Low In Service Exam Score

[cecumbowels]

Hi guys! I am currently a R1 about to start R2 year soon. I just received my in service exam score the DXIT exam score and scored <10% on it, which is not good. I also have not studied much during this year, which I know does not help. I am also at a program where we take true independent call which is going to be starting soon for me. I am definitely not ready to do that.

I am even strongly considering switching to IM, for a number of reasons. I like the material in radiology, but I also miss seeing patients. Anyways taking everything together my low in service exam score and my thoughts towards radiology, I am strongly considering switching back to IM. I honestly do not even know if that would be possible because I do not know where I would get new letters of rec from or other things. Honestly dont know what to do at this point and it makes me sad to see all the time I have wasted if I ultimately switch back to IM. Maybe I should reach out to the IM PD at my institution to see if there is an extra spot.

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[GoPelicans]

You literally have not encountered 95% of the materal on the exam as an R1. I guessed C for almost everything and got a score just slightly worse than yours. Nobody cares. Care more about it next year.

 

[guytakingboards]

I would not take a low in-service score as a sign of your fitness for radiology. All it says is that you haven't been studying. A knowledge deficit/studying can be made up.

I can't speak about your desire to return to clinical medicine, but it's not an uncommon 'grass is greener' scenario. You've spent a lot more time in clinical medicine than radiology so far, so that seems more familiar; meanwhile radiology as an R1 is pretty friggen tough.

I would talk to some attendings you trust or even your PD. They'll tell you if you're so far off you're unlikely to make it in radiology. (Spoiler alert: its super uncommon to be so bad at radiology you gotta leave the specialty).

Independent call is what it is. You will miss stuff. That's to be expected. It's trial by fire but also happens to be one of the best growth periods in a resident's career.

 

[letmebe]

Hey man, I’ve been going through this dilemma of what to switch into for this entire year. To be honest, I got hints of me picking the wrong specialty back during my IM prelim year. I’m jealous that you actually “like” the radiology material. It’s nothing more than a chore to learn all that stuff for me.

I just want to say.. after slightly looking into it.. unfortunately.. for us that are nearing the end of R1 at this point.. your only option is to look for a vacant spot because obviously you can’t swap with other specialties who have yet to go through R1 year. If you look at current vacancies, most are in subpar programs. I also assume that you’d want to do a fellowship and so account for all that training time. One thing to also keep in mind, most IM residents start unsupervised call during their second year. So while you may be able to make your intern year count, do you really feel like you can rev your engines to a second year level in IM. It’s definitely doable in my opinion and I think rads knowledge can still help, but even straight IM residents feel pretty anxious going into second year. Your other option is to repeat intern year, and at that point you have set yourself back in total amount of years in training. Having said all that, I do think it’s completely worth it if you don’t enjoy rads and know you’ll enjoy IM.

In terms of your independent call.. I don’t know what to tell you other than I hear how many bad calls happen at night and the ED is usually aware of it. Unless you will be punished for wrong calls, I would worry more about the CORE exam. And frankly, I wish I had more serious calls because ours are staffed and you’re basically under no pressure. I do think it’s great for learning and developing search patterns.

In terms of passing the boards, that’s a different beast that I’m still trying to figure out. I think I’ve come to the conclusion that I should study at work and take a small hit in terms of numbers of cases I read. I’m tired of planning to study after my shift and then the week passes by and I realize I haven’t done anything. Obviously, studying at work is only possible if you’re not forced to read a certain amount of cases.

I’ve said this before, but now even after nearing the end of R1, I still feel incompetent and sad. And the social life is the worst I ever had. I don’t know if it’ll get better and honestly I don’t know if I’ll fully get through radiology. I do know I just want to be done with training and have very very few hours of work per week and I’m ok taking a pay cut for that. People say this may be possible with rads but I don’t know.

Anyway, I’m posting just to share my personal sentiments which may be similar to what you’re currently feeling. You’re not alone. I don’t know what the best answer is.

 

[cecumbowels]

Wow I really appreciate all the responses and they are helpful!

I exactly feel how you are describing it letmebe. Everyday is a constant struggle if I should push forward in Radiology or switch. I can also say that my social life is the worst I ever had as well. I honestly do not think it will get better. Especially in private practice radiology, the job from what I hear from attending and senior residents is grinding through the list and it gets even more isolating. Furthermore, I dont blame radiology completely for my poor social life because I have never been a really social person for most of my life. However, choosing radiology did not help my social life either.

