Conflicted with choosing Diagnostic Rads vs Medicine (M3)

[Morc]

I'm an M3 soon-to-be M4 applying in this upcoming match. During my clinical year, I could not really envision myself doing any specialty in the core rotations other than IM. I did a radiology elective and I was surprised, they let me look through some of the junior R1 cases on an extra workstation and I enjoyed the workflow/thought processes.

Random thoughts:
- If I did IM, I'd want to specialize, I was thinking cards -> EP. A big turn-off is that it's another competition for specific fellowships (cards, GI).
- The big part I'm hesitating on is that I do like spending time with patients, even some of the more mundane or tedious interactions.
- I have an engineering background (BME) and have always enjoyed building PCs, coding, etc.


Questions:
1) When did you know that you wanted to do radiology? Was there a specific experience, or specialty you chose it over?
2) Any regret in choosing radiology deeper in your career? Do you miss the lower-to-no patient interaction?
3) Hard to tell without step 2 yet, but how competitive is my application so far?

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[bronx43]

Do rads. Patient care is just glorified customer service. I wish I had gone into rads when I was a med student.

 

[Neopolymath]

Are you running from the challenge of enduring the pure hell that is IM and continued competition for fellowship or are you actively gravitating toward rads? If it's the former, there isn't anything wrong with that feeling by any means and it's normal but it does require further examination and reflection if rads really fits or if there is a more clinical plan that would also be adequate (and retain the things you give up with radiology).

But, yeah, if you ask radiologists, typically they don't hate patients or interaction or whatever weird things people say, they could just take it or leave it so why not get a better job based on the other categories. I am growing to love radiology more each day as expected but I think it's pretty typical to choose it for pragmatic reasons.

 

[CyrusHabs7695]

step 2 will make or break it, other than that your app is obviously great.

 

[brownman23]

Questions:
1) When did you know that you wanted to do radiology? Was there a specific experience, or specialty you chose it over?
2) Any regret in choosing radiology deeper in your career? Do you miss the lower-to-no patient interaction?
3) Hard to tell without step 2 yet, but how competitive is my application so far?

I'm a R1/PGY-2.

1) I didn't think about Radiology until late into M3. I didn't love any of my core rotations, but didn't hate any of them either. I wanted to like ophtho for the lifestyle, but didn't like clinic. I wanted to like anesthesia, but I didn't like that I couldn't control my schedule. Someone recommended to think about DR, and I never looked back. Being in a specialty that's never at the forefront (but always a key player) in patient care, able to think about every organ system pathology, and the ability to impact care of 100s of patients in a day drew me in. The attending salary is also quite nice.

2) No regrets so far. I feel extremely stupid, and get humbled every day by my misses, but I know I will get better as I progress through residency and (hopefully) attending-hood. I don't miss the patient interaction. I still see patients during my GI/Flouro and IR rotations. I talk to techs and physicians from other services multiple times a day. I follow up on interesting patients' charts, and knowing how a CT/MRI/US read I was part of affected the patient's care is plenty rewarding for me. The amount of phone calls/interruptions Radiologists have to face during a work day is ridiculous though. The interruptions was certainly not something I was expecting, and it's probably most people's least favorite thing about Radiology. A phone call from a physician to go over imaging findings is fine (and sometimes rewarding), but phone calls about when a read will get in, and reminders from techs to protocol studies get annoying.

 

[Tiger100]

It's a hard decision and is crapshoot.

Don't think about it too much. You will be fine in both fields.

 

[Womb Raider]

Questions:
1) When did you know that you wanted to do radiology? Was there a specific experience, or specialty you chose it over?
2) Any regret in choosing radiology deeper in your career? Do you miss the lower-to-no patient interaction?
3) Hard to tell without step 2 yet, but how competitive is my application so far?

I jumped around constantly in M3, and even had some LORs for another specialty. Decided on radiology for a variety of reasons at the very end of R3, after getting a feel for what medicine was really like.

