Getting IR exposure during residency

[je355804]

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I came across the IR match statistics the other day, and some shocking numbers presented themselves. Apparently in 2010 50% of the IR programs filled and nearly everyone matched who applied. Fastforward to 2014 and nearly all programs filled and 20%+ of the applicants didn't match.
With that said, the program I matched at in radiology does not have IR... yet I'm still extremely interested in pursuing a fellowship.

I am wondering if you all can suggest what someone in a position such as myself can do to make themselves competitive coming from a program without IR. With that said, I have approximately 8 programs within 3 hours of mine which do have IR. 2 of these programs are within 30 minutes of mine... do you think it is possible to do research at programs that aren't associated with your own? If not, what other types of activities can I get involved in to make myself maximally competitive?

I really want to make sure that I am participating in the correct types of activities during my radiology residency... I'm sort of concerned that coming from a program without an IR fellowship is going to limit my exposure and thus eliminate any real chance I have of getting a fellowship.

Thanks for the input everyone!

 

[shark2000]

I came across the IR match statistics the other day, and some shocking numbers presented themselves. Apparently in 2010 50% of the IR programs filled and nearly everyone matched who applied. Fastforward to 2014 and nearly all programs filled and 20%+ of the applicants didn't match.
With that said, the program I matched at in radiology does not have IR... yet I'm still extremely interested in pursuing a fellowship.

I am wondering if you all can suggest what someone in a position such as myself can do to make themselves competitive coming from a program without IR. With that said, I have approximately 8 programs within 3 hours of mine which do have IR. 2 of these programs are within 30 minutes of mine... do you think it is possible to do research at programs that aren't associated with your own? If not, what other types of activities can I get involved in to make myself maximally competitive?

I really want to make sure that I am participating in the correct types of activities during my radiology residency... I'm sort of concerned that coming from a program without an IR fellowship is going to limit my exposure and thus eliminate any real chance I have of getting a fellowship.

Thanks for the input everyone!

7 years ago you could not pay a radiology resident enough to do IR or mammo. Only 30% of their spots used to fill. Now everyone wants to do either IR or mammo. And nothing fundamentally really changed about these fields. It is not like that we have found a percutaneous technique to treat breast cancer or we have taken back the vascular turf. Both fields are the same even with more hassles. The thing that has changed is the job market. 10 years ago everyone was in love with MSK and Neuro. And now it is IR and mammo. I don't blame anybody. Just saying that this amount of fluctuation in liking or disliking radiology or IR or mammo or MSK or Neuro all comes from the job prospects and market. Once you tell 100 times that you like mammo, you yourself also will be convinced that mammo is something that you have dreamed about your whole life.

The reason I talk about all this BS is because things change extremely rapidly. In 3-4 years don't get surprised if everybody wants to do chest or Nucs or flouroscopy fellowship. I can clearly see the first signs of extra saturation of IR and mammo market in my area. Now how far and how deep it will go from here, nobody know. The very obvious thing is that Neuro, MSK or body market will see less fluctuations over time as they have filled their spots in the last 15 years always. However, something like mammo and IR have pumped out only 1/3 of their capacity in the last 10-15 years, except for the last 3 years in which both fields pumped out trainees with their full capacity. Already now the relative shortage has resolved and both of these markets are going towards over saturation, no different than Neuro or MSK.

If things stay like the way they are now, you will not have a good shot at top IR programs. But you will find a spot somewhere and will be IR trained. How much that matters? Nothing since whatever oncology and transplant work that you learn in a top notch fellowship doesn't exist in pp. So I don't see any MEANINGFUL additional skill for pp in a graduate of a top IR program.

What is my guess? Nobody knows what will happen in the future. But a few years down the road, by the time that you finish your training the market will open up. Then again you won't be able to pay residents enough to do mammo and IR and everyone all of a sudden will find Neuro and MSK their dream fellowship.

