Tiger100

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Mar 11, 2017
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I hope the moderator doesn't delete this post.

I am a midcareer radiologist who has worked in both academic and private practice setting. Also had work in management position for a while and have been in hospital committees and the chair of radiology at a midsize hospital in the past.

The only reason that I post in this forum is to contribute and to share my experience with people who may have less experience than me.
I made some posts about IR and unfortunately, some IR fellows and residents and medical students don't want to hear what I say. Even if my comments are wrong, they can disagree with me. But their irrational behavior and their anger is surprising.

Anyway, in the other discussion, for unknown reasons the moderator decided to close the discussion or at least close it to me and didn't let the discussion continue. I don't think that was a reasonable thing to do.

Anyway, if the moderator doesn't want a reasonable discussion to continue, I respect his/her policy and won't continue. But at the same time, I don't see any reason to contribute to this forum at all. It seems the forum wants people to say that it is all roses out there and everything is perfect.


Long story short, I am not going to post anymore on this forum. If anybody think that I can help them, they can always PM me. But there is no point in post here anymore.

Best Regards and Good luck
 
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Gurby

2+ Year Member
Jul 28, 2014
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I'm a medical student currently waffling between DR, IR and vascular surgery.

I think I gained a lot of insight from that thread and appreciate your input there.

Thank you for your time and energy.
 

Ho0v-man

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Nov 28, 2014
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Former rad tech turned med student here. I’ve worked in IR as a tech in a non academic facility and literally everything you said in that thread is 100% accurate. The poster(s) in that thread who disagreed with you were really showing their own ignorance of the real world. The worst part is that they’re too naive to be embarrassed by their comments. SDN can be rather toxic if you take it too seriously. Sometimes a break is necessary.

Best wishes!
 
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qxrt

5+ Year Member
Apr 2, 2013
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Having finished IR training and seen the realities of IR practice in both community and academic practice, and also as a lurker who has read many of your posts as well as those of others who argue with you, I can attest to many (in fact, most) of the points you make about the realities of IR in private practice. However, it's somewhat dismaying to see how vicious and uncollegial some other future IRs can get, and how they have been treating you. Even if there are points that can be disagreed upon, for some reason there seems to be an almost militant IR faction here on this forum who tries to ridicule anyone who brings a DR perspective of IR.

I actually think many of the points brought up by everyone in the other thread are valid, yet it seems that there are some who have not yet learned how to disagree in a professional manner, likely encouraged to act this way by the anonymity afforded by an online forum!
 

doctorsdatdo

Osteopathic Medical Student
Sep 22, 2018
205
120
It is indeed regrettable that some chose to appeal to emotions rather than discuss things in a rational manner.

At the end of the day, there are two major type of IR docs. One type identify themselves as surgeons and others identify as radiologists. The surgeon types are more commonly represented in SIR and in academic practices and advocate for a space to build their practice, the center piece of which is presence of IR clinic.

DRs and radiology type IRs often see this type of pursuit as non-revenue generating and argue to pay the more clinical type of IR less. Yet they may not have seen the downstream value of a clinical IR practice to the hospital as well as to the radiology practice.

It is important to see the DR prospective, in that all members of the team must generate revenue. But then again, sometimes that means you have an IR who walk in, do the procedure when patient is already prepped and draped, and walk out and clear the list. Meanwhile, patients were consented by a mid level and may not have ever met their IR doctor. I understand that perhaps this is the most fair way revenue wise for an IR in a traditional DR group practice, but this is not personally how I like to practice and there are many IRs who feel that way. It’s regretable that this desire is viewed as militant or deviant.

Also, there are changes in the IR job market or the way IR is being practiced. More and more candidates no longer view the traditional practice model being integrated with DR practice as desirable, in light of rising RVU requirements, rampant corporate buy outs such as radpartners and proliferation of other Ir practice models like OBL or IR only groups.

Lastly, I am intimately familiar with IRs who indeed took a pay cut (significant one) to practice his/her desired practice setting and turned down a lucrative partnership DR/IR job. Live and let live.
 

JoshSt

Train, Say Your Prayers, Take Your Vitamins
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@Tiger100 - I've always been a fan of your posts
 
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Oct 6, 2018
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I really wish that unnamed “other” luck. Someone who responds the way he did has not lived, and will not live an easy life/career.
 
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Norick13

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Nov 2, 2010
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Thanks very much for your insight.

Having seen how medicine works in one surgical specialty, and having switched into radiology, I think your input on the realities of practice have been incredibly accurate.
 

Kuratz

7+ Year Member
Oct 13, 2011
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Thank you to all in this thread, the other thread, and the rest of this sub-forum. It's extremely helpful as students/trainees to hear the perspectives of much more experienced attending physicians out in practice, especially when there is a healthy disagreement about the state of things. Please consider continuing to donate your time by posting... lots of lurkers out there.
 

