Ask me anything: Vascular Interventional bound PGY5 radiology resident.

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badasshairday

badasshairday

Vascular and Interventional Radiology
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Hi all i am a PGY5 radiology resident on my way to an interventional radiology fellowship. Ask me anything.
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Don't want to be 'that guy,' but I will- what was lifestyle like during rads residency?

Thanks for doing this!
 
What is the job market like if you didn't do a fellowship?

How competitive are each of the fellowships/what does it take to get accepted to one?

What did your typical day look like as a radiology resident?
 
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Appreciate you taking the time to do this.

Sort of similar to the question above but once in a rads residency, how hard is it to get to an IR fellowship? Are there people who go into rads for IR but get stuck in diagnostic because they can't get a fellowship? (Not that getting "stuck" in diagnostic sounds at all bad)

Also what are your opinions of the integrated IR residencies vs the traditional fellowship route?
 
Were you always considered to be the "smart" kid in hs, college, etc.?
 
Commer_Knocker said:
Don't want to be 'that guy,' but I will- what was lifestyle like during rads residency?

Thanks for doing this!
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Radiology residency in terms of hours in the hospital is better than a lot of other specialties. Typically it is around 7:30ish to 5pm on normal days on most su specialty services at most programs. There is a morning didactic conference at most programs in the morning and at lunch time. Most programs have a swing shift style call from 5pm to 9ish pm or so. Then there is overnight call. Radiology is a 24/7 service so while we have a decent lifestyle, it is no rad/Onc, derm, pmr. With that being said, when you are not on call most days are 8am to 5pm.

The exception is when you are on interventional radiology as the hours are longer and can be quite variable due to emergencies and urgent cases that can happen late in the day or at nights.
 
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LuluLovesMe said:
What is the job market like if you didn't do a fellowship?

How competitive are each of the fellowships/what does it take to get accepted to one?

What did your typical day look like as a radiology resident?
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Job market for someone without a fellowship is limited. Jobs are there, but are in more rural places. I'd wager that 90%+ residents do fellowship these days. It is a de facto requirement for all midsize to large metropolitan areas. There was a time back in the early 2000's to around 2008 or 2009 where the radiology job market was so hot that a huge number of residents did not do fellowship. The job market these days is tighter in big cities. Radiology private practices like to market that they have subspecialists and some referring physicians often expect it to.

Fellowships at are not hard to get outside of IR and maybe breast right now.

Typically I come in around 8am and leave at 5pm. If I'm on nights it is 9pm to 8am. If I'm on IR it is around 7am to 6-9pm with home call.
 
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The Knife & Gun Club said:
Appreciate you taking the time to do this.

Sort of similar to the question above but once in a rads residency, how hard is it to get to an IR fellowship? Are there people who go into rads for IR but get stuck in diagnostic because they can't get a fellowship? (Not that getting "stuck" in diagnostic sounds at all bad)

Also what are your opinions of the integrated IR residencies vs the traditional fellowship route?
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IR fellowship is the most competitive fellowship at the moment. There are many people these days, including myself, who went into radiology for IR. Fortunately the last three years there have been approximately the same number of IR spots as applicants. I think there are around 250ish spots and last year 15 went on unmatched, and the year before was like 50 people unmatched. However only 30% get there number 1 choice. Majority of diagnostic radiology residents have no interest in IR as it is more surgical minded and lifestyle is worse. But it is a freakin slick field. It also has the best job market and pay, but that is not enough reason to do it, you have to love it.

IR integrated residencies are long overdue. It is important for IR doctors to maintain top notch imaging skills because that is what differentiates us from other specialists who try to incorporate image guided procedures. The Diagnostic skills are also important because most jobs at least incorporate some diagnostic imaging into the schedule. Also the residency will allow IR to further transition into a full on clinical specialty.
 
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What radiology fellowship should one do if they plan on working as a pure diagnosic radiologist? No procedures, just reading and dictating cases all day, everyday. That's my dream.