 

[je355804]

7 years ago you could not pay a radiology resident enough to do IR or mammo. Only 30% of their spots used to fill. Now everyone wants to do either IR or mammo. And nothing fundamentally really changed about these fields. It is not like that we have found a percutaneous technique to treat breast cancer or we have taken back the vascular turf. Both fields are the same even with more hassles. The thing that has changed is the job market. 10 years ago everyone was in love with MSK and Neuro. And now it is IR and mammo. I don't blame anybody. Just saying that this amount of fluctuation in liking or disliking radiology or IR or mammo or MSK or Neuro all comes from the job prospects and market. Once you tell 100 times that you like mammo, you yourself also will be convinced that mammo is something that you have dreamed about your whole life.

The reason I talk about all this BS is because things change extremely rapidly. In 3-4 years don't get surprised if everybody wants to do chest or Nucs or flouroscopy fellowship. I can clearly see the first signs of extra saturation of IR and mammo market in my area. Now how far and how deep it will go from here, nobody know. The very obvious thing is that Neuro, MSK or body market will see less fluctuations over time as they have filled their spots in the last 15 years always. However, something like mammo and IR have pumped out only 1/3 of their capacity in the last 10-15 years, except for the last 3 years in which both fields pumped out trainees with their full capacity. Already now the relative shortage has resolved and both of these markets are going towards over saturation, no different than Neuro or MSK.

If things stay like the way they are now, you will not have a good shot at top IR programs. But you will find a spot somewhere and will be IR trained. How much that matters? Nothing since whatever oncology and transplant work that you learn in a top notch fellowship doesn't exist in pp. So I don't see any MEANINGFUL additional skill for pp in a graduate of a top IR program.

What is my guess? Nobody knows what will happen in the future. But a few years down the road, by the time that you finish your training the market will open up. Then again you won't be able to pay residents enough to do mammo and IR and everyone all of a sudden will find Neuro and MSK their dream fellowship.

Thanks so much for the response shark!

To be honest, I don't have much interest in the "oversaturation" of the market debate. I understand that it will affect where I can work, how much I'll make etc., however, I want to go down the IR path because of love procedures... I love the hands on nature of the field. If I can't make as much as I could in 2007 I'm fine with that. I'm not really doing this for the money... my wife is also a physician so it's not like I'll be scraping by in the future. I'm content with making less in a job that I love. (This is not to say that I fault ANYONE who is concerned... this is our livelihoods we're talking about here.)

Does getting involved with the SIR and attending conferences during residency and networking improve my opportunities? I'm just looking for advice on what type of activities I should be looking to participate in during residency to A. get the IR fellowship and B. get it at the best institution possible.

I have to say that I'm very anxious about not matching into IR... I would hate to not have the opportunity to do what I am passionate about.

 

[irwarrior]

Thanks so much for the response shark!

To be honest, I don't have much interest in the "oversaturation" of the market debate. I understand that it will affect where I can work, how much I'll make etc., however, I want to go down the IR path because of love procedures... I love the hands on nature of the field. If I can't make as much as I could in 2007 I'm fine with that. I'm not really doing this for the money... my wife is also a physician so it's not like I'll be scraping by in the future. I'm content with making less in a job that I love. (This is not to say that I fault ANYONE who is concerned... this is our livelihoods we're talking about here.)

Does getting involved with the SIR and attending conferences during residency and networking improve my opportunities? I'm just looking for advice on what type of activities I should be looking to participate in during residency to A. get the IR fellowship and B. get it at the best institution possible.

I have to say that I'm very anxious about not matching into IR... I would hate to not have the opportunity to do what I am passionate about.

 

[irwarrior]

Yes. I too went into radiology specifically to do IR. I went into the fellowship, when a lot of my co-residents and attendings were naysayers. But, I could not see myself as satisfied as I would be in IR. I love the head to toe anatomy, pathology, pathophysiology. I thoroughly love my relationship with the patients and I find the rapid expansion of the field very exciting. More and more IR are developing clinics and admitting their patients and following them longitudinally. I also see that there is plenty of vascular disease out there provided you are motivated to go out there and get it, be it from primary care, podiatry or direct patient referrals. There is so much on the horizons with good data being produced and exciting innovations including PE thrombolysis, DVT thrombectomy, IVC filter retrievals, prostate artery embolization, bariatric IR, renal denervation for hypertension, afib, OSA etc. Pulmonary artery denervation? Oncology including ablations and trans arterial therapy. Also, I think there has been a great number of resident and medical student events at SIR and so I would encourage you to check that out as a resource. Going to the annual meeting of SIR is always a great opportunity to meet many of the leaders of the field and network with other residents and fellows. Good luck. IR is an amazing field.

