an effect on someone's life directly. at the end of the day, those surgeons are who hospitals want to hire b/c they bring business/money into the hospital...radiologists can be replaced easily esp. given the fact that there are sooo many graduates a year and not as many jobs. but all i'm saying is that it's not hard to find something to say badly about any field....but only those who don't like the field they're in feel compelled to do so. sorry about that man.

...so...you're unhappy with the field you are in?
 
so first, no i'm not a dentist. second, my point was not to bash radiology. frankly, i have a lot of respect for radiologists and actually feel that they along with pathologists are some of the smartest doctors in the hospital...the point i was trying to make is that there seems to be some pple who love to bash other fields all the time and i was just trying to point out that it's really not that hard to bash any field if you really want to. every person picks a field b/c of different reasons and each field has a lot to offer whether it be radiology, ent, uro, etc...it's unfortunate that the medical culture is such that we often have a need to bash every other field that we are not in. and i think pple who do that are those who are just not really happy with their own fields...i mean why else do it??

We are really lucky to have a dentist coming to our forum and open our eyes to the true nature of our field.
Thanks a bunch for opening my eyes. I am going to switch to Urology.

A just a question: Have you ever been to a "dark reading room" in your life?
 
This post should not be dignified with a response, but just to set the record straight, please see the charting outcomes 2011 data, including step 1/2 averages for these fields. The only field listed that is *marginally* more competitive than rads is ENT and only because rads is a juggernaut field with 4 times the # of spots so it has a flatter distribution curve. To say that any of those three are "much much more competitive" than rads is laughable.

To be clear, I've rotated on ENT and know many senior iowa (#1 ent prog) and harvard-trained senior ENTs, all of whom hate ent with a passion. They are so jaded, in fact, that they wish they never went into medicine, especially the harvard-trained ents.



[YOUTUBE]http://www.youtube.com/watch?v=nFlSGmB8RlQ[/YOUTUBE]

You compare this high-tech workstation with sticking your finger up a grown man's ass x10k in urology? I wouldn't even call this a downside...it's like being in an exclusive club with mood lighting. But I guess if you're afraid of the dark and stuck in the anal phase of development, you might find urology a better fit.



It is important to help students who don't have experience or insight into these fields. The negative aspects of fields are far more important down the line, especially for fields like uro, ent, er, etc. Honestly, you don't know enough about radiology or even urology to have a meaningful discussion of the costs and benefits. Your analysis is roughly on the level expected of a MS1. Even your understanding of the competitiveness, which is objective data, is completely wrong.

This isn't unexpected, though...most students do not get much specialty experience and are forced to choose before they can even take many electives in 4th year. If you're dead set on uro, make sure you spend a lot of time with senior pp uros and know exactly what you're getting into...I know many uros personally and I can tell you you're in for a rude awakening. The students who apply to urology have this superficial understanding of it as a laid-back surgical field, without appreciating the true nature of the work. The point was not to "bash" anything...it was to provide a practical distillate of a complex cost-benefit analysis.

Very, very cool stuff. No wonder radiologists never seem to retire.
 
This post should not be dignified with a response, but just to set the record straight, please see the charting outcomes 2011 data, including step 1/2 averages for these fields. The only field listed that is *marginally* more competitive than rads is ENT and only because rads is a juggernaut field with 4 times the # of spots so it has a flatter distribution curve. To say that any of those three are "much much more competitive" than rads is laughable.

To be clear, I've rotated on ENT and know many senior iowa (#1 ent prog) and harvard-trained senior ENTs, all of whom hate ent with a passion. They are so jaded, in fact, that they wish they never went into medicine, especially the harvard-trained ents.



[YOUTUBE]nFlSGmB8RlQ[/YOUTUBE]

You compare this high-tech workstation with sticking your finger up a grown man's ass x10k in urology? I wouldn't even call this a downside...it's like being in an exclusive club with mood lighting. But I guess if you're afraid of the dark and stuck in the anal phase of development, you might find urology a better fit.



It is important to help students who don't have experience or insight into these fields. The negative aspects of fields are far more important down the line, especially for fields like uro, ent, er, etc. Honestly, you don't know enough about radiology or even urology to have a meaningful discussion of the costs and benefits. Your analysis is roughly on the level expected of a MS1. Even your understanding of the competitiveness, which is objective data, is completely wrong.

