Hate to sound like a complainer/whiner/quitter but I'm not liking rads (just started pgy2 year in july) and am having very serious second thoughts. ultimately gut is telling me I would not feel proud of being a radiologist. it's late in the game to feel that way, but any residents further along in the path with experience with this and can give me some perspective?
Not liking rads
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Quit rads and go into FM or IM if you want to feel more like a "doctor". Somebody else will want your spot.
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My dad is a radiologist and we were discussing how he picked his speciality. He talked about how he truly regretted his choice for quite sometime. He hated radiology and felt as if he should've gone into surgery. He pushed through because, at the time, he had no other real option. Now he doesn't regret it, he came to terms with the things that he was missing on before and was able to throw a bit of a substitute in by doing a fellowship. I'm not saying that is going to be you, but it doesn't seem to be tremendously uncommon to have a bit of buyer's remorse with something that is a significant life decision.
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What other specialties were you considering before you chose radiology? I'm a 3rd year student and I think I'll feel the same way as you if I go into radiology.
I'm intrigued, what is it about Rads that you don't like?
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Hmm...you wouldn't feel "proud" to be a radiologist? I find that humorous.
I'm curious, how as a first year (first month) radiologist you can be at a point where you feel you couldn't be proud about doing something that you aren't even good enough yet to be a beginner in? At this point, I'm assuming you know like 1% of what the average 2nd-3rd year radiology resident knows. If I were to throw a stack of thirty CT's, MRI's, ultrasounds, and nucs studies and give you 2-3 hours to read them without guidance and without much help in the history from colleagues, then you will be a peer of the radiologists, and not until then.
I guess reading your sentence surprised me because it sounds like you don't have a sense of humility that, as a doctor, I would expect you to have developed by now. It's like a third year medical student saying they couldn't feel 'proud' about being a surgeon; what does the med student even know?
At this point, if I were you, I'd concentrate on getting a clue about the basics of radiology. By 6 months you should start to have a sense of what it actually means to be a radiologist. By 12-18 months you'll discover you read better than most non-radiologist Fellows and even Attendings. By the end of third year you'll feel comfortable enough that you'll feel confident calling most things, and that you can provide useful clinical guidance to people. Then by the beginning of Fellowship you'll feel like an idiot again when you realize how much more the radiology specialists know than you, even after all those years. Then, starting practice as a board-certified radiologist you'll get your butt kicked by how quickly you'll be expected to read. Eventually you'll get settled.
Good luck. Don't make any decisions until at least 6 months. My guess is that you've been brainwashed during your intern year by nonradiologists who don't know what they're talking about. See what it's actually like before you make any decisions.
I'm curious, how as a first year (first month) radiologist you can be at a point where you feel you couldn't be proud about doing something that you aren't even good enough yet to be a beginner in? At this point, I'm assuming you know like 1% of what the average 2nd-3rd year radiology resident knows. If I were to throw a stack of thirty CT's, MRI's, ultrasounds, and nucs studies and give you 2-3 hours to read them without guidance and without much help in the history from colleagues, then you will be a peer of the radiologists, and not until then.
I guess reading your sentence surprised me because it sounds like you don't have a sense of humility that, as a doctor, I would expect you to have developed by now. It's like a third year medical student saying they couldn't feel 'proud' about being a surgeon; what does the med student even know?
At this point, if I were you, I'd concentrate on getting a clue about the basics of radiology. By 6 months you should start to have a sense of what it actually means to be a radiologist. By 12-18 months you'll discover you read better than most non-radiologist Fellows and even Attendings. By the end of third year you'll feel comfortable enough that you'll feel confident calling most things, and that you can provide useful clinical guidance to people. Then by the beginning of Fellowship you'll feel like an idiot again when you realize how much more the radiology specialists know than you, even after all those years. Then, starting practice as a board-certified radiologist you'll get your butt kicked by how quickly you'll be expected to read. Eventually you'll get settled.
Good luck. Don't make any decisions until at least 6 months. My guess is that you've been brainwashed during your intern year by nonradiologists who don't know what they're talking about. See what it's actually like before you make any decisions.
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, hah, wtf?I am sure you could switch into medicine or general surgery very easily, there will probably be droves of residents in those specialties who'd kill to switch into rads
Maybe the OP is having internship blues. He/she loved internship and all the patient contact and now misses it. From speaking to rads residents, one thing in common is their dislike of internal medicine and patient contact in general. So to the OP, if you miss patient contact maybe you should reconsider what you're doing otherwise you may as well be unhappy in the long run.In my case, I'm counting the days until internship is over. I really dislike internal medicine, and i can't picture myself doing anything but rads.
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What other specialty are you inclined towards?
Radiology is such a coveted residency. You could easily switch into IM, GS, or most other specialties, but I worry that you would have regrets.
I would just finish up radiology, perhaps try practicing for a few years, and if you absolutely still hate it (and the income and lifestyle!), go back into a more clinical residency. If you hate clinic, you can always quit and go back to being a radiologist.
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I'm pretty sure we have a case of troll here. 1 post. "...not proud..." wtf?
:troll:
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My intention is not to feed the troll - I'll start with that as my disclaimer.
I most certainly am not a troll - I've posted on this board enough times to prove that.
I relate to what the OP is saying, if not how s/he said it. I think it was just a mix-up of wording; and since one online post from a three dimensional person without the benefit of an actual conversation, body language, etc., is likely to be easily taken differently than intended, I don't think giving the benefit of the doubt is unreasonable.
To the OP: I hear you. I am also a PGY-2 radiology resident and I would be lying if I said I wasn't having second thoughts. My reasons may be different than yours. I'll start by saying I love radiology, in terms of the science and the body of knowledge, and the idea of using imaging to direct patient care so that people get what they need, and not what they don't.
