Radiology Faculty--Answering Questions/"AMA"

[eartwj]

---

Members don't see this ad.

How strong of a connection to a city is undergrad connection? Especially if ones medical school is outside of that region. For reference, I’d like to end up in New Orleans. Main reason being I love the city and also did undergrad at a small college there (not affiliated with any of the residency/medical school programs). My current medical school is in NE. Is the fact I went to undergrad in the city/love the city a significant enough factor to breakthrough to that city and/or region?

 

[vin5cent0]

I would really appreciate your thoughts on LORS.

I currently have two strong LORs, one from a pediatrician and one from a well-known academic radiologist. I also have what I imagine is a very generic but favorable FM letter, and a favorable/probably slightly generic letter from an IM doc. I had intended on working hard on an IM sub-I in my 4th year to get a good letter, but my schedule has not worked out well and I don't imagine I will have time to get a letter like that before applying in a month or so.

A PP radiologist offered to write me a very strong letter on my last rotation. She's allowing me to write a portion of it to make it very personalized, and then said she would add on some additional supporting info to make a strong case for me.

My question is - Which would be the better combinations of letters to apply with?

A: Strong peds letter, two strong letters from radiologists

B: Strong peds letter, strong letter from a radiologist, generic/favorable letter from IM/FM

I'm wondering if two of my letters from radiologists may be too redundant and a FM/IM letter might be a better choice? Thank you

 

[RadiologyPD]

Hello, thank you for taking the time to answer our questions.

I am interested in rads but have had some worries of not matching. I go to a new DO school, first graduating class which is the worrisome part. My STEP1 was 242, STEP2 was 248, no red flags. How should I approach applying to DR from a new DO school, as in should I have a backup specialty or should I not apply to DR at all?

Sorry, but I don't really know what the landscape looks like for DO applicants. My guess is that you can match somewhere. You might try the "chance me" thread for the experiences of others in similar situations.

 

[RadiologyPD]

How strong of a connection to a city is undergrad connection? Especially if ones medical school is outside of that region. For reference, I’d like to end up in New Orleans. Main reason being I love the city and also did undergrad at a small college there (not affiliated with any of the residency/medical school programs). My current medical school is in NE. Is the fact I went to undergrad in the city/love the city a significant enough factor to breakthrough to that city and/or region?

I think I've addressed this before, and I'm not sure why the information isn't sticking. "Connection to geography" is as strong as you want to express it and only matters to a program that needs to consider how serious the applicants are about wanting to be in their area so that they don't waste interview slots on individuals who prefer to be in another area and who are strong enough to get a spot in another area. Search this thread for other posts on this topic to understand the issue.

 

[RadiologyPD]

I would really appreciate your thoughts on LORS.

I currently have two strong LORs, one from a pediatrician and one from a well-known academic radiologist. I also have what I imagine is a very generic but favorable FM letter, and a favorable/probably slightly generic letter from an IM doc. I had intended on working hard on an IM sub-I in my 4th year to get a good letter, but my schedule has not worked out well and I don't imagine I will have time to get a letter like that before applying in a month or so.

A PP radiologist offered to write me a very strong letter on my last rotation. She's allowing me to write a portion of it to make it very personalized, and then said she would add on some additional supporting info to make a strong case for me.

My question is - Which would be the better combinations of letters to apply with?

A: Strong peds letter, two strong letters from radiologists

B: Strong peds letter, strong letter from a radiologist, generic/favorable letter from IM/FM

I'm wondering if two of my letters from radiologists may be too redundant and a FM/IM letter might be a better choice? Thank you

Option A. Get your best letters.

 

[guytakingboards]

Hi, was wondering if I could get an opinion in what would be the best move in terms of step 1 moving pass fail. My school is allowing students to take the exam early and will give them permits for it assuming they can demonstrate a passing score. Would you feel having a step 1 scored in the first cycle of it being pass fail is worth it? Assuming students could reasonably pass the exam, would you have any idea how this would be interpreted in radiology?

For example, if students score something like a 210-220 are you going to just treat is as neutral, perhaps even negative to an application? Do you want to see 230+ to have a positive impact on an application in radiology? Thank you!

The current average of matched radiology residents is 240. Have to imagine <230 isn't going to be viewed well. Even 230-240 just puts you in the ballpark but below the average. I'd say take the P on step 1 and then crush step 2.

 

[222211100]

Thank you for helping so many applicants, this thread is a godsend. My questions and situation are a little unique, and I haven't seen it addressed elsewhere int he thread. I am a 4th year medical student at what i consider a mid tier large midwest med school, applying DR. My Step 1/Step 2 is 250/263 and i have honors in all rotations except 2 (ob/gyn and peds) in which I have HP. I don't have any publications but have tried to show consistent interest and involvement in research, a lot of my projects have just hit snags or had lackluster results at the end.

My issue is this, during one of my clinical rotations this year we had these forms filled out weekly by a resident just confirming we participated in sign out. At the end of my rotation I realized I had misplaced my last form and made the incredibly stupid decision to change the date on an old form and submit that in order to make the assignment deadline. To be clear I wasn't trying to change my assessment score, and completed all my clinical responsibilities well and am getting an LOR from my attending on that rotation. As a result my school issued an academic probation and an Isolated deficiency in professionalism, which will appear on my MSPE as "student was placed on academic probation after submitting the same assignment twice, altering the sate on the second submission, this was deemed a violation of the misconduct policy, but not representative of a pattern of behavior, and student successfully remediated this deficiency"

Now I am wrestling with whether I include it in my personal statement (right now I am leaning yes and have proceeded as such), and how my prospects in terms of interviews might be affected by this red flag on my record. Once i can get an interview I feel confident can explain my mistake and how I've grown from it, which i also try to do in a much shorter way in my PS. One of my LORs is from a fairly prominent radiologist at my institution, hopefully that might help by way of getting interviews. I know I messed up, and this is the only issue i have ever had in my career, I'm a strong student and typically make good impressions with those I work with, I just hope I can get to the stage where I can show that to programs. Any advice as to what I can do to maximize my prospects? Thanks