Just think of some of the things you'll be doing/dealing with for the rest of your life in clinical medicine:

• patient quality/satisfaction metrics
• answering patient messages online
• pissed off patients
• ungrateful patients
• dealing with nurses
• managing midlevels
• fighting with insurance companies
• Learning about your niche and forgetting everything else we learned in medical school
• Possibly being "on-call" - I loved surgery, but knew myself enough to realize that although trauma surgery is badass now, I wouldn't feel the same way waking up at 3:30 AM on a Saturday when I'm 50 with kids

Radiology is hard in its own way. You have to be very self-motivated to learn a vast quantity of knowledge. You have to deal with incessant phone calls and interruptions. It can be mentally exhausting, being 100% on the entire time you're at work. Your mistakes are solidified in writing for eternity. You are not always respected as a physician (see orthopods), although being in the spotlight has never been my desire so this doesn't bother me. You lose the "patient-patient" interaction, which can be very rewarding once in a blue moon. It can be isolating and lonely depending on your practice.

The perks far outweigh the downsides though. In addition to what's mentioned above, radiology is not as taxing on your body as most specialties and you can work til you have a stroke yourself, can choose to entirely work from home, won't be fighting with midlevels, nurses, patients, or insurance companies. Oh yeah, and you make great money. To me, it was a no-brainer.

 

[Ho0v-man]

Apply rads and do a prelim at a large academic center. You can probably stay on in IM if you like it.

If you’re sane, you’ll be counting down the days to R1 by New Years.

 

[Cognovi]

Attending now. No regrets. I don't miss the patient interaction. Every time I have to talk to a patient now I feel I am performing. It feels unnatural and also inefficient. Being at work as a radiologist and talking to fellow professionals I feel more at ease.

 

[DoctorMD1]

Attending now. No regrets. I don't miss the patient interaction. Every time I have to talk to a patient now I feel I am performing. It feels unnatural and also inefficient. Being at work as a radiologist and talking to fellow professionals I feel more at ease.

Can not agree more.

 

[Cognovi]

I'm getting ready to work from home moonlighting today while sitting in my gym shorts. It's a weekend and nice day outside but I'll make enough to pay for my next vacation.

 

[Splenda88]

Do rads. Patient care is just glorified customer service. I wish I had gone into rads when I was a med student.

As an IM (hospitalist), I agree with what bronx43 says.

Patient interaction is akin to customer service and it's overrated IMO.

The only aspect of IM that might be better than radiology is that it's probably less stressful.

 

[bronx43]

As an IM (hospitalist), I agree with what bronx43 says.

Patient interaction is akin to customer service and it's overrated IMO.

The only aspect of IM that might be better than radiology is that it's probably less stressful.

I find it quite stressful when patients are yelling or making complaints/threats - often for you doing the actual right thing or things out of your control.

If you’ve never had that happen to you then count your blessings . If you have, then you know that it’s not something that you can just chuckle at and forget quickly. Clinical medicine is total garbage. If you can avoid it by doing rads then I see no reason not to.

 

[DoctorMD1]

I find it quite stressful when patients are yelling or making complaints/threats - often for you doing the actual right thing or things out of your control.

If you’ve never had that happen to you then count your blessings . If you have, then you know that it’s not something that you can just chuckle at and forget quickly. Clinical medicine is total garbage. If you can avoid it by doing rads then I see no reason not to.

Can you just discharge them from your practice and never see them again?

 

[Splenda88]

I find it quite stressful when patients are yelling or making complaints/threats - often for you doing the actual right thing or things out of your control.

If you’ve never had that happen to you then count your blessings . If you have, then you know that it’s not something that you can just chuckle at and forget quickly. Clinical medicine is total garbage. If you can avoid it by doing rads then I see no reason not to.

That happens few and far between.

 

[bronx43]

That happens few and far between.