This isn't unexpected, though...most students do not get much specialty experience and are forced to choose before they can even take many electives in 4th year. If you're dead set on uro, make sure you spend a lot of time with senior pp uros and know exactly what you're getting into...I know many uros personally and I can tell you you're in for a rude awakening. The students who apply to urology have this superficial understanding of it as a laid-back surgical field, without appreciating the true nature of the work. The point was not to "bash" anything...it was to provide a practical distillate of a complex cost-benefit analysis.



okkkkk i guess you're right....radiology is the ONLY field of medicine medical students should consider. every other field of medicine is just garbage compared to radiology. all hail radiology!! thank you for showing me the light....

not a ms1, actually entering my fourth year. second, yes all those fields are more competitive that radiology these days....just look at the percent of U.S. seniors that match into each field...hmm 98% for rads vs. 75% in uro and similar for ent/ortho...basically students going into these fields could have pretty easily gotten into rads too but not sure the other way around would be as true as often. in fact, i have many friends who matched into radiology who weren't even in the top 50% of their class...that would never happen in those surgical specialties given how much smaller those fields are and how much more selective they can be.

also, i know many ents/ortho/uro attendings who absolutely love what they do and would not do anything else. i also know radiologists who dissuade students from going into the field these days given the job market and concern for the future of the field...

but again, all hail radiology!! no matter what field i match into, i promise to go to the reading room every day in residency and beyond and bow in front of all the radiologists and tell them how i was not worthy enough to become a radiologist.
 
The more I read this forum, the more abnormal personalities I find in Medicine.
Do not talk about anybody specifically, how come we have only few "normal" personalities in medicine.
This happens always in Medical forums.
If I say ortho is a good field, someone will jump with a very primitive immature reaction and talk about how Ob-Gyn are good because there are some happy attendings at their medical center.

Decline in radiology job market is more interesting to other specialties than radiologists itself. Now all those jealous people write with full of excitement and happiness about the bad job market and "unclear future" of the field.
 
What do you guys really want to prove by writing down these numbers?
This means nothing. Find what you like and go for it.
If you like ENT go for it. If you like Radiology go for it.

Some of the happiest doctors I've ever seen are Peds docs in our hospital. They are by any scale and any number, one of the least competitive and one of the least paid ones. They do not have any attitude or any claim, come to work happy and leave happy. Now all the miserable surgeons and rads and ... can hit each other in the head and claim that their field is the most competitive one. Whom do you think is the winner and whom do you think is the loser??

Grow up.
 
ahhahahah....someone clearly is insecure and upset about the field of medicine they're in...i take it you're in radiology. so u come on and bash all these fields...but then why are all of them (ortho, ENT, and uro) much much more competitive these days than rads if they're all "garbage."

I dunno, I think what Dumb said has some element of truth to it, although he's trying to pump his own field up in the meantime. Most medical students don't really know what they're getting themselves into and are really just following the herd or their egos. The med students see the cool robotic surgeries in uro and are quickly sold, but few did many DREs, which is a major part of the specialty.

Going into competitive fields because it's competitive is a surefire way of being miserable ten years down the line.
 
The more I read this forum, the more abnormal personalities I find in Medicine.
Do not talk about anybody specifically, how come we have only few "normal" personalities in medicine.
This happens always in Medical forums.
If I say ortho is a good field, someone will jump with a very primitive immature reaction and talk about how Ob-Gyn are good because there are some happy attendings at their medical center.

Decline in radiology job market is more interesting to other specialties than radiologists itself. Now all those jealous people write with full of excitement and happiness about the bad job market and "unclear future" of the field.

I think it comes from the long sadistic training process that nearly every medical field has, even the "lifestyle" specialties. It's easy to see how some (ahem, general surgeons) would be particularly bitter and full of schadenfreude. And no one wants to admit that they just trained for a decade into a declining specialty.

The process is simply too long, and it's almost impossible to switch. PAs have a better deal than us in that respect, much easier to change specialties.
 
LOL! You can't possibly be this stupid if you're in contention for any of these fields, can you?

