IR vs Diagnostic Rads?

[fizzle]

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I'm just a med student, but I've been somewhat confused by the distinction between IR and diagnostic radiology.

Here's what I do understand: IR requires an additional year or two of fellowship after a DR residency, and the DR residency often includes quite a few IR procedures.

My confusion arises from the fact that, aside from the use of imaging modalities such as MRI's and X-rays, the two fields appear to be completely different: DR seems to simply involve studies of x-rays and MRI scans on a computer screen, while IR seems to be a completely surgical/procedural field that just happens to use MRI and x-rays to visualize surgical techniques. If this is the case, then what happens if I'm interested in IR but not DR as much? What if I want to perform procedures in IR, but I don't want to simply sit in front of a computer all the time in DR? It doesn't seem as if an IR fellowship is a guarantee after a DR residency, so do people who want but don't get into an IR fellowship get "stuck" with DR?

Could someone clarify this for me?

 

[Gute]

DR residents who want to do IR will be able to get a fellowship. Not a ton of residents go into DR wanting to do IR in the end, and alot of those residents ultimately decide in the end that IR isn't for them.

Realize that MSK, neuro, and body radiologists (who all fit under the DR designation) also do interventional procedures. That being said, these radiologists generally spend time reading out images rather than doing procedures.

 

[penguin24]

IR has a worse lifestyle than DR, thus many people say IR has more of a 'surgeon's lifestlye'. Thus you can see how the type of people who went into DR in the 1st place may not care much for IR. Basically, IR isn't that competitive, so you would likely match.

You worrying about not getting into IR is like a pre-med having second thoughts about med school b/c he's worried that he won't match into a Family Practice residency and he might be 'stuck' doing Derm/Plastics. (in this case the pre-med doesn't know that FP is not competitive).

However, even if you get into DR, successfully match into a IR fellowship, when you get a job the Rads group may only have you do 50% IR and 50% Gen Rads. At my hospital, each Rads subspecialist does his own area (Mammo, IR, MSK, Neuro, etc), but on the weekends when they take call they are responsible for all modalities, so for example the Neuro guy on call on Saturday may have to read Body CT's from the ED. So if you really can't stomach sitting in front of a computer looking at pictures, you shouldn't get into IR. From my understanding, only a small minority of Interventional Radiologists have a practice where they do only IR, the vast majority do at least some General Rads.

 

[fizzle]

Thanks for your responses; I'm getting a better idea now.

IR has a worse lifestyle than DR, thus many people say IR has more of a 'surgeon's lifestlye'. Thus you can see how the type of people who went into DR in the 1st place may not care much for IR. Basically, IR isn't that competitive, so you would likely match.

You worrying about not getting into IR is like a pre-med having second thoughts about med school b/c he's worried that he won't match into a Family Practice residency and he might be 'stuck' doing Derm/Plastics. (in this case the pre-med doesn't know that FP is not competitive).

However, even if you get into DR, successfully match into a IR fellowship, when you get a job the Rads group may only have you do 50% IR and 50% Gen Rads. At my hospital, each Rads subspecialist does his own area (Mammo, IR, MSK, Neuro, etc), but on the weekends when they take call they are responsible for all modalities, so for example the Neuro guy on call on Saturday may have to read Body CT's from the ED. So if you really can't stomach sitting in front of a computer looking at pictures, you shouldn't get into IR. From my understanding, only a small minority of Interventional Radiologists have a practice where they do only IR, the vast majority do at least some General Rads.

That 50% IR/50% DR sounds perfect to me. I don't mind spending part of my time looking at a computer screen; it's just that I don't want it to be the ONLY thing I do all day, every day. I'm looking for at least some patient contact, which is why I'm interested in IR. And to be honest, I'm surprised that IR isn't competitive (relative to DR). I thought it was a popular option. I guess not.

 

[C5toC9]

I thought IR fellowships were getting a lot more competitive?

 

[penguin24]

I thought IR fellowships were getting a lot more competitive?

Although I am far from an expert in the competitiveness, I've been interested in Rads for a number of years already and have NEVER heard of a Radiology resident who couldn't match into IR and had to do something else. (of course there will always be somebody who knows this 1 guy who fits this profile, but I don't put much stock into anecdotal evidence).