But what I have seen throughout my internship year is most specialists reading their own stuff and then bashing radiologists for doing it badly or not as well. And before you all yell at me, I have seen many posts by others about how one of the challenges confronting radiology is that many radiologists are in fact NOT as good as the clinical specialists reading their own stuff. I don't think this is necessarily a manifestation of a shortcoming on the part of radiology but rather just a consequence of the fact that when you have access to the patient it's easier to know what's going on. You can't tell me it's not easier to find the fracture when the patient tells you exactly where it hurts, that's why most ED docs are pretty darn good at finding fractures. I rotated with many specialists, all of whom read their own stuff because now it's easier to do so thanks to technology (vis a vis PACS, etc).
I don't think radiologists have gotten any better or worse than they ever were, personally (and I will completely grant you that is just my opinion). But now, you have specialists, who are responsible for one very specific clinical area, with the ability to access and see (and even perform in many cases) imaging for their patients. Plus, they already know the patient and the history, which we often spend a lot of time sifting through clinical information systems trying to figure out, and still don't know as well as the clinician.
Radiologists still have a role and a lot to offer, it just seems like that role is becoming more related to churning out a report for the chart and validating what the clinician already thinks for medico-legal reasons. We had a lecture about c-spine injury in which the neurorad basically told us the only thing neurosurg wants to know is stable or unstable, and only so that if they're wrong, they have it in writing that someone else agreed with their interpretation... it's not that they need our expertise so much as CYA validation.
I know I will be absolutely trashed for speaking my mind by those who are too defensive about this field to have a real conversation. It's really too bad that these message boards seem to inspire the lesser elements almost more than the better. I really hope someone is willing to not just dismiss me as a "troll" and perhaps offer to some real advice and insight. I can only say that from an academic perspective I do enjoy radiology as a science, I like reading my B&H and learning about all these disease processes I never heard about in med school. I think radiology is a great field and if I didn't, then this wouldn't be a dilemma and I'd just switch to another field.
The sum of advice should not be "someone else will take your spot, go into FM." The OP and myself both matched into radiology after four years of medical school. I can't speak for the OP but I, myself, worked my ass off to match into radiology and I should be able to thoughtfully question myself and ask advice without being thrown to the curb by my peers.
To the OP: I will tell you that I have spoken with a couple of fourth year radiology residents at a different program who told me that the first year sucks just because we're so stupid about radiology. Both of them had miserable first year experiences and pretty much hated going into the hospital everyday. From them, it gets better. My personal dilemma has more to do with whether or not this is the role I want... but I agree that it's rough knowing absolutely nothing, the learning curve is really, really steep. Another consideration: is it your program? That is something I struggle with, as I really dislike the environment I am in, the faculty, and even most of my co-residents. I get along fine with everyone it's just that no one is of the sort I'd ever wanna grab a beer with and I think that's a factor, too.
I most certainly am not a troll - I've posted on this board enough times to prove that.
I relate to what the OP is saying, if not how s/he said it. I think it was just a mix-up of wording; and since one online post from a three dimensional person without the benefit of an actual conversation, body language, etc., is likely to be easily taken differently than intended, I don't think giving the benefit of the doubt is unreasonable.
To the OP: I hear you. I am also a PGY-2 radiology resident and I would be lying if I said I wasn't having second thoughts. My reasons may be different than yours. I'll start by saying I love radiology, in terms of the science and the body of knowledge, and the idea of using imaging to direct patient care so that people get what they need, and not what they don't.
But what I have seen throughout my internship year is most specialists reading their own stuff and then bashing radiologists for doing it badly or not as well. And before you all yell at me, I have seen many posts by others about how one of the challenges confronting radiology is that many radiologists are in fact NOT as good as the clinical specialists reading their own stuff. I don't think this is necessarily a manifestation of a shortcoming on the part of radiology but rather just a consequence of the fact that when you have access to the patient it's easier to know what's going on. You can't tell me it's not easier to find the fracture when the patient tells you exactly where it hurts, that's why most ED docs are pretty darn good at finding fractures. I rotated with many specialists, all of whom read their own stuff because now it's easier to do so thanks to technology (vis a vis PACS, etc).
I don't think radiologists have gotten any better or worse than they ever were, personally (and I will completely grant you that is just my opinion). But now, you have specialists, who are responsible for one very specific clinical area, with the ability to access and see (and even perform in many cases) imaging for their patients. Plus, they already know the patient and the history, which we often spend a lot of time sifting through clinical information systems trying to figure out, and still don't know as well as the clinician.
Radiologists still have a role and a lot to offer, it just seems like that role is becoming more related to churning out a report for the chart and validating what the clinician already thinks for medico-legal reasons. We had a lecture about c-spine injury in which the neurorad basically told us the only thing neurosurg wants to know is stable or unstable, and only so that if they're wrong, they have it in writing that someone else agreed with their interpretation... it's not that they need our expertise so much as CYA validation.
I know I will be absolutely trashed for speaking my mind by those who are too defensive about this field to have a real conversation. It's really too bad that these message boards seem to inspire the lesser elements almost more than the better. I really hope someone is willing to not just dismiss me as a "troll" and perhaps offer to some real advice and insight. I can only say that from an academic perspective I do enjoy radiology as a science, I like reading my B&H and learning about all these disease processes I never heard about in med school. I think radiology is a great field and if I didn't, then this wouldn't be a dilemma and I'd just switch to another field.
The sum of advice should not be "someone else will take your spot, go into FM." The OP and myself both matched into radiology after four years of medical school. I can't speak for the OP but I, myself, worked my ass off to match into radiology and I should be able to thoughtfully question myself and ask advice without being thrown to the curb by my peers.
To the OP: I will tell you that I have spoken with a couple of fourth year radiology residents at a different program who told me that the first year sucks just because we're so stupid about radiology. Both of them had miserable first year experiences and pretty much hated going into the hospital everyday. From them, it gets better. My personal dilemma has more to do with whether or not this is the role I want... but I agree that it's rough knowing absolutely nothing, the learning curve is really, really steep. Another consideration: is it your program? That is something I struggle with, as I really dislike the environment I am in, the faculty, and even most of my co-residents. I get along fine with everyone it's just that no one is of the sort I'd ever wanna grab a beer with and I think that's a factor, too.