LittleFoot

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Apr 18, 2014
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Interesting you guys are all siding with the guy who had to deal with this terrible "mean stranger" and also throwing out insults such as "Stupidity doesn't have any limits", and "It seems I am talking with a second grade kid".
 
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Feb 3, 2019
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I brought constructive thoughts based on my experience working in many different locations in IR. I was not mean I was not disrespectful until this user tried to bully me. You all act like he came, gave a respectful response and that simple is not the case. I don’t understand how you could read the entire previous thread and feel bad for him/her. I agree he/her brings great insight from one vantage point but we meaning me and that other user have different mindsets on how we want to practice and that’s ok but don’t attack someone for it and that’s what he/her did attacked me for it.
 
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Feb 3, 2019
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Read in the previous thread, his opening response to me and after you do let me know why based on how he opened the conversation you feel sorry sorry for him. I have a feeling I won’t get a response from any of you.
 
Oct 6, 2018
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Despite my better judgement, I think I’ll bite.

You enter a thread specifically about DR residents perceiving ESIR or straight IR residents as “gunnery,” you make some pretty bold, condescending statements about near-graduating DR residents not “knowing what IR is about,” and then an experienced radiologist’s response was essentially “slow your role.”

Perhaps he could have phrased it gentler. Perhaps he need have never responded in the first place if you didn’t choose condescending words—perhaps that isn’t your intention, but it is high past time somebody past-graduating from medical school understands the significance of the words they choose.

After that, both of you just kept escalating, but I’m going to be so bold and say that you have to have known you barging in the way you did was going to garner a response more or less like that, and if you didn’t, you 1) prove the original thread creator correct and 2) have quite a few social graces to learn.

That is why the people in this thread are responding the way they are (or, at least, those are my sympathies). Do with that what you will. I’m really not in the mood to argue.

Finally, keep in mind that this is a professional forum, and we should all act in such a manner—to students, to potentially “less informed” graduating DR-residents, experienced physicians, etc. Generally speaking, nobody wants to work next to anyone who is hostile and/or opinionated.

Best.
 
Feb 3, 2019
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Despite my better judgement, I think I’ll bite.

You enter a thread specifically about DR residents perceiving ESIR or straight IR residents as “gunnery,” you make some pretty bold, condescending statements about near-graduating DR residents not “knowing what IR is about,” and then an experienced radiologist’s response was essentially “slow your role.”

Perhaps he could have phrased it gentler. Perhaps he need have never responded in the first place if you didn’t choose condescending words—perhaps that isn’t your intention, but it is high past time somebody past-graduating from medical school understands the significance of the words they choose.

After that, both of you just kept escalating, but I’m going to be so bold and say that you have to have known you barging in the way you did was going to garner a response more or less like that, and if you didn’t, you 1) prove the original thread creator correct and 2) have quite a few social graces to learn.

That is why the people in this thread are responding the way they are (or, at least, those are my sympathies). Do with that what you will. I’m really not in the mood to argue.

Finally, keep in mind that this is a professional forum, and we should all act in such a manner—to students, to potentially “less informed” graduating DR-residents, experienced physicians, etc. Generally speaking, nobody wants to work next to anyone who is hostile and/or opinionated.

Best.
I agree I could have used a lighter touch, For those I offended I’m sorry that said I don’t think the substance of my comments are wrong and I think I gave a long thoughtful explanation why. Regarding ESIR making DR residency gunner “like” I actually never disagreed with the statement, I think the statement is accurate but I also think competition is a good thing it makes the field better. Thanks for your feedback.
 
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doctorsdatdo

Osteopathic Medical Student
Sep 22, 2018
205
120
I agree I could have used a lighter touch, For those I offended I’m sorry that said I don’t think the substance of my comments are wrong and I think I gave a long thoughtful explanation why. Regarding ESIR making DR residency gunner “like” I actually never disagreed with the statement, I think the statement is accurate but I also think competition is a good thing it makes the field better. Thanks for your feedback.
Because this is an anonymous forum, people are going to speak their minds about how they really feel about DR vs IR. It’s really a spectrum.

Now, I understand that some IRs have gotten themselves into extremely good situations like a few procedures a day, no DR responsibilities, just sitting around and watch their trainee doing work while their DR counterparts are crushed from the list. Some of those are left over from the day when IR reimbursements were great, and some of those are just structures of the department.

That unfairness can definitely have some DR becoming resentful. Many DR, including the OP, seem to have the notion that IRs demand a higher salary as well. That is not true for many graduating IRs. Many of those who want to build a clinical practice do in fact take a lower salary.

