Internal Medicine vs Radiology

[Phoenix510]

Hey guys this is my first post on SDN but I've been reading these threads for a long time and I could really use some advice. I'm currently an M4 and at the end of my interview trail. I've really been struggling with the decision of going into internal medicine (with an eventual fellowship in pulm/CC or GI [those are my two main interests]) or going into radiology. I understand that the fields are very different but I'm listing my thoughts about them below:

IM
Pros
- Patient contact - I still love that feeling when I've done something right for a patient however I don't know whether this is coming from a perspective of a med student who has only had to carry 3 patients max at any given time. Will I still have time to appreciate this as a resident/attending or will the unappreciative/noncompliant patients and sheer patient load take away from this?
- Variety of pathology
- Using most of the knowledge gained in medical school - I mean this in the sense of physical exam skills, knowing medications, etc. (Not in terms of anatomy, pathology, etc that radiologists would use as well).
- Being up and about and interacting with various ancillary staff and being in different hospitals and clinics - I know this depends on the environment you're in but overall I have had pleasant interactions in most of my rotations and enjoy little conversations here and there.

Cons
- Lower pay than radiology - I hate to take this into consideration but the reality is that most people have to (I have a significant amount of student debt). However, with radiology jobs being hard to find nowadays (I do believe there are cycles with most job markets and this will change, although I don't know to what extent) and the compensation decreasing, are most salaries comparable to a IM specialist's salary?
- Getting into fellowships - Seeing how my interview season has gone, I have received radiology interviews from some mid to high tier radiology programs while my IM invites have ranged from low to mid tier (not sure what it was in my application that led to less and lower tier IM interviews but I'm thinking that with IM becoming more competitive, programs wanted to see more of a focus on IM rotations and electives). I know I would have to work hard during IM residency to obtain a competitive fellowship whereas with radiology it's almost guaranteed that you will be able to find a fellowship in the subspecialty you want somewhere in the country.
- Paperwork and too-long rounds

Radiology
Pros
- Imaging - This encompasses so much but the technology is cool and there are so many different modalities nowadays.
- Variety of pathology - This belongs here as well
- Knowledge of many different fields - You end up reading images for surgery, peds, ob/gyn, etc. However, what is the reality of that once you subspecialize and are hired?

Cons
- Environment - Unless you are getting up to do procedures or taking breaks (and obviously, not everyone does procedures) you are sitting/standing in one area and reading reports all day long. I understand that once you start reading reports you become engrossed with your work but I don't know about doing it day after day.
- Job market and work load - See above. Additionally, most radiologists complain about having to deal with higher volume and longer hours with compensation not matching accordingly (prob a complaint in most fields).

I don't know yet what field of radiology I would want to subspecialize in and I have read some threads where some people suggest doing IR as a sort of middle road (patient contact, procedures and radiological aspect) but I don't know if I could handle the more surgical type lifestyle of IR (or if IR is totally doable and I don't know the reality of it - I am, after all, considering pulm/CC or GI).

I would really appreciate any and all insights, especially from current residents or attendings, but thanks in advance for your help!

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[Rocher]

Hey guys this is my first post on SDN but I've been reading these threads for a long time and I could really use some advice. I'm currently an M4 and at the end of my interview trail. I've really been struggling with the decision of going into internal medicine (with an eventual fellowship in pulm/CC or GI [those are my two main interests]) or going into radiology. I understand that the fields are very different but I'm listing my thoughts about them below:

IM
Pros
- Patient contact - I still love that feeling when I've done something right for a patient however I don't know whether this is coming from a perspective of a med student who has only had to carry 3 patients max at any given time. Will I still have time to appreciate this as a resident/attending or will the unappreciative/noncompliant patients and sheer patient load take away from this?
- Variety of pathology
- Using most of the knowledge gained in medical school - I mean this in the sense of physical exam skills, knowing medications, etc. (Not in terms of anatomy, pathology, etc that radiologists would use as well).
- Being up and about and interacting with various ancillary staff and being in different hospitals and clinics - I know this depends on the environment you're in but overall I have had pleasant interactions in most of my rotations and enjoy little conversations here and there.