Depends what you mean by few and far between. Also depends where you practice.

I trained at a large tertiary care center in a bigger metro area, then practiced there as a hospitalist for a year. Complaints were often. I'm talking like once every 7 day stretch that a patient would complain to you then call patient experience. It is annoying and ultimately you become callous and take it. It is still very unpleasant nonetheless, and I would bet money it would have contributed to burnout if I stayed.
Yelling happened to me once every 6 months or so as a hospitalist. I have had it several times as a rheumatologist. Almost never is it for something reasonable. Mostly it was for actually making the right diagnosis and treatment plan that the patient didn't like.
Threats to bodily harm is very rare, yes. As a resident, I had a clinic patient threaten us with gun violence. Cops were called and we were escorted to our cars.

Some people may tolerate this nonsense better than others. For me, it's just not worth it if you have the option to never interface with the customer. Rads all day every day if you are deciding your career path.

 

[bronx43]

Can you just discharge them from your practice and never see them again?

Sure, though sometimes admin would push back depending on what the patient did. Threatening violence is a given for discharge, but being unpleasant/demanding/unreasonable usually isn't.
If you own your own practice, then you can theoretically end your doctor patient relationship for any reason, as long as you still provide emergency care for X period of time.

 

[Splenda88]

Depends what you mean by few and far between. Also depends where you practice.

I trained at a large tertiary care center in a bigger metro area, then practiced there as a hospitalist for a year. Complaints were often. I'm talking like once every few days that patients would complain to you then call patient experience. It is annoying and ultimately you become callous and take it. It is still very unpleasant nonetheless, and I would bet money it would have contributed to burnout if I stayed.
Yelling happened to me once every 6 months or so as a hospitalist. I have had it several times as a rheumatologist. Almost never is it for something reasonable. Mostly it was for actually making the right diagnosis and treatment plan that the patient didn't like.
Threats to bodily harm is very rare, yes. As a resident, I had a clinic patient threaten us with gun violence. Cops were called and we were escorted to our cars.

Some people may tolerate this nonsense better than others. For me, it's just not worth it if you have the option to never interface with the customer. Rads all day every day if you are deciding your career path.

I did residency as well at a tertiary care center. I don't remember any patient complains about me or call patient advocate (whatever they call it) during residency. I am year 2 as an hospitalist attending and I have 1 patient that fired me and 2 that complained; the 2 that complained was because I wasn't giving them narcotics.

I think hospitalist lifestyle and salary are good. My tune might change after 5 yrs. Lol

Of course, I would not mind making 500-600k/yr reading imaging and not seeing patient while having 8 wks vacation.

 

[bronx43]

I did residency as well at a tertiary care center. I don't remember any patient complains about me or call patient advocate (whatever they call it) during residency. I am year 2 as an hospitalist attending and I have 1 patient that fired me and 2 that complained; the 2 that complained was because I wasn't giving them narcotics.

I think hospitalist lifestyle and salary are good. My tune might change after 5 yrs. Lol

None of my bad encounters were as a resident on inpatient service. Residents are usually protected from most of the slimy underbelly of medicine save for very isolated incidents.
I think if you are a hospitalist in a big city, your experience may be different.

But why even deal with any of that when you can just sit in a dark room reading images?

 

[Splenda88]

None of my bad encounters were as a resident on inpatient service. Residents are usually protected from most of the slimy underbelly of medicine save for very isolated incidents.
I think if you are a hospitalist in a big city, your experience may be different.

But why even deal with any of that when you can just sit in a dark room reading images?

One can make the argument that after prison, hospitals arguably have some of the worse people in society

 

[bronx43]

One can make the argument that after prison, hospitals arguably have some of the worse people in society

Not only that but we coddle patients just because they are patients. Things really took a turn for the worse when Obamacare instituted press ganey surveys which directly lead to hyperinflation of patient entitlement.

