How is radiology considered a lifestyle specialty?

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TzX

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Hello,

Radiology is always considered one of the "ROAD" specialties to a comfortable lifestyle. However, it seems, here in Europe, they work 10 hours a day minimum, and take call about one in 5 (depending on how large the group is), and easily get woken up for call at least 3 times a night. That's not a comfortable lifestyle at all, is it? Am I missing something about the radiology lifestyle? Dermatology and ophthalmology are much cusher, right?

I do realize the money is good, but I would gladly get paid a lot less for a lighter day/call schedule. Is this possible at all?

Thanks

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In the U.S., it's not and hasn't been for some time. Salaries in radiology are still good, but you will work for it.

Academics can offer the light workload/lower pay you seek, but then you're dealing with a whole different set of issues. Occasionally, private practices will offer part-time positions, but that is rare and usually reserved for breast imagers, in my experience.
 
In the past it was a lifestyle specialty before stat reads were expected 24/7 and before cross sectional imaging exploded. Now a typical private practice radiologist will eat their lunch while working and work a 10 hour day. Call overnight is very busy without time to sleep. Incomes are still relatively high. Medical students seeking a lifestyle specialty should look into primary care (yes, really), derm, rad onc, or optho.
 
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Definitely not a lifestyle specialty but most of healthcare is trending toward longer hours with increased workload and decreased resources.
 
Definitely not a lifestyle specialty but most of healthcare is trending toward longer hours with increased workload and decreased resources.

Not necessarily. Employment of physicians has generally improved working hours for primary care docs. Instead of rounding on your patients in the hospital and then going to clinic most are just seeing pts in the office now. Can easily get jobs working 8-5, 4 days a week nowadays with no nights/weekends/call.
 
Primary care can be cush, but they still get worked and busy at times. They are subsided by the specialists fields to an extent in larger groups. My friend is a family medicine doc in the DMV region (DC/MD/VA). Their large group pays primary care docs $250k with cap of 2,500 patients managed total per physician (so really only $100 per patient...). They get 5% 401k matching benefits, no cost health insurance, and I think 4 weeks vacation.

Another friend of mine in a large FL group is a hospitalist and works 6 days on and 8 days off. Shifts can be 10 hours, but there is early sign-out some days so it averages to like 40-45 hours a week. With production bonuses, he'll make $300k. If he took extra shifts to kill himself and have no life, he can make $400k. PP rads can make $400k and not deal with the crap he has to on a regular basis. His baseline deal is pretty good in terms of the norm for hospitalsts. EM is another well paid field (imo the most cush lifestyle, but crappiest time at work) that makes $3-400/hr.

With that said, there are better regular jobs out there for cush lifestyle. You can work in DC for the federal gov't and make over $100k a year in almost any Department if you have an undergrad degree and have them pay for your part-time masters program. It won't take many years to get over $100k..and you can work at home a couple days a week and never work nights, weekends, or holidays, ACLS/BLS recert, license renewals, malpractice/lawsuits, CME/continuing education, online modules to stay "up to date" on hospital policies, etc...THAT'S cush. Medicine's pay is not really that worth it when you see how much more crap you deal with compared to a normal job that can be obtained with an easier graduate degree. It better be because you like the work itself.
 
Primary care can be cush, but they still get worked and busy at times. They are subsided by the specialists fields to an extent in larger groups. My friend is a family medicine doc in the DMV region (DC/MD/VA). Their large group pays primary care docs $250k with cap of 2,500 patients managed total per physician (so really only $100 per patient...). They get 5% 401k matching benefits, no cost health insurance, and I think 4 weeks vacation.

Another friend of mine in a large FL group is a hospitalist and works 6 days on and 8 days off. Shifts can be 10 hours, but there is early sign-out some days so it averages to like 40-45 hours a week. With production bonuses, he'll make $300k. If he took extra shifts to kill himself and have no life, he can make $400k. PP rads can make $400k and not deal with the crap he has to on a regular basis. His baseline deal is pretty good in terms of the norm for hospitalsts. EM is another well paid field (imo the most cush lifestyle, but crappiest time at work) that makes $3-400/hr.

