the end of pure nucs in the U.S.

[partusa]

I am still waiting for the SNM to make the JOB advertisements free, as they promised during the SNM residents meeting one month ago.
They are taking more than a month to do this simple change in their website and they don't need to ask for permission to modified their own policies to the ACR, just imagine how long are they going to take to work in the job crisis!!
UNACCEPTABLE!!

---

Members don't see this ad.

 

[FWHM]

Good discussion started by cathance and contribution by others. I noticed there was a post on auntminnie on residents forum with a link to this discussion and not many responses. Just proves not many radiologists are interested in our problem. Perhaps, a link should be posted on medical student forum on auntminnie. If we can prevent at least one stray medical student from committing to this dead end specialty, we have done some justice to the society.

 

[gathi]

Hi Partusa,

Thanks for your help and inputs so far.

Can you please advice about this-
As I discussed previously about doing another residency after NM. But, the ECFMG says that (and you also rightly mentioned it in a previous post) change of specialty is not allowed after PGY2 on a J1 visa. Does it mean that doing a second residency is impossible on J1?

Thanks.

 

[partusa]

Hi Partusa,

Thanks for your help and inputs so far.

Can you please advice about this-
As I discussed previously about doing another residency after NM. But, the ECFMG says that (and you also rightly mentioned it in a previous post) change of specialty is not allowed after PGY2 on a J1 visa. Does it mean that doing a second residency is impossible on J1?

Thanks.

Hey,

Check your inbox, I replied to your message!

 

[NM2010]

Hi, all there:

I believe you guys received the email from SNM regarding the CT exam survey for hybrid imaging.

The last entry is "comment". I believe this is a good chance to tell what you think about the probems of the current nuclear medicine residency training. It can be very long by my opinion.

At least you can copy and paste from this forum or at least put a link into it.

I asked for more CT training, at least one year. I believe the exam should be administered by ACR, not ABNM, not SNM. It is crap if it is administered by ABNM or SNM. But I do believe it should be part of ABNM certification and recertification exam. It should guide CT training in nuclear medicine residency in the right way, like we discussed here.

I forgot to mention there is a need for CT fellowship for nuclear medicine residents/physician. The reason is very obvious.

Good luck all.

 

[NM2010]

The main issues that concern current NM residents that were
expressed during this luncheon were:

1. The paucity of job openings for nuclear medicine board
certified physicians

2. The practice of nuclear medicine positions being filled
by radiology trained physicians with less experience in
nuclear medicine than a nuclear medicine trained
physician

3. The need for a recognized and accepted avenue or path
way for nuclear medicine trained physicians to be certified
and then hired to read CT.

It was also evident that residents want to be assured that
the leadership of the SNM, ACNM, ABNM and the ACGME are
acknowledging these issues and working to help resolve these
issues.

.......

It was stated that the number one priority and commitment
of the SNM was to have residents acquire employment
after graduation and that a job task force was organized and was
looking at what immediate short term practical actions could be
undertaken to assist residents in employment. The leadership
present also expressed that there is ongoing communication
amongst the ACNM, SNM, ACR, and ABNM regarding the decline
of nuclear medicine job opportunities.

2. Radiology and Nuclear Medicine residency pathways are
now being redesigned and reevaluated. Currently the issues of
nuclear medicine borders and radiology borders are being discussed
and evaluated. There are changes ahead in the near
future regarding the training of radiology and nuclear medicine
residents, which may positively impact the job opportunities in
the future.

 

[Taurus]

So, nuc med physicians learn to read some CT so that they can do PET/CT. What about the next new thing which is PET/MRI? MRI is heck of a lot harder to read than CT.

There are no simple solutions for nuc med physicians. The problem is structural and whether nuc med needs to be its own specialty or part of radiology. Even if nuc med physicians can read PET/CT, the problem is that they're not as attractive to radiology groups as nuc med fellowship-trained radiologists because nuc med physicians can't read all the modalities, do the procedures, and take radiology call.

 

[partusa]

Here we go again,

@ Scintillator,

Please!! Stop giving false expectations!!

I was present at that lunch, and as I remember, someone said that by the end of the year there should be important updates, even more jobs opportunities for NM graduates. It's been 6 months since the SNM meeting and nothing changed, I mean, nothing changed for good.

I was told that if an IMG wants to get into NM residency, the STEP 3 is required. People of the SNM, ABNM and NMRO, that's the perfect excuse to make all NM residencies dissapear! Well done!! At least you are doing something!

 

[NM2010]

Here we go again,

I was told that if an IMG wants to get into NM residency, the STEP 3 is required. People of the SNM, ABNM and NMRO, that's the perfect excuse to make all NM residencies dissapear! Well done!! At least you are doing something!

A correction.

If you are IMG and did residency at your home country, and if you passed step 3 with score more than 80, you don't need to do a clinical year in the US to be qualified for NM residency.

I got it from ABNM newsletter.

