Radiologists, at what point in training did you know you made the right (or even wrong) specialty choice?

[Maybedoc1]

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IM prelim here who matched DR at a great program after really struggling with their specialty choice for a long time. I was between EM, IM, Anesthesia (all with likely a critical care fellowship), and DR. I narrowed it down to anesthesia vs DR and decided on DR 2 weeks before apps were due. I ultimately chose DR for a number of reasons including the vast knowledge base of both common stuff and zebras, focus on diagnosis, being the “doctors doctor”, ability to work from home, lack of mid level encroachment, compensation, and the humane (albeit long) training among other things. I did two radiology rotations and even though I sat there doing nothing, I found it fascinating. Now that I’ve matched, have started residency, and am looking at 5-6 more years of training I’m naturally praying I made the right decision. I think the hard part of radiology is unlike some specialties, you can’t really get a feel for what it’s actually like as a medical student. It’s not like IM or something where you can see patients, come up with plans, call consults on them, etc as a medical student. I think you have to wait for residency to know if radiology is actually right for you. It kind of takes lots of self reflection and a leap of faith to decide on it in my opinion.

So rads peeps, at what point in training did you know you made the right or wrong choice?

P.S. A few months of intern year has solidified that I feel meh about patient interaction and don't think I'll miss it terribly in radiology. Also while I think the medicine in IM can be very interesting, I hate the practice of it.

 

[MadRadLad]

Very few people truly regret it enough to leave. If you miss patient contact you can do IR or mamms. If you like clinic, owning the patient etc then IR is an option. If it's a small itch you can scratch it via basic body, msk, neuro procedures.

I only know 2 people who have truly regretted radiology and both tried to return after leaving residency. Even a few of the wannabe neurosurgery regret guys ended up doing IR and neuroIR respectively and very happy.

 

[Radguy12]

If you already feel that way about IM you should be fine. But let me just say ,depending on the program, training can be very arduous. I did a surgery intern year at a tertiary care center and there wasn't a single day where I felt as exhausted as I do after a busy ER shift. Alot of clinical medicine, if not all is mindless work, which can be a lot less stressfull when compared to an ever growing list of traumas and cancer bombs coupled with other physicians and techs constantly interrupting your workflow. DR training at a good program is no cake walk

 

[colbgw02]

Any lingering doubt that I had was gone at the end of my first day of internship. My internship had an OB/GYN rotation, and doing 20+ pelvic exams on day 1 had me ready to get to the reading room.

That said, I don't think any of the anecdotes you'll find here should be instructive for you. There's too much reasonable variation between individuals' decision processes. Instead, I would focus on big picture and overall trends. Chiefly, I think radiology has a big tent. Is there another specialty that offers choices as different as running your own IR clinic versus working exclusively from home from anywhere in the U.S. with a decent internet connection? Chances are you can find your place, too.

I'm a former military radiologist, which means that I saw a lot of people who were free do additional training without the constraints of ACGME funding. Off the top of my head, I knew former fully-trained family practitioners, internists, general pediatricians, neurologists, OB/GYNs, general surgeons, and even a pediatric cardiologist who decided they'd rather be a radiologist. I never knew anyone who went in the opposite direction. Not exactly a scientific analysis, but perhaps helpful nonetheless.

 

[Melkor]

Making 1 mill+ working 210 easy-ish days/yr, a year or two after training was when I was 100% sure. Sureness level just kept going up gradually from med school to residency to attending. Residency sucked but knew it was finite and now I get to enjoy all the goodness of rads for rest of life.

 

[GadRads]

Making 1 mill+ working 210 easy-ish days/yr, a year or two after training was when I was 100% sure. Sureness level just kept going up gradually from med school to residency to attending. Residency sucked but knew it was finite and now I get to enjoy all the goodness of rads for rest of life.

Are you in the boonies? Just wondering how you make this much working 210 “easy” days.

I also don’t think most people would consider rads easy. Making the wrong call or a miss could be devastating for a patient, so every scan is read with some level of healthy intensity. That is not easy, especially with the time pressure.

While this is a nice gig for the right personality fit, there are rads who are trying to leave or cut back due to the high volumes.

 

[Melkor]

Are you in the boonies? Just wondering how you make this much working 210 “easy” days.