 

[Hippocrates II]

Is a letter of rec more meaningful from a long-standing PP radiologist with >25 years practice but no academic ties, or a very new (<3 months of practice) radiologist who works at a top academic institution and is actively doing research? I got a strong letter from two radiologists that fit these descriptions but I only need one letter. Thanks

 

[matthew87922]

I’m a 4th year from low-tier med school. I’m planning to apply for DR this year. I’m concerning my odds of getting into some competitive programs. Can you give me some advices? Thank you so much. My brief summary of app as follows:

I’m a US army veteran. Did bunch of volunteers during med school. 4H and 2HP during Clerkships. Published couple case reports and submitted two radiology paper to RSNA that still under review (I’m the 1st and 2nd authors). Four strong letters from gen surgery, IM, two from radiologists. I got 247 on step1 but got 241 on step2.
I want to do DR residency at New York, preferably New York City where my family lives. Can you guys let me know if I have any chances match into a competitive DR residency at NY? Or anywhere? (I’m really concern of my drop in step2 score)

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?

I’m thinking to apply 80-100 programs

What’s my odds of getting into TY programs?

Any guidance/advices are appreciated, thank you so much.

 

[RadiologyPD]

Sorry, just back from extended 10 day break. Can't say it was a vacation because it involved moving/setting up two kids in two different cities.

Hello, I have a bit of a unique situation. I dual applied last cycle and matched psychiatry. I'm realizing I made a huge mistake in the way I ordered my rank list and am interested in reapplying. I am a DO with step 1/2 both >250. Do you know if my intern year in psychiatry would count as an intern year for radiology? I have 6 blocks (could add a 7th) that are inpatient wards, EM, inpatient/outpatient neuro. I have some radiology case reports published from before I graduated. Do you think I have a shot at matching at an advanced program and starting next year as an R1? If not, do you think I have a chance at matching an advanced program but having to redo intern year?

This is a big jump to make but I think it is right for me and what my career goals are, any advice or input would be greatly appreciated. Thank you

Unfortunately, I don't think the first year in Psychiatry meets the ACGME Program requirements for Radiology. See page 20 of this document:

ACGME Program Requirements for Radiology

"To be eligible for appointment to the 48-month program, residents must have successfully completed a prerequisite year of direct patient care in a program that satisfies the requirements in III.A.2. in anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, surgery or a surgical specialty, a transitional year, or any combination of these."

You'll have to go back into the Match and look for either an "A" or "C" program in which you redo an internship and start Radiology in July 2023--unless you can somehow morph your current year to meet ACGME requirements. I would call ACGME to find out if this is possible.

If somehow this is possible, then you would be eligible for an "R" position. This would start July 2022. I've written previously about R positions--search for that, or google it. There are only about 20-25 each year, IIRC.

Hi, was wondering if I could get an opinion in what would be the best move in terms of step 1 moving pass fail. My school is allowing students to take the exam early and will give them permits for it assuming they can demonstrate a passing score. Would you feel having a step 1 scored in the first cycle of it being pass fail is worth it? Assuming students could reasonably pass the exam, would you have any idea how this would be interpreted in radiology?

For example, if students score something like a 210-220 are you going to just treat is as neutral, perhaps even negative to an application? Do you want to see 230+ to have a positive impact on an application in radiology? Thank you!

No bonus points for taking it scored if you don't score well. But I can't imagine programs aren't going to ask for some score--so they will probably ask for EITHER Step 1 scored or Step 2 scored. That would be what I would do if I were still PD. Not because I think scores are the "be all end all"--but low scores (bottom tercile for Step 1, bottom quintile for Step 2) portend substantial difficulty with the Radiology Core exam:

The Relationship Between US Medical Licensing Examination Step Scores and ABR Core Examination Outcome and Performance: A Multi-institutional Study

I’m a 4th year from low-tier med school. I’m planning to apply for DR this year. I’m concerning my odds of getting into some competitive programs. Can you give me some advices? Thank you so much. My brief summary of app as follows:

I’m a US army veteran. Did bunch of volunteers during med school. 4H and 2HP during Clerkships. Published couple case reports and submitted two radiology paper to RSNA that still under review (I’m the 1st and 2nd authors). Four strong letters from gen surgery, IM, two from radiologists. I got 247 on step1 but got 241 on step2.
I want to do DR residency at New York, preferably New York City where my family lives. Can you guys let me know if I have any chances match into a competitive DR residency at NY? Or anywhere? (I’m really concern of my drop in step2 score)

I know it’s a little bit late but is there anything I can do to boost my application a lit bit more? Or increases my chances?

I’m thinking to apply 80-100 programs

What’s my odds of getting into TY programs?

Any guidance/advices are appreciated, thank you so much.

This isn't a "chance me" thread, but my overall impression is that you will match in Radiology. Step scores are good enough and veteran status is a plus, in my opinion. Research box has been checked. Would not worry too much about the relatively lower Step 2. Having said that, I have no "feel" for the NYC programs--there is a wide spectrum of "prestige" in those programs, so you are clearly qualified for some, but the most prestigious might be out of range (though not sure, the veteran status really could be played as a marker of maturity, so boosts you).

I have no special insight into TY chances--again, maybe take these questions to the chance me thread.

 

[RadiologyPD]

Sorry, missed two other inquiries--addressed below:

Thank you for helping so many applicants, this thread is a godsend. My questions and situation are a little unique, and I haven't seen it addressed elsewhere int he thread. I am a 4th year medical student at what i consider a mid tier large midwest med school, applying DR. My Step 1/Step 2 is 250/263 and i have honors in all rotations except 2 (ob/gyn and peds) in which I have HP. I don't have any publications but have tried to show consistent interest and involvement in research, a lot of my projects have just hit snags or had lackluster results at the end.

