ApacheIndian Please Advise

[MuffDiver]

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Hey ApacheIndian,

I have been reading your posts and I have to say that you do give a realistic view of medicine and radiology, no sugar added. I am a piss-ant medical student (IMG) looking for some advice.... Please could you help?

-- Are all of your posts from your experience through medicine and what you found to be suitable or not?

-- When you where in medical school, how did you study? What was your plan or daily regimen? Did you read books? Professors notes? How did you hack it and become so knowledgeable and do well on the USMLE Step 1?

-- Please, do you have any general advice for someone wanting to score well on Step 1? Avoid social groups? Become a loner? Hibernate? Stay focused?


Thanks for you wisdom and help.. Keep the posts coming, I enjoy your honesty and realistic point of view......

 

[AK_MD2BE]

Dear Muff,
Call me old fashioned...but I would highly suggest finding a new screen name if you want to be taken seriously around here. 😎

 

[MuffDiver]

Dear Muff,
Call me old fashioned...but I would highly suggest finding a new screen name if you want to be taken seriously around here. 😎

Thanks daddy, for lame the suggestions! 👍 One would think that you would focus on my post rather than my handle, which is irrelevant. Maybe I should have chosen a winner name, like so (AK_MD2BE), which is nothing more than jibberish that means nothing..... You may have taken offense because you are unable to relate to my handle, but that is neither here nor there. Are you the forum police in-cognito with nothing better to do at 4:10 in the morning? Maybe you should be eager to learn from the responses to my posts, that would make better use of your time..... Likely you should listen more and comment less!! You're not focusing on the concept here....

Don't judge a book by it's cover, save some embarrassment.....

 

[NPR]

Curb the attitude. You talk way too much and way too loudly for an IMG who hasn't even taken Step 1.

 

[MuffDiver]

Thanks Apache!

I look forward to your sequel reply. I am certain that you have some great information. Research, that's exactly what I'm doing now. I do have an interest in radiology along with some experience, but at this point, my main focus is how to get the most out of medschool and smash Step1. In clinical years, then I can begin rigorous research within specialities. Thanks in advance....

 

[Trooth]

ApacheIndian is my *twin.




*step1

 

[MuffDiver]

Disciplined, structured study. Unless you have a photographic memory, that is the only way to do well in the basic sciences and on Step 1. It ain't rocket science, we all know that -- but you do have to read, understand, memorize, memorize, memorize, and then regurgitate for tests. Again, not rocket science, but doing that does take discipline and hard work.

Absolutely do not avoid social groups! You only live once -- work hard, play hard is my motto. When you party, PARTY. Chase tail galore. Bed as many women as possible. Indulge in "high-yield partying" -- don't get involved with time wasting crap that so many people do -- Friends reruns, stupid birthday parties (there is always gonna be one), silly extracurricular activities. Do not be a loner, have a small, good group of friends -- ambitious, driven, disciplined people like you, not losers -- but let it be known that you will call them, they needn't call you. Oh and lastly and perhaps most importantly of all, workout, do cardio, and eat right. Body and mind function best together, in synergism -- 1+1=3.

Apache -- not to my surprise, you delivered once again. I appreciate your input and willingness to help, "lil ole me -- pee-on" medical student. Thank You!! Great advice that i'll put to use right away..... If anything else should cross your mind, please add it in here. ----- Kudos ------ 👍

 

[MuffDiver]

Apache -- if I may ask, are you a resident? Private practice? Work from home? IR? What's your speciality?

 

[Steiner]

How long is the World Domination fellowship?

 

[Trooth]

There is something very rockstarish about Apache. I wonder where you work/if I have met you.

 

[MrBurns10]

I did ok on Step 1 (244) but not great

It's sad when a 244 is considered just "ok." I think that's a great score, regardless of what's said on SDN/AM.

 

[MrBurns10]

There is something very rockstarish about Apache.

Seriously. My initial reaction was to roll my eyes at "bed as many women as you can" and then I realized I probably would have considered myself lucky to be his drunken last resort. Girls are stupid like that.

 

[Trooth]

wait wait..you would fall for his/her line of " I am a radiologist"

i think most random ppl think that is the person who reminds them not to wear deodorant when they schedule their mammogram.