Cons
- Lower pay than radiology - I hate to take this into consideration but the reality is that most people have to (I have a significant amount of student debt). However, with radiology jobs being hard to find nowadays (I do believe there are cycles with most job markets and this will change, although I don't know to what extent) and the compensation decreasing, are most salaries comparable to a IM specialist's salary?
- Getting into fellowships - Seeing how my interview season has gone, I have received radiology interviews from some mid to high tier radiology programs while my IM invites have ranged from low to mid tier (not sure what it was in my application that led to less and lower tier IM interviews but I'm thinking that with IM becoming more competitive, programs wanted to see more of a focus on IM rotations and electives). I know I would have to work hard during IM residency to obtain a competitive fellowship whereas with radiology it's almost guaranteed that you will be able to find a fellowship in the subspecialty you want somewhere in the country.
- Paperwork and too-long rounds

Radiology
Pros
- Imaging - This encompasses so much but the technology is cool and there are so many different modalities nowadays.
- Variety of pathology - This belongs here as well
- Knowledge of many different fields - You end up reading images for surgery, peds, ob/gyn, etc. However, what is the reality of that once you subspecialize and are hired?

Cons
- Environment - Unless you are getting up to do procedures or taking breaks (and obviously, not everyone does procedures) you are sitting/standing in one area and reading reports all day long. I understand that once you start reading reports you become engrossed with your work but I don't know about doing it day after day.
- Job market and work load - See above. Additionally, most radiologists complain about having to deal with higher volume and longer hours with compensation not matching accordingly (prob a complaint in most fields).

I don't know yet what field of radiology I would want to subspecialize in and I have read some threads where some people suggest doing IR as a sort of middle road (patient contact, procedures and radiological aspect) but I don't know if I could handle the more surgical type lifestyle of IR (or if IR is totally doable and I don't know the reality of it - I am, after all, considering pulm/CC or GI).

I would really appreciate any and all insights, especially from current residents or attendings, but thanks in advance for your help!

Do you get a gut feeling with either of them? In third year I was torn between a couple of more "competitive" specialties and IM but deep down I always knew I was destined for IM.

 

[PlutoBoy]

IM, man. Sucks to be tucked away in a dark room somewhere in the basement of a hospital.

 

[Phoenix510]

Do you get a gut feeling with either of them? In third year I was torn between a couple of more "competitive" specialties and IM but deep down I always knew I was destined for IM.

The only gut feeling I've gotten so far is when I go on department tours during radiology interviews. I get kind of down when I see most of the reading rooms since most of them are individual small rooms divided by body area (I'm much happier to see big open reading rooms - and no, I'm not claustrophobic). Hahah but that might be a sign, huh?

 

[DrBowtie]

Your impressions sound like your exposure is limited to the ivory towers of academia.

Even with radiology subspecialization you'll likely still be reading a fair share of general radiology, especially on call in a private practice setting.

 

[Slack3r]

Would you rather be bored on rounds or bored in a dark room?

Kidding (kind of). IR, at least where I've been, are more of "proceduralists " than actual surgeons. The lifestyle is much more benign, although you will still have emergencies. Many IR residents will say that the lifestyle was a big draw, although if you want "ownership" of your patients, you may be in for a letdown.

 

[ravupadh]

Your impressions sound like your exposure is limited to the ivory towers of academia.

Even with radiology subspecialization you'll likely still be reading a fair share of general radiology, especially on call in a private practice setting.

Even if you go into IR? I was under the impression that if you do IR you wouldn't have to be sitting in a dark room and would just be doing procedures all day..

 

[jazzman84]

IR will definitely have the lion's share of procedural time during the day compared to most other subspecialties, the possible exception being breast imagers doing biopsies/needle localizations/aspirations. However, a truly 100% IR job (i.e. no non-IR diagnostic work) is uncommon in most practices. I'm not sure how the dedicated IR residency will affect this as people get less comfortable with bread-and-butter general rads (i.e PE studies, acute stroke MRI/MRA, nucs). In most practices, the IR guys will have to do some general work to a) keep the queue from piling up and b) there can be long lulls between procedures, again depending where you are/volume/turf.

In my mind, the biggest misconception people have about radiology is that it is "sitting in a dark room all day with no human contact". Of course, dictating studies is kind of what we do, but I personally never feel isolated or starved for human contact. I like individual reading rooms with closing doors that open out into a hallway peppered with reading rooms. The privacy is nice because, especially early on, thinking through a case and planning your dictation is a lot easier when you don't have people dictating all around you or yelling back and forth across the big open reading rooms you see in a lot of university practices. If I have a question or an interesting case, I can pop across to the body guy or the MSK guy or the Peds guy....you get the idea. I find interacting with my co-residents and staff to be plenty of interpersonal exposure for the day; granted I'm no social butterfly but I don't break out in a cold sweat if I have to talk to people.

My residency is a high-volume, academic/PP hybrid model so the work never really stops and the lists are always growing. My "slowest" days are the rare ones (usually post-holiday) where the outpatient scanners are quiet and the ER is staying on its game. On days where the hits keep coming, even though it's mentally taxing, the actual workday just about flies by. Also, these busy days are ones where I can look at my finished studies list and feel like I brought it, either in terms of speed/efficiency or complexity/quality.

