Bored in Radiology - Switch Residency?

[lolly1212]

Rising R2 at a well regarded academic program. I'm so bored. If I could never look at another scan in my life I'd be happy. It's just not what I thought it would be when I was a med student. In med school I loved it and got honors in it. My advisors told me I would like rads. I thought I would absolutely hate prelim year in medicine but I didn't. I dread coming to work everyday. I count down the minutes until I can go home. I miss the other parts of Medicine, the labs, the ddx, putting it all together with the history... This is not existent in rads. I consider IR because it's more clinical but I don't like the procedures. The thought of taking senior call just makes me want to cry. I'm not motivated to study rads but I would study general medicine (IM or crit care) gladly. I feel like I'm in the wrong place. That's not to say I never enjoy a case. We have excellent teachers and I have only good things to say about the program itself. So that's not the issue. I don't know if it will get better and I should ride it out or if I should get out now. I feel like I'm going to hate reading 70 scans a day as an attending with so much pressure. It sounds terrible. I probably would do anesthesia or crit care or maybe ED if I would do it over but those specialities also have problems. Thoughts? Ideas?

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[bashwell]

Rising R2 at a well regarded academic program. I'm so bored. If I could never look at another scan in my life I'd be happy. It's just not what I thought it would be when I was a med student. In med school I loved it and got honors in it. My advisors told me I would like rads. I thought I would absolutely hate prelim year in medicine but I didn't. I dread coming to work everyday. I count down the minutes until I can go home. I miss the other parts of Medicine, the labs, the ddx, putting it all together with the history... This is not existent in rads. I consider IR because it's more clinical but I don't like the procedures. The thought of taking senior call just makes me want to cry. I'm not motivated to study rads but I would study general medicine (IM or crit care) gladly. I feel like I'm in the wrong place. That's not to say I never enjoy a case. We have excellent teachers and I have only good things to say about the program itself. So that's not the issue. I don't know if it will get better and I should ride it out or if I should get out now. I feel like I'm going to hate reading 70 scans a day as an attending with so much pressure. It sounds terrible. I probably would do anesthesia or crit care or maybe ED if I would do it over but those specialities also have problems. Thoughts? Ideas?

Sorry to hear it. On the plus side I would think it's easier to switch from rads to IM and anesthesia than to switch into rads, so if you really wanted to switch into one of those two you should be able to. I'm not sure about EM though.

I know anesthesia tends to be open to people who want to switch specialties. I would think IM would be as well. How far along are you in this process? For example have you broached the topic of possibly switching with the anesthesia or IM or EM programs where you are, at least to get a sense of what they might say (although it might not be good to make it too obvious yet in case it comes back to your PD)?

It's probably easier to get into critical care via anesthesia than IM where I assume you'd want to apply pulm/cc (although I have heard straight cc is not so difficult, but straight cc may not be as employable as pulm/cc either). In IM you'd need to get into as good of an IM program as you can (preferably mid-tier or higher). However, pulm/cc might be the better way to go because of all the problems in anesthesia. Also once you get older I have heard you can focus your practice to doing more outpatient pulm and less cc so you can have a better work/life balance.

When you say though that you don't like the procedures, does that mean you don't like the IR procedures, or that you don't like procedures in general? Obviously it's a problem if you don't like procedures in general if you want to pursue critical care because there are a lot of procedures. Same with anesthesia and to a lesser extent EM.

I think right now it might be a good idea to get back to basics and ask yourself what you really want out of medicine. Such as whether you like procedures or not, whether you like seeing patients or not (critical care patients aren't always communicative and you'd be dealing with their families a lot of the time too), whether you can stomach working a lot of your career on nights, weekends, and holidays as that's what you'd have to do in EM and critical care. I know radiology has some, but radiology seems (in my very limited experience) to have a much more balanced lifestyle. Also ask yourself if you like to work alongside surgeons which anesthesia has to do. Or supervising CRNAs which right now seems like it's only going to be increasingly the case in the future for anesthesia and so you won't necessarily get to sit your own cases.

Sorry this was all over the place, but I'm just rushing to type as I have to get back to doing some work, but I'm just throwing out some ideas for you. Best of luck!

 

[SageRad]

There was a guy who felt the same in my program many moons ago, and he went back to do IM, where he did a prelim year, and lived happily ever after. If you do not like residency, you should cut your losses and do something else.

70 cases per day? Ha, maybe on a slow day.

 

[meister]

Switch to medicine.

 

[lolly1212]

Thanks for your responses.I don't like IR procedures. I like procedures in general. I like critical thinking and I'm happy to interact with patients to a limit. Obviously no one wants to deal with the super annoying patients... I don't like all the paperwork and bureaucracy in medicine and the insurance company headaches and I don't want to spend my career filling out forms. Lifestyle is important to me. I want to be able to enjoy what I do but not work crazy hours. I'm very conflicted.

I haven't looked into the details that much because I'm so nervous to give up a prestigious residency that will give me a relatively lifestyle friendly career that pays well. And I'm afraid to talk to my PD even though he's really nice and approachable.

I keep thinking that people try to switch into rads what is wrong with me that I feel like I want to leave. I'm also nervous that I'm glorifying the medicine that I did last year as a prelim and that I'll hate all the running around when I get back.....

Do you really think I should just go back into medicine and live happily ever after?

 

[scootad.]

Maybe consider breast imaging? Plenty of procedures/biopsies. Not much paperwork. But given that you seem to get "bored" easily, would you get bored with all the mammograms?

 

[meister]

Seems like an obvious solution to me for you to switch. Unless I missed it you didn't really say one good thing about radiology other than decent lifestyle and pay, neither if which are unique to radiology or guaranteed. In fact you said taking more advanced call makes you want to cry.

That's fine, it seems like it's not a good fit. Move on.

