HandOfMrsRoentgen

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That Step 1 score will probably hurt at the more prestigious programs, but I'd be surprised if you couldn't find a radiology position, especially with strong clinical grades (sounds like you're an AMG?) That being said, switching means you'd be applying for open positions from residents dropping out or unmatched spots after last year's match, so that would be more unpredictable than applying for the upcoming cycle.

How sure are you that you want to do this? EM and Radiology are very different specialties. Have you spoke to either PD at your institution?
 
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da8s0859q

I'm an EM PGY-3. I and many of my group had thoughts of switching early. It's a normal response to early intern year.

I say this only to say that if you're going to switch, be sure you're doing it for the right reasons.
 

Cubsfan10

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I switched to rads from a different field and I'm 10x happier. I was once told that 20% of radiologists started out in a different field and I rarely hear of a physician that switched out of radiology.
The things I will say though is you are most likely going to lose a year. If you apply this year for rads, it would be a 2017 start. Yes, there are 8-10 pgy-2 spots each year that could be had but usually they are at programs that aren't super desirable and/or there is a ton of competition for them. Likely, you'd have to take a 2017 start and thus have a gap year. This has been done by many residents including myself and there are various things you can do during that year: research, urgent care, etc. The one thing I don't know in your case is if your EM year would even count for the intern year required by Rads. You may have to do another intern year.
As far as EM goes....it's my least favorite specialty for a lot of reasons that I won't name on here because they are my personal opinions but one thing that is accurate to think about is generally EM docs are "retired" after 10-15 years of EM whereas a radiologist can practice literally 40+ years if he/she wants.
If you truly want rads, then now would be the time to make the switch.
 
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Thank you all for your replies. It is nice to know that switching does occur, and that it is a real possibility. Yes, I am an AMG, and I'm certain I want to switch. Really, I was interested early, then decided it was out of reach.
 
Aug 26, 2015
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First, there is no need to worry about being competitive. Your numbers are competitive enough for radiology. Whatever data or conjecture led you to believe that you wouldn't match radiology as an MS 4 was misguided. Even in the 2014 match, you would have landed at a decent place. Radiology far from filled its positions in the match. In my region, you would have been an easy match within the region for radiology but less likely to match at an EM program around where I live because EM in my region is very locally competitive. Supply and demand differs widely depending on where you are. MGH is probably beyond your reach, but there are 100 radiology programs that would have been happy to have you barring any odd personality or work ethic issues.

There are programs posting PGY-2 openings on Aunt Minnie all the time, but they are usually undesirable programs (hence the openings).

Your year of EM will count as an eligible PGY-1 year as long as your program is ACGME-accredited, and all of your time is spent doing clinical medicine (i.e. you don't have more than 2 months on the pathology or radiology service). Any radiology rotation you take this year should be within the confines of an ACGME-accredited training program. EM is actually probably far more relevant as a PGY-1 year experience when compared to IM.

One thing to understand is that once you matched EM, you were earmarked for 3 years of 100% funding by CMS. This means that whatever program you attend will have to have VA money or hospital funding to cover your other 2 years of training. It's probably not a big issue, but it can be a stumbling block in select places. If you keep your current position in lieu of starting radiology in 2017, this subtracts one more year of CMS eligibility.

If you want to go through the regular match, you should be applying soon, as in next week. The match is where you will have the best shot at a good education. Opting for the most immediately-available opening runs a risk of a disastrous outcome. There are programs out there run by private attendings who just throw you in front of a computer for 4 years and tell you to read some books.

You have an IMG radiology resident locally, so I am going to go out on a limb and say that you are not in the most desirable location. Your best odds are at your current place, particularly if you are native to the area, and there is funding for you. I assume that you don't have family issues to complicate matters.

This should not be a matter of "chances." It's a matter of whether this is something that you are willing to do or not.

If you start radiology in 2017, you will graduate in 2021 and finish a fellowship (pretty much necessary now) in 2022. Your current EM colleagues will have been in practice for 4 years with a million in the bank if they know what they are doing; and there are plenty of areas where EM pay is not that different from radiology pay (with the preponderance of such markets likely to increase by 2022). You couldn't pay me enough personally to do EM, but I can't gauge what you don't like about it.