My issue is this, during one of my clinical rotations this year we had these forms filled out weekly by a resident just confirming we participated in sign out. At the end of my rotation I realized I had misplaced my last form and made the incredibly stupid decision to change the date on an old form and submit that in order to make the assignment deadline. To be clear I wasn't trying to change my assessment score, and completed all my clinical responsibilities well and am getting an LOR from my attending on that rotation. As a result my school issued an academic probation and an Isolated deficiency in professionalism, which will appear on my MSPE as "student was placed on academic probation after submitting the same assignment twice, altering the sate on the second submission, this was deemed a violation of the misconduct policy, but not representative of a pattern of behavior, and student successfully remediated this deficiency"

Now I am wrestling with whether I include it in my personal statement (right now I am leaning yes and have proceeded as such), and how my prospects in terms of interviews might be affected by this red flag on my record. Once i can get an interview I feel confident can explain my mistake and how I've grown from it, which i also try to do in a much shorter way in my PS. One of my LORs is from a fairly prominent radiologist at my institution, hopefully that might help by way of getting interviews. I know I messed up, and this is the only issue i have ever had in my career, I'm a strong student and typically make good impressions with those I work with, I just hope I can get to the stage where I can show that to programs. Any advice as to what I can do to maximize my prospects? Thanks

Definitely explain in PS. Should be fine, you will definitely match well with your other performance metrics.

Is a letter of rec more meaningful from a long-standing PP radiologist with >25 years practice but no academic ties, or a very new (<3 months of practice) radiologist who works at a top academic institution and is actively doing research? I got a strong letter from two radiologists that fit these descriptions but I only need one letter. Thanks

If both letters are similarly strong with the same level of knowledge of you, then go with the academic one...unless the PP one is from a former academic radiologist. In general, comments about your work ethic and tenacity are better than comments about your intelligence/research ability.

 

[AndyHarold]

Hi, thanks for providing so much help for all the folks out there.

I am an IMG with diagnostic radiology board certification obtained in Europe, and I have research background and green card.
My questions are:
1) my primary plan is to apply to ABR alternate pathway program; however, I have found only a few institutes that list alternate pathway on their website. Is there an online list of places that offer this option - or maybe is it an option at every place, but not listed on the website?
2) would it make sense to apply for DR residency instead of searching for alternate pathway options? I'm in my late 30s and always thought that residency programs prefer younger people with no prior training in radiology. I also saw the stats you posted earlier on the chances of being interviewed as IMG.

Thank you for your advice

 

[RadiologyPD]

Hi, thanks for providing so much help for all the folks out there.

I am an IMG with diagnostic radiology board certification obtained in Europe, and I have research background and green card.
My questions are:
1) my primary plan is to apply to ABR alternate pathway program; however, I have found only a few institutes that list alternate pathway on their website. Is there an online list of places that offer this option - or maybe is it an option at every place, but not listed on the website?
2) would it make sense to apply for DR residency instead of searching for alternate pathway options? I'm in my late 30s and always thought that residency programs prefer younger people with no prior training in radiology. I also saw the stats you posted earlier on the chances of being interviewed as IMG.

Thank you for your advice

There are not many places that still have the alternative pathway active, and I don't know of any listing. It requires consecutive ACGME accredited fellowships, so generally only available at the more academic places. Anecdotally, I know of people who have done this at Mallinckrodt and Ohio State. There may be others, just don't know.

As for applying for DR residency, the age should not be as much as a factor if you have great credentials, but it is difficult regardless. The main way the age hurts you is if it has been a while since you've been doing radiology (i.e, how long ago was your European experience?). Keep in mind that you will have to do an internship (but I think that may also be true for the alternative pathway now--not sure).

 

[RadiologyPD]

I checked the ABR website--here is a list of unique places that have sponsored Holman pathway (alternative pathway) residents since 2002. This includes RadOnc, so some may not be applicable. Good luck.

Brigham & Women’s Hospital

Emory University

Geisinger Health System

Georgetown University Hospital

Henry Ford Hospital

Indiana University

Jackson Memorial Hospital

Loyola University

Medical College of Wisconsin

Medical University of South Carolina

Memorial Sloan-Kettering Cancer Center

Mount Sinai Medical Center

NY Presbyterian Hosp (Columbia Campus)

NY University School of Medicine

Ohio State University

Oregon Health & Science University

Penn State University/Milton S. Hershey Medical Center

Stanford University

U of Texas SW Medical School

UC/San Diego Medical Center

UCLA Medical Center

UCSF

Univ of Alabama Medical Center

Univ. of Texas, MD Anderson Cancer Center

University of Alabama

University of Arizona Hlth. Sci. Center

University of California, San Francisco

University of Colorado

University of Iowa

University of Maryland

University of Massachusetts

University of Michigan

University of North Carolina Hospitals

University of Pennsylvania

University of Rochester

University of South Florida

University of Texas Health Science Center at San Antonio (UTHSCSA)

University of Vermont

University of Wisconsin

Vanderbilt University Medical Cent er

Virginia Commonwealth University Health System

Wake Forest University

Washington University, St. Louis

Weill Cornell Medical College

Yale University

 

[AndyHarold]

I checked the ABR website--here is a list of unique places that have sponsored Holman pathway (alternative pathway) residents since 2002. This includes RadOnc, so some may not be applicable. Good luck.

