2nd year medical student with an interest in IR and/or DR/IR... What to expect?

[sovereign0]

I have yet to take Step 1, but I've been having a hard time narrowing down a specialty to shoot for, especially regarding what type of research I should start to invest myself in. I've always been drawn to inpatient and procedural specialties, ranging from Anesthesia to surgical sub-specialties like NSG/ENT. It wasn't until my second year of med school that I learned how/which procedures are part of the scope of practice for DR, and that, of course, led me to discover IR.

Anyways, as a second year, I'll be graduating in 2020 and thus I would be applying for IR right around the time that the "traditional pathway" of DR → IR fellowship is being phased out in favor of the Integrated vs. Independent vs. Independent with ESIR pathways.

Society of Interventional Radiology- IR Residency

I know it's impossible to predict the future, but if anyone would have insight into what to expect, it would be those perusing this forum.

Essentially, I wanted to gain a better understanding of the differences in competitiveness and advantages/disadvantages of each of the three pathways into IR I will be facing. It's my understanding that recently, people have been applying IR with DR and an IR fellowship planned as a backup due to the highly competitive nature of the budding integrated IR residencies.

Since I'll be applying right when that backup won't be an option anymore, I want to set myself up for success ASAP. I know that Step 1 will be hugely important (I know DR is around 240s and IR is even higher), and I know that grades/AOA will be important too. What about research? In your experience, is highly specific IR research as important as specific research is in the fields of Rad-Onc / NSG? What are the expectations?

A couple of miscellaneous things I've picked up to be relevant: my institution does have a home IR program, and I would absolutely be happy with a career in DR, or having DR be a significant part of my practice - though I feel that the procedural aspects would be more fulfilling than reading studies.

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[JaneDoe1]

Your options would be:
1) Do an Integrated IR/DR residency (6 yrs)
2) Do Early Specialization in IR (ESIR) at a DR program (5 yrs) followed by an "Independent IR Residency" (1 yr if you do ESIR, 2 yrs if you don't).

The IR/DR residencies are definitely more competitive than DR residencies. There is a lot of debate about whether it's better to go to a "top" DR program vs. a low-tier IR/DR program. There is no right answer, but personally I would opt for a top 20 DR program than a community-based IR/DR program. When considering DR programs, find out how many ESIR spots they have. Some schools only have 2 ESIR spots/yr, but 5 residents/yr that want to do it. This creates a terrible situation where residents are competing for ESIR spots, and some residents will have to add on a year to their training. Other programs have a huge IR case volume and can accommodate the entire residency class into ESIR, so you won't have to worry about that. There are some gems out there like Hopkins that will guarantee that you can stay on for IR fellowship if you do DR there. Therefore, I'd much rather do DR at Hopkins (with the plan to stay for IR) than IR/DR at some mediocre program. My point is - some DR programs are a great option for people who want to do IR, while others are not. You have to do your research.

The worst case scenario for the new training paradigm is that there will not be enough Independent IR Residencies to accommodate all of the people who do ESIR. The IR PDs looked at recent trends for IR applications and don't think that this will happen, but no one knows for sure. If this does happen, I think the people who will be screwed will be the people doing ESIR at middle-tier and low-tier DR programs. If you go to a top 30 or so DR program, I'm guessing you will be in a good place to match regardless (but no one knows).

While Step scores are important, the importance of demonstrating interest and engagement in IR cannot be overstated. Perhaps more so than any other specialty, it seems that IR/DR PDs want to make sure you know what you're getting into, since you now have to commit so early. Get involved with your school's IR Interest Group (or start one if you don't have one!) and the SIR Medical Student Council. Another thing that is HUGELY helpful is to have a letter of rec from a big name in IR. IR is a super small community, and a quality LOR from a big wig can get you in the door almost anywhere. If your school doesn't have a great IR program, consider doing an away.

Research is a great attribute for your CV. It doesn't have to be IR related now, but you'll want to have started some IR projects by the time you apply. If you're interested in IR now, shoot to have an abstract submitted to SIR. Then you can apply for the SIR medical student travel scholarship.

Hope this helps.

 

[sovereign0]

Your options would be:
1) Do an Integrated IR/DR residency (6 yrs)
2) Do Early Specialization in IR (ESIR) at a DR program (5 yrs) followed by an "Independent IR Residency" (1 yr if you do ESIR, 2 yrs if you don't).

The IR/DR residencies are definitely more competitive than DR residencies. There is a lot of debate about whether it's better to go to a "top" DR program vs. a low-tier IR/DR program. There is no right answer, but personally I would opt for a top 20 DR program than a community-based IR/DR program. When considering DR programs, find out how many ESIR spots they have. Some schools only have 2 ESIR spots/yr, but 5 residents/yr that want to do it. This creates a terrible situation where residents are competing for ESIR spots, and some residents will have to add on a year to their training. Other programs have a huge IR case volume and can accommodate the entire residency class into ESIR, so you won't have to worry about that. There are some gems out there like Hopkins that will guarantee that you can stay on for IR fellowship if you do DR there. Therefore, I'd much rather do DR at Hopkins (with the plan to stay for IR) than IR/DR at some mediocre program. My point is - some DR programs are a great option for people who want to do IR, while others are not. You have to do your research.