I love when clinical teams or surgeons stop by the reading rooms, either to talk to me or the attending, because both sides can add so much to the discussion. I really like talking to the med and surg residents because we can actually teach each other things. One of the best things about radiology is learning about all the cool pathology across all systems and really nailing the anatomy. I often laugh at how horrible my grasp of anatomy was as an intern, even though I was probably better than average. I didn't know half of the structures in the shoulder even existed until I started learning joint anatomy earlier this year.

 

[medstudent7860]

IR will definitely have the lion's share of procedural time during the day compared to most other subspecialties, the possible exception being breast imagers doing biopsies/needle localizations/aspirations. However, a truly 100% IR job (i.e. no non-IR diagnostic work) is uncommon in most practices. I'm not sure how the dedicated IR residency will affect this as people get less comfortable with bread-and-butter general rads (i.e PE studies, acute stroke MRI/MRA, nucs). In most practices, the IR guys will have to do some general work to a) keep the queue from piling up and b) there can be long lulls between procedures, again depending where you are/volume/turf.

In my mind, the biggest misconception people have about radiology is that it is "sitting in a dark room all day with no human contact". Of course, dictating studies is kind of what we do, but I personally never feel isolated or starved for human contact. I like individual reading rooms with closing doors that open out into a hallway peppered with reading rooms. The privacy is nice because, especially early on, thinking through a case and planning your dictation is a lot easier when you don't have people dictating all around you or yelling back and forth across the big open reading rooms you see in a lot of university practices. If I have a question or an interesting case, I can pop across to the body guy or the MSK guy or the Peds guy....you get the idea. I find interacting with my co-residents and staff to be plenty of interpersonal exposure for the day; granted I'm no social butterfly but I don't break out in a cold sweat if I have to talk to people.

My residency is a high-volume, academic/PP hybrid model so the work never really stops and the lists are always growing. My "slowest" days are the rare ones (usually post-holiday) where the outpatient scanners are quiet and the ER is staying on its game. On days where the hits keep coming, even though it's mentally taxing, the actual workday just about flies by. Also, these busy days are ones where I can look at my finished studies list and feel like I brought it, either in terms of speed/efficiency or complexity/quality.

I love when clinical teams or surgeons stop by the reading rooms, either to talk to me or the attending, because both sides can add so much to the discussion. I really like talking to the med and surg residents because we can actually teach each other things. One of the best things about radiology is learning about all the cool pathology across all systems and really nailing the anatomy. I often laugh at how horrible my grasp of anatomy was as an intern, even though I was probably better than average. I didn't know half of the structures in the shoulder even existed until I started learning joint anatomy earlier this year.

Just like the OP, I'm considering both IM and radiology. My biggest concern with radiology is the procedures. I am not a procedure person and don't ever want to do procedures in my career (aside from a central line here and there; that's doable). I have heard, though, that radiologists, even if they're not IR, still have to do a lot of procedures (ex. during residency). Is this true? Also, I'd like reading scans, but I don't actually want to do the imaging procedures. As a radiologist, would you have to do/know how to do ultrasounds, CT scans, etc. yourself?

 

[radiologyology]

Good discussion so far guys, thanks for the read! (I'm using this post to sort of bookmark this thread)

 

[colbgw02]

Just like the OP, I'm considering both IM and radiology. My biggest concern with radiology is the procedures. I am not a procedure person and don't ever want to do procedures in my career (aside from a central line here and there; that's doable). I have heard, though, that radiologists, even if they're not IR, still have to do a lot of procedures (ex. during residency). Is this true? Also, I'd like reading scans, but I don't actually want to do the imaging procedures. As a radiologist, would you have to do/know how to do ultrasounds, CT scans, etc. yourself?

The only sure way to be a radiologist without procedures is to practice 100% teleradiology. As of now, that's certainly doable, but going the teleradiology route comes with its own set of problems. Nearly all traidtional jobs will require you to do procedures at least occasionally. Even then, I could envision a large, highly compartmentalized group or academic department where you could carve out a niche of just reading studies. Overall, it's a question of how much you're willing to narrow your scope of practice and the effects that could have on your marketability.

The only modalities in which radiologists have any meaningful hands-on contribution to image acquisition are fluoroscopy and ultrasound. For fluoro, the radiologist is usually in the room with the patient, operating the fluoroscope. For ultrasound, it's usually in a problem-solving situation when the radiologist gets involved. For example, I've had to help the technologist acquire images when there's some anatomy involved that's outside of their wheelhouse, or sometimes there's a finding that needs to be observed real-time rather than on the representative images that the sonographer takes.