Rads match %age: 96; step 1 240
EM match %age: 90; step 1 223
IM/Peds match %age: 88; step 1 230
ENT match %age: 86; step 1 243
General surgery match%age: 80; step 1 227

Conclusion: General surgery is "much, much more competitive" than rads and ENT!!!! :rolleyes:


Good luck in urology. Make sure you double-glove, brah...would make for some awkward lunches otherwise.


hahahahah, this is getting too funny...at this point, i just feel bad for you. you either really really love radiology (which is great) or you just are trying to bash other fields to make yourself feel better about not having the guts to actually become a surgeon. so yeah, if you ask any 4th year medical student who has any good sense, they'll tell you that uro, ent, and ortho are all more competitive than radiology these days. you obv. don't want to believe that but sorry it's true. i mean, those who want to match into those surgical specialties NEED to obv. have high grades and do at least 1-2 (often more) away rotations to even have a chance whereas i know of many friends who matched into rads w/o even doing a single away rotation and these kids were not even at the top of the class or anything. listen, i'm not saying rads is super easy to get into cuz it's not but rads is easier to get into these days than the surgical specialties. that may change in teh future but it's just the way it is now. just deal with it.

as for your utter hatred of all surgeons and esp. urologists, well i hope you never have a kidney stone, kidney cancer, bladder cancer, prostate cancer, etc...b/c you won't be making fun of them when they're the ones you'll need. along teh same note, i came across an article that basically sums up the relationship of radiologists with surgeons (urologist in this case).

http://www.renalandurologynews.com/...r-for-patients-untimely-death/article/246123/

even though the radiologist was "correct" in what type of scan to get, he still went ahead and listened to the urologist as he was the surgeon and the one who bascially told the radiologist what to do. also as youll see, the radiologist's insurance had to pay more in the end too even though he was technically right...gotta suck to be that radiologist. so moral of the story, just listen to the surgeons and read the goddamn scans and stay quiet b/c even if you had an opinion...they're the ones who ultimately make the final decision and tell you what to do. sorry.
 
hahahahah, this is getting too funny...at this point, i just feel bad for you. you either really really love radiology (which is great) or you just are trying to bash other fields to make yourself feel better about not having the guts to actually become a surgeon. so yeah, if you ask any 4th year medical student who has any good sense, they'll tell you that uro, ent, and ortho are all more competitive than radiology these days. you obv. don't want to believe that but sorry it's true. i mean, those who want to match into those surgical specialties NEED to obv. have high grades and do at least 1-2 (often more) away rotations to even have a chance whereas i know of many friends who matched into rads w/o even doing a single away rotation and these kids were not even at the top of the class or anything. listen, i'm not saying rads is super easy to get into cuz it's not but rads is easier to get into these days than the surgical specialties. that may change in teh future but it's just the way it is now. just deal with it.

You're clearly missing the point, and while Dumb may be going too far, he is posting the real numbers from the NRMP.

There are two questions being answered here, and it's up to you which is the more important one:

Which specialty is it easier to match into a bad program?

Which specialty is it easier to match into a decent program?

Bad programs in radiology are easier to get into than bad surgery programs simply by the sheer number of spots.

For decent programs, radiology applicants will be clearly more competitive based on research, USMLE and AOA.

(Top 5 or 10 programs in the various specialties can be a wash too, since there are usually enough stellar applicants to fill those spots in all specialties.)


Personally, I was more interested in getting into a decent program than getting into the worst program in a specialty just to say I matched into it.
 
hahahahah, this is getting too funny...at this point, i just feel bad for you. You either really really love radiology (which is great) or you just are trying to bash other fields to make yourself feel better about not having the guts to actually become a surgeon. so yeah, if you ask any 4th year medical student who has any good sense, they'll tell you that uro, ent, and ortho are all more competitive than radiology these days. You obv. Don't want to believe that but sorry it's true. I mean, those who want to match into those surgical specialties need to obv. Have high grades and do at least 1-2 (often more) away rotations to even have a chance whereas i know of many friends who matched into rads w/o even doing a single away rotation and these kids were not even at the top of the class or anything. Listen, i'm not saying rads is super easy to get into cuz it's not but rads is easier to get into these days than the surgical specialties. That may change in teh future but it's just the way it is now. Just deal with it.

