Concerns about quantity of patient contact

[Fermi Paradox]

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Foremost, thank you for your time, please excuse the smurf account. I am a PGY-1 finishing my intern year in the next few weeks, and will be beginning a radiology residency during the next academic year. I was lucky enough to have a Radiology rotation during my intern year, and rotated briefly through a number of departments (Mammo, peds, msk, neuro, IR) during that time. I wanted to address this concern anonymously with the forum, as I feel like my position is a bit of an outlier in comparison to my peers.

I was very frustrated with the amount of patient contact required during my Radiology rotation. I have no desire to physically interact with patients in any form or fashion. It appears that direct patient contact is unfortunately a mainstay of mammo, peds and IR. Furthermore, there was a small but appreciable amount of patient contact on neuro, body, msk. I was somewhat perturbed by this realization, and have yet to reconcile my feelings on the matter.

I have no concerns w/ physician or administration communication, but it has become abundantly clear that for me, direct patient contact is the most unpleasant aspect of work. It is something I would like to avoid, if not completely abstain from in my career.

My questions to residents and attendings in the field:
1. In residency and practice, what percent of your time is spent interacting with patients?
2. Once graduated, what positions have the least or zero patient interaction (ie PP vs academia, nights)?
3. What sub-specialties are best situated to have no patient interaction?

The above questions are in hope of discerning a trajectory of best fit for my career. Your guidance and time are greatly appreciated, thank you.

 

[colbgw02]

You'll see more of patients in residency and fellowship than in private practice.

Almost all subspecialties involve at least a few procedures. IR and mammo are heavy in procedures, so those sound like they're off the table for you. Peds is relatively patient contact heavy because 1) peds rads like to do their own ultrasounds, which are more common in this population (no ionizing radiation, obviously) and 2) peds is a low volume subspecialty, so these people need to feel like they're doing something with their time.

It sounds like you'll gravitate toward neuro, msk, nucs, or body. Procedure heavy fellowships exist in those subspecialties, so just avoid those.

You'll have to suck it up to a certain extent until you're done with training. Then get a telerads job where you'll have zero patient contact. Neuro is probably your best bet for that, considering many telerads jobs involve after-hours work, where neuro is valued. Obviously, you have to enjoy the material too. That is, I wouldn't go into neuro if I hated it just to get a telerads job. It's a balance, and only you can decide what is a priority.

 

[Fermi Paradox]

You'll see more of patients in residency and fellowship than in private practice.

Almost all subspecialties involve at least a few procedures. IR and mammo are heavy in procedures, so those sound like they're off the table for you. Peds is relatively patient contact heavy because 1) peds rads like to do their own ultrasounds, which are more common in this population (no ionizing radiation, obviously) and 2) peds is a low volume subspecialty, so these people need to feel like they're doing something with their time.

It sounds like you'll gravitate toward neuro, msk, nucs, or body. Procedure heavy fellowships exist in those subspecialties, so just avoid those.

You'll have to suck it up to a certain extent until you're done with training. Then get a telerads job where you'll have zero patient contact. Neuro is probably your best bet for that, considering many telerads jobs involve after-hours work, where neuro is valued. Obviously, you have to enjoy the material too. That is, I wouldn't go into neuro if I hated it just to get a telerads job. It's a balance, and only you can decide what is a priority.

As always, your input is greatly appreciated colbgw02, you are a boon to this forum. My interests lie in Neuro and Body at the moment, I'll be sure to think more on nucs and MSK as well. While the concept of telerads and PP is not foreign to me, I really don't know much about it. As other with other residents, exposure to any practice outside of the ivory tower of academia is very limited. Is there a resource you know of where I could learn / read more about teleradiology?

I also do enjoy physically being in the hospital. Interacting w/ colleagues and attendings, sharing knowledge and interesting cases is an aspect of rads I appreciate. Is Body or Neuro at any one hospital less likely to be procedural than at another hospital? For example, do some hospitals have all (or a vast majority of) procedures done by IR?

 

[scootad.]