Also, I dont like bashing Radiology on this subforum because it does have many benefits compared to other specialties (vacation time, salary, working hours, working from home, etc.). Honestly don't know what to do at this point.

 

[RadJon]

You literally have not encountered 95% of the materal on the exam as an R1. I guessed C for almost everything and got a score just slightly worse than yours. Nobody cares. Care more about it next year.

This. R1 exam does not matter at all. At that point I hadn't had cardiac, nuclear medicine, mams, msk... so.. i did terrible

 

[qwerty89]

as an R1 i got >90th percentile on neuro without having had my neuro rotation.
as an R2 i got <10th percentile on neuro after having 2 neuro rotations.

 

[SirGecko]

I get what the people saying “you haven’t seen all the material” are saying but the percentile you are being compared to is your peers. (Who had all seen the same six months of basic rotations that you had when you took the test)

That said I agree that the score on the inservice is not the end all be all of residency success. The thing I’m more concerned about for you op is that you said you haven’t studied all year. You have more time to study as a first year than you ever will again. First year like half of what you should be doing is studying. Do you think you’d be more likely to engage with material if you switched residencies? I would not base a switch decision off this test or fear or taking call. You will have to take call and take tests in IM as well. I think you need to decide what material you feel excited to master.

 

[JasonsMom]

Echoing the comments of everyone else here.

R1 year: did almost no actual studying for my rotations outside of the occasional Brandt and Helms chapter. 50th percentile on the Inservice.

R2: had a busy call schedule, started doing RadPrimer, but not religiously. Also had a kid that year. 25th percentile on the Inservice.

R3: went to AIRP, started to actually care cause the CORE was coming up, and did a lot more RadPrimer. 50th percentile on the Inservice despite getting through 25% of the material before hardcore CORE studying.

CORE exam: passed easily.

The Inservice is probably the worst measure of your abilities as a resident. These questions that they use are crappy questions that were CORE exam rejects. Badly worded, and probably not an actual measurement of your abilities as a resident or your ability to pass the CORE.

Example: had a coresident score ~50th percentile R1, 85th percentile R2, and 50th percentile R3. We did about the same on the actual CORE.

 

[cecumbowels]

Echoing the comments of everyone else here.

R1 year: did almost no actual studying for my rotations outside of the occasional Brandt and Helms chapter. 50th percentile on the Inservice.

R2: had a busy call schedule, started doing RadPrimer, but not religiously. Also had a kid that year. 25th percentile on the Inservice.

R3: went to AIRP, started to actually care cause the CORE was coming up, and did a lot more RadPrimer. 50th percentile on the Inservice despite getting through 25% of the material before hardcore CORE studying.

CORE exam: passed easily.

The Inservice is probably the worst measure of your abilities as a resident. These questions that they use are crappy questions that were CORE exam rejects. Badly worded, and probably not an actual measurement of your abilities as a resident or your ability to pass the CORE.

Example: had a coresident score ~50th percentile R1, 85th percentile R2, and 50th percentile R3. We did about the same on the actual CORE.

Those are really high scores on the in service though, comparing your 50% to my <10%. I understand what you and everyone are saying though in regards to it not being a good metric.

 

[Cognovi]

If you like the material in radiology, you should be studying more. Satisfaction in radiology, in my opinion, comes when you are actually competent and can make a call that somebody else (another radiologist or the referring clinician) might've missed or misinterpreted and YOU are responsible for changing the direction of that patient's care.

 

[RadJon]

Those are really high scores on the in service though, comparing your 50% to my <10%. I understand what you and everyone are saying though in regards to it not being a good metric.

Ok I've seen as low as 5%. That resident crushed CORE and found a great academic job. No one will look at your DIXIT exam.

 

[Derv]

Dont worry about it. I also tanked the exam as an R1 then got better over time. Here are my scores.
- R1 9th percentile
- R2 60th percentile
- R3 - 60th percentile
- R4 - 50th percentile.

I did above national average on CORE exam, probably around 60th percentile. You will be fine.

 

[5777]

With R1 DXIT below 20th percentile, your relative risk of failing Core exam is 2.47.

