Does Radiology Residency Prestige/Brand Name Matter?

[meister]

Would you buy a Maserati SUV even though you know for a fact that the comparable Mazda is a better car?

Lucky for many of us the Maserati SUV can't beat my 5.0 Mustang on the track.

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[Docfunk22]

Would you buy a Maserati SUV even though you know for a fact that the comparable Mazda is a better car?

I think the analogy is wrong, you aren't choosing between buying a Mazda or a Maserati...you are being gifted either a Mazda or a Maserati. I wouldn't buy a Maserati but I sure as hell would choose one as a gift over a Mazda. Why? Because it's inherently more valuable as an asset. When you are matching into a program it can be hard to judge what the true experience will be like. If you have the chance to get into a high powered place that fits your life well, you should take it.

 

[Gadofosveset]

I think the analogy is wrong, you aren't choosing between buying a Mazda or a Maserati...you are being gifted either a Mazda or a Maserati. I wouldn't buy a Maserati but I sure as hell would choose one as a gift over a Mazda. Why? Because it's inherently more valuable as an asset. When you are matching into a program it can be hard to judge what the true experience will be like. If you have the chance to get into a high powered place that fits your life well, you should take it.

That's a distinction with no difference. Talk of "assets" would matter if training programs were associated with future income levels, which they most certainly are not.

It's a pretty simple concept: most of us will choose a prestigious name over a less prestigious name regardless of the true facts of the matter, often because we aren't interested in the true facts of the matter and part of the goal of choosing medicine as a career is to impress people.

FWIW, I work at a "top 10" program and the practical training among larger programs is not that different, regardless of name. Of course, no one's interested in that. They're interested in putting an ivy name on their web profile. I can't blame them. I might choose the Maserati over the Mazda. Just as long as I don't lie to myself that it's somehow better.

The whole thing is really a kind of pointless exercise in defining "better".

 

[DrfluffyMD]

That's a distinction with no difference. Talk of "assets" would matter if training programs were associated with future income levels, which they most certainly are not.

It's a pretty simple concept: most of us will choose a prestigious name over a less prestigious name regardless of the true facts of the matter, often because we aren't interested in the true facts of the matter and part of the goal of choosing medicine as a career is to impress people.

FWIW, I work at a "top 10" program and the practical training among larger programs is not that different, regardless of name. Of course, no one's interested in that. They're interested in putting an ivy name on their web profile. I can't blame them. I might choose the Maserati over the Mazda. Just as long as I don't lie to myself that it's somehow better.

The whole thing is really a kind of pointless exercise in defining "better".

You hit the nail on the head there. The trainings are all equal but the post training opportunities are significantly increased by a specific piece of letter head.

 

[tco]

Lucky for many of us the Maserati SUV can't beat my 5.0 Mustang on the track.

Mustang twins!

In cars and in training programs!

 

[qxrt]

Agreed. Big names will help in practices that are academic or expect you to do a lot of Dx and some IR. For a hardcore IR group , multispecialty, or Diag + IR group that allows IR to run wild, the Rush guy all day.

Interestingly, I happen to be a resident at a non-academic place with one of those hardcore IR groups, with both older and younger attendings, and they encouraged me to rank places like MGH or Miami Vascular over places like Rush or Brown. Brand name is a big deal everywhere you go (Miami Vasc is one of those rare places that happens to have both brand name and fame among young interviewees, but I digress), and places that are known only for their IR actually don't seem that great when looking for jobs. I still remember my BID interview, when everyone was calling them "the best program in Boston," yet they admitted that they had a hard time placing graduates into jobs on the opposite coast, while MGH told me, "no problem, we have connections everywhere," and was evidenced by their current fellows getting interviews and jobs on the west coast. Guess which one I ranked higher? Perceived "IR fame" as judged by current interviewees seems to have little cache when it comes to actually finding a job. As a result, my opinion is that you can't go wrong with brand name, but if you try to do something like rank a place like BID, Rush, or MUSC then try to find a California job, you're gonna have a not-as-good time.

