MSK vs Body fellowship?

[Chequepues]

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I like both body and MSK, but I've heard conflicting things about the marketability of a body fellowship. I really like different things about each one and am hoping for more information, particularly relating to private practice to tip me one way or the other since so far I've only seen the academic side of things. Any insight would be greatly appreciated!

 

[guytakingboards]

Good question. Pretty common question too.

I'm in PP and am neither a body or MSK-trained rad.

My group (honestly) doesn't hire a ton of body-trained rads. but if they do, there are a few things they look for:
1) can crush a stack of general studies (CT/MR/US/PF)
2) can crush a stack of cancer follow-up's quickly. (reading 40-50 cancer f/u CT's per day)
3) can do entire spectrum of non-vascular procedures (thoras/paras/LP's/thyroids plus CT/US guided drains and biopsies)
4) can be the body MR expert.
5) +/- can read mammo

There's always gonna be a place for the body-MR guy and/or the body procedures guy. Non-body people can't fill those roles super comfortably. IMHO a group is never gonna regret hiring a guy comfortable with body procedures if they have any hospital seats.

Flip side. MSK in PP runs the gamut. Some places MSK only reads 20% in specialty and are otherwise generalists. The most sub-specialty MSK i've heard of in PP is 60-80% (short of being a boutique MSK-only practice).

Pro's of doing an MSK fellowship:
1) you like the pathology/modalities (most non-MSK trained people shouldn't be reading MRI beyond shoulders and knees)
2) you like and want to build an MSK-specific procedure practice
2) you like the referrers (Ortho, Pain, Rheum and PM&R).

Ultimately it comes down to your preferences and also the needs of any group/city you'd be looking to move to. If a group NEEDS an MSK guy they're going to hire an MSK guy. If a group just needs to add a warm body, they can't go wrong with hiring a body guy comfortable with procedures and MRI.

 

[Chequepues]

Thanks for this! It was incredibly helpful. On average, how much of one's day is comprised of procedures for an MSK radiologist in PP? Also, are there more opportunities for outpatient MSK vs Body?

 

[guytakingboards]

Highly variable depending on how the practice is set-up. A smaller group probably doesn't have the volume of MSK procedures and a lot of your time will be spent reading general and/or doing general procedures. Heck even a lot of larger groups aren't going to devote a ton of resources to MSK procedures because an MSK rad is way more valuable reading MRI's than doing joint injections.

Obviously the caveat is if you join a boutique-MSK only group or decide to work for an ortho group, they may have a pretty decent MSK procedure volume.

 

[Tiger100]

In many places all the needle work is done by IR. Rural practices are different story.

Anyway, the difference in marketability of Body versus MSK is not significant. In the recent years, Body is a little more marketable mostly due to Body MR. But as the groups hire enough body rads, things may change. The exact thing happened to MSK in the last decade. Most groups were looking for someone who can read their MSK MRIs. Once they hired enough people, the hot market of MSK cooled down.

MSK MRI and Body MRIs are not emergencies. They can sit on the list for 1-2 days. As a result, many groups can function well with only 1-2 body or MSK rads.

Body CT can be hard but in most private practices it is considered general radiology and everybody reads them.

 

[LittleFoot]

Thank you all for your input. Is there any significant change in lifestyle between an MSK trained vs Body trained rad in private practice? Also, I know body fellowships are not through the match. Is it also less competitive than MSK overall?