 

[Labslave]

Seriously. My initial reaction was to roll my eyes at "bed as many women as you can" and then I realized I probably would have considered myself lucky to be his drunken last resort. Girls are stupid like that.

I've been on SDN for four plus years now and somehow it still freaks me out that you're a girl - I might actually have to run into you on the interview trail to actually believe it. That avitar and screen name packs some serious testosterone.

 

[MrBurns10]

wait wait..you would fall for his/her line of " I am a radiologist"

No, I mean because he's cocky. Truthfully, I don't usually go for that, but girls in general find it hot.

 

[MrBurns10]

I've been on SDN for four plus years now and somehow it still freaks me out that you're a girl - I might actually have to run into you on the interview trail to actually believe it. That avitar and screen name packs some serious testosterone.

Just because I'm a girl now doesn't mean I've always been one...


Actually, yes it does. I created this lame screenname just to "find all posts by" my boyfriend and make fun of him...I never intended on posting, so I just picked my favorite Simpsons character and favorite number. I post on AM occasionally but under a different sn.

Are you a 3rd year? If so, maybe we'll meet on the IV trail next year.

 

[Doublecortin]

Curb the attitude. You talk way too much and way too loudly for an IMG who hasn't even taken Step 1.

wow!😱 talking about attitude! 😱 Get off your high horse, Mr. NPR

 

[NPR]

wow!😱 talking about attitude! 😱 Get off your high horse, Mr. NPR

No I'm quite comfortable up here.

 

[MuffDiver]

Hey Apache -- evaluate this offer and please tell me what you think....

My professor approached me today with an offer to tutor/TA the class below me in only one given subject. The offer is a couple thousand (3K) $$$ for one semester with a 6 hour weekly time commitment for tutoring (I make my own hours).

-- Should I take the opportunity to make a few thousand and sacrifice my own study time to do so?

---- OR ----

-- Should I pass on the money and focus solely on my own studies, take it as a loss and move on?

Whats your take on the situation? What would you do?

 

[MuffDiver]

Sounds like a winner...!! 👍

 

[MuffDiver]

Im sure you'd agree that "live specimens" are best when identifying the "main" structures of the urogenital triangle and testing T4 sensory innervation...?

 

[Substance]

Hey Apache,

I've read your posts over the last little while. They're quite bluntly informative, which is refreshing in the inefficient, self-important world of medicine. Now, I have a question:

You say that cash is king, and thus advise students to pursue fields that pay well per hour worked - rads, gas, derm. What I'm wondering is why you never suggest path or rad onc? Are there any particular things about either field that would cause you to discourage others from pursuing? As far as I know, both pay quite exceptionally well and both have very good hours.

 

[NPR]

Hey Apache,

I've read your posts over the last little while. They're quite bluntly informative, which is refreshing in the inefficient, self-important world of medicine. Now, I have a question:

You say that cash is king, and thus advise students to pursue fields that pay well per hour worked - rads, gas, derm. What I'm wondering is why you never suggest path or rad onc? Are there any particular things about either field that would cause you to discourage others from pursuing? As far as I know, both pay quite exceptionally well and both have very good hours.

Path isn't fantastically well-paying as far as I've seen. Path subspecialties are but they require fellowships and can often be fantastically competitive (see: dermpath)

Radonc might be the hidden gem out of all of these. Lifestyle approaches that of derm. Reimbursements are good. I see two problems though:

1) You have to be able to deal with chronically ill patients. (I'm as guilty of anyone as yammering on about lifestyle/$. But I just couldn't imagine myself in this field dealing with end of life issues/palliative care) Something rads/gas/derm don't have to.

2) If the doomsday scenario arrives where reimbursement is slashed for radiation therapy, that would be bad as that's their sole treatment modality.

Of course I could be all wrong on this. Let's hear from the expert.

 

[medgator]

Rad Onc - YOU WILL SPEND YOUR LIFE READING BORING JOURNALS. You will read them at breakfast, you will read them on the commuter rail, you will even read them on the john. Rad Onc's by definition are academic eggheads. Now I'm not saying there's anything wrong with that, but me I'd rather have my eyes gouged out than have to read geeky journals for the rest of my life, and I suspect with time and experience, most of you will feel the same. And yeah the whole patients and cancer and Kubler-Ross stages and family and empathy stuff -- while there's nothing inherently wrong with that, it gets really old after a while. Most of you will wanna -- after about 2-5 years post-residency -- work as little as possible, make as much money as possible, and have as much time off as possible. There are MUCH easier ways to do that than become a rad onc. Poor bastards are hella smart too, any one of them coulda done rads if they wanted to -- but they didn't choice correctly -- their loss, your gain 😎.