I also don’t think most people would consider rads easy. Making the wrong call or a miss could be devastating for a patient, so every scan is read with some level of healthy intensity. That is not easy, especially with the time pressure.

While this is a nice gig for the right personality fit, there are rads who are trying to leave or cut back due to the high volumes.

City of >150k pop but not any "big" cities nearby so that might be considered boonies?

I get what you're saying about it not necessarily being easy but I really do find it to be a very low stress job. Maybe I got hit in the head too much playing soccer as a kid but I read quickly and I don't generally stress about misses.

Edit: I will add, I don't stress about most scans partly because I live in a community that I perceive the average patient to be very low risk for lawsuits. If I was practicing in NYC/NJ, Chicago, FL or CA I would probably be a lot more stressed day to day. As it is now, I feel like a manual laborer on the assembly line floor. Never ending but a slow (perceived) pace. Boring and I love it.

 

[GadRads]

City of >150k pop but not any "big" cities nearby so that might be considered boonies?

I get what you're saying about it not necessarily being easy but I really do find it to be a very low stress job. Maybe I got hit in the head too much playing soccer as a kid but I read quickly and I don't generally stress about misses.

Edit: I will add, I don't stress about most scans partly because I live in a community that I perceive the average patient to be very low risk for lawsuits. If I was practicing in NYC/NJ, Chicago, FL or CA I would probably be a lot more stressed day to day. As it is now, I feel like a manual laborer on the assembly line floor. Never ending but a slow (perceived) pace. Boring and I love it.

I am on the coasts. Pay is good but not as high as yours, unless you moonlight. Work in a tertiary center with high complexity, but still get run-of-the-mill routine cases, but because of exposure to complex cases and population, I still maintain high vigilance even on what I believe is a normal scan after reading for 30s. Still read normal chest CT in 3 mins. Our fastest readers do it in 2 mins. I think average rad spends 5-6 mins on these. I have seen some slow ones spend 9-10 mins.

 

[jambro]

City of >150k pop but not any "big" cities nearby so that might be considered boonies?

I get what you're saying about it not necessarily being easy but I really do find it to be a very low stress job. Maybe I got hit in the head too much playing soccer as a kid but I read quickly and I don't generally stress about misses.

Edit: I will add, I don't stress about most scans partly because I live in a community that I perceive the average patient to be very low risk for lawsuits. If I was practicing in NYC/NJ, Chicago, FL or CA I would probably be a lot more stressed day to day. As it is now, I feel like a manual laborer on the assembly line floor. Never ending but a slow (perceived) pace. Boring and I love it.

Pretty sure NJ, chicago, FL, NYC are a lot worse than CA from a malpractice standpoint

 

[Melkor]

Pretty sure NJ, chicago, FL, NYC are a lot worse than CA from a malpractice standpoint

Sure, but the pt pop is just as bad (IMO) as those other places which would make the job as stressful as the other locales.

 

[vm26]

Are you in the boonies? Just wondering how you make this much working 210 “easy” days.

I also don’t think most people would consider rads easy. Making the wrong call or a miss could be devastating for a patient, so every scan is read with some level of healthy intensity. That is not easy, especially with the time pressure.

While this is a nice gig for the right personality fit, there are rads who are trying to leave or cut back due to the high volumes.

I've been with 5 PP's in various locations and have seen the spectrum of what rads do. Bottom line is 1M is >>99th% MGMA for income which usually means ditto for wRVU productivity.

 

[Melkor]

Bottom line is 1M is >>99th% MGMA for income which usually means ditto for wRVU productivity.

I would strongly disagree that 1 mill is 99th percentile for 1 FTE, let alone something like 99.5+ percentile. Many groups in the Midwest are hitting 1 mill+ which turns out to be 50-65$/wrvu w2 for comp. That's around 15-20k wrvus avg for a group so you get your mammos averaging low 20s and non mammos averaging 13-14k. Check out AR-FB weekly Friday job post. Many groups who are recruiting share that partners are doing 1 mill+ in their adds. Radhq has even more case examples.

Lots of groups might still be doing it the hard way by reading 20k+ wrvus to hit that million (or using slave labor/aka employees/associates to boost partner pay) but most of those are mid to larger groups or have bad leadership that haven't been as agile in negotiating with their hospital systems the past few years to get them to a reasonable $/wrvu.

I've been with 5 PP's in various locations and have seen the spectrum of what rads do.