As for your utter hatred of all surgeons and esp. Urologists, well i hope you never have a kidney stone, kidney cancer, bladder cancer, prostate cancer, etc...b/c you won't be making fun of them when they're the ones you'll need. Along teh same note, i came across an article that basically sums up the relationship of radiologists with surgeons (urologist in this case).

http://www.renalandurologynews.com/...r-for-patients-untimely-death/article/246123/

even though the radiologist was "correct" in what type of scan to get, he still went ahead and listened to the urologist as he was the surgeon and the one who bascially told the radiologist what to do. Also as youll see, the radiologist's insurance had to pay more in the end too even though he was technically right...gotta suck to be that radiologist. So moral of the story, just listen to the surgeons and read the goddamn scans and stay quiet b/c even if you had an opinion...they're the ones who ultimately make the final decision and tell you what to do. Sorry.

nuts ....
 
Rads isn't as away heavy as fields like EM and some of the surgical specialties. Then again, the training isn't as team oriented as surgery and as students have little or no formal training in radiology, aways aren't as useful in evaluation.

If you look at the NBME stats, you'll see that rads has the most 260+ step 1 scores of any specialty besides internal med, and that ratio increased this year with ~20 more 260s and less applicants. It's certainly one of the most stat heavy specialties and that is likely because evaluating applicants is done by seeing how good they are in other areas of medicine. Radiology has more spots than any of the surgical specialties so simply matching somewhere isn't hard, but the top programs are very competitive.

hahahahah, this is getting too funny...at this point, i just feel bad for you. you either really really love radiology (which is great) or you just are trying to bash other fields to make yourself feel better about not having the guts to actually become a surgeon. so yeah, if you ask any 4th year medical student who has any good sense, they'll tell you that uro, ent, and ortho are all more competitive than radiology these days. you obv. don't want to believe that but sorry it's true. i mean, those who want to match into those surgical specialties NEED to obv. have high grades and do at least 1-2 (often more) away rotations to even have a chance whereas i know of many friends who matched into rads w/o even doing a single away rotation and these kids were not even at the top of the class or anything. listen, i'm not saying rads is super easy to get into cuz it's not but rads is easier to get into these days than the surgical specialties. that may change in teh future but it's just the way it is now. just deal with it.

as for your utter hatred of all surgeons and esp. urologists, well i hope you never have a kidney stone, kidney cancer, bladder cancer, prostate cancer, etc...b/c you won't be making fun of them when they're the ones you'll need. along teh same note, i came across an article that basically sums up the relationship of radiologists with surgeons (urologist in this case).

http://www.renalandurologynews.com/...r-for-patients-untimely-death/article/246123/

even though the radiologist was "correct" in what type of scan to get, he still went ahead and listened to the urologist as he was the surgeon and the one who bascially told the radiologist what to do. also as youll see, the radiologist's insurance had to pay more in the end too even though he was technically right...gotta suck to be that radiologist. so moral of the story, just listen to the surgeons and read the goddamn scans and stay quiet b/c even if you had an opinion...they're the ones who ultimately make the final decision and tell you what to do. sorry.
 
http://www.renalandurologynews.com/...r-for-patients-untimely-death/article/246123/

even though the radiologist was "correct" in what type of scan to get, he still went ahead and listened to the urologist as he was the surgeon and the one who bascially told the radiologist what to do. also as youll see, the radiologist's insurance had to pay more in the end too even though he was technically right...gotta suck to be that radiologist. so moral of the story, just listen to the surgeons and read the goddamn scans and stay quiet b/c even if you had an opinion...they're the ones who ultimately make the final decision and tell you what to do. sorry.

You must be trolling. Did you read the last section of the article? The first moral of the story was clearly that surgeons should listen to the radiologists because radiologists are the experts on imaging studies. Regardless of how the settlement payment worked (for all we know it could be for technical legal reasons), it was the urologist's fault that a patient died. The second moral of the story was that the radiologist should have either been more insistent or documented the disagreement and decision. Radiologists are board-certified professionals that should exercise some degree of independence in determining which study to do.
 
I think it is difficult to assess the relative competitiveness of a specialty by the numbers available, especially when you are using competitiveness as a proxy for specialty "quality" and "desirability."

Match percentage depends on supply versus demand. Clearly supply in radiology is higher (1124 spots) than in ortho (670), optho (461), derm (372), rad onc (171), and plastics (108).

Demand is largely determined by a priori interest in the specialty among medical students. I don't think 10x the number of med students have radiology as their dream specialty versus plastics, a priori. So mathematically speaking plastics will be more competitive, but not necessarily semi-objectively a more desirable specialty.

