is nuclear medicine an edge for a radiologist in private practice

[sonu1234]

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Hey!!! wanted to know whether doing a combined residency in radiology and nuclear medicine (7yrs) a good idea. Would I have an edge over other radiologists in academics or private practice?

 

[f_w]

A 'combined' residency ? What is more typical is that people who don't make it into a rads residency will frequently do a nucs residency in order to have 2 more opportunities to match in rads.
As for the 'edge'. Nucs is a fringe area of radiology. Most of the bread and butter stuff like cardiac and bones a normal board certified radiologist will be able to do. And within radiology groups all you need to cover nucs is one person with a fellowship in nuclear radiology. It is kind of neat and these days probably no particular disadvantage to have nucs training, but at least for the private practice market it is certainly not an 'edge'.

 

[GuP]

are there any such places that offer combined programs?

 

[doepug]

As mentioned above, most people who match into rads who are interested in nucs really have no need of a nucs residency. PET is obviously a burgeoning field, and a nucs/PET fellowship may prove to be an attractive feature for a job candidate. All major academic centers should offer such training, and this should be easily attainable for most rads residents. Good luck!

 

[Molly Maquire]

Do you need a nucs fellowship to treat cancer with radiopharmacueticals?

 

[Docmike2006]

What if you decide in themiddle that you don't want to do nucs? Committing to 7 years is pretty serious.

That said, PET and PET-CT scanning is the future - so nucs people will be in demand.

 

[f_w]

Do you need a nucs fellowship to treat cancer with radiopharmacueticals?

In order to use radiopharmaceuticals like the various labelled CD-20 antibodies, you need a NRC (nuclear regulatory commission) materials license. To get this license, you have to proove proficiency in the use of the particular isotope. Outside of a nuclear medicine residency, nuclear radiology fellowship or radiation oncology residency you are rather unlikely to get this experience.

 

[GuP]

what places offer combined programs?

 

[f_w]

If you are interested in nucs you are best off to do a 4 year rads residency and then a 1 year fellowship. That way you:
- don't spend unneccesary time in training
- actually have a chance to find a job

 

[GuP]

If you are interested in nucs you are best off to do a 4 year rads residency and then a 1 year fellowship. That way you:
- don't spend unneccesary time in training
- actually have a chance to find a job

i hear ya.

but i was just curious as to whether these combined programs exist or are just a myth.

 

[f_w]

I haven't heard about any formal 'combined' programs. What I do hear however is that some nucs residencies (which are harder and harder to fill) have struck a deal with their respective residency program guaranteeing their residents a rads spot after graduation. That way they can lure unsuspecting medstudents into doing a nucs residency.

 

[GuP]

I haven't heard about any formal 'combined' programs. What I do hear however is that some nucs residencies (which are harder and harder to fill) have struck a deal with their respective residency program guaranteeing their residents a rads spot after graduation. That way they can lure unsuspecting medstudents into doing a nucs residency.

is that legal i.e. can a person do dual residencies? i thought the funding would be an issue.

 

[ariwax]

Doing two residencies is legal, but funding is an issue. Being that Medicare will only fully fund postgraduate training for the duration of the first categorical residency you sign to, all but the most well-funded academic programs might see a previous completed residency as a minus of sorts. It may not be a deal-breaker, as it also increases your diversity, etc but it depends on the institution and the individual PD.

 

[f_w]

A misunderstanding out there is that medicare only funds one residency. Medicare funds as many residencies ast you wish, but after you completed the 'initial residency period' (the time it would take to finish the first residency you started), the funding amount drops by about 20k per year (e.g. from 110k to 90k per year).

 

[ariwax]

Hm. My understanding, flawed though it may be, is that a certain percentage of your program's reimbursement comes from direct, and some from indirect medicare compensation. Indirect compensation payments, comprising a variable but hefty proportion of reimbursement, do not change over time regardless of how long ago you started your first residency or how long it was slated to be. Direct payments, though, do get cut after the initial residency's time period has elapsed - immediately and in half, as you are considered as a "half-FTE", or half-full-time equivalent. What this amounts to depends on the particular program's breakdown of funding per resident, but typically might be something like 15-20k per year given the average resident's cost to a program. The graduated continual decrease by 20K/yr with no base reimbursement is news to me. (Keep in mind my undergrad was in music, not economics.)

 

[GuP]

A misunderstanding out there is that medicare only funds one residency. Medicare funds as many residencies ast you wish, but after you completed the 'initial residency period' (the time it would take to finish the first residency you started), the funding amount drops by about 20k per year (e.g. from 110k to 90k per year).

interesting...no offense, but how do you know this?

 

[f_w]

Indirekt 80-120k/year
Direct 20-40k/year

So if DME gets cut by 50% the maximum damage is 20k/year.

(ballpark numbers. The individual payment to the hospital is governed by the formula= (medicare inpatient days / %age of medicare patients) * the number pi / GNP of Angola )

 

[f_w]

interesting...no offense, but how do you know this?

There is a nice little brochure titled 'GME funding, what every resident and medical student should know' issued by the AAMC. Look in the publications section of their website and you will find it.

I had to deal with the issue having done two residencies (btw, if you do a medicine prelim year, your radiology program gets docked for the last three years of your residency because in the goverments computer your initial residency is listed as internal medicine. Only if you do a TY or a surgical prelim your rads program gets paid the full amount)

 

[ariwax]

Indirekt 80-120k/year
Direct 20-40k/year

So if DME gets cut by 50% the maximum damage is 20k/year.

Right. It doesn't keep going down though, the DME just drops to half and stays that way.

As a USIMG who tried for radiology but ended up scrambling this year into a 3-year residency in FP (!), and is still working out how to make the dream happen, Medicare funding is a factor, and therefore so is time.

(I am playing all the options against each other. Finish my FP residency, making connections and doing research along the way, and then reapply to the rads residency in a sister hospital? Take off after a year, do a hard-won pre-residency fellowship in IR at places that know me, try and rematch (or pre-match) there? Return to the country where I went to medical school, do residency there, then return to the US, get a faculty/fellowship position for four years, then petition the ABR for accreditation? Chuck medicine and learn carpentry? If anybody has any input, throw me a rope.)

 

[f_w]

Right. It doesn't keep going down though, the DME just drops to half and stays that way.

That is my understanding from the limited sources on the issue that I could consult (including the GME administrator at my residency hospital who was nice enough to run through the actual numbers with me).

I wish you the best of luck for your pursuit of radiology. Just keep reapplying, it is hard out there for a FMG trying to get into rads these days.

Chuck medicine and learn carpentry?

Plumbing, I tell you, the money is in plumbing.

 

[GuP]

airwax and f_w, thanks for the informative posts.

f_w, if you dont mind answering, what two residencies did you do?

 

[ariwax]

Thanks for the encouragement, f_w. Every little bit helps.

As far as which programs might offer this combined rads/nucs option, nothing turns up on Frieda. I did find two combined NM/IM programs - although one of them seems to be defunct.