It's a tough decision. If the options out there were only for bad radiology programs, I'd finish EM and see what materializes toward the end of training.
 
Dec 9, 2011
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4 years of attending work and one million saving!!! No way unless he spends 10K a year.
First, there is no need to worry about being competitive. Your numbers are competitive enough for radiology. Whatever data or conjecture led you to believe that you wouldn't match radiology as an MS 4 was misguided. Even in the 2014 match, you would have landed at a decent place. Radiology far from filled its positions in the match. In my region, you would have been an easy match within the region for radiology but less likely to match at an EM program around where I live because EM in my region is very locally competitive. Supply and demand differs widely depending on where you are. MGH is probably beyond your reach, but there are 100 radiology programs that would have been happy to have you barring any odd personality or work ethic issues.

There are programs posting PGY-2 openings on Aunt Minnie all the time, but they are usually undesirable programs (hence the openings).

Your year of EM will count as an eligible PGY-1 year as long as your program is ACGME-accredited, and all of your time is spent doing clinical medicine (i.e. you don't have more than 2 months on the pathology or radiology service). Any radiology rotation you take this year should be within the confines of an ACGME-accredited training program. EM is actually probably far more relevant as a PGY-1 year experience when compared to IM.

One thing to understand is that once you matched EM, you were earmarked for 3 years of 100% funding by CMS. This means that whatever program you attend will have to have VA money or hospital funding to cover your other 2 years of training. It's probably not a big issue, but it can be a stumbling block in select places. If you keep your current position in lieu of starting radiology in 2017, this subtracts one more year of CMS eligibility.

If you want to go through the regular match, you should be applying soon, as in next week. The match is where you will have the best shot at a good education. Opting for the most immediately-available opening runs a risk of a disastrous outcome. There are programs out there run by private attendings who just throw you in front of a computer for 4 years and tell you to read some books.

You have an IMG radiology resident locally, so I am going to go out on a limb and say that you are not in the most desirable location. Your best odds are at your current place, particularly if you are native to the area, and there is funding for you. I assume that you don't have family issues to complicate matters.

This should not be a matter of "chances." It's a matter of whether this is something that you are willing to do or not.

If you start radiology in 2017, you will graduate in 2021 and finish a fellowship (pretty much necessary now) in 2022. Your current EM colleagues will have been in practice for 4 years with a million in the bank if they know what they are doing; and there are plenty of areas where EM pay is not that different from radiology pay (with the preponderance of such markets likely to increase by 2022). You couldn't pay me enough personally to do EM, but I can't gauge what you don't like about it.

It's a tough decision. If the options out there were only for bad radiology programs, I'd finish EM and see what materializes toward the end of training.
Your post is based on few assumptions

1- I assume the OP does not like EM. If OP doesn't like EM, he has to switch. Life is too short to do something that you hate. I always say that you don't have to love what you do but at least you should not dislike/hate most of it. Obviously, every job has some parts that we hate. But it should not be the majority of your job. One of mentors used to say: "The enjoying parts will become routine, the painful parts will become more painful." Make sure that the painful parts are only a small portion of what you do.

If the OP likes EM, he should stick with EM because that is what he likes. Otherwise, if he likes radiology more he has to switch. period.

2- I can't believe that by working for 4 years one can save a million in the bank. This is very wrong. I am not going to argue over this, but if you are able to save that much money, good for you. Anyway, life is not a competition over saving more money. If the OP doesn't like EM, these wrong calculations are useless.

3- Going back to salaries. Most rads make more than most EM docs. There are always exceptions. For example, most neurosurgeons make more than most rads but one of NS in our hospital makes general IM level salary. But let' say your claim is correct and EM and rads make similar. Still I choose over rad any day of the week. Making 50K or 100K more money should not be a deal maker.

If he switches to radiology, even if we believe in what you say, he will have 1 mil less saving that his EM residents. I can argue that as a radiologist he can work easily 4 years more than an ED doctors (though most radiologists work 30+ years and most ED docs retire after 15-20 years) and compensate for his current loss. Anyway, life is not a competition over who makes more. Both fields make good money, enough to have a decent life. The OP should base his decision on his interests and not salary.