 

[shark2000]

Thanks so much for the response shark!

To be honest, I don't have much interest in the "oversaturation" of the market debate. I understand that it will affect where I can work, how much I'll make etc., however, I want to go down the IR path because of love procedures... I love the hands on nature of the field. If I can't make as much as I could in 2007 I'm fine with that. I'm not really doing this for the money... my wife is also a physician so it's not like I'll be scraping by in the future. I'm content with making less in a job that I love. (This is not to say that I fault ANYONE who is concerned... this is our livelihoods we're talking about here.)

Does getting involved with the SIR and attending conferences during residency and networking improve my opportunities? I'm just looking for advice on what type of activities I should be looking to participate in during residency to A. get the IR fellowship and B. get it at the best institution possible.

I have to say that I'm very anxious about not matching into IR... I would hate to not have the opportunity to do what I am passionate about.

As I said before, by the time you apply it may not be a competitive fellowship anymore.

 

[je355804]

As I said before, by the time you apply it may not be a competitive fellowship anymore.

At the same time however, it could be twice as competitive... I suppose it's nearly impossible to predict.

Given the unpredictability, I need to position myself as well as possible in that time. Even if the level of competition drops off the map, I'll be competing for the best fellowship position possible. It's a never ending cycle of attempting to improve one's CV regardless of circumstances related to the IR field.

 

[irwarrior]

I think that is wise. I just got back from the national IR meeting and there was a lot of interesting discussion about IR training and IR fellowships were so sought after that over 50 people did not match into IR last year. The other thing that I heard after going to the SIR meeting is that there is going to be a significant reduction in spots in VIR fellowships as programs start to convert to the IR/DR training paradigm. Since IR training will essentially be a 2 year fellowship (the programs will likely offer half as many spots). On top of that many of the IR spots will slowly convert to application directly from medical school and so that further will reduce the total supply of IR fellowships for the conventional radiology training path. I would check out sirweb.org to find out more it seems the timeline for medical students applying for IR residency will be around 2016.

 

[je355804]

IRWarrior I've been reading about those changes and their description of the transition is fairly ambiguous. As I understood, the fellowships wouldn't be phased out until 7 years after the implementation of the IR/DR pathway.

I would be devastated to lose out on a chance at a fellowship just because they are adding a new training pathway.

What options do current DR residents have? The way I interpreted the literature is that DR residents will be able to transfer into the IR/DR programs as PGY-6 residents.

Lol the uncertain nature of my medical training follows me like a dark cloud. Just for once it would be nice to have a clear path.

 

[shark2000]

Why didn't you apply to a direct IR program? It seems that you are doing radiology only for IR. Or at least you could rank a program with IR fellowship higher.

If what these people say about new pathway is true, you may not match in IR. Then are you OK doing DR? Think about all of your alternatives.

 

[irwarrior]

From what I gathered and reviewing the SIR website, you are correct they plan on phasing out fellowships so it should not affect anyone for years to come, and they are also looking for an alternate pathway of training that more resembles the current model, but you have to do additional years of training to compensate so it may be a 7 year track instead of a 6 year track. This was a hot topic of discussion at our annual meeting.

 

[je355804]

Why didn't you apply to a direct IR program? It seems that you are doing radiology only for IR. Or at least you could rank a program with IR fellowship higher.

If what these people say about new pathway is true, you may not match in IR. Then are you OK doing DR? Think about all of your alternatives.

To be honest, I didn't have any IR exposure until very late in the application season. Additionally, I didn't even know such a thing existed when I applied to DR.

From what I gathered and reviewing the SIR website, you are correct they plan on phasing out fellowships so it should not affect anyone for years to come, and they are also looking for an alternate pathway of training that more resembles the current model, but you have to do additional years of training to compensate so it may be a 7 year track instead of a 6 year track. This was a hot topic of discussion at our annual meeting.