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CaptKirk, you've highlighted several of the main issues facing radiology today - chief among them avoiding "commoditization" and the increasing role of subspecialization.
I'll only point out that many residents - perhaps most - train at large tertiary care centers where there are lots of clinical subspecialists. I've found those physicians typically order studies with a very specific clinical question in mind, and - not surprisingly - they're perfectly capable of conducting a limited read of the study and getting the answer they need. (Insert obligatory comment about the urologist missing the liver tumor here)
My perception is that "real world" medicine is vastly different. My wife is a family practitioner, and she could not more read an abdominal CT than she could breathe in space. Yet she sees plenty of patients with abdominal pain and orders plenty of CTs. There are also plenty of PAs and NPs out there who order imaging, and I suspect that trend will increase. Suffice it to say that subspecialists reading their own studies represents only a fraction of imaging. If you're looking to add to the clinical picture, then I think there is still plenty of opportunity to do so.
Even if you're concerned about others reading our studies, I would encourage you to carefully observe the interaction between the MSK radiologists and the orthopods, the neuroradiologists and the neurosurgeons/ENTs, the body radiologists and the general surgeons. At least at my institution, the clinicians routinely rely on these subspecialists for complex cases, and I always come across impressed with the level of detail we can offer.
I'll only point out that many residents - perhaps most - train at large tertiary care centers where there are lots of clinical subspecialists. I've found those physicians typically order studies with a very specific clinical question in mind, and - not surprisingly - they're perfectly capable of conducting a limited read of the study and getting the answer they need. (Insert obligatory comment about the urologist missing the liver tumor here)
My perception is that "real world" medicine is vastly different. My wife is a family practitioner, and she could not more read an abdominal CT than she could breathe in space. Yet she sees plenty of patients with abdominal pain and orders plenty of CTs. There are also plenty of PAs and NPs out there who order imaging, and I suspect that trend will increase. Suffice it to say that subspecialists reading their own studies represents only a fraction of imaging. If you're looking to add to the clinical picture, then I think there is still plenty of opportunity to do so.
Even if you're concerned about others reading our studies, I would encourage you to carefully observe the interaction between the MSK radiologists and the orthopods, the neuroradiologists and the neurosurgeons/ENTs, the body radiologists and the general surgeons. At least at my institution, the clinicians routinely rely on these subspecialists for complex cases, and I always come across impressed with the level of detail we can offer.
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+1 for don't worry about subspecialists being able to read films better or as good as you. I would think that would be minor fraction of the cases you see. Most of the time you are adding lots of useful information. I myself, not a super subspecialist, rely on radiologist reads all the time, even plain films. Part of it is the crappy monitors we look at, but most of it isn't. You add a lot to my clinical management.
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If Obamacare comes true, there will be less incentive to specialize. Hence, rad reports will be very critical in pt management.
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internship IM
residencies Pathology/Radiology
fellowship Interventional
Current practice body imaging , Hospital/Office
Make dozens of great diagnoses for specialists every day
Home by 5 most days, 12 weeks vacation, pay lots of taxes
Any regrets . No, except I should have started earlier!
residencies Pathology/Radiology
fellowship Interventional
Current practice body imaging , Hospital/Office
Make dozens of great diagnoses for specialists every day
Home by 5 most days, 12 weeks vacation, pay lots of taxes
Any regrets . No, except I should have started earlier!
Thanks for replies. To clarify (mostly for myself) my current reservations not in any particular order (and bare with me bc this is still forming in my head and most of it yes, very naive based on 6-7 weeks of observation + 1 year of internship + 1 MS4 rotation)
1) re: CaptKirk's post, I sort of thought that way for a while but I have seen enough examples in the past few weeks where it worked differently and rads did guide important decisions. But along the same vein, the radiologist is very much a generalist (maybe just in this stage of my training) and so yes, often times you are less knowledgeable.
2) very related to #1 I see the senior radiology residents and attendings have a lot of "knowledge" about seemingly obscure info. But it strikes me as superficial knowledge... often a laundry list of possible diagnoses but without deeper understanding of pathophys and often times without desire to understand pathophys. B/c it doesnt matter, their job is to provide dx or list of poss dx. Just as a matter of respect of what knowledge means to me, is understanding. And I get a sense that the pulmonologist understands lung physiology and pathology more than the chest radiologist.
3) I'm a physician-scientist and want to continue along that trajectory. I am interested in research geared toward "discovery" and less excited about "development." There are few examples out there of successful phsycian-scientists, fewer still in radiology, and I'm very hard-pressed to find ones who do "discovery" type research. Distinction is not always black and white but there is an important difference (at least for me).
4) I hated my IM intern year, and felt very resentful a lot of the time for all of the time I was being dragged away from my family. It should have been aparent to me though that for all of the anger I had during last year, I never was angered/annoyed by the patients--and I had plenty of pain in the ass patients. I was annoyed at nurses, at consults, at my chief residents, at my department head, at the radiologists (often by the way). There were plently of patients I did not like; but really, I liked to be the one giving people information good news or bad. I felt like it was my responsibility. Every once in a while I do fluoro and its like a breath of fresh air to talk to patients, get the story, teach them some things, show them some pictures. That said, its not my responsibility to get the HPI right or to deal with the results of the test, so it is DEFINITELY an easier job.
5) It seems cool (but very rare) to be an awesome clinician. I did see some examples of those in my IM program. I think I went to medical school to feel comfortable/confident to handle situations when people around me need help. Not from altruistic reason. Just made me feel better. Radiologists are so critical--the backbones of the hospital. But it's very different from the reason I went into medical school.
6) I like the idea of my son having a pediatrician for a dad more than the idea of my son having a radiologist for a dad. Dont know where that is coming from, but seems to be something I keep coming back to.
7) I'm good at treating people with respect. Not very good at a lot of other things. But I do think I'm good at least at that. I can treat doctors with respect as a radiologist, but I feel like it is a bit like a wasted muscle.