As for STEP scores -- that's also confounded by the fact that highly g-loaded specialties like radiology will attract smart people, not necessarily because of any competitive effect of the smart applicants squeezing out the dumb ones.

If you're outpatient medicine your intelligence matters little because your throughput is not improved much as it is limited by external factors like patient availability and support staff. In radiology, the smarter you are, the better you are at radiology in both speed and accuracy of your reporting. Hence there is a relative economic advantage (RVU/hour) to going into radiology if you are smart. And this is not politically correct but true: STEP scores are a proxy for IQ, modified to a small degree by industriousness.
 
Also this is just my opinion but the nature of the work in radiology is so much more enjoyable than other attainable specialties in medicine (ie gas, hospitalist medicine, etc) that if you don't like radiology you should seriously consider quitting medicine.

Maybe derm and rad onc can compare but really those are not options for the majority of medical students, who are either not smart enough or not willing to put up with the BS required to compete for these specialties with low number of spots per applicant.

It's true radiology is a grind but then again every part of life separate from orgasms or drug-induced hazes is. At least you're making a lot of money so you can increase the proportion of time you get the spend in the latter.
 
I think it is difficult to assess the relative competitiveness of a specialty by the numbers available, especially when you are using competitiveness as a proxy for specialty "quality" and "desirability."

Match percentage depends on supply versus demand. Clearly supply in radiology is higher (1124 spots) than in ortho (670), optho (461), derm (372), rad onc (171), and plastics (108).

Demand is largely determined by a priori interest in the specialty among medical students. I don't think 10x the number of med students have radiology as their dream specialty versus plastics, a priori. So mathematically speaking plastics will be more competitive, but not necessarily semi-objectively a more desirable specialty.

Overall, I agree with your analysis. But I'm not sure "apriori interest" is what's driving the competitiveness. In the case of derm and rad onc, it is clearly the economic model in the US and the lifestyle that the specialties afford. This is obvious because we have "controls"...countries where the economics do not favor derm. In said countries, derm is not competitive at all. One foreigner actually told me that derm is the least competitive field of all in his country. Rads, on the other hand, is competitive in every country in the world, which means there is both intrinsic and extrinsic interest. Plastics and derm also have a great image in popular culture through shows like Nip/Tuck and Dr.90210. Students, however, do not know that elective/cosmetic practices in metro areas are supersatured, far worse than the rads job market for comparison.

As for STEP scores -- that's also confounded by the fact that highly g-loaded specialties like radiology will attract smart people, not necessarily because of any competitive effect of the smart applicants squeezing out the dumb ones.

If you're outpatient medicine your intelligence matters little because your throughput is not improved much as it is limited by external factors like patient availability and support staff. In radiology, the smarter you are, the better you are at radiology in both speed and accuracy of your reporting. Hence there is a relative economic advantage (RVU/hour) to going into radiology if you are smart. And this is not politically correct but true: STEP scores are a proxy for IQ, modified to a small degree by industriousness.

I think you're overstating the influence of IQ in rads vs. other fields. RVUs are important in every field and seeing more patients in outpt medicine (or inpt like I'm currently doing) depends a lot on your own efficiency. I also don't agree about the relationship between IQ and step scores. Memory is, in general, only loosely correlated with IQ. Marilyn vos Savant, e.g., has a shamefully poor memory and she would perform poorly on the step exams. I also think Einstein would have done poorly on the steps. Intelligence is most important for complex problem-solving, not rote memorization so medicine is actually a poor choice from a "scientific interest" or "IQ" perspective (compared to, e.g., theoretical physics or any sort of real innovation). I do agree that rads is highly g-loaded, but I'm not sure that's different than any other specialty...seeing 90 patients a day in retina clinic takes just as much processing power. Sure, the patients are wild cards in a clinic, but most doctors don't bend their schedules much to patients anymore and even in outpt med, they are very aware of the time spent per pt.
 