With that said, there are better regular jobs out there for cush lifestyle. You can work in DC for the federal gov't and make over $100k a year in almost any Department if you have an undergrad degree and have them pay for your part-time masters program. It won't take many years to get over $100k..and you can work at home a couple days a week and never work nights, weekends, or holidays, ACLS/BLS recert, license renewals, malpractice/lawsuits, CME/continuing education, online modules to stay "up to date" on hospital policies, etc...THAT'S cush. Medicine's pay is not really that worth it when you see how much more crap you deal with compared to a normal job that can be obtained with an easier graduate degree. It better be because you like the work itself.

Any chance of getting that government cush lifestyle if you go with VA radiology? Or some type of government MD job, for those of us already in too deep.
 
Any chance of getting that government cush lifestyle if you go with VA radiology? Or some type of government MD job, for those of us already in too deep.

Non-clinical gov't physician jobs with most options are probably with the CDC. Their requirements are broad and not excluding rads, but it's worded in a way for IM/ID MDs, but I'm sure an MPH will help. For instance: https://www.usajobs.gov/GetJob/ViewDetails/440870300/

Or for the Department of Health and Human Services. This is a radiology-specific one like the VA attending jobs: https://www.usajobs.gov/GetJob/ViewDetails/427512900/

Non-specific supervisory MD role: https://www.usajobs.gov/GetJob/ViewDetails/445413100/

They have a lot more analyst positions that make good money, but a masters in something else would probably help rather than just an MD and radiology residency.

VA radiology jobs are less stressful than academic/private practice given less call duties and volume. For that, they get paid like 25%+ less in salary and vacation make a little of that difference back in benefits (compared to some places) and malpratice.
 
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From what I understand speaking to attendings at rotations (please correct me if I'm wrong), the average radiology PP job is 8-4 M-F (or another 9 hour slot) with two 10 hour weekend calls per month. This comes out to an average of 50 hours per week. The young attending I spoke to told me that is about the standard job you'll find after training, salary <300k. Again, if this information is wrong please do correct me.

50hrs/week for a physician is, in my opinion, definitely a good lifestyle to have. All the radiology attendings I've worked with seemed to have thriving lives outside of the reading room, and were quite satisfied (although PP was not satisfied with their compensation).
 
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From what I understand speaking to attendings at rotations (please correct me if I'm wrong), the average radiology PP job is 8-4 M-F (or another 9 hour slot) with two 10 hour weekend calls per month. This comes out to an average of 50 hours per week. The young attending I spoke to told me that is about the standard job you'll find after training, salary <300k. Again, if this information is wrong please do correct me.

50hrs/week for a physician is, in my opinion, definitely a good lifestyle to have. All the radiology attendings I've worked with seemed to have thriving lives outside of the reading room, and were quite satisfied (although PP was not satisfied with their compensation).

I think that's atypical. PP rads probably work closer to 60 hours. 12 hour shifts are pretty standard for new pp rads, from what I understand.
 
In the past it was a lifestyle specialty before stat reads were expected 24/7 and before cross sectional imaging exploded. Now a typical private practice radiologist will eat their lunch while working and work a 10 hour day. Call overnight is very busy without time to sleep. Incomes are still relatively high. Medical students seeking a lifestyle specialty should look into primary care (yes, really), derm, rad onc, or optho.

Primary care can be cush, but they still get worked and busy at times. They are subsided by the specialists fields to an extent in larger groups. My friend is a family medicine doc in the DMV region (DC/MD/VA). Their large group pays primary care docs $250k with cap of 2,500 patients managed total per physician (so really only $100 per patient...). They get 5% 401k matching benefits, no cost health insurance, and I think 4 weeks vacation.

Another friend of mine in a large FL group is a hospitalist and works 6 days on and 8 days off. Shifts can be 10 hours, but there is early sign-out some days so it averages to like 40-45 hours a week. With production bonuses, he'll make $300k. If he took extra shifts to kill himself and have no life, he can make $400k. PP rads can make $400k and not deal with the crap he has to on a regular basis. His baseline deal is pretty good in terms of the norm for hospitalsts. EM is another well paid field (imo the most cush lifestyle, but crappiest time at work) that makes $3-400/hr.