 

[DrfluffyMD]

Interestingly, I happen to be a resident at a non-academic place with one of those hardcore IR groups, with both older and younger attendings, and they encouraged me to rank places like MGH or Miami Vascular over places like Rush or Brown. Brand name is a big deal everywhere you go (Miami Vasc is one of those rare places that happens to have both brand name and fame among young interviewees, but I digress), and places that are known only for their IR actually don't seem that great when looking for jobs. I still remember my BID interview, when everyone was calling them "the best program in Boston," yet they admitted that they had a hard time placing graduates into jobs on the opposite coast, while MGH told me, "no problem, we have connections everywhere," and was evidenced by their current fellows getting interviews and jobs on the west coast. Guess which one I ranked higher? Perceived "IR fame" as judged by current interviewees seems to have little cache when it comes to actually finding a job. As a result, my opinion is that you can't go wrong with brand name, but if you try to do something like rank a place like BID, Rush, or MUSC then try to find a California job, you're gonna have a not-as-good time.

This is my experience as well. I chose brand name over fame among young interviews and fortunately ended up in a place that is well liked everywhere. I was specifically told that I am good to go for jobs all over the nation.

 

[meister]

If you want to live in California, train in California.

 

[badasshairday]

If you want to live in California, train in California.

Or go to Miami Vascular. Amirite bro?

 

[DrfluffyMD]

If you want to live in California, train in California.

That's true for DR, but not true for IR. I was interviewing in the last season, when a mid tier Cali program (not UCSF, Stanford, UCLA or USC) had all its fellows not getting a California job (one landed in North Dakota and another one was still searching and couldn't find an ideal CA job).

Meanwhile, folks at my current program, which is quite far from CA, gets Cali job just fine in the same year.

Again, n = 1 experience, but it sounds like some big east coast programs have a bigger foot print and stronger reputation than some local shops.

 

[Tiger100]

That's true for DR, but not true for IR. I was interviewing in the last season, when a mid tier Cali program (not UCSF, Stanford, UCLA or USC) had all its fellows not getting a California job (one landed in North Dakota and another one was still searching and couldn't find an ideal CA job).

Meanwhile, folks at my current program, which is quite far from CA, gets Cali job just fine in the same year.

Again, n = 1 experience, but it sounds like some big east coast programs have a bigger foot print and stronger reputation than some local shops.

not correct.
Local connections are always more important.

When it comes to jobs, also a very important factors is how much are you willing to give up to get a job in a certain geographic location.

IR is still in demand. If someone gets a job in North Dakota it may be his personal choice, for better compensation or for better quality of job.

 

[DrfluffyMD]

not correct.
Local connections are always more important.

When it comes to jobs, also a very important factors is how much are you willing to give up to get a job in a certain geographic location.

IR is still in demand. If someone gets a job in North Dakota it may be his personal choice, for better compensation or for better quality of job.

Do you have a source for your assertion? The IR fellow who got a job in ND DID not prefer to work there....Again, I was on the interview trail a few month ago and my comment represents the state of the 2017 job market.

 

[qxrt]

Eh, I think there is truth to both, and it's not a black-and-white either-or. Regional/local preference is obviously a huge deal when it comes to hearing about and finding local jobs, but there are limits, and sometimes the big name on the opposite coast does seem to trump the lesser local name. I've seen cases where big names on the opposite coast took priority over local program and cannot say that location and local preference trumps all...because certain top names will still open doors for you all over the country and even the world, whereas some small local programs don't have great local reputations for good training. For example, Miami Vascular IR fellowship will open doors for you everywhere in the country, and will give you priority over local lesser known program in many cases. People don't choose to train at Miami vascular because they want to live in Miami; they do so because of its reputation and job prospects elsewhere.

 

[DrfluffyMD]

not correct.
Local connections are always more important.

When it comes to jobs, also a very important factors is how much are you willing to give up to get a job in a certain geographic location.

IR is still in demand. If someone gets a job in North Dakota it may be his personal choice, for better compensation or for better quality of job.

Went through this poster's post history. He/she also seem to think a separate IR residency is a "mistake". Care to elaborate on that also?

 

[meister]

It's a mistake for DR. Not really for IR since now they can take all the procedures they want from DRs, claim superiority and still obtain a DR certificate. Quite the accomplishment for them. DRs are unconscionably stupid for allowing it to happen.

Remember, once upon a time radonc and radiology went through the same training pathway. Look at them now.

 

[Tiger100]

Do you have a source for your assertion? The IR fellow who got a job in ND DID not prefer to work there....Again, I was on the interview trail a few month ago and my comment represents the state of the 2017 job market.