Looks like they have trouble to get even IMG.

 

[heidegger1]

I've just stumbled upon this thread and find it very interesting that residents would actually be writing the ACGME to try to end their specialty.

The truth is, nothing discussed here is new and could have been easily researched on message boards before you entered the residency. So while I certainly feel for your situation, you do have to research something fully, particularly a huge commitment like residency.

The things you are talking about here aren't going to work. I admire your will, but there is a lot of naivete here. My advice is to make sure you are anonymous before you organize against your own specialty, because burning bridges can only hurt you, and most of you probably aren't in a position where you can afford that. Other physicians have completed residencies in medicine and surgery and then decided to do radiology (I even know of physicans who practiced many years and then entered radiology residency), so you are not unique if end up having to do another residency. So really, you should just try to finish up your nucs training with good references, and move on.

The primary thing to realize is that nuclear medicine is controlled by radiology in the US, and that will not change.

I'm a practicing radiologist who did a 1 year nuc med fellowship after residency, both ABR and ABNM certified. I'm the author of a (I like to think) fairly widely used textbook in an area of nuclear medicine. I have practiced in both academic and private practice settings, currently in private practice. I've trained both radiologists and nonradiologists in nuclear medicine.


I can provide some perspective on nuclear medicine training vs radiology nuc med training. I've trained and trained with several nonradiologist nuc med physicians who were excellent. However, the best case scenario is that this physician also has a clinical background outside of pure nucs, such as internal medicine or cardiology. For example, I have encountered cardiologists who have full nucs fellowship who are good in nucs and very strong in nuclear cardiology, their clinical background certainly helps them. So I think that if you do not have radiology training, you should have training in a clinical specialty, rather than just straight nucs. Either that, or have a PhD which allows you to do high level research. Both these backgrounds also help with the job problem.

As to those who think that 4 months of nucs training in radiology is not adequate - yes and no. In my experience, if the issue is producing a read that gives the basic information, a radiologist with 4 months of training can do that. The primary deficiency is understanding. I find that many radiology residents don't really understand nucs beyond a very simplistic level. For example, understanding why things are done, and how to adjust things when there is a problem. Fortunately, you can do a lot of things in medicine without full understanding. Another deficiency is research, even rads who specialize in nucs don't tend to do much of it - which is why most of this will be done outside the US, which is not a big deal. Now there are some people in radiology who say that you should have fellowship training to read almost anything - which is why radiology has moved to a much more specialized boards system. In the future, there will be fewer rads doing nucs who only have 4 months of training. However, from a practical perspective, there can't be specialized coverage of everything, and that includes nucs.

However, I find that radiology training - not just CT training - has been tremendously helpful for me in nucs. Again, you do not "need" it to produce a read that give the basic information. But it can add definite additional value at some times. So it is really the same issue here as that of 4 months of training. Is not having a radiology background for nucs ideal? No. Is 4 months of training ideal? No. But we usually don't have ideal IRL.

 

[partusa]

@heidegger1

Thank you for your feedback.

Anyone can give basic information with only 4 month of nuclear medicine, even medical students. In my opinion a good practice is not based on providing a read with basic information, it's based on excellence and good patient care which is achieved by a well trained physician.
Any medical school graduate can provide basic medical care to a patient, so why are we getting into residency?
There is a reason why medicine is divided in specialties, right?.


Any nuclear medicine physician/resident can provide a BASIC radiology read after rotating in radiology, but we do not get certified either by the ABR or the SNM to read radiologic studies after residency, why? What's the difference? are radiologists smarter than nuclear medicine physicians?

 

[heidegger1]

@heidegger1

Thank you for your feedback.

Anyone can give basic information with only 4 month of nuclear medicine, even medical students. In my opinion a good practice is not based on providing a read with basic information, it's based on excellence and good patient care which is achieved by a well trained physician.
Any medical school graduate can provide basic medical care to a patient, so why are we getting into residency?
There is a reason why medicine is divided in specialties, right?.


Any nuclear medicine physician/resident can provide a BASIC radiology read after rotating in radiology, but we do not get certified either by the ABR or the SNM to read radiologic studies after residency, why? What's the difference? are radiologists smarter than nuclear medicine physicians?

Partusa,

Reading your prior posts, to be blunt, you are very naive, which is not necessarily a bad thing.

I guess we should get rid of family practitioners, since there are people who are probably better at everything they do.

It is a lot harder to do radiology after 4 months than nuclear medicine after 4 months, because the knowledge base in radiology is much larger. I know this, as a specialist in both fields. Having taken both exams, the ABR exam is MUCH harder to pass than the ABNM exam. I personally found the ABNM exam very easy, yet I understand people are saying it should be easier?