8) re: another CaptKirk thought. I do think radiologists around me are not my kind of people. Really, cross the board medical people are not so much my kind of people. But I think back at intern year and tehre were definitely cooler people around me then--though bigger pool of people obviously.
9) I like to teach. Lots of teaching in rads, true. But I think I liked teaching patients/families more than teaching other doctors.
10) I like to think of myself as a consult as a radiologist. But most of the rest of the hospital does not seem to think that way. In some ways they're right b/c maybe I need more clinical time b/4 I really call myself a consult.
....
Anyway, enough for now. Happy to hear more thoughts, appreciate everyones input. For med students out there, keep doing your homework, but a disclaimer, I'm absolutely not the right person to listen to since I'm only 6-7 weeks into this thing, I maybe very different from you, I'm probably just having 2nd thoughts related to grass is always greener type of thing...
1) re: CaptKirk's post, I sort of thought that way for a while but I have seen enough examples in the past few weeks where it worked differently and rads did guide important decisions. But along the same vein, the radiologist is very much a generalist (maybe just in this stage of my training) and so yes, often times you are less knowledgeable.
2) very related to #1 I see the senior radiology residents and attendings have a lot of "knowledge" about seemingly obscure info. But it strikes me as superficial knowledge... often a laundry list of possible diagnoses but without deeper understanding of pathophys and often times without desire to understand pathophys. B/c it doesnt matter, their job is to provide dx or list of poss dx. Just as a matter of respect of what knowledge means to me, is understanding. And I get a sense that the pulmonologist understands lung physiology and pathology more than the chest radiologist.
3) I'm a physician-scientist and want to continue along that trajectory. I am interested in research geared toward "discovery" and less excited about "development." There are few examples out there of successful phsycian-scientists, fewer still in radiology, and I'm very hard-pressed to find ones who do "discovery" type research. Distinction is not always black and white but there is an important difference (at least for me).
4) I hated my IM intern year, and felt very resentful a lot of the time for all of the time I was being dragged away from my family. It should have been aparent to me though that for all of the anger I had during last year, I never was angered/annoyed by the patients--and I had plenty of pain in the ass patients. I was annoyed at nurses, at consults, at my chief residents, at my department head, at the radiologists (often by the way). There were plently of patients I did not like; but really, I liked to be the one giving people information good news or bad. I felt like it was my responsibility. Every once in a while I do fluoro and its like a breath of fresh air to talk to patients, get the story, teach them some things, show them some pictures. That said, its not my responsibility to get the HPI right or to deal with the results of the test, so it is DEFINITELY an easier job.
5) It seems cool (but very rare) to be an awesome clinician. I did see some examples of those in my IM program. I think I went to medical school to feel comfortable/confident to handle situations when people around me need help. Not from altruistic reason. Just made me feel better. Radiologists are so critical--the backbones of the hospital. But it's very different from the reason I went into medical school.
6) I like the idea of my son having a pediatrician for a dad more than the idea of my son having a radiologist for a dad. Dont know where that is coming from, but seems to be something I keep coming back to.
7) I'm good at treating people with respect. Not very good at a lot of other things. But I do think I'm good at least at that. I can treat doctors with respect as a radiologist, but I feel like it is a bit like a wasted muscle.
8) re: another CaptKirk thought. I do think radiologists around me are not my kind of people. Really, cross the board medical people are not so much my kind of people. But I think back at intern year and tehre were definitely cooler people around me then--though bigger pool of people obviously.
9) I like to teach. Lots of teaching in rads, true. But I think I liked teaching patients/families more than teaching other doctors.
10) I like to think of myself as a consult as a radiologist. But most of the rest of the hospital does not seem to think that way. In some ways they're right b/c maybe I need more clinical time b/4 I really call myself a consult.
....
Anyway, enough for now. Happy to hear more thoughts, appreciate everyones input. For med students out there, keep doing your homework, but a disclaimer, I'm absolutely not the right person to listen to since I'm only 6-7 weeks into this thing, I maybe very different from you, I'm probably just having 2nd thoughts related to grass is always greener type of thing...
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Just give it some time. See if you think differently in a few months. You can always do IR if you want more patient contact. If you still end up hating rads, you can always do internal medicine or pediatrics - if you find that more intellectually and personally gratifying. Making an essentially irreversible switch like this - which has profound implications for your income and lifestyle (rads earning often more than twice what primary care IM or peds does and with better hours) - without really testing out what rads is like would be a bad idea. Give it a little more time.
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"I like the idea of my son having a pediatrician for a dad more than the idea of my son having a radiologist for a dad. "
Why not go into peds radiology? There is lots of short and sweet patient/parent contact, interesting pathology and usually good relationships with referring docs. Just a thought...
Why not go into peds radiology? There is lots of short and sweet patient/parent contact, interesting pathology and usually good relationships with referring docs. Just a thought...
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One thing to consider. If you're seeing rads that you don't think are helping anyone, you could be right. You might not proud to be a mediocre rad, but you would be proud to be a good rad. Look around your dept. I'll bet there's a couple of really good rads that the clinicians seek out as their go to guy/girl on some pathology. Getting through radiology residency and passing boards is not that hard. Being really good takes commitment.
Point #2 is that the subspecialty ortho types or whatever can do a good job looking at studies, but have a different perspective. They only read selected cases. We read it all. Lots of "sports medicine" NP's ordering knee and shoulder MR's for example that need help from us. Lots of ED docs ordering spine MR etc etc.
Point #2 is that the subspecialty ortho types or whatever can do a good job looking at studies, but have a different perspective. They only read selected cases. We read it all. Lots of "sports medicine" NP's ordering knee and shoulder MR's for example that need help from us. Lots of ED docs ordering spine MR etc etc.
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OP: I agree with the other poster who mentioned pediatric radiology. My first rotation was pediatric rads. One of the pediatric radiologists had been an FP before doing rads. He loved pediatric radiology because he still got to diagnose and treat and really help out the clinicians without the baggage of primary care.