With that said, there are better regular jobs out there for cush lifestyle. You can work in DC for the federal gov't and make over $100k a year in almost any Department if you have an undergrad degree and have them pay for your part-time masters program. It won't take many years to get over $100k..and you can work at home a couple days a week and never work nights, weekends, or holidays, ACLS/BLS recert, license renewals, malpractice/lawsuits, CME/continuing education, online modules to stay "up to date" on hospital policies, etc...THAT'S cush. Medicine's pay is not really that worth it when you see how much more crap you deal with compared to a normal job that can be obtained with an easier graduate degree. It better be because you like the work itself.

What do you guys think of anesthesia in regards to lifestyle?
 
Starting salary LESS than 300k? Your region must be a horrible place to practice. Our starting salaries are significantly higher no matter what subspecialty. Starting IR and NIR are quite nice although hours much worse.
 
Starting salary LESS than 300k? Your region must be a horrible place to practice. Our starting salaries are significantly higher no matter what subspecialty. Starting IR and NIR are quite nice although hours much worse.

I'm in the Northeast so maybe that's why. Perhaps that's why the hours are less too?
 
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Diagnostic radiology is a "lifestyle" specialty in the sense that you can work your set hours and go home without worrying about a patient you've admitted or getting paged to come in for a call case. It's still a big perk in my opinion, but it's no longer as unique as other specialties have morphed in that direction (e.g., internal medicine --> hospitalists),
 
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sitting in a dark and comfy room = lifestyle points?
 
What do you guys think of anesthesia in regards to lifestyle?
Anesthesia is not really a lifestyle specialty, just talk to the guys over on the anesthesia forum.

You could get a mommy track job in anesthesia, but here's what Karen Sibert who is an anesthesiologist says:
For starters, I have to laugh when I hear anesthesiology mentioned with dermatology and radiology as one of the “lifestyle” professions. Certainly there are outpatient surgery centers where the hours are predictable and there are no nights, weekends or holidays on duty. The downside? You’re giving sedation for lumps, bumps and endoscopies a lot of the time, which can be tedious. You may start to lose your skills in line placement, intubation and emergency management.

Occasionally, though, if you work in an outpatient center, you’ll be asked to give anesthesia for inappropriately scheduled cases on patients who are really too high-risk to have surgery there. These patients slip through the cracks and there they are, in your preoperative area. Canceling the case costs everyone money and makes everyone unhappy. Yet if you proceed and something goes wrong, you can’t even get your hands on a unit of blood for transfusion. To me, working in an outpatient center is like working close to a real hospital but not close enough — a mixture of boredom and potential disaster.

http://in-training.org/why-not-not-go-anesthesia-karen-sibert-md-9276
 
It seems there is a lot of misinformation out there.

Private practice rads get, on average, about 10 weeks of vacation a year -- more than any other specialty.

It is also typical for pp rads to be able to sell the call they have. Many partners will sell some of their call and some will sell almost all of it. I know hundreds of radiologists and I personally do not know a single pp rad working 60+ hours per week unless they want to. Even in busy pp, rads average about 50 hours a week. There are lifestyle pp groups that average closer to 40.

If you account for the extra vacation (fields like derm and rad onc only offer a few weeks a year), pp radiologists probably work the least hours per week averaged over the year of any specialty. That doesn't even address that there are many hours of "off the clock" documentation per week required in more clinical fields like derm and rad onc.

The lifestyle of radiologists in academics, VA, Kaiser, etc. is unbelievably relaxed. If any of you students have concerns about lifestyle, shadow radiologists in any of these settings and any misconceptions will be quickly clarified.
 