Also, the SNM cannot certify anyone to do anything. "Certification" does not determine who can practice what. With a medical license, you can practice just about anything (although nuclear medicine is different as it is regulated by the NRC). Partusa, if you want to practice radiology, as long as you have a license, you CAN practice radiology, in fact, you can practice neurosurgery. No hospital will give you privileges to do it. But you can set up a private clinic with your 4 months of radiology training and see if anyone will send you patients. You could also, legally, perform surgery in your private clinic. But, there's also the issue of malpractice.

What certification does do is suggest a certain level of competence to employers and hospitals granting privileges. The ABNM COULD say you are competent to practice radiology, but no radiology group would believe that is comparable to ABR certification, and correctly so. That's why it is called the ABNM in the first place, and not the ABR. Now if you want to be certified by the ABR, just compete like every else and enter a radiology residency. But that is the hard part isn't it?

 

[NM2010]

Peace.


Whatever the facts are, we can't fight the systems.

I do have a belief, though.

That is we should voice loudly: the pure nuclear medicine residency should be abolished. For everybody's goods. So, I wouldn't and many young medical students will not be trapped.

Many people say you should search for info before you enter nuc. But for nuc, it is difficult. You all know why.

 

[heidegger1]

Peace.


Whatever the facts are, we can't fight the systems.

I do have a belief, though.

That is we should voice loudly: the pure nuclear medicine residency should be abolished. For everybody's goods. So, I wouldn't and many young medical students will not be trapped.

Many people say you should search for info before you enter nuc. But for nuc, it is difficult. You all know why.

Well it isn't difficult. Anyone who posts a question here or on Auntminnie would be told that there are almost no jobs for pure nucs. You would think everyone would do that before making a huge decision like spending 3 years of their life on something. Also, the fact that it is completely noncompetitive should also tell you something. I am not sure how the current NM residents break down percentagewise - 1) went in from med school expecting to get a NM job, 2) didn't get into radiology and are trying to backdoor into rads, 3) are IMGs who just want to be in the US, or 4) have already completed another residency like IM and want to do something else.

 

[NM2010]

Well it isn't difficult. Anyone who posts a question here or on Auntminnie would be told that there are almost no jobs for pure nucs. You would think everyone would do that before making a huge decision like spending 3 years of their life on something. Also, the fact that it is completely noncompetitive should also tell you something. I am not sure how the current NM residents break down percentagewise - 1) went in from med school expecting to get a NM job, 2) didn't get into radiology and are trying to backdoor into rads, 3) are IMGs who just want to be in the US, or 4) have already completed another residency like IM and want to do something else.

Dear Dr. heidegger:

I do believe that is the whole purpose of this discussion here, which started in mid of this year.

We all recognize that radiology is very competitive and nuclear medicine like many other specialties are not competitive at all. I do know that I am not going to get dermatology residency in this life. We all believe this is the only residency that leads to no job with so called ACNM certificate and ACGME accreditation.

I do thank you for your input and great advises.

By the way, if you have any info regarding PET/CT moonlighting opportunity or job, please let me know.

Thanks again.

 

[heidegger1]

NM2010,

I wonder if you would be willing to reveal what the response was to the letter you sent (to the ACGME I think you mentioned)? My guess is that there was no response, but I would be curious what the response was if you received one. The ACGME probably does not consider the issue of whether or not residents get jobs to be within their purview.

 

[partusa]

Partusa,

Reading your prior posts, to be blunt, you are very naive, which is not necessarily a bad thing.

I guess we should get rid of family practitioners, since there are people who are probably better at everything they do.

It is a lot harder to do radiology after 4 months than nuclear medicine after 4 months, because the knowledge base in radiology is much larger. I know this, as a specialist in both fields. Having taken both exams, the ABR exam is MUCH harder to pass than the ABNM exam. I personally found the ABNM exam very easy, yet I understand people are saying it should be easier?

Also, the SNM cannot certify anyone to do anything. "Certification" does not determine who can practice what. With a medical license, you can practice just about anything (although nuclear medicine is different as it is regulated by the NRC). Partusa, if you want to practice radiology, as long as you have a license, you CAN practice radiology, in fact, you can practice neurosurgery. No hospital will give you privileges to do it. But you can set up a private clinic with your 4 months of radiology training and see if anyone will send you patients. You could also, legally, perform surgery in your private clinic. But, there's also the issue of malpractice.

What certification does do is suggest a certain level of competence to employers and hospitals granting privileges. The ABNM COULD say you are competent to practice radiology, but no radiology group would believe that is comparable to ABR certification, and correctly so. That's why it is called the ABNM in the first place, and not the ABR. Now if you want to be certified by the ABR, just compete like every else and enter a radiology residency. But that is the hard part isn't it?

Forums are nice because of this! Open DISCUSSION!!

