M3 competitiveness and resident/attending lifestyle questions? Help is much appreciated

[Cremaster reflex]

Hi all,

First of all, I have read through the threads on this forum to learn about IR but would like further advice as to 1 if I could realistically expect to match given that I am now halfway through M3 and 2 if it would be a good fit for me given that lifestyle is my most important factor.

I have shadowed in IR and thought it may be the coolest field in medicine but that was only through one attending's eyes and would like more opinions/experiences.

About me:
-Step 1: 263
-So far 5 Rad Onc publications with ~8 more submitting or in review
-10+ abstracts/presentations
-Mostly honors in M3, now halfway through
-Top 20 med school

I don't mean to be neurotic because I know I have done well thus far but I understand that IR is the most competitive speciality and I am unsure how non-IR research will be perceived. I know I would be far from a shoe-in to match, but given my stats thus far is it realistic to assume I would match?


About the field:
Residents: what is your lifestyle/hours like on IR? The works seems really, really cool but are you satisfied with your life at this point? Would you go into the field again?

Attendings: What is you lifestyle/hours like in IR? Do you find you work meaningful? Is this career compatible with family life?



I know this thread is asking a lot but I am halfway through M3 and having serious doubts about the field I initially thought I would go into and its stressing me out, I think IR may be for me but I would like more opinions/advice.

Thank you

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[qxrt]

if it would be a good fit for me given that lifestyle is my most important factor.

Honestly, this statement alone tells me that IR may not be a good fit for for you. IR IS the coolest field in medicine; I have no regrets. That said, if, as per your own words, lifestyle is your most important factor, do not go into IR. It is definitely not a lifestyle field; you will be on call throughout the rest of your career, and depending on how big the institution, may be coming in pretty frequently in the middle of the night. IR is notorious for being a rougher lifestyle than DR. Within just the past 6 months, I've had several call shifts where I worked 24-30 hours straight -- and that's not 30 hours of standby call where you sit around and wait, but 30 hours straight of rounding on patients, writing notes, and doing procedures. Not only that, realize that IR is oftentimes an extremely busy service with never-ending procedures, and every procedure you defer due to wanting to go home on time typically becomes one of your colleague's problems the next day; not a great way to build camaraderie in a department. Don't get me wrong, it is definitely not surgical lifestyle, but on the other hand, the lifestyle is closer to surgery than it is to cush office-hour specialty fields.

The above is my perspective as a fellow. It gets better as an attending, but you will still come in overnight, and even my attendings occasionally do go through straight 24 hour shifts.

That said, at the end of the day, I still feel good about my work, and what gets me through is that the stuff we do is definitely life-saving and helps the patient, usually immediately, and oftentimes IR is considered a last-resort specialty -- we can do things to fix patients when other services are no longer able to offer any potential therapies.

 

[Cremaster reflex]

Honestly, this statement alone tells me that IR may not be a good fit for for you. IR IS the coolest field in medicine; I have no regrets. That said, if, as per your own words, lifestyle is your most important factor, do not go into IR. It is definitely not a lifestyle field; you will be on call throughout the rest of your career, and depending on how big the institution, may be coming in pretty frequently in the middle of the night. IR is notorious for being a rougher lifestyle than DR. Within just the past 6 months, I've had several call shifts where I worked 24-30 hours straight -- and that's not 30 hours of standby call where you sit around and wait, but 30 hours straight of rounding on patients, writing notes, and doing procedures. Not only that, realize that IR is oftentimes an extremely busy service with never-ending procedures, and every procedure you defer due to wanting to go home on time typically becomes one of your colleague's problems the next day; not a great way to build camaraderie in a department. Don't get me wrong, it is definitely not surgical lifestyle, but on the other hand, the lifestyle is closer to surgery than it is to cush office-hour specialty fields.

The above is my perspective as a fellow. It gets better as an attending, but you will still come in overnight, and even my attendings occasionally do go through straight 24 hour shifts.

That said, at the end of the day, I still feel good about my work, and what gets me through is that the stuff we do is definitely life-saving and helps the patient, usually immediately, and oftentimes IR is considered a last-resort specialty -- we can do things to fix patients when other services are no longer able to offer any potential therapies.

I appreciate the response. This is exactly the perspective I am looking for, the work seems awesome and definitely something I would like. I am okay doing call and coming in at night...occasionally. What would you say your average weekly hours are and how are they distributed?

