Can a DO match Diagnostic Radiology without research?

[Zendo]

Hi all,

OMS3 here. Came in wanting to do Radiology but at this point haven't done anything notable. No red flags, but no research or other ECs. I really hate the research/twitter/networking game. I spent 6-7 months on a research project and it went nowhere. I'm an older student with a family and have no will or desire to do those things. I just want to work hard, learn medicine and do very well on Step 2, and then practice community medicine after residency. Don't need an academic program or a desirable city.

With the current climate, can a DO still match DR in a community program in the midwest/northeast (something like Kettering, Christiana Care, Allegheny tier) by just having a 260+ Step 2, good letters, and doing a few away rotations? From what I understand this was pretty normal until just a couple of years ago.

Thanks in advance.

@Ho0v-man
@Neopolymath

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[Ho0v-man]

Yeah. Flesh out some hobbies bc that’s what people want to talk about on interviews. But even today, a lack of research won’t necessarily break you. When I compare my CV (or lack thereof lol) to my colleagues it becomes very clear that they just ranked us by step scores more than anything else.

You don’t necessarily need to go to a big name place and I think a lot of rads community programs are actually very good. But I would try to shoot for an academic tertiary care center of some kind if you have the option. While I’m probably not reading quite the volume of my colleagues in community programs, the complexity is insane. It’s rare to have a negative study on call. But with the competition today I’m not sure how easy that is for a DO anymore.

Edit: although there were a few community programs I ranked over academic programs.

 

[Zendo]

Yeah. Flesh out some hobbies bc that’s what people want to talk about on interviews. But even today, a lack of research won’t necessarily break you. When I compare my CV (or lack thereof lol) to my colleagues it becomes very clear that they just ranked us by step scores more than anything else.

You don’t necessarily need to go to a big name place and I think a lot of rads community programs are actually very good. But I would try to shoot for an academic tertiary care center of some kind if you have the option. While I’m probably not reading quite the volume of my colleagues in community programs, the complexity is insane. It’s rare to have a negative study on call. But with the competition today I’m not sure how easy that is for a DO anymore.

Edit: although there were a few community programs I ranked over academic programs.

That's encouraging to hear. I'll take my shot then.

For tertiary care and complexity, is looking at the number of residencies and fellowships offered at a hospital a good rule of thumb?

 

[MateoGM416]

Yeah. Flesh out some hobbies bc that’s what people want to talk about on interviews. But even today, a lack of research won’t necessarily break you. When I compare my CV (or lack thereof lol) to my colleagues it becomes very clear that they just ranked us by step scores more than anything else.

You don’t necessarily need to go to a big name place and I think a lot of rads community programs are actually very good. But I would try to shoot for an academic tertiary care center of some kind if you have the option. While I’m probably not reading quite the volume of my colleagues in community programs, the complexity is insane. It’s rare to have a negative study on call. But with the competition today I’m not sure how easy that is for a DO anymore.

Edit: although there were a few community programs I ranked over academic programs.

Would published research in a non-radiology field help a radiology app at all?

 

[Ho0v-man]

That's encouraging to hear. I'll take my shot then.

For tertiary care and complexity, is looking at the number of residencies and fellowships offered at a hospital a good rule of thumb?

Not sure about that metric. Basically you want academic place that doesn’t compete with another academic place if possible. For instance, SLU is academic but it’s in the same town as Mallincrockdt. It probably has better trauma, but less complexity in every other way.

Meanwhile West Virginia U isn’t a gigantic program but is basically taking every complex case in the state. So every weird cancer or whatever other complexity is going there. Couple that with its location that is less desirable by most med students standards and it becomes a solid place to train that’s realistic for DO applicants despite being “low-tier.” These would be the places I would target as a DO applying today. University programs in less desirable locales.

There’s obvious exceptions of course like CCF and Case Western both have no shortage of complexity and are just good at different things. On the other end of the spectrum, some university programs like Toledo are basically like community programs (nothing wrong with that!)

Would published research in a non-radiology field help a radiology app at all?

Absolutely. Any is good. But despite the craziness, rads doesn’t weigh research too heavily if you don’t have the test numbers.

 

[MateoGM416]

Absolutely. Any is good. But despite the craziness, rads doesn’t weigh research too heavily if you don’t have the test numbers.

Why is that? Also is that true for all specialties that are more competitive than primary care

 

[Ho0v-man]

Why is that? Also is that true for all specialties that are more competitive than primary care

Because in rads after a long day you’re still supposed to study about an hour a day. High scores select for people who do that.

Derm, surgical subs, higher tier IM and really just higher tier programs in general will value research and scores more. But in general just having scores above the 50th percentile and nothing else will get you into most specialties until you get to rads, gas, derm and surgical subs if you don’t care about location/prestige (which DOs don’t have the luxury of considering).