 

[lolly1212]

I liked it in medical school enough to apply for residency. But I didn't realize how non clinical it would be. When I did my electives it was very case based. Now whenever I want to know about the clinical situation no one cares.

I don't get bored easily. But I'm bored here. It's like OK so you made the finding yay now what?? I'm not saying it doesn't take advanced skills to read cardiac MR or neuro or MSK etc but I find that we're looking for tiny things that often aren't clinically significant. I always want to know more about the patient than just the CT... And I also knowing what to do. I like when someone asks me how to treat xyz I know what to do. It's not that I don't see brilliant radiologists here and I love the attendings but I can't seem to get excited in general. Of course there are crazy cases here and there that are interesting. It wouldn't be intellectually honest to say it's not ever interesting but those cases would probably be interesting to me on the clinical side as well.

In terms of leaving, it's not easy and I might have to drop out and then be unemployed for a year. I'm not exactly sure how it works. Plus I think they like me here (I hope) and I feel like it would be a slap in the face to a program that has been really good to me.

Im so frustrated. I feel ennui and the worst it that I feel like I started not to care and just to get through the days. Sometimes I feel like I'm on a radiology elective and that one day it will be over and I'll get back to the real medicine. But I'm not..

I don't want you to think I don't appreciate radiology. I do. The question is just whether or not I want to do it myself.

 

[meister]

Again, you aren't even discussing the actual positives of being a radiologist. I am not saying this to criticize you, only pointing out a fact. You sound like you hate it, and that's fine. Someone has to review all of the images so the incidental cancer hiding somewhere isn't missed. Doesn't sound like you want to do that. If you enjoy clinical medicine, then mammo or IR would be your best options within radiology.

If the idea of writing notes and rounding appeals to you more than reviewing scans and talking about renal cysts, then spend some time figuring out how to switch out and do it. I doubt your PD will hold it against you, if he's as nice as you state.

Anyway just my 2c.

 

[Postictal Raiden]

Can't radiologists do interventional pain fellowship now? Wouldn't that be a way to reenter the clinical side of medicine?

 

[lolly1212]

Of course I'm real. I just am not the type to post. I know some people have nothing better to do than troll. And there are plenty of people who just read and don't post. But I'm so frustrated and I don't know whom to ask so I figured I'll crowdsource. I even tried to reach out to my med school advisor who I originally had these conversations with. It's not like the other people in my program are the right people to ask. And my friends in internal medicine have no idea what rads is about and would never even consider it. The people I'm close with in my life like friends and family all say they can't help me this has to be my decision etc. But I need input from other people who are a bit ahead of me and have perspective.

 

[imnamerican]

In terms of leaving, it's not easy and I might have to drop out and then be unemployed for a year. I'm not exactly sure how it works.

I might start with the program where you did your prelim year? In my area, there was a resident in a specialty that's also hypercompetitive and well-compensated (but not rads) who decided during his prelim year that his calling was medicine. He spoke with the IM program director where he did his prelim and basically begged to stay. They didn't have any room for him to enter directly as a categorical R2 (so this year he's with the program where he originally matched), but they were able to finagle things to let him enter as an R2 starting this summer. Not sure how common this is, but it's worth a shot?

From what it sounds like, his original PD tried to get him to stay since their residency class is really small, but in the end the program was really supportive and let him go.

Regardless of what you decide, good luck to you!

 

[SageRad]

It sounds like you are really not sure what you want, and that is completely okay. I would reach out to either your program director or another mentor in your program and discuss with him or her. We all have doubts; it is normal, and I am 110% certain that program leaders have had these conversations before and more frequently than you might imagine. I am a little bit concerned based on the statements that you have made that there might be an element of burnout and or depression, and you should probably check that out, too (as discretely as possible).

To be real, the radiology job is not that exciting. In fact, perhaps other than fields like trauma surgery (which is exciting in the wrong way, IMO), none of it is all that exciting. Boredom might set in, sooner or later, no matter what field you choose. Find something that fits your personality and something where you feel like you can excel.

Finally, do not feel bad about leaving the program or radiology if it does not suit you. The program director wants to develop well-trained, well-adjusted radiologists who are happy with their career selection. The program will survive without you and perhaps someone else who really wants to be a rad will benefit from a spot opening up.

Best of luck.

 

[Postictal Raiden]

Boredom >>> dealing with annoying patients

 

[Light at end of tunnel]

Boredom >>> dealing with annoying patients

Some docs are far more difficult to deal with than their patients, and you actually have to be nice to referring docs, who essentially have us by the you know what.

 

[postbacpremed87]

Boredom >>> dealing with annoying patients

Wise choice my friend.

 

[lolly1212]

Maybe it's just that the radiologists at my institution take so much $hit from the other doctors. It seems like we write the reports for them, not the patients. People call and demand reports as if we are secretaries. They would never dare call another service for a consult and demand anything like that. Or that so many times we call with a recommendation and they tell us oh yeah we already looked at it ourselves ... Like we are totally irrelevant.

 

[Light at end of tunnel]

Maybe it's just that the radiologists at my institution take so much $hit from the other doctors. It seems like we write the reports for them, not the patients. People call and demand reports as if we are secretaries. They would never dare call another service for a consult and demand anything like that. Or that so many times we call with a recommendation and they tell us oh yeah we already looked at it ourselves ... Like we are totally irrelevant.

Oh its like that all over. Radiologists are known for being cowards, maybe bc we are at the mercy of ordering providers or bc we are being squeezed worse than street level bookies by the mafia from all sides these days.

Your primary role is to make your customers happy, and customers being other doctors of course. Oh, and maybe make some diagnoses along the way.

 

[SageRad]

Maybe it's just that the radiologists at my institution take so much $hit from the other doctors. It seems like we write the reports for them, not the patients. People call and demand reports as if we are secretaries. They would never dare call another service for a consult and demand anything like that. Or that so many times we call with a recommendation and they tell us oh yeah we already looked at it ourselves ... Like we are totally irrelevant.

