Interventional Radiology Interview Thread 2016-2017

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You are incorrect.

It's the number of people being trained. NOT the number of graduates. The reason is that the ACGME won't allow there to be more trainees than there are "learning opportunities" available.

If a program had 2 fellows per year, that means they had enough cases and rotations available for just 2 people each year. When that fellowship got accredited, the ACGME came and inspected them and said they could meet the requirements to train 2 fellows per year. If a program had the ability to train 4 individuals in the department at any given time, why wouldn't they have had 4 fellows? It's very unlikely that a program has the capacity to train more people but chose not to. If a program had enough capacity for 4 fellows, they would have already petitioned the ACGME to increase their fellow complement to 4. A program that has 2 fellows will likely only be able to prove to the ACGME that they will have enough capacity to train 2 trainees at a time. In that case 1 PGY-5 and 1 PGY-6.

I know there will be exceptions. But I challenge you or anyone else to go through the database and see how many programs have fewer IR/DR positions compared with their traditional fellowship positions. Go ahead and see for yourself.

Moreover, many programs are applying for the independent residency just as a way to deal with the transition from fellowship to integrated residency. There will dozens of programs that are approved for independent residencies that DON'T use the spot. That's because when programs apply for independent/integrated programs they have to promise to the ACGME that they won't exceed the training complement in any given year. If they do, they'll be in violation.

If you don't believe me, ask you own local med school program director (if they have IR training programs) how it works.


IR4thewin said:
Fab5Hill33 I also disagree with some of what you said. I think your mistake is in how you are counting "IR Trainees." What you should be counting is, how many IRs are being produced each year into the market. Right now it is that 250 number. That will continue in the future if not increase slightly.

The question is, how many IR pgy6 positions will there be six years from now? I guarantee you there will be at least 250, which in our case will be 120 integrated and at least 130 independent.


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Fab5Hill33 said:
You are incorrect.

It's the number of people being trained. NOT the number of graduates. The reason is that the ACGME won't allow there to be more trainees than there are "learning opportunities" available.

If a program had 2 fellows per year, that means they had enough cases and rotations available for just 2 people each year. When that fellowship got accredited, the ACGME came and inspected them and said they could meet the requirements to train 2 fellows per year. If a program had the ability to train 4 individuals in the department at any given time, why wouldn't they have had 4 fellows? It's very unlikely that a program has the capacity to train more people but chose not to. If a program had enough capacity for 4 fellows, they would have already petitioned the ACGME to increase their fellow complement to 4. A program that has 2 fellows will likely only be able to prove to the ACGME that they will have enough capacity to train 2 trainees at a time. In that case 1 PGY-5 and 1 PGY-6.
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Trainee quotas are in part determined by volume of cases, but are also capped so as not to flood the job market. There are quite a few programs I saw on the trail who seemed to honestly have more volume than the fellows could cover. When you go on tours and they are running 4 rooms but only have 2 fellows, and they say that's not unusual, I am inclined to believe them. Of course, residents on the IR block will jump in on cases, but that program could technically train more fellows.

Also, current fellows are pretty much on the IR service 24/7. You are assuming that every trainee in the new paradigm in PGY5 and PGY6 year are on the IR service 24/7. That is not the case. Most programs have months on vascular, ICU, DR call, and more during the PGY5 year, so you will technically need more trainees in the program to cover. It is not double the number of trainees, but it certainly isn't a 1:1 replacement of fellows with IR residents.

It will be up to each program as to how many spots they allocate to the Integrated vs. Independent program. I have looked at the spreadsheet, but also found it very helpful to speak with program directors. I visited a little over 20 IR programs and Dr. Killoran at BWH was the only program director who directly stated that they probably won't accept any independent residents, they are pretty much filling exclusively with integrated residents. At the other end of the spectrum is MIR, who off the top of my head are taking 2 integrated residents/year. They have the ability to train many more and will through the independent pathway.

My original point is that the current setup puts out about 250 IR trainees/year. After talking with PDs on the interview trail, some of who are very involved with SIR and the implementation of this whole thing, I believe this will absolutely be the case 6 years from now, there is not going to be a sudden drop to 120 or 150 IR trainees when our class graduates.
 
Trainee quotas are in part determined by volume of cases, but are also capped so as not to flood the job market. There are quite a few programs I saw on the trail who seemed to honestly have more volume than the fellows could cover. When you go on tours and they are running 4 rooms but only have 2 fellows, and they say that's not unusual, I am inclined to believe them. Of course, residents on the IR block will jump in on cases, but that program could technically train more fellows.