Nobody has done a randomized controlled trial about job hunting.

Work experience, personality and local connections are usually more important than name of the program.

Yes, You get better training at Miami vascular. But a many IR jobs these days are practically a DR job with some bread and butter procedures. If they interview two people, one from local mediocre program and one from Miami vascular and the applicant from local program look more flexible, they may prefer him.

It is all case by case.

 

[Tiger100]

It's a mistake for DR. Not really for IR since now they can take all the procedures they want from DRs, claim superiority and still obtain a DR certificate. Quite the accomplishment for them. DRs are unconscionably stupid for allowing it to happen.

Remember, once upon a time radonc and radiology went through the same training pathway. Look at them now.

I disagree with you. You have a narrow tunnel vision of the practice of radiology in community.

I have been in this business for more than 15 years. Why do you think radiology groups are consolidating these days? Without going into details, I think this is what will happen. 10 years down the road, there will be a generation of new IR trained people who want to practice separately and they will separate for a while. But eventually the market forces will make them join with DR groups again and the practice set up will be similar to what we have now with one difference. This generation of IR people will have a lot of flaws in their diagnostic skills. All of this is true if and only if 15 years from now we still have private practice. If we go towards a socialized model, it doesn't matter what is what. It will be like VA.

 

[DrfluffyMD]

I disagree with you. You have a narrow tunnel vision of the practice of radiology in community.

I have been in this business for more than 15 years. Why do you think radiology groups are consolidating these days? Without going into details, I think this is what will happen. 10 years down the road, there will be a generation of new IR trained people who want to practice separately and they will separate for a while. But eventually the market forces will make them join with DR groups again and the practice set up will be similar to what we have now with one difference. This generation of IR people will have a lot of flaws in their diagnostic skills. All of this is true if and only if 15 years from now we still have private practice. If we go towards a socialized model, it doesn't matter what is what. It will be like VA.

Interesting perspective. Honestly though, if we move away from the pp fee for service model and move into a socialized model where salary stay constant regardless of work performed, I am honestly unsure why I wouldn't gate keep the hell out of imaging studies if I am paid the same regardless of how many studies I read.

For starters, I would request a multiple page requisition form detailing the specific clinical program, a formal neuro exam for anything spine related. ED TAT would be out of the window as I will have no incentive to do an imaging study until patient has been throughly worked up by the ED.

I'll aiming for 5 CTs a day in a socialized environment...

 

[Tiger100]

Interesting perspective. Honestly though, if we move away from the pp fee for service model and move into a socialized model where salary stay constant regardless of work performed, I am honestly unsure why I wouldn't gate keep the hell out of imaging studies if I am paid the same regardless of how many studies I read.

For starters, I would request a multiple page requisition form detailing the specific clinical program, a formal neuro exam for anything spine related. ED TAT would be out of the window as I will have no incentive to do an imaging study until patient has been throughly worked up by the ED.

I'll aiming for 5 CTs a day in a socialized environment...

It is not that easy.

Socialized medicine means physicians lose their autonomy. It means that you are the employee of a big system that dictates what to do. Definitely we will work less and get paid less but I don't think the amount of imaging studies will decrease substantially.

I personally believe that socialized medicine and single payer model will never happy in this country. It is against the "American way of doing things". But who knows and who am I?

 

[meister]

I disagree with you. You have a narrow tunnel vision of the practice of radiology in community.

An interesting perspective, but what's to stop IRs from separating and competing directly for DR business? Have you never met a late 40 something IR who's tired and ready for the reading room? DRs have undermined their field by allowing those with maybe 3 years of training in DR (if we are generous) to claim equivalence, while not reducing DR training itself. Idiotic and insulting, if we are being honest. Furthermore, DRs that want to do IR have to tack on an additional year of training for the same qualifications now? It's amazing really.

I'm happy to hear different perspective but you're foolish to think you have any more of an idea of what's going to happen than anybody else.

 

[DrfluffyMD]

An interesting perspective, but what's to stop IRs from separating and competing directly for DR business? Have you never met a late 40 something IR who's tired and ready for the reading room? DRs have undermined their field by allowing those with maybe 3 years of training in DR (if we are generous) to claim equivalence, while not reducing DR training itself. Idiotic and insulting, if we are being honest. Furthermore, DRs that want to do IR have to tack on an additional year of training for the same qualifications now? It's amazing really.

