Radiology is amenable to working from home some of the time or remotely all of the time.
During residency, you can make more money than other specialty residents by moonlighting in the evenings and weekends, which merely requires you to be on site in case of an adverse event during a scan and possibly answer occasional tech questions, but you can be studying, watching YouTube, or playing video games otherwise.
What other specialties did you consider and why did you pick this one?
I considered other specialties like internal medicine for the cognitive aspects but found the care coordination and logistics tedious and stressful, and the patient interactions too performative. I feel most in control of my work when there's a well-defined task list that I can get through independently. I feel most myself when communicating with fellow physicians.
What challenges will this specialty face in the next 10 years?
Imaging utilization is rising faster than the radiologist workforce is expanding. Radiologists are overworked. Most practices have job vacancies currently.
What are common practice settings for this specialty?
All are possible.
How challenging or easy is it to match in this specialty?
It is above average in competitiveness.
What excites you most about your specialty in the next 5, 10, 15 years from now?
First, I would like dictation software that gets what I am trying to say with 99.9% accuracy.
Second, I would like a PACS software that hangs the images onto my screen the way I want them rather than having to manually drag images over at the beginning of reading each study.
Third, I would like scanners to get faster so that scans on fidgety patients don't come out looking like garbage.
Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
Yes. I'm looking forward to all these radiology AI startups figuring out what the actual business case is for their currently mediocre products.
What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
Detail oriented
Work independently
Curious and knowledgeable about a lot of medicine
If you love hitting the space bar in Anki, radiology may be for you.
Spatial intelligence
Good at technical writing
Good at oral communication to other physicians
What does a typical workday consist of in your specialty?
8:00-5:00, M-F: read studies (look at images, look at priors, look at chart, dictate report, occasionally call/message referrer, repeat)
Intermittently: answer phone calls/emails/messages from referrers and technologists, eat, have coffee, chat with colleagues
Sometimes: do procedures.
Sometimes: present at multidisciplinary conferences (eg, tumor board).
Sometimes: work evening or weekend shifts. Maybe 6 weekends a year.
Sometimes: teach.
What is the career progression for your specialty?
Not sure what this means.
What you are doing day 1 as a resident is essentially what you are doing the last day of your career in terms of clinical task: interpret images and produce a report.
There is no ramp-up period as a new attending because you don't need to build your own referral base. You plug into a group and get cranking on the list at full speed on day 1.
Later you get more responsibilities for non-clinical (administrative, leadership, teaching) tasks.
How has your work impacted your life dynamics? What is your work-life balance?
My hours are predictable. Radiology is well known as a controllable lifestyle specialty as part of the ROAD acronym.
How does healthcare policy impact your specialty?
Policy protects our specialty. The work is not being outsourced to developing country radiologists because of the protectionist healthcare laws and regulations in this country that require physicians to be licensed and located in the country; this was a concern 25 years ago. Similarly, the work will not be delegated to AI without a radiologist sanity check (in the same way I check all reports produced by my fellows) because of the policies in this country that put liability for the practice of medicine on the physician and their employer.
Radiology is involved in nearly every specialty of medicine and in many cases is part of the primary work-up for new medical conditions. This necessitates an incredibly broad knowledge base. Radiologists were once known as the "doctor's doctor" because clinicians of all types came to radiology for answers. (E.g. at different points during training we have to learn the different types of pediatric leukodystrophies, uterine cervical cancer staging and ins/outs of the latest greatest rotator cuff repair).
In reference to the above, a radiologist's work is mostly for clinicians rather than patients. Some radiologist's have very little contact with patients and almost never go over their report with patients (excluding patient-facing subspecialties like IR and mammography).
Diagnostic radiology is mostly shift work, but is truly a 24/7 specialty. Evenings and deep nights shifts are typically far busier than day shifts whereas a lot of specialties working after hours see decreased volume/need.
What other specialties did you consider and why did you pick this one?
Surgery, surgical subs and anesthesia. I desired something where I could get to sub-specialty level mastery, have procedures and a component of work-life balance. Ultimately work-life balance won out, although sub-specialty level mastery is very much on the table. When I'm off shift, I am off shift. I can upscale/downscale procedures as a part of my practice very easily. Career wise, radiology is very easy to downscale over time and many practicing rads are in the 60's and 70's (by choice).
What challenges will this specialty face in the next 10 years?
The two biggest challenges are AI and mid-level encroachment. Radiology thus far has very little mid-level encroachment but I think that's a far bigger concern in the next 10 years than AI replacing radiologists.
What are common practice settings for this specialty?
Hospital-based, outpatient/imaging center -based, and remote.
How challenging or easy is it to match in this specialty?
Above average difficulty
What excites you most about your specialty in the next 5, 10, 15 years from now?
AI is the elephant in the room but it potentially has the ability to turbo charge radiology speed and efficiency if done correctly.
Does your specialty currently use or do you foresee the incorporation of technology such as Artificial Intelligence?
Being a technology-based specialty, there are already significant AI usage but an almost absurd number of potential uses moving forward.
The most notable AI usage that is relatively recent but has an enormous impact is the use of deep learning networks in MRI image generation (e.g. the GE MAGiC software). This has brought the scan times down from 20-30 min to 10mins or less depending on the protocol. As a result, 30-50% more MRI's can be scanned in the same amount of time.
From a clinical interpretation standpoint, several vendors have products for the detection of: intracranial hemorrhage, intracranial aneurysms, large vessel occlusions, pulmonary emboli, spine fractures, pulmonary nodules, etc.. that are already used daily.
What are some typical traits to be successful in this specialty? (For example, organization skills, work independently)
Able to absorb and integrate a large knowledge base.
Able to work both independently and collaboratively.
Strong deductive skills. (Radiology often requires integrating one-off imaging findings with clinical history and lab values to make the diagnosis).
Attention to detail
Strong communication skills, both written and oral.
Intellectual curiosity (and the ability to utilize Dr. Google to find an answer).
What does a typical workday consist of in your specialty?
9hr work day: predominantly reading studies (image interpretation, comparison with priors, cross-referencing the EMR, dictating reports). Interruptions for: tech questions, provider calls, minor procedures (e.g. lumbar punctures). In my old job I had a dedicated period for lunch but in my current job I run, get food, and either take a very short lunch break if not eat at the workstation.
What is the career progression for your specialty?
Highly variable depending on the job chosen. An all-subspecialty academic job is very different than a community private practice job.
In general, I think (assuming 4 year residency, 1 year fellowship) the first 1-3 years out of training all about: cementing fellowship/subspecialty knowledge, building general rad speed, and becoming comfortable with procedures. Newbs out of training are far slower than year 2/3 rads. Years 5-15 is probably peak clinical compentency: it's the best combination of knowledge and speed
As Cognovi mentioned, the later into your career you transition more into non-clinical tasks.
How has your work impacted your life dynamics? What is your work-life balance?
Being shift work, my job is very consistent but also more comoditizable. My group has going rates for day/evening/weekend shifts and its usually not too difficult to find someone to pick up a shift if the money is right.
How does healthcare policy impact your specialty?
A ton. Scope of practice is being fought in every single state. The US government is currently reviewing policy that would allow mid-level providers to start independently reporting radiographs for the VA.
Money is always a big deal. For many years diagnostic radiology was routinely at the top of the list for largest Medicare reimbursement cuts.
Given how fast moving the technology in radiology is, getting new techniques/studies procedures covered by the government is a never-ending battle.
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