Do you think it would be advisable to contact a few IR fellowship program coordinators and ask them what changes in the program they expect to occur for individuals interested in IR who are beginning residency this year?

 

[irwarrior]

I would wait and see what comes from the various organizations ABR,AUR, SIR and see how they are addressing this nationally.

If you are truly interested in VIR , then I would really work with your radiology program director to see if you can adjust your curriculum so that when the IR residency does become available you will have all the pre-requisites including ICU rotations , case mix and volume, IR rotations etc and proper ACGME accredited internship (for eg IM or GS) that would allow you to easily transition into an IR residency.

 

[Bradstein]

Anyone have any idea what a radiology resident does on an ICU rotation? Are they SICU or MICU? You have already finished an internship, but I have a hard time seeing a radiology resident acting as a senior resident on a medicine team (or surgery)

 

[DrBowtie]

Anyone have any idea what a radiology resident does on an ICU rotation? Are they SICU or MICU? You have already finished an internship, but I have a hard time seeing a radiology resident acting as a senior resident on a medicine team (or surgery)

Idk. I'm still bearish on this new IR path. With the abundance of hospitalists and CCM, I'm not sure that IR doing complex medical management is the ideal way to do things.

 

[Bradstein]

Idk. I'm still bearish on this new IR path. With the abundance of hospitalists and CCM, I'm not sure that IR doing complex medical management is the ideal way to do things.

I'm not either. But if they're going to do it, I'm extremely curious as to what it'd look like.

I know the pp group at my institution is pretty mixed on the changes. I think in general they think the "IR Classic" is a fine training pathway, and IR splitting off is a political move more than anything. They also think SIR hanging their hat on interventional onc might be a road to nowhere because they think advances in molecular medicine will mean you won't need to physically localize treatments because you can do that with better molecular targeting.

 

[tco]

Idk. I'm still bearish on this new IR path. With the abundance of hospitalists and CCM, I'm not sure that IR doing complex medical management is the ideal way to do things.

From what I've heard about the current IR specific pathways, it's less than ideal. Most services interests are not in teaching you, but rather their own residents.

 

[irwarrior]

I would check out the UVA VIR pathway as an example of how well the IR residents are trained and also how well respected they are amongst their clinical peers.

I wish I could have gotten similar training, it would have allowed to me to avoid some of the pitfalls and hurdles that I painstakingly had to overcome. My initial years were extremely challenging and rough and I feel if I could have had that clinical acumen that a pathway would have afforded me, I would have had a much easier time at things.

 

[omarsaleh66]

I came across the IR match statistics the other day, and some shocking numbers presented themselves. Apparently in 2010 50% of the IR programs filled and nearly everyone matched who applied. Fastforward to 2014 and nearly all programs filled and 20%+ of the applicants didn't match.
With that said, the program I matched at in radiology does not have IR... yet I'm still extremely interested in pursuing a fellowship.

I am wondering if you all can suggest what someone in a position such as myself can do to make themselves competitive coming from a program without IR. With that said, I have approximately 8 programs within 3 hours of mine which do have IR. 2 of these programs are within 30 minutes of mine... do you think it is possible to do research at programs that aren't associated with your own? If not, what other types of activities can I get involved in to make myself maximally competitive?

I really want to make sure that I am participating in the correct types of activities during my radiology residency... I'm sort of concerned that coming from a program without an IR fellowship is going to limit my exposure and thus eliminate any real chance I have of getting a fellowship.

Thanks for the input everyone!

You could try reaching out to the closer programs and try going to some of their journal clubs dinners, dinner case conferences after work, ask to shadow some of the IR guys when they are taking IR call solo to some some cases after hours/weekends

You could set up some IR rotations at these places on your elective months

You can try to see if the vascular surgeon/interventional cardiologist/nephrologist/ pain doc/ msk radiologist at your hospital is doing endovascular or image guided procedures and see if you can get some exposure with them.

Gluck, IR is a very fun and rewarding field. I am almost done with my first year of private practice and when I started we were just doing paras, thoras , biopsies and drains and now we have expanded into all types of procedures such as vascular, oncology, GI, womens health, pain , some neuro, etc..