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Overall, I agree with your analysis. But I'm not sure "apriori interest" is what's driving the competitiveness. In the case of derm and rad onc, it is clearly the economic model in the US and the lifestyle that the specialties afford. This is obvious because we have "controls"...countries where the economics do not favor derm. In said countries, derm is not competitive at all. One foreigner actually told me that derm is the least competitive field of all in his country. Rads, on the other hand, is competitive in every country in the world, which means there is both intrinsic and extrinsic interest. Plastics and derm also have a great image in popular culture through shows like Nip/Tuck and Dr.90210. Students, however, do not know that elective/cosmetic practices in metro areas are supersatured, far worse than the rads job market for comparison.



I think you're overstating the influence of IQ in rads vs. other fields. RVUs are important in every field and seeing more patients in outpt medicine (or inpt like I'm currently doing) depends a lot on your own efficiency. I also don't agree about the relationship between IQ and step scores. Memory is, in general, only loosely correlated with IQ. Marilyn vos Savant, e.g., has a shamefully poor memory and she would perform poorly on the step exams. I also think Einstein would have done poorly on the steps. Intelligence is most important for complex problem-solving, not rote memorization so medicine is actually a poor choice from a "scientific interest" or "IQ" perspective (compared to, e.g., theoretical physics or any sort of real innovation). I do agree that rads is highly g-loaded, but I'm not sure that's different than any other specialty...seeing 90 patients a day in retina clinic takes just as much processing power. Sure, the patients are wild cards in a clinic, but most doctors don't bend their schedules much to patients anymore and even in outpt med, they are very aware of the time spent per pt.

Well I chose radiology before I ever met a radiologist or saw a reading room. I just did a thought experiment, which included considerations of nature of the work, and lifestyle, with a dominant emphasis on nature of the work -- you work too much in any field of medicine to not enjoy or at least tolerate the work. That's what I mean by a priori interest.

I disagree that STEP 1 is primarily a memorization test. You do require a minimal knowledge base which is incredibly easy to attain simply by osmosis doing UWorld. The primary skills to score highly are procedural and innate. As Charles Murray puts it, ability varies. Some people no matter how hard they study and memorize, will never hit 265+. These are the people who read First Aid 3 times and outlined everything, read every Rapid Review and BRS whatnot, and still scored in 240s. We all know these people.

I also disagree that people who score very highly on STEPs would make better doctors in general. Probably there is a nerd cliff phenomenon. However, radiology is a very pure specialty in terms of g loadedness - taking radiology call is as close as you can get to taking a standardized test in medicine, so I expect efficiency/accuracy would correlate well with STEP scores. But this is fairly unique to radiology.

Don't get me wrong - I'm not saying higher IQ/efficiency doesn't make you a better clinician elsewhere. But but but in radiology the correlation is much higher, also being deficient in other areas such as social skills hurts you a lot less. So there is a relative advantage to people who are ONLY smart and don't bring much else to the table to go into radiology.

I'm not aware of any hospitals that assign number of patients on an inpatient service according to ability, so your efficiency isn't going to make you more RVUs there.
 
1- Overall, the analysis about competitiveness is correct. But one other major point is Standard error of selection. Imagine the error of selection from applicants is 5% in all specialties. It is equal to 60 in radiology, but is about 15 in derm and is only 5 in plastics. It means at the end of the match there will be 60 people who were not qualified enough (I don't know what does that mean, but in theory), but matched in radiology. It is only 5 for plastics. So you will know 60 people that matched into radiology and were considered mediocre, but you only know 5 mediocre people who matched into plastics.

2- After doing it for a while, I do not give a $hit about what is competitive and what is not. It is just a subjective measurement of medical student's interest and to me means nothing. If urology is the most competitive one I will not do it even one day and if radiology is the least competitive I will do it every day.

3- Good Doctor: Is the most subjective thing you can talk about, esp in clinical medicine.

In private practice it means who can advertise the most and have the best rapport with patients. You may be the best nephrologist in the world, but still patients think your collegue who kills them left and right is the best one.

In academics means whoever writes the most number of papers, or whoever can convince medical students that he is better. Though, still in clinical academics it is much less subjective.

4- To me a good doctor in radiology is much less subjective than any other field including pathology.
The Quality of your work is assessed by another doctor/ professional and not by the guy in the street. After a few years in practice, almost everyone knows who is the better radiologist. If you work in reading room, you will see that clinician's constantly come to one or two specific radiologists and ask their "second opinion";
" Excuse me Dr. Smith, this was read yesterday as pancreatic duct IPMN, what do you think??"