What's the volume like? How many cases are you completing in a typical day? Do you get to a certain point in your training where you can do dictations almost on "autopilot" or do you still struggle to find the right words to describe stuff sometimes? What happens if you get a study where you don't even know what the hell you're looking at?

Does radiology attract a certain "type" of person? In other words, can you make any generalizations about the personalities of your colleagues? I was always under the impression that radiologists are generally more laid-back and chill type people.
 
Foot Fetish said:
What radiology fellowship should one do if they plan on working as a pure diagnosic radiologist? No procedures, just reading and dictating cases all day, everyday. That's my dream.

What's the volume like? How many cases are you completing in a typical day? Do you get to a certain point in your training where you can do dictations almost on "autopilot" or do you still struggle to find the right words to describe stuff sometimes? What happens if you get a study where you don't even know what the hell you're looking at?

Does radiology attract a certain "type" of person? In other words, can you make any generalizations about the personalities of your colleagues? I was always under the impression that radiologists are generally more laid-back and chill type people.
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Practice setting will dictate more of how you spend your day. There are some groups that most everyone does light procedures like LP, paracentesis, thyroid biopsies, while leaving more invasive procedures to IR. Other groups are set up in such a way that the only people doing needle work are the interventionalist, while the rest of the group does pure diagnostic radiology. However you still will likely need to do fluoroscopy studies like esophograms etc which require patient interaction. If you want pure diagnostics with no patient interaction, teleradiology can be the best option.

Volume in private practice is around 100 cases a day, mix of X-ray, ultrasound, ct, MRI, and fluoroscopy. It is busy but you learn to get fast and accurate during training and as a junior attending. There are times you don't know what you are looking at, but that is the fun I radiology, figuring out the case like a detective.

In general diagnostic radiologists like their jobs and are very thankful there is minimal patient contact and the negatives associated with it. They find patient contact exhausting and innefficient. They also like that when they leave the hospital they are done, no pager to deal with outside of the hospital. Diagnostic Radiologists are laid back in general. Interventional radiologists are another story.
 
The Knife & Gun Club said:
Appreciate you taking the time to do this.

Sort of similar to the question above but once in a rads residency, how hard is it to get to an IR fellowship? Are there people who go into rads for IR but get stuck in diagnostic because they can't get a fellowship? (Not that getting "stuck" in diagnostic sounds at all bad)

Also what are your opinions of the integrated IR residencies vs the traditional fellowship route?
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In 2020, IR will only be integrated
 
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The Knife & Gun Club said:
Is that like your assumption or an actual official shift the field is making?
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"Independent IR residency
The nationwide launch date for the new independent IR residency is July 1, 2020. ACGME accreditation of the current one-year subspecialty fellowship in vascular and interventional radiology (VIR) will cease on that date and all accredited GME training in interventional radiology will be accomplished via the IR residency. Applications for independent IR residency program accreditation must be submitted to the ACGME by July 1, 2017 to be ready to launch an independent IR residency on July 1, 2020."

I'm on the SIR student listhost and I've gone to some symposiums for IR. They are trying to recruit interested students so there are a bunch of symposiums going on
 
radnonymous said:
Do you worry about radiation exposure?
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I think about it, however as a radiologist I am trained in minimizing my dose and my patients dose. Other specialists I have seen use fluoro do not take the same precautions as radiologists.
 
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Do radiology residencies only care about Step 1 too? This website makes me feel that your board score is all that matters in life. My research is in a surgical sub-speciality with MRI utilization. I have many first author publications, honored most courses M1 and M2, and have been honoring most M3 courses. Top 40 school. I have only in the 220s tho so I am preparing my mindset right now to SOAP when my Step 1 holds me back next year inevitably. I have no chance right?...because I blew the most important test I will ever take in my life.
 
failedatlife said:
Do radiology residencies only care about Step 1 too? This website makes me feel that your board score is all that matters in life. My research is in a surgical sub-speciality with MRI utilization. I have many first author publications, honored most courses M1 and M2, and have been honoring most M3 courses. Top 40 school. I have only in the 220s tho so I am preparing my mindset right now to SOAP when my Step 1 holds me back next year inevitably. I have no chance right?...because I blew the most important test I will ever take in my life.
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Post this in the radiology forum. There are many students and interns who recently have gone through the match and can better direct you. It is competitive but there are a lot of programs. So you may not end up in that big name academic program in CA, Chicago, or NY, but you may have a shot at community programs and smaller academic center.
 
