Anyone MISS patient contact?

[Lacuna]

Hello,

I am a 3rd year considering radiology as well as ophthalmology (retina). Do any of the practicing radiologists or residents out there wish they had patient contact? If I like patient care as a med student, but love images, is radiology a poor choice?

Do you feel that your work is gratifying even if you don't see the patient improve as a result of your efforts? Ever get cookies or fruit baskets from patients?

Thanks!

---

Members don't see this ad.

 

[colbgw02]

No.

 

[medgator]

If you like imaging and the idea of patient contact/longitudinal follow-up, try radiation oncology. I liked looking at imaging but hated sitting in a dark room all day interpreting images. You get some pt. contact with mammos, nuc med, and IR, but it's limited.

Rad onc on the other hand is a clinically based specialty where you use imaging to help treat cancer patients with radiation. You see patients every day yet it is very much an imaging-based specialty. You use the images for treatment, not to diagnose something. You have to be pretty comfortable dealing with onc patients. It's nice because you aren't dealing with PCP issues like HTN and diabetes, but you are an outpatient-based specialist who generally will be home by 5-6 PM most days and will rarely get called in on a weekend. It's a very gratifying job IMO --- there is a fair amount of palliative stuff you do, but by and large, most radiation cases are curative. You develop pretty close ties with your patients and yes I've gotten fruit baskets and cookies from patients before 😉 I leave work every day and can't imagine doing ANYTHING else ---- not radiology, derm or optho!

 

[ScooterBanks]

This question, in some form, comes up about once a month. The solution is so easy:

If you like Radiology and a patient contact specialty and are having a hard time deciding between the two, by all means go through the Radiology match.

Do your intern year in a good, big name program in prelim-medicine/surgery (even FP or peds if they will let you). By January of your intern year, reconsider just "how much" you like patient care. My guess is by that time you will laugh at yourself for even considering it. You only lose a year of your life by slaving away at some difficult prelim year instead of going to a cush transitional year, and you will begin to count down the days until you start Radiology.

If for some freak reason during your prelim year you decide you actually like medicine/surgery etc, just go to your program director, tell them you've had a change of heart and want a categorical spot and switch...I can assure you there will be one for you. If for some strange reason there is not, I also can assure you that you will have no trouble getting a categorical resident to essentially switch to Radiology for you. Again, you lose no time by doing this and will have a categorical spot at a strong program where you went for your prelim year without having to take a year off.

You are going to find out that patient care in unbelievably overrated. As a medical student you have a fraction of the responsibility and workload of a resident or attending. This allows you to see a side of "patient care" that you will never see and a resident or attending. You are not getting the page at 3am that says "Mr. Jones is hungry, can he eat", or the 4am special "Mrs. Smiths potassium is 3.8, what do you want to do about it", or at 5pm when you are just about to leave the hospital for your kids birthday party that "Mr. Taylor's sats are dropping he's not looking good". Don't think all of that stuff stops once you finish residency either. I contend it gets worse, because unless you end up at an academic institution, you will not have residents to take all of those annoying pages and you will be getting them.

Patients will eventually become the enemy. You will become so overworked that the only thing that will be going through your mind when you admit or round on someone will be "how fast can I get this gomer out of here". Chances are you will become very resentful and bitter towards 90% of patients. Sure there are rewarding moments, but they are few and far between. You will understand the 8th Law of House of God with newfound clarity: "They can always hurt you more".

If you like Radiology AND something else equally and can't decide, go through the Radiology match. It's much easier to switch the other direction without losing any time.

If you decide you like something else more than Radiology, God bless you and go for it. I'm happy there are people out there that can tolerate that stuff because someone needs to do it!

 

[f_w]

No.

I have just the amount of patient contact I care for. Depending on the day, I see anywhere between 2 and 10 patients. And yes, patient contact is overrated.

 

[anotherhopeful]

wow that is TOTALLY me....i'm at the second stage about to transition to the 3rd stage...and i'm holding on to gas because i still wanna be a "real" doctor and "save lives" by running codes and such. but it seems like every day that goes by in my M3 year, i'm realizing just how awesome rads is and how much i don't like talking to patients. might as well just give in and go for rads huh?

 

[Mariah246]

Pre-med and med students generally move through predictable stages when it comes to desiring patient contact:

1. Pre-med/junior med student watches a couple episodes of ER/House/Doctor 90210/(pick your medical drama de jour) or shadows a relative for a couple days or whatever and proudly declares that he too wants to be a neuro/trauma/vascular/plastic surgeon or cardiologist and SAVE LIVES AND HEAL HUMANITY AND MAKE THE WORLD A BETTER PLACE. Student gets lots of uninformed nods of approval from friends, relatives, and other laypeople, and this further reinforces his ostensibly noble convictions. Student may even get laid once or twice because his naive declaration impresses some 17 year old at the local watering hole.