Yes, that is certainly an issue. In an ideal world, we are sitting around a communal workroom, incense burning, sipping lattes, and leisurely making great, improbable, earth shattering diagnoses, to the delight of adoring patients and appreciative colleagues. In the real world, yes, we are more often running as fast as possible on the treadmill, and the only time we get feedback is when we make a mistake or miss a TAT cutoff.

The fact is that the typical medical career will be a grind, no matter which path is chosen. Yes, there will be moments of exhilaration and great satisfaction, but these will be islands in a sea of routine and uninteresting. Whether you are an attending in the MICU or in the reading cubicle, most of what you spend your time doing will have little impact, sorry to say, so in order to find professional satisfaction, you will have to savor these moments.

As far as taking crap from other docs, someone wiser than me explained it this way (paraphrasing): The referring docs have to take crap from the patients, the insurance companies, the administration, etc. much more than the radiologist has to take crap from the referring doc. But everyone has to take crap from someone.

 

[Shifty B]

Like the others in this forum, I agree that it might be reasonable to switch. However, I would be very cautious because it seems like the biggest problem here is that the reality of radiology did not match your expectations. For that reason, you should be very careful about your expectations about other specialties.

Think internal medicine has more critical thinking than radiology? Hmm, not sure about that. IM docs definitely aren't sitting around making earth-shattering diagnoses either. They are busy with paperwork and ordering imaging studies when they don't know what's going on. It's not uncommon for hospitalists at my hospital to request fluoro-guided LPs because they simply don't have time with the 20 patients they have to round on. Meanwhile I make the diagnosis with MR and then confirm it with the LP.

But yeah, there is a lot of grinding for any specialty. I read a lot of normals. I read a lot of follow-ups with no change (and sometimes no point!). I can tolerate that grind. You need to find something where you can tolerate the worst parts of it. The worst thing you could do here is quit, set yourself back 3 years in terms of completing training, and then find yourself in the same bored situation 3 years from now.

 

[SageRad]

I feel like I'm going to hate reading 70 scans a day as an attending with so much pressure.

Again, keeping it real, I just got home from work. I rarely track my daily numbers, but I did look today, from being on one of the "general" rotations. I read exactly 170 cases, about 30 CTs (90% body), 30 Ultrasound/nucs (mostly U/S), a couple of body MRIs, and the rest were plain films. That is probably typical for the assignment of today, and I know that I have read considerably more in the past on the same shift. I am not sure where the "70 scans" came from, but unless it's at least two-thirds CT/MRI, it's probably not a realistic private practice number.

 

[lolly1212]

The volume for our attendings is way way less than what you described. We are an academic center so maybe that has something to do with it? On a 13 hour call I've seen attendings real 150 plain films and 100 cross sectionals but that's a lot. And that's on call reading out everything from the ED, not a typical day.

I am considering switching to EM. It has the broad range and lots of procedures without the long term patients of IM. The fun part for me is the crashing patients. Or maybe EM and then toxicology. I did an elective in med school and LOVED it. After being out of clinical medicine for a year I don't even know if I can still do it. Or maybe it just sounds fun but it gets old and it isn't fun in real life. I did a biopsy on a patient today and she did not smell very good (being honest here) and I was thinking that there is way worse to deal with on the clinical side. But I did feel good that we made her feel relaxed. She was so nervous about it. Every time I think that I can stay in rads and that its not so bad I remember that being a resident isn't like being an attending and the volume will probably go way way up.

 

[Shifty B]

Well, before you switch to EM I'd befriend someone who's been out in practice for 5 years or so. The burnout rates are very high and the hours are not good for most people. Lots of days off but many of them spent recovering from overnight/late shifts. Lots of work during social hours (5p-10p weekdays and weekends). The crashing patients sound fun, but for every complex patient, there are 5 who need medication refills and have primary care problems. Depends a lot on the center though, obviously, but it's a lot of primary care with patients who aren't very good at following up, have insurance problems, etc. Problem solving also can take a back seat to patient throughput. For me, ER is about the last thing I would do if not radiology.

There is a wide range of volumes in jobs out there, and it depends heavily on the practice. Some private practices have high volumes and high salaries, while others are more balanced. Academic centers tend to be much less, although the case complexity is often (although not always) higher.

I'm an academic neuroradiologist at a place that's considered on the busier side. A typical day would be 30-70 MR/CT +/- 0-3 procedures. Strict numbers don't tell the whole story though. Head CTs with a high negative rate go fast. Glioblastoma follow-up MRs after 2 resections and on avastin do not. A couple of really good trainees and you can blast through a lot of studies. A bad trainee is worse than no trainee.

You need to find something that fits your personality. I feel extremely lucky to do something I think is awesome and get paid very well. On most days, it doesn't feel like work at all. You need to find that while being cautious about thinking the grass is greener in some other field.

 

[postbacpremed87]

.

 

[postbacpremed87]

Boredom >>> dealing with annoying patients

You'll come to appreciate boredom later in your later.

 

[Radology]

I'm with the others on here. You do not sound happy in radiology. At all. You are only an R2, and even the most gung ho radiologists lose some interest over the course of their residency. If you truly feel as you say in the OP, This will not get better. For your own sake, transfer to another field. People do it all the time, and it's really not to complicated. If you are at a big program, you won't impact anyone's day to day schedule, and nobody will care.

 

[lolly1212]

So I went to speak with one of the senior attendings who I really like and respect (not the PD) and I told him exactly how I feel. We didn't get to finish talking because you know, wet reads all day, but basically he told me not to be so quick to switch and that I should think about how I want my lifestyle to look in ten years and that with all the changes in medicine it's becoming more and more paperwork and running on the wheel for the hospital administrators. He thinks that in radiology we are a little bit protected from that. He thinks that my interest in clinical medicine can be a huge asset. He also said don't worry about the program they will get over it an be fine - which I know - but it was a relief to hear it.