LOL, naive? That's because I want to change something that is impossible to change?
I appreciate your feedback again. Of course that I can keep arguing with you about this topic for ever.
What really bothers me is that radiologists think that they can properly read nuclear medicine with only 4 months of rotation. The knowledge base in nuclear medicine can be as larger as you wanted to be; and in my opinion it can be much larger than the radiology knowledge base. But that's up to every individual case and interest.
ABNM vs ABR, of course no comparison, apples to apples, right? Not apples to pears. This is showing that you all think that NM specialty is the same as radiology, if you are a fellowship trained nuclear radiologist, you should know that this is completely false. I will not get into this, because the comparison is not valid at all.
Why the ABR is certifying in NM? I would like to see radiologists with 4 months of NM rotation taking the ABNM. If you say that the ABR is harder than the ABNM, just make all the radiology grads to take the ABNM, in order to get certified in NM. I would love to see the passing rate.
This will solve our job crisis problem. No pass, no NM certification, no NM read! This would end the NM job crisis.
Specialty Boards, it's all about $$$$$. There are physicians that are not required to take the boards or renew them, why? because probably they created the boards!! But that's another topic.
I know that you can freely practice medicine with a medical license and that's why radiologist with no adequate nuclear medicine training are reading NM studies.
I don't want to be a radiologist, ABR certified or read radiologic studies, because I don't like the specialty. I know and understand that NM and radiology are different specialties, that's why I got into NM and I am struggling to get a job.
FYI, I am not a frustrated radiologist, so, you are not hurting me saying
"compete like every else and enter a radiology residency. But that is the hard part isn't it?"
I would like to see how competitive the radiology residency would be if the radiology salaries, go down to the level of a family practitioner or pediatritian.
I am a doctor and I will not hurt my patients, misreading studies just because of money.

 

[heidegger1]

PartUSA,

There is a substantial difference between the body of practical knowledge one needs to practice and the overall body of knowledge in the field. For example, the body of knowledge in family practice is the in theory largest in all of medicine, but the body of practical knowledge needed to practice family practice is not that large.

The body of practical knowledge needed to practice radiology is substantially larger than that needed to practice nuclear medicine. This is not a commentary on either field, it is simply because radiology encompasses many more areas.

I studied about 10 x as much for the radiology boards as the nuc med boards. That should tell you something about the degree of knowledge needed. A radiology resident with 4 months of NM training probably would not pass the ABNM. A family practictioner would probably not pass the internal medicine boards, but FPs do plenty of internal medicine, perhaps you should be complaining about that. However, if radiology residents were allowed 3 additional months to study for the ABNM, they probably could pass it. On the other hand, if I gave NM residents 6 months to study for the radiology boards, I am certain almost everyone would fail - again, this is not about NM residents, but about the size of the knowledge base.

I would agree with you that NM requires a different frame of thinking than most of radiology. Most radiologists start by thinking about the image reading. In NM I start by understanding the basic processes we try to image. The image reading in NM is the easy part, the understanding is the hard part. Many radiologists don't understand NM very well, so they think NM is easy, because the image reading part actually is. However, note that I could turn your argument against you. I use my radiology background in NM all the time to improve my reports with CT, MRI, plain film and ultrasound correlation. So I could argue that you should only be allowed to read NM in an ideal world if you have BOTH the ABR and ABNM - note how this happens to benefit me, just as your argument - coincidence? - happens to benefit you.

As for NM being part of radiology, in the US, this is true. Saying otherwise is just irrelevant. I could say that echocardiography is part of radiology, but does this make it so?

As someone with background in both NM and radiology, I'm trying to provide a useful perspective. You are making comments about radiology without really knowing much about it, it takes a bit of arrogance for someone who hasn't practiced radiology to argue with a practicing radiologist about his own field. It would be like me arguing with a practicing internist about his field because I did a one-year IM internship.

In the final analysis, there isn't much to argue about if one party persists in a view of the world which has no concordance with reality. When you say things like only ABNM certified physicians should be allowed to practice NM, that has no signficance as it has zero chance of happening. Reasonable people make statements that might be practically possible. I'm curious though, what have you actually done to change the situation for the better on a practical level?

 

[rxv421]

heidegger1,

I am in a similar situation as you (minus the academic past) and agree with your posts. I would love your opinion on something...I got a donation request card from the ABNM this past week and thought that was very unusual and somewhat troubling... What do you think?

 

[IDBasco]

This thread and the whole NM forum itself is pretty disappointing. If there were much hope of job availability after residency, I would be very interested in the field.

 

[heidegger1]

heidegger1,

I am in a similar situation as you (minus the academic past) and agree with your posts. I would love your opinion on something...I got a donation request card from the ABNM this past week and thought that was very unusual and somewhat troubling... What do you think?

rxv421,

I don't recall getting the card, but it is certainly possible I threw it out without paying attention.

It is a bit pathetic and desperate for a specialty board to be hitting up its diplomates for donations. I can think of hundreds of organizations I would donate to before the ABNM.

I know for a fact that the ABNM board members went on a junket to a nice resort (in the Caribbean if I remember correctly) to WRITE TEST QUESTIONS. Yes, they could not collaborate by email, they had to go to a resort to work on these questions. I don't know how many times this has occurred.