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failedatlife said:
Do radiology residencies only care about Step 1 too? This website makes me feel that your board score is all that matters in life. My research is in a surgical sub-speciality with MRI utilization. I have many first author publications, honored most courses M1 and M2, and have been honoring most M3 courses. Top 40 school. I have only in the 220s tho so I am preparing my mindset right now to SOAP when my Step 1 holds me back next year inevitably. I have no chance right?...because I blew the most important test I will ever take in my life.
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I would still apply. Your demonstrated interest in advancing knowledge will count for something. Try to do better on Step 2 CK.
 
Any idea what you expect your life to be after fellowship?
 
As a med student who struggles with interpreting images, do you have any resources that you used in the beginning (or in med school) to help you interpret images? It's so frustrating to see residents in various fields know how to interpret images and think that in 2 years I'll be expected to know how to read images like them.

Also, how is the transition from med school to residency since we don't really get that much exposure to radiology and interpreting images.
 
tymont12 said:
Any idea what you expect your life to be after fellowship?
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Probably 7 to 6 with q4 call for emergencies. If I pick a job with more diagnostics more likely 8 to 5.

HelpPleaseMD said:
does your eye hurt from all radiology reads.
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Sometimes. 20 20 20 rules helps. Every 20 minutes take a 20 second break to allow your eyes to gaze 20 feet into the distance.
 
smarts1 said:
As a med student who struggles with interpreting images, do you have any resources that you used in the beginning (or in med school) to help you interpret images? It's so frustrating to see residents in various fields know how to interpret images and think that in 2 years I'll be expected to know how to read images like them.

Also, how is the transition from med school to residency since we don't really get that much exposure to radiology and interpreting images.
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Just keep looking at imaging and read the reports. Make sure you know what correct and incorrect placement of feeding tubes, et tubes, and central lines look like before internship to start out.
 
How many hours per day (on average) do you study during rads? How does learning from conferences and at the station help? Did your study time decrease as you advanced through the years?
 
Cyal said:
How many hours per day (on average) do you study during rads? How does learning from conferences and at the station help? Did your study time decrease as you advanced through the years?
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Studying about an hour or so a day when you get home is helpful. On days off, which you have plenty of in radiology, you want to hit the books a little harder. That said, one hour a day everyday is probably good enough. You learn a huge amount at the workstation and conferences help too. The best thing to learn radiology is see a huge number of cases and chief them out with a subspecialist.

Most people study a lot when they start out because radiology is an enormous field. Then they relax a little second year before picking up hardcore the second half of third year in preparation for boards. 4th year is just casual reading since most everyone is burnt out from boards.
 
failedatlife said:
Do radiology residencies only care about Step 1 too? This website makes me feel that your board score is all that matters in life. My research is in a surgical sub-speciality with MRI utilization. I have many first author publications, honored most courses M1 and M2, and have been honoring most M3 courses. Top 40 school. I have only in the 220s tho so I am preparing my mindset right now to SOAP when my Step 1 holds me back next year inevitably. I have no chance right?...because I blew the most important test I will ever take in my life.
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What in the hell? Have you looked at the charting outcomes data?

I had similar stats and am at a large university program in p53's "honorable mention" list. Getting into university programs and community programs in desirable locations (LA/SF/NYC/Boston/Seattle) will be tough but I can guarantee you can match at a solid midwestern program if you want. People don't realize how much of a difference there is in competitiveness between the middle of the country and the coasts (desirable parts that is). A Santa Clara Valley or Virginia Mason (downtown Seattle), Cedars-Sinai (LA) will be more competitive than most Chicago programs (outside of NW and maybe UofC). I wouldn't be surprised if a UCI had the same competitiveness of a WUSTL.