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Actually, the 10 weeks of vacation you are quoting for PP is deceiving. Because you have to factor in the weekend and evening shifts. Many groups that offer the 8-12 wks of vacation you mention also require one Saturday and Sunday per month and one evening/swing shift (5-9 or 10 pm) every two weeks. If you add that back, that amounts to 3 more working days per month or 36 more working days per year [approx 7 weeks of M-F equivalent]. Ok, so some PP will give you the post call Monday off. So that adds back another 12 working days bringing you to 24 extra working days per year [or approx 5 weeks of M-F equivalent]. When you subtract that back from the 10 weeks you are quoting, you really only get 5 weeks of vacation compared to someone working a M-F 8-5 type job.

As you probably know, Derm and Radonc don't have nights or weekend shifts.

So there's not much of a difference.
 
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Even in your example, 5 weeks of vacation per year is more than derm or rad onc and most other specialties. And like I said, it is standard to be able to sell the call you reference in pp. There are also lifestyle groups (with lower pay) where call is minimal and they still get 8-10 weeks vacation. You do have a choice...people just tend to choose busier jobs for higher pay.

It is also a misconception that other lifestyle fields do not work on the weekends. Rad onc in particular works a lot on the weekend between contouring volumes, essentially required research, catching up on charting, treatment planning, etc. Derms also have extremely busy clinic with an extra 1-2 hours of charting per day. Some derm departments have Saturday clinic. There is also a baseline of extra work simply by virtue of being a clinician, especially if running your own clinic. Many times the extra work they have is off the clock. It is not uncommon to hear my friends in both fields tell me they are "charting" or "playing catch up" during nights and weekends.

If you think working 40-50 hours a week with at least 5 weeks of vacation, the ability to sell your call, and no significant documentation is not a lifestyle gig in medicine, then there is no field in medicine (including derm, rad onc, ophtho, gas) that meets the standard.
 
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Then why do derms score higher on Medscape lifestyle surveys than radiologists? Every single year, derm tops the list.
 
There are far more females in dermatology than radiology. If you compare only the females in radiology with dermatology, the results would be more comparable. Of course lifestyle is better if all you are doing is mammography with little call and 8 weeks of vacation (for less pay). Guys tend to favor compensation over lifestyle. If you actually get to know high volume dermatologists that make equivalent compensation, you will start to realize that the lifestyle is not all that different and may even be worse in derm. The dermatology jobs for moms that are only 3 days a week (at low compensation) are also disappearing, primarily for financial reasons. You don't have to take my word for it...you can hear it directly from the horse's mouth. There are many vocal derm posters on SDN stating that explicitly.
 
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It's easy and simple to look at hours worked and conclude that radiology is a lifestyle specialty, but that's misleading. After all, there's a reason why many older radiologists are lamenting the good old days and internists are writing articles about how technology is killing the field.

In the face of declining reimbursements, radiologists have chosen to become more efficient rather than sacrifice income. That increased efficiency was made possible by technology, but other things came with and added to it. Whereas a radiologist might be able to take a few extra minutes to chat in the dining room with other physicians, now we eat lunch at our workstations. An odd or interesting finding might have once prompted a few minutes of research or consultation with a colleague, but now we're increasingly forced to blurt out something semi-intelligent before moving on to the next study.

The increased focus on turn-around time has also spurred greater efficiency. Part of that came from inside the field, where PACS systems made images accessible nearly immediately, and voice recognition software led to self-editing with reports often available within minutes. But some factors were external as well, such as the ED's near singular focus on disposition and billboards advertising less than 15-minute wait times. It has become a bit of a positive feedback cycle, whereby the ability to have a short turn-around time has fueled expectations that it will always be like that, thus pressing us to work even harder and faster.

Also, as recently as when I was a resident, getting an MRI after-hours was kind of a big deal. Now, some hospitals have magnets solely dedicated for the ED. Heck, I used to have to do my own ultrasounds on call because they didn't keep a sonographer in-house overnight. Bottom line is that this used to be much more of a 9-5 type specialty, whereas now it's very much a 24/7/365 field. When I'm on call, I'm in house with the intensivists, hospitalists, EPs, and whoever's in the OR (ortho, trauma, neurosurg, anesthesia, etc.), which is a relatively recent phenonemon for radiology.