5- At the end of the day, all of these are BS. Do what you think is good for you. And good for you means, you will be happy or at least not miserable the time you leave the hospital. It is a long long life time road.
 
Well I chose radiology before I ever met a radiologist or saw a reading room. I just did a thought experiment, which included considerations of nature of the work, and lifestyle, with a dominant emphasis on nature of the work -- you work too much in any field of medicine to not enjoy or at least tolerate the work. That's what I mean by a priori interest.

I disagree that STEP 1 is primarily a memorization test. You do require a minimal knowledge base which is incredibly easy to attain simply by osmosis doing UWorld. The primary skills to score highly are procedural and innate. As Charles Murray puts it, ability varies. Some people no matter how hard they study and memorize, will never hit 265+. These are the people who read First Aid 3 times and outlined everything, read every Rapid Review and BRS whatnot, and still scored in 240s. We all know these people.

I also disagree that people who score very highly on STEPs would make better doctors in general. Probably there is a nerd cliff phenomenon. However, radiology is a very pure specialty in terms of g loadedness - taking radiology call is as close as you can get to taking a standardized test in medicine, so I expect efficiency/accuracy would correlate well with STEP scores. But this is fairly unique to radiology.

Don't get me wrong - I'm not saying higher IQ/efficiency doesn't make you a better clinician elsewhere. But but but in radiology the correlation is much higher, also being deficient in other areas such as social skills hurts you a lot less. So there is a relative advantage to people who are ONLY smart and don't bring much else to the table to go into radiology.

I'm not aware of any hospitals that assign number of patients on an inpatient service according to ability, so your efficiency isn't going to make you more RVUs there.

So an 8 hour licensing test, one day of your entire medical education, equates to how good of a radiologist you are going to be?
 
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Step 1 is absolutely a memorization test. You need baseline test taking skills, but anyone with decent reading comprehension (ie not running out of time) and basic logical reasoning skills can do very well on it.

The MCAT and SAT are much closer to IQ tests than the USMLE.
 
OK, STEP 1 is not a predictor of your future performance.

Now could you please give me a way to select the residents?

If you are talking about medical school transcript, scores and recommendations, it is a very very subjective measurement and very different across the programs.

The same problem is with radiology fellowship. There is no official test like USMLE. Believe me, each and every resident in the country has the best LORs. Esp in a large department, it is easy to find 3 or 4 people to like you and write you a good LOR, even if the rest of the department hate you.
 
What factors are most important for fellowship apps? Regarding LORs, don't programs require one from the PD and/or chairman? If so, it seems like it would be tough to get a nice PD letter if most of the department hates you.

Not really. After being trained and working with people for 4 years, they may not give a personal call for you, but they usually write a good LOR.

Overall, fellowships are relatively easy to land. And it is very variable year to year. You can land a fellowship even in good and top notch programs.

For example MGH has 3-4 times fellows of each year resident. It means if even each and every of their residents want to stay, they can fill 25% of the spots.

You will be able to match in a decent fellowship if you are geographically flexible and also you do not piss off your PD.
 
"Step 1 is absolutely a memorization test. You need baseline test taking skills, but anyone with decent reading comprehension (ie not running out of time) and basic logical reasoning skills can do very well on it.

The MCAT and SAT are much closer to IQ tests than the USMLE."

STEP 1 requires a higher level of baseline knowledge than MCAT/SAT, but to score in the 260s and above you have to be smart also. I think you are cognitively biased in thinking that everyone has the "baseline test taking skills" and "decent reading comprehension" you have. A lot of people study a long time for the STEP 1 but peak in their practice test scores way before the end of their study period. How to explain this phenomenon?

1) Knowledge in = knowledge out. They are forgetting as much each day as they manage to learn. I would argue that the amount of knowledge you would need to amass for this flux equivalence to be true would far exceed the amount you can learn in the 6-8 weeks you study for the test. And if this is true, none of us would be good radiologists, because the amount of knowledge you are supposed to learn in radiology residency is far greater than the amount you need to do well on STEP 1.

2) They are limited by their test-taking skills to progress further. I think this is more likely. This is why verbal on MCAT correlates the best with STEP 1 performance, even though verbal is by no means a measure of medical knowledge.

*Can you be smart and do poorly on STEP 1? Sure, if you don't bother to learn the baseline knowledge.