Not sure if it's helpful or not... I've talked to a lot of people, including some from my internship year (whom I also liked more than many of the people I'm around now), as well as folks from my medical school (chaplain, etc). All very supportive about changing fields but also very strongly recommending to wait at least six months - good advice since as one other poster implied, it's easier to go from rads to primary care than the reverse (esp if you started in rads in the first place).
Not sure about your program, but being in an academic setting definitely cultures the esoteric and irrelevant factoids. I love getting pimped endlessly about some mundane finding and then after asking my attending if I should dictate it into the report, being told "absolutely not, it's of no clinical significance." lol So I totally get where you're coming from.
The retired dept chairman was at a noon conference last week and he and I chatted a bit (not about this of course). But he asked how things were going and basically said the first six months is rough, it's like starting over, and that it gets better. Without me saying anything... so I think it's maybe more common than we're generally led to believe to have these feelings and I think it will get better... here's hoping. lol
Good luck man.
Not sure if it's helpful or not... I've talked to a lot of people, including some from my internship year (whom I also liked more than many of the people I'm around now), as well as folks from my medical school (chaplain, etc). All very supportive about changing fields but also very strongly recommending to wait at least six months - good advice since as one other poster implied, it's easier to go from rads to primary care than the reverse (esp if you started in rads in the first place).
Not sure about your program, but being in an academic setting definitely cultures the esoteric and irrelevant factoids. I love getting pimped endlessly about some mundane finding and then after asking my attending if I should dictate it into the report, being told "absolutely not, it's of no clinical significance." lol So I totally get where you're coming from.
The retired dept chairman was at a noon conference last week and he and I chatted a bit (not about this of course). But he asked how things were going and basically said the first six months is rough, it's like starting over, and that it gets better. Without me saying anything... so I think it's maybe more common than we're generally led to believe to have these feelings and I think it will get better... here's hoping. lol
Good luck man.
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Don't mean to hijack this thread
but can you elaborate on peds rads? What kind of procedures do they do (fluoro?) and what fraction of their day involves dealing with kids and their families? What is their lifestyle like? Are they confined to academic centers? etc.- Joined
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gluon999,
I'm probably going into pediatric radiology so I'll try and give you broad overview. So ped rads is usually a 1 year fellowship but some some will do a second nonaccredited year with a focus such as neuro or interventional.
As far as procedures thats really dependent on what you're comfortable with. I rotate through a smaller(6 fulltime rads) peds hospital but we do LPs, picc lines, CT/US guided biopsies, placement of drainage catheters, renal cyst sclerosis, arthograms for MRI, nephrostomy tubes and the occasional cerebral angiogram. Some of the larger peds hospital will do more traditional IR stuff b/c they have peds IR trained staff and we don't.
Fluoro is still a prominent modality in peds but its different than the adult world. You aren't doing preop gastric bypass UGI's all day. Most of the fluoro work that I've seen is for malrotation, bowel obstructions, and reflux. You often provide critical information to the ordering docs ie. no malrotation, your patient has hirschsprungs etc.
As far as patient/parent contact, it is still MINIMAL compared with other specialities(peds, IM etc). However, it is enough for most people that chose radiology! The parents are often in the room during fluoro and some procedures. As a parent myself, I enjoy explaining procedures to the parents and diminishing the anxiety b/c the parents are often scared too death. Despite what you may hear, most parents are not crazy, irrational people.
You will have lots of contact with referring docs and inpatient teams but I found this to be a plus most of the time. These physicians are often caring for kids with complicated diseases and most value what the radiologist have to say. There are less turf battles in peds and less "i can read the studies better than you" from the nonradiology docs.
There are a ton of jobs in peds. However, most will be in a chidrens hospital but there are some pp jobs out there. Some childrens hospitals are very academic with lots of research and fellows/residents running around but many are just like any private practice group. The group we rotate with has 6 full time radiologists and 3 part time guys. There are no fellows and no research. They are a private group with a hospital contract. Call and lifestyle vary. If you have a small group you take more call but you have a large group(Cinci has 37 radiologists) you will take much less call and probably get more vacation. The pay for pediatric radiologist is less than adult private practice but is still excellent. You will make more than most specialities with 8-12 weeks vacation.
Hope this helps.
I'm probably going into pediatric radiology so I'll try and give you broad overview. So ped rads is usually a 1 year fellowship but some some will do a second nonaccredited year with a focus such as neuro or interventional.
As far as procedures thats really dependent on what you're comfortable with. I rotate through a smaller(6 fulltime rads) peds hospital but we do LPs, picc lines, CT/US guided biopsies, placement of drainage catheters, renal cyst sclerosis, arthograms for MRI, nephrostomy tubes and the occasional cerebral angiogram. Some of the larger peds hospital will do more traditional IR stuff b/c they have peds IR trained staff and we don't.
Fluoro is still a prominent modality in peds but its different than the adult world. You aren't doing preop gastric bypass UGI's all day. Most of the fluoro work that I've seen is for malrotation, bowel obstructions, and reflux. You often provide critical information to the ordering docs ie. no malrotation, your patient has hirschsprungs etc.
As far as patient/parent contact, it is still MINIMAL compared with other specialities(peds, IM etc). However, it is enough for most people that chose radiology! The parents are often in the room during fluoro and some procedures. As a parent myself, I enjoy explaining procedures to the parents and diminishing the anxiety b/c the parents are often scared too death. Despite what you may hear, most parents are not crazy, irrational people.
You will have lots of contact with referring docs and inpatient teams but I found this to be a plus most of the time. These physicians are often caring for kids with complicated diseases and most value what the radiologist have to say. There are less turf battles in peds and less "i can read the studies better than you" from the nonradiology docs.