So, yeah, we can look at hours worked, and that goes a long way for a lot of people, but it doesn't tell the whole story. For all the reasons above, radiologists are working harder than ever, and I imagine that our increase in productivity (and with it the expectation to produce) over historical baseline is greater than most or all other specialties. That's the downside of working in a task-driven profession. It's also why I hear about so many radiologists squirrelling away money in hopes of retiring early and complaining about burnout.

Obviously, people will define "lifestyle" in different ways, so the OP's question requires a decently nuanced answer. I think when we talk about PP radiology, we tend to think about the individual workday, which is often jam packed with mentally exhausting work. But we forget about the bigger picture, which includes lots of vacation and the ability to leave at the end of a shift without worrying about getting paged. Those are the upsides of working in an efficiently run task-driven profession.

As an aside, the ability to sell one's call is a zero-sum game. For every radiologist taking less call there is one taking more. So what's really being espoused here is the field's flexibility, i.e. jobs that let you work as much as you want. I think you'll find that private practice radiology groups are less flexible than many other fields. There are strong expectations to maintain productivity for the partners, or subset of partners, who want to keep their incomes up. I can't tell you the number of times I've heard a radiologist wish they could work 25% less for 25% less pay, but that's just not an option in their practices.
 
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I think people have a distorted view of derm too. A successful practice (in PP) is packed to the brim with patients and every moment of your day you are spending maybe 5 min with a patient then quickly onto the next. It's not a relaxed pace.

Rad onc is having problems with their job market like we did 2 years ago. Oversupply for not enough jobs.

This is why you shouldn't pick based on lifestyle/job market. There isn't that much difference between these fields. Pick what you enjoy and let the chips fall where they may.
 
The other hole in this discussion is the focus on private practice radiology. Many/most people who choose to go into pp do so because they prioritize compensation over lifestyle.

If the question is "can I find a radiology job with reasonable compensation that has a good lifestyle?," the answer is yes. That's the actionable bottom line for students. Look into academics, VA, Kaiser, mammography, outpatient MSK, outpatient only IR without call (it does exist), and possibly nuclear medicine. If you are intent on private practice, look for lifestyle groups; they exist even in the most desirable areas.

The truth is that, between these practice settings, there are enough lifestyle jobs...it's just that people see the big pp salaries and make trade offs, especially men. After a few years of busy pp, some people realize the lifestyle route would be a better long term fit for them, even if it was expedient to clear their debts and start a nest egg with the higher paying job in the short term. Many women realize this early on and are able to land a family-friendly fellowship and job from the start.
 
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I think people have a distorted view of derm too. A successful practice (in PP) is packed to the brim with patients and every moment of your day you are spending maybe 5 min with a patient then quickly onto the next. It's not a relaxed pace.

Rad onc is having problems with their job market like we did 2 years ago. Oversupply for not enough jobs.

This is why you shouldn't pick based on lifestyle/job market. There isn't that much difference between these fields. Pick what you enjoy and let the chips fall where they may.


Agree on the distorted view. No one in derm is complaining because unlike many we (mostly) have no nights, few weekends and low acuity patients.

However seeing 40-50 high maintenance clinic patients a day while throwing in procedures on half of them and dealing with ever-increasing documentation/ insurance hassles all in 10 minutes per patient isn't exactly laid back either.

If you want to have a truly laid back job don't go into medicine at all.


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Agree on the distorted view. No one in derm is complaining because unlike many we (mostly) have no nights, few weekends and low acuity patients.

However seeing 40-50 high maintenance clinic patients a day while throwing in procedures on half of them and dealing with ever-increasing documentation/ insurance hassles all in 10 minutes per patient isn't exactly laid back either.

If you want to have a truly laid back job don't go into medicine at all.


Sent from my iPhone using SDN mobile

This! If I could tell my 24 year old self this years ago, I would be a lot happier. I personally wish I had not gone into Medicine. I would really like to go into administrative/non clinical stuff at this point.
 
This! If I could tell my 24 year old self this years ago, I would be a lot happier. I personally wish I had not gone into Medicine. I would really like to go into administrative/non clinical stuff at this point.
Which specialty are you in ?
 