 

[Splenda88]

Not only that but we coddle patients just because they are patients. Things really took a turn for the worse when Obamacare instituted press ganey surveys which directly lead to hyperinflation of patient entitlement.

Now we have MyChart lol

As you already stated, medicine is a customer service job and physicians should be wise to treat it as such in order to lessen the path of quick burn out.

 

[DoctorMD1]

I did residency as well at a tertiary care center. I don't remember any patient complains about me or call patient advocate (whatever they call it) during residency. I am year 2 as an hospitalist attending and I have 1 patient that fired me and 2 that complained; the 2 that complained was because I wasn't giving them narcotics.

I think hospitalist lifestyle and salary are good. My tune might change after 5 yrs. Lol

Of course, I would not mind making 500-600k/yr reading imaging and not seeing patient while having 8 wks vacation.

our vacation is never that short. lol

 

[Cognovi]

our vacation is never that short. lol

I'm looking at an academic radiology job that has less than 3 weeks of vacation.

 

[DoctorMD1]

I'm looking at an academic radiology job that has less than 3 weeks of vacation.

where?! The lowest I saw in academics is like 6 weeks and not including CME/conference time.

 

[GadRads]

I have seen 4-6 weeks for academic radiology excluding CME and academic time.

 

[Cognovi]

where?! The lowest I saw in academics is like 6 month and not including CME/conference time.

I don't know what you are talking about 6 months. I have like 5 weeks including vacation, conference, and holidays.

 

[guytakingboards]

where?! The lowest I saw in academics is like 6 month and not including CME/conference time.

The University of Texas system academic departments (UTSW, UTHSA, UTH, UTMB) start you off at roughly 1 day per month for pure vacation. And I've been told you have earn your vacation before you can use it ( i.e. you can't take a week off until you've built up 5 days).

 

[Prehealth1011]

Of course, I would not mind making 500-600k/yr reading imaging and not seeing patient while having 8 wks vacation.

Wouldn't you prefer your current vacation structure more? I've heard that radiologists have to take their time off in larger chunks. I'm just a resident but to me, every other week off sounds better (making appointments, getting things done)

 

[Splenda88]

Wouldn't you prefer your current vacation structure more? I've heard that radiologists have to take their time off in larger chunks. I'm just a resident but to me, every other week off sounds better (making appointments, getting things done)

I don't have any vacation as a hospitalist. I work 1 week on/off.

I don't think I will a big fan of taking vacation in chunks, but I will definitely be ok with making 500-600k while having very minimal patient interaction.

I agree that every other week is good. Used to work Mon-Frid (8am-5pm) as a RN , and will probably never go back working that kind of schedule.

 

[DoctorMD1]

I don't know what you are talking about 6 months. I have like 5 weeks including vacation, conference, and holidays.

sorry. I meant 6 weeks

 

[DoctorMD1]

The University of Texas system academic departments (UTSW, UTHSA, UTH, UTMB) start you off at roughly 1 day per month for pure vacation. And I've been told you have earn your vacation before you can use it ( i.e. you can't take a week off until you've built up 5 days).

I don't understand why people would agree to something like that given today's job market.

 

[guytakingboards]

I don't understand why people would agree to something like that given today's job market.

It's not quite as bad as it sounds upfront. At least in radiology, my friends get credit for the call they take which can be used as extra time off. That adds up to another 2-3wk of time off. Add in 2wk/year CME time, 1 day off a week for academic time and trainees prelim'ing every report you sign and it ends up being not so bad.

On the most generous interpretation of the benefits, it can end up being around 7-8wk time off with 1 academic day off per week.

But yes, upfront it sounds awful. My training program had a very tough time recruiting faculty when the candidates heard "1 day off per month" which is what they have to tell people.

 

[Womb Raider]

It's not quite as bad as it sounds upfront. At least in radiology, my friends get credit for the call they take which can be used as extra time off. That adds up to another 2-3wk of time off. Add in 2wk/year CME time, 1 day off a week for academic time and trainees prelim'ing every report you sign and it ends up being not so bad.