Also, I recently took the ABNM MOC exam which was quite expensive. The questions were pretty bad, and I recall thinking that if I paid all that money at the very least I should get reasonably thought out test questions, perhaps they only spent a couple of hours a day at the resort actually writing the questions. Oh, and there were some CT questions on the ABNM MOC exam, perhaps to say that the ABNM diplomates have been tested on CT?

Here is a CT question I remember. CT image of huge AAA. What is the diagnosis? AAA, or 4 other absurd options which no one could choose. This question would insult even a med student.

Do you have the ABR NM CAQ also? I only did the ABNM as I thought the CAQ would be redundant. I also have the nuclear cardiology board certification, but I will probably not recertify for that.

 

[rxv421]

Yes, I feel the same...seems very desperate.




I was "advised" to take the ABNM over the ABR CAQ but on a whim took the ABR test as well. It is a lifetime cert for me and I am seriously considering not recertifying with the ABNM in 3 years when my ABNM expires. I am a bit worried that the ABNM may not even be around in 10 years....

 

[NM2010]

I was "advised" to take the ABNM over the ABR CAQ but on a whim took the ABR test as well. It is a lifetime cert for me and I am seriously considering not recertifying with the ABNM in 3 years when my ABNM expires. I am a bit worried that the ABNM may not even be around in 10 years....

I have the same feeling. If this country is still capitalist, then the system can't fight with capitalism, though we can't fight with the system.

Anyway, good luck to everyone.

If you don't get something you want, sometimes, it may not be a bad thing.

 

[md2456]

I am a board certified internist with a dilemma. I have been accepted at two nuc med residencies so far and I don't know what to do. I love nuc med; I believe it fits me well and I like everything about it. For any salary I would do nuc med because I like it. I discovered it late (during/after my IM residency)--[which in retrospect, based on the nuc med job outlook, may be have been a good thing actually, because if I had know about nuc med in med school, I would have for sure pursued it, and probably be jobless at this time] the interest is there 100%, the problem is it doesn't do any good if there are no jobs out there. Yet I don't know what do in my situation. For one, my training would only be 2 years. and I would always have IM to fall back on if I can't find any nuc med jobs. This changes the situation a bit (not as grim as someone going to nuc med from med school), but still will be an uphill job search effort after finishing residency. I am truly torn on what to do; I feel as if I would be giving up an opportunity here if I don't take the spot offered me.
I am wondering if anyone has any insights or advice for those who already have certification in another field who want to go into nuc med.
The situation in nuc med is complicated. Yes if you google nuc med jobs, you get 1-2 results, but it appears as some have suggested that there are unpublicized jobs out there; in the programs I have interviewed at, there seems to be that 1 resident who does find a job.....(to be conservative, I would say in the 10% rate, but this is purely an unscientific guesstimate based on my observations of the programs I have been to.). Bottom line is it's grim outlook but may be not "zero" as others suggest. What is interesting is that at some of these programs, there are very young faculty, straight out of nuc med residencies themselves. some are "kept" by their own residencies, but some are from external programs.
I don't know if having an IM background would put me at an advantage compared with "pure nuc" MD's.
Another puzzling factor in this nuc med crisis is this.....the VA seems to be the last place that still embraces the nuc med physician, where it is not encroached upon by rad or cardiology, but still you don't hear about too many job openings at the VA either. Not too many retiring I guess.
As an internist, I could do a subspecialty for 2-3 years instead of nuc med, and guarantee myself a job anywhere. If you ask me where my heart lies, it would be in nuc med--no doubt; but by mind is more practical and is steering me towards an IM subspecialty. I am also interested in cardiology, and am looking at nuc med as potentially a stepping stone into getting into cardiology (unless I find a nuc med job).

Some of the comments on this post have been very insightful and I am interested in getting some feedback:
1) what is overall recommendation for someone in IM (or other specialty) going into nuc med?

2) Is an internist who does nuc med at an advantage for any potential job opening in nuc med?

3) does doing nuc med, with eventual certification in nuclear cardiology, put me at an advantage if I decide on pursuing cardiology (which is very competitive)

4) should I ignore my heart and go with the practical choice of IM subspecialty?

