DR vs. ESIR vs. IR as it relates to subinternship/prelim years

[deleted674723]

I know there is information about the changes to DR/IR programs in various forms all over the internet and I've read most of them. I am trying to understand what the correct choices are for a student who is interested in radiology and possibly IR but not ready to commit fully to an integrated IR residency.

I like DR and I also like procedures so I can see my end game being a 50/50 split or some variation of that. However, I bailed on a surgical sub specialty because I couldn't imagine thriving in that environment so I am hesitant to commit to IR.

This leaves me thinking of pursuing ESIR programs. It is hard to understand from the resources I've found how this all works. I believe that the point of ESIR is for DR residents to have a pathway to IR. However, I am seeing that at least some programs are enrolling applicants into their ESIR programs from the get go? I thought the point was to be able to make your decision after having some experience with IR at the resident level.

My main question is... as an MS3/4 which sub-i should I complete to keep my options for IR open? Must I do a surgical subinternship? Will it hurt me later on if I pursue IR through ESIR if I did a medicine sub-i? The same question applies for my prelim years. If I am interested in ESIR, do I need to do a surgical prelim year before my DR residency begins?

Any insight is hugely appreciated. Thank you so much!

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[Kuratz]

Sub-I does not matter. At all. Do what you find interesting/tolerable, especially if you are applying only DR. SICU is probably the most useful. An actual IR rotation will help you get a feel for the field and if it's something you want to pursue.

As far as internship goes I received mixed advice from my home PD and other IRs at my home institution. Some felt it didn't matter while others really thought a surgical internship is best. I ultimately chose a surgical prelim at a community hospital where I was familiar from rotating there and knew most of the prelims. It is a "humane" year (still have to work hard), good program culture, and with plenty of opportunities to do procedures/OR and get to rotate through IR twice, vascular surgery and SICU. The prelims going into IR highly recommended it and actually seem happy vs. my home academic prelim surgery program where the prelims were completely beat down and hating life with never-ending scutwork. That would be a total waste, imo. It's not one size fits all. I'm hoping for ESIR as well and believe doing a rigorous surgical year will let my new program know that I'm truly invested in going the IR route. My personal preference was the day-to-day work of surgery vs medicine and I wanted a robust year to hone some clinical skills. Plenty of folks become IRs after a chill TY, though.

Also aside from Baylor (Houston) I didn't run across any programs that directly matched ESIR or "held spots". Most suggested you need to make the decision to do ESIR by the end of R1 and have to apply if too many people are interested. For someone on the fence like you I think applying to DR and focusing on the ESIR opportunities is probably the way to go. If you can find a surgical year where they genuinely treat prelims well and don't work you to the bone then you might consider it.

I'd also like to hear from more experienced folks who are familiar with the process.

 

[deleted674723]

Sub-I does not matter. At all. Do what you find interesting/tolerable, especially if you are applying only DR. SICU is probably the most useful. An actual IR rotation will help you get a feel for the field and if it's something you want to pursue.

As far as internship goes I received mixed advice from my home PD and other IRs at my home institution. Some felt it didn't matter while others really thought a surgical internship is best. I ultimately chose a surgical prelim at a community hospital where I was familiar from rotating there and knew most of the prelims. It is a "humane" year (still have to work hard), good program culture, and with plenty of opportunities to do procedures/OR and get to rotate through IR twice, vascular surgery and SICU. The prelims going into IR highly recommended it and actually seem happy vs. my home academic prelim surgery program where the prelims were completely beat down and hating life with never-ending scutwork. That would be a total waste, imo. It's not one size fits all. I'm hoping for ESIR as well and believe doing a rigorous surgical year will let my new program know that I'm truly invested in going the IR route. My personal preference was the day-to-day work of surgery vs medicine and I wanted a robust year to hone some clinical skills. Plenty of folks become IRs after a chill TY, though.

Also aside from Baylor (Houston) I didn't run across any programs that directly matched ESIR or "held spots". Most suggested you need to make the decision to do ESIR by the end of R1 and have to apply if too many people are interested. For someone on the fence like you I think applying to DR and focusing on the ESIR opportunities is probably the way to go. If you can find a surgical year where they genuinely treat prelims well and don't work you to the bone then you might consider it.

I'd also like to hear from more experienced folks who are familiar with the process.