There are a ton of jobs in peds. However, most will be in a chidrens hospital but there are some pp jobs out there. Some childrens hospitals are very academic with lots of research and fellows/residents running around but many are just like any private practice group. The group we rotate with has 6 full time radiologists and 3 part time guys. There are no fellows and no research. They are a private group with a hospital contract. Call and lifestyle vary. If you have a small group you take more call but you have a large group(Cinci has 37 radiologists) you will take much less call and probably get more vacation. The pay for pediatric radiologist is less than adult private practice but is still excellent. You will make more than most specialities with 8-12 weeks vacation.
Hope this helps.
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Hey thanks for the info. brandtson. Very helpful. I like the idea of patient contact without the baggage, i.e. no H and Ps, social issues, d/c summaries. IMO, best patient contact is the short and sweet kind.
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Advice for OP:
1. Wait 6 months before making any decisions. For what it's worth, I found the first year of radiology residency to be the most stressful and least enjoyable of all my years of medical training. Being a beginner and not adding much value are not my thing. It wasn't until I settled in that I realized how great a field radiology is. Now, I shudder at the thought of having to be a non-radiologist. Most doctors are in the dark and can't make medical decisions without imaging; their attempts at learning how to read imaging, too, is a tacit acknowledgment of how much they depend on imaging, often to the detriment of physical exams or history.
2. Become an academic specialist. If you want to have thorough mastery of a limited field, academics is for you. Ditto, if you want to invent and/or develop things. Plus, you'll be the go-to person of specialist clinicians. Downside is money, relative to private rads, but it's still better pay than for most internists.
3. If you like light patient contact, consider peds, IR, mammography, body imaging (biopsies), and ultrasound.
4. If you like scientist types, consider a nuc med fellowship.
5. From your second post, you seem to have anger issues. Potentially working on that outside of radiology hours may be of use.
1. Wait 6 months before making any decisions. For what it's worth, I found the first year of radiology residency to be the most stressful and least enjoyable of all my years of medical training. Being a beginner and not adding much value are not my thing. It wasn't until I settled in that I realized how great a field radiology is. Now, I shudder at the thought of having to be a non-radiologist. Most doctors are in the dark and can't make medical decisions without imaging; their attempts at learning how to read imaging, too, is a tacit acknowledgment of how much they depend on imaging, often to the detriment of physical exams or history.
2. Become an academic specialist. If you want to have thorough mastery of a limited field, academics is for you. Ditto, if you want to invent and/or develop things. Plus, you'll be the go-to person of specialist clinicians. Downside is money, relative to private rads, but it's still better pay than for most internists.
3. If you like light patient contact, consider peds, IR, mammography, body imaging (biopsies), and ultrasound.
4. If you like scientist types, consider a nuc med fellowship.
5. From your second post, you seem to have anger issues. Potentially working on that outside of radiology hours may be of use.
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Have you thought about rad onc? We're an image-based specialty like rads, but that's pretty much where the similarties end. You see patients every day, do physical exams (esp in H/N and Gyn) at consultation and to follow people up after treatment. It's a very clinical specialty, but at the end of the day, we're still consultants, and NOT PCPs. You have to be comfortable explaining RT to patients and answering their questions, but it's a focused issue, not like their general medical stuff.
Plus the call is way better during residency than rads call
I noticed you're a physician-scientist (MD-PhD)? Plenty of them end up choosing rad onc for the basic science research available, and there are quite a few faculty/chairman with that background.
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AT THE END OF THE DAY ALL SPECIALITES BECOME A JOB!!! So you will not LOVE any medical specialty! IT is work! NO WORK IS FUN!
Therefore pick the specialty that gives you the most money and the most vacation time so you can use that extra time with family and/or travel.
Radiology is not easy BUT name another specialty in which you get to leave your job behind when you leave the hospital AND
get paid in the top 3 of all medical specialities PLUS
get 12-16 weeks of VACATION.
REPEAT THAT
NO PATIENT RESPONSIBILITY AND 12-16 WEEKS OF VACATION A YEAR I.E 3 TO 4 MONTHS OF VACATION A YEAR.
Therefore pick the specialty that gives you the most money and the most vacation time so you can use that extra time with family and/or travel.
Radiology is not easy BUT name another specialty in which you get to leave your job behind when you leave the hospital AND
get paid in the top 3 of all medical specialities PLUS
get 12-16 weeks of VACATION.
REPEAT THAT
NO PATIENT RESPONSIBILITY AND 12-16 WEEKS OF VACATION A YEAR I.E 3 TO 4 MONTHS OF VACATION A YEAR.
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Rad ONC is a great field but the reason I picked radiology is because
Radiology does NOT have the paper work and the clinic time.
THAT IS THE BIG DIFFERENCE BETWEEN RADIOLOGY, DERMATOLOGY, AND RAD ONC.
IF YOU LOVE PATIENTS IN CLINIC ALL DAY GO TO DERMATOLOGY OR RAD ONC. Yes, this also means doing H and P's and writing notes just like an intern/3rd year medical student.
Radiology does NOT have the paperwork BS or the long days in clinic. If you like patients consider interventional radiology, dermatology and rad onc.
Plus we get to wear Golf Shirts and Khakis to work. Also, we get to listen to the radio or television in the reading room while working.
NAME ANOTHER SPECIALTY THAT ALLOWS YOU TO WATCH/LISTEN TO THE NCAA BASKETBALL TOURNAMENT WHILE STILL WORKING?
Radiology does NOT have the paper work and the clinic time.
THAT IS THE BIG DIFFERENCE BETWEEN RADIOLOGY, DERMATOLOGY, AND RAD ONC.
IF YOU LOVE PATIENTS IN CLINIC ALL DAY GO TO DERMATOLOGY OR RAD ONC. Yes, this also means doing H and P's and writing notes just like an intern/3rd year medical student.
Radiology does NOT have the paperwork BS or the long days in clinic. If you like patients consider interventional radiology, dermatology and rad onc.
Plus we get to wear Golf Shirts and Khakis to work. Also, we get to listen to the radio or television in the reading room while working.
