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FAQ2: What to look for in a radiology program.

Discussion in 'Radiology' started by hans19, May 27, 2006.

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  1. hans19

    hans19 I'm back... Moderator Emeritus 5+ Year Member

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    Warm'n fuzzy:
    Location- you'll be there for 4-5 years, make sure you and your spouse/S.O. will be happy. Is it close to family, friends, and your support network?

    Esprit de corps- Can you work with that group of residents for 4-5 years? Do the residents socialize outside of work? Are most married or single? (sucks to be the only single resident) Are there other women in the residency? (there can be resentment you are the only female resident, get pregnant, the others have to pick up your work vs if there are several female residents who are more understanding-- just stating an observation.)

    Vibe- sometimes things just click and you know its the right place!

    The practical:

    Reputation of program:

    It matters, sort of...
    The most important thing in becoming a good radiologist is for you to get solid training and do a lot of reading and self-study (there is simply too much information for lecturers spoon feed you everything there is to know.)

    The most important thing in landing a good job is your reputation during your residency which will be revealed in your 'file' or in your letters of reference. If you have a rep for being pleasant to work with, knowledgeable, hardworking and EFFICIENT (can you get the work done quickly with accuracy?) your reputation will preceed you and you should have no problem landing a good job.

    However, if you plan to work a very competitive market or plan to have career at a top academic program, it always helps to have a good pedigree. 2-3 years ago the radiology shortage was so dire that it didn't matter at all where you went, you could get a job almost anywhere. The shortage has abated somewhat. There are still plenty of lucrative jobs in the less popular/underserved areas, but if you want a good job in a saturated market, any edge you have will help.

    Again, the most important thing is to get solid training and to have a good reputation and letters of recommendation. If you come from a lower tier academic or community program with supportive letters, you should still have no problem getting a good job. If you come from a top place, but your references suggest you are difficult to work with or are lazy, you'll have a tough time getting hired anywhere.

    Being from a community program won't necessarily hurt you, but academic programs tend to have better reputations, FWIW.

    If you come from a no name program and you feel you have deficiencies in some areas and you want to land a job in a competitive market or high level academics, no worries..... you can do a 1 year fellowship at a well-known place to help buff up your CV. However, its easier to land a top fellowship if you are from a top residency in the first place.



    Variety and number of cases:

    This should be obvious. look for a place which offers a wide variety and a large number of cases. Usually the best mix is at an academic program with an affiliation with a large public/county hospital and/or a VA hospital and/or (if you're lucky) a children's hospital. This may mean a larger work load, but the more you see, the more experience you get, the better off you'll be in the long run. Its better to see a bizarre or tough case in residency and say later on 'yeah, I've seen on of those before!', than to see something crazy for the first time in private practice and be totally clueless and unhelpful to the clinician.

    Along the same vein: MRI and cardiac cases...
    OK folks, the next generation of radiologists absolutely has to be comfortable with MRI! Specifically ask what kind and how much dedicated MRI experience you get. The more, the better. How much MRI do you get during neuro rotations? MSK rotations, Body (GU/GI) rotations? 15 years ago, people did fellowships in cross sectional imaging (CT/US/MRI) but those are all routine by now. If you don't want to get left behind in the near future, you need to be comfortable reading MRIs. If the program is weak in MR, you can do a fellowship in MR or MSK later on, but these fellowships are the most competitive fellowships to get currently, so don't count on it.

    Cardiac imaging: CTA of the coronaries and MR perfusion will probably be mainstream for the radiologist in the future, and is being emphasized on the radiology board exams. Not all programs offer cardiac CTA, Perfusion MR at this time, but if the program does, its a good thing.

    Faculty:
    Its always nice to have well-known faculty that wrote the book in a certain subject area. However as many of you know by now, being a big name in research does not necessarily translate into having an apptitude for teaching. Just because Famous Seamus, MD is at your residency doesn't mean you will necessarily get to read out with him on a regular basis, as he/she may spend the majority of time with the fellows, or away giving visiting lectures.

