ESIR without the fellowship?

[DrK2020]

Long time lurker of this thread. I came into radiology residency wanting to do IR 100%, no doubt. I wanted to be a part of the next generation of IR that embraces continuity of care, clinic, and all the high end procedures like BRTO, Y90, UFE's...you name it.

As radiology residency went along, I learned that I really enjoyed the cerebral aspect of diagnostic radiology. I just finished my IR rotation, and I really did enjoy all facets of the job. With that being said, the hours definitely weighed on me after awhile. I really enjoyed the procedures overall, but I realized some of the higher end stuff I could care less to do. I was honestly happy just trucking through the day and doing my fair share of lines, tubes, drains, ports, and biopsies. The other struggle I faced was I realized a lot of IR in PP is just lite IR, and you are honestly overqualified for the job.

Admittingly, I feel like being a diagnostic radiologist alone wouldn't scratch my procedural itch, but full on IR with all that it entails (soliciting referrals from other doctors, seeing patient's in clinic, and super super long procedures) might be too much practically for IR. I am happy practicing IR in the fashion that it is currently practiced in PP where you read studies and do lite procedure. There was someone I knew who did ESIR + breast fellowship and another that did ESIR + neuro fellowship. My question for you is what are your thoughts on this set up? The way I see it, I can do another diagnostic fellowship and when I'm out in PP, I can offer my other partners my skillset in being able to do lite procedures.

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[SeisK]

If you do ESIR you join the IR callpool and are a defacto senior IR resident / fellow. You’ll have to cover consult and clinic (if you guys have that), and will do overnight call where you cover the high end emergent endovascular stuff. That’s a lot of extra BS for someone who only wants to do drains, biopsies, and lines. Instead of that, if IR educational leadership is ok with it, I’d take a good chunk of 4th year elective time doing the bread and butter procedures like CT / US guided biopsies and drains and lines. A lot of times the IR fellows and junior DRs on service are happy to not do that, and that way you don’t have all the additional low-yield work. You get better focus on what you want for your career which affords you more 4th year elective time for your mini-fellowship.

Something to think about though: in private practice if you’re a diagnostic guy they want you reading images as much as possible, and they want the IR guys doing procedures as much as possible, because the narrowed focus improves time-efficiency. Moreover, the IR guys in a practice may not want to fork over their procedures even if they are lower end. If you want to be the bread and butter procedure guy it’s going to be much more feasible for you if you do IR full-on. You’ll be reading general, but if you’re comfortable they’ll usually be happy with you doing other “general-adjacent” imaging including large joint MRI, body MRI, degen spine MRI, and breast. If you go gung-ho on these during your DR rotations and you do a lot of extra outside time studying and looking at archived images, I think for what you want the IR fellowship plus gen rads plus a little extra would be best.

 

[Kuratz]

A practice could reasonably plug an IR guy into some general diagnostic rotations. But someone with a limited procedural skillset cannot be easily put into standard IR shifts because they cannot handle bleeders, complex venous work etc. It just doesn’t make sense logistically to scrape off the easier procedures from the IR shift unless they are just completely overloaded. What you are envisioning (lite IR + diagnostic) might still be possible in some places but the trend is subspecialization down the board even in private practice. I think you are far more likely to have the practice you envision by grinding through the IR training and then maintaining some DR skills. I couldn’t make IR work due to family priorities but would’ve been nice to have that skillset.

 

[Isonicphoton]

A practice could reasonably plug an IR guy into some general diagnostic rotations. But someone with a limited procedural skillset cannot be easily put into standard IR shifts because they cannot handle bleeders, complex venous work etc. It just doesn’t make sense logistically to scrape off the easier procedures from the IR shift unless they are just completely overloaded. What you are envisioning (lite IR + diagnostic) might still be possible in some places but the trend is subspecialization down the board even in private practice. I think you are far more likely to have the practice you envision by grinding through the IR training and then maintaining some DR skills. I couldn’t make IR work due to family priorities but would’ve been nice to have that skillset.

While specialization is a thing, an IR/DR skill set being able to do DR and light IR is still highly desirable in many jobs. Especially in the midwest and south. Small groups of 5-10 don't have the luxury to have 3-4 IRs.