But we’re talking matching rads and atm just matching anywhere. So it’s all about scores. There are super picky places that really highly value research. But they usually don’t take DOs so it’s whatever.

 

[Zendo]

Not sure about that metric. Basically you want academic place that doesn’t compete with another academic place if possible. For instance, SLU is academic but it’s in the same town as Mallincrockdt. It probably has better trauma, but less complexity in every other way.

Meanwhile West Virginia U isn’t a gigantic program but is basically taking every complex case in the state. So every weird cancer or whatever other complexity is going there. Couple that with its location that is less desirable by most med students standards and it becomes a solid place to train that’s realistic for DO applicants despite being “low-tier.” These would be the places I would target as a DO applying today. University programs in less desirable locales.

There’s obvious exceptions of course like CCF and Case Western both have no shortage of complexity and are just good at different things. On the other end of the spectrum, some university programs like Toledo are basically like community programs (nothing wrong with that!)



Absolutely. Any is good. But despite the craziness, rads doesn’t weigh research too heavily if you don’t have the test numbers.

That makes a lot of sense. Thank you. This kind of deeper insight (especially for DOs) is hard to find from school advisors, reddit, etc.

 

[Zendo]

I hope the new signal system also helps out us DOs, as we will be more likely to designate low-tier and community as gold. I believe programs like to match people who had them high on their rank list.

 

[voxveritatisetlucis]

Yea just apply broadly. I have a feeling rads will be competitive this cycle but then drop off a bit

 

[Postictal Raiden]

Yea just apply broadly. I have a feeling rads will be competitive this cycle but then drop off a bit

Unless the fear of AI catches momentum among med students, Rads will only get more competitive.

It’s a great field. It allows you practice medicine without having to deal with annoying patients and endless administrative/social work. Pay is fantastic, thought truth to be told, the $ per mole of energy and time spent is a lot worse than it used to be a decade ago. What I think would be one of the most attractive perks about it (socially among millennials) is the ability to work remotely.

I almost applied to the field. Ultimately chose a different speciality. From time to time, I regret not doing Rads. But similarly I sometimes regret going into medicine altogether.

 

[voxveritatisetlucis]

Unless the fear of AI catches momentum among med students, Rads will only get more competitive.

It’s a great field. It allows you practice medicine without having to deal with annoying patients and endless administrative/social work. Pay is fantastic, thought truth to be told, the $ per mole of energy and time spent is a lot worse than it used to be a decade ago. What I think would be one of the most attractive perks about it (socially among millennials) is the ability to work remotely.

I almost applied to the field. Ultimately chose a different speciality. From time to time, I regret not doing Rads. But similarly I sometimes regret going into medicine altogether.

A few people at my school aren’t applying because of AI fears. Not sure if it’s justified (probably not) but definitely may be a trend to keep an eye on

Why do you regret going into medicine

 

[MateoGM416]

Unless the fear of AI catches momentum among med students, Rads will only get more competitive.

It’s a great field. It allows you practice medicine without having to deal with annoying patients and endless administrative/social work. Pay is fantastic, thought truth to be told, the $ per mole of energy and time spent is a lot worse than it used to be a decade ago. What I think would be one of the most attractive perks about it (socially among millennials) is the ability to work remotely.

I almost applied to the field. Ultimately chose a different speciality. From time to time, I regret not doing Rads. But similarly I sometimes regret going into medicine altogether.

Also, what specialty did you choose

 

[Postictal Raiden]

Neurology. I really enjoy it most the days. There’s tons of radiology in it to satisfy the crave.

Had I done a different career, I would have started living like an adult 8 years earlier. I would have started making money when houses were third of what they cost now. It’s the grass-is-greener-on-the-other-side mindset.

 

[Zendo]

Neurology. I really enjoy it most the days. There’s tons of radiology in it to satisfy the crave.

Had I done a different career, I would have started living like an adult 8 years earlier. I would have started making money when houses were third of what they cost now. It’s the grass-is-greener-on-the-other-side mindset.

I like Rads and IM because of the broad knowledge base in both. Having a general idea about everything appeals to me more than being a niche expert in one thing. I've heard Neurology also requires broad knowledge and good understanding of general medicine compared to other specialized fields. Would you agree with that, or is it not really relevant in actual practice? Would you recommend neurology to someone who isn't particularly passionate about neuroscience or neuroanatomy?

Seems like a great field with inpatient and outpatient options, tons of subspecialties, telehealth options, and high demand with very good compensation. I'm just not sure if the brutal residency is worth it if you don't LOVE it.

 

[Postictal Raiden]

I like Rads and IM because of the broad knowledge base in both. Having a general idea about everything appeals to me more than being a niche expert in one thing. I've heard Neurology also requires broad knowledge and good understanding of general medicine compared to other specialized fields. Would you agree with that, or is it not really relevant in actual practice? Would you recommend neurology to someone who isn't particularly passionate about neuroscience or neuroanatomy?

