DIRECT IR residencies

[vandypatty]

I was just curious as to what some of the more veteran rad members thought about this path. I've heard as you get older, it's very beneficial to have diagnostic to fall back on when you slow down....and I get the impression you wouldn't be able to do this with the DIRECT IR training. Any thoughts would be appreciated.

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[f_w]

You will still be board certified in radiology, so you certainly have the formal qualification to do diagnostic radiology. It comes down to remaining comfortable doing diagnostic work. The experience has been that some of the people who have done full-time IR for 20 years and then try to go back into DR (usually after a L4-S1 spinal fusion) had a hard time to catch up with progress that DR has made in the interim.
Otoh, pure IR jobs are not that common, in most private practice groups the IRs continue to do some DR work including taking call.

 

[hans19]

Reason #1, against: There is so much flux in academic radiology. Staff coming and going, even at strong places. Because of this I would tend to discourage the Direct IR pathway, unless you are confident it will be strong, when it is time for you to be an IR fellow. Even at the strong places there can be totally unexpected change. Stanford was once king of the West coast programs until big faculty left for the east. UW was once in shambles, but is now a strong place for IR. All within the span of 3 years.

If you match now, there is no guarantee that the really awesome IR attendings you want to work with will still be there when its time for you to be a fellow.

Reason #1, for: The advantage is that you get much more clinical experience earlier on. This is only a minor advantage because you can still get clinical experience through a surgery or IM prelim if you pay attention, and later on if you go to a clinically oriented Fellowship. Besides, fellowships are still relatively wide open, why tie yourself down at one place? If you do it the conventional way, if your star attendings leave-- no worries, you can follow them or go somewhere even better for fellowship.

Reason number 2, against: How do you know you won't fall in love with Neuro or MSK or Nucs or Peds?

These are my personal observations.

 

[YupGypsy]

Reason number 2, against: How do you know you won't fall in love with Neuro or MSK or Nucs or Peds?

which would be the best $$$ path?

 

[hans19]

which would be the best $$$ path?

MBA.

 

[danielmd06]

MBA.

Wise words.

Listen to this man. He definitely knows what he is talking about...

 

[nutcancer]

You will still be board certified in radiology, so you certainly have the formal qualification to do diagnostic radiology. It comes down to remaining comfortable doing diagnostic work. The experience has been that some of the people who have done full-time IR for 20 years and then try to go back into DR (usually after a L4-S1 spinal fusion) had a hard time to catch up with progress that DR has made in the interim.
Otoh, pure IR jobs are not that common, in most private practice groups the IRs continue to do some DR work including taking call.

errrrrr..L4-S1 spinal fusion? are you implying IR is hard on someone's back? hehehe, i guess that rules me out of IR. sadly, one of the main reasons i'm not going into surgery is because of the back and feet pains.

i saw a flouro case today, don't want to say which one. but the doc was def. bending weirdly.

 

[f_w]

errrrrr..L4-S1 spinal fusion? are you implying IR is hard on someone's back? hehehe, i guess that rules me out of IR. sadly, one of the main reasons i'm not going into surgery is because of the back and feet pains.

You do stand a lot and most of the day with a 2-piece lead. Not unlike an interventional cardiologist and orthopods on their OR days. It is important to have some sort of exercise to maintain a balanced back musculature to keep the wear in check.

 

[nutcancer]

You do stand a lot and most of the day with a 2-piece lead. Not unlike an interventional cardiologist and orthopods on their OR days. It is important to have some sort of exercise to maintain a balanced back musculature to keep the wear in check.

what about feet pains?

 

[YupGypsy]

MBA.

what if u want $$$ & radiology at the same time?

 

[hans19]

what if u want $$$ & radiology at the same time?

Skip the fellowship and general radiology in a highly underserved area. You can pull >500K a year, but it comes at a cost. You WILL work long hours. If you want a vacation, you pay for it (literally) by hiring a locums to cover you for each day you are out. If you don't want to take call, you will pay a nighthawk to cover it for you.

 

[medinah]

How many years is the direct IR pathway? How would one go about looking up these programs on Freida or CareerMD? After completion of the program, would one be competent enough in Diagnostic to exclusively work in it should one desire to do so?

 

[hans19]

How many years is the direct IR pathway? How would one go about looking up these programs on Freida or CareerMD? After completion of the program, would one be competent enough in Diagnostic to exclusively work in it should one desire to do so?

6 years, so it is equal in duration to internship + residency + fellowship. In a DIRECT pathway, you would get 24 months of IR. Thats 6-8 months more than in a residency + fellowship. Caveat emptor, this extra experience comes at the expense of the other subspecialty rotations, but hopefully you will get at least the minimum to pass the radiology boards. BTW, the only officially required rotation in Dx radiology is 4 months of nuclear medicine, there is no officially mandated minimum number of months for Neuro, Peds, etc. Potentially you may get a single month of Neuro or Peds during your tenure.

Furthermore, the direct pathway is NOT a back door into radiology. At the programs I know of, you are ranked with the other diagnostic residents and if you match, one of the IR fellowship slots will be allocated for your year. In other words you are in the same applicant pool as the diagnostic candidates, there is no a separate applicant pool for the DIRECT pathway.

Moreover, you will likely complete the fellow year before PGY6 (when you would normally complete a fellowship year). If you want to be a radiologist through the DIRECT pathway, you WILL finish the IR year. You can't just drop the IR portion and proceed like a conventional diagnostic resident.

I think the DIRECT pathway is definitely a step in the right direction. If Interventional radiologists want to stay competitive with cardiologists and vascular surgeons, than they MUST become more clinically-oriented. If you are truly interested in IR, get as much clinical training as you can your intern year. Do a surgery or IM prelim rather than transitional.

As I alluded to in previous posts, academic radiology is constantly in flux. Really strong IR divisions can unexpectedly falter and vice versa in the span of a few years, IE west coast programs. If you are confident that IR at your program will be strong when you are to become a fellow (places like UVA, NW, or JH) then consider the DIRECT pathway.

 

[IheartCaffeine]

MBA.

This isn't necessarily true. Some of my undergrad friends went on to get their MBAs and are now either working at some random company for average pay or sitting around at home waiting for an opportunity. I think you had to have gone to a top-25 business school to guarantee money for yourself in business. In any case, I think medicine is the only field in which merely having gone to medical school (and passing your exams, etc.) will guarantee you at least a $100k/yr for the rest of your career (regardless of which school you went to or what your work experience is). There's a lot less luck involved, while in business you can work your arse off and still need to rely on a lucky break.

 

[f_w]

This isn't necessarily true. Some of my undergrad friends went on to get their MBAs and are now either working at some random company for average pay or sitting around at home waiting for an opportunity. I think you had to have gone to a top-25 business school to guarantee money for yourself in business. In any case, I think medicine is the only field in which merely having gone to medical school (and passing your exams, etc.) will guarantee you at least a $100k/yr for the rest of your career (regardless of which school you went to or what your work experience is). There's a lot less luck involved, while in business you can work your arse off and still need to rely on a lucky break.

I think hans meant an MBA in addition to residency training.

In that case the 'networking' aspect of getting your MBA at well known school is not as important, getting the basic theoretical business knowledge an MBA provides is more important. Having an MBA as a physician opens up physician leadership positions in large practices and opportunities in the insurance and pharmaceutical industry. The physicians with MBAs I know make specialist physician type incomes while doing a paper-pushing desk job (no call !).

And I don't think anything but a keen business sense, ability to lead people and some luck 'guarantee' you a career in business. But from what I understand there is a large gradient between graduates of the top25 business (or law) schools and the rest. Something that can't be said for medicine.