2. Student gets about halfway through his 3rd year of med school and begins to think to himself that this patient contact thing isn't all that it's cracked up to be -- in fact, it is NOTHING like it is on TV, and then fields like gas/rads/derm start to look like a decent escape plan. But since he's already told everyone for years that he wants to be REAL DOCTOR, he persists in a Kubler-Ross denial-type state trying to convince himself that HE WILL BE DIFFERENT AND WILL BE A REAL HERO DOCTOR.

3. By the end of his 3rd year, student he will have realized the follie of his uneducated plans that were laid out years prior. He'll then announce to everyone that he's going to switch gears and pursue Interventional Radiology, because in IR he'd get lots of PATIENT CONTACT and is still a REAL DOCTOR and since he has a "keen eye for findings" (I often hear this cited and frankly, find it a bit ridiculous) and blah blah blah he'll do great in diagnostic radiology too -- but he'll emphasize that doing radiology is simply a means for him to do IR later, which is what his goal really is... i.e. to be a REAL DOCTOR. His friends and family will think he's a wimp for bailing on his GUNG-HO plans, but student will exhaustively explain to them THAT IR GUYS ARE REALLY REAL DOCTORS.

4. If the student remained competitive in med school and ended up successfully getting a rads spot, about halfway through residency he'll realize that IR is pretty much a pain in the a$$ too, and that bread & butter diagnostic rads is truly the holy grail of all of medicine and surgery, and he'll bail on IR altogether. He'll laugh at himself for being so foolish years prior, and feel pity on his cohort in some garbage field of surgery or medicine, destined to a life of misery dealing with gomers forever. At this point our brave student will probably be making so much money moonlighting and have so much time off to do other stuff and have so many oh-so-sweet deals lined up for after residency that any doubt from friends and relatives will be dispelled, and they too will finally realize that radiology is the best job in the world.

Don't buy it? This is a true story people. That stupid and naive and uninformed student was me -- started off gung-ho NEUROSURGERY -- "settled" on neurointeventional -- and finally came to my senses and stuck with plain 'ole diagnostic rads. I'm thankful that I was able to navigate the confusing and bias maze of pre-med/med school and not be brainwashed like so many other poor souls are.

Patient contact sucks. You can accept it now or you can accept it later, but accept it you will, I assure you.

Good luck!

good points

a cursory glance at auntminnie though shows that the field isn't as rosy as others may claim. any truth to the following points that seem to crop up on that forum? or are they overblown?

1) dropping reimbursements (yeah, everyone faces it, but the big earners are the big targets. and like you say, rads is one of the big ones at the top right now)

2) inability to practice solo with your own office (yeah, most people don't pursue this pathway no matter which field they pick. but with all the cancelled radiology contracts featured on auntminnie, point #2 would be a nice option to have)

3) high liability (yeah, it's prevalent in other fields too. but in the event you were trying to pick between derm and rads, go for derm. hard to mess up that severely 😉)

 

[f_w]

1) dropping reimbursements (yeah, everyone faces it, but the big earners are the big targets. and like you say, rads is one of the big ones at the top right now)

You answered your own question.

2) inability to practice solo with your own office (yeah, most people don't pursue this pathway no matter which field they pick. but with all the cancelled radiology contracts featured on auntminnie, point #2 would be a nice option to have)

I am in a solo practice. Currently as part of a larger organization, but a number of the rural places around me are run by classic single-practice radiologists or groups with up to maybe 4 members.

Also, cancelled contracts may be a bummer for the groups that lost them, but at the same time they open opportunities for independent enterpreneurial rads who can step in once the hospitals that canned their groups start to get desperate.

3) high liability (yeah, it's prevalent in other fields too. but in the event you were trying to pick between derm and rads, go for derm. hard to mess up that severely 😉)

For liability, you have insurance. If you keep you fingers off mammography and OB ultrasound, your risk to get sued drops by 60% (and into a range similar to most other specialties).

 

[anotherhopeful]

I'm not sure if you're being sarcastic or not -- regardless, gas is a good field, you can't go wrong with it either.

def not being sarcastic. i just feel like i'm getting pulled by radiology and i'm fighting it cuz i wanna maintain some patient contact with gas...but at this point i almost don't even care about talking to patients any more. i think in a few more months i'll be positive i don't wanna talk to patients any more.