On the most generous interpretation of the benefits, it can end up being around 7-8wk time off with 1 academic day off per week.

But yes, upfront it sounds awful. My training program had a very tough time recruiting faculty when the candidates heard "1 day off per month" which is what they have to tell people.

Academic days* assuming fully staffed sections. Many of our attendings don’t get most of their academic days because our chair can’t manage to hire enough attendings. Don’t see this problem getting better anytime soon but what do I know.

 

[Isonicphoton]

I find it quite stressful when patients are yelling or making complaints/threats - often for you doing the actual right thing or things out of your control.

If you’ve never had that happen to you then count your blessings . If you have, then you know that it’s not something that you can just chuckle at and forget quickly. Clinical medicine is total garbage. If you can avoid it by doing rads then I see no reason not to.

I agree medicine is less stressful. In rads, after a hard call shift, I am constantly worrying about if I missed a head bleed or some lung nodule, etc. There's so much to miss that will sit in the PACS record for eternity any lawyer can point to and name you in a lawsuit.

In IM, I did not feel this way. I was more physically tired and more annoyed by inefficiencies, but really, if you didn't know something, you had swaths of consultants who would basically tell you what to do.

 

[bronx43]

I agree medicine is less stressful. In rads, after a hard call shift, I am constantly worrying about if I missed a head bleed or some lung nodule, etc. There's so much to miss that will sit in the PACS record for eternity any lawyer can point to and name you in a lawsuit.

In IM, I did not feel this way. I was more physically tired and more annoyed by inefficiencies, but really, if you didn't know something, you had swaths of consultants who would basically tell you what to do.

Being an intern is not the same thing as being the attending. I loved my intern year and my whole residency. I would go back to those days in a heartbeat. The moment I graduated, it was different. I realized just how much of the grotesque underbelly was being shielded from trainees.

I don't mean to say that IM is more stressful than rads or vice versa - simply that IM carries significant stress. Each person takes stress differently and has different tolerance to various types of stress. But your experience as an intern during TY is simply not representative of what clinical medicine is like in this day and age. And likewise, I certainly have no personal experience of the stresses that rads face on a daily basis. Unless there's someone who's dual certified in radiology and IM, a firsthand comparison cannot be made.

At the end of the day, I regret not pursuing rads as a student and would actually consider going back to rads residency if I could. I doubt you would ever consider doing another 2 years of IM to practice as a clinician.

 

[Splenda88]

At the end of the day, I regret not pursuing rads as a student and would actually consider going back to rads residency if I could. I doubt you would ever consider doing another 2 years of IM to practice as a clinician.

It's not a fair 'comparison' because most people would not downgrade from 500k job to a 300k plus opportunity cost when both jobs can equality be suck.

There might be pressure for quick turn around 'read' in radiology, i.e you constantly have to read to catch up with the BS tests that EM/IM docs order. However, there is less of that in IM. For instance. Today I watched an entire 2-hr soccer game in the physician lounge, and I don't think radiologists at my place can pull that off.

 

[Clean7795]

Radiology is fast-paced, high productivity, and relatively high stakes for the volume you do. That's just how it works for the specialty. If you have a highly anxious personality, it will be more challenging for your personality type.

Questions:
1) When did you know that you wanted to do radiology? Was there a specific experience, or specialty you chose it over?

M3. No specific experiences.

I enjoyed most specialties and could've been happy being a specialist in almost anything. I enjoy working with technology a lot, am problem-solving oriented, don't "love" the OR, and so radiology was a good fit. Basically, I could see myself doing it (i.e. sitting at a computer, solving problems, helping patients indirectly, doing the occasional procedure).

2) Any regret in choosing radiology deeper in your career? Do you miss the lower-to-no patient interaction?

No I don't miss having more patient interaction in my day.

