R4 body fellowship - attending input

[808s&heartbreak]

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1. What are the advantages of doing a nucs dual certification? My understanding is you can read nucs studies as diagnostic radiology. Am I missing something?
2. I have also seen many residents over the last few years forgo fellowship training, and ended up at really good jobs in desirable locations.
3. People should stop equating time spent on a subspecialty rotation or number of studies read with diagnostic skills. At my academic center (top 10 in the nation), some of the younger attendings did their dedicated 4th year in their subspecialty (without fellowship), and my co-residents and I think they are actually better than most of the senior attendings. Radiology technology changes all the time. New modalities are added and old modalities get discarded. I quite frankly do not see the need for prolonged training as long as you feel comfortable with your skills.

 

[Radology]

I felt most confident in my skills the day before I started fellowship.

Confidence is good. Overconfidence (which you seem to have) will come back to bite you. This is a very humbling profession at times.

 

[Tiger100]

Nucs dual certification is becoming more and more desirable as less people are nucs and jobs are opening up. One of the reasons I’m being hired at the new job is because I’m right out of training and am comfortable reading nuclear medicine studies...
PET/CT is 3.0 rvus per exam. For reference, a mri brain without and with is 3.1.

PET/CT is considered a low RVU study in the private practice world. For the time that you spend reading it and comparing it the prior studies, it pays pretty low.

Anyway, it doesn't matter since in a group we have to provide all services.

If someone is comfortable reading Nucs, they are valuable to a practice but it doesn't mean that they have to do a fellowship. For Nucs, just being comfortable is good enough unless you want to join an academic or cancer center.

 

[Tiger100]

1. What are the advantages of doing a nucs dual certification? My understanding is you can read nucs studies as diagnostic radiology. Am I missing something?
2. I have also seen many residents over the last few years forgo fellowship training, and ended up at really good jobs in desirable locations.
3. People should stop equating time spent on a subspecialty rotation or number of studies read with diagnostic skills. At my academic center (top 10 in the nation), some of the younger attendings did their dedicated 4th year in their subspecialty (without fellowship), and my co-residents and I think they are actually better than most of the senior attendings. Radiology technology changes all the time. New modalities are added and old modalities get discarded. I quite frankly do not see the need for prolonged training as long as you feel comfortable with your skills.

A lot of these people who skipped fellowship are from big programs and many of them stay at the same institution or they end up getting jobs at the local private practices BECAUSE OF CONNECTIONS.

I think people are missing a very big point. Most people end up doing a fellowship. Most practices prefer someone with 4 years of residency + fellowship to someone with 3 years of residency + fellowship (let's say the 4th year is considered a fellowship). The value of fellowship is not significantly more than a piece of paper for many practices. But the important thing is the skills that you bring with you.

You are right that the skills are important and not the length of training but you have to convince the practices that you are joining. You are competing with other applicants. Most of them have done a separate year of fellowship. If you can get a job through connections by just skipping fellowship, then do it. But it is not typical for many applicants.

In our practice, we hired two people recently and all of the applicants had a fellowship plus a minifellowsip or fellowship or whatever you call it.

 

[Tiger100]

There is a huge misconception about IR.

Yes, the DR part is 3 year. But practices hire IR rads for their IR skills. The IR guys typically are not going to read a lot of high end studies. Anyway, they are busy doing IR 50-60% of the time and the other 40% will be general radiology. But for DR, in many private practices you are expected to read most of radiology. You can probably skip a few niches like MSK MRI or PET-CT or prostate MRI. But that's all for most practices. So having a broader skills helps a lot to land a good job.

If you can get DR certificate in 3 years in IR pathway, it doesn't mean you are as good as a neurorad or MSK or Body imager. If a group wants to hire a DR, they want someone who can do more than his subspeciality and by more I don't mean just CXRs.

Q: Which one do you hire?
- Someone who has done body fellowship during 4th year + Neurorad fellowship or someone who has done body fellowship in 4th year without additional training.
Answer: If it is academic center, they don't give a crap. If it is a superspecialized pp, they may not care. But even in that case, they care because the first guy can help fill the empty spots. If it is a typical pp, they will definitely hire the first person unless the second person is well connected or has something more to bring to the table.