*Can you be average/dumb and do well? Sure you can compensate for not being able to make that last leap of reasoning by more memorization, but since the knowledge required to move up linearly in score increases exponentially, I'd be surprised if you scored 265+ with average test-taking skills.

I'm not an IQ elitist. I don't think IQ/STEP scores are everything, in fact they are only helpful in training and early career when the images you see are somewhat novel. Once everything becomes routine, the playing field is leveled.

I just find it annoying that intelligence is so taboo to discuss even on an anonymous public forum. We have no problems discussing other abilities that vary, such as social charm, athletic ability, musical ability, etc. In fact I'd probably rather have any of the latter than intelligence. However, since I'll never be a rock star or politician, I'm making the best of being smart, and becoming a radiologist. Please don't hate.

"OK, STEP 1 is not a predictor of your future performance.

Now could you please give me a way to select the residents?"

While I'm on the contrarian / taboo breaking warpath, let me mention another factor which is often ignored in polite discussion. Physical attractiveness. Not as much for guys because the vast majority of guys are average-looking. But for a girl, how physically attractive you are is probably the most important thing at the interview. Clearly they ask you questions and evaluate your dynamic with the other interviewees, but this isn't going differentiate most interviewees. There aren't enough sociopaths to weed out.

For a girl, how physically attractive they are is very important. It is a huge determinant of their social status and how well they are treated. And I think it is no different in residency selection. The hot girls get a big boost. And by hot I don't mean 9s and 10s, because you really don't see any of those in medicine, but 7s and 8s you definitely get a competitive edge over the homelier 4s and 5s. I'm not saying this is right, but an empiric trend I've noticed. This may be especially true in dermatology, and male-dominated fields like surgery, and ultra-competitive fields/programs where there are more than enough people with the requisite paper credentials to fill the program.
 
OK, STEP 1 is not a predictor of your future performance.

Now could you please give me a way to select the residents?

If you are talking about medical school transcript, scores and recommendations, it is a very very subjective measurement and very different across the programs.

The same problem is with radiology fellowship. There is no official test like USMLE. Believe me, each and every resident in the country has the best LORs. Esp in a large department, it is easy to find 3 or 4 people to like you and write you a good LOR, even if the rest of the department hate you.

Same way that many programs do, look at the whole applicant, and emphasize the intervie. I have no problem with the STEP exams being used as a competitive entity, but I have an issue with the idea that the NBME believes "PASS" facade is enough (therefore you cannot take it again) when it is clearly not in many cases. People should have the opportunity to retake it at least once (not unlimited times) IF it is being used as something beyond a pure licensing exam. Everyone has a bad day for whatever reason, taking into consideration practice tests.

This is only my opinion, but this is getting off topic. The system is what it is and we have to play the game. I am applying to radiology regardless.
 
Same way that many programs do, look at the whole applicant, and emphasize the intervie. I have no problem with the STEP exams being used as a competitive entity, but I have an issue with the idea that the NBME believes "PASS" facade is enough (therefore you cannot take it again) when it is clearly not in many cases. People should have the opportunity to retake it at least once (not unlimited times) IF it is being used as something beyond a pure licensing exam. Everyone has a bad day for whatever reason, taking into consideration practice tests.

This is only my opinion, but this is getting off topic. The system is what it is and we have to play the game. I am applying to radiology regardless.

Fact of the matter is, STEP 1 is used for something. That something is not your perverse ability to memorize a **** ton of factoids from First Aid, 99% of which are useless for radiology.

That something is g-factor, or general intelligence, a measure of your ability to solve novel problems. For some reason it's considered taboo to administer an actual objective IQ test unless you're applying for the military or civil service, but STEP 1 is the best albeit imperfect proxy we have in medicine.
 
Fact of the matter is, STEP 1 is used for something. That something is not your perverse ability to memorize a **** ton of factoids from First Aid, 99% of which are useless for radiology.
Yes it is.

That something is g-factor, or general intelligence, a measure of your ability to solve novel problems. For some reason it's considered taboo to administer an actual objective IQ test unless you're applying for the military or civil service, but STEP 1 is the best albeit imperfect proxy we have in medicine.

So step 1 is the next IQ exam, huh? What score is considered "intelligent" then? 210? 220? 230? 240? And what level is considered "mentally ******ed"?
 
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