What has happened to us? Someone who makes 250K-300K + still should not pursue his interest and should base his decision just on the 50K or 100K that he may or may not be able to make in one field or the other.

Believe me as an attending in private practice. After 5 years, you will be fine financially and the only thing that matters to you will be your like or dislike of your day to day practice. If you like EM (or rads), you will be happy. If you hate EM (or rads), you will be miserable. Higher salary can not fill this gap.
 
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Aug 26, 2015
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Jesus, a rant over a small part of one sentence. EM docs at my hospital make over $250K a year. I should have said a million in realized income. It's the point of the statement that matters, not the actual numbers. Whatever numbers you quote for Iowa will have no resemblance at all to California, so referring to any salary number on this board has no utility.

Private EM in my market approximates academic rad. Nonetheless, making a claim that "most radiologists work 30+ years and most ED docs retire after 15-20 years" is more bizarre of a generalization than anyone can make about money, especially if you look at the uncertainty of physician pay over the next 30 years in general. I've never heard of an EM doc straight up retiring from medicine at age 45. The specialty was only invented 30-40 years ago.

Much of this depends on family. If you have kids and need money over the next 10 years of their lives, you may be Bill Gates at 60, but if you were living off a resident income when you had 4 or 5 mouths to feed, does the extra money at the end of your career serve any purpose? That's my point.

Real life example: A friend of mine has 3 kids, goes to a radiology residency in a place that has zero job openings, so he goes somewhere else for a fellowship. At the end of the year, nope, no job in that area either. So he has to consider telerad vs. rural town someplace where his wife will still be miserable and where he has to read mammo. Should he have done EM instead? Absolutely not, but it was a circumstance that he hadn't thought of. That is the utility of a discussion board--to make sure that the OP understands that he is talking about a career that will now not start until 2022.

I think the reason why this forum is so dead is because it is impossible to give real advice without knowing one's real personal situation, where you are, and where/how you need/want to live the rest of your life.

Anyway, all he was asking about was "chances." How and where to find the best program is the real issue here.
 
Dec 9, 2011
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Jesus, a rant over a small part of one sentence. EM docs at my hospital make over $250K a year. I should have said a million in realized income. It's the point of the statement that matters, not the actual numbers. Whatever numbers you quote for Iowa will have no resemblance at all to California, so referring to any salary number on this board has no utility.

Private EM in my market approximates academic rad. Nonetheless, making a claim that "most radiologists work 30+ years and most ED docs retire after 15-20 years" is more bizarre of a generalization than anyone can make about money, especially if you look at the uncertainty of physician pay over the next 30 years in general. I've never heard of an EM doc straight up retiring from medicine at age 45. The specialty was only invented 30-40 years ago.

Much of this depends on family. If you have kids and need money over the next 10 years of their lives, you may be Bill Gates at 60, but if you were living off a resident income when you had 4 or 5 mouths to feed, does the extra money at the end of your career serve any purpose? That's my point.

Real life example: A friend of mine has 3 kids, goes to a radiology residency in a place that has zero job openings, so he goes somewhere else for a fellowship. At the end of the year, nope, no job in that area either. So he has to consider telerad vs. rural town someplace where his wife will still be miserable and where he has to read mammo. Should he have done EM instead? Absolutely not, but it was a circumstance that he hadn't thought of. That is the utility of a discussion board--to make sure that the OP understands that he is talking about a career that will now not start until 2022.

I think the reason why this forum is so dead is because it is impossible to give real advice without knowing one's real personal situation, where you are, and where/how you need/want to live the rest of your life.

Anyway, all he was asking about was "chances." How and where to find the best program is the real issue here.
Real advice: My friend was in the same situation as you friend. Didn't find a job in Boston. Moved to a smaller town for 2 years and then found an opening in Boston after 2 years. In real life, your first job is usually temporary and most physicians change jobs more frequently. So you are right. In real life, not finding a job in the area that you like is not a disaster. You can always find something in the next 2-3 years. But in an online forum it is considered a disaster because the assumption is that you are doomed to stay in that job forever.

If you read my post, the main emphasize was on what he likes or dislikes and he should follow that. If he hates ED, what is the point of getting a job in the exact location that you want but you hate every moment of your work. In contrast, if he likes radiology there is a 100% guarantee that he will eventually find a job in the location that he wants within 3-4 years of finishing his fellowship.