 

[tco]

You’re not seeing problems with them because most of them do a mini fellowship and a formal fellowship. THAT makes you a strong candidate and we love hiring these people because you can plug them in two subsections comfortably. If you cut out the formal fellowship part, the point of the mini fellowship is debatable and you’re weaker than what came out of the old style residency

And I’m on the Hiring committee of a coastal PP. I’m not gonna keep arguing about this. I haven’t said anything negative about the mini fellowship itself, just advising not to market it this way for a job because it’s misleading. But by all means, be my guest

If his program is anything like mine, most residents don't exactly...Exert themselves during most of that "fourth year of residency." It's a lot like MS4.

IMO, it would be more beneficial for him to do that year long fellowship and practice in a small town or do another fellowship in an unrelated field. I realize that OP is considering neither of these options, it's just my two cents (which is probably worth two cents).

 

[meister]

Some programs actually put their R4s to work. My fourth year was my toughest year.

 

[tco]

Some programs actually put their R4s to work. My fourth year was my toughest year.

IMO, there should be a balance. Our second year is horrendous and soul crushing.

Fourth year should be part service, part elective. Ours is like 10 months elective, but we have a limit to how much of any one subspecialty we can do.

The problem here is with the transition. How are you going to add responsibility to a specific class without that class bucking because they already went through second year? I guess gradual acclimation of call/night responsibility would be the best bet?

I digress...

 

[entrepreneurMD]

If his program is anything like mine, most residents don't exactly...Exert themselves during most of that "fourth year of residency." It's a lot like MS4.

IMO, it would be more beneficial for him to do that year long fellowship and practice in a small town or do another fellowship in an unrelated field. I realize that OP is considering neither of these options, it's just my two cents (which is probably worth two cents).

From what I hear, my program (top 15) has a chill R4 year and based on the feedback on this thread it doesn’t really help to over exert yourself I.e go HAM R4 with fellowships back to back. You’re gonna end up doing a regular fellowship anyways. So it’s much easier to just do a couple 3 month electives, travel/ enjoy life and then do a fellowship

 

[Radology]

When I finished my residency program (top 17.5), it was clear that you need to go to a top π fellowship program to land any decent job

But only go by the AP poll, the coaches poll is whack

 

[entrepreneurMD]

After all this input I’m thinking the following: R4 do a 3 month body and 3-6 month mammo with 3 months off for vacation. Fellowship would be in body. Thoughts?

Also partnership jobs that much worth it?

 

[Radology]

I think this is a decision a recently matched medical student doesn’t need to make right now

 

[DrfluffyMD]

After all this input I’m thinking the following: R4 do a 3 month body and 3-6 month mammo with 3 months off for vacation. Fellowship would be in body. Thoughts?

Also partnership jobs that much worth it?

How can you have 3 month off for vacation?

 

[tco]

How can you have 3 month off for vacation?

"Research."

 

[DrfluffyMD]

People like him is why some practices are distrustful of medicore residents from top 20 residencies and will take great residents from a known mid tier over unknown from top tier almost everytime.

I bust my ass in my resident driven program while people chill in fellow driven program

 

[meister]

Ivy League know how to play the game, that’s for sure.

 

[entrepreneurMD]

People like him is why some practices are distrustful of medicore residents from top 20 residencies and will take great residents from a known mid tier over unknown from top tier almost everytime.

I bust my ass in my resident driven program while people chill in fellow driven program

I plan on being anything but mediocre in residency but I also understand the principle of diminishing returns. You reading a couple more CTs in residency probably won’t make a difference in the end, sadly. When I was interviewing for residencies the notion of fellow driven vs resident driven programs was artificially created to sooth those egos that didn’t match top radiology programs (almost all of which are fellow driven). I noticed that the residents at both programs ended up at the same spot but fellow driven residents had way more free time and had to work less to get there.