Brigham & Women’s Hospital

Emory University

Geisinger Health System

Georgetown University Hospital

Henry Ford Hospital

Indiana University

Jackson Memorial Hospital

Loyola University

Medical College of Wisconsin

Medical University of South Carolina

Memorial Sloan-Kettering Cancer Center

Mount Sinai Medical Center

NY Presbyterian Hosp (Columbia Campus)

NY University School of Medicine

Ohio State University

Oregon Health & Science University

Penn State University/Milton S. Hershey Medical Center

Stanford University

U of Texas SW Medical School

UC/San Diego Medical Center

UCLA Medical Center

UCSF

Univ of Alabama Medical Center

Univ. of Texas, MD Anderson Cancer Center

University of Alabama

University of Arizona Hlth. Sci. Center

University of California, San Francisco

University of Colorado

University of Iowa

University of Maryland

University of Massachusetts

University of Michigan

University of North Carolina Hospitals

University of Pennsylvania

University of Rochester

University of South Florida

University of Texas Health Science Center at San Antonio (UTHSCSA)

University of Vermont

University of Wisconsin

Vanderbilt University Medical Cent er

Virginia Commonwealth University Health System

Wake Forest University

Washington University, St. Louis

Weill Cornell Medical College

Yale University

Thank you (and especially for the instant reply), this is very helpful!
For me it was not clear whether IMGs can apply for the Holman pathway, but it is good to hear if that is the case. I have not practiced for 4 years but the research is focused on clinical imaging so I am not far from radiology. I guess I should emphasize that in the personal statement to counterweight the gap in practice years.

 

[MrMimeGuy]

Is having no LoR from a radiologist a major red flag? I decided very late to apply and only have clinical letters from IM/FM/Peds/ICU. Stats are low but still good odds (90%) per data

 

[RadiologyPD]

Is having no LoR from a radiologist a major red flag? I decided very late to apply and only have clinical letters from IM/FM/Peds/ICU. Stats are low but still good odds (90%) per data

Not major red flag, but what is your hook if your stats are low?

You seem to be banking on the fact that most radiology applicants match--you can match without a radiology letter, but a lot depends on the rest of your application. It can't all be half-ass.

 

[Noemata]

Hi, could you briefly explain what the Holman Pathway is? I know one program that has canceled this pathway and I'm just curious to know why this pathway is on a downtrend. Thank you

 

[Broseiden]

Hello, this is a rather specific question. How do you compare candidates coming from schools with P/F clinical rotations? I know this doesn't pertain to many schools, but I am wondering how you normalize between the changing curriculum of different schools. Did you calculate a clinical score from other criteria? Do clinical electives matter at all? What about schools that have absolutely no grades? Thank you for your time.

 

[guytakingboards]

Hi, could you briefly explain what the Holman Pathway is? I know one program that has canceled this pathway and I'm just curious to know why this pathway is on a downtrend. Thank you

The Holman Pathway is basically the residency version of a medical school MD/PhD (though you don't need to finish the PhD to finish the pathway). The goal is to train people with a career in research in mind. Candidates basically have to do all the things a PhD candidate would do: conduct research, write papers, and present findings at the end of the pathway.

You are correct that the pathway is decline in radiology. Most of the Holman pathway graduates in the last decade were in radiation oncology.

I'm familiar with a program that had offered the Holman pathway in radiology. There's a lot of factors in play.
- Gotta have strong institutional support. One significant consideration is funding for the research time/graduate classes/etc... Also, there has to be an understanding of the logistics of undertaking two very different endeavors (clinical radiology training and graduate-level research) concurrently.
- Takes an exceptional candidate to be able to do both competently. Clinical residency training is hard enough, but cut the number of months in radiology from 36mo to 27mo and the candidate better be excellent to come out nearly as good as those who got 9 more months of training. The research side is its own beast. There are so many people who drop out of regular PhD programs; someone in Holman has to be incredibly disciplined to make their way through the research side while simultaneously balancing the clinical training demands.

The program I know of had trouble getting the caliber of people needed to succeed in the pathway. They sometimes recruited people who were either deficient in clinical skills, research or both.

As for why more exceptional candidates don't do the pathway? I don't think the juice is worth the squeeze. A top candidate can more easily go to a top academic radiology program, find mentors, do some research and find a job at an academic center with a 1/10th of the effort of trying to complete a residency and PhD at the same time. Most academic attendings doing research, even at good programs, don't need a PhD to do what they do.

 

[RadiologyPD]

Yes, guytakingboards has stated it well.

I apologize for any confusion I introduced by conflating the "IMG" pathway with the Holman pathway. Two different things.

So that list I provided was for the Holman pathway, not the IMG pathway.

See the ABR site for details--see alternate pathway listings on the left: ABR Alternate Pathways

 

[RadiologyPD]

Hello, this is a rather specific question. How do you compare candidates coming from schools with P/F clinical rotations? I know this doesn't pertain to many schools, but I am wondering how you normalize between the changing curriculum of different schools. Did you calculate a clinical score from other criteria? Do clinical electives matter at all? What about schools that have absolutely no grades? Thank you for your time.

When I ran the show, there were some programs in which the "clinical score" could not be assessed, so the surrogate would fall on the Dean's letter "relative performance" assessment, along with some weighting for the "quality" of the medical school. I believe every school has to provide this, but the categories can be huge (i.e., top 10%, next 80%, bottom 10%).

Generally, if you are a great candidate on other metrics, not having a way to understand your "clinical score" hurt you slightly. If you were a marginal candidate on other metrics, not having a way to understand your "clinical score" might actually slightly help you, in the event that the score would also be marginal if we had a way to understand it.

Keep in mind, I no longer run the show at my shop.