Great advice. Thanks a ton. I think the prelim year is a bigger decision than the sub-I so I'll just do whatever works with my schedule and interests best. Do most people get enough experience in R1 to be able to make a confident decision about wanting to do ESIR?

 

[Purple&Gold]

Agree - sub-I doesn’t matter, elective in IR can show what it’s like.

Intern year - do what’s best for you! Prelim surg intern can be tough, prelim medicine can be better with some programs with sweet/easy elective opportunities.

Matching into DR opens up the option of ESIR - you should get plenty of IR exposure in R1/early R2 (ask for it) to make a decision - there are plenty of procedures outside of IR - body, chest, pedi, msk, breast, neuro all have some procedural skills - general radiologists do ‘light’ IR work all the time.

IR is competitive and not for everyone! The new ESIR programs are gearing away from DR skills - to be honest, I wouldn’t want an IR rad reading my DR studies (mammo, pedi plain films, neuro/msk/body MRI - hell, no!!) - the training and repetition of reading DR stops after R3 - these skills get forgotten when not done in R4/R5, so make sure you want the IR life - you may be giving up the quality of your DR reading skills!

 

[irwarrior]

Most Independent IR program directors are looking for a commitment to IR early on. They are comparing to the integrated residents who have had a ton of IR and surgical experience as early as MS4 (2 or 3 IR aways, vascular surgery, ICU, surgical subIs) and then a busy surgical internship and more months of IR , ICU, surgery in the early years (R1 to R3). So, the ESIR trainee is at a competitive disadvantage when it comes to clinical and technical skills compared to their IR counterpart. As we start to see the first groups of integrated coming up the pipeline , it becomes more challenging training a standard ESIR resident to be a strong clinician.

I would encourage those who are truly interested in ultimately pursuing IR via ESIR and are not afraid of the surgical lifestyle and numerous emergency cases that IR has to come in for, to pursue a surgical internship and showcase your true interest in IR early and often. The independent residency match will have fewer and fewer positions as more and more will convert their spots to integrated positions.

 

[NDcienporciento100]

I know there is information about the changes to DR/IR programs in various forms all over the internet and I've read most of them. I am trying to understand what the correct choices are for a student who is interested in radiology and possibly IR but not ready to commit fully to an integrated IR residency.

I like DR and I also like procedures so I can see my end game being a 50/50 split or some variation of that. However, I bailed on a surgical sub specialty because I couldn't imagine thriving in that environment so I am hesitant to commit to IR.

This leaves me thinking of pursuing ESIR programs. It is hard to understand from the resources I've found how this all works. I believe that the point of ESIR is for DR residents to have a pathway to IR. However, I am seeing that at least some programs are enrolling applicants into their ESIR programs from the get go? I thought the point was to be able to make your decision after having some experience with IR at the resident level.

My main question is... as an MS3/4 which sub-i should I complete to keep my options for IR open? Must I do a surgical subinternship? Will it hurt me later on if I pursue IR through ESIR if I did a medicine sub-i? The same question applies for my prelim years. If I am interested in ESIR, do I need to do a surgical prelim year before my DR residency begins?

Any insight is hugely appreciated. Thank you so much!

Surgical Sub-internships don't matter at all. It is going to be harder and harder to get into IR from DR just recently the IR PD at Medical College of Wisconsin Dr Patel (who is a big name in IR) posted a message on the Society of Interventional Radiology website saying that the DR Residents at his program where having a hard time getting IR interviews and I think its only going to get harder. There are some PDs (cough cough Cleveland Clinic as an example) that are admit in his believe that surgical internships are the best. So now knowing how competitive it is and that some PDs will want to see a surgical Internship it would be wise to keep your options open and do a surgical internship. You should know if you want to do IR after 1 month sub I in 4th year and no R1 is probably not going to give you all that much more insight but this will depend on what program you go. Try to figure out what you want to do with your life ASAP and if its IR just apply Direct because its not going to be easy later, and PDs hate applicants that are indecisive (Just my take after over 20 interviews in both IR and DR over the last few months). Cheers!

 

[irwarrior]

I think the surgical sub internships and vascular surgery rotations are high yield for those thinking about pursuing IR as it preps you to get the most out of your surgical internship. Surgical internship is almost becoming a requirement in many IR PD's mind as it more closely reflects the modern day interventionists day to day existence.