 

[heidegger1]

I am a board certified internist with a dilemma. I have been accepted at two nuc med residencies so far and I don't know what to do. I love nuc med; I believe it fits me well and I like everything about it. For any salary I would do nuc med because I like it. I discovered it late (during/after my IM residency)--[which in retrospect, based on the nuc med job outlook, may be have been a good thing actually, because if I had know about nuc med in med school, I would have for sure pursued it, and probably be jobless at this time] the interest is there 100%, the problem is it doesn't do any good if there are no jobs out there. Yet I don't know what do in my situation. For one, my training would only be 2 years. and I would always have IM to fall back on if I can't find any nuc med jobs. This changes the situation a bit (not as grim as someone going to nuc med from med school), but still will be an uphill job search effort after finishing residency. I am truly torn on what to do; I feel as if I would be giving up an opportunity here if I don't take the spot offered me.
I am wondering if anyone has any insights or advice for those who already have certification in another field who want to go into nuc med.
The situation in nuc med is complicated. Yes if you google nuc med jobs, you get 1-2 results, but it appears as some have suggested that there are unpublicized jobs out there; in the programs I have interviewed at, there seems to be that 1 resident who does find a job.....(to be conservative, I would say in the 10% rate, but this is purely an unscientific guesstimate based on my observations of the programs I have been to.). Bottom line is it's grim outlook but may be not "zero" as others suggest. What is interesting is that at some of these programs, there are very young faculty, straight out of nuc med residencies themselves. some are "kept" by their own residencies, but some are from external programs.
I don't know if having an IM background would put me at an advantage compared with "pure nuc" MD's.
Another puzzling factor in this nuc med crisis is this.....the VA seems to be the last place that still embraces the nuc med physician, where it is not encroached upon by rad or cardiology, but still you don't hear about too many job openings at the VA either. Not too many retiring I guess.
As an internist, I could do a subspecialty for 2-3 years instead of nuc med, and guarantee myself a job anywhere. If you ask me where my heart lies, it would be in nuc med--no doubt; but by mind is more practical and is steering me towards an IM subspecialty. I am also interested in cardiology, and am looking at nuc med as potentially a stepping stone into getting into cardiology (unless I find a nuc med job).

Some of the comments on this post have been very insightful and I am interested in getting some feedback:
1) what is overall recommendation for someone in IM (or other specialty) going into nuc med?

2) Is an internist who does nuc med at an advantage for any potential job opening in nuc med?

3) does doing nuc med, with eventual certification in nuclear cardiology, put me at an advantage if I decide on pursuing cardiology (which is very competitive)

4) should I ignore my heart and go with the practical choice of IM subspecialty?

Go into an IM subspecialty.

You haven't stated specifically what it is that draws you towards nuc med, that is, what specifically about nuc med appeals to the "heart". It sounds like you want to use nuc med as a springboard into cardiology.

Nuc med might give you a slight edge when applying to cardiology (better to ask on the cardiology board though). It doesn't make sense to spend two years of your life trying to get a slight edge. However, it is important to understand that due to recent changes in reiumbursement, nuclear cardiology is far less profitable in the outpatient cardiology setting, and as a result, many cardiologists have simply sold their practices and work for the hospital. Without the profits from technical fees, I suspect cardiologists will find doing nuclear cardiology far less attractive.

There is one simple fact - nuclear medicine is part of radiology in vast majority of institutions. No radiology practice, whether private practice or academic, would hire a non-radiologist over an equally qualified radiologist. The only reason pure nucs has some jobs in academics is that radiologists do not want these positions, they go into private practice where the income is higher. Very few radiologists would even consider a VA nuc med position because of the low pay. On the most fundamental level, you would be trying to enter a specialty where the majority of the clinical work is controlled by ANOTHER specialty,and your potential work consists in doing what the other specialty doesn't want to do. Common sense should tell you that is not a good idea.

Being an internist will not make much of a difference, it is really more helpful in terms of having a fallback. IM nuc med people do tend to be stronger in my experience than straight med school people though. The thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research.

 

[NM2010]

Go into an IM subspecialty.

You haven't stated specifically what it is that draws you towards nuc med, that is, what specifically about nuc med appeals to the "heart". It sounds like you want to use nuc med as a springboard into cardiology.

Nuc med might give you a slight edge when applying to cardiology (better to ask on the cardiology board though). It doesn't make sense to spend two years of your life trying to get a slight edge. However, it is important to understand that due to recent changes in reiumbursement, nuclear cardiology is far less profitable in the outpatient cardiology setting, and as a result, many cardiologists have simply sold their practices and work for the hospital. Without the profits from technical fees, I suspect cardiologists will find doing nuclear cardiology far less attractive.

There is one simple fact - nuclear medicine is part of radiology in vast majority of institutions. No radiology practice, whether private practice or academic, would hire a non-radiologist over an equally qualified radiologist. The only reason pure nucs has some jobs in academics is that radiologists do not want these positions, they go into private practice where the income is higher. Very few radiologists would even consider a VA nuc med position because of the low pay. On the most fundamental level, you would be trying to enter a specialty where the majority of the clinical work is controlled by ANOTHER specialty,and your potential work consists in doing what the other specialty doesn't want to do. Common sense should tell you that is not a good idea.

Being an internist will not make much of a difference, it is really more helpful in terms of having a fallback. IM nuc med people do tend to be stronger in my experience than straight med school people though. The thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research.

Dear Dr. heidegger1:

Wow, great analysis. Everyone who wants to pursue nuclear medicine, regardless of background, should read this.

Any doubt, question, hesitation, unreal speculation should be solved.