First post... resurrecting a 2 year old thread :banana:

Any current rads willing to comment on this? Does the current job market lend itself to rads being a "lifestyle" specialty?
 
I think it can be, but depends on work setting.

For instance, I work in an outpatient Radiology group. My work hours are Monday-Friday 8am-5pm. No call, nights, or weekends.

Even those that join hospital based groups with call, can join a group with generous amount of vacation. This is where it depends on which group you join. The market has improved to the point where PPs have been offering more attractive terms (better $, more vacation) than they have in the past, to attract applicants. There are still some predatory groups out there though.

If you join a 7 night on, 7 night off, night-hawk telerad position, I wouldn't consider that "lifestyle friendly." Nor would I consider working for one of the large Corporate groups. They tend to skim money off you, make you work till your eyes fall out (based on RVU), and foster a poor work environment. But those places have been having trouble filling of late.
 
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First post... resurrecting a 2 year old thread :banana:

Any current rads willing to comment on this? Does the current job market lend itself to rads being a "lifestyle" specialty?

Job market is relatively strong, however a lot of suboptimal corporate jobs (RPs, Mednax, envision etc) out there where you will work your a$$ off and get underpaid since the middlemen need to get a cut of your fees....as things stand now theres a wide variety when it comes to private practice. I'm currently a partner in a small lifestyle group. We work on average 3.5 days/week. Not killing it with respect to income but doing pretty well. Stress level is pretty low. However have to be able to do most things (light IR, breast, cardiac nucs, all MR etc)
 
However have to be able to do most things (light IR, breast, cardiac nucs, all MR etc)

Is it really possible to be able to read all MR as good as subspecialty trained guys and read it well?
 
Is it really possible to be able to read all MR as good as subspecialty trained guys and read it well?

Gosh, I hope not. Otherwise, all these people doing fellowships are wasting their time. That isn't to say that people can't be really good if they work at it. It's not like academia has the knowledge under lock and key, so part of it is an issue of motivation. It's just not necessary for most PP radiologists to develop those skill sets because 1) the patient/provider population doesn't demand it and 2) you can almost always curbside your partners who already have those skills. Apart from motivation, volume can be an issue too. To use my subspecialty as an example, there just aren't enough cases of bone tumors or finger MRs in most private practices for a non-MSK guy to learn it well on the job.

An exception might be breast imaging, where the crusty old general radiologist who's been reading mammograms for 25+ years will be better than the newly minted fellowship trained guy. I'm not entirely sure why that is, but maybe it's because only one body part is being imaged and volume is typically a non-issue? And obviously, even in this example, the subspecialist brings value in terms of newer modalities and technologies.
 
Is it really possible to be able to read all MR as good as subspecialty trained guys and read it well?

Well enough for a small community practice (about 60 miles from a medium-sized metro area), where most cases are bread and butter (cuff tear, meniscal tear, stroke, stenosis etc). Complex cases get referred out to large academic centers where their clinicians would either repeat the exam or have one of their subspecialty guys do an over-read. Some of my partners have been practicing for 20-30 years. At times their reports may lose style points since they don't sound as sophisticated as a subspecialist's report but they are usually answering the clinical question and guiding management appropriately.
 
Well enough for a small community practice (about 60 miles from a medium-sized metro area), where most cases are bread and butter (cuff tear, meniscal tear, stroke, stenosis etc). Complex cases get referred out to large academic centers where their clinicians would either repeat the exam or have one of their subspecialty guys do an over-read. Some of my partners have been practicing for 20-30 years. At times their reports may lose style points since they don't sound as sophisticated as a subspecialist's report but they are usually answering the clinical question and guiding management appropriately.

I asked my question because we do over-reads on most outside studies and given the critical misses I have seen, I have come to conclude that subspecialty training is important. Recently over-read an outside study where the attending was able to pick up a repaired congenital anomaly and a few other critical findings that were missed, suspicious lesions being called benign on multiple reads from the outside group, etc. So I don't believe it is possible to read all studies as good as subspecialty-trained radiologists. It may not matter in most cases, but I have seen enough where it made a difference in the patient's care.
 