Again read my post. It is a very personal decision. I hate mammo and have not done it in the last 4 years. But still I prefer to do mammo over ER big time.

I feel talking about mammo, telerad and talking about not finding the job right after fellowship are overemphasized on online forums. Not everyone wants to live in a big city. Not everyone hates mammo.

I just corrected your very distorted calculation. If an ED makes 250K, a resident also makes 60K. The different is 190K and if you take away the tax the different is 120K.

Also no matter whom you talk to, an average diagnostic radiologist can work comfortably more years than an average ED doctor or most other clinicians except for derm and pathology. It was just an example to say that losing 4 years now can be compensated later.

It is a very personal decision, but I myself would rather do something non medical than being an ED doctor. My biased personal opinion.
 
Aug 26, 2015
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I hereby rescind any comment I made about unrecovered income from 2017-2022. Forget I mentioned it. It should have no bearing whatsoever on your decision. I am an idiot for even thinking that anyone would consider such an asinine premise.

If we are going to make this about whether you should switch or not, it is a personal decision. Why didn't the OP simply rank both specialties as a medical student if interest in radiology was originally high? If there is already dislike for EM 2 months in, what was flawed about the perception, and how can you correct the thinking going into radiology?

At any rate, whether he should or not wasn't the question. It's whether he can. He can. There is not much risk in trying. Go for it.
 
Dec 9, 2011
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I hereby rescind any comment I made about unrecovered income from 2017-2022. Forget I mentioned it. It should have no bearing whatsoever on your decision. I am an idiot for even thinking that anyone would consider such an asinine premise.

If we are going to make this about whether you should switch or not, it is a personal decision. Why didn't the OP simply rank both specialties as a medical student if interest in radiology was originally high? If there is already dislike for EM 2 months in, what was flawed about the perception, and how can you correct the thinking going into radiology?

At any rate, whether he should or not wasn't the question. It's whether he can. He can. There is not much risk in trying. Go for it.
yes, it is stupid to base the decision about a life time career on 4 years of junior attending income.

Everybody can make a mistake at some point. It is stupid to say that if you apply for ED or Radiology or Surgery or OB you have to stick with it the rest of your life. I had a classmate who finished an IM residency and then started a radiology residency. I know a guy who started with Derm and switched to OB-Gyn. Both are very happy with their decisions.
 

Baller MD

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yes, it is stupid to base the decision about a life time career on 4 years of junior attending income.

Everybody can make a mistake at some point. It is stupid to say that if you apply for ED or Radiology or Surgery or OB you have to stick with it the rest of your life. I had a classmate who finished an IM residency and then started a radiology residency. I know a guy who started with Derm and switched to OB-Gyn. Both are very happy with their decisions.
Wow. I guess anything in this world is possible.
 
Aug 26, 2015
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Switching away from dermatology is not uncommon. There is not much exposure to it in medical school, so people don't know what they are signing up for. If it reimbursed the same as medical genetics, it would be just as popular.

I know 2 people who switched from neurosurgery to family medicine, but my favorite is a guy who switched from psychology to pathology.

The question remains what is wrong with our medical education system that people are in medical school for over 3 years, and they still can't make a properly informed decision?
 
Dec 9, 2011
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Switching away from dermatology is not uncommon. There is not much exposure to it in medical school, so people don't know what they are signing up for. If it reimbursed the same as medical genetics, it would be just as popular.

I know 2 people who switched from neurosurgery to family medicine, but my favorite is a guy who switched from psychology to pathology.

The question remains what is wrong with our medical education system that people are in medical school for over 3 years, and they still can't make a properly informed decision?
There is nothing wrong with medical education. People always change their minds in life. Our perspectives change as we get older or more experienced. It does not mean that there is something wrong with the system.

If you don't try something you never know you like it or not. Choosing a medial specialty or a career has also a component of randomness/luck to it.
 
Aug 26, 2015
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There is a ton wrong with medical education. It's too expensive, unnecessarily long, lacks any discussion of the business of medicine, and has basically failed to adapt to the changing healthcare system over the last 100 years.