I do disagree with one argument.Quote: "the thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research."

Nobody is doing a medical residency just simply for a high level research. A Ph.D. is more than enough, to me.

Dr. heidegger1, thanks again for your great insights and contribution to this open discussion.

-------

To md2456:

I want to discuss on two issues:

1. We do see people win lottery. By mathematics, that is small probability event. By its definition, it is considered it will never happens practically.

2. Nuclear medicine is very boring, if you do it as pure nuclear physician. One reason that it is boring is it is probably the easiest specialty. Of course, if you have a stable job with good pay, that is good thing. The reality is nobody is going to hire you to do simple and easy things with big pay.

The academic centers do hire. But to me, the trend is they want to hire dual board certified radiologist too. You can check recent John Hopkins, Emory's, University of Coloroda,'s nuc med job ads. I believe Emory's ad is still alive.

Another issue concerns me is how stable the job is even if you get a nuc med job. I really doubt that. The technology advances so fast. The nuc med residency doesn't prepare you for that, based on what I know. Just like Dr. heidegger1 said, the knowledge base is not that great in Nuc, practically.

I don't know how you figure out that nuc med is very interesting. It may look like. But it is not. It consists of imaging part, nuclear cardiology, treatment part, research part. Imaging part is mainly dominated by radiology. The patient volume is going down, at least here. They cut tech and physician positions dramatically. I don't want to tell you how many the nuc physician read daily. But it is far less than the number that the radiologists do in the same institution. You may not know that nuc exams are very very very easy to read, per my personal experience. The treatment part really doesn't create job for nuc physician. I heard the endocrinology is taking over. The nuc cardiology(stress test) is controlled by cardiology in many states. PET/CT is very interesting. But it mainly falls into radiologist's hands. Now you should know how much is left for you. It is interesting specialty. But what falls in your hand is really not. Research is never exciting for US medical students.

Probably it will survive as an independent specialty. But by my opinion, it should be only for people who don't have choice, or who is desperate, or who have backup plan and do it as hobby, or who plan well and take it as a step stone knowing the risk, or who is naive, like me.

-------------------------

Sorry, shouldn't say this much.

 

[partusa]

Go into an IM subspecialty.

You haven't stated specifically what it is that draws you towards nuc med, that is, what specifically about nuc med appeals to the "heart". It sounds like you want to use nuc med as a springboard into cardiology.

Nuc med might give you a slight edge when applying to cardiology (better to ask on the cardiology board though). It doesn't make sense to spend two years of your life trying to get a slight edge. However, it is important to understand that due to recent changes in reiumbursement, nuclear cardiology is far less profitable in the outpatient cardiology setting, and as a result, many cardiologists have simply sold their practices and work for the hospital. Without the profits from technical fees, I suspect cardiologists will find doing nuclear cardiology far less attractive.

There is one simple fact - nuclear medicine is part of radiology in vast majority of institutions. No radiology practice, whether private practice or academic, would hire a non-radiologist over an equally qualified radiologist. The only reason pure nucs has some jobs in academics is that radiologists do not want these positions, they go into private practice where the income is higher. Very few radiologists would even consider a VA nuc med position because of the low pay. On the most fundamental level, you would be trying to enter a specialty where the majority of the clinical work is controlled by ANOTHER specialty,and your potential work consists in doing what the other specialty doesn't want to do. Common sense should tell you that is not a good idea.

Being an internist will not make much of a difference, it is really more helpful in terms of having a fallback. IM nuc med people do tend to be stronger in my experience than straight med school people though. The thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research.

Probably one of the main reasons why radiologists are reading NM is because of money and also for choosing radiology as specialty.
Patient care? Good practice? Who cares?
In my opinion this is one of the reasons why the country's health care system is so messed up.

Being this my last post in this fourm, I would like to thank you all for your feedback.

Bye

 

[heidegger1]

Probably one of the main reasons why radiologists are reading NM is because of money and also for choosing radiology as specialty.
Patient care? Good practice? Who cares?
In my opinion this is one of the reasons why the country's health care system is so messed up.

Being this my last post in this fourm, I would like to thank you all for your feedback.

Bye

Good luck in your future career. Actually, since you seem to be criticizing anyone who wants to make money, there is an easy way for you to find a NM job. Offer to work an attending job for a resident salary - I'm sure you will have plenty of job offers. Since, as you say, caring about money is bad, the salary shouldn't matter to you at all. Problem solved.

 

[Oncdoc78]

Hello there fellow colleagues,

I wish to briefly share with you my experience with this field as I would never want a repeat of it to anyone else. Several years ago I had a director erroneously recruit me to his program saying I could double-board with Internal Medicine if I came to his program. Being more naive at the time I left my IM residency after intern year to come there only to find out that the entire thing was a lie.