TLDR: you will match, and well all things considered.
 
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Hi @badasshairday! Thanks for this!

As an interventional radiologist, how much patient interaction can you have? Do you have designated clinic, and, if so, how many times per week for how long? What types of cases are the most common for you all? What characteristics would you say the field requires most for someone to be a good fit? And what about IR drew you personally to it? Sorry for all the questions 🙄 I'm an incoming M1 trying to learn about fields I'm most interested in potentially pursuing 🙂
 
How do you expect your attending lifestyle to compare to an attending in a surg subspecialty like ortho or uro? Do you think you will be doing clinic? What is the patient population like in IR? I read online that it's a lot of palliative treatments. Was getting through a DR residency tough for you since you knew you wanted to do IR? Was not being able to do procedures difficult to bear for 5 years? When you say call q4 what does this mean exactly? Did you ever find DR a socially isolating residency? Thanks for your input, really debating uro vs rads-->IR right now. Like the idea of having a physical craft and getting better at it, like the idea of working as part of a team. But I'm a career changer in my 30's and just don't know if I have the stamina left in me anymore to start a surgical residency without burning myself out to the point I'd want to kill myself.
 
Thanks for doing this. How is the job market looking for you and your colleagues (both DR and IR)? Do offers pre-fellowship still exist? Any issues with getting interviews for the type of job you want (e.g., academic vs. PP vs. VA) in an area you want?
 
During your diagnostic radiology residency, what percentage of your day was spent reading images versus doing minor procedures?

I am very interested in radiology, not sure if I want to do IR specifically but I would like to be able to do some minor procedures as you mentioned earlier. Is there a specific fellowship other than IR/breast that tends to be a bit heavier on procedures than strictly Diagnostic rads? Thanks!
 
About to start my radiology residency soon and I have my eyes on IR but am otherwise keeping an open mind. Did you have any preconceptions about IR that changed as you did rotations in it during residency?
 
yoyoni said:
Hi @badasshairday! Thanks for this!

As an interventional radiologist, how much patient interaction can you have? Do you have designated clinic, and, if so, how many times per week for how long? What types of cases are the most common for you all? What characteristics would you say the field requires most for someone to be a good fit? And what about IR drew you personally to it? Sorry for all the questions 🙄 I'm an incoming M1 trying to learn about fields I'm most interested in potentially pursuing 🙂
Click to expand...

I'll answer each question in order:
"As an interventional radiologist, how much patient interaction can you have? Do you have designated clinic, and, if so, how many times per week for how long?"
You have a lot of patient interaction in IR from procedures to consults to clinic. Designated clinic is necessary and is often a half day a week.

"What types of cases are the most common for you all?"
One thing that you will find out is that IR is very variable depending on the individual practice. The nice thing about IR and radiology in general is that we cross multiple disciplines. I was talking to my friends who are a married couple, a nephrologist and rad/Onc throwing around ideas of a group practice. I told my friend I could be her HD access/maintainence guy and I can do interventional oncology such as ablutions for my rad/Onc friend. Rad/Onc and nephrology have pretty much zero overlap other than they both have relationships with IR.


"What characteristics would you say the field requires most for someone to be a good fit? And what about IR drew you personally to it?
You need to be a hard worker and not afraid of dealing with emergencies and rapidly deteriorating patients. Personally I was drawn to IR because of the variety of procedures that we can provide through a minimally
Invasive route as well as the innovative spirit of the field.
 
