Applying into DIRECT interventional radiology programs

[Pomplemousse]

Hi all! I'm interested in interventional radiology and I was wondering if anyone can give some insight into the application process for the DIRECT pathway.

I guess what I am trying to understand is whether the direct pathway is something you apply into separately or rather a pathway you choose after getting into a radiology residency. Is there a separate application? Do schools set aside specific spots for those in the direct IR pathway? Is it kosher to say you are applying into IR in your essays/interviews or can that hurt you?

Also, does the general ranking/quality of a radiology program correlate to that of it's IR program? Are there any particularly good programs for IR?

Thanks for your help guys, I would really appreciate any advice.

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[Pomplemousse]

Oh and also, any advice on what clinical clerkships to take in preparation of applying to a DIRECT program? Is a surgery subinternship (maybe in vascular surgery or general or whatever) looked upon favorably or not particularly important? How about an elective or subI in another field in radiology, like body CT?

 

[penguin24]

I would suggest you don't try a direct route. Radiology has many sub-specialties, and if you commit to IR, what if you change your mind? Fellowships are easy to get, so I don't see any benefit for you making up your mind right now. I didn't know there was even a such thing as the direct route.

If, say, you wanted a direct Plastic surgery, or direct Neurosurgery, then I see why you would go directly and save yourself the hassle (as well as extra years) of applying to Gen Surg and then applying for Plastics/NSGY fellowship. This logic doesn't apply to IR.

 

[Dimoak]

This website should help answer your questions on the DIRECT pathway to VIR. Good luck!

 

[Pomplemousse]

I've heard the same advice from a few sources so I am definitely seriously considering applying only into diagnostic radiology, but it can't hurt to find out more about the direct pathway too, especially if I can apply to both.

As for the website, thanks Dimoak. It did have a lot of information on the structure and sites for direct IR programs. It seemed to be more directed towards residents applying though. From what I understand, most people apply during their rads/surg/int med residency as a PGY-1 or 2. Is that a correct interpretation? I'm still confused as to how it works for medical students who wish to apply....is there a separate application or does the residency director just submit your application into DIRECT after you have already matched into rads?

Sorry for all the confusion, I'm clearly far too sleep deprived 😛😴

And on a somewhat unrelated note, is a surgery or med subI recommended for applying into diagnostic rads?

 

[penguin24]

Dude, IR fellowships do not even completely fill every year (many rads fellowships are like that). Something to keep in mind.

Regarding internship year. One may think that since IR is procedure-oriented, that a surgery internship may be more helpful. However, almost everybody either does a medicine-preliminary year or Transitional year. The short answer is b/c surgery-prelim is so much harder that not many choose that route. Transitional years are easier, and from what I hear from residents, your internship year doesn't really help you become a better radiologist, so might as well have the most laid-back internship possible. Another argument is that surgery-interns don't even get much OR time (since everybody is gonna know you're not going into surgery), and most of the year is on the floor doing scut-work.

I know it 'sounds' better to do surgery-prelim, but one thing is to ponder doing a surgery year, and another is to actually do it.

 

[Taurus]

IR fellowships are not competitive. Makes no sense to apply to direct pathway programs and pigeonhole yourself into IR. Plus, direct pathway residents have to take both general radiology and IR boards. They have more difficult time passing the former. I heard Penn shut down their direct pathway because too many of their residents were failing the boards.

 

[Pomplemousse]

yes, everyone, I fully understand that going into the DIRECT program is a terrible idea and that IR fellowships are wide open etc etc. But, hypothetically, let's say that I want to apply both ways. For ****s and giggles. Could I?

1. Ie, when matching, could I rank both UNowhere for diagnostic and then separately, the direct pathway? Are there separate interviews/applications/essays/residency spots?

2. Is a surgery or med subI recommended for applying into diagnostic rads? One/both/neither?

 

[penguin24]

2. Is a surgery or med subI recommended for applying into diagnostic rads? One/both/neither?

Medicine prelim is recommended

 

[irwarrior]

Well, as a practicing interventionalist I have a quite different perspective. If you want to do IR well a one year fellowship is not adequate. If I had to do it over again I would have considered a strong clinical interventional DIRECT pathway.

Yes, several IR fellowships go unfilled but it i getting increasingly competitive and last year over 150 people filled IR through the match and this year looks even more competitive. The really strong IR fellowships (Miami Vascular etc) always fill and are highly competitive.

Doing 4 years of radiology, one will forget how to be a clinician and that can be a huge detriment to building a strong busy IR practice.

I admit between 5-10 patients a week to my own IR service and I am managing their blood pressure, sugars, lipids, pain control, nausea etc. Coming straight out of fellowship I was ill prepared to practice IR. Diagnostics you can read in a book and most places give you adequate training. IR, no way around doing procedures and you have to be able to admit patients as well as do a formal consult and also it is important to have a strong clinical foundation.

As far as routes in.

some allow you to apply right out of medical school.
others require at least 2 clinical years (and thus outside of the match).
still others require you to be board certified in IM or surgery and then you apply. So you get triple boarded (IM, DR, IR) etc.

Good luck and hope that helps.

 

[penguin24]

Well, as a practicing interventionalist I have a quite different perspective. If you want to do IR well a one year fellowship is not adequate. If I had to do it over again I would have considered a strong clinical interventional DIRECT pathway.