 

[tco]

During call, you come in as many times as you need to come in. It's also not an 8-5 job. What is it, exactly, that you think is so cool about IR? I feel that you're misguided.

 

[clue_cells]

IR is cool to the casual observer but the tedium exists for all specialties. I think this is what the above poster is identifying. DR is much more a lifestyle field. Have you thought about DR? Do you need patient contact?

 

[Cremaster reflex]

IR is cool to the casual observer but the tedium exists for all specialties. I think this is what the above poster is identifying. DR is much more a lifestyle field. Have you thought about DR? Do you need patient contact?

Yeah, unfortunately I do think I need patient contact or else I would go crazy. Thats why I was hoping I could find a job that had a mix of IR/DR, i think that would be ideal for me.

 

[clue_cells]

Yeah, unfortunately I do think I need patient contact or else I would go crazy. Thats why I was hoping I could find a job that had a mix of IR/DR, i think that would be ideal for me.

Rads can have quite a bit of patient contact in mammo which may appeal to the onc side of you. There are plenty of procedures (eg, msk) as well if you want to tailor your practice in that way. Generally, DR has a more broad scope than most give credit.

What you will not get in rads is the continuity available to an oncologist. I think that's the real question you are asking. IR does not have this continuity either, sorry. It may be time to get to the drawing board and figure out what you like doing. Is it clinic? procedures? inpatient? outpatient? It may also be time to figure out what life will be in 20 years. You will need to find the right specialty that you can build your life around. IR is not family friendly and you are pivoting from one of the lifestyle specialties. Have you considered derm or IM subspecialties (H/O, GI, RHEUM)? These are all well reimbursed with varying degrees of good lifestyles.

 

[bluebubbles]

My suggestion is that you consider rad onc. You should be able to get into a top 5 program. That seems like your original plan. I usually discourage med students from pursuing rad onc because of job market issues, and these med students either do med onc if they like cancer, rads/IR if they like imaging, or derm if they don’t give a s*** (ahem, if they like pattern recognition).

IR seems ok, it’s more competitive now and appealing to higher-achieving med students like yourself. But it still has downsides vs. rad onc and always will. You don’t have continuity of care, you have emergent cases (bleeds, ischemia, etc.), and it’s “messier” than rad onc and at least outpatient med onc. The oncologic procedures aimed at tumor control are mainly aimed at symptomatic relief and are generally not as effective in terms of durable oncologic response as surgery, radiation, or systemic therapy (come at me, if you disagree). I see IR like neurosurgery; very competitive, lucrative, tech/procedure-oriented, and self-selecting, but not a lifestyle specialty.

Bottom line, I’d take a very close look at IR since it’s its own residency now. Don’t do it just because all the cool kids are doing it.

 

[irwarrior]

I would state that ablative therapy for HCC in limited disease is as effective as surgical resection. The tools (microwave etc) continue to improve and our options and technology continue to improve and grow. We as a specialty need to improve our data to support our procedures similar to our radonc colleagues. It is not a lifestyle specialty in any stretch of the imagination and there are growing number of IR emergencies that we have to cover. I agree if you want to pursue a lifestyle specialty, IR is probably not a good choice.

 

[SeldingerFan78]

I agree with most of the above advice. If you like imaging, image-guided procedures, and a nice lifestyle, I'd pursue rad onc, body DR, MSK, or mammo. As long as you don't have major red flags or a crappy personality, you should be competitive for rad onc, DR, or IR. If you don't want to commit and keep your options open, DR residency is a great option. Also, if lifestyle is really important to you, you can get away with doing a really laidback TY program for internship in rad onc/DR. Many IR programs will push you to do a surgery prelim year.

 

[Tiger100]

Choosing a medical specialty is somehow a gamble. You don't know whether you like something or not unless you do it for a few years as an independent attending after you finish training.

But one thing is certain. If your lifestyle is your priority (Nothing against it. In fact, it may be a wise decision to prioritize your lifestyle over career; Different strokes for different folks), it gets worse over time. In other words, as you get older, waking up at night becomes harder and harder and you will hate your job. People who are fine working nights at the age of 50, are the same people who don't think about lifestyle at all when they are 30.

If lifestyle is important to you, do Rad-onc, Med-onc, Derm or probably DR. DR is not as life-style friendly as you might think and will get worse over time.

 

[deleted950463]

What about med onc?