Meanwhile, my best friend (medicine resident) told me flat out she thinks I should definitely switch.
I was on IR today and while I don't want to do IR I was so busy all day I felt like I got stuff done for the service and the patients. It was a good feeling.

Then I start to second guess myself and say ok maybe it will get better and I will learn to like it. It's cool when you know what's going on and can help the clinicians. But I still don't want to open the book and study. But I would gladly study heart failure...

I know that no one can make this decision for me. Everything has plusses and minuses I just can't figure out which are the most important to me. Not sure that anyone here can help me either but I appreciate the advice/responses so far.

 

[DrfluffyMD]

What you said about reading about heart failure really resonated with me.

I am going to be frank and say that I enjoy reading surgical literature far more than I enjoy reading about diagnostic radiology. I thought about switching to general surgery quite often in my first and second years...

However, I am firmly commited to IR. I personally think IR IS surgery, the less invasive form, and the future of surgery.

On one of the IR fellowship interviews, the PD flat out told us that they will have to train us to be surgeons. I liked that.

 

[colbgw02]

So I went to speak with one of the senior attendings who I really like and respect (not the PD) and I told him exactly how I feel. We didn't get to finish talking because you know, wet reads all day, but basically he told me not to be so quick to switch and that I should think about how I want my lifestyle to look in ten years and that with all the changes in medicine it's becoming more and more paperwork and running on the wheel for the hospital administrators. He thinks that in radiology we are a little bit protected from that. He thinks that my interest in clinical medicine can be a huge asset. He also said don't worry about the program they will get over it an be fine - which I know - but it was a relief to hear it.

Meanwhile, my best friend (medicine resident) told me flat out she thinks I should definitely switch.
I was on IR today and while I don't want to do IR I was so busy all day I felt like I got stuff done for the service and the patients. It was a good feeling.

Then I start to second guess myself and say ok maybe it will get better and I will learn to like it. It's cool when you know what's going on and can help the clinicians. But I still don't want to open the book and study. But I would gladly study heart failure...

I know that no one can make this decision for me. Everything has plusses and minuses I just can't figure out which are the most important to me. Not sure that anyone here can help me either but I appreciate the advice/responses so far.

The advise about taking your time, while true, strikes me as a pretty useless. I doubt you would have started this thread on a whim, and if one of our residents came to me with this, then I would assume he or she had already contemplated it for awhile.

As much as you can, try to separate practicing and studying radiology. If my profession matched what I enjoy studying, then I probably would have ended up an anthropologist or - in medicine - a nephrologist. But I really like my job and would probably be miserable doing those other things. Frankly, I think studying radiology, while necessary, is pretty boring, and I always learned more by reading a higher volume and "seeing" more patients.

My point is that you're still on the steep part of the learning curve, which requires you to study radiology as much or more than you practice it. In time, you'll become more experienced and competent, and the slope of the curve will flatten out dramatically. If you're able to tease out the difference between the two in your daily life, then I think it'll go a long way in helping you decide. That is, if you're still unhappy when you're doing something at which you're comfortable doing, then switch. But I wouldn't let your lack of motivation about studying be a major deciding factor.

 

[Radology]

So I went to speak with one of the senior attendings who I really like and respect (not the PD) and I told him exactly how I feel. We didn't get to finish talking because you know, wet reads all day, but basically he told me not to be so quick to switch and that I should think about how I want my lifestyle to look in ten years and that with all the changes in medicine it's becoming more and more paperwork and running on the wheel for the hospital administrators. He thinks that in radiology we are a little bit protected from that. He thinks that my interest in clinical medicine can be a huge asset. He also said don't worry about the program they will get over it an be fine - which I know - but it was a relief to hear it.

Meanwhile, my best friend (medicine resident) told me flat out she thinks I should definitely switch.
I was on IR today and while I don't want to do IR I was so busy all day I felt like I got stuff done for the service and the patients. It was a good feeling.

Then I start to second guess myself and say ok maybe it will get better and I will learn to like it. It's cool when you know what's going on and can help the clinicians. But I still don't want to open the book and study. But I would gladly study heart failure...

I know that no one can make this decision for me. Everything has plusses and minuses I just can't figure out which are the most important to me. Not sure that anyone here can help me either but I appreciate the advice/responses so far.

Again, nothing you say shows any interest in radiology. The only positive thing about radiology you said in this thread is that you liked the patient exposure in IR--but are not considering IR as a field.

It is silly you are even debating this. If you literally cannot find a single facet of radiology enjoyable, get out of the field or prepare for a lifetime of job dissatisfaction.

 

[tco]

A bad trainee is worse than no trainee.

Sorry, y'all.

 

[johnjohn1990]

I just matched into radiology (DR) and I'm finding myself in a similar situation. I decided on radiology for a number of reasons - partly the lifestyle (I'll admit), but also I enjoyed the scientific aspects of it and thought it would be more intellectually stimulating, and bc I really enjoy things like anatomy, and diagnosis. However, I'm realizing now that it's just as mechanical and repetitive (if not more) as any other field, and I have found it increasingly dull as I've gotten more experience in it. I've also come to realize I will definitely miss the patient involvement and contact, which I initially did not expect...