If you stay below 20th percentile as R2, your relative risk of failing Core exam is 3.83.

Worry more if you can't raise the in-service above 20th percentile as an R3 (relative risk of failing Core goes up to 4.18 if so).

On the other hand, if you can get your in-service over 50th percentile as R3, risk of failing Core is practically zero.

Relationship between DXIT and Core Exam

 

[JasonsMom]

Additonally I know a guy who got in the 11th percentile as an R4 (took the inservice optionally just to see how he’d do prior to the CORE since our exam was moved back due to COVID). He passed.

 

[guytakingboards]

With R1 DXIT below 20th percentile, your relative risk of failing Core exam is 2.47.

If you stay below 20th percentile as R2, your relative risk of failing Core exam is 3.83.

Worry more if you can't raise the in-service above 20th percentile as an R3 (relative risk of failing Core goes up to 4.18 if so).

On the other hand, if you can get your in-service over 50th percentile as R3, risk of failing Core is practically zero.

Relationship between DXIT and Core Exam

I think that's bad data. That assumes a significant correlation between steady long term studying and Core pass rates that just isn't there in my opinion.

In the same way I saw med school classmates in the 3rd and 4th quartiles in the first two years study balls for Step 1 and rock a 240+, I saw plenty of residency classmates not study regularly at all, go balls out on a dedicated study period and easily pass the Core. That type of person/studier absolutely confounds that data.

There was someone in my program who was 1st percentile his R3 year, studied like crazy for 3 months and passed the Core first attempt. Heck, i had one of the in-services be below 10%; i studied balls for two months before the Core and passed easily.

Conversely, there was a guy who the program thought was going to struggle academically and possibly fail the Core exam so they put him on a study plan. He review multiple prior year exams before taking each years inservice and got like 60-70% in his first two years.... then failed the Core exam.

 

[guytakingboards]

Side note: what awful programs are making their R4's take the in-service exam?!? If they've already passed the Core as an R3, there's literally nothing to be gained from taking it as an R4.

 

[JasonsMom]

I’m

Side note: what awful programs are making their R4's take the in-service exam?!? If they've already passed the Core as an R3, there's literally nothing to be gained from taking it as an R4.

He took it mostly cause he was nervous about how he’d do on the CORE. The In-Service the year we took the CORE as R4s (because of COVID) happened right before the exam. Needless to say the in-service had zero predictive value on how his CORE performance went.

The rest of us did not take the in-service.

 

[5777]

I think that's bad data. That assumes a significant correlation between steady long term studying and Core pass rates that just isn't there in my opinion.

Ummm---I don't think you understand the concept of relative risk or empirical data. That data can't be "bad"--it is what was observed. The conclusions one draws from that data can be faulty, but the data seems pretty straightforward to me.

Most residents pass the Core.

If you look at that data, of the R3 residents who scored in the 1st quintile, 38% failed--that means 62% passed. Your colleague is one of these.

Of the R3 residents who scored above 50th percentile, only 1% failed--both residents who had scored in the lowest quintile as R2s.

The point wasn't that the OP needed to study for the in-service. The point was that the in-service gives the OP a reasonable idea of if they are on track for Core success or whether they are at increased risk of failure compared to peers. In fact, one could make the argument that you should NOT study for the in-service by looking at old tests, etc. Use the in-service as a measure.

Of course, if I just wasn't putting in any effort, then low in-service scores as an R1 and R2 are meaningless. OP says he/she/they have not really been studying radiology because not sure if the field is a good fit. In that setting, getting a low R1 in-service is NOT an indication of your suitability for radiology. Getting a low score on the in-service as an R1 is to be expected if one puts in no effort to learn the material (for whatever reason, including the notion that the material is not of interest).

If I were the OP, I would discount the in-service results as a measure of how good I would be as a radiologist given the fact that OP hasn't put in any effort. If I decided to give Radiology another year, I'd put in some effort and use the R2 in-service as a benchmark for how well I was getting the concepts in radiology that faculty want to test--i.e., how well I was studying (not how hard).

If I felt that I was putting in adequate effort for learning radiology but not getting good in-service scores (above 20th percentile), then I would do a self-intervention at the end of the R2 year, and either (1) get out, since it is clear there is no interest; or (2) figure out a better way to tackle the material.