There is absolutely NO cap to "avoid flooding the market." The ACGME does not care about the job market when they cap programs. They only care that the program fulfills the training requirements. I'm sure there are many programs that do more cases than the minimum (which is only 500/year by the way). Just because you have 4 rooms doesn't mean you deserve 4 fellows. That's not how it works. Either programs may not fulfill other requirements OR the hospital may be over the medicare limit that dictates how many residents/fellows that the entire institution may have.


Also, current fellows are pretty much on the IR service 24/7. You are assuming that every trainee in the new paradigm in PGY5 and PGY6 year are on the IR service 24/7. That is not the case. Most programs have months on vascular, ICU, DR call, and more during the PGY5 year, so you will technically need more trainees in the program to cover. It is not double the number of trainees, but it certainly isn't a 1:1 replacement of fellows with IR residents.

Fair point. But out of your 2 years in IR, you're not spending an entire year rotating on another service. At most you're talking abouat 3-6 months on a non-IR rotation. The amount of time off IR most often does not translate into the addition of another trainee position. Maybe if you have 5 IR fellows, you can go to 3 IR/DR positions. That math makes sense. Or maybe if a hospital was understaffed they go from 5 IR fellows to 3 IR/DR plus 1 independent position. Either way there is 1-2 fewer people that that program will accept on a yearly basis. Just do the math.


It will be up to each program as to how many spots they allocate to the Integrated vs. Independent program. I have looked at the spreadsheet, but also found it very helpful to speak with program directors. I visited a little over 20 IR programs and Dr. Killoran at BWH was the only program director who directly stated that they probably won't accept any independent residents, they are pretty much filling exclusively with integrated residents. At the other end of the spectrum is MIR, who off the top of my head are taking 2 integrated residents/year. They have the ability to train many more and will through the independent pathway.

MIR has 5 fellows per year. It makes sense that they would downsize to 2 IR/DR and then add maybe 1 or 2 independent spots. But that's exactly my point. Their 5 fellowship spots - with 5 people being accepted to their program each year - doesn't translate into 5 positions in the new system. They will accept fewer people each year and consequently graduate fewer people each year. That's because of my original point that the department can only handle X number of trainees at any given time. It has nothing to do with how many people graduate per year.


My original point is that the current setup puts out about 250 IR trainees/year. After talking with PDs on the interview trail, some of who are very involved with SIR and the implementation of this whole thing, I believe this will absolutely be the case 6 years from now, there is not going to be a sudden drop to 120 or 150 IR trainees when our class graduates.

There will be a drop. Not to 120. But there will be a drop. Just do the math:

120 IR/DR = 240 IR housestaff (120 PGY5 and 120 PGY6. Let's say each housestaff is only spending 2/3 of their time in IR (I think it will be closer to 80-85%, but I'll give you the best possible scenario for you). So that means 160 residents actually rotating in IR at any given time. Compare that with 250 in the present system. So that means IR departments are short 90 trainees. So that's 90 independent fellowship spots. So 120 IR/DR spots + 90 integrated spots = 210. That is fewer than the current 250 fellowship spots. And that's the best case scenario.
 
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I appreciate your reply, we can agree to disagree.


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A few things that are missing in those calculations.

1. There will be more than 120 integrated IR/DR residents per year. That was only for this current match. New programs have already been approved in January, more are being approved in April, more probably being approved over the next year or two but that's just speculation on my part. We don't know the exact number of integrated residents once it is all said and done but it will be more than 120. I'm guessing ~150-175 but who knows.

2. There will probably be more independent residency spots than you think. Look at this article https://www.ncbi.nlm.nih.gov/pubmed/28161025. There was only a 56% response rate, and those that did respond said they expected to add 61 to 76 independent residency spots in total. If we take the low 61 number and divide by 56% to try and extrapolate what the number would have been with 100% response rate, that would be ~109 independent residency spots. And that is the low estimate. There definitely could be response and/or selection bias with those that responded to the survey but this is the only hard data I have seen on the number of independent residency spots so it's all we have to go on.

So, taking a low estimate, 150 (IR/DR) + 109 (independent) = 259 total trainees per year. Obviously an estimate, but just my $0.02 and based on the only hard data we know.
 
I agree with point #1. There will be more than 120. But that will only detract from the number of independent spots that are actually used (not how many are approved. See my next point).

The problem with point #2 is that many programs will apply for and get accreditted for an independent residency slot, but MANY won't use the spot unless they have vacant spots in their IR/DR residency or they may only use it during the transition period between fellowship and IR/DR.


harambe4ever said:
A few things that are missing in those calculations.

1. There will be more than 120 integrated IR/DR residents per year. That was only for this current match. New programs have already been approved in January, more are being approved in April, more probably being approved over the next year or two but that's just speculation on my part. We don't know the exact number of integrated residents once it is all said and done but it will be more than 120. I'm guessing ~150-175 but who knows.