I'll take rad onc residency hours and call any day 😉 Plus we get to look at images and see and talk to people every day. I'd probably fall asleep in a dark room If I had to rads, which is why the variety in rad onc keeps me interested.

 

[PublicEnemy]

im matching radiology this year. i worked in rad onc as a clinical research coordinator for a few years though. rad oncs definitely have nice lifestyles and do not at all mind what they do. every rad onc i've ever met was as passionate and thrilled about their job as any radiologist i've come met.

radiation oncologists don't work past 5 ever, they don't work on weekends ever and they make as much as diagnostic radiologists. their training is also shorter than a fellowship trained radiologist. also being an academic driven field and working with a multitude of other specialties its easy for them to conduct large research projects and publish significantly even while being a nearly 100% clinician.

its true that its a brainy field and they do have to keep up with the literature but so do radiologists, radiologists that trained 15-20 years ago if what they do now is anything like what they trained on. they didn't have pacs, they had barely any mri exposure, ct was single slice, no resolution etc. but new technology comes out and everyone either gets on it or gets out of the way. this is how it is in every field.

i think you also have to realize that radiation oncologists are consultants. they should not be confused as a primary care doc or internist. people come to see a rad onc at their busy practices with films in hand, biopsy done, diagnosis of cancer already, and 3-4 other docs managing them already. radiation oncologists are also more often not the primary oncologist either, they do a job. oncology in general is a very team oriented area. the most interdisciplinary care, tumor boards you've got rads, paths, oncs, rad oncs, pulms, gi's, surgeons etc talking about the same patient making decisions collectively.

within rad onc, you're very team dependent too. you've got physicists, dosimetrists, radiation techs, onc nurses. and there's new and exciting technology in addition to external beam radiation, XRT, 3DCRT, IMRT, there's gamma knife/cyberknife which is basically like doing surgery via a videogame joystick, and also brachytherapy. ct simulations are cool too. but team dependency may or may not be for everyone, because you're often in an admin type of role. also because of this, job options are more limited, you have to join either academic centers or hospitals or ambulatory cancer centers that have and support these services and there are much fewer places that have radiation therapy and rad onc departments.

for me, ultimately i chose rads because i didn't want to work only within oncology. in rads you're dealing with every aspect and also i haven't ruled out the idea of doing something heavy on patient care like IR or mammo, but again going into rads residency i've got all of those options and i'll have the flexibility to join a practice of my choice academic vs private practice, purely interventional vs mixed or mostly diagnostic. but i def don't think rad onc is a bad gig for anyone interested in that field i think its pretty underrated.

 

[NPR]

Excellent point Apache ---- I bet you have banged your head against the wall a million times trying to get these people to "see the forest before the trees" ?

What crosses your mind when your at the hospital and you see these people so overly happy to stand in surgery for hours on end, so eager to do rectals, so pumped to be an internist? LOL, I bet you have some crazy thoughts and chuckle as you pass by..... thinking -- ***, Geek, Nerd -- swooped by society and can never escape being an idiot..... They are doomed?

you're doing a fine job of @$$ kissing but watch your mouth

 

[Doublecortin]

you're doing a fine job of @$$ kissing but watch your mouth

apache has quite a big following on here because he has the gonads to tell it like it is. I see nothing wrong with @$$ kissing the right people 😀

 

[hans19]

apache has quite a big following on here because he has the gonads to tell it like it is. I see nothing wrong with @$$ kissing the right people 😀

The job market is getting tight. New fellows in Rads are having a hard time finding jobs. I know people from top flight residencies and fellowships that are looking for a decent job in a decent city. Telerads jobs are a dime a dozen, with relatively little stability. When push comes to shove (IE Medicare reimbursement readjustment), rad groups will get leaner and cover their own call. The only jobs left will be those in remote/undesirable parts of the country.

Its not all the gravy that some would have you think. Be wary of advice you get from one vocal person on an anonymous forum. Talk to as many people as you can and form your OWN opinion. People might flock to Apache because he presents his situation in the most appealing light. But his story, if true, does not necessary reflect the current rads job market in general.