 

[RadJon]

Honestly brant and helms for the most part is very dry... there's much better books out there for the various modalities that are better at explaining imaging patterns.

You could also buy the UCSF or wash u rad lectures and see how other residents are being spoonfed.

Both options are way better than b&h. I had to read it like 8 times to get it to stick and retrospectively I wish I did other means of learning the material than wasting my time on the so called bible.

 

[guytakingboards]

Ummm---I don't think you understand the concept of relative risk or empirical data. That data can't be "bad"--it is what was observed. The conclusions one draws from that data can be faulty, but the data seems pretty straightforward to me.

Most residents pass the Core.

If you look at that data, of the R3 residents who scored in the 1st quintile, 38% failed--that means 62% passed. Your colleague is one of these.

Of the R3 residents who scored above 50th percentile, only 1% failed--both residents who had scored in the lowest quintile as R2s.

The point wasn't that the OP needed to study for the in-service. The point was that the in-service gives the OP a reasonable idea of if they are on track for Core success or whether they are at increased risk of failure compared to peers. In fact, one could make the argument that you should NOT study for the in-service by looking at old tests, etc. Use the in-service as a measure.

Of course, if I just wasn't putting in any effort, then low in-service scores as an R1 and R2 are meaningless. OP says he/she/they have not really been studying radiology because not sure if the field is a good fit. In that setting, getting a low R1 in-service is NOT an indication of your suitability for radiology. Getting a low score on the in-service as an R1 is to be expected if one puts in no effort to learn the material (for whatever reason, including the notion that the material is not of interest).

If I were the OP, I would discount the in-service results as a measure of how good I would be as a radiologist given the fact that OP hasn't put in any effort. If I decided to give Radiology another year, I'd put in some effort and use the R2 in-service as a benchmark for how well I was getting the concepts in radiology that faculty want to test--i.e., how well I was studying (not how hard).

If I felt that I was putting in adequate effort for learning radiology but not getting good in-service scores (above 20th percentile), then I would do a self-intervention at the end of the R2 year, and either (1) get out, since it is clear there is no interest; or (2) figure out a better way to tackle the material.

Perhaps I phrased my point incorrectly, because as you’ve pointed out: data is data.

But I think even your post agrees with the notion that using in service scores to determine a) ultimate fitness for radiology or b) core pass rates is sketchy at best if you’re not putting your best foot forward on the studying front. Call me crazy but I think that’s a pretty substantial number of people. Maybe people as a whole don’t cram to the degree I or my colleague did but it really skews the utility of the inservice score if people aren’t studying steadily.

 

[MadRadLad]

Can only speak for a few people but I have never met anyone who actually studied for the DXIT, maybe just as part of their usual prep for the R3 one prior to CORE coming up. Some programs I think push their residents more to do well. Others don't care and maybe will have a talk with you if you get under 10th percentile.

 

[5777]

But I think even your post agrees with the notion that using in service scores to determine a) ultimate fitness for radiology or b) core pass rates is sketchy at best if you’re not putting your best foot forward on the studying front.

Agree.

Can only speak for a few people but I have never met anyone who actually studied for the DXIT, maybe just as part of their usual prep for the R3 one prior to CORE coming up.

Agree.

Again, to be clear, I was not making a case for studying for the DXIT.

To summarize the issue: OP did poorly on DXIT as R1, admits hasn't studied radiology, is now wondering if low R1 DXIT score somehow points to unsuitability of radiology as a career.

Quick answer: No.

Nuanced answer: The low R1 DXIT score doesn't mean you won't be a good radiologist. However, if you can't get motivated to study/learn radiology, you will have some problems including struggling to pass Core. You can use the next DXIT (the total score, not the individual section scores which are probably meaningless) as a measuring stick to assess your progress.

Plan: Assuming you haven't already decided to bail on radiology, put in more effort to study/learn radiology over the next year (2nd half R1 and first half R2). Don't study FOR the DXIT, but definitely do some more studying of radiology because what you are doing so far isn't really cutting the mustard. Use your R2 DXIT score to assess your efforts in learning radiology (not studying for the test)--if you stay below 20th percentile DESPITE putting in some effort, there's now better evidence that you are "not getting it", and you are at increased risk to fail the Core. That doesn't necessarily mean you won't be a "good radiologist", but there is an issue--assuming you were trying.