2. There will probably be more independent residency spots than you think. Look at this article https://www.ncbi.nlm.nih.gov/pubmed/28161025. There was only a 56% response rate, and those that did respond said they expected to add 61 to 76 independent residency spots in total. If we take the low 61 number and divide by 56% to try and extrapolate what the number would have been with 100% response rate, that would be ~109 independent residency spots. And that is the low estimate. There definitely could be response and/or selection bias with those that responded to the survey but this is the only hard data I have seen on the number of independent residency spots so it's all we have to go on.

So, taking a low estimate, 150 (IR/DR) + 109 (independent) = 259 total trainees per year. Obviously an estimate, but just my $0.02 and based on the only hard data we know.
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I think at the end of the day spots need to stay around 250. There are only 260 applicants to IR in this fellowship match per ERAS preliminary data.

IR fellowship was not always competitive. At one point they had trouble filling.
 
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IR4thewin said:
Trainee quotas are in part determined by volume of cases, but are also capped so as not to flood the job market. There are quite a few programs I saw on the trail who seemed to honestly have more volume than the fellows could cover. When you go on tours and they are running 4 rooms but only have 2 fellows, and they say that's not unusual, I am inclined to believe them. Of course, residents on the IR block will jump in on cases, but that program could technically train more fellows.

Also, current fellows are pretty much on the IR service 24/7. You are assuming that every trainee in the new paradigm in PGY5 and PGY6 year are on the IR service 24/7. That is not the case. Most programs have months on vascular, ICU, DR call, and more during the PGY5 year, so you will technically need more trainees in the program to cover. It is not double the number of trainees, but it certainly isn't a 1:1 replacement of fellows with IR residents.

It will be up to each program as to how many spots they allocate to the Integrated vs. Independent program. I have looked at the spreadsheet, but also found it very helpful to speak with program directors. I visited a little over 20 IR programs and Dr. Killoran at BWH was the only program director who directly stated that they probably won't accept any independent residents, they are pretty much filling exclusively with integrated residents. At the other end of the spectrum is MIR, who off the top of my head are taking 2 integrated residents/year. They have the ability to train many more and will through the independent pathway.

My original point is that the current setup puts out about 250 IR trainees/year. After talking with PDs on the interview trail, some of who are very involved with SIR and the implementation of this whole thing, I believe this will absolutely be the case 6 years from now, there is not going to be a sudden drop to 120 or 150 IR trainees when our class graduates.
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I was at SIR and multiple PDs said the total number of IR trainees graduating each year will be very similar, unfortunately.

The big unknown is how will programs deal with the huge interest from med students? 450 med students applied this year. Will PDs be able to resist expanding in order to keep jobs good and the top talent coming into the field? I hope so but there is a poor track record when it comes to this. IR spots are up about 10 percent from a few years ago, and until this year, the job market was really lukewarm at best, and expansion continued anyway.
 
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I just like the "this is how you should rank things" thought, 3 weeks after rank lists were submitted.
 
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I've actually been saying "this is how you should rank things" for months. I only added updated info to the thread after returning from SIR this past week.


Applicant17 said:
I just like the "this is how you should rank things" thought, 3 weeks after rank lists were submitted.
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Today most (hopefully all) of us will match, however, none of us will know if we matched IR/DR or just DR. :/
 
IRorBustguy said:
Today most (hopefully all) of us will match, however, none of us will know if we matched IR/DR or just DR. :/
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Yeah I think today is the important day for people applying into Derm/Plastics/Neurosurg/Rad Onc.
 
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IR4thewin said:
2 of them were Categorical. I have my guesses on these.
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I'm extraordinarily impressed by the Match. I was thinking all IRs would match to DR (lots of empty IR spots) or all DRs would match to IR (100% IR fill) [i.e. people interested more in DR but who applied to IR for the hell of it]. Six unfilled seems like neither of these scenarios happened.
 
All participants in the match have it in their reports section. Says that we can't reproduce the document so I'm not sure if it is totally public yet.
 
IR4thewin said:
All participants in the match have it in their reports section. Says that we can't reproduce the document so I'm not sure if it is totally public yet.
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How many unfilled DR spots?
 
One of the unfilled IR positions was at Henry Ford Hospital - however, this position was only set up for a single military candidate who had military funding. This would have allowed an additional resident without going over the institutional funding cap. It was allowed by the NRMP since there are no accredited military IR Integrated residency positions. This position was only set up for this specific scenario. Henry Ford Hospital did fill their "normal" complement of residents, through the match.
 