I have also become worried about the future of the field as a whole, which tbh is weighing heavily on me. I've been reading a lot of these articles about machine learning and AI and how this will gradually replace radiology departments in hospitals to save money...Google, IBM, etc, are all workign on this...I know this is years or decades away but as someone just entering the field, the possibility of this negatively affecting the future job market feels very real. There is also this ever present talk of 'outsourcing', which I don't know much about... I am curious to hear what established residents/practicing docs think about these two issues... (I know there are a lot of forums on SDN about this, and I've probably read them all, but I like to ask people that aren't already involved in those discussions)

I am also kind of worried about the prospects of going into IR. According to sirweb.org, DR graduates will still be able to go into IR after 2020, but it will be through an 'independent residency' that will take 2 years instead of the traditional 1, which is kind of lousy ... and there's no gaurantee it will continue into 2022, which is when I would apply... I imagine it will also be increasingly competitive to get into these programs, and I wonder how many schools will even offer it, given that the new residency route seems to be the preferred way. My other concern about IR is the increased cancer risk of interventional radiologists, like 2x more likely to get brain cancer, for example. This doesn't seem to get talked about that much but seems pretty important to me...

Anyway, to make a long story short, I am worried about DR because: 1) I don't think I will enjoy it much, and 2) AI and outsourcing replacing our jobs us in the next 10-20 years. And I am worried about IR because: 1) the difficulty of getting into the field after finishing a DR program 5 years from now, and 2) all that radiation exposure...

Sorry for the long rambling message, but I am at the very beginning of my intern year and feeling very tempted to try switching into something else while it's still early in the year, and would love to have some input on these issues...

 

[GadRads]

All of medicine gets mechanical and repetitive. Plus you are just beginning intern year. Are you doing a medicine or surgery year?

Every senior I have spoken to in radiology has found radiology more intellectually stimulating than IM.

That said, no field of medicine is bad. It mostly comes down to what you can/can't tolerate. Everything gets mundane, but less so in radiology, it appears.

Sorry for the long rambling message, but I am at the very beginning of my intern year and feeling very tempted to try switching into something else while it's still early in the year, and would love to have some input on these issues...

 

[WeAreNotRobots]

I've been reading a lot of these articles about machine learning and AI and how this will gradually replace radiology departments in hospitals to save money...Google, IBM, etc, are all workign on this...I know this is years or decades away but as someone just entering the field, the possibility of this negatively affecting the future job market feels very real. There is also this ever present talk of 'outsourcing', which I don't know much about...

Sorry for the long rambling message, but I am at the very beginning of my intern year and feeling very tempted to try switching into something else while it's still early in the year, and would love to have some input on these issues...

honestly, primary care, and probably most of internal medicine, will be replaced by "robots and algorithms" long before radiology is. just think of the complexity of interpreting imaging vs. laboratory values + symptoms: different worlds. i'd be way more fearful of my job being replaced by coding if it involved checking BPs, A1C's, UA's, bili's, and TSH's (objective numbers) vs being the guy that THOSE GUYS turn to for help.

and outsourcing--naw. only can outsource to US trained/board certified people living overseas. when that changes, all MD's are in trouble.

you said you like anatomy, diagnosis, and intellectual stimulation-- i think the anatomy and diagnosis components of radiology speak for themselves. as for intellectual stimulation: after X# months of internship, you may find less gratification and intellectual stimulation from patient contact than you now express. please revisit us and share your experiences later this year.

 

[Light at end of tunnel]

honestly, primary care, and probably most of internal medicine, will be replaced by "robots and algorithms" long before radiology is. just think of the complexity of interpreting imaging vs. laboratory values + symptoms: different worlds. i'd be way more fearful of my job being replaced by coding if it involved checking BPs, A1C's, UA's, bili's, and TSH's (objective numbers) vs being the guy that THOSE GUYS turn to for help.

and outsourcing--naw. only can outsource to US trained/board certified people living overseas. when that changes, all MD's are in trouble.

you said you like anatomy, diagnosis, and intellectual stimulation-- i think the anatomy and diagnosis components of radiology speak for themselves. as for intellectual stimulation: after X# months of internship, you may find less gratification and intellectual stimulation from patient contact than you now express. please revisit us and share your experiences later this year.

The grass is definitely not always greener.

 

[radnonymous]

honestly, primary care, and probably most of internal medicine, will be replaced by "robots and algorithms" long before radiology is. just think of the complexity of interpreting imaging vs. laboratory values + symptoms: different worlds. i'd be way more fearful of my job being replaced by coding if it involved checking BPs, A1C's, UA's, bili's, and TSH's (objective numbers) vs being the guy that THOSE GUYS turn to for help.

and outsourcing--naw. only can outsource to US trained/board certified people living overseas. when that changes, all MD's are in trouble.

you said you like anatomy, diagnosis, and intellectual stimulation-- i think the anatomy and diagnosis components of radiology speak for themselves. as for intellectual stimulation: after X# months of internship, you may find less gratification and intellectual stimulation from patient contact than you now express. please revisit us and share your experiences later this year.

Regardless of what we think "will" or "should" be replaced first, the fact is that all of the hype is surrounded around image-based specialties. The reasons for this are multifactorial (rads seen as commodity, potential $$ savings for admins, patients don't know we exist, etc). Not arguing who is right or wrong, just pointing out that the companies working on this technology have radiology in their bullseye, not primary care.

 

[RadsFTW123]

Agree with above - it is just as much about our place in the value chain and lack of visibility (i.e. most patients wouldn't "miss" us) that make us appealing (I wouldn't say easy) targets for automation. That being said, if you look at all the different things that a radiologist does in a day (many different types of indications, comparisons to prior studies that may be of different modalities, different quality, or outside the institution, thousands of different types of pathologies which interact with each other in complex ways, protocoling, supervising techs, doing procedures, advising clinicians, etc etc) it is hard to imagine the job of "radiologist" being replaced. I am not sure if all of these things can ever be done by a computer (and even AI proponents agree that 'jobs that require cross-modality thinking with lots of variety are not amenable to replacement by AI). The nature of the job may change over your career, but that will happen in any job.

Most of these companies either already know or will realize a much easier route to profitability is to develop tools that radiologists will pay for that will either make us better or more efficient (avoids liability, avoids resistance/lobbying from those who currently control imaging, etc).