Your post reminds me of mine 7 years ago. I disliked patient interaction and doing procedures. This lasted all the way through residency. But my perspective has since changed. In PP, most procedures (arthrograms, LPs/myelos, breast biopsies, etc.) are only 5-10 minutes long (once you know what you are doing). The interaction is very fleeting. It really is not annoying for the most part. You learn quickly how to interrupt the rare "problem" patient who wants to tell you about their unrelated back or knee pain or whine about something dumb.

And as colbgw02, if all else fails, there's always telerad (although I usually don't recommend that to young rads).

 

[colbgw02]

As always, your input is greatly appreciated colbgw02, you are a boon to this forum. My interests lie in Neuro and Body at the moment, I'll be sure to think more on nucs and MSK as well. While the concept of telerads and PP is not foreign to me, I really don't know much about it. As other with other residents, exposure to any practice outside of the ivory tower of academia is very limited. Is there a resource you know of where I could learn / read more about teleradiology?

I also do enjoy physically being in the hospital. Interacting w/ colleagues and attendings, sharing knowledge and interesting cases is an aspect of rads I appreciate. Is Body or Neuro at any one hospital less likely to be procedural than at another hospital? For example, do some hospitals have all (or a vast majority of) procedures done by IR?

I think it's instructive to remember that there are very few things that are deal-breakers when it comes to practicing radiology. There's so much variance in the scope and type of practices out there that nearly everyone can find a niche. Don't want to read mammo? Work nights? Talk to patients? Do procedures? Read outside your subspecialty? Jobs exist for all of these people, but it obviously comes with risk. As soon as you start placing limitations on what you're willing to do, the job pool shrinks. That isn't to say that things can't work out, but it means you have to judge accurately how much you're willing to sacrifice to get what you want.

To give an example, a former colleague of mine lost out on a great job because the group insisted that he do diagnostic angiography. He was geographically limited, so he ended up taking a slightly less desirable job in a nearby city, resulting in a terrible commute. In this case, limiting his practice with respect to both location and scope didn't work out well. In contradistinction, another colleage of mine was only interested in jobs that were 90+% within his subspecialty. He was relatively open to moving, however, so he was able to find several jobs that fulfilled his criteria.

It's like sliding-scale, zero-sum game. Slide your geography bar down because you have to live in City X, then your other variables need to go up (e.g., willing to have a wider scope, work nightfloat, take an employed position).

For you, if you are 100% dead set against ever seeing a patient, then I maintain that teleradiology is the only way to ensure that. Scootad's right though. Practicing full-time teleradiology comes with its own set of baggage. If you think you can tolerate minimal patient contact, then there's almost certainly a private practice job out there for you somewhere. Just like in training, you may need to suck it up for a few years until you develop the right reputation, but people carve out niches in private practice too. For example, maybe you get into a high-volume neuro position where your fellow neuroradiologists enjoy, or at least don't mind, the LPs and myelograms. That leaves you free to knock out the list in the reading room while they're in the fluoro suite.

 

[Shifty B]

I'd be interested in knowing what it is, specifically, about patient interactions that you don't like, because that will make a difference. You clearly were interested in being a doctor when you decided to go to medical school, and most doctors see patients.

Some people who are more introverted just get very nervous talking to strangers, and that tends to get better with experience. Especially the shorter, more limited interactions in radiology. They even get a little more rewarding over time because it breaks up the long stretches in the reading room.

Other people get frustrated with the type of patients that they have been dealing with during their training. A lot of training hospitals see patients very sick patients, many of whom may not be very invested in their own health (for a variety of reasons, some of which are in their control and others of which are not). It can be very frustrating dealing with these patients as well, but this also can be addressed because most private hospitals and private practices have patients who are less sick and more involved in their own care.

Some people just realize they don't like patients AT ALL (or any people for that matter), which is also fine. There is an old joke about radiologists the gist of which is, "I'm a people person, but patients aren't my type of people." In that case you'll have to consider the discussion above.

 

[Fermi Paradox]

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