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Interested in IR but not DR?

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2gunornot2gun

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Is anyone else in this boat? I don't really have any interest in DR, but I have a lot of interest in IR. Is it worth pursuing the limited spots in the DIRECT programs?
 

Tejas

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Crurent rads resident. I have felt the same since the begining. Went into radiology with the sole purpose of doing IR. Still no question in my mind; I will be going into IR. Conciously chose not to do the direct pathway as I would have been dissapointed to have matched into one only later to find out that it lacks some of the things I really want to do in IR. Having said that, our IR dept is amazing but, it is lacking in 2 areas that I am very interested in getting great training in.
 

2gunornot2gun

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Crurent rads resident. I have felt the same since the begining. Went into radiology with the sole purpose of doing IR. Still no question in my mind; I will be going into IR. Conciously chose not to do the direct pathway as I would have been dissapointed to have matched into one only later to find out that it lacks some of the things I really want to do in IR. Having said that, our IR dept is amazing but, it is lacking in 2 areas that I am very interested in getting great training in.

did it ever cross your mind that you might not make it into an IR fellowship? That would be the biggest fear I have going that route. I am considering doing GS->vascular (i know they aren't the same but there are a lot of similar aspects that interest me) because I would rather have GS to fall back on than DR.
 

shark2000

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At least you have to be able to tolerate doing DR for half of you time.
What if you may not find a 100% IR job? There are many IR jobs are there which are solely IR, but most of them require you to do at least 30-40% of DR.
If there is a big radiology group you are all set to do 100% IR.
However many groups require you to do some DR which IMO is a positive aspect as you do not get over-whelmed by IR hours.
At least for now it is not very difficult to find a spot in IR. Most people find a good spot and I don't think it will change in the near future.
Vascular surgery is not also a bad choice if you want to do only vascular work. It may be in the safer side regarding turf wars, however you are doomed to do only endovascular work the rest of your life. In contrast, in IR you can do many non-vascular stuff or even you can switch back to DR if you like it.
 

davidjones

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I went into Rads to strictly do IR, fell in love with it between my first and second year of medicine and pretty much loved everything else in med school, (and sort of tolerated DR), but nothing really grabbed my like IR did, from the breadth of cases, to the innovation and potential of the field.

I'm almost done with my second year of rads residnency, and the first year was shear torture, the second was a little better because I like being on call and get to sort of run the whole hospital, since it's only residents in house and they all come to us asking for stuff, you get to build relationships and always sneak in a mention about IR, not an insignificant source of referrals for us since we have many residents doing the same thing.

However, the more I progress through DR, the more I'm realizing that a job that's 75% IR (including clinic/admitting/consults) and 25% imaging, or 80/20, is actually probably my dream job. We have a float rotation in my program where the residents just go where the rotation is short a person, and I love the weeks when I spend 4 days in IR and one day doing diagnostics. First, because we're pretty busy in IR, and I get exhausted, though it's fun as hell, and I'll stay late or post-call to do cases. The one day of doing diagnostics is great, DR is actually pretty interesting once you get the hang of it, and know what to look for, and breaks up your week, from constantly being in a rush and running from case to case, or patient to patient.

Some people might say they can use that one day for clinic, but the follow-up, pre and post-procedure work-up is pretty minimal, as it is in most procedural fields that are primarly invasive like gen surge and it's sub-specialties. ENT/Urology/Ortho are sort of a different beast, and our work-up is pretty minimal, with the exception of PAD/UFE patients, and even then you can knock those out in a 1/2 day clinic per week unless you're overwhelmingly busy.

Plus the DR part is where you generate a lot of RVUs, you can get through a ton more CTs/hour then UFEs or stents. and you can keep your skills up when you're too tired/old to operate, which will happen, surgeons don't have that fall-back, and it's nice to be able to slow down and still generate the income that will give you the life you will become used to living.

If you are going to go the DIRECT route, realize that you will still have to be very adept at the DR part as you will be required to become board-certified in DR. But you'll spend a lot more time doing IR and clinical rotations in the DIRECT pathway; so that means you will have less time to learn the DR you need to be as good as people who do 4 years of it; it is quite doable, but you have to weigh the pros and cons. If possible I'd try to contanct DIRECT pathway residents or PDs and see how people feel about it, I know off hand that UVA, UPenn and Christiana Care have great programs with solid training.