Any type of exposure you get will help you as radiologist/IR later on

 

[CoopDoc]

From what I've heard about the current IR specific pathways, it's less than ideal. Most services interests are not in teaching you, but rather their own residents.

Disagree. At our institution, residents in the clinical pathway are treated as equivalent to residents on the service, sometimes with slightly less scut which is replaced with more one-on-one learning with the attending. Most services have spent the past decade or more complaining about having to clean up the clinical messes of IR. They see the value in our specialty taking more ownership of our patients and less dumping on them.

From what I gathered and reviewing the SIR website, you are correct they plan on phasing out fellowships so it should not affect anyone for years to come, and they are also looking for an alternate pathway of training that more resembles the current model, but you have to do additional years of training to compensate so it may be a 7 year track instead of a 6 year track. This was a hot topic of discussion at our annual meeting.

As long as residents in the traditional or clinical pathway have 500 IR procedures and 14 months of IR and IR-related procedures (VIR, BIR, neuro interventions, and clinical rotations such as ICU, vascular surgery, cardiology, hepatology, etc), they will be eligible to enter into the SECOND year of the independent IR Residency Programs (the two year programs), and circumvent the 7 year issue. This is why developing more IR experience in your program is so important right now. You don't want residents at your program being forced to do a 7th year because you are forcing them to rotate through chest three times in their senior year!

 

[CoopDoc]

Idk. I'm still bearish on this new IR path. With the abundance of hospitalists and CCM, I'm not sure that IR doing complex medical management is the ideal way to do things.

We aren't really talking about complex medical management. Our specialty has the reputation of ZERO medical management in the past. THAT is the problem. Why would a vascular surgeon refer a patient to you if you are just going to ask them to admit and discharge the patient and handle easy calls about pain management and post-procedural nausea, etc - when they can easily learn the procedure and then the entire patient experience (and the reimbursement) can be theirs?

My personal goal is to manage as many medical issues in my patients as possible, and rely on other specialists as minimally as possible. But there will always be a role for referral to our colleagues.

Additionally, this new IR path addresses another obvious problem with the existing training system - that there is simply TOO MUCH to learn in a year. This increases the IR and IR-related clinical experience to 26 months - a much more comfortable timeframe to develop a clinical interventionalist that is skilled in the full gamut of procedures and peri-procedural clinical care that our specialty demands.

 

[CoopDoc]

Why didn't you apply to a direct IR program? It seems that you are doing radiology only for IR. Or at least you could rank a program with IR fellowship higher.

If what these people say about new pathway is true, you may not match in IR. Then are you OK doing DR? Think about all of your alternatives.

Not a bad idea, although many of the DIRECT programs are winding down (read: not accepting new applicants) in anticipation of the new IR residency. You might also consider seeking out programs that have implemented a Clinical Pathway (UVA, Ohio State, Michigan, many others), as these programs are poised to implement the IR residency seemlessly in the next few years. There will be less headaches for implementation if they have already laid the groundwork for the clinical pathway, which has many parallels to the new IR Residency system.

I also agree that if you hate DR, IR may not be the perfect choice for you. Don't get me wrong - our specialty is amazing and I can sell it to almost anyone - but imaging excellence is a HUGE part of what makes us unique and competitive in the minimally invasive market. And many IRs read imaging, particularly in private practice. Even in academics - there are often CTAs and MRAs which are read by the interventional section. Just something to keep in mind.

 

[tco]

Coop, are you a resident or an attending? At the institution that I'm taking about (a VERY well known program), the Attendings are unfortunately oblivious to what the residents go through as far as menial tasks are concerned.

Sent from my SCH-I535 using Tapatalk

 

[CoopDoc]

Coop, are you a resident or an attending? At the institution that I'm taking about (a VERY well known program), the Attendings are unfortunately oblivious to what the residents go through as far as menial tasks are concerned.

Sent from my SCH-I535 using Tapatalk

I'm a resident at Ohio State. I helped start our pathway, and I have helped create several other clinical pathways at other hospitals. If the usefulness of the rotation is less than ideal, you should approach the leadership of that department or find a more useful clinical rotation to substitute.