If you are blinded by ignorance and someone is pissing on you telling that "its raining... Hooray!" and I'm telling you "hey- that dude is pissing on you" Maybe you'd rather believe that its raining. Maybe it makes me less popular- so be it...

 

[MrBurns10]

LOL -- I bet you where the fat kid at school, you know, the one with the red curly hair, fat belly that hangs out the bottom of your shirt and ate your boogers. The one that every body hit in the nads and then ran off laughing and pointing. You must of been punked every day as a kid --- You must be pissed that you lost the moderator battle and now your trying to show your skills? LOL You are ONLY a medical student as well, or at least your GAY handle says you are. You'll prolly be nothing more than a lowly peds doc or nurse equivalent at most --- scurry along p-on, you prolly have some secaterial work to do and asses to wipe... When I'm passing by with my winner Rads posse, I'm sure you'll be quite obvious, the one walking around with poooh and puke all over you ---- LOL

Later Loser...... 👎

LOL -- telling me to watch my mouth --- watch deeeees gametes

Oh good, an ad hominem argument. Those are the best.

We get that Apache gives you that tingley sensation all over...he does that to many on here (probably not hans, though). There's no need for personal attacks, though.

 

[hans19]

Diver to NPR:

You'll prolly be nothing more than a lowly peds doc or nurse equivalent at most

Oh Really?!?

I am a piss-ant medical student (IMG) Please could you help?

Sorry I don't think there's anything that I can do as an AWESOME radiologist to help you with that.

 

[NPR]

The job market is getting tight. New fellows in Rads are having a hard time finding jobs. I know people from top flight residencies and fellowships that are looking for a decent job in a decent city. Telerads jobs are a dime a dozen, with relatively little stability. When push comes to shove (IE Medicare reimbursement readjustment), rad groups will get leaner and cover their own call. The only jobs left will be those in remote/undesirable parts of the country.

Its not all the gravy that some would have you think. Be wary of advice you get from one vocal person on an anonymous forum. Talk to as many people as you can and form your OWN opinion. People might flock to Apache because he presents his situation in the most appealing light. But his story, if true, does not necessary reflect the current rads job market in general.

If you are blinded by ignorance and someone is pissing on you telling that "its raining... Hooray!" and I'm telling you "hey- that dude is pissing on you" Maybe you'd rather believe that its raining. Maybe it makes me less popular- so be it...

My beef wasn't with Apache at all but rather the blatant butt smooching the OP was performing. I find Apache's comments to be fantastic. Who wouldn't want a future like that? Sadly, I do think that Hans' scenario is more likely for newly graduating residents.

All in all, it's not a huge deal because the OP was clearly a troll and is now banned

 

[medgator]

One HUGE point that I forgot to mention that further detracts from Rad Onc's appeal: NO GEOGRAPHIC FLEXIBILITY.

Are you joking? There are plenty of locum tenens opportunities in rad onc. Don't spread misinformation. People are looking to get away for weeks to months, and some hospitals need someone to fill-in while they look to hire someone permanent.

And if you want to re-locate, go ahead. Outside of the bigger cities, there are job opportunities in most places. I'd imagine its the same situation in rads.

 

[medgator]

After RAD, I'd throw Rad Onc in the group of 2nd tier medical specialties... along with EM and Path.

Actually I'd throw rads in there and put rad onc on top. Decreasing re-imbursement creating a pressure to read more and more studies in a given period of time lessens the appeal of rads immensely. Plus, throw in the med malpractice, and well rads isn't the shining specialty you might think it is.

I'll never get paged at 3AM in residency to read the 4th head CT of the night. Not that there's anything wrong with that. The only people I've met that are more chill than us are the people in nuc med.

 

[InternationlDoc]

Question to the minted radiologists/residents: Apache, hans, Voxel whoever

Is there such thing as opening up your own "group" / private practice in radiology? Is capital the problem or connections to hospitals sending reads? how much one go about establishing their own practice (if there is such concept in radiology) and not rely on job market/ big groups.