 

[futuredoc111]

Hi Radiology PD,

First off I wanted to say thank you so much for all of these insightful comments, they have been very helpful. I have kind of a unique situation (but probably not really since I know a lot of people switch) that I need some help with if you could help guide me. To give you some background I'm a DO student from one of the better known DO schools if that means anything. My scores were mid 230s for Step 1 and high 230s for step 2, with low 600s for Level 1 and mid 600s for Level 2. I was first quartile (top 10%) in my med school class, honored all but my surgery rotation (lol), have 3 first-authored publications in decent basic science journals, and tons of volunteer + EC + leadership experience. I matched general surgery last year and had surprisingly great interviews for a DO student at a handful of mid-tier academic places that take way more MDs than DOs, and even a few "reach" places as well. I'm currently an intern right now in general surgery and I very soon realized surgery is not for me. I was ecstatic about this field at first and basically grew up wanting to become a surgeon. I am also at a program that is not-malignant and very very supportive. That being said, i'm just bummed out right now how unmotivated I am in this field at the moment. I still work hard and always back up my co-residents, and I can see myself finishing this residency, but painfully so. I hate the social work, the patient interactions are just so crappy now, and I really don't care about operating anymore. This is even after some great comments from some critical surgeons telling me how much I am improving. While it's great hearing that, it's not enough motivation for me to pursue this career past another year like it is most other surgery residents that get their high from cutting. That being said, I know I am pretty set on switching and I thought about Radiology for a while now. I was almost going to dual apply but convinced myself that I should just stick to surgery since I was more familiar with the field despite hating the social work and long hours (definitely a mistake on my part, didn't know how much I would actually dread this part). I've been working with radiologists just through my day to day work and get to work with the residents at times to review scans and such, and also attend their conferences. I am a little salty that I didn't find out more about this field earlier and what it truly entails. By no means is Radiology free from burnout, and I completely understand that, but I absolutely love that you guys can really focus on direct medical care without the nuances of all the extra clinical inefficiencies and BS that happens on the floor. Sometimes in surgery I can rarely focus on the problem at hand before getting paged about the dumbest thing ever that I have to get up from my chair and go to the floor to handle, and it's just painful...

That being said, what are my options for transferring into a Radiology program? I have a few questions here so I'll list them out in # format so it's easier for you to reply. Also, I apologize in advance for the long read above, just thought it'd be more informative for you to know my story. My questions are:
1. What are my options on transferring into a Radiology program this year (I will not be applying this cycle, it's just too late for that and didn't bring this up to my PD yet as I only very recently decided I really should change)? That is to start as a PGY-2 (R1) in July 2022. How would that happen and how do I approach this?
2. Assuming I can't transfer directly and have to reapply through the next match cycle, that means after the year I interview I will have a whole extra year, does this affect accreditation or does this have to be explained if I match into Radiology? Or do they understand this is how long someone might have to wait after they transfer? What does one do during those two years (the interview year and the year you wait to get into the PGY2 spot)? Is it looked down upon to travel and visit family or do they expect to grind out hard research or something like that? So if I apply July 2022, I guess that means I won't actually start until July 2024 since I have to wait that extra year to get accepted into the PGY2 spot right?
3. Since I am a DO student with below average board scores for Radiology, how do you see my chances of matching into Radiology? I honestly don't mind matching into a lower-tier or community program. That being said, I know I had interviews at some great places for surgery, but I also had great letters and a great PS for surgery. I am fearful that I might not be able to obtain quality radiology letters. Are radiology letters required to match into radiology or can my surgery attendings write them for me? Do you think I have an okay shot at matching into Radiology given my entire profile now and that it's worth reapplying/trying to transfer given my situation? Or that it's highly unlikely?
4. What is the best way to approach other PDs and definitely my own PDs about this? I know in-person is likely ideal, but how would you go about approaching the email to meet in person with other PDs in your town or even to set up a call with other PDs via email outside of your state?
5. If I can't transfer directly for a PGY2 spot in July 2022 and have to reapply in July 2022 for a PGY2 spot for July 2024, will this have to be explained to the Radiology boards down the line? Have you ever heard of anyone not being board-certified because of something like this?
6. Any other advice for me going through this about the transfer/reapplication process? At this point even if I had to take a year to interview, and an extra year to wait in between getting accepted for that July 2024 spot as a PGY2 in Radiology, I realize it's really really worth it and I'm willing to do that. Do you think PDs would care what I did after getting potentially accepted in July 2023 for a July 2024 spot? E.g. working at a company vs. doing rads related research or something like that?

Thank you so much once again for answering all of this. I will definitely have more questions to ask and will post it along the way. This whole forum has been a godsend!!

 

[RadiologyPD]

1. What are my options on transferring into a Radiology program this year (I will not be applying this cycle, it's just too late for that and didn't bring this up to my PD yet as I only very recently decided I really should change)? That is to start as a PGY-2 (R1) in July 2022. How would that happen and how do I approach this?

1. Understand the difference between R positions, C positions, and A positions. There are previous posts on this in this thread. At this point, you need to register for the 2022 Match, and you would prefer an R position that starts July 2022, but may have to settle for an A position that starts 2023. You might or might not be eligible for C positions that start July 2022, depending upon whether the institution relies exclusively on federal funding for the internship year (many do, and they won't see you as eligible, some don't and you would be)--but taking a C position means re-doing an internship year.

The following comments apply to programs that use the Match, which is practically all programs. Programs MUST fill through the Match if there is a Match available to fill the spot. Since you are looking for a spot starting July 2022, and there currently is a Match that can fill that spot (using an R position in the Match coming up in March 2022), any program that has a known opening has to go through the Match. The only time you can fill a spot outside the Match is if it can't be filled through the Match--meaning the spot opened up AFTER the match quota was turned in by the program (January 31).

So if a program learns that one of it's incoming residents for an R1 position (PGY-2) starting July 2022 is NOT going to come and learns of that well BEFORE Jan. 31 which gives them time to recruit, then they petition the Match to allow them to convert that opening to an R position, and they fill it through the Match. If they learn of it AFTER Jan. 31, then they try to fill outside the match using advertising (see APDR website): APDR open positions

If you look at that link, you will see that in April 2021 (after January 2021), Jacobi had a spot available for an R1 position starting July 2021. You will ONLY find such R1 positions advertised between February to July of any given year, because if the program knew about the spot before February, they typically convert it to an R position through the Match. After July, it's too late and they convert it to an R position or A position in the next match.

All the other spots (R2-R4) cannot be filled through a Match, so it is open season to advertise for those all year.

does this affect accreditation or does this have to be explained if I match into Radiology?