Now, maybe your program is one of those where the R2 year is super stressful, the clinical work you do is not broadly representative of "general radiology", you never really got to put in effort into learning stuff leading into R2 DXIT, and/or you had a bad day. OK--but maybe your heart really just isn't into it. With a poor R1 and R2 DXIT, decide if you really want to be a radiologist, not because the combined poor R1 and R2 DXIT mean you can't be good but the consistency of poor results might mean your heart or your brain just aren't suited for the field. If your heart just isn't into it, that would be the time to bail.

If you choose to continue because your heart is ok with it and can't get your R3 DXIT above 20th percentile because your brain isn't suited for it, then alarm bells should be ringing. At that point (after finishing 2.5 yrs of radiology), it's too late to not finish radiology, IMO. Finish but get a tutor, do something different, to prepare your brain for the Core because in the absence of doing that, you have at least a 35% chance of failing the exam on your first try. Which isn't the end of the world--eventually you will pass.

Once you pass the Core, seek out what little niche of radiology you actually can intellectually master and do that. Radiology has enough diversity of material that you can probably find that niche.

All assumes your heart is ok with it--not that you love radiology, but that you don't hate it.

 

[enamor2]

I hope you don't mind me putting in my 2 cents.

Soaped radiology, wanted surgery. 3 days before match, I remember distinctly saying "i'd rather die than do radiology, i hate pictures"- not lying or exaggerating btw. Took what I got though in SOAP. Started IM, was good at it, and then rads. Terrible at it. Suffered through, managed to pick up findings/enough knowledge to get through independent call at my program. Did well though. Always thought I should do clinical medicine, and wanted out. Didn't end up transferring to another specialty because hey- well, lifestyle. I scored below 10th percentile on my first Dxit too LOL.

Residency goes on, my last year, Ended up transferring my fellowship into a field I truly dislike (personal reasons, had a fellowship I loved and transferred to another subspecialty of radiology I said I'd never do). Hated that too. In fact, I dreamed of quitting.

Ended up finding my niche of radiology- and I love it. First time since I started training I can honestly say I LOVE going to work. Love my job. Can't imagine doing anything else.

Was it worth suffering through 7+ years of stuff I hate? YES.

So you never know how it's going to work out.

 

[Neopolymath]

I hope you don't mind me putting in my 2 cents.

Soaped radiology, wanted surgery. 3 days before match, I remember distinctly saying "i'd rather die than do radiology, i hate pictures"- not lying or exaggerating btw. Took what I got though in SOAP. Started IM, was good at it, and then rads. Terrible at it. Suffered through, managed to pick up findings/enough knowledge to get through independent call at my program. Did well though. Always thought I should do clinical medicine, and wanted out. Didn't end up transferring to another specialty because hey- well, lifestyle. I scored below 10th percentile on my first Dxit too LOL.

Residency goes on, my last year, Ended up transferring my fellowship into a field I truly dislike (personal reasons, had a fellowship I loved and transferred to another subspecialty of radiology I said I'd never do). Hated that too. In fact, I dreamed of quitting.

Ended up finding my niche of radiology- and I love it. First time since I started training I can honestly say I LOVE going to work. Love my job. Can't imagine doing anything else.

Was it worth suffering through 7+ years of stuff I hate? YES.

So you never know how it's going to work out.

Tell us about the fellowship you love.

 

[letmebe]

@enamor2

Please do tell how you found your love and passion. And also, how is it that you think 7 years of torture is worth it?

I'm losing hope more and more with every passing day.

I wish there's an out. I cannot fathom delaying my attendinghood after putting in 2 yrs in rads residency + 1 prelim. This is why I feel stuck. I wish I can guarantee I'd be happy in something else that I can switch into. That would make me stomach the extra years no problem and I would make the jump in a heartbeat.

I just know, I hate pure and exhaustive cerebral work and grinding through a never ending list in a sweatshop with declining reimbursements and constantly fighting and competing to be labeled a good+fast radiologist, since everything is relative after all.

Smh...