I'm curious what the timespan of that was? The market of course has really changed the past 2-4 years so working for pp's before that time period likely wouldn't reflect todays market if the group has good leadership.

 

[vm26]

I would strongly disagree that 1 mill is 99th percentile for 1 FTE, let alone something like 99.5+ percentile. Many groups in the Midwest are hitting 1 mill+ which turns out to be 50-65$/wrvu w2 for comp. That's around 15-20k wrvus avg for a group so you get your mammos averaging low 20s and non mammos averaging 13-14k. Check out AR-FB weekly Friday job post. Many groups who are recruiting share that partners are doing 1 mill+ in their adds. Radhq has even more case examples.

Lots of groups might still be doing it the hard way by reading 20k+ wrvus to hit that million (or using slave labor/aka employees/associates to boost partner pay) but most of those are mid to larger groups or have bad leadership that haven't been as agile in negotiating with their hospital systems the past few years to get them to a reasonable $/wrvu.

I'm curious what the timespan of that was? The market of course has really changed the past 2-4 years so working for pp's before that time period likely wouldn't reflect todays market if the group has good leadership.

MGMA 2021 90th% nationally is $801K, mid-west $787K, South 884K.

MGMA 2021 90th% nationally for wRVU production is 15,681, mid-west and South is around 16K. Median nationally is around 10K.

Median wRVU for latest 2025 MGMA is around $55/wRVU (W2 divided by wRVUs).

MGMA data is limited but its the best we have. Also these #'s are outdated, maybe productivity/income has increased 15-20%? Reimbursement has been stagnant/depressed unless one is receiving a solid hospital subsidy.

I've been in practice for 13 years. Currently in a PP in the midwest, around 30 rads. Our 4-5 breast imagers are around 20k and the rest of us are around 13/14K for wRVUs. Even with solid subsidization, we are no where near 7 figures.

I appreciate your comments and insight. Call me pessimistic but the only way to make big time bank in rads is cranking high volume.

 

[GadRads]

I am on the coasts. No one is nearing $1 million. If you get that, you have to work very very hard, or be a very fast reader.

I do believe it is possible to get 1m in the Midwest. I know some rads in the Midwest, except I am not willing to move there.

 

[jambro]

I am on the coasts. No one is nearing $1 million. If you get that, you have to work very very hard, or be a very fast reader.

I do believe it is possible to get 1m in the Midwest. I know some rads in the Midwest, except I am not willing to move there.

There are absolutely people on the west coast nearing a mil. But you have to read a lot to get there, like prob 20k wrvu or more

 

[Kuratz]

You can definitely be highly compensated regardless of where you live if you work the current system.

I’m 100% Neuro tele covering low complexity community hospitals at $40/rvu and live in a desirable west coast city.

Pretty easily can hit 100 rvu in a shift without feeling burned out or unsafe.

In a typical hour that’s roughly:
-2 CTAs, often for dizziness, headache etc (10 min each)
-3 combo head/c-spine CT (6 min for each combo, often old people falls and negative)
-non con brain MR stroke r/o (6 min)
-15 minutes leftover for when there are complex cases, coffee break etc.

Totally doable but again you have to make the system work for you. I could not be even close to safely doing 100 RVU a day reading a bunch of xray, PET, onc body CT, complex neuro/head and neck, having to answer a bunch of tech questions, protocoling, doing occasional procedures, tumor board etc etc etc. All those low-efficiency RVU tasks are important and probably more professionally satisfying than cranking through a bunch of largely negative or straightforward exams but that’s what the current system rewards and to be able to work highly flexible hours with no commute making about 7 figures in my early career is just too good to pass up for now. Once loans are paid off, have a nest egg and kids are a little older and don’t want to hang out as much I’ll look at going back to something more traditional for that professional satisfaction. But hard not to feel incredibly satisfied with my career choice when I watch my Urologist neighbor in his 50s have to get up, commute to multiple different sites and slog through a busy clinic/OR schedule plus occasional busy overnight call for probably less money.

 

[point542]

I'm an R4. This is 100% the right choice for me and many others. I am very sensitive to inefficient uses of my time, of which pure DR practice has little of. If I miss patient interaction, I'll go do a procedure or two. Otherwise I'm chopping through the list at home and making $$$. What's not to like? Can't convince me of a better field in medicine for my priorities.