Many state-funded medical schools, particularly those with rural branch clinical sites, discourage their students from anything but primary care. How can a student get enough exposure to make an informed decision? You have to plan early and go out on your own for many specialties.
 
Dec 9, 2011
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There is a ton wrong with medical education. It's too expensive, unnecessarily long, lacks any discussion of the business of medicine, and has basically failed to adapt to the changing healthcare system over the last 100 years.

Many state-funded medical schools, particularly those with rural branch clinical sites, discourage their students from anything but primary care. How can a student get enough exposure to make an informed decision? You have to plan early and go out on your own for many specialties.
Your post is irrelevant to the discussion. The OP was questioning about ED versus Radiology. I don't know how come we are talking about the expenses of medical education. The OP has paid those expenses anyway.
 
Aug 26, 2015
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Agreed. The thread got derailed when you went off on the salary issue Sunday.

As I said before...

Anyway, all he was asking about was "chances."
If his mind is made up, the "chances" issue is settled IMO, but those things I pointed out in my original response were highly relevant to the OP's chances.
 
Dec 9, 2011
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Agreed. The thread got derailed when you went off on the salary issue Sunday.

As I said before...



If his mind is made up, the "chances" issue is settled IMO, but those things I pointed out in my original response were highly relevant to the OP's chances.

You said crap and I clarified things.

Your original response is full of $hit. Now go back and study for your USMLE or take your ER shift.
 
Aug 26, 2015
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My brother started IM, regretted it, and then latched onto a radiology program that had an opening after realizing that a lot of programs in his reach were not considering people who couldn't get fully funded. It's a relevant point that needed to be raised.

The program he went to was terrible--no teaching, far from state-of-the-art, and there were a lot of exams he wasn't comfortable reading afterward because the program was that bad. Plus, at the time he graduated (2013), the job market tanked. He wound up doing 2 fellowships.

We agree--he is happier now having made the switch and finally just now starting employment, but he thought all programs were equal enough, so he took the fastest means to an end. He would have been happier delaying things a year and getting comprehensive training.

Now, when you look at Core exam passage rates, a small portion of the programs are reportedly having a tough time getting their residents to pass the test. These are the ones where you are going to find the openings.

Over the past 10 years, SDN and AM have become cemeteries, as people get tired of hearing how the ABR lost its way, and how the job market sucks. Only shark and a few other practicing radiologists post, so the value of diverse discussion is staunchly diminished. Here I thought shark was a professional who had earned some respect, and I get these snide unprofessional snarky remarks in response. No wonder nobody posts here anymore.
 
Dec 9, 2011
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My brother started IM, regretted it, and then latched onto a radiology program that had an opening after realizing that a lot of programs in his reach were not considering people who couldn't get fully funded. It's a relevant point that needed to be raised.

The program he went to was terrible--no teaching, far from state-of-the-art, and there were a lot of exams he wasn't comfortable reading afterward because the program was that bad. Plus, at the time he graduated (2013), the job market tanked. He wound up doing 2 fellowships.

We agree--he is happier now having made the switch and finally just now starting employment, but he thought all programs were equal enough, so he took the fastest means to an end. He would have been happier delaying things a year and getting comprehensive training.

Now, when you look at Core exam passage rates, a small portion of the programs are reportedly having a tough time getting their residents to pass the test. These are the ones where you are going to find the openings.

Over the past 10 years, SDN and AM have become cemeteries, as people get tired of hearing how the ABR lost its way, and how the job market sucks. Only shark and a few other practicing radiologists post, so the value of diverse discussion is staunchly diminished. Here I thought shark was a professional who had earned some respect, and I get these snide unprofessional snarky remarks in response. No wonder nobody posts here anymore.

Your brother example is one anecdote.

Doing two fellowships is not the end of the world. We have a fellow right now working per diem for our group and we will most likely hire him for the next year. If you add what we pay him to his fellowship salary, he makes primary care level salary during his fellowship, though he works a fair number of weekends. However, he doesn't work even one night and is never on night call.

There are definitely good and bad programs out there. If you read my older posts, I always encourage people to go to the best university program that they can. Nothing beats a great education during residency. Not all programs are equal. Part of the reason that people do two fellowships is because of subpar training.