It’s sad that’s the way that life is. I believe almost entirely in hard work but the game is not that. It values names vs material effort 🙁. Look st me. I was ready to bust my butt off doing a 1 year body thing but it would make no difference car

That being said I don’t think we will be competing for the same jobs. My program like many others have feeder practices all over the country with our alumni running them. So a phone call is all that’s needed to be placed for us.

I just wish the game wasn’t like this

 

[DrfluffyMD]

I plan on being anything but mediocre in residency but I also understand the principle of diminishing returns. You reading a couple more CTs in residency probably won’t make a difference in the end, sadly. When I was interviewing for residencies the notion of fellow driven vs resident driven programs was artificially created to sooth those egos that didn’t match top radiology programs (almost all of which are fellow driven). I noticed that the residents at both programs ended up at the same spot but fellow driven residents had way more free time and had to work less to get there.

It’s sad that’s the way that life is. I believe almost entirely in hard work but the game is not that. It values names vs material effort 🙁. Look st me. I was ready to bust my butt off doing a 1 year body thing but it would make no difference car

That being said I don’t think we will be competing for the same jobs. My program like many others have feeder practices all over the country with our alumni running them. So a phone call is all that’s needed to be placed for us.

I just wish the game wasn’t like this

Good luck buddy

 

[tco]

I plan on being anything but mediocre in residency but I also understand the principle of diminishing returns. You reading a couple more CTs in residency probably won’t make a difference in the end, sadly. When I was interviewing for residencies the notion of fellow driven vs resident driven programs was artificially created to sooth those egos that didn’t match top radiology programs (almost all of which are fellow driven). I noticed that the residents at both programs ended up at the same spot but fellow driven residents had way more free time and had to work less to get there.

It’s sad that’s the way that life is. I believe almost entirely in hard work but the game is not that. It values names vs material effort 🙁. Look st me. I was ready to bust my butt off doing a 1 year body thing but it would make no difference car

That being said I don’t think we will be competing for the same jobs. My program like many others have feeder practices all over the country with our alumni running them. So a phone call is all that’s needed to be placed for us.

I just wish the game wasn’t like this

Wow, this guy...

 

[meister]

That is a high quality troll post.

 

[Tiger100]

Agree.

 

[Radology]

I plan on being anything but mediocre in residency but I also understand the principle of diminishing returns. You reading a couple more CTs in residency probably won’t make a difference in the end, sadly. When I was interviewing for residencies the notion of fellow driven vs resident driven programs was artificially created to sooth those egos that didn’t match top radiology programs (almost all of which are fellow driven). I noticed that the residents at both programs ended up at the same spot but fellow driven residents had way more free time and had to work less to get there.

It’s sad that’s the way that life is. I believe almost entirely in hard work but the game is not that. It values names vs material effort 🙁. Look st me. I was ready to bust my butt off doing a 1 year body thing but it would make no difference car

That being said I don’t think we will be competing for the same jobs. My program like many others have feeder practices all over the country with our alumni running them. So a phone call is all that’s needed to be placed for us.

I just wish the game wasn’t like this

Entitled as F and striving for the bare minimum of work in residency. People like you are the reason Parternships aren’t guaranteed out of fellowship.

Good luck my friend.

You’re going to need it

 

[IJL]

Entitled as F and striving for the bare minimum of work in residency. People like you are the reason Parternships aren’t guaranteed out of fellowship.

Good luck my friend.

You’re going to need it

lol yeah. Is that guy for real?

 

[DrfluffyMD]

I have no doubt that this poster can do minimal work at a big name residency and still do well on their fellowship search or initial job search though. After that I am not sure.

 

[Tiger100]

I have no doubt that this poster can do minimal work at a big name residency and still do well on their fellowship search or initial job search though. After that I am not sure.

Exactly.

I have been in this job for 16 years and have seen many radiologists with different age, experience, education, culture, nationality, etc background.

I have seen some of the smartest and hardworking radiologist from both small and big programs. I have seen some of the best radiologists without fellowship training and I have seen some radiologists with fellowship who really suck, overcall and can't make the final decision.

If I want to hire someone, I prefer to hire someone who has passed their test by working somewhere else. The best radiologist to hire is the one who has worked somewhere else for 4-5 years, learned the tricks and has done well. The training background is not that important.