The worst case scenario for the new training paradigm is that there will not be enough Independent IR Residencies to accommodate all of the people who do ESIR. The IR PDs looked at recent trends for IR applications and don't think that this will happen, but no one knows for sure. If this does happen, I think the people who will be screwed will be the people doing ESIR at middle-tier and low-tier DR programs. If you go to a top 30 or so DR program, I'm guessing you will be in a good place to match regardless (but no one knows).

While Step scores are important, the importance of demonstrating interest and engagement in IR cannot be overstated. Perhaps more so than any other specialty, it seems that IR/DR PDs want to make sure you know what you're getting into, since you now have to commit so early. Get involved with your school's IR Interest Group (or start one if you don't have one!) and the SIR Medical Student Council. Another thing that is HUGELY helpful is to have a letter of rec from a big name in IR. IR is a super small community, and a quality LOR from a big wig can get you in the door almost anywhere. If your school doesn't have a great IR program, consider doing an away.

Research is a great attribute for your CV. It doesn't have to be IR related now, but you'll want to have started some IR projects by the time you apply. If you're interested in IR now, shoot to have an abstract submitted to SIR. Then you can apply for the SIR medical student travel scholarship.

Hope this helps.

This is amazing information. Thank you so much, this cleared up a lot with respect to what SIR is going for with the new programs. I'm a bit confused how the non-integrated pathway will be different from the current system where people match DR and just do an IR fellowship. Is it just that you would have to designate your interest in IR when you are applying to match DR as opposed to applying for the fellowship during/after your DR residency? Are they just replacing the word "IR fellowship" with "Independent IR residency"?

 

[JaneDoe1]

Yes - the "Independent IR residency" is essentially just the "IR fellowship" rebranded. One difference is that the "IR fellowship" was only 1 year, and the "Independent IR residency" is 2 years if you don't do ESIR. But the vast majority of people who go on to the "Independent IR residency" will do ESIR, making the "Independent IR residency" only 1 year, and essentially the same training paradigm as before.

To do ESIR, you have to spend most of your R4 year (the last year of your DR residency) doing IR or IR-related rotations (9 out of 12 months, I think). I believe you usually apply for ESIR during your R2 year. As discussed above, some programs will let everyone do ESIR, and some programs have a limited number of spots.

If your plan is to do ESIR, you don't actually have to announce your interest in IR when you apply/match to DR. You're just like every other DR resident, and you don't have to apply for ESIR for a year or two. ESIR is perfect for people who come in wanting to do DR, and then realize that they love IR their R1 or R2 year. Alternatively, if you get accepted into ESIR and then decide you hate IR, you can usually switch out. ESIR just means that you're signing up to take almost all of your electives with the IR section. It's kind of like picking a college major - you usually declare your major during your freshman or sophomore year, take a bunch of classes in that major during your later years, but if you decide later that your true calling is Late Renaissance French poetry, you can usually switch out.

Pros of ESIR:
1) Potentially easier to match at a top DR program, since IR/DR is currently more competitive. However, many programs want diversity of interests in their residency class (e.g. they don't want their whole class gunning for IR, and no one interested in nuc med), so if your application screams IR, I don't know how much this would help you.

2) Flexibility - everyone thinks they want to do IR, but remember how many kids came into med school thinking they wanted to be a cardiothoracic or trauma surgeon? I'm doing IR, but DR is freaking awesome, both in terms of lifestyle and how interesting/intellectually challenging it is. It's hard to know for sure what you prefer until you rotate through both as a resident.

3) Training at multiple institutions - You can do ESIR at Program A and then "Independent Residency" at Program B. It can be helpful to see how different IR groups of attendings approach the same problem, so that you can decide which approach you prefer or mesh the two together. It can also be helpful because different programs see different types of pathology - Program A may do a lot of interventional oncology work but Program B may do PAD.

4) Couples matching - will your partner also be applying for fellowship in 5 years? Now you guys can go to a school that is great for both of you, rather than essentially forcing your partner train where you did residency, or having to suffer through 1 year apart.

Cons of ESIR:
1) Uncertainty about matching into IR fellowship - If you match IR/DR, you're locked in. If you do ESIR, it may be equally competitive to get an Independent Residency spot in a few years, and could even go unmatched.

2) Having to go through another application process. It's expensive enough the first time.

3) Less continuity - if you know you're going to be at an IR/DR place for 5-6 years, you have the opportunity to get involved in more longitudinal research and the IR faculty consider you "one of their own" from Day 1.

4) Prestige - let's face it, some people are attracted to the prestige of matching into IR/DR, arguably the most competitive specialty out there right now.