 

[WeAreNotRobots]

Regardless of what we think "will" or "should" be replaced first, the fact is that all of the hype is surrounded around image-based specialties. The reasons for this are multifactorial (rads seen as commodity, potential $$ savings for admins, patients don't know we exist, etc). Not arguing who is right or wrong, just pointing out that the companies working on this technology have radiology in their bullseye, not primary care.

yes. yes. i agree with you and your points.

And not to argue either, but rather just to share my own rationale regarding the "hype"...

I'm quite hung up on the fact that swapping out human MD's for less-trained human professionals (think CRNAs, NPs, DNPs) is already occurring in clinical practice, whereas swapping out human MD's for non humans (AI) is unprecedented. medicine and the health system are slow to change, so its more likely that the current trends will continue, and that AI research will result in applications that enhance people's abilities (either those of MD's or of lesser-trained professionals ever-more enabled to expand into MD-like roles) before any widespread "AI-for-MD replacement" happens.

if any of that made sense...guess my only point is, every specialty has its own set of "threats", but i don't think this one deserves enough weight to dissuade students who are otherwise genuinely interested in going into radiology.

 

[lolly1212]

Still deciding what to do. Every day I hope it will get better but it really hasn't changed. I keep thinking that maybe in ten years I will be happy I stayed but inside I am miserable. Zero interest or motivation to study. Do you think it's worth it? I'm sure that if I didn't like the people I work with so much that I would be long gone. But the good work environment and resident life makes it hard for me to give it up. But I know I need to think about the future not residency. Like do I tell myself this is a great specialty, suck it up, forget about everything else and start studying a lot even though I don't like it or go through the hassle of switching in the hopes that I'll like what I do. But that means going to a job with half the pay and twice as bad hours and lifestyle and everything else..

 

[DrfluffyMD]

Still deciding what to do. Every day I hope it will get better but it really hasn't changed. I keep thinking that maybe in ten years I will be happy I stayed but inside I am miserable. Zero interest or motivation to study. Do you think it's worth it? I'm sure that if I didn't like the people I work with so much that I would be long gone. But the good work environment and resident life makes it hard for me to give it up. But I know I need to think about the future not residency. Like do I tell myself this is a great specialty, suck it up, forget about everything else and start studying a lot even though I don't like it or go through the hassle of switching in the hopes that I'll like what I do. But that means going to a job with half the pay and twice as bad hours and lifestyle and everything else..

Look bud, diagnostic radiology still bore me to the bone everyday. Doesn't matter since I am going for interventional.

 

[lolly1212]

Interventional is not much more interesting. What's so exciting about tips or ufe? Or putting in ivc filter or tunnelled catheter... Or nephrostomy tubes. It's not very intellectual either. Ugh. At least I can say that I love and respect the people I work with. That's a huge plus right now.

 

[DrfluffyMD]

Interventional is not much more interesting. What's so exciting about tips or ufe? Or putting in ivc filter or tunnelled catheter... Or nephrostomy tubes. It's not very intellectual either. Ugh. At least I can say that I love and respect the people I work with. That's a huge plus right now.

If radiology isn't intellectual enough for you, what do you think is?

 

[Radology]

Why are you toughing through this? You hate this field. The people you work with will be spread all over the country and never talk to you again. What are you doing man?

 

[SageRad]

Still deciding what to do. Every day I hope it will get better but it really hasn't changed. I keep thinking that maybe in ten years I will be happy I stayed but inside I am miserable. Zero interest or motivation to study. Do you think it's worth it? I'm sure that if I didn't like the people I work with so much that I would be long gone. But the good work environment and resident life makes it hard for me to give it up. But I know I need to think about the future not residency. Like do I tell myself this is a great specialty, suck it up, forget about everything else and start studying a lot even though I don't like it or go through the hassle of switching in the hopes that I'll like what I do. But that means going to a job with half the pay and twice as bad hours and lifestyle and everything else..

Interventional is not much more interesting. What's so exciting about tips or ufe? Or putting in ivc filter or tunnelled catheter... Or nephrostomy tubes. It's not very intellectual either. Ugh. At least I can say that I love and respect the people I work with. That's a huge plus right now.

By the tone, I am concerned that you are depressed, burned out, or both. I still think you need to have a heart to heart with a program director or other senior mentor (even a Chief Resident). Either that, or you are hitting your midlife crisis early ("is this all there is?").

That aside, I nce you are established, nothing in medicine is exciting. You mention IM or ER as possibilities. What is so exciting about an H&P? Checking an A1C level? Ordering a belly CT on an EMR? Or calling in the cath team for a STEMI? This is what IM docs and ER docs do all day.

We do what we do to help our patients and our fellow colleagues and much of it is as exciting as watching paint dry, especially once you have seen or done it 10 or 100 or 1000 times. You take satisfaction in a job well done, that you are a vital and valued part of a team, that you might be helping someone in need, and that you get paid often much more than your effort or skill should deserve to be... in radiology, in ER, in trauma surgery, in dermatology, or whatever field you choose.

 

[sloh]

You might want to read this thread if you're considering IM.

Why is IM always at the bottom for career satisfaction?

"Have you done your IM rotation yet?

One thing I can tell you, is that many people go into IM for the wrong reasons. Getting to see exciting rare presentations? No No No. It's great if you want to be responsible for a huge knowledge base and you want to retain most of what you learned in med school, but that stuff won't be what you actually do most of the time, even though it's always in the back of your mind. You better love and get fulfillment from managing chronic illness. If you're looking to roam the hospital stamping out disease, you picked the wrong field.

Also, some go in only wanting fellowship, and hating IM. Some get stuck!

