Radiologist seeking EM residency

[TroubleNparadis]

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Just wanted to get some opinions on how a radiologist seeking a 2nd residency in EM would be received by the residents and attendings? How useful would the fund of knowledge a radiologist might bring into the ED be? How much difficulty would it be to obtain such a residency? Has anyone encountered such a scenario? Thank you.

 

[Apollyon]

Just for information, this dude (? - maybe a chick, I don't know) posted a similar thread in the rads forum, and a few SDN radiologists took the opportunity to MF EM docs. One guy (again, ?) even came into this forum and posted something in the finance thread, and edited it out quite quickly.

That said...

As an EM resident, then attending, you will be looking at all of your own plain films, and you have to know how to interpret a head CT through a transverse plane that crosses the basal ganglia. You do NOT have to be able to interpret U/S (except the ones that you do bedside), MRI, chest or abdominal CT, or angiography.

So, being rads boarded, you will be put into some "interesting" (as in, "possibly risky") situations. First, you will see something on a plain film the radiologist will miss. Or, you will miss it, and the radiologist will find it, and that can range from ribbing (gentle or otherwise) to threats of litigation (even if you are not working as a radiologist, you are trained and boarded as a radiologist, so you could be held to the same standard). Likewise, you will order a certain modality, and the radiologist will refuse to do it, or you will speak with the radiologist, and rads will say 'X', and you will say 'Y', and that can engender a problem if you don't say "OK, 'X' it is", unless you can, diplomatically, make the case for 'Y'.

Your colleagues will put you in a difficult position by curbsiding you to look at their plain films (less risky) or CTs, which pulls you away from your patients, and can cause friction when you say it, and your colleague takes it and says it, and, when pressed as to why they say it, they'll refer back to you. However, if you decline to look at the films, there will be bad feeling.

Also, as an EM resident, you will do "radiology conference", where some of your residency mates will expect you to do the 'heavy lifting', and to know everything at all ever about radiology, and others will resent you, and will cackle with glee if you get something wrong or don't know it.

Those are just my first thoughts. As rads takes their boards during residency, I don't know if you can train in it without taking those exams.

As to actually doing it, I know of one guy peripherally, but I don't even remember his name.

 

[EC3]

Radiology pays better, is more interesting, and has higher overall job satisfaction...why would you even consider changing?

 

[leorl]

I think in the current climate, there is more radiologist interest in seeking other career pathways. In-patient radiology is in some places losing out to teleradiology groups. Residencies are closing. Graduating radiology residents are being forced to take very low-paying fellowships. The job-market is uncertain. And the ever-contentious point is that Radiology in general views that some specialties including ours are encroaching on their territories and further compromising already diminishing job security. I won't get into it here, but these factors and more are definitely decreasing radiology job satisfaction.

In general, to the OP, I think you'll find many places rather open to the idea of having a radiologist as an EM resident. And I use the term "open" specifically, as the above poster demonstrates perfectly the closed-minded opinion of radiologists who lack clinical expertise. I think the things Apollyon said are caveats you'll have to consider, as well as the fact that EM is obviously very clinically-based and you would have been out of clinical practice for a very long time (having only done a prelim medicine / transitional year during residency). That is a legitimate obstacle that could keep you from succeeding in an EM residency.

Radiology and probably more specifically Radiology residents take the view that ED orders are without clinical basis. While I won't argue that there are some EDs which seem to order tests from triage without a physician seeing the patient first and therefore use imaging as the only way to diagnose, they are in the minority. You would have to get used to the fact that there will be many times that patients present with vague symptoms and you would be asked to get scans to rule out x vs. y vs. z . That might rub against your nature. You'd also have to get used to the fact that many of us read images before the radiologist does and trigger the correct treatment pathway before getting the reads back - unless we need something specific answered, we don't wait for the reads before diagnosing and consulting. This would probably be an instance where a residency would value your experience, but it might go against your nature.

 

[DreamingTheLive]

Radiology pays better, is more interesting, and has higher overall job satisfaction...why would you even consider changing?

For now. No way. Probably not for long.

 

[TroubleNparadis]

Just hoping to kick this around for more input. I really appreciate all the responses.

 

[goodoldalky]

I would ignore all of the advice you get. Figure out what you want to do, and do it. Don't make it more complicated than it is.

 

[deleted109597]

If you're a great candidate, and seem like you work well with others, somebody would probably give you a spot. They wouldn't be worried about board pass rates likely.
Hard part is going to be letting someone give you a chance. You would need a couple EM docs to write you some good letters.
Do whatever lets you sleep at night.

 

[la gringa]

If you're a great candidate, and seem like you work well with others, somebody would probably give you a spot. They wouldn't be worried about board pass rates likely.
Hard part is going to be letting someone give you a chance. You would need a couple EM docs to write you some good letters.
Do whatever lets you sleep at night.

agree.

plenty of folks train in a 2nd specialty. we had a guy switch from ortho when i was a resident... he was too busy filling in the blanks in everything BUT ortho to be the "ortho guy" except on rare occasions. i think everyone tried to respect that he was an "EM guy" now.

 

[Silent Cool]

Just wanted to get some opinions on how a radiologist seeking a 2nd residency in EM would be received by the residents and attendings? How useful would the fund of knowledge a radiologist might bring into the ED be? How much difficulty would it be to obtain such a residency? Has anyone encountered such a scenario? Thank you.

Trouble,

What year rads are you? Are you looking to switch? Or finish rads then do EM

thanx,
😎

 

[Silent Cool]

Hey, OP, interesting that you want to switch from Rads to EM. Usually it is the other way around. I think that EM is experiencing the same surge in interest that Rads did around the year 2000. Likewise, the incomes have surged. Just as in rads, however, the incomes and job offers will decrease. It is all cyclical. From all that I have read--which is a fair amount, both on here and auntminnie--I would say only leave rads if you hate or detest it. It seems that rads, moreso than any other field, has people switching IN to it from other residencies. I'm neither a rads or em resident nor a doctor, but that's just my observation.

g'luck

 

[TroubleNparadis]

Trouble,

What year rads are you? Are you looking to switch? Or finish rads then do EM

thanx,
😎

I'm currently a PGY3 soon to be PGY4. I plan on finishing. I enjoy radiology but the absence of patient interaction has revealed a tremendous void that radiology subspecialties including IR and Mammo won't fill. I guess ultimately my real question is how competitive would I be applying for a 2nd residency in ED given that my funding, as I understand it, would be cut in half and my training history is non-traditional to say the least?

 

[engineeredout]

I'm currently a PGY3 soon to be PGY4. I plan on finishing. I enjoy radiology but the absence of patient interaction has revealed a tremendous void that radiology subspecialties including IR and Mammo won't fill. I guess ultimately my real question is how competitive would I be applying for a 2nd residency in ED given that my funding, as I understand it, would be cut in half and my training history is non-traditional to say the least?

Brings up what I was going to ask. How does funding work if you decide to do a 2nd residency after completing a 1st?

 

[gutonc]

Brings up what I was going to ask. How does funding work if you decide to do a 2nd residency after completing a 1st?

This has been discussed extensively on the Gen Res forum and it's probably worth a quick search on your part (not mine). The short answer is that GME funding is divided into 2 parts, direct (your salary and benefits) and indirect (all the other crap). The split between the two varies between different programs but a 50/50 split is good enough for gummint work and to make a point.

For those going beyond their funding clock (fellowships, repeated years, 2nd residencies), IME funding remains at 100% but DME drops to 50%. So the total CMS reimbursement for a second residency (or fellowship or extra chief year or whatever beyond your initial funding) is roughly 75% (again...good enough to make a point).