 

[LongDogLife]

Hi guys! I am currently a R1 about to start R2 year soon. I just received my in service exam score the DXIT exam score and scored <10% on it, which is not good. I also have not studied much during this year, which I know does not help. I am also at a program where we take true independent call which is going to be starting soon for me. I am definitely not ready to do that.

I am even strongly considering switching to IM, for a number of reasons. I like the material in radiology, but I also miss seeing patients. Anyways taking everything together my low in service exam score and my thoughts towards radiology, I am strongly considering switching back to IM. I honestly do not even know if that would be possible because I do not know where I would get new letters of rec from or other things. Honestly dont know what to do at this point and it makes me sad to see all the time I have wasted if I ultimately switch back to IM. Maybe I should reach out to the IM PD at my institution to see if there is an extra spot.

I wouldn't put too much thought into this. I'm pretty sure I scored around the same as you as an R1, then around 15th percentile for R2, then 39th percentile at an R3. I still passed the core comfortably and did fine during call. Just start studying and building a foundation. Also try to read as many cases as you can while on rotation. You will be fine!

 

[GoPelicans]

I recently passed my CORE. I got 0% percentile as an R1 and around 5% as an R2. Simply didn't study board-relevant stuff, prob was a mistake but I was doing well at work so didn't think much of it. I also just guessed C on 90% of the questions in my R1 year. 45% as an R3. Passed with a fairly average score. It's an exam, and can be prepared for like literally any other standardized exam you have taken over the past 10 years. I also knew absolutely nothing about physics until maybe March, which in hidsight I wish I looked at sooner (barely passed physics).

 

[bronx43]

@enamor2


I just know, I hate pure and exhaustive cerebral work and grinding through a never ending list in a sweatshop with declining reimbursements and constantly fighting and competing to be labeled a good+fast radiologist, since everything is relative after all.

Smh...

As opposed to pure, exhaustive customer service work, grinding through a census or clinic schedule in a sweatshop with declining reimbursement and social BS, patient complaints, prior authorizations, peer to peers?

Stick with rads. The grass ain't greener. There's nothing but festering bull excrement on this side of the fence.

 

[odyssey2]

As opposed to pure, exhaustive customer service work, grinding through a census or clinic schedule in a sweatshop with declining reimbursement and social BS, patient complaints, prior authorizations, peer to peers?

Stick with rads. The grass ain't greener. There's nothing but festering bull excrement on this side of the fence.

Which side of the fence is that? Chill clinic work in fields like derm, ophtho, allergy can be amazing.

 

[bronx43]

Which side of the fence is that? Chill clinic work in fields like derm, ophtho, allergy can be amazing.

The clinical side. Derm has some demanding patients, especially if you're in a major metro area. I honestly wouldn't want to deal with those people. The pace is also breakneck... they see 40-50/day.
My hours are great (8-5 4.5 days), and even pace is ok as a rheumatologist (15-18/day). But the customer service aspect of all patient-facing specialties really wears you down, and can be absolutely intolerable at times.

 

[MadRadLad]

Which side of the fence is that? Chill clinic work in fields like derm, ophtho, allergy can be amazing.

Most people I know in those fields don't have "chill clinic" work, they see an insane amount of patients back to back especially in group settings. If you hang up a shingle and are okay with making a lot less to control you schedule more, you could potentially do it but you also will have to manage the business end and overhead. "Amazing" probably doesn't exist in medicine now outside of certain exceptions.

Not saying you can't find better gigs, but there's no free lunch. And derm requires you to pretty much bat flawlessly in med school and be a social media marketer.

 

[deleted1111261]

Radonc here. Some overlap with how people feel when they start RO - it's so different. Same issue with our in-service, too. "Mentors" that drag you down. Very smart colleagues, some that just pick up things quicker and make it hard to relate since there is only a few of you in a given cohort.

The part I wonder about is that OP and another person mentioned social life. And, 12 years out from training, I've started to think about this with regards to specialty selection. If your day to day and your colleagues don't brighten occasionally make you happy or brighten your mood, it just may not be a good fit. Doesn't mean you wouldn't kill it at dx rads in a few years or find some sort of satisfaction. But, I wonder if I spent more time thinking of the type of people and "setting" that I would be in, I probably would have been happier in something not RadOnc.