Most DR IR spots are created from taking DR spots away.

Compared to last year, 30 new IRDR spot, 80 taken away from DR
 
DrfluffyMD said:
Most DR IR spots are created from taking DR spots away.

Compared to last year, 30 new IRDR spot, 80 taken away from DR
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what numbers are you looking at? weren't there like 100 new IR spots and 50 less DR spots. It was like a 5 % total increase I believe.
 
PL198 said:
what numbers are you looking at? weren't there like 100 new IR spots and 50 less DR spots. It was like a 5 % total increase I believe.
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I was looking at nrmp data. Please go review.
 
DrfluffyMD said:
I was looking at nrmp data. Please go review.
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are you just looking at only categorical spots or something? there were definitely more than 30 IR spots created.
 
PL198 said:
are you just looking at only categorical spots or something? there were definitely more than 30 IR spots created.
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Go to nrmp 2017 advanced data table. Compare all diagnostic pgy 1 and 2 positions from 2016 versus 2017 and IR positions 2016 versus 2017.

The data is out there. I applaud this approach to our profession. We really don't need to overtrain like pathology.
 
PL198 said:
http://www.nrmp.org/wp-content/uploads/2017/03/Advance-Data-Tables-2017.pdf

here we are.

2016: 151 categorical DR positions, 3 categorical IR positions, 982 advanced DR positions, 11 advanced IR positions
2017: 121 categorical DR positions, 29 categorical IR positions, 932 advanced DR positions , 95 advanced IR positions

so 80 less DR positions, 110 more IR positions
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Good job. As you can see 80/110 IR/Dr are created from DR and only 30 are brand new. I think we can agree on that.
 
Fair enough I see what you meant now by new
 
PL198 said:
http://www.nrmp.org/wp-content/uploads/2017/03/Advance-Data-Tables-2017.pdf

here we are.

2016: 151 categorical DR positions, 3 categorical IR positions, 982 advanced DR positions, 11 advanced IR positions
2017: 121 categorical DR positions, 29 categorical IR positions, 932 advanced DR positions , 95 advanced IR positions

so 80 less DR positions, 110 more IR positions
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Is there a list of the categorical IR positions out there somewhere? Can you see whether a program is categorical on FREIDA or ERAS? Thanks.
 
Categorical IR: BWH, Henry Ford, USF, MGH, Cornell, Beaumont, Albany, Georgetown, Loma Linda, Maine, AZ, AR, MN, UVA, and Iowa.
Vanderbilt was listed categorical on ERAS, but created Joint Advanced/Preliminary positions. Not sure if any other programs did this. http://www.nrmp.org/wp-content/uploads/2015/08/Joint-AP.pdf
Rush was also categorical on ERAS, but ended up being an advanced program this year. Also, not sure if any other programs did this.
 
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Smoking Jay Cutler said:
Categorical IR: BWH, Henry Ford, USF, MGH, Cornell, Beaumont, Albany, Georgetown, Loma Linda, Maine, AZ, AR, MN, UVA, and Iowa.
Vanderbilt was listed categorical on ERAS, but created Joint Advanced/Preliminary positions. Not sure if any other programs did this. http://www.nrmp.org/wp-content/uploads/2015/08/Joint-AP.pdf
Rush was also categorical on ERAS, but ended up being an advanced program this year. Also, not sure if any other programs did this.
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Michigan too, right?
 
Interestingly, 80 DR --> IR spots,

AND coincidentally,

81 unmatched spots in 2014, most ever for any given match cycle.

Could DR be nearing a dynamic equilabrium of sorts, and people have started figuring that out?
 
Smoking Jay Cutler said:
Categorical IR: BWH, Henry Ford, USF, MGH, Cornell, Beaumont, Albany, Georgetown, Loma Linda, Maine, AZ, AR, MN, UVA, and Iowa.
Vanderbilt was listed categorical on ERAS, but created Joint Advanced/Preliminary positions. Not sure if any other programs did this. http://www.nrmp.org/wp-content/uploads/2015/08/Joint-AP.pdf
Rush was also categorical on ERAS, but ended up being an advanced program this year. Also, not sure if any other programs did this.
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Thanks! Emory was not categorical?
 
m3db01 said:
Ok, I think I just got confused because I read that they had a tailored pre-lim program for their incoming IR residents. Must be something you apply to separately. Thanks!
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yah it's a tailored TY for IR residents but only 2 spots (emory has 4 IR/DR spots)
 
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Where can I find the complete list of 17 categorical programs? I saw Dr. Patel's post on SIR connect today but I can't seem to find the list


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I see that this thread was not renewed as Interventional Radiology interview thread 2017-2018.
 
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