NAME ANOTHER SPECIALTY THAT ALLOWS YOU TO WATCH/LISTEN TO THE NCAA BASKETBALL TOURNAMENT WHILE STILL WORKING?
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path.
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I rarely write notes (only on inpatients, and my H&Ps are NEVER more than 1 page, double-sided). Most notes are dictated
8-5 is not a long day in my book.
How about that call in residency? I like taking call at home
We can do the same while contouring.
I've caught games during my light clinic days.
There is more to a job than just how much free time you have. Rad onc isnt for everyone, but nearly everyone I know (including myself) who is in it enjoys the patient contact and the daily aspects of the job.
Thanks again for the advice everybody. Before we get lost in which specialty is the best debate, I'm interested in some practical information in case my current feeling does not change in the coming months. Does anyone know how one can switch specialties? Is that something I have to do outside of the match if I leave after one R1 year? Would I have to scramble for a different position? Or is my match obligation only for the first year? Just in case I can't shake this feeling...
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Interesting post. It really makes me wonder why you even picked radiology?
I think you might be a tad bit too idealistic for your own good which may or may not get you into trouble in searching for that nebulous "soul affirming" career path in medicine. You want to play Louis Pasteur and "discover" great things along the vein of a M.D. PhD scientist, yet you yearn to become that well rounded and robust clinician with plenty of face time with patients and their families. You seem hung up on how your son/family would view you as a radiologist vs (insert any other clinician).
I think you need to take a deep breath and do some soul searching before you impulsively jeopardize such a hard earned a coveted training position. I'm not saying you couldn't have wrongly chosen rads over something else, but I'm sure your thought process in choosing your chosen specialty made logical sense for you at some point in time. I think you want to be a lot of different things that just can't be perfectly realized in a single specialty. You're going to have to make some sacrifices at some point along the line and figure out what's most important to you.
I'm not saying rads is the best fit for you, but it's always a red flag to me when I see someone ready to bail with such limited exposure this newly into residency. Please consider all the fellowship options that would allow you to customize your practice before writing off such a hard earned opportunity.
Everything becomes a "job" after enough time. You're more than likely not going to be this idealistic in 15 yrs. You're going to be more concerned with getting home to open presents with the family, take the kids out on the boat, relax on the back porch, check out the retirement portfolio, etc.. You definitely will NOT be thinking "man... I'm sure glad my son grew up knowing me as a pediatrician instead of a radiologist"... when he's 15 and screaming "F You Dad! I'm going out anyway!" and slams the front door.
I think you might be a tad bit too idealistic for your own good which may or may not get you into trouble in searching for that nebulous "soul affirming" career path in medicine. You want to play Louis Pasteur and "discover" great things along the vein of a M.D. PhD scientist, yet you yearn to become that well rounded and robust clinician with plenty of face time with patients and their families. You seem hung up on how your son/family would view you as a radiologist vs (insert any other clinician).
I think you need to take a deep breath and do some soul searching before you impulsively jeopardize such a hard earned a coveted training position. I'm not saying you couldn't have wrongly chosen rads over something else, but I'm sure your thought process in choosing your chosen specialty made logical sense for you at some point in time. I think you want to be a lot of different things that just can't be perfectly realized in a single specialty. You're going to have to make some sacrifices at some point along the line and figure out what's most important to you.
I'm not saying rads is the best fit for you, but it's always a red flag to me when I see someone ready to bail with such limited exposure this newly into residency. Please consider all the fellowship options that would allow you to customize your practice before writing off such a hard earned opportunity.
Everything becomes a "job" after enough time. You're more than likely not going to be this idealistic in 15 yrs. You're going to be more concerned with getting home to open presents with the family, take the kids out on the boat, relax on the back porch, check out the retirement portfolio, etc.. You definitely will NOT be thinking "man... I'm sure glad my son grew up knowing me as a pediatrician instead of a radiologist"... when he's 15 and screaming "F You Dad! I'm going out anyway!" and slams the front door.
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salamander: you made the decision to pursue your specialty after the limited time you spent during your third year in various specialties, yet you criticize the OP for making a decision based on limited knowledge. You're considered a novice in every specialty except the one in which you now pursue. Lighten up, hot shot.
Nice POV. Give the guy some credit though. You're a little idealistic in thinking that everyone chooses the right specialty after medical school. I'm sure you have enough experience to know that people don't always make the right decisions. And just because something is competitive (i.e., derm, rads, rad onc, ortho... med school, law school, etc.) doesn't mean that those who are in the field cannot have regrets and/or second thoughts.
We all want to make the right decisions. Have you met ever someone whose said "you know, I think I'll make the wrong move today so that I can regret it later.." Sure.
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Ali Purinol: ? I critized OP for saying he knew he couldn't feel 'proud' about being a radiologist despite not having completed a month in residency and not being good enough yet to even be a beginner. If Ali's point is he dislikes people being 'hot shots' perhaps he could counsel OP that it sounds kinda arrogant to say it's beneath your pride to even work with your colleagues, particularly when they are trying to teach you in good faith and all know way more than you.
Sure, have gut feelings, but also have humility. I repeat, 6 months is a good amount of time before making a huge decision like jumping ship.
Sure, have gut feelings, but also have humility. I repeat, 6 months is a good amount of time before making a huge decision like jumping ship.
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Pwned.
Reading the "issues" these newbs have with rads made me want to laugh. You guys must thing the community hospitals are full of a bunch of William Oslers or something.
Jeez, I wasn't even that dumb or naive when I was a PGY-2.
Being a radiologist is THE place to be in medicine right now. There is no other gig that can beat it. The clinicians who deride us secretly wish they had matched into radiology and most hate their job.
Get a grip on reality.
Yeah - the academic ranks may have a couple true brilliant super-specialists, but that is probably < 1% of the total number of physicians. Most community practices are full of clueless docs, NPs, PAs etc who won't touch a patient until they have a CT reading.
Jeez, I wasn't even that dumb or naive when I was a PGY-2.