 

[medgator]

I've said it before and I'll say it again, all patients should be shot.

Spoken like a true radiologist/pathologist.

To each his own --- that's what's so great about medicine. There are enough options for varying levels of patient contact. There's always an exit plan if you figure out that pt. contact isnt for you or that you want it in only a limited manner (even if you write that oh-so-humanistic essay about wanting to help people when you were a premed).

 

[Taurus]

def not being sarcastic. i just feel like i'm getting pulled by radiology and i'm fighting it cuz i wanna maintain some patient contact with gas...but at this point i almost don't even care about talking to patients any more. i think in a few more months i'll be positive i don't wanna talk to patients any more.

How much patient contact do you think that anesthesia has?

I'm doing an anesthesia acting internship right now and I can tell you that they have minimal contact.

 

[Doublecortin]

Well in that case rads is definitely for you. Mind you in the unlikely event that you still do want to see patients after 1+4 years of rads, you really can do IR (or even mammo, which is a lot like clinic). Again, the beauty is flexibility -- if you do an IR fellowship (a relatively painless and heck, even kind of fun year) you can always switch hit between IR and diagnostic rads depending on what mood you're in regarding dealing with patients.

But again, gas is a good field too -- matter of fact, pain guys do a lot of the same stuff that IR's do.

I've said it before and I'll say it again, all patients should be shot.

man! I love your brutal honesty

 

[Long Dong]

good points

3) high liability (yeah, it's prevalent in other fields too. but in the event you were trying to pick between derm and rads, go for derm. hard to mess up that severely 😉)

👍

 

[manning18]

It's funny when Healthcare Professionals talk about how much they despise patients.

If you think about it (and you don't even have to think about it very carefully), patients are your clients!

If patients were shot and killed, all doctors (Radiologists included!) would be unemployed! Why become a Doctor if you hate patients that much? There are other ways to make good money.

 

[Mariah246]

It's funny when Healthcare Professionals talk about how much they despise patients.

If you think about it (and you don't even have to think about it very carefully), patients are your clients!

If patients were shot and killed, all doctors (Radiologists included!) would be unemployed! Why become a Doctor if you hate patients that much? There are other ways to make good money.

true but not all of us have an accurate cannon arm, mr. manning

(or enjoy hamming it up in commercials)

 

[Strength&Speed]

It's funny when Healthcare Professionals talk about how much they despise patients.

If you think about it (and you don't even have to think about it very carefully), patients are your clients!

If patients were shot and killed, all doctors (Radiologists included!) would be unemployed! Why become a Doctor if you hate patients that much? There are other ways to make good money.

I like people. But sooner or later it becomes an endless parade of needy, whiny, or gomerish types. I understand there are many beautiful people who are your patients. Unfortunately they are the minority. And not only the minority, but generally the silent minority as well, because they are respectful, strong willed, compliant, etc. It is the majority of gomers and needy individuals who have psychiatric problems, chronic issues that will never be solved that command most of your time.

The reasons most specialists are more happy than generalists is that they can avoid most of this crap by referrin them to the generalist whenever any one of their complaints isnt about their specialty problem. Even them, they'll probably refer back to PCP. Oh, and they're better compensated.

Rads certainly has the drawback of being somewhat impersonal and isolated. However, its a fair trade for the alternative.

 

[Lacuna]

Pre-med and med students generally move through predictable stages when it comes to desiring patient contact

AI, that was a brilliant post. I think you're dead on👍. I am definitely in stage 3 right now, IR sounds awesome. Here are my impressions of what an interventional radiologist does:

Medicine and surgery docs get stuck with a patient who develops an abscess, hydro, portal HTN or what have you. They call IR desperate for help. Then IR comes in like a stud, fixes the problem, slaps a sticker in the chart, and the patient returns to the medicine or surgery service. The IR will also burn a few fibroids and liver tumors by day’s end.

Occasionally there’s a call in the middle of the night to the IR for a bleeder (post-partum hemorrhage, GSW etc.) Again, the IR waltzes in and embolizes the bleeding vessel, saving the patient’s life and the med/surg/ob’s butt.

This seems awesome to me. And the IR can go anywhere in the country, do locums for a while, and fatten his wallet. Sure, there are turf wars with other specialties, but there is plenty of work to go around. Later in life, when the IR wants to take it easy, he can pare down the interventional work and read films from home.

How far is this from the truth? Are there aspects I have not considered that I should know about?