It also helps if you have a real heart for caring for the chronically ill, and you're not that judgemental how they got themselves to your door. Mother Teresa-like love of CHF, COPD, ESLD, ESKD, DM2, obesity, substance abuse, poverty, low health literacy/education, so much of which are lifestyle factors that either aren't gonna change or it's too late... is helpful IMHO, and frankly, I've found it hit or miss in internists. Even so, it's a lot of psychosocial factors of sadness and stress, and that takes a toll even on a big heart.

You frequently "tune up" people who are going to "bounce back." And not bounce back in the good way, bounce back to be readmitted to the hospital in short order.

Even docs that love the medical side of managing chronic illness, still find the social, financial, administrative barriers/tasks etc to be somewhat draining over time.

Whatever I would do over 2 weeks just trying to tweak the beta blocker and lasix dose to try to get euvolemia and avoid orthostatic hypotension in my CHF/CLD'er, would not be nearly as frustrating as the hoops and paperworks and discussions with SW just trying to get SNF placement.

You could say I signed up for both, but on some level one is what you actually *have* to do the manage the *patient* and the other, is made up busywork that doesn't exist in the rational mirror universe, or even bizarro land, Sweden, but is just a byproduct of our administrative medicolegal system of pure waste.

Those tasks are always trying to suck the marrow from your bones, and while they absolutely cannot be cut out of your day, it ends up that time with individual patients is the variable you can control and cut to make space for this bull****.

It didn't make me overly stressed having so many exciting things to click through in the EHR, notes to read on my patients. I loved going to see them, except that I hated going to see them, because of the notes hanging over my head to finish. The notes I sort of enjoyed writing when it was thoughtful, and each day was like an unfolding puzzle in numbers and words, however I sort of hated it when it was the #1 limiter of my time with patients or eating meals, and half the time it was this ridiculous copy pasta but I had to waste enough time being sure to make it look like it wasn't the bull**** that it is.

My example, we all help patients with less than exciting medical problems that fall in our sphere on the regular. However, the amount of paperwork or administrative task burden and sense of futility can be high in IM.

When you cut out all the kids under 12 (mostly everyone under 18), all the pregnant people, and you mostly relegate yourself to the hospital, and outpatient you got FM docs mostly doing the outpt stuff.... ultimately you've set yourself up to be the master of medical trainwrecks. Which is what you should want to be if you choose IM. You are not choosing the well. You are choosing the sick, as your patient population. Even if you go outpatient, you are likely to attract more complicated patients for all I said, and it's frankly a waste of your training if you're not. Then if you go outpatient you are facing all the challenges PCPs do, but with sicker people as your base.

This can all be fun mentally, but can have a sense of futility to your spirit unless you take pleasure in the "tune up" or ongoing management, and will carry with it so many stressors from outside the hospital that you can't control but control you and the patient, for better or mostly worse.

While it isn't the absolute bulk of your patients, probably the worst ones you'll get are the gomers, or just other old people that aren't too gone to feel suffering, but aren't really calling the medical decision-making shots anymore. You also have your other old or dying. Cancers. Everyone trapped in a bed of urine with bedsores for one reason or another (motorcycle accident, MS, ALS, MD, etc etc), trying to not to die from an infection of wind, water, wound.

So far, I only really addressed the patient population, most seen dx, the administrative BS and psychosocioeconomic determinants of health that one faces in IM.

I'm less familiar with all the things that attendings have experience with that might be particularly draining in IM, doing it for years, the financial, billing, malpractice, medicolegal aspects over time.

Many people laud the 7 on and 7 off schedule, but as I understand it, that week the attending is on, the hours are actually the same for a resident during an inpatient month, maybe worse with no work hour restrictions, only the attending's census can be twice as big, and they don't have the sort of caps on admits and all that residents do.

So working harder than a resident does every other week with a week off in between might not be the Promised Land 10-40 years in that people expect it to be, especially if they didn't go in really wanting what it is to be a general internist."

 

[johnjohn1990]

I've started to warm up again to the idea of being in radiology.... I'm in my first month of intern year (surgery) and am reminded of why I chose to avoid inpatient/clinical mecicine altogether. I've worked over 90 hours every week, with nothing but negative reinforcement for the rarest of tiniest of mistakes. When you perform flawlessly - having every page, every note, every lab, every dressing memorized and completed on time, all the while comforting upset families (often for upper level screw ups), coordinating social work, and having disgruntled nurses yelling at you etc etc etc, - you are basically invisible. No one notices - not patients, not upper levels, not anybody. They only notice when something falls through the cracks and then you get yelled at....Why would anybody choose this path...

I know this is also just part of being an intern regardless of field. But the bigger picture and the bigger part of my career dissatisfaction is that this type of stuff IS medicine. It is simply not an intellectual line of work - regardless of field. None of it really requires any genuine creativity or thought. It's just reacting to situations by algorithm day in day out. I realized this half way through my third year and almost decided not to apply to residency altogether. I am dual degree (MDPHD) student and came extremely close to doing a post-doc instead of residency to continue my research. But for reasons I wont go into I applied for residency instead, choosing radiology thinking that at least the hours will be OK, and that it will be somewhat more "intellectual".... I could make some money maybe get back into research at some point or maybe do something else altogether...im still hoping this will be rue.. But medicine as a whole I've become increasingly disenchanted with bc I think as a career it is a huge scam and totally misadvertised. The way it's sold to us while in college, and portrayed by society, you think it will an exciting, cutting edge career, but instead you're just a tool for extracting as much as money as possible from payers and patients. The amount of documentation, EMRs, ICD coding, and the whole mess, is just not really worth it anymore. Surgery is fun, but also extremely repetitive and the hours suck.