You may have enjoyed IM because you enjoy being on the floor or around other internists. To tell you the truth, I like hospitalists and medicine specialists. I feel like I have way more in common with them. And sometimes even if the subject matter or hours or lifestyle is not what you thought you would like, being around like minded people can make you like your job. Hospitalists look like they are having fun - interacting with everyone else, coordinating care, etc. It seems kinda fun for an extrovert like me! I had so much fun as an intern and I look back on that year so fondly.

It's just a thought! In my opinion, I think it's just the nature of medical training that is getting you down. You will most likely learn this stuff and be an excellent radiologist. But, if you choose not to, there is always a way out (especially this early in training). You will need like 2 weeks as a PGY2 in IM to fit back in again.

 

[letmebe]

@RealSimulD

Even though I’m way more junior to you.. I totally agree and wish I had someone like you give me this advice back when I was an early R1.

I have no hate or ill will towards any of my co-residents. They are all very nice and helpful. But I zero relate to almost any of them. I know for a fact it’s not my type of people. I reminisce on the days of intern year and how fun and collegial it was back then.

Too bad I don’t have the courage to make a switch. I’ve worked hard to start having a productive rhythm in rads. And now, in addition to the lack of courage, I just don’t know if I have the energy to go through a big hassle and huge re-adjustment. And who knows, what if I don’t match after declaring to my program I don’t want rads anymore. It would be very awkward to continue, if they let me continue. Also, I still am not certain what I’d switch into, although anything with a little bit more of a social interaction would be more desirable in my case.

For now, I look at myself as if I’m serving time in a prison cell. Ironic cause the lifestyle is not that bad. But I feel like I just have to serve 5 years and may be somehow find something that I enjoy after. Just sad that when I look at our graduates who secured really nice jobs, they describe their work as the only radiologist sitting in an outpatient center dictating in a closet all day. Makes me cringe.

 

[MadRadLad]

@RealSimulD

Even though I’m way more junior to you.. I totally agree and wish I had someone like you give me this advice back when I was an early R1.

I have no hate or ill will towards any of my co-residents. They are all very nice and helpful. But I zero relate to almost any of them. I know for a fact it’s not my type of people. I reminisce on the days of intern year and how fun and collegial it was back then.

Too bad I don’t have the courage to make a switch. I’ve worked hard to start having a productive rhythm in rads. And now, in addition to the lack of courage, I just don’t know if I have the energy to go through a big hassle and huge re-adjustment. And who knows, what if I don’t match after declaring to my program I don’t want rads anymore. It would be very awkward to continue, if they let me continue. Also, I still am not certain what I’d switch into, although anything with a little bit more of a social interaction would be more desirable in my case.

For now, I look at myself as if I’m serving time in a prison cell. Ironic cause the lifestyle is not that bad. But I feel like I just have to serve 5 years and may be somehow find something that I enjoy after. Just sad that when I look at our graduates who secured really nice jobs, they describe their work as the only radiologist sitting in an outpatient center dictating in a closet all day. Makes me cringe.

That's not how all jobs are. My rads colleagues are more collegial and fun than my intern year ones were, everyone on the floors seemed way more burned out by social work and other bs that they were fine but basically wanted to get done with the work and leave. The prelims I worked with who went to other fields also seem more burned out. But this is very program and hospital specific - just know that there is variety in everything.

In any case, i'm sorry you have to go through this, but you have to make some concessions to your mindset or you're going to keep being miserable. Easier said than done of course but maybe see what else you can do or learn that would allow you to flex away from doing pure DR work in the future, maybe something more interactive like IR or peds in a more academic setting, or even industry work like consulting, tutoring/teaching etc. You can also work from home and make good money while still having a life outside of medicine.

If you were able to match rads and you wanted to switch to IM, I'd be really surprised if you couldn't match. Many programs would love to have someone like that. But be warned, it will be hard to come back to rads if you ever did want to. My program had 2 people transfer out over 5-6 years, both of them asked to return within 6 months but we had filled the spots and they were stuck with the programs they went to.

 

[odyssey2]

That's not how all jobs are. My rads colleagues are more collegial and fun than my intern year ones were, everyone on the floors seemed way more burned out by social work and other bs that they were fine but basically wanted to get done with the work and leave. The prelims I worked with who went to other fields also seem more burned out. But this is very program and hospital specific - just know that there is variety in everything.

