Hi everyone,
I'm a MS3. Full disclosure, I have been juggling with the thought of being an IR vs. being a surgeon, and am truly struggling with my decision. I have great reasons for pursuing both, in addition to some reasons for avoiding both, but ultimately I know that my final decision will be between these two fields. I have some questions, primarily for those who were interested in Surgery who pursued DR/IR for the procedural aspects of this field.
For those of you who were originally interested in Surgery (or any other field) and decided on IR, do you ever have any regrets about your choice?
Do you ever feel like you would have gotten more out being a surgeon? As if you're missing out?
Do you ever feel like you wish you could give more to patients?
Are the outcomes of interventional procedures satisfying enough for you?
On the flip side, do you feel enlightened and fulfilled as an IR?
Is your job satisfying, day in and day out?
Were those few years during DR and out of the OR and away from patients worth it to become an IR?
Sorry if I am coming off as completely naive for even asking these questions, or if they appear to be triggered or sided questions. I've seriously thought about what the answer to these questions might be in my own future and some experienced perspective may help shed light on whether this field is really for me.
Thanks
I'll preface this with I'm a senior radiology resident, getting ready to begin my IR fellowship this upcoming summer. I went into radiology knowing I wanted to do IR. I'll answer your questions first, and then elaborate on what I've noticed during my radiology training.
For those of you who were originally interested in Surgery (or any other field) and decided on IR, do you ever have any regrets about your choice?
I never seriously considered other fields other than medical oncology, so I can't comment on choosing between fields. I have zero regrets.
Do you ever feel like you would have gotten more out being a surgeon? As if you're missing out?
Zero regrets.
Do you ever feel like you wish you could give more to patients?
Yes, however that is only limited by the hours in the day; see below for the current dichotomy in practicing IRs and some "real-world" radiology workplace lingo.
Are the outcomes of interventional procedures satisfying enough for you?
Not sure what you mean by this really. A large majority of IR procedures are down in end-stage diseased patients, so there are many depressing circumstances. I will say that you are able to help 20+ patients a day on procedure days as cases are less invasive facilitating quicker room turnaround and patient recovery times, compared to much less (<10) on a typical surgical procedure day.
On the flip side, do you feel enlightened and fulfilled as an IR?
Given the right practice, you can intervene on every organ system head to toe; few procedural specialties can say that. On a practical note, if you're in a major city and academic center, are you going to be doing coronary angiograms and endovascular stroke treatment? No. However, if you're in a more community practice, these opportunities exist.
Is your job satisfying, day in and day out?
It will be a hard job, but I hope so. Side note: A lot of med students are somewhat disillusioned by the "cool" surgical and IR cases; don't get me wrong, it's why I plan on doing IR. You have to remember though, is the same Whipple or TIPS you put in the first time going to be as exhilarating and fulfilling as the 500th you do? Similarly, keep in mind the number of hours for those said procedures... There is something to say that, when you're 60 years old, it will be much easier to ease back to being a DR reading imaging studies, as compared to continuing the grueling hours that a surgical field demands.
Were those few years during DR and out of the OR and away from patients worth it to become an IR?
Absolutely.
The main thing separating IRs from surgical fields is the DR training. It is hard to get a good grasp of DR in medical school, and it is an extremely interesting field. I think med students don't realize that as a DR, you have to know the normal pathogenesis and management of every pathology (benign and malignant) you see. DR has really become the new "physical exam" in medicine, which is somewhat sad. At the ground level, you impact triaging for EM and primary care physicians drastically. At the more specialized level, you assist surgical specialists on operative planning.
Yes, a majority of surgical specialties are pretty good at reading studies
for that they need to (CTs; not as much for MRIs), however where DR comes in is tailoring imaging studies when needed, helping with procedural specifics, and dealing with incidental findings. Example: Urology is going to know how to read and interpret findings of the genitourinary tract (common renal masses, obstructive stones, etc.) on CT fairly well, however if on that same CT there is an enhancing liver or pancreatic mass, they are going to have no idea on what to do nor should they really as it part of their training (e.g. is it benign? malignant? will this postpone or change my planned urological treatment plan?). As the DR, I need to recommend to them what to do for these findings. It is common to speak to varying specialties throughout a DR shift; on a recent call shift within an hour I helped a trauma surgeon, urologist, and pediatric resident all manage care through image findings.
Now as I get closer to being an IR, I bring the same DR skill-set to multidisciplinary tumor boards. Common example: Hepatobiliary and GI Tumor conference. Because of my DR training, I know how to interpret CT and MRIs of proposed malignancies,
as well as what surgical and treatment options are available. Using hepatocellular carcinoma as an example, part of DR training is knowing a) imaging findings of HCC b) typical pathogenesis and spread of HCC and c) what makes the patient an operative/non-operative candidate (e.g. does the tumor invade any adjacent structures?). Further IR training requires knowing when I should and should not consider an embolo- or ablative therapy.
Final thoughts:
I can tell you that I've seen much more residents/attendings change from surgical specialties (e.g. general surgery, neurosurgery) to radiology than the inverse. Of those that have switched to radiology, not all end up doing interventional because of the similar forthcoming lifestyle that IR is becoming (e.g. moreso like surgery where there is overnight call and patient management issues, compared to the more "shift-work" DR lifestyle).
Would be happy to discuss more; send me a PM if interested.