I'm happy to hear different perspective but you're foolish to think you have any more of an idea of what's going to happen than anybody else.

And DR training vs IR diagnostic training is different how? At UCSF you can have a funded research year as an R4 (that replaces the typical R4 year) and never step into a reading room or read a single study. Does that mean they are inferior also?

 

[Tiger100]

An interesting perspective, but what's to stop IRs from separating and competing directly for DR business? Have you never met a late 40 something IR who's tired and ready for the reading room? DRs have undermined their field by allowing those with maybe 3 years of training in DR (if we are generous) to claim equivalence, while not reducing DR training itself. Idiotic and insulting, if we are being honest. Furthermore, DRs that want to do IR have to tack on an additional year of training for the same qualifications now? It's amazing really.

I'm happy to hear different perspective but you're foolish to think you have any more of an idea of what's going to happen than anybody else.

Not a nice way to finish a discussion that was meant to be based on mutual respect.

Since you talk this way I am not going to continue the discussion with you. And the FOOL is the one who says it.

 

[meister]

How you survive tumor boards being that thin skinned? Relax, my man, no disrespect was intended.

And DR training vs IR diagnostic training is different how? At UCSF you can have a funded research year as an R4 (that replaces the typical R4 year) and never step into a reading room or read a single study. Does that mean they are inferior also?

I can assure you allowing R4s to spelunk the basement for research nuggets for an entire year is not the norm at 90+% of programs around the country so I don't see how that's relevant.

In the end I really hope I'm wrong but I don't see how the split does anything good for DR.

 

[Tiger100]

And DR training vs IR diagnostic training is different how? At UCSF you can have a funded research year as an R4 (that replaces the typical R4 year) and never step into a reading room or read a single study. Does that mean they are inferior also?

It is not typical. What you are talking about is an anecdote. A typical DR training will be 4 years of DR plus one year of fellowship. I don't think it is going to be similar to 3 years of DR that IR people do. Also most people who enter IR residency will probably be more invested in IR than DR.

Anyway, it doesn't matter. The most important thing here is the logistics and practice model. There are very few successful outpatient IR only groups but it is not typical. Most IR is a hospital based work. So let's say IR splits from DR. Now the hospital has to contract with two groups; an IR group and a DR group. The DR group will do all the diagnostic imaging work and the IR will do all the IR work.

- I don't know how the IR can do diagnostic imaging work. I mean there is already a group that covers the DR work and is always available. The only part of diagnostic imaging that IR can claim is something like part of vascular US (which they have to fight with vascular surgery) and probably some CTAs and may be some of their followups of TACE cases and few imaging here and there. But since they are separate from DR they can't seek help from diagnostic radiology group body imager . Also I don't think CTA brain from ER for stroke will go to IR to read.

- Similarly, with the same logic that IR will want to do some DR work, I don't know what stops the DR group from doing some procedures. For example, I don't think breast biopsies will go to IR. Now if DR group is doing breast biopsies, what about thyroid FNA? Why not other biopsies? Why not drains? But then they can't seek help from IR group for complications.

And if you practice like above for a while, eventually both group will come to the conclusion that it is better to join together.

Separating IR from DR is a real B$ that was started by some academic guys in Ivy towers who don't have any clue about practice of medicine in community. It is doomed to fail.

 

[DrfluffyMD]

It is not typical. What you are talking about is an anecdote. A typical DR training will be 4 years of DR plus one year of fellowship. I don't think it is going to be similar to 3 years of DR that IR people do. Also most people who enter IR residency will probably be more invested in IR than DR.

Anyway, it doesn't matter. The most important thing here is the logistics and practice model. There are very few successful outpatient IR only groups but it is not typical. Most IR is a hospital based work. So let's say IR splits from DR. Now the hospital has to contract with two groups; an IR group and a DR group. The DR group will do all the diagnostic imaging work and the IR will do all the IR work.

- I don't know how the IR can do diagnostic imaging work. I mean there is already a group that covers the DR work and is always available. The only part of diagnostic imaging that IR can claim is something like part of vascular US (which they have to fight with vascular surgery) and probably some CTAs and may be some of their followups of TACE cases and few imaging here and there. But since they are separate from DR they can't seek help from diagnostic radiology group body imager . Also I don't think CTA brain from ER for stroke will go to IR to read.