 

[CuriousKat]

One HUGE point that I forgot to mention that further detracts from Rad Onc's appeal: NO GEOGRAPHIC FLEXIBILITY. You have a locked patient base that you are following and seeing and treating year after year after year. What if you're tired of living wherever you are and wanna up and move? TOO BAD. You better stay right where you are -- sure you can move, if you're ready to start from scratch again. What if you wanna take a 3 month sabbatical and go to Tibet to meditate? Again, you are pretty much screwed -- it would take a monumental effort to get someone to cover your load and his for any long period of time.

What about rads? A radiologist can move at the drop of a hat. Here today, gone -- wherever the hell I want -- tomorrow. Take 3 months to spend with underage girls in Bangkok? Have at it -- no prob whatsoever -- there will be plenty of studies to read whenever I get back. Heck if I really want I can prelim US studies from Bangkok too!

You really can't put a price on this sort of freedom and flexibility -- it really is, to use a somewhat trite expression, priceless.

Rads isn't alone in this strong point -- EM has it, gas has it albeit to a somewhat lesser degree. Derm, while a great field overall, notably, does not have it.

Look I'm not saying that Rad Onc blows. It doesn't. It's not a bad gig, but anyone who puts it up there with Rads doesn't know what he's talking about. After RAD, I'd throw Rad Onc in the group of 2nd tier medical specialties... along with EM and Path.

Apache makes a good point, one that medical students don't really think about. Teleradiology is really a unique job not only in medicine but in society in general. In what other profession can you live in San Diego and then decide you want to live in New York and move without worrying about your job? It is a high paying gig with total flexibilty. Sure it may not be as high paying or stable as a traditional job in radiology, but Apache seems to be doing pretty well. If your idea of the American Dream is living in the midwest, married, with 2.5 kids for a 30 year career, maybe this flexibilty isn't that important. But if you want to see the country, not be tied to single area, it is definitely something to think about.

I have a friend from med school currently looking for a job in pathology. There are a couple cities he is highly interested in that simply are not hiring. He was willing to work for a low salary, long partnership track, etc. No dice.

With radiology you can literally live wherever you want. It is something I wish I had thought about.

 

[medgator]

Can a rad onc make bank from home in his jammy-jamz? Well I DO JUST THAT BROTHA.

Let's hope outsourcing leaves your gig intact...

 

[medgator]

I can't attest to the veracity of this (I have never heard of it) but if it is true then I digress, you may be right.

And what about the med mal, apache?

 

[medgator]

If you're so confident in your rad onc choice what are you doing lurking around the rads forums? Go back to your dweeby journals and Dungeons & Dragons or whatever it is you do. Seems to me like you are looking for some reaffirment of your choice of rad onc over rads -- well you aren't gonna get it from me friend. But there is hope for you: Like I said rad onc is competitive so if you got rad onc you can definitely get rads. Here's my advice: BAIL ON RAD ONC and segue to rads! Denial ain't just a river in Africa friend, face the truth now before it's too late -- deep down you want to be a radiologist!

Im quite happy in rad onc but I do feel the need to clarify your misconceptions on the field.

 

[cdql]

Coupla questions if someone wanted to find themselves in your position:

1. Does it matter what residency program you come from?

2. Does it matter what fellowship you pursue?

3. What skills does it require? Just an insane ability to read through studies quickly? Solid people skills to convey the information?

4. Do you need to work in-hospital for these #s? Pure teleradiology? Join a private group?

I'm curious because you paint a bright picture and it doesn't seem to be the same picture being painted by others on auntminnie.

 

[hans19]

I'm curious because you paint a bright picture and it doesn't seem to be the same picture being painted by others on auntminnie.

Which is what I've been saying all along.

Apache's mantra of bang as many chicks as you can, make money and buy an Aston Martin may actually appeal to a lot of the bored-out-of-my-mind-been-studying-all-my-life-don't-have-a-social-life nerds that he so often maligns. Most radiologists don't live like that. Perhaps he doesn't even live like that. You can't easily prove or disprove what is said in an anonymous forum.

Don't you think its odd? Most accomplished womanizers don't brag about it. Most who drive fancy cars don't brag about the cars they drive. Those who make alot of money try to stay under the radar.

There is plenty of BS being made and there are plenty hungry to eat it up.

 

[cdql]

I think it's odd but still possible.