Anyway I'm not even sure what my point is anymore.... Basically for better or worse, I'm stuck in this career path towards radiology. I know it will be dull and repetitive, but having done two degrees I'm already a bit older than most...and never having made any real money, I just can't stomach the thought of changing careers. (As a side note, I will add, its extremely frustrating to see how the path of my career has aligned with the timing of the US economy...my friends and I came of age professionally during the housing meltdown crisis, and those that had jobs (coming out of 4 year college plans) were able to buy houses and investments for extremely cheap, and now some of them are essentially selling out and retiring from the workforce in their early 30s, to travel and enjoy their lives...and here I am, I'm finally making a little bit of resident money and housing costs are through the roof and I have nothing...basically I feel like I've worked so hard for so long, am now over 30, and still have to rent a shared 2/1 to make ends meet, despite having what society would tell you is a high paying, upper tier career....no time to date, no time to pursue other interests or travel, no personal life...)

In retrospect I should have pursued something with more creativity and thought and involved for my own needs, but at this point I just have to go to work every day and look for ways outside of my career to satisfy those desires. The money will come, and is frankly not the main issue, even if frustrating at times. However, this is why, in my earlier post I was so petrified of radiology becoming an unemployable career (ie, machine learning etc). I will completely go insane if after another 5-7 years of training I never reach any sort of pay off. It will break me. ....In any case, I will most likely try to get into IR for this reason, even if it means worse hours and getting brain cancer...

I know this is a long disorganized rant that probably sounds like burnout, but got to vent somewhere.

 

[radsisrad]

I've started to warm up again to the idea of being in radiology.... I'm in my first month of intern year (surgery) and am reminded of why I chose to avoid inpatient/clinical mecicine altogether. I've worked over 90 hours every week, with nothing but negative reinforcement for the rarest of tiniest of mistakes. When you perform flawlessly - having every page, every note, every lab, every dressing memorized and completed on time, all the while comforting upset families (often for upper level screw ups), coordinating social work, and having disgruntled nurses yelling at you etc etc etc, - you are basically invisible. No one notices - not patients, not upper levels, not anybody. They only notice when something falls through the cracks and then you get yelled at....Why would anybody choose this path...

I know this is also just part of being an intern regardless of field. But the bigger picture and the bigger part of my career dissatisfaction is that this type of stuff IS medicine. It is simply not an intellectual line of work - regardless of field. None of it really requires any genuine creativity or thought. It's just reacting to situations by algorithm day in day out. I realized this half way through my third year and almost decided not to apply to residency altogether. I am dual degree (MDPHD) student and came extremely close to doing a post-doc instead of residency to continue my research. But for reasons I wont go into I applied for residency instead, choosing radiology thinking that at least the hours will be OK, and that it will be somewhat more "intellectual".... I could make some money maybe get back into research at some point or maybe do something else altogether...im still hoping this will be rue.. But medicine as a whole I've become increasingly disenchanted with bc I think as a career it is a huge scam and totally misadvertised. The way it's sold to us while in college, and portrayed by society, you think it will an exciting, cutting edge career, but instead you're just a tool for extracting as much as money as possible from payers and patients. The amount of documentation, EMRs, ICD coding, and the whole mess, is just not really worth it anymore. Surgery is fun, but also extremely repetitive and the hours suck.

Anyway I'm not even sure what my point is anymore.... Basically for better or worse, I'm stuck in this career path towards radiology. I know it will be dull and repetitive, but having done two degrees I'm already a bit older than most...and never having made any real money, I just can't stomach the thought of changing careers. (As a side note, I will add, its extremely frustrating to see how the path of my career has aligned with the timing of the US economy...my friends and I came of age professionally during the housing meltdown crisis, and those that had jobs (coming out of 4 year college plans) were able to buy houses and investments for extremely cheap, and now some of them are essentially selling out and retiring from the workforce in their early 30s, to travel and enjoy their lives...and here I am, I'm finally making a little bit of resident money and housing costs are through the roof and I have nothing...basically I feel like I've worked so hard for so long, am now over 30, and still have to rent a shared 2/1 to make ends meet, despite having what society would tell you is a high paying, upper tier career....no time to date, no time to pursue other interests or travel, no personal life...)

In retrospect I should have pursued something with more creativity and thought and involved for my own needs, but at this point I just have to go to work every day and look for ways outside of my career to satisfy those desires. The money will come, and is frankly not the main issue, even if frustrating at times. However, this is why, in my earlier post I was so petrified of radiology becoming an unemployable career (ie, machine learning etc). I will completely go insane if after another 5-7 years of training I never reach any sort of pay off. It will break me. ....In any case, I will most likely try to get into IR for this reason, even if it means worse hours and getting brain cancer...

I know this is a long disorganized rant that probably sounds like burnout, but got to vent somewhere.

This, ladies and gents, is why you should not do a surgery prelim unless you're forced to.

johnjohn, I suspect that your life will get enormously better after this year.

 

[deleted556287]

I found radiology and all of medicine to be painfully boring. Envision the fact that you will be doing a minimum of 4 years residency + 1 year fellowship to become a radiologist. You will read thousands upon thousands of crap studies cataloging findings that are of dubious utility. I am completely absolutely burned out on this profession and if I had had the guts like you I would have switched out of radiology into something more engaging and able to get you out of training faster (like EM). Your life will only get worse as an attending unlike other specialties. Do it.

 

[CyberMaxx]

Wow, I'm really sorry some of you guys are having a rough time. This might actually be the most depressing thread on SDN though...

 

[GadRads]

I love radiology. It is intellectual, challenging, detail-oriented and requires a vast knowledge base. It is better than giving lasix, ordering ABG's and antibiotics, or finding placement/SNFs, which is not to say these aren't important in helping patients get good care.

Even though most studies are normal and we are just "cataloging"/ruling out structural disease, I like learning the anatomy, diverse pathology and how they can present on imaging. I don't find it boring. Moreover, it is easy to miss a subtle finding that could have serious implications if one thinks he/she is merely cataloging.

The hours are also better, although there is more independent reading.