The stakes for a new IR vs new DR is also higher. For a new DR, maybe you cannot read as fast as senior partners or have some “jitters”, couple small misses perhaps (no adequately trained rads should have life threatening misses in the general radiology arena). But for an IR, complications can be life and death for a newly minted attending. It’s surprising that many DRs are cavalier about the amount of training required to safely practice IR (oh this takes just a year etc). Biopsy and drains can produce some of the worst complications and from the institutions I’ve seen, there are drastically different standard of safety variability between institutions. There are big centers where it’s acceptable to have frequent ICU admissions from biopsies or place drain into a hollow organ, and there are big centers where occurrences of that more than once in a blue moon can lead to termination. Having seen how safe an experienced IR can be, I would say that multiple years of training is not just a luxury, but necessity.

At the end of the day, medicine are more and more reliant on IR because the personalities are changing. Now days, many millennial physicians like to concentrate on their given field and the jack of all trade doctors are disappearing. Medicine docs dont want to touch a needle. ED docs don’t want to touch a chest tube. Surgeons don’t want to operate. Plenty of work for IRs, especially after 5pm.
 
May 7, 2019
4
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80 year female presents with hot gallbladder cannot be cleared for anesthesia because it's Friday night and the Cardiologists don't work on weekends and can not get CCTA, or nuclear cardiac study to clear for surgery. Surgeon demands that IR put in cholecystostomy tube right now so everybody can go home, have the weekend off, and they'll worry about the patient on Monday. Only problem- anesthesia won't sedate patient (cardiac concerns), so IR has to put in tube without anesthesia- only local- real fun!!
This is the now the typical lifestyle of Interventional Radiology. We have become the dumping ground for everything no one else wants to do, especially at night and on weekends.. If you enjoyed being an intern and doing scutt work- then you'll love IR. It's like being an intern all over again..
I should know- I am a B/C, dual fellowship-trained IR , and neuro IR with 30 years of actual experience.
 

Dave1980

10+ Year Member
Jan 25, 2007
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80 year female presents with hot gallbladder cannot be cleared for anesthesia because it's Friday night and the Cardiologists don't work on weekends and can not get CCTA, or nuclear cardiac study to clear for surgery. Surgeon demands that IR put in cholecystostomy tube right now so everybody can go home, have the weekend off, and they'll worry about the patient on Monday. Only problem- anesthesia won't sedate patient (cardiac concerns), so IR has to put in tube without anesthesia- only local- real fun!!
This is the now the typical lifestyle of Interventional Radiology. We have become the dumping ground for everything no one else wants to do, especially at night and on weekends.. If you enjoyed being an intern and doing scutt work- then you'll love IR. It's like being an intern all over again..
I should know- I am a B/C, dual fellowship-trained IR , and neuro IR with 30 years of actual experience.
Interesting...I'm DR but do a lot of procedures.

I've never sedated a patient for a chole tube. I usually just do it with lido +/- 1 mg subQ dilaudid based on how anxious and in pain they look. What do you use?
 

doctorsdatdo

Osteopathic Medical Student
Sep 22, 2018
205
120
80 year female presents with hot gallbladder cannot be cleared for anesthesia because it's Friday night and the Cardiologists don't work on weekends and can not get CCTA, or nuclear cardiac study to clear for surgery. Surgeon demands that IR put in cholecystostomy tube right now so everybody can go home, have the weekend off, and they'll worry about the patient on Monday. Only problem- anesthesia won't sedate patient (cardiac concerns), so IR has to put in tube without anesthesia- only local- real fun!!
This is the now the typical lifestyle of Interventional Radiology. We have become the dumping ground for everything no one else wants to do, especially at night and on weekends.. If you enjoyed being an intern and doing scutt work- then you'll love IR. It's like being an intern all over again..
I should know- I am a B/C, dual fellowship-trained IR , and neuro IR with 30 years of actual experience.
Yep. And a lot of private practice group contractually cover all imaging at all hours without stipend so being the IR, you are not only scutted out, you are also not compensated for your time.

The pager is brutal.
 
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Tiger100

2+ Year Member
Mar 11, 2017
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80 year female presents with hot gallbladder cannot be cleared for anesthesia because it's Friday night and the Cardiologists don't work on weekends and can not get CCTA, or nuclear cardiac study to clear for surgery. Surgeon demands that IR put in cholecystostomy tube right now so everybody can go home, have the weekend off, and they'll worry about the patient on Monday. Only problem- anesthesia won't sedate patient (cardiac concerns), so IR has to put in tube without anesthesia- only local- real fun!!
This is the now the typical lifestyle of Interventional Radiology. We have become the dumping ground for everything no one else wants to do, especially at night and on weekends.. If you enjoyed being an intern and doing scutt work- then you'll love IR. It's like being an intern all over again..
I should know- I am a B/C, dual fellowship-trained IR , and neuro IR with 30 years of actual experience.
Which hospital is this? Very unusual scenario.