Seems like a great field with inpatient and outpatient options, tons of subspecialties, telehealth options, and high demand with very good compensation. I'm just not sure if the brutal residency is worth it if you don't LOVE it.

Definitely do Rads over IM (unless you end up specializing in cardiology, GI or heme/onc). General IM is a grind.

Neurology is extremely broad. Yes, you need to have a very good understanding of general medicine to do neurology well. The field is very intellectually stimulating and constantly evolving.

With that said, neurology is also a grind. Think of the types of consults we see (weakness, encephalopathy, numbness, pain). Very vague stuff that has very little objectivity. Patients and other doctors expectations often don’t align with what you can offer.

AI is something to be mindful of. I’m not a radiologist so I can’t with confidence claim that the field is safe for the foreseeable future (because to me it does seem safe). This is my little disclaimer to counter my initial recommendation to pursue Rads.

 

[deleted1139416]

Definitely do Rads over IM (unless you end up specializing in cardiology, GI or heme/onc). General IM is a grind.

Neurology is extremely broad. Yes, you need to have a very good understanding of general medicine to do neurology well. The field is very intellectually stimulating and constantly evolving.

With that said, neurology is also a grind. Think of the types of consults we see (weakness, encephalopathy, numbness, pain). Very vague stuff that has very little objectivity. Patients and other doctors expectations often don’t align with what you can offer.

AI is something to be mindful of. I’m not a radiologist so I can’t with confidence claim that the field is safe for the foreseeable future (because to me it does seem safe).

Can I ask you a quick question? I did a Neuro ICU rotation last month and felt it to be basically IM. Most of the neuro related care came down to monitoring CT changes, EEGS, and balancing sodium to make sure ICP is controlled. That's about it. Felt challenging in a LOT of ways but not in a "critical thinking about neurology" kind of way, ya know? Is that your experience as well?

 

[Postictal Raiden]

Can I ask you a quick question? I did a Neuro ICU rotation last month and felt it to be basically IM. Most of the neuro related care came down to monitoring CT changes, EEGS, and balancing sodium to make sure ICP is controlled. That's about it. Felt challenging in a LOT of ways but not in a "critical thinking about neurology" kind of way, ya know? Is that your experience as well?

Neuro ICU is a different bread. They are closer to being IM than neuro, honestly.

NCC and to a lesser extent stroke, are neuro sanctuaries for neurologists who realize they like the CNS but also hate your bread and butter neurology (localization of peripheral lesions, encephalopathy, seizures, movement disorder, etc). They are tired of the subjectivity and want more concrete data. Obviously this is a generalization but that’s the consensus I got from my friends who pursued these fields.

Do another neurology rotation, perhaps an outpatient one, and you’ll get a better taste of neurology. Most likely you’ll hate it. It’s a very self selective field.

 

[deleted1139416]

Neuro ICU is a different bread. They are closer to being IM than neuro, honestly.

NCC and to a lesser extent stroke, are neuro sanctuaries for neurologists who realize they like the CNS but also hate your bread and butter neurology (localization of peripheral lesions, encephalopathy, seizures, movement disorder, etc). They are tired of the subjectivity and want more concrete data. Obviously this is a generalization but that’s the consensus I got from my friends who pursued these fields.

Do another neurology rotation, perhaps an outpatient one, and you’ll get a better taste of neurology. Most likely you’ll hate it. It’s a very self selective field.

Do you think that this phenomenoa with NCC and stroke explains why midlevels are so prolific in these areas of neurology?

 

[Postictal Raiden]

Ofc. These two fields are perfect for midlevels because:

1) very algorithmic
2) diagnoses are based on data rather than clinical acumen
3) reimbursement is high
4) they are more like service/commodity rather than a “brand”
5) scope is narrow

 

[voxveritatisetlucis]

Ofc. These two fields are perfect for midlevels because:

1) very algorithmic
2) diagnoses are based on data rather than clinical acumen
3) reimbursement is high
4) they are more like service/commodity rather than a “brand”
5) scope is narrow

Which sub specialties in neurology are most resistant to mid levels

 

[Postictal Raiden]

Which sub specialties in neurology are most resistant to mid levels

This is my opinion but I think the less they meet the criteria above the safer they are from invasion.

NIR is very safe simply because it’s very procedural and stakes are high. It may appear algorithmic but it is far from that. You often need to improvise your initial plan

Movement disorder due to the nuance of the conditions and how little objectivity there is when it comes to making the diagnosis. It also requires very good understanding of neuro pharmacology to personalize and optimize regimen

Neurocognitive and neuroimmunology due to our lack of understanding of these systems and the robust ongoing research in these fields. Also specialists in these fields are “brands” rather than services. Patients seek them due to reputation the same way patients seek surgeons.