I asked my question because we do over-reads on most outside studies and given the critical misses I have seen, I have come to conclude that subspecialty training is important. Recently over-read an outside study where the attending was able to pick up a repaired congenital anomaly and a few other critical findings that were missed, suspicious lesions being called benign on multiple reads from the outside group, etc. So I don't believe it is possible to read all studies as good as subspecialty-trained radiologists. It may not matter in most cases, but I have seen enough where it made a difference in the patient's care.

I don't disagree that subspecialty is important, I completed 2 fellowships, but critical misses likely have more to do with high volume within a practice rather than fellowship training. My practice is about 5oth% with respect to RVU production based on MGMA so we are not super busy and have time to consult each other, use StadDx etc. I previously worked at a practice that was 95th%with respect to RVU production and misses were a whole lot more common (made by fellowship trained rads).... I've also seen critical misses in the large academic centers in the midwest and west coast where I did my fellowships (and thats with studies being read by a resident, fellow, and then a sub-specialized attending). Unfortunately this comes with the territory. Subspecialty training is great but one should not lose their general radiology skills. Ask your breast attendings if they can read a MSK MRI or ask your MSK attendings if they read a Tomo screener or breast MR with confidence. Ask if any of them can perform a liver, lung, or thyroid biopsy, LP, or abscess drainage etc
 
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I don't disagree that subspecialty is important, I completed 2 fellowships, but critical misses likely have more to do with high volume within a practice rather than fellowship training. My practice is about 5oth% with respect to RVU production based on MGMA so we are not super busy and have time to consult each other, use StadDx etc. I previously worked at a practice that was 95th%with respect to RVU production and misses were a whole lot more common (made by fellowship trained rads).... I've also seen critical misses in the large academic centers in the midwest and west coast where I did my fellowships (and thats with studies being read by a resident, fellow, and then a sub-specialized attending). Unfortunately this comes with the territory. Subspecialty training is great but one should not lose their general radiology skills. Ask your breast attendings if they can read a MSK MRI or ask your MSK attendings if they read a Tomo screener or breast MR with confidence. Ask if any of them can perform a liver, lung, or thyroid biopsy, LP, or abscess drainage etc

I agree. Increased volume and the concomitant speed of reading this studies will lead to more misses.

Our attendings are very very good at their subspecialties but have most likely lost their skills in general radiology. I once saw a neuro attending consult a chest attending on what happened to be a PAU in the aortic arch. I was a little bit surprised but that's what happens when you have been reading only neuro for the past 20 years and nothing else.
 
Is there a significant difference in lifestyle and pay between the different subspecialties of radiology? i.e. Does MSK get paid less than neuro
 
I don't disagree that subspecialty is important, I completed 2 fellowships, but critical misses likely have more to do with high volume within a practice rather than fellowship training.

I don't know how it works in private practice yet, but if a PP attending can spend a 10-sentence paragraph describing the normal findings of the liver, yet miss the obvious cirrhosis (true story), I don't think it's simply a volume issue.

It's really a jungle out there.
 
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I don't know how it works in private practice yet, but if a PP attending can spend a 10-sentence paragraph describing the normal findings of the liver, yet miss the obvious cirrhosis (true story), I don't think it's simply a volume issue.

It's really a jungle out there.


It is a jungle out there, wide range of quality/knowledge...I would describe a normal liver as: Normal in size and signal with homogenous enhancement.
 
It is a jungle out there, wide range of quality/knowledge...I would describe a normal liver as: Normal in size and signal with homogenous enhancement.

Basically the same way I do it: short, simple and to the point.

My impression is my impact statement and I use as few words as necessary to convey an accurate yet non-superfluous message to the clinician containing whatever is needed for him/her to proceed to the next step in management.
 
It is a jungle out there, wide range of quality/knowledge...I would describe a normal liver as: Normal in size and signal with homogenous enhancement.

That is about 4-6 too many words. “The liver is unremarkable” “The liver is normal” “Liver: Normal”
 
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