I agree with Shark in that most PP jobs out there for IR are <100% IR, most being between 50-75%, which is still 3-4 days/week; which given how busy PP is, most people consider the DR time a respite. And if you are motivated, you can easily turn that 75% into a 100% by bringing in new procedures, getting more referrals by marketing etc.

I guess the point of this on-call rambling is that DR is more of a hoop for you to jump through to get to DR, like GS is a hoop for people who want to do surgical onc or vascular or whatever, but much like GS, DR is difficult and represents a large part of your training, so you had better at least know that you can be successful at it, because likely by the time you get to residency IR will be quite competitive and your performance in DR will determine your fellowship placement.

There is also a huge push for a dual-primary certificate in IR and DR residency, similar to DIRECT, except that IR training would be more standardized and have more requirements. However, I'm not sure what the timeline for that is and it might be an option for you.
 

shark2000

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any thoughts on interventional cardiology (yeah I know touchy subject lol) in regards to endovascular procedures, even beyond the heart? I have seen studies showing cardiologists and vasc surgeons taking more and more of the endovascular cases while rads is losing a small amount comparatively (based off medicare billing info).

In my case I don't mind DR and could get through residency but not entirely convinced on IR's future in endovascular work (which I think most people find the most interesting and enjoyable). I see IR moving to a lot more oncology (unless radonc takes it or this aspect of IR is absorbed into radonc - which doesn't sound that bad imo for those interested in that kind of stuff with the working relationship with rads and radonc - hopefully surg onc doesn't take it...) based work as well as CT guided stuff while retaining it's diagnostic routes as well (such as angios). I also don't mind IM too much and could do that residency. Oh and don't get me wrong. They'll always be a need for IR I just think their role is starting to change. Also I will say I think academic IR is completely different that PP IR with respect to the cases each does so it is sometimes hard to lump IR into one big pool.

Is IR fellowship harder to get than cards? Percentages for US grads matching is essentially the same. Figure competing against the typical IM resident doing cards is a little easier than the typical rads resident (arguably they have much better board scores and things of that nature, plus interest in IR is on the rise in students, residents, and docs looking for a job lol).

Your post clearly reveals that you are not practically familiar with IR that much. That is totally fine. I bet you have not get your hands dirty or even watched completely an endovascualr procedure (PAD or Chemoembo or ...). Again it is totally fine.
But something I do not understand is that how do you know you like endovascular work and how do you now that this is very challenging that you have limited all your choices only to cards, vasc surgery and IR doing vascualr stuff?

Let me tell you something. As a medical student many things appear very challenging to you. Ironically when you do it yourself you find it horrible after doing it 10-15 times.

Choosing something because it seems interesting at the MS level is crazy. After 2-3 years of practice everything will be the same. You will lose you interest. But, the backbone of your specialty will be there.

Endovascular work: One of the most over-rated procedures in medicine. They are generally boring. It is OK if you do a few ones in a week and mix it with other stuff. Patients are generally sick with a lot of hemodynamic issues. They are vasculopaths. They will come back to you very soon for stent thrombosis, stenosis, ... If dealing with all these issues are OK with you go for it.

IR: IMO, good choice mostly because the backbone is radiology. You can do variety of procedures. You can do endovascualr work 1-2 days a week. you can combine it with 30% DR as a variety. You can do it for a while and if after 10 years you are tired of it, you can switch back to DR. You can skip the endovascular work and do for example other image guided procedures, You can do pain management. LOTS OF POTENTIAL. Can do mamo.
The main problem is turf wars. If you do not like DR, don't do it.

Vascular Surgery: You are doomed to do endovascular work the rest of your life. Turf wars are less. If you are tired of endovascular work, you should do general surgery which is horrible. I personally can not do GS myself and to me doing just endovascular work is boring that I can not last for a long time.
If you do not like long hours and surgery itself don't do it.

Cards: OK choice. Heart belongs to you. The safest regarding turf wars. Interventional call can be brutal mostly because of 90 minutes rule. You have to run a busy clinic and also you are bound to the hospital and admissions.If you are tired of it, you do not have any a lot of options. You are doomed to see MI and chest pain the rest of your life.
If you want to sleep nights and do not like seeing chest pain day and night don't do it.

All of these are true in pp. Forget about what is going on in your university. Academics and pp are two different worlds and it includes all fields.

I am a senior radiology resident and clearly I am biased towards my specialty. I tried my best to be neuter.
 
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