If I can't transfer directly for a PGY2 spot in July 2022 and have to reapply in July 2022 for a PGY2 spot for July 2024, will this have to be explained to the Radiology boards down the line? Have you ever heard of anyone not being board-certified because of something like this?

2. You don't have to explain anything about previous training when applying for ABR Board certification. Obviously, when you are applying for training, you will have to explain to the programs you are interviewing, but ABR doesn't care.

Assuming I can't transfer directly and have to reapply through the next match cycle, that means after the year I interview I will have a whole extra year, does this affect accreditation or does this have to be explained if I match into Radiology? Or do they understand this is how long someone might have to wait after they transfer? What does one do during those two years (the interview year and the year you wait to get into the PGY2 spot)? Is it looked down upon to travel and visit family or do they expect to grind out hard research or something like that?

3. If you have a great application, you don't have to do anything with your "off time". If not, it can help to supplement your application with activities that demonstrate motivation, ability to work in teams, ability to contribute to "brand" for the program--see previous posts about what programs want.

Since I am a DO student with below average board scores for Radiology, how do you see my chances of matching into Radiology? I honestly don't mind matching into a lower-tier or community program.

Do you think I have an okay shot at matching into Radiology given my entire profile now and that it's worth reapplying/trying to transfer given my situation? Or that it's highly unlikely?

What is the best way to approach other PDs and definitely my own PDs about this? I know in-person is likely ideal, but how would you go about approaching the email to meet in person with other PDs in your town or even to set up a call with other PDs via email outside of your state?

4. Understand your hook, if you have one, or develop one. Your approach depends on your hook. If you have no hook, and can only sell yourself as a "DO student with below average metrics and ordinary background activities that realized late that Surgery was a poor choice"--well, then it's going to take good salesmanship. I can't tell you what that means for you or how to do it.

Are radiology letters required to match into radiology or can my surgery attendings write them for me?

5. No. I think I've covered this ad nauseum.

Do you think PDs would care what I did after getting potentially accepted in July 2023 for a July 2024 spot? E.g. working at a company vs. doing rads related research or something like that?

6. After matching?...why ask me, ask your PD if he/she cares. Most will not--they are mostly focused on their current residents, not worried about grooming some incoming resident. If he/she does care, then try to meet their expectations and enlist their help in doing so.

 

[azn32]

Hi Radiology PD,

I am a 4th year (Step 239/243) applying radiology, have received honors for all rotations except my last rotation due to "professionalism", due to severe family illness, I asked my preceptor to leave early a couple of times during the rotation and my school deemed it unprofessional. Now it is on my MSPE, I am planning on addressing it in my PS. Also wondering how my prospects in terms of interviews might be affected by this red flag on my record? And whether I should apply to backup specialty. Thank you in advance for your insight.

 

[RadiologyPD]

Hearing only your story, it sounds pretty harsh in terms of your treatment, unless you just totally blew off your professional responsibilities.

I think it is a good idea to address it head on. It is not a "deal-breaker". Your step scores are a bit under average for radiology (but good enough). However, your clinical rotation grades are excellent, depending on what school you go to (at some schools, 50% of the students get honors, so that wouldn't help, but most are not like that).

Do you know where your MSPE "ranks" you? If below average (which I can't imagine with "all honors" in 3rd year), then something's wrong.

A lot will depend on whether you are MD or DO, the brand name of your school, and the geography you are targeting. I don't think you would "not match" with those clinical grades, unless you only apply to reach programs. Also, can you make any inroads on the program at your school? Ultimately, I wouldn't think you need a "backup specialty" if you are willing to apply broadly/smartly. But if you have another field that interests you that is "easier" to match (like Rad Once these days), it's ok to consider. It just seems like a lot of effort in terms of getting letters tailored correctly, etc.

 

[THis is for the fires]

Hi im wondering how programs view DUIs >13 years ago. Do you automatically throw them out? I'd imagine from your previous posts that your prior institution specifically would have so many qualified applicants that risk aversion would be at play regardless of time. Currently applying this cycle, With pretty much average stats step 1 mid 240s step 2 + 5. Also one more question how does being from an underrepresented group come into play? I have seen many radiology rosters across the country and sometimes find almost no black or Latino students in the new class. thanks for doing this btw.

 

[guytakingboards]

Hi im wondering how programs view DUIs >13 years ago. Do you automatically throw them out? I'd imagine from your previous posts that your prior institution specifically would have so many qualified applicants that risk aversion would be at play regardless of time. Currently applying this cycle, With pretty much average stats step 1 mid 240s step 2 + 5. Also one more question how does being from an underrepresented group come into play? I have seen many radiology rosters across the country and sometimes find almost no black or Latino students in the new class. thanks for doing this btw.

My personal observations of the URM question from when I was involved in resident recruitment: (yes, these are generalizations)
-URMs are a small percentage of the radiology applicant pool.
-URM's that meet the average accepted applicant numbers are even smaller.
-the superstar URM's pretty much have their choice of programs, and not surprisingly many shoot high.
-URM's tend not to end up in fly-over country where there aren't a lot of other URM's.

Personal anecdotes:
-when i was at Duke for fellowship, a place that "prizes diversity", they had zero black residents. Now one had just finished residency and was still a body fellow there, but it just seemed like they couldn't recruit their caliber of URM resident to come to Durham, North Carolina. Their residency roster was predominatnly made up of Caucasian people from flyover country who had no problem coming to North Carolina.
-In residency, we interviewed several URM candidates every year. The ones we'd have been excited to get went elsewhere. Even the same thing went for female applicants. One year we tried to make a push to balance the male/female ratio in the residency by ranking women basically 15 of our 20 top spots on the ranking list. We got 0 women in that entire class. Basically for individual programs, it may not be for a lack of trying that classes lack diversity.

 

[7331poas]

Heard rumors that Radiology programs record who registers/attends their virtual open houses to gauge an applicant's interest pre-interview.

Any truth to this?

