EM/Rads: can anyone comment??

[cpb80]

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Hi M4 applying to EM...
I recently realized that I also like radiology, and I was wondering if any of you thought that it was feasible to do both. I have played with the idea of applying to a three year EM program and then doing rads for four years (assuming that radiology programs would allow me to skip a transitional year?) What's my reason? Well aside from enjoying radiology, I think it would make me a better EM physician (not to mention that I was already planning on doing a fellowhip in US). I am also a bit worried about burnout down the road, & I have been playing with the idea of working fewer shifts as I get older and supplementing my income with diagnostic reads on the side. I understand that pursuing both may seem unrealistic, but I had to ask.
Any feedback would be much appreciated.
Thanks!

 

[deleted77919]

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[AmoryBlaine]

Rare indeed would be the student who could really motivate themselves and succeed in both fields. You want to do 3-4 years of EM and then go sit in a dark room learning the ddx of white appearing lesions on T2 images of the spine?

There would be no reason to do this to enhance job performance/marketability as an emergency doc. Billing would be an issue as well b/c there would be conflict of interest at work if you ordered a study and then billed for its interpretation.

Big difference between doing US fellowship and doing Rads residency. US is a dynamic, bedside modality that in emergency medicine usually seeks to answer a very specific question i.e. does this patient have an IUP, where is the IJ, is there fluid in the belly. Radiology is a great field, but alot of it is the dark room....

 

[cpb80]

thanks for your input guys.

 

[cabruen]

You would also run into funding issues for the second residency.

However, you can investigate some of the combined residences. There are programs that pair EM with FM and IM.

 

[bartleby]

Even if it were feasible, doing these two residencies would be a waste of time. You can either devote the time and effort to being a good clinician, or you can be a good radiologist, but not both. In order to develop any expertise in either field you need to either see a ton of patients or see a ton of films. After 20 years in clinical emergency medicine, I doubt that you would be well qualified to work as a radiologist, having allowed your diagnostics skills to atrophy, radiology residency or not. Furthermore, think of how much the field of radiology might change in the next 20 years. 1988 was a whole different ball of wax--CT was still in its infancy, and many of the uses for MRI had not even been conceived of yet.

There would be little cross-pollination between your interest in emergency ultrasound and radiology, because the goals of these two subjects are entirely different. Emergency ultrasound is about searching for specific life-threatening diagnoses using a focused bedside study, while radiologists use ultrasound to evaluate for a much wider field of possible diagnoses. When I use ultrasound to look at a kidney, I have a specific question: is there hydronephrosis or not. , The radiologist is looking for that as well as evidence of renal parenchymal disease and 100 other things.

I have heard of burnout, and I've also heard of Santa Claus, but neither come exclusively to emergency physicians. I've seen more cardiologists and internists get sick of their jobs and either leave medicine entirely or switch to an entirely different kind of job within their specialty of an emergency physicians. Medicine in general is a demanding occupation which puts extraordinary strains on you as a person as well as on your family. If you are not able to find a positive way to deal with these stresses and "keep your batteries charged" you'll burn out whether you are a neurosurgeon or a pediatrician.

Physician wellness is a subject which has been gathering more attention in the past several years and is not an issue exclusive to emergency medicine by a long shot. Are we emergency physicians have our own set of stressors including irregular hours, an energy-intensive workplace, in the joys of dealing with the cream of society. To avoid emergency medicine because you think it will allow you to steer clear of this issue is misguided.

 

[gutonc]

Something else to think about which is not w/o precedent. EM now while you're young and can deal w/ the pressure. Work for a while and if you still love Rads also, go back to residency for that and spend your golden years sitting in a dark room and drinking coffee.

 

[keeping-it-real]

If you were considering this, you'd probably be better off doing a residency in one now and then doing the other down the road. The most reasonable sequence would be ER now while you're young and then Rads when you get older if you no longer like the ER lifestyle/work,etc.

The level or radiology knowledge required to become a proficient ER physician does not require anywhere near an entire radiology residency. The ER radiology is limited to mostly routine plain films, ultrasounds and CTs with MRIs to a lesser extent. With enough time and exposure, and maybe a few electives and self-study, you can become very proficient at reading these types of studies and feeling comfortable with your radiology skills. The more esoteric stuff that will be covered in a Rads residency like PET scanning, different types of MRI studies, physics, rare disease presentations etc... will be of little or no value.

My advice would be this. If you really like Radiology and are a strong applicant, apply to radiology programs and try to mach Rads. It is a more regular schedule and the pay is better. If, on the other hand, you like Rads to the extent that it applies to EM, then just apply to EM and spend extra time reading films and doing self-study (there are plenty of resources on this material); you can even find programs where there is extensive ultrasound experience during residency.

If you're unsure what you want to do, you can always apply to both, interview both, and then rank both specialties although this is usually discouraged. Both specialties have very rigorous work schedules and when you're at work, you're working non-stop. If you can live without patient care and want to make more money, then go Rads. If you prefer a clinical setting, EM may be more appropriate.