Being a radiologist is THE place to be in medicine right now. There is no other gig that can beat it. The clinicians who deride us secretly wish they had matched into radiology and most hate their job.
Get a grip on reality.
Yeah - the academic ranks may have a couple true brilliant super-specialists, but that is probably < 1% of the total number of physicians. Most community practices are full of clueless docs, NPs, PAs etc who won't touch a patient until they have a CT reading.
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That's medicine in the US, in Latin America (where I live) it's definetly not like that. Medicine over these "third world countries" doesn't depends on thechnology that much, wich makes it a way more enjoyable place to practice medicine as a clinician if you ask me...but hey, that's just my opinion and I don't intend to disrespect you guys
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That's medicine in the US, in Latin America (where I live) it's definetly not like that. Medicine over these "third world countries" doesn't depends on thechnology that much, wich makes it a way more enjoyable place to practice medicine as a clinician if you ask me...but hey, that's just my opinion and I don't intend to disrespect you guys
In other countries with socialized medicine like England, you also finish medical training faster, get your schooling paid, have less BS paperwork, and you don't have to worry about frivolous lawsuits. I wouldn't mind being a clinician in other countries either. But in the US, I wouldn't want to be one.
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Well, somehow somewhere, you regressed.
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In other countries with socialized medicine like England, you also finish medical training faster, get your schooling paid, have less BS paperwork, and you don't have to worry about frivolous lawsuits. I wouldn't mind being a clinician in other countries either. But in the US, I wouldn't want to be one.
I've heard some awful stories about clinical practice in the US...didn't know for sure if they were true, but now that you're telling me this...well, no wonder why rads is soooo competitive over there, here it's not competitive at all
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It depends on the financial incentives of each country. I have spoken with physicians from Germany and India and they tell me that radiology is highly sought after. The same is not true for derm. Derm is one of the least competitive specialties in those countries and many others. If we ever allow physicians who complete their residencies in other countries to come here and practice immediately, derm would be in big trouble from oversaturation.
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Seeing as derm residencies are limiting the number of highly qualified American medical students from entering their field, I don't think dermies have anything to worry about in terms of foreign "invasion".
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Derm residencies in Germany are quite hard to get into, together with residencies in ophthalmology. This is, however, not due to the financial opportunities after residency, it's just a consequence of limited training spots.
Radiology is not that hard to get into, although it is at the top of the list of specialties in terms of salaries.
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I think the hardest to get into in Costa Rica would be optho, or plastics...Im not sure.
But that changes a lot anyways. For example, a couple of years ago there was a HUGE lack of anesthesiologists, so A LOT of people got in the field, now we have very young anesthesiology attendings with big responsabilities (some of them are chiefs of the gas department in their hospital) and an oversaturated field.
But that changes a lot anyways. For example, a couple of years ago there was a HUGE lack of anesthesiologists, so A LOT of people got in the field, now we have very young anesthesiology attendings with big responsabilities (some of them are chiefs of the gas department in their hospital) and an oversaturated field.
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Make sure you're exploring all your career possibilities. Residency seems to provide only a small glimpse of the real world of practice. I suggest that you do some extensive research before you switch because you'll probably never go back to that specialty.
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Ditto!!
Intern year has definitely reaffirmed why I chose Rads. The shortlist of complaints during intern year so far include prerounding, rounding, notes, telling patients to lose weight and take their meds, cross-cover on medicine, waiting on lab values and nurses to do stuff, begging for consult services to come see your patients, social work, etc etc.
-tx
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Ditto!!
Intern year has definitely reaffirmed why I chose Rads. The shortlist of complaints during intern year so far include prerounding, rounding, notes, telling patients to lose weight and take their meds, cross-cover on medicine, waiting on lab values and nurses to do stuff, begging for consult services to come see your patients, social work, etc etc.
-tx
I cannot wait to turn in my pager at the end of the year because of this.
Never again do I want to hear that Mrs. Smith on the Blue Team needs something for breakthrough pain. At 3 in the morning.
P
Pterion
deodeo said:
The first year of radiology can be demoralizing in some ways. You've worked very hard to get here and now are looking at things through very different lenses. As an intern you at least knew what a normal creatinine was and could broadly infer what an elevated value may mean.
But then you sit at the workstation the first day and look at the PA/LAT CXR and think, WTF? Is it normal? Looks like it. Wait, what's that? Rib, right? Hazy, sure but edema/effusion/consolidation/artifact?!? What do I say? The orthopod calls and asks you how you could possibly have missed the Boxer's fracture on that hand film you looked at an hour ago which results in you calling fractures every time you see a nutrient channel in the metacarpals for the rest of the day. Often the attending is cross-covering and cannot provide the at-the-box instruction you really need. Then at the end of the day you take home your 400 page text on just chest films and try to learn stuff. It's like starting medical school all over again.
Then maybe, just maybe, you think "well, I hated the hours of internship but I really didn't hate medicine/peds/surgery. But I hate this not knowing anything".
General radiology is a very broad specialty. It takes at least 4 years to learn the anatomy (with normal variants), rad/path correlation and yes, physiology to be even passably good. Sure the orthopod will see the fracture. Its all he/she does. You still have every other single body part, variant, differential and followup to learn in ALL specialties. It takes time. Yeah, the surgeon saw the small flow disruption in the liver on that CT and you didn't. On the other hand, you had 1386 images to evaluate in that study and the reason for exam that you were given was "finger pain".
Not intending to sound abrupt, but relax. It's hard because it is genuinely hard. There's a lot to know. Trust the process and do your best. If, at the end of at least a year and a half you still hate it, you can always change. You just can't change back. Is it the best specialty in the world? It is to me. It's not right for everyone, and that's fine. Take your time with this.
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Well said, Pterion. I agree completely, particularly with this part. When I first got to radiology, I felt like I knew as much about it as I did about medicine on the first day of gross anatomy. That's a discouraging thought for anyone that's already had 5 years of training. The learning curve is steep though, and before too long your brain adjusts and things start to become second nature.