Yes, several IR fellowships go unfilled but it i getting increasingly competitive and last year over 150 people filled IR through the match and this year looks even more competitive. The really strong IR fellowships (Miami Vascular etc) always fill and are highly competitive.

Doing 4 years of radiology, one will forget how to be a clinician and that can be a huge detriment to building a strong busy IR practice.

I admit between 5-10 patients a week to my own IR service and I am managing their blood pressure, sugars, lipids, pain control, nausea etc. Coming straight out of fellowship I was ill prepared to practice IR. Diagnostics you can read in a book and most places give you adequate training. IR, no way around doing procedures and you have to be able to admit patients as well as do a formal consult and also it is important to have a strong clinical foundation.

As far as routes in.

some allow you to apply right out of medical school.
others require at least 2 clinical years (and thus outside of the match).
still others require you to be board certified in IM or surgery and then you apply. So you get triple boarded (IM, DR, IR) etc.

Good luck and hope that helps.

Question for you: The DIRECT pathway only has 27 months set for Diagnostic imaging. Do you think that is adequate preparation to read imaging films as a practicing radiologist? I mean, most IR jobs are not 100% IR, most jobs require a significant portion of your time to read other non-IR imaging studies. Do you think a graduate of the DIRECT pathway would be able to handle 50% IR and 50% general radiology?

 

[skiz knot]

I admit between 5-10 patients a week to my own IR service and I am managing their blood pressure, sugars, lipids, pain control, nausea etc. Coming straight out of fellowship I was ill prepared to practice IR. Diagnostics you can read in a book and most places give you adequate training. IR, no way around doing procedures and you have to be able to admit patients as well as do a formal consult and also it is important to have a strong clinical foundation.

Wow! Where do you work. In the two places I have seen (my medical school and residency) any patients that require admission after IR procedures get dumped on Surgery or IM. Kudos to you!

 

[Taurus]

Well, as a practicing interventionalist I have a quite different perspective. If you want to do IR well a one year fellowship is not adequate. If I had to do it over again I would have considered a strong clinical interventional DIRECT pathway.

Yes, several IR fellowships go unfilled but it i getting increasingly competitive and last year over 150 people filled IR through the match and this year looks even more competitive. The really strong IR fellowships (Miami Vascular etc) always fill and are highly competitive.

Doing 4 years of radiology, one will forget how to be a clinician and that can be a huge detriment to building a strong busy IR practice.

I admit between 5-10 patients a week to my own IR service and I am managing their blood pressure, sugars, lipids, pain control, nausea etc. Coming straight out of fellowship I was ill prepared to practice IR. Diagnostics you can read in a book and most places give you adequate training. IR, no way around doing procedures and you have to be able to admit patients as well as do a formal consult and also it is important to have a strong clinical foundation.

As far as routes in.

some allow you to apply right out of medical school.
others require at least 2 clinical years (and thus outside of the match).
still others require you to be board certified in IM or surgery and then you apply. So you get triple boarded (IM, DR, IR) etc.

Good luck and hope that helps.

I agree that IR should be more than a 1 year fellowship. In order for IR to compete effectively against the cards, vascular surgeons, neurosurgeons, interventional nephro's, etc, they have to be more clinical. They have to be able to admit and managed pts pre-op and post-op. If they don't, then interventional work will be sliced up and claimed by the specialists based on system.

 

[irwarrior]

Yes, where I was a med student and resident it was the same case. The IR dumped on the other services. I vowed that I would try to avoid that if I did IR. I went to a fellowship program where one of the IR had a busy clinical vascular IR practice. Saw 20 patients a week in clinic and admitted all of his own patients. So, once I became an IR attending I did the same thing. ADCVANDIML. How big a deal is that? I think it is sad when IR just does a case and dumps the clinical responsiblity of follow up and admissions/discharge etc to someone else. Even more pathetic is when IR does a procedure (complex one with intervention) without seeing the patient and family and discussing the procedure with the patients.

 

[freddydpt]

Taurus,
You are mistaken about Penn's DIRECT program. It is alive and well. I have a good friend who started as a first year this year.

 

[Entgegen]

Well, as a practicing interventionalist I have a quite different perspective. If you want to do IR well a one year fellowship is not adequate. If I had to do it over again I would have considered a strong clinical interventional DIRECT pathway.

Yes, several IR fellowships go unfilled but it i getting increasingly competitive and last year over 150 people filled IR through the match and this year looks even more competitive. The really strong IR fellowships (Miami Vascular etc) always fill and are highly competitive.

Doing 4 years of radiology, one will forget how to be a clinician and that can be a huge detriment to building a strong busy IR practice.

I admit between 5-10 patients a week to my own IR service and I am managing their blood pressure, sugars, lipids, pain control, nausea etc. Coming straight out of fellowship I was ill prepared to practice IR. Diagnostics you can read in a book and most places give you adequate training. IR, no way around doing procedures and you have to be able to admit patients as well as do a formal consult and also it is important to have a strong clinical foundation.

As far as routes in.

some allow you to apply right out of medical school.
others require at least 2 clinical years (and thus outside of the match).
still others require you to be board certified in IM or surgery and then you apply. So you get triple boarded (IM, DR, IR) etc.

Good luck and hope that helps.

Wow, I always envisioned IR as having all of the benefits of doing procedure-based stuff (if that's your thing) and none of the drawbacks of having to deal with patient management...