 

[dphoenix]

Cards doing UFEs? damn, I thought that UFE was relatively safe as most OB/GYNs are unwilling to venture this route due to lack of access/expertise in catheter-related interventions. Although new interventions are being made all the time, i think IR docs (and the radiology groups with them) need to protect their turf aggressively and stop letting attrition be a "fact of life" in IR. Or at least for my sake, so i have some procedures left when I start practicing 😕

Lacuna:

You got it baby -- IR guys are the uber-referral specialists... the guys that other docs call when there is no one else to call... the buck stops at the IR suite... as an IR you will save lives, bail clinicians out of trouble, and be a hero. And like you astutely pointed out, you can always do straight diagnostics for a while if you want to take it easy. Turf issues certainly exist and while it's true that many procedures historically done by IR's are now going to other specialists (e.g. I know of cards guys doing UFE's), for every procedure lost (e.g. perc neph) there is a new one on the horizon (RF ablation).

IR's a great combo for both patient contact (of the brief, meaningful variety -- the only kind that any normal human being would want) and intellectual diagnostics sans patients.

Good luck to you bro

 

[hans19]

Cards doing UFEs? damn, I thought that UFE was relatively safe as most OB/GYNs are unwilling to venture this route due to lack of access/expertise in catheter-related interventions. Although new interventions are being made all the time, i think IR docs (and the radiology groups with them) need to protect their turf aggressively and stop letting attrition be a "fact of life" in IR. Or at least for my sake, so i have some procedures left when I start practicing 😕

Clinicians used to hand referrals to IR on a silver plate. Then the clinician had to deal with any of the IRs complications. Then clinicians, seeing their own reimbursements fall, and seeing the higher reimbursement and lower complication rate AND effectiveness of IR procedures, decided to get into the minimally invasive business. Since the clinicians could see the patient first, they got first dibs and cherry picked the easy or highly reimbursing procedures and if it was too complicated or a high risk, they would dump it on to the IR. But no more. IRs have wisened up and are fighting back.

To be a high-level IR and compete with the self-referring clinicians like the cardiologists, you have to become a clinician yourself. You have to be willing to work up a patient, round on them in the hospital and see them in follow up.

If you make it easy for your primary care referrers, and are good about marketing to the public you will get the referrals. You lose some of the little-to-no-patient-contact perks that Apache was talking about. You can be a successful IR while hanging on to high level IR procedures, but have to be a go-getter. In the end you have to drum up your own business rather than waiting for something to fall into your lap as a tertiary referral.

Cardiologists in general are an aggressive bunch. More cardiologists are minted every year than Vascular surgeons, IRs and CV surgeons combined. CV surgery used to be one of the most respected and highly paid specialties. Then the cardiologists came in and brought CV surgery to its knees, and pushed many CV surgeons into retirement or into Thoracic (minus the cardio-) surgery. Now adays its nearly impossible for a new CV fellow to find a job doing cabg's. Anyone who can bring a top-flight surgical subspecialty to near-ruin is a force to be reckoned with.

 

[judu]

Pre-med and med students generally move through predictable stages when it comes to desiring patient contact:

4. If the student remained competitive in med school and ended up successfully getting a rads spot, about halfway through residency he'll realize that IR is pretty much a pain in the a$$ too, and that bread & butter diagnostic rads is truly the holy grail of all of medicine and surgery, and he'll bail on IR altogether. He'll laugh at himself for being so foolish years prior, and feel pity on his cohort in some garbage field of surgery or medicine, destined to a life of misery dealing with gomers forever. At this point our brave student will probably be making so much money moonlighting and have so much time off to do other stuff and have so many oh-so-sweet deals lined up for after residency that any doubt from friends and relatives will be dispelled, and they too will finally realize that radiology is the best job in the world.

And..

5. The resident goes out into the real world and (if he's smart) realizes that radiology is a business.

 

[judu]

: )

 

[AK_MD2BE]

What are the competitive fellowships in Radiology?

 

[f_w]

What are the competitive fellowships in Radiology?

Right now: anything MRI

'competitiveness' of radiology fellowships is highly cyclical. There was a time you had to have excellent connections to land an IR fellowship, then there where a couple of years you could walk into all but maybe the top 2-3 fellowships if you had a heartbeat and finished some sort of radiology residency. Same applies to neuro, for decades the holy grail of specialty radiology and at other times you couldn't entice fellows by paying them a faculty salary. For a couple of years now, MSK was the 'hot' thing to do, but that has abated a bit.

Competitiveness of fellowships doesn't necessarily translate into being a competitive applicant once you start looking for a job. In PP, the guy that can crank out the body CTs mixed with a smattering of basic neuro and MSK MRs (and biopsy 'misc. organs with nodules' in between) will be as competitive as any of the sub sub sub-specialists.