Epilepsy. I’m not taking about “start him on 1g bid of Keppra” type of epilepsy. I’m talking about managing intractable epilepsy using multiple meds and neuromodulation as well as surgical planning. This requires lots of training in EEG and deep understanding of epilepsy neuropharm

Neuromuscular as well due to the frequent use of biologics and also due to our helplessness when it comes to many neuromuscular conditions

 

[deleted1139416]

This is my opinion but I think the less they meet the criteria above the safer they are from invasion.

NIR is very safe simply because it’s very procedural and stakes are high. It may appear algorithmic but it is far from that. You often need to improvise your initial plan

Movement disorder due to the nuance of the conditions and how little objectivity there is when it comes to making the diagnosis. It also requires very good understanding of neuro pharmacology to personalize and optimize regimen

Neurocognitive and neuroimmunology due to our lack of understanding of these systems and the robust ongoing research in these fields. Also specialists in these fields are “brands” rather than services. Patients seek them due to reputation the same way patients seek surgeons.

Epilepsy. I’m not taking about “start him on 1g bid of Keppra” type of epilepsy. I’m talking about managing intractable epilepsy using multiple meds and neuromodulation as well as surgical planning. This requires lots of training in EEG and deep understanding of epilepsy neuropharm

Neuromuscular as well due to the frequent use of biologics and also due to our helplessness when it comes to many neuromuscular conditions

What is your opinion on pursing general neurology without fellowship? It really seems daunting to spend extra years after residency.

 

[Postictal Raiden]

What is your opinion on pursing general neurology without fellowship? It really seems daunting to spend extra years after residency.

I didn’t do a fellowship. Tons of jobs. Not needed at all

 

[deleted1139416]

Neuro ICU is a different bread. They are closer to being IM than neuro, honestly.

Best thing about my neuro ICU rotation was that I never needed equipment. It's not "neuro enough" to need a reflex hammer and also not "IM enough" to need a stethoscope

 

[Neopolymath]

Zendo, hopefully I have some more time to give you an extensive response to your question but I do have a few thoughts.

First, I think that even without research you can match rads. There are many good programs, community and academic, that understandly value high board scores, good letters, and a well-rounded/likeable person behind them. It's not a specialty (yet?) that lives and dies by research as nothing more than a filtering tool like the surgical subs.

That said, if the ERAS filter is typically no research versus doing something for your app, then it would be great value to do some random easy project(s). Radiology sees all kinds of wild things every day. Case reports for Case in Point or the myriad other rads journals are easy and plentiful. Everyone is willing to share cool cases for you to write up. It takes a couple hours on a weekend. Just do it.

My take: The best way to predict your future is to create it. The best way to balance extra life requirements outside work with your career is to adopt high value activities first and foremost. Use a low effort, high ROI project to eliminate an easy filter from your app. I hate research too! I think you would likely be fine (matching versus not matching) but I think it would be remiss to do no case report/series given the security and benefit to your program choices compared to the effort. It also looks better on your rotation because DR rotations are passive.

Keep us updated.

 

[Zendo]

Zendo, hopefully I have some more time to give you an extensive response to your question but I do have a few thoughts.

First, I think that even without research you can match rads. There are many good programs, community and academic, that understandly value high board scores, good letters, and a well-rounded/likeable person behind them. It's not a specialty (yet?) that lives and dies by research as nothing more than a filtering tool like the surgical subs.

That said, if the ERAS filter is typically no research versus doing something for your app, then it would be great value to do some random easy project(s). Radiology sees all kinds of wild things every day. Case reports for Case in Point or the myriad other rads journals are easy and plentiful. Everyone is willing to share cool cases for you to write up. It takes a couple hours on a weekend. Just do it.

My take: The best way to predict your future is to create it. The best way to balance extra life requirements outside work with your career is to adopt high value activities first and foremost. Use a low effort, high ROI project to eliminate an easy filter from your app. I hate research too! I think you would likely be fine (matching versus not matching) but I think it would be remiss to do no case report/series given the security and benefit to your program choices compared to the effort. It also looks better on your rotation because DR rotations are passive.

Keep us updated.

Thank you for taking the time to share your thoughts, I really appreciate it. This thread has been encouraging for sure. It's reassuring to hear from residents that the fundamental qualities of a good student are still what matters for many programs. I hear what you're saying about just getting something easy on the board. I agree, it would be neglectful to apply with a blank ERAS section. Especially with research where quality is vague. I imagine for most programs, it wouldn't make much sense to compare the research of two applicants but it would help to differentiate between someone who has done scholarly work and someone who hasn't done any at all.

I will get to work on securing some sort of case report at the least and then stop anguishing over it.

Your advice is practical and applicable to many things. It is very clutch at this period of my life. Thanks again!