In any case, i'm sorry you have to go through this, but you have to make some concessions to your mindset or you're going to keep being miserable. Easier said than done of course but maybe see what else you can do or learn that would allow you to flex away from doing pure DR work in the future, maybe something more interactive like IR or peds in a more academic setting, or even industry work like consulting, tutoring/teaching etc. You can also work from home and make good money while still having a life outside of medicine.

If you were able to match rads and you wanted to switch to IM, I'd be really surprised if you couldn't match. Many programs would love to have someone like that. But be warned, it will be hard to come back to rads if you ever did want to. My program had 2 people transfer out over 5-6 years, both of them asked to return within 6 months but we had filled the spots and they were stuck with the programs they went to.

They realized the grass wasn't actually greener on the non-rads side? What did they switch into?

 

[MadRadLad]

They realized the grass wasn't actually greener on the non-rads side? What did they switch into?

IM (with intention to do GI or cards) and anesthesia. Anecdotally I also know people across the country (not my hosp) who did a year of surgery and transferred into either rads or anesthesia and are much happier.

To be honest, rads has its own set of downsides. For some, these relatively minimal to other fields. Personally I hate social work and dispo stuff which many fields cannot avoid. So I can deal with the negatives of rads, because overall I like what I do and find satisfaction in it. My point was to OP that if he is truly so miserable, you're better off at least exploring those other options because it doesn't make sense to do something you hate for so long, or finding a way to get some positives out of doing this work. But just a fair warning that it's hard to come back if your new field isn't what you thought it would be so just do your research and ask around a lot.

 

[odyssey2]

IM (with intention to do GI or cards) and anesthesia. Anecdotally I also know people across the country (not my hosp) who did a year of surgery and transferred into either rads or anesthesia and are much happier.

To be honest, rads has its own set of downsides. For some, these relatively minimal to other fields. Personally I hate social work and dispo stuff which many fields cannot avoid. So I can deal with the negatives of rads, because overall I like what I do and find satisfaction in it. My point was to OP that if he is truly so miserable, you're better off at least exploring those other options because it doesn't make sense to do something you hate for so long, or finding a way to get some positives out of doing this work. But just a fair warning that it's hard to come back if your new field isn't what you thought it would be so just do your research and ask around a lot.

What are the negatives unique to rads would you say?

 

[MadRadLad]

I wouldn't say the negatives are unique. The work is unique. Volumes are very high and rads has a relatively unique pressure for accuracy because our reports and images are always available for someone to retroactively check. Turn around time matters too at the corporate level. The amount of necessary knowledge is extremely high, and the boards are very difficult. While there can be social interaction, there is the "sit down and crush the list" element that some other fields don't have, which results in less downtime. You often have to learn/do a variety of procedures, especially poorly paying stuff that other fields don't want.

Perks are less charting, social work, annoying patients. More flexibility in working from home, etc. Good mix of variety in the right gigs and can mix procedures in. Nice opportunity to work with other clinicians and provide input (can be a pro or con). Pay and vacation is better than some fields although you work very hard for this and you need it to prevent burnout.

Grass is always greener. Pick what you like and understand you are going to have to make some compromises in any field.

 

[letmebe]

@MadRadLad

You’re right I have to change my mindset. I’m working on it. The risks/reward of switching right now is too high. I can’t guarantee happiness in any other field at this point. I think, for me at least, once you have 2/3 of the harder years in rads done, there’s a high chance that I’ll hate myself for not finishing it and moving on with life. I’ll see about IR, barely have any exposure to it. But, in addition to it being a terrible lifestyle and surprisingly lowly compensated (found out that the higher IR salaries are due to more call and cramming reads in between cases), what worries me is the increased risk of cancer. There are studies definitely proving for eg increased brain cancer risk. I don’t know, may be I’ll take my chances and try to retire early. I won’t lie, going over cases and figuring out weird things can be fun at times, but it’s the endless hours of doing it in solitude that gets me. May be I’ll post what the end result of my journey is. Prayers appreciated.

 

[MadRadLad]

Wish you best of luck. Try to find a job where you work with residents, this may keep you a little more engaged and give you some satisfaction from teaching. Good luck and power through. As you said, the hardest years you're almost through and things do get better when you're not second guessing yourself over the most basic findings and can provide more valuable service to patients and clinicians.