 

[azn32]

Hearing only your story, it sounds pretty harsh in terms of your treatment, unless you just totally blew off your professional responsibilities.

I think it is a good idea to address it head on. It is not a "deal-breaker". Your step scores are a bit under average for radiology (but good enough). However, your clinical rotation grades are excellent, depending on what school you go to (at some schools, 50% of the students get honors, so that wouldn't help, but most are not like that).

Do you know where your MSPE "ranks" you? If below average (which I can't imagine with "all honors" in 3rd year), then something's wrong.

A lot will depend on whether you are MD or DO, the brand name of your school, and the geography you are targeting. I don't think you would "not match" with those clinical grades, unless you only apply to reach programs. Also, can you make any inroads on the program at your school? Ultimately, I wouldn't think you need a "backup specialty" if you are willing to apply broadly/smartly. But if you have another field that interests you that is "easier" to match (like Rad Once these days), it's ok to consider. It just seems like a lot of effort in terms of getting letters tailored correctly, etc.

Hi, thank you for responding! I was wondering if I could message you privately to give you more details?

 

[Dave1980]

Hi Radiology PD,

I am a 4th year (Step 239/243) applying radiology, have received honors for all rotations except my last rotation due to "professionalism", due to severe family illness, I asked my preceptor to leave early a couple of times during the rotation and my school deemed it unprofessional. Now it is on my MSPE, I am planning on addressing it in my PS. Also wondering how my prospects in terms of interviews might be affected by this red flag on my record? And whether I should apply to backup specialty. Thank you in advance for your insight.

Doesn't look good and sounds kind of fishy to me. Frankly, it is hard to believe that that is the whole story. Did you do something else or leave something out?

Like say "I need some time off to collect my thoughts" and then peace out for a week?

 

[RadiologyPD]

Hi im wondering how programs view DUIs >13 years ago

In my experience, these infractions from a decade or more ago that usually occurred in college are not a factor.

Also one more question how does being from an underrepresented group come into play? I have seen many radiology rosters across the country and sometimes find almost no black or Latino students in the new class.

Most, if not all, programs want diversity and are measured on it by their academic institutions. As guytakingboards explained, the lack of diverse residents in a program does not necessarily mean the program isn't trying, but I can guarantee you that they are being pushed to try harder. Sometimes the process that program uses needs serious retinkering (i.e, a program that relies heavily on USMLE scores as a comparative measure may not highly rank diverse candidates who have USMLE scores that are clearly "good enough" but which don't shine compared to others).

Having said that, there is substantial confusion about what constitutes diversity, since the main actual "metric" can vary from school to school. Nationally, the historic definition of URM from 2003 encompasses 4 groups: (1) Black; (2) Mexican-American; (3) Native American; (4) mainland Puerto Rican. AAMC URM Definition The broader "Hispanic/Latino" designation does not consistently qualify. At some specific schools, the term expands to include other groups, including some Asians (Filipino, Hmong, Vietnamese) UCSF URM Definition

Bottom line--if the program/school sees you as URM, your diverse perspective adds comparative value to the program and can overshadow comparatively weaker aspects of your application.

Hi, thank you for responding! I was wondering if I could message you privately to give you more details?

Rather not. Prefer to discuss in generalities for the benefit of many. I'm not saying that you should provide details broadly, what I'm saying is that the details don't really matter to many and probably not that important to understand for the purposes of the answer--the answer being that each person has unique circumstances, and you should use your application to address head-on any weaknesses that require/benefit from explanation.

Heard rumors that Radiology programs record who registers/attends their virtual open houses to gauge an applicant's interest pre-interview.

Any truth to this?

I don't know but highly doubt that this is important for most applicants. If you have a strong desire to be at a particular program, attend the open house.

 

[slapshot regatta]

Hi, any idea on how long your rank list should be to feel secure in matching in DR? I have heard anecdotally ten, but with covid/virtual interviews, maybe more? Thanks.

 

[7331poas]

Hi, any idea on how long your rank list should be to feel secure in matching in DR? I have heard anecdotally ten, but with covid/virtual interviews, maybe more? Thanks.

Same question but for couples match

 

[RadiologyPD]

Those are both impossible questions to answer because it depends on the relative strength of your application and the relative difficult to match for the programs you rank. You could go unmatched if you are a great student (so got interviews) but an absolute jerk and horrible interviewee and only rank the top 20 programs in the country. You could just rank 1 if you are a student at that school, know everyone really well, they are begging you to stay, and they tell you that you are ranked to match.

My guess is that if you can be totally honest about your application compared to others (you can use the NRMP reports to help you), then you should probably have at least 3-4 "safety" programs on your list. Or at least 2 that tell you that you are "ranked to match" (some programs do this, many don't).

Same would be true for couples, where a safety is a location/programs where you both are highly competitive.

Of course, that could easily translate to ranking 10 programs.

Here are NRMP documents that might help you assess your competitiveness:

MD

DO

 

[Jstnschltz]

Was hoping to get Rads PD input here. I was initially looking to go into surg onc but liked rads/neurorads a lot more than I initially thought.

MS3/4 (Currently in a gap between M3 and M4)
- Top 20 Med School
- No pre-clinical ranking
- 4th quartile for clinicals (3 honors and rest HP somehow gets me 4th quartile at my school)
- AOA: No
- GHHS: No
- Step 1: 237
- Step 2: Taking in summer

- Clinical grades: 3 honors (peds, psych surg), rest high pass. Somehow this gets me a 4th quartile at my school. Whatever.

- Don't have any recs as of yet (can get from some mentors though). Haven't done a DR elective or sub-I or anything like that yet.

- Research: 40ish publications on my CV, mix of translational/wet lab research (in radiology), and a number of oncology/surgical oncology clinical research papers. 2 book chapters. 22 abstracts/presentations. Two research awards at a few conferences. Was also heavily involved in designing, establishing an IDE clinical trial at my institution to evaluate a novel biomedical device for implant in patients.