From my understanding, Rads fellowships are not competitive in general. The hard part is getting into Rads, and once you're in you have a very reasonable chance of getting your specialty.
*Contrast this w/ surgery, where matching into GenSurg is easy. Yet getting a Plastics/NSGY fellowship is tough.

 

[werewethere]

Although I am far from an expert in the competitiveness, I've been interested in Rads for a number of years already and have NEVER heard of a Radiology resident who couldn't match into IR and had to do something else. (of course there will always be somebody who knows this 1 guy who fits this profile, but I don't put much stock into anecdotal evidence).

From my understanding, Rads fellowships are not competitive in general. The hard part is getting into Rads, and once you're in you have a very reasonable chance of getting your specialty.
*Contrast this w/ surgery, where matching into GenSurg is easy. Yet getting a Plastics/NSGY fellowship is tough.

Actually, this last year's IR match was the most competitive in years. It's a combination of an excellent IR job market, new procedures, and slowly growing awareness among clinicians of what IR can do. Although there still are a few spots that didn't fill, they were mostly at somewhat marginal programs, as all the top programs filled. The other thing to keep in mind about radiology fellowships in general and IR fellowships in particular is that it can be very competitive to get into a desirable program if you do not come from that program. There is a tremendous amount of internal filling that occurs, and a program may show 4 or 8 spots available, but only really have 1 that they will match outside. And lastly, remember that there is a wide variety of types of IR fellowships. Some are very clinically oriented, others are a little more procedural and without clinic. Some are IO intensive, some focus more on PVD, others focus on a mixture. And don't forget other IR fields that have their fellowships such as peds IR and neuro IR.

 

[werewethere]

Here's a link to the NRMP results this year:
http://www.nrmp.org/fellow/match_name/radiology/stats.html

 

[phatfarm]

I'm just a med student, but I've been somewhat confused by the distinction between IR and diagnostic radiology.

Here's what I do understand: IR requires an additional year or two of fellowship after a DR residency, and the DR residency often includes quite a few IR procedures.

My confusion arises from the fact that, aside from the use of imaging modalities such as MRI's and X-rays, the two fields appear to be completely different: DR seems to simply involve studies of x-rays and MRI scans on a computer screen, while IR seems to be a completely surgical/procedural field that just happens to use MRI and x-rays to visualize surgical techniques. If this is the case, then what happens if I'm interested in IR but not DR as much? What if I want to perform procedures in IR, but I don't want to simply sit in front of a computer all the time in DR? It doesn't seem as if an IR fellowship is a guarantee after a DR residency, so do people who want but don't get into an IR fellowship get "stuck" with DR?

Could someone clarify this for me?

Fizzle,
Great question. I don't think I fully understood what IR was all about as a medical student. I definitely have a much better understanding as a radiology resident.

Diagnostic Radiology uses a variety of imaging modalities to help clinicians make their diagnoses.

Interventional Radiology uses a variety of imaging modalities to perform minimally invasive interventions to help a patient with a condition. Often these minimally invasive treatments results in a much shorter length of stay and recovery time than open surgery.

Right now, one of the pathways of doing interventional radiology is first completing one year of intership (PGY 1) followed by 4 years of diagnostic radiology (PGY2-5) followed by one year of IR fellowship (PGY 6).

However, we also have a direct pathway. I unfortunately don't know too much about it. I've included the link below. Perhaps one of the direct pathway residents can chime in.

http://www.sirweb.org/fellows-residents-students/DIRECTpathway.shtml

I know it does seem like a long road just to do IR. I knew I wanted to do IR even before residency. But I feel fortunate to have all the diagnostic training that I have had because I really feel it will help me as an interventionalist.

To answer your last question, you are correct that an IR fellowship is not guaranteed by any means. This past year was very competitive, perhaps the most competitive year thus far. But don't let that dissuade you. There are a number of excellent IR fellowships out there. Most say you get one of your top 3.

Please PM me if you have any more questions about radiology or IR.

- phatfarm