I have a few wonderful memories of patients I really enjoyed working with & the gratitude they had for me helping them out as a senior medical student/intern. But I also recognize that these are a minuscule minority, and the majority of interactions are either neutral or mildly negative.

 

[bronx43]

It's not a fair 'comparison' because most people would not downgrade from 500k job to a 300k plus opportunity cost when both jobs can equality be suck.

There might be pressure for quick turn around 'read' in radiology, i.e you constantly have to read to catch up with the BS tests that EM/IM docs order. However, there is less of that in IM. For instance. Today I watched an entire 2-hr soccer game in the physician lounge, and I don't think radiologists at my place can pull that off.

I would do rads for no increase in pay. Worth the opportunity cost just to not have to deal with humans on a daily basis.

Your hospitalist job is not the norm. My old hospitalist job was balls to the wall from the moment I stepped into the hospital until I left at 5. You practice in rural right? Some people would hate to live in rural places. I find it wholly unsatisfying. Rads can live wherever they want and maintain their qol. It’s win win win.

 

[DoctorMD1]

I would do rads for no increase in pay. Worth the opportunity cost just to not have to deal with humans on a daily basis.

Your hospitalist job is not the norm. My old hospitalist job was balls to the wall from the moment I stepped into the hospital until I left at 5. You practice in rural right? Some people would hate to live in rural places. I find it wholly unsatisfying. Rads can live wherever they want and maintain their qol. It’s win win win.

The huge advantage of rad in my opinion is ability to work from home and have whatever schedule you like. Have you thought about doing another residency in rad? 4 more years in training is kinda long though

 

[Splenda88]

I would do rads for no increase in pay. Worth the opportunity cost just to not have to deal with humans on a daily basis.

Your hospitalist job is not the norm. My old hospitalist job was balls to the wall from the moment I stepped into the hospital until I left at 5. You practice in rural right? Some people would hate to live in rural places. I find it wholly unsatisfying. Rads can live wherever they want and maintain their qol. It’s win win win.

I am not sure if I should call it rural or a small city (60k people). My gig is ok for the most part.

They just announced that we will get a 20k raise in July after a few people were saying to others (not to the leadership) they are starting to look for other jobs because 330k/yr no longer justify staying in small town or city when the hospitalist job market is getting better.

So 350k/yr for a ~70 hrs every other week hospital medicine job is not that bad.

 

[bronx43]

I am not sure if I should call it rural or a small city (60k people). My gig is ok for the most part.

They just announced that we will get a 20k raise in July after a few people were saying to others (not to the leadership) they are starting to look for other jobs because 330k/yr no longer justify staying in small town or city when the hospitalist job market is getting better.

So 350k/yr for a ~70 hrs every other week hospital medicine job is not that bad.

I would call anything under 100k people rural, but others may disagree. Though, I would say that QOL doesn't change much until you hit a metro of at least 500k. That's when the good restaurants and commercial centers become attractions.
Sure, 350k for hospitalist isn't a bad gig. That's heck of alot more than what I got paid as a hospitalist. But, it still matters that this is all in a rural/small town, which a lot of doctors find unacceptable. As radiology, you can live in whatever metro you want to live in, enjoy all the culture and food it has to offer, and still make 500k with zero patient interaction.

 

[Splenda88]

I would call anything under 100k people rural, but others may disagree. Though, I would say that QOL doesn't change much until you hit a metro of at least 500k. That's when the good restaurants and commercial centers become attractions.
Sure, 350k for hospitalist isn't a bad gig. That's heck of alot more than what I got paid as a hospitalist. But, it still matters that this is all in a rural/small town, which a lot of doctors find unacceptable. As radiology, you can live in whatever metro you want to live in, enjoy all the culture and food it has to offer, and still make 500k with zero patient interaction.

Agree about QOL in a metro vs (small city or town)...

Zero patient interaction is ALWAYS a win.