- Similarly, with the same logic that IR will want to do some DR work, I don't know what stops the DR group from doing some procedures. For example, I don't think breast biopsies will go to IR. Now if DR group is doing breast biopsies, what about thyroid FNA? Why not other biopsies? Why not drains? But then they can't seek help from IR group for complications.

And if you practice like above for a while, eventually both group will come to the conclusion that it is better to join together.

Separating IR from DR is a real B$ that was started by some academic guys in Ivy towers who don't have any clue about practice of medicine in community. It is doomed to fail.

This ultimately depends on competitiveness for recruitment of each specialty. For example, I understand that vascular surgery took away EVAR from IR/rad because they refuse to provide open vascular surgical service if they were not contracted as the sole provider of EVAR.

Along the same vein, if IR become popular and there is a shortage, an IR group can easily demand exclusive access to certain procedures. DR may not have the bargaining chips due to availablity of tele rad or even IR groups themselves.

 

[Tiger100]

This ultimately depends on competitiveness for recruitment of each specialty. For example, I understand that vascular surgery took away EVAR from IR/rad because they refuse to provide open vascular surgical service if they were not contracted as the sole provider of EVAR.

Along the same vein, if IR become popular and there is a shortage, an IR group can easily demand exclusive access to certain procedures. DR may not have the bargaining chips due to availablity of tele rad or even IR groups themselves.

What do you mean by certain procedures? Can you name some?

There is a misconception among some medical students that if you do this dual certificate pathway you will be an IR doctor who will also read brain MRs or MRI abdomen in between your cases. No. That won't be the case. The 3 year of diagnostic radiology will provide you with the skills to read bread and butter studies but you won't be equal to a body imager or neuroradiologist.

It is not about bargaining power. It is also about the capability to provide a certain service in a timely manner. Let's say IR wants to do some DR and they have the bargaining power to do so because of the shortage of IR. Do you think with shortage of IR, they can provide report in a timely manner for CT abdomen and pelvis that is ordered by ER or stat inpatient?

I work closely with IR people in my group and worked with them in previous groups. In reality, IN A LARGE SCALE the only way that IR will be able to do DR is to be part of a radiology group except for some limited studies like vascular US and a few things here and there.

That is the reason that I think splitting these two fields is a mistake and IMO, even if they split in private practice, eventually working as ONE group will be the only way to go. Also right now, other than very few exceptions almost all IR doctors are part of radiology groups. I don't think they will leave the IR group and try to negotiate a new contract with the hospital as independent IR group.

Taking away EVAR by vascular surgery had more to do with the referral pattern than their refusal to provide coverage for complications. Simply put, they just learned the skill and didn't refer the patient. But I don't know what it has to do with DR versus IR.

As I said, there are some turf wars within radiology especially IR. Making a new turf war by splitting the field is a big mistake.

 

[qxrt]

I'm inclined to agree with Tiger100. Right now, IR is trying to have its cake and eat it too, by "separating" from DR yet trying to maintain its certification in DR. This is not sustainable, and something has got to give, whether IR remains integrated with DR or separates entirely and loses its DR certification, similar to what rad onc did (speaking of which, if you visit the rad onc forums occasionally, you'll notice that they are one of the fields most prone to having an identity crisis and worrying about the future of their field, since their specialty is based on a modality/method of treatment rather than an organ system...sound familiar?). The die-hard separatists tend to be clustered in the academic institutions, the trainees yet to go out into the real world, and those in specialized environments like Kaiser's HMO system, but this kind of identity separation is not how the majority of the real world works. An IR who cannot read DR is going to have very limited employment prospects outside of academics, yet even if they do try to read DR, they cannot compete with a DR group in giving satisfactory reads on high-end studies for a hospital's needs. And yet, having separate IR and DR groups bargain for contracts at the same hospital only weakens the position of both groups relative to the hospital. It is not in either field's interest to have to compete with each other; infighting will only open the way for other outside specialties to try to take more pieces of the imaging and procedural pie.

 

[tco]

Lucky for many of us the Maserati SUV can't beat my 5.0 Mustang on the track.

5.0 nation checking in!

Though I'm considering a trade to decrease my debt.