 

[Kuratz]

And to actually answer OPs question:

I’d say R2 is when I really knew Rads was the right choice. It’s after the massive learning curve of R1, you start to get the hang of what radiology is and feel like you know some stuff, and during R2 call is when I felt like part of the patient’s team again between busy ED shifts and procedures.

Med school and training is incredibly long and a ton of life happens in this period. I went in single and gung-ho on being a surgeon. Didn’t care about the potential lifestyle. Since then I’ve gotten married and had 3 kids. My priorities are vastly different and every single day I thank God that I didn’t delude myself into choosing surgery.

Radiology has allowed me to be incredibly present in my kids lives. I genuinely don’t think I’m missing any of their childhood because of how flexible my work is. It also has allowed me to provide a very nice life for them, better than I grew up by far. And it’s not trivial that you can choose to live exactly where you want to live. That just isn’t the reality for many fields.

I know I focus mainly on lifestyle but for myself and I’m sure many others that’s what allows a fulfilling life outside of work and most important for me. Some people are wired differently and need to feel that intensity of being in the hospital directly helping people and staying late etc. These people are in my experience the only ones who would really “hate” radiology but you know who they are and you know if you are one of them. But dude I’m telling you walking into your office, throwing on some tunes or a podcast while you work from home doing aesthetically-pleasing, largely no-bs work, and being able to work hours on your terms if you want is just unbeatable. Truly.

The practice of radiology itself isn’t perfect, as the volumes are pretty nonstop. But that being said I really enjoy my job, feel like an expert at what I do, and try to provide value to my reads when I can. After fellowship and a couple years of practice you really start to be damn good and efficient which is just an amazing feeling. And yet there is so much to learn that you can still develop new skills and knowledge pretty much daily if you seek it out.

Overall for the right person Rads is by far the best field in medicine right now. Hard to predict the future with AI, reimbursement, etc but for the near-term I don’t see this changing.

 

[hopefulraddaddypls]

And to actually answer OPs question:

I’d say R2 is when I really knew Rads was the right choice. It’s after the massive learning curve of R1, you start to get the hang of what radiology is and feel like you know some stuff, and during R2 call is when I felt like part of the patient’s team again between busy ED shifts and procedures.

Med school and training is incredibly long and a ton of life happens in this period. I went in single and gung-ho on being a surgeon. Didn’t care about the potential lifestyle. Since then I’ve gotten married and had 3 kids. My priorities are vastly different and every single day I thank God that I didn’t delude myself into choosing surgery.

Radiology has allowed me to be incredibly present in my kids lives. I genuinely don’t think I’m missing any of their childhood because of how flexible my work is. It also has allowed me to provide a very nice life for them, better than I grew up by far. And it’s not trivial that you can choose to live exactly where you want to live. That just isn’t the reality for many fields.

I know I focus mainly on lifestyle but for myself and I’m sure many others that’s what allows a fulfilling life outside of work and most important for me. Some people are wired differently and need to feel that intensity of being in the hospital directly helping people and staying late etc. These people are in my experience the only ones who would really “hate” radiology but you know who they are and you know if you are one of them. But dude I’m telling you walking into your office, throwing on some tunes or a podcast while you work from home doing aesthetically-pleasing, largely no-bs work, and being able to work hours on your terms if you want is just unbeatable. Truly.

The practice of radiology itself isn’t perfect, as the volumes are pretty nonstop. But that being said I really enjoy my job, feel like an expert at what I do, and try to provide value to my reads when I can. After fellowship and a couple years of practice you really start to be damn good and efficient which is just an amazing feeling. And yet there is so much to learn that you can still develop new skills and knowledge pretty much daily if you seek it out.

Overall for the right person Rads is by far the best field in medicine right now. Hard to predict the future with AI, reimbursement, etc but for the near-term I don’t see this changing.

This resonates a lot with me. Was gung ho surgery through med school, short term relationships with women, burn the candle fast Im going to be young forever. Well, after intern year Ive realized a lot of life has happened. Im in my late 20s, and rads residency has allowed me to live life in a way that wasnt possible in med school or internship. I think med students and people in medicine vastly overlook the impact that an "easy" residency will have on your life (obv rads isnt easy, but you get the point were not bound to the hospital), and add in that rads is cool asf and pays a ton as an attending? Only other field that is comprable is derm