- Patents: 3, hopefully a 4th one before ERAS is submitted.

- Extracurriculars: Consulted for a few medical device companies during med school. Engaged with the FDA to allow clinical trial approval/etc, European approval. Wrote (almost entirely) a grant that got funded for about ~$1M from the NIH.

- Currently in a gap year in industry working on the development of AI/novel technologies as it applies to both DR and IR.

Ideally, really really really would want to match at one of the NY academic radiology programs (NYU/Cornell/Sinai) if possible. I grew up in NYC and would love to finally return home.

 

[GadRads]

Was hoping to get Rads PD input here. I was initially looking to go into surg onc but liked rads/neurorads a lot more than I initially thought.

MS3/4 (Currently in a gap between M3 and M4)
- Top 20 Med School
- No pre-clinical ranking
- 4th quartile for clinicals (3 honors and rest HP somehow gets me 4th quartile at my school)
- AOA: No
- GHHS: No
- Step 1: 237
- Step 2: Taking in summer

- Clinical grades: 3 honors (peds, psych surg), rest high pass. Somehow this gets me a 4th quartile at my school. Whatever.

- Don't have any recs as of yet (can get from some mentors though). Haven't done a DR elective or sub-I or anything like that yet.

- Research: 40ish publications on my CV, mix of translational/wet lab research (in radiology), and a number of oncology/surgical oncology clinical research papers. 2 book chapters. 22 abstracts/presentations. Two research awards at a few conferences. Was also heavily involved in designing, establishing an IDE clinical trial at my institution to evaluate a novel biomedical device for implant in patients.

- Patents: 3, hopefully a 4th one before ERAS is submitted.

- Extracurriculars: Consulted for a few medical device companies during med school. Engaged with the FDA to allow clinical trial approval/etc, European approval. Wrote (almost entirely) a grant that got funded for about ~$1M from the NIH.

- Currently in a gap year in industry working on the development of AI/novel technologies as it applies to both DR and IR.

Ideally, really really really would want to match at one of the NY academic radiology programs (NYU/Cornell/Sinai) if possible. I grew up in NYC and would love to finally return home.

Strong application. As long as you come across as normal during your interviews, you will have a good chance to match at a top program.

 

[RadiologyPD]

Was hoping to get Rads PD input here. I was initially looking to go into surg onc but liked rads/neurorads a lot more than I initially thought.

MS3/4 (Currently in a gap between M3 and M4)
- Top 20 Med School
- No pre-clinical ranking
- 4th quartile for clinicals (3 honors and rest HP somehow gets me 4th quartile at my school)
- AOA: No
- GHHS: No
- Step 1: 237
- Step 2: Taking in summer

- Clinical grades: 3 honors (peds, psych surg), rest high pass. Somehow this gets me a 4th quartile at my school. Whatever.

- Don't have any recs as of yet (can get from some mentors though). Haven't done a DR elective or sub-I or anything like that yet.

- Research: 40ish publications on my CV, mix of translational/wet lab research (in radiology), and a number of oncology/surgical oncology clinical research papers. 2 book chapters. 22 abstracts/presentations. Two research awards at a few conferences. Was also heavily involved in designing, establishing an IDE clinical trial at my institution to evaluate a novel biomedical device for implant in patients.

- Patents: 3, hopefully a 4th one before ERAS is submitted.

- Extracurriculars: Consulted for a few medical device companies during med school. Engaged with the FDA to allow clinical trial approval/etc, European approval. Wrote (almost entirely) a grant that got funded for about ~$1M from the NIH.

- Currently in a gap year in industry working on the development of AI/novel technologies as it applies to both DR and IR.

Ideally, really really really would want to match at one of the NY academic radiology programs (NYU/Cornell/Sinai) if possible. I grew up in NYC and would love to finally return home.

Your application has serious strengths, and I think it is very competitive for academic programs in general. I think it could be "strong enough" for the specific programs you mention, but I don't have evidence to say it is "strong" for those programs because I don't know how much weight they put into the standard Step score and Class rank metrics.

Keep in mind I have not been the PD at my program for a few years. When I was PD, I kept track of where our applicants matched. So I checked the last match I was involved with in my program 2 years ago (Match 2020) to search for applicants who matched at either NYU, Cornell, Columbia, or Mt. Sinai. Since we are a west coast program, we didn't get a ton of applicants who prefer to be at NYC, so the data is limited, but here is what I found:

7 of our applicants matched in NYC (none from medical schools in NY--these people were from PA, MD, MI, IN, TN, KY, and TX--so much for the "local connection" that everyone seems to misunderstand). 4 went to Columbia, 1 to Cornell, 2 to NYU, none to Mt. Sinai. Mean and median Step 1 score was 244 and 250. Mean and median Step 2 score was 256. Mean and median class rank was 74th percentile and 78th percentile (i.e., intersection of top and 2nd quartile). Class rank range was 48.5% to 81.8%. I had a method to convert Dean's letter categories to the middle number of the class rank range they represented (so, for example, if the Dean's letter said "outstanding", and "outstanding" referred to the top 22%--in other words, between 78% and 100%--then I would assign that person's class rank as the middle of that range, or 88.5%).

None of those candidates had your research portfolio or industry experience, which are huge.

If I were the PD at those programs, the only thing that would give me pause is the bottom quartile ranking. Would have to carefully read your Dean's letter to understand why that might be. Most likely it is because your school factors in USMLE scores in the class rank--or perhaps because class rank is dominated by 3rd year "core clerkships" = surgery, IM, peds, OB/GYN

To me, you have a great future in radiology and will match at a top program--but whether it is one of the 3 you mention is hard to gauge. I don't know those programs well enough to understand what type of candidate they like.

 

[RadCatDad]

Dear RadiologyPD,


I am applying currently and have had the good fortune of having 2 programs in my desired city who have made me feel that they would be happy to match me. One is a tried and true academic program (Program A), the other is a 5-7