There is no hospital that I know of that doesn't have cardiologist during weekends or at nights. In fact, the cardiac clearance is the easier part of the whole problem. Also if it is emergent, it doesn't need cardiac Nucs study. CCTA is barely used for preop evaluation. Also you can use moderate sedation for perc chole tube that doesn't need anesthesiologist or preop clearance.

I looked at your other post in the forum and you mentioned there that you are dual fellowship trained in Neuro and cardiac radiology with 35 years of experience. Am I missing something?


272262
 
Feb 3, 2019
81
32
Which hospital is this? Very unusual scenario.

There is no hospital that I know of that doesn't have cardiologist during weekends or at nights. In fact, the cardiac clearance is the easier part of the whole problem. Also if it is emergent, it doesn't need cardiac Nucs study. CCTA is barely used for preop evaluation. Also you can use moderate sedation for perc chole tube that doesn't need anesthesiologist or preop clearance.

I looked at your other post in the forum and you mentioned there that you are dual fellowship trained in Neuro and cardiac radiology with 35 years of experience. Am I missing something?


View attachment 272262
Don’t get mad at me for this Tiger but lolololololol!!!! Seriously good find that’s funny, to bad he/she’s not dual certified in general surgery he/she could remove the gallbladder on Monday. Lol
 

doctorsdatdo

Osteopathic Medical Student
Sep 22, 2018
205
120
Which hospital is this? Very unusual scenario.

There is no hospital that I know of that doesn't have cardiologist during weekends or at nights. In fact, the cardiac clearance is the easier part of the whole problem. Also if it is emergent, it doesn't need cardiac Nucs study. CCTA is barely used for preop evaluation. Also you can use moderate sedation for perc chole tube that doesn't need anesthesiologist or preop clearance.

I looked at your other post in the forum and you mentioned there that you are dual fellowship trained in Neuro and cardiac radiology with 35 years of experience. Am I missing something?


View attachment 272262
Maybe unusual in private practice, but very usual to be dumped on like this in an academic or an employed setting. As you know if pt is ASA3 or above technically you cannot do moderate sedation without anesthesia being around. I certainly would not feel comfortable sedating a pt with possible cardiac hx.

You can absolutely do chole tube with local. It sucks, but it can be done.
 

UChicagoIR

Interventional Radiologist
2+ Year Member
Mar 26, 2015
26
13
Chicago, IL
Status
Attending Physician
This scenario seems a bit far fetched.

1) Surgery (or any specialty for that matter) doesn't "demand" anything of us as IRs. IR is a clinical service just as they are. They have no authority to "demand" any procedure or force another physician to perform a procedure outside the standard of care.

2) I would hope one would develop a collegial relationship with their surgery colleagues. Surgeons know that IR is there to bail them out of complications (uncontrolled postop bleeding, nicked ureters, abscesses, etc). I know the vast majority of my surgery colleagues respect me and the help our section has provided on many occasions.

3) You should be aware of the CHOCOLATE trial which demonstrated that lap chole was superior to chole tubes for acute cholecystitis. Having mentioned this, I still try to work my surgery colleagues and work out a reasonable plan for all involved. I do place chole tubes when needed and I'm happy to do so. It's a very quick and satisfying procedure.

4) Placing a chole tube with local anesthesia is not a big deal at all. Chole tubes have been placed at bedside using lidocaine for decades. It takes longer for my fellows to dictate the case and put in orders than it does for them to do the case as primary operator.


80 year female presents with hot gallbladder cannot be cleared for anesthesia because it's Friday night and the Cardiologists don't work on weekends and can not get CCTA, or nuclear cardiac study to clear for surgery. Surgeon demands that IR put in cholecystostomy tube right now so everybody can go home, have the weekend off, and they'll worry about the patient on Monday. Only problem- anesthesia won't sedate patient (cardiac concerns), so IR has to put in tube without anesthesia- only local- real fun!!
This is the now the typical lifestyle of Interventional Radiology. We have become the dumping ground for everything no one else wants to do, especially at night and on weekends.. If you enjoyed being an intern and doing scutt work- then you'll love IR. It's like being an intern all over again..
I should know- I am a B/C, dual fellowship-trained IR , and neuro IR with 30 years of actual experience.
 

badasshairday

Vascular and Interventional Radiology
10+ Year Member
Apr 6, 2007
3,903
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U cam and should do Chole tube with local and maybe a touch of fentanyl at most. These people are high surgical risk so why in the world do you use anesthesia? I do many with local alone at bedside with trocal techniques takes 5 minutes.