If you are going to learn from someone, why not the best? 🙂

 

[cdql]

no seriously, we'd like your answers too

 

[rickjamesbtch]

LOL -- some people have more drive than others. The appealing scenario that Apache speaks of can be possible. We all should strive to be at the top, however there is only room for a select few. Clearly, Apache is there or well on his way, maybe he's hustler, a go-getter, if so, don't knock him for it, learn a few things and get to the top yourself.

I think everyone on this forum can benefit from someone who is willing to give good advice and be REALISTIC, you are less likely to be let down if you truly know what to expect. Apache does a great job of putting that out there.

There will always be haters.....

Apache - what region of the USA does your ideology apply to, speaking of wages / lifestyle?

 

[hans19]

I'm not hating... I'm "telling it like it is".

If any one is hating, its those who put down other specialties because rads is so AWESOME and everything else is lame.

In most cases, telerads gigs are neither desirable/stable/or lucrative. Ask anyone on Auntminnie. Most of the telerads company stocks have tanked... you think GM and Citigroup have it bad? The way to win a teleradiology contract as an independent guy is to low ball an existing contract. You do the math. A parttime telerad gig is a great source of supplemental income for a resident, but a full time telerad gig gets you no where near the top for an attending.

Lets go back in time to the pre-med forums... What would you think about someone bragging about MCATS and GPA?

Fast forward to the MS forums what would you think of someone bragging about Step 1 scores and AOA?

What would you think about a new radiologist who brags about how much he makes? Short of seeing a W2, its hard to know what to believe.

One more thing, I hate to break it to you guys but Santa doesn't exist.. neither does the toothfairy.

 

[Studebug]

🙄

Fine Hans. You win. I am full of hot air.

Attention SDN radiology forums readers:

HANS is the man. HANS speaks the truth. HANS sets the standard. Everyone should aspire to be like HANS.

Thanks Hans, for bringing us all down to earth. Now everyone can happily be mediocre just like you.

Apache

Can you give us your wisdom on the pay/benefit differences for telerads, locum tenens, and private practice?

Can you combine like say private practice with doing nighthawk support periodically on a weekend? Is there a different "combination" that works better together to maximize the bang?

 

[Re3iRtH]

I'm not hating... I'm "telling it like it is".

If any one is hating, its those who put down other specialties because rads is so AWESOME and everything else is lame.

In most cases, telerads gigs are neither desirable/stable/or lucrative. Ask anyone on Auntminnie. Most of the telerads company stocks have tanked... you think GM and Citigroup have it bad? The way to win a teleradiology contract as an independent guy is to low ball an existing contract. You do the math. A parttime telerad gig is a great source of supplemental income for a resident, but a full time telerad gig gets you no where near the top for an attending.

Lets go back in time to the pre-med forums... What would you think about someone bragging about MCATS and GPA?

Fast forward to the MS forums what would you think of someone bragging about Step 1 scores and AOA?

What would you think about a new radiologist who brags about how much he makes? Short of seeing a W2, its hard to know what to believe.

One more thing, I hate to break it to you guys but Santa doesn't exist.. neither does the toothfairy.

Hello hans, are you a rads fellow? If so, what subspecialty?

 

[Goober]

As an attending, I highly recommend that people on this forum talk to actual practicing radiologists in the private practice setting and those doing teleradiology. Some of the posts on this thread are way out there and not realistic. The vast majority of rads do not do teleradiology by choice. A very large number that have tried it have gone back to traditional practices. There is a reason for this and it is not because they are mediocre or not interested in making money.

 

[testingpig]

Hey Apache,
Are you really a teleradiologist? I mean you are not associated full-time with any practice and you got these jobs straight out of residency? What do you think will be the future of teleradiology 10yrs from now?

 

[Baller MD]

Hey Apache,
Are you really a teleradiologist? I mean you are not associated full-time with any practice and you got these jobs straight out of residency? What do you think will be the future of teleradiology 10yrs from now?

I don't think he is...

 

[psychforme]

Dear Muff,
Call me old fashioned...but I would highly suggest finding a new screen name if you want to be taken seriously around here. 😎

A wtf quote from dictionary.com:

muff

   /mʌf/ Show Spelled Pronunciation [muhf] Show IPA –noun 1. a thick, tubular case for the hands, covered with fur or other material, used by women and girls for warmth and as a handbag.
...

Later there was a more vulgar explanation of anatomy.