The director pulled a "bait and switch" and tried to trick me into the 3-year version of the program. When I approached the director about my concerns his answer to me was "it looks like you're kinda screwed then". I independently went ahead and found an R2 position in Internal Medicine without his recommendation, having to use only prior references from intern year and thank goodness landed a position for the following year. When the NM program director found this out he became incomprehensibly vindictive and made every effort to try and kick me out of the program. I became generically labelled as "incompetent". Every error or anything perceived as such was recorded and filed away filled with lies and spin doctoring. Teaching did not exist anymore for me and he made everything deeply personal.

I resigned from the program several months later and it was after I had left that he became even more malignant, making phone calls to my new program trying to ruin my opportunity to "warn them" about me and went as far as contacting my student loan lenders and getting me taken off temporary deferral. It took me almost 2 years to fix my credit report.

I continued on back to Internal Medicine and with hard work and perseverence succeeded and got through just great. However, when I applied for a medical license he tried to force me to sign my rights away on a waiver form so he could badmouth me to the medical board, and would not accept the standard board release form. The lies and relative truths continued. It didn't matter to him that I succeeded and completed my residency or that I was now a fellow not even going to practice nucmed. In truth I had never harmed anyone, done anything illegal or unethical, and was only there to learn under the harshest of conditions by an egomaniac who was sublimating his own insecurities onto me.

I survived with great success and am on my way to being the best Heme/Oncologist I can be. It did teach me great humility and not a day goes by that I say thank goodness I am an internist and thank g-d I am a fellow.

Nuclear Medicine I have heard and experienced some very strange personality types and only encourge studying this if you have another specialty to fall back on.

I wish you all the best and know that even from the biggest hardships come great success and happiness.

Have a wonderful and happy new year and the best of luck to all of you.

Thankfully yours.

 

[NM2010]

Sorry to hear your sad story. Anyway, eventually, you are much better off.

Nuclear Medicine is very very very strange field. Full with very very very weird attendings. Our techs worked in several hospitals and tell the same thing. Cornell is one of them, I heard from my friends. I don't have personal experience and wouldn't hold any responsibility for this.

A waste basket of medicine.


--------------------------------------------

Happy new year, all!

 

[Oncdoc78]

I completely agree with you. This field has some very strange personality types. I honestly think that there is for the non-ABR attendings a strong element of professional insecurity and unfortunately they will sublimate it onto the residents. This is almost like an emotional punching bag.

One of my fellow colleagues who was a year ahead of me at the time had issues getting licensed at first because this malignant director pulled him off the "nucs call schedule" when a pager wasn't working. On paper when the medical board sees you were pulled off a call schedule it sounds really bad..and it would be terrible if you were say in IM or surgery. He tried to get into Radiology and did in the end...but the director tried getting in his way and tried to sucker him into doing a PET/CT fellowship in the same department to get more free labor. When had had to scramble he gave this guy a list so he could make calls for him, and the next day the director tells him "ohh was I supposed to making calls for you?".

A lot of these programs are very small and as such become hiearchal very fast. This one director I had was so evil and vindictive and it baffled me why he would do what he did. People change specialties all of the time without much discourse. For him it was deeply personal because I didn't do what HE wanted. Bear in mind he lied to me about dual-training in the first place and I had simply corrected the mistake.

I did get my license no problem in the end because the medical board saw I tried to get my information released the regular way and saw he was trying to force me to sign ALL of my rights away so he could lie and make up or exaggerate stories to the board. It's no accident that I went on to complete my IM residency and become a fellow afterwards and get through my exams and with great evaluations.

So it's like that at Cornell too? Well mine was in the midwest AND....the worst part is that it was at my ALMA MATER that I had at one point had high respect and trust for. It was sad on many levels.

There is a happy ending but goodness what frustration in the interim.

 

[lefou55]

hi

I'm a med student from Europe looking for an interesting speciality. I am a tech fanatic so NM seemed good until reading this posts and hearing some rumours.

In the Netherlands NM residency consists of 5y training,
9 months IM, 1y radiology, 3,25y pure NM.

What I've read as the biggest disadvantage: there was no future for NM, because of the developments in radiology, diffusion MRI...
That in the future because of the cost, patient exposure to radiation, and image quality, dMRI will take over.
For me that is the big question, is there a future for PET in the era of dMRI?

We don't have the problem of radiologist getting training in NM, and taking over NM jobs from NM specialists. But I'm still worried because Europe follows US trends often, and I fear maybe one day, will have the same issues here in Europe.

So my question to NM residents is, is the field interesting? Not boring? Do you have patient contacts? Don't you miss doing consultations, examing and treating people? Would you recommend the speciality if the radiologist weren't taking your jobs...?


Greetings from Europe

 

[lefou55]

by the way,

I'm one of those people who does care about his pay check, so I was wondering how the pay is/was for NM specialists compared to other specialities? (Like radiology or radiation therapy... )

 

[DoctorMD1]

x

 

[Hedgeman]

Let me say this once and let it sink in:

ABNM stands for American Board of No Marketability