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GoPelicans said:
How do you expect your attending lifestyle to compare to an attending in a surg subspecialty like ortho or uro? Do you think you will be doing clinic? What is the patient population like in IR? I read online that it's a lot of palliative treatments. Was getting through a DR residency tough for you since you knew you wanted to do IR? Was not being able to do procedures difficult to bear for 5 years? When you say call q4 what does this mean exactly? Did you ever find DR a socially isolating residency? Thanks for your input, really debating uro vs rads-->IR right now. Like the idea of having a physical craft and getting better at it, like the idea of working as part of a team. But I'm a career changer in my 30's and just don't know if I have the stamina left in me anymore to start a surgical residency without burning myself out to the point I'd want to kill myself.
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Lifestyle of IR is similar to a surgeons lifestyle including surgical subspecialty. More intense than urology since we can treat just about every single urologic emergency i.e. Obstructive nephropathy and renal trauma. Probably less intense than ortho trauma, but more intense than an ortho who does mostly joint replacements etc.

Definitely will have clinic.

Patient population in IR is quite diverse. One patient could be a sick old male smoker with peripheral arterial disease, then the next could be a healthy young female patient with symptomatic uterine fibroids, followed by a end stage renal disease patient with a fistula problem, and finally a middle aged patient with cirrhosis. We see in treat patients with problems involving nearly all organ systems. IR is not a lot of palliative treatments, though we definitely do some of those as well. Again it is a very broad field.

Getting through DR residency was not too bad as you need to be a good diagnostic radiologist to be a good interventionalist. Also diagnostic radiology residency includes severe months of IR including dedicated service for months and call nights and weekends so you do do many procedures during diagnostic radiology residency. I was doing 4 vessel cerebral angiograms from start to finish as primary operator as a PGY3. Not only that, but diagnostic radiologists do procedures as well. Ie. When I was on musculoskeletal radiology I did joint arthrograms/aspirations/steroid injections and numerous bone biopsies. At many places the body radiology division does solid organ biopsies and abscess drain ages while the ultrasound section does thyroid biopsies.

Q4 means either every 4th night or every 4th week (for a week straight ).

DR is not a socially isolating residency. Lots of cool people in diagnostic radiology.
 
fetorius said:
Thanks for doing this. How is the job market looking for you and your colleagues (both DR and IR)? Do offers pre-fellowship still exist? Any issues with getting interviews for the type of job you want (e.g., academic vs. PP vs. VA) in an area you want?
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Job market is opening up in DR. It was in a slump from about 2009-2014 or 2015. Things have picked up quite a bit in the past 2 years and those ahead of me have secured nice jobs in desirable locales for good terms. IR is also in some demand do to the nature of the field. Offers pre-fellowship do exist, but usually in smaller cities/towns that are less sought after locations. I have not started looking seriously for jobs yet, but will start in about 6 months.
 
JPSmyth said:
During your diagnostic radiology residency, what percentage of your day was spent reading images versus doing minor procedures?

I am very interested in radiology, not sure if I want to do IR specifically but I would like to be able to do some minor procedures as you mentioned earlier. Is there a specific fellowship other than IR/breast that tends to be a bit heavier on procedures than strictly Diagnostic rads? Thanks!
Click to expand...

Diagnostic radiologists do a lot of procedures. Your average diagnostic radiologist will be able to do thoracentesis, paracentesis, biopsies of things such as thryroid nodules and lung nodules, joint injections, lumbar punctures, and drain abdominal fluid collections such as abscesses. Many will be able to do chest tubes and PICC lines for venous access as well. The sub specialties other than IR/mammo that do a decent amount of procedures would be musculoskeletal and body imaging. Majority of your time as a diagnostic radiologist will be reading imaging, like 90%.
 
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badasshairday said:
Diagnostic radiologists do a lot of procedures. Your average diagnostic radiologist will be able to do thoracentesis, paracentesis, biopsies of things such as thryroid nodules and lung nodules, joint injections, lumbar punctures, and drain abdominal fluid collections such as abscesses. Many will be able to do chest tubes and PICC lines for venous access as well. The sub specialties other than IR/mammo that do a decent amount of procedures would be musculoskeletal and body imaging. Majority of your time as a diagnostic radiologist will be reading imaging, like 90%.
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Thank you! Beyond residency I would imagine that you can tailor your practice a little bit to what you like doing, would I possibly be able to do more procedures than the "average" diagnostic radiologist?

Are there some days where it is all reading 8am-5pm and then other days where it'll be reads for half the day procedures for the other half?
 
Might be hard to speak to, but as a future M1 I am wondering on the relative competitiveness of the integrated residencies. I will be graduating in 2021 when it will be fully integrated so I am just wondering what sort of step 1 might be necessary, closer to DR scores or higher up closer to surgical specialties?

Thanks!
 
JohnWill30 said:
Might be hard to speak to, but as a future M1 I am wondering on the relative competitiveness of the integrated residencies. I will be graduating in 2021 when it will be fully integrated so I am just wondering what sort of step 1 might be necessary, closer to DR scores or higher up closer to surgical specialties?

Thanks!
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It honestly is hard to say. When I was a med student in 2013 a prestigous fellowship had a DO fellow who happened to graduated from a very small residency. This year there are people from top 10 med school and big name residency with 250, lots of research etc not even offered interviewed there.
 
CherryRedDracul said:
About to start my radiology residency soon and I have my eyes on IR but am otherwise keeping an open mind. Did you have any preconceptions about IR that changed as you did rotations in it during residency?
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Good to keep an open mind. My preconception about IR was when I was a medical student I thought most IR programs/practices ran the way it did at my medical school. There is a huge variation in practice pattern depending on the way the IR service is run. At some places it is mostly low end procedures that are done as order entry procedure. While at other ends they do an enormous amount of high end procedures and the IR service is run like a surgical subspecialty with clinic and legitimate inpatient consults. Many places are somewhere in between.
 
JohnWill30 said:
Might be hard to speak to, but as a future M1 I am wondering on the relative competitiveness of the integrated residencies. I will be graduating in 2021 when it will be fully integrated so I am just wondering what sort of step 1 might be necessary, closer to DR scores or higher up closer to surgical specialties?

Thanks!
Click to expand...

Hard to tell. This past match was the first one for the IR/DR combo residency and it was incredibly competitive. Things go in cycles. DR is becoming more competitive now and was up there with surgical subspecialties 10-15 years ago. However just a few years ago was only moderately competitive.
 
JPSmyth said:
Thank you! Beyond residency I would imagine that you can tailor your practice a little bit to what you like doing, would I possibly be able to do more procedures than the "average" diagnostic radiologist?

Are there some days where it is all reading 8am-5pm and then other days where it'll be reads for half the day procedures for the other half?
Click to expand...

There are some procedure heavy body imaging fellowships such as UCLA and MGH. Most body fellowships give you good experience in biopsy of solid organs and drainages of abdominal/pelvic fluid collections. MSK rads do a decent amount of procedures as well including bone biopsies and joint injections/aspirations/arthrograms. A schedule in which you do a half day procedures can be possible in the aforementioned specialties, however probably isn't very common. Typically you will be reading and have a sprinkling of procedures throughout the day in which you leave your work station and do the procedures.
 
So from reading, I gather that there are 3 pathways to IR. 1) the direct pathway 2) the ESIR pathway and 3) the traditional pathway.

For someone who is primarily more interested in DR, but also likes to have IR as an option if he chooses to pursue after residency, will the traditional pathway still exist circa 2023? Or will it slowly phase out and IR becomes 100% seperate specialty?
 
Ibn Alnafis MD said:
So from reading, I gather that there are 3 pathways to IR. 1) the direct pathway 2) the ESIR pathway and 3) the traditional pathway.

For someone who is primarily more interested in DR, but also likes to have IR as an option if he chooses to pursue after residency, will the traditional pathway still exist circa 2023? Or will it slowly phase out and IR becomes 100% seperate specialty?
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Traditional is done by 2020. Next year is supposed to be the last year of one fellowship year class.
 
What's your take on Vascular Surgery, and do you find yourself competing with them a lot?
 
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