    Faculty turn over is a fact of life. Its hard to retain people in academics when private practices are offering 2-3x the salary of the academic places. Just make sure the program you are looking at has at least more than on subspecialist in each of the core areas. Do you they have fellowship trained full time Neuro/Neuro IR, IR, MSK attendings? Do you have dedicated full time faculty in pediatrics, thoracic, GU, GI, nuclear medicine, mammography etc? Or does most of your staff cover everything? (Jack of all trades,master/teacher of none)

    Equipment:
    EVERY program should be fully PACS by now, and may even be upgrading to a next generation PACS. It should not be the deal maker, but not being fully PACS should raise a red flag. PACS, with its idiosyncrasies, still makes life a hell of a lot easier than reading from hard copy films. As far as systems go, I know that Stentor, Dominator, and Centricity are great systems. Again, not a big deal.

    Even some very good institutions won't have the newest latest and greatest machines, so don't sweat this too much. But its nice, but by no means necessary, to have 3T magnets and a 64 slice CT scanners. CT/PET fusion should be at most institutions by now.
    The bare minimum: Multiple 16 (or greater) slice CTs and 1.5 T magnets.

    Fellows/Fellowship placement: A lot of fellowships are not terribly too competitive to get, and the majority of graduating residents are doing fellowships. If you hear that a person got a fellowship at a MGH, take it with a grain of salt. What was the subspecialty was the fellowship in? and where? Realize that the ivy institutions may have an impressive name for undergrad or med school, but they are not necessarily the top places for radiology fellowships. MRI and MSK are the toughest fellowships to get these days, so if a program places a lot of residents in these areas, thats a good sign. But then again, not every graduating senior wants or needs to do an MRI or MSK fellowship. Everything else is not that competitive. A paid MSK fellowship at UCSD with Resnick is impressive, thoracic imaging at MGH-- less so (no offense to the thoracic fellow at MGH, if your reading this).

    A case has also been made that an institution with too many fellows will take away from the residents and a place without fellows means more subspecialty cases for the resident. This may or may not be true, just realize that a some of of the top fellowships fill internally, so if it helps to be at an institution with a good fellowship in an area you think you might be interested in.

    Board pass rates: This should go without saying. Ask how the program helps prepare residents for physics, writtens, oral boards. A lot of programs have structured physics lectures preceding the physics board. Many have recall libraries and/or give time off to study for writtens. Many programs will send residents to a review coarse for oral boards. If a program consistently has problems passing residents on any of the above, it should raise a red flag.
    As far as oral boards its desirable to have all seniors pass 'outright' rather than to have a 'conditional' pass.

    Call: A lot of programs are switching to a night float system, in which you take a week or 2 of night float per year. These programs tend to have have 24 hour in house attendings to read out with.

    Programs with traditional overnight call will give you the post call day off. But before you leave in the morning, most require you to review and dictate with an attending, the studies that you gave preliminary interpretations on, on call. I like this system because it gives you a little autonomy and builds confidence. Between the time the attending leaves at night and comes in the morning, YOU are one making the call, and you get to see if you were right or not in the morning. Also with the post call day off, you can moonlight!
    Most programs have no call the first 6 months of R1 and no call the last 6 months of R4 so that seniors have time to study for oral boards. You tend to take more calls the first year, and less as you advance.

    Other details to inquire about: Salary (duh), academic appointment? (gives you added perks of a university staff), free food on call, book fund, vacation (most programs will give 15 working days plus an unofficial week around Christmas- so effectively 4 weeks), how much money do they give you for AFIP (its tough to afford 6 weeks of rent, fuel and food in DC), most programs will send you to RSNA once for free and one conference for free, and others for free if you present a paper. Parking? Health benefits? Dental? Subsidized housing (if you live in Manhattan?) Moonlighting opportunities, be tactful the way you ask this question-- is it allowed, is there built-in moon lighting? Moonlighting can substantially augment your salary your final years and give you good real world experience.

    Thats all I can think of at the moment. I encourage other residents to add anything I may have left out or clarify things.
     
    Saharsima and g8orlife like this.
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  3. Taurus

    Taurus Paul Revere of Medicine 10+ Year Member

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    Great post! :thumbup:
     
  4. f_w

    f_w 1K Member 5+ Year Member

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    Ought to be stickied.
     
  5. GammaRay

    GammaRay Member 2+ Year Member

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    Thanks!! This post should definitely be made very easily available and visible.
     
  6. Carb Addict

    Carb Addict Member 7+ Year Member

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    Fantastic hans19!!

    But I'd like to note some things from your post, that you suggest asking about, that should not be discussed with faculty, esp the program director. I do not intend to imply that you meant to have all of your points directed to faculty, hans19 -- just thought I'd offer a word of caution. Much of this is common sense (i.e., think of what questions you would find inappropriate if you were a program director).

    1. I would not ask about call in an interview. If the program's style of call is discussed in the introductory remarks, great! Perhaps you can clarify anything at the end of such remarks; otherwise, I'd simply ask residents about this.

    2. Many of the things listed in the last section ("Other details...") are best directed to residents. For example, moonlighting is a very bad choice of topic to broach with faculty (because they probably don't know much, if anything about it), let alone the program director (who may not look kindly on it). But it's perfectly appropriate to talk about it in informal discussions with residents.

    Some may disagree with me and are able to find more opportunities to be open about these issues, so choose your own path. No need to piss off the faculty when the residents can easily answer such questions, I say. :)
     
  7. bigfrank

    bigfrank SDN Donor 7+ Year Member

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    Another excellent post.

    Voxel should be removed as moderator (I can still beg, correct?).
     
  8. KB_Xiii

    KB_Xiii Member 5+ Year Member

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    Deja vu! lol
     
  9. navin715

    navin715 New Member

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    hi guys

    what is the procedure for radiology residency. Do I have to match for PGY1 medicine and radiology program in the same program or do I have to work in 2 different programs, the first yr in medicine and then radiology in another program.

    How do we coordinate the interviews and how to apply for radiology.

    please let me know about your suggestions.

    thanks very mcuh
     
  10. trouta

    trouta Senior Member 7+ Year Member

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    Typically you apply for both radiology and your intern year at the same time. These two programs can be at the same place or can be in completely different places (I am doing my TY in one area of the country and my rads in another).

    Coordinating your interviews is merely a matter of fitting them all in. A good time to go to intern year programs is during RSNA (assuming you arent going) since most rads programs wont interview then.
     
    g8orlife likes this.
  11. ljl1982

    ljl1982 ljl1982 5+ Year Member

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    I received information packets from two programs where I interviewed (Wayne State and William Beaumont) that I found useful as I evaluated programs:

    Factors
    Location
    Setting (university vs. community hospital)
    Reputation
    Stability of the program/Program accreditation
    Subspecialty strengths
    Gut feeling about program's advantages and disadvantages

    Education
    Faculty teaching (conferences, didactics, journal club)
    Stability of the staff
    Where have the staff trained
    Faculty:Resident ratio
    Involvement of the faculty and residents in organized radiology
    Funding for AFIP
    Post-residency plans of graduates
    Fellowship opportunities
    Research/teaching opportunities (available/encouraged?)
    Hospital's patient population, diversity of pathology
    Strengths of clinical departments, number of admissions, ER visits, surgeries
    Equipment, PACS
    Department library/teaching files
    Dept. of Radiology's relationship with other departments/referring physicians
    Volume (*Minimum 7000 studies per resident per year*)
    Board pass rate
    Board preparation/courses offered by the program
    Oral Board examiners in the department?
    Program accreditation (for how many years?)
    Opportunities for procedures and cases

    Work Environment
    Size of the program (number of residents, fellows, attendings)
    Call frequency, type of call system
    Ancillary support (nursing, availability of techs)
    On-call support
    Time allowed for conferences/vacations
    Moonlighting opportunities
    Hospital facilities

    Transitional Year Included?
     
    g8orlife likes this.
  12. hans19

    hans19 I'm back... Moderator Emeritus 5+ Year Member

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    Excellent post!
     
  13. Osteopathology

    Osteopathology 2+ Year Member

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    Sticky Pls....
     
  14. ApolloDok

    ApolloDok Carpe diem - Carpe noctem 2+ Year Member

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    Great post here...thanks a lot!
     
  15. Plue00

    Plue00 7+ Year Member

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    Thanks man this really helped...and i mean really.
     
  16. donvicious

    donvicious Senior Member 7+ Year Member

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    Hans,

    As a resident, would you rather be at a place where the attending depends on you to get through cases or would you rather be at a place where you can spend an hour on an interesting case while the attending catches you up?
     
  17. choi

    choi

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    Hi I was wondering if anyone could recommend a post bac programs for radiology? The programs that i did find were certification program, but im looking a bs program, recommendations?? Thanks
     
  18. PeepshowJohnny

    PeepshowJohnny 2+ Year Member

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    Earth
    This forum is geared toward medical students and doctors who are or are interested in becoming radiologists.

    I think your question would be much better answered on auntminnie.com where they have a forum designed for technologists. They'd have much more experience and better recommendations.
     
  19. Howser

    Howser 2+ Year Member

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    thanks for the info
     
  20. johnson1234

    johnson1234

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    One useful thing to do when you interview for residency programs is to get a sense for how often the resident is left along to read a pile films by themselves and how often is the resident reading out with the attending. Remember, you can't learn radiology from a book -- you need attendings during residency to show you how they read and interpret films, etcs... Residents should be able to preview films and make their own decision, but for every case, there must be an attending to overread the case and provide immediate feedback. Without this feedback, a resident will never learn the intricacies of radiology.

    One useful way to assess the reputation of a residency program is to ask where the graduates ended up for fellowship. How many made were accepted to top fellowship programs such as MSK/osteoradiology at UCSD with Resnick or Body imaging at Stanford? Like Hans said, don't be fooled, not all fellowships at famous institutions are good -- for example, body imaging at UCSF or the MRI fellowship with Bradley at UCSD are not competitive and provide a limited experience: fellows are stuck "reading out" by themselves or they are farmed out to imaging centers as free labor.

    Subsequently, what the alumni are doing now? How many are in private practice? Academics? Of those in private practice, how many were able to get jobs in competitive markets like SF or NY -- how many are stuck in Indiana or Montana? How many are stuck in dead end teleradiology jobs or night hawk? How many could only find a job at Kaiser?

    Finally, look at the research reputation of the department you are interested in. Search online for the radiology departments with the most NIH funding -- these tend to have the best residencies and fellowships. Institutions which invest heavily in research will have the best attendings teaching you the latest standards of care and the newest techniques. It would be nice to learn flouroscopy from Igor Laufer at Penn, but let's face it, flouroscopy is becoming less and less useful with CT.
     
  21. subvij

    subvij

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    I have been doing radiology and imaging practice for more than 20yrs after completion of my MBBS and DMRE from India. The practice includes modern imaging (CT/MR/USS). During these years and after enormous experience I feel that my qualification remains a bar for better prospects always, although I'm happy professionally. At this juncture if anybody can guide me for fellowship equivalent to postgraduate degree acceptable in India and Europe. Age is also a factor as PGS in India have age restriction.
     
  22. Rouleaux

    Rouleaux

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    Might be a stupid question but what qualifies as an intern year for radiology? I am a PGY2 in pathology and if I wanted to switch over to radiology I guess I would have to do the whole clinical intern year thing hu? It would be fantastic if that time in path would translate into a intern year and I could just jump into the radiology stuff.
     
  23. drizzt3117

    drizzt3117 chick magnet 10+ Year Member

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    Prelim surg, medicine, or transitional year; path won't count.
     
  24. killinsound

    killinsound 10+ Year Member

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    can't you do prelim family, peds or obgyn also?
     
  25. drizzt3117

    drizzt3117 chick magnet 10+ Year Member

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    I know one person that's done peds and it required a waiver. You need to have 3 mo of ward medicine or surgery, one month or equivalent of emergency medicine, and one ambulatory month. Most programs have a ICU month also but I'm not sure if that's a ABR requirement.
     
  26. Bayonetwork

    Bayonetwork 7+ Year Member

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    Bump...just wanted to see if any residents/attendings/PD's have anything to add to the OP since its a decade old?
     
  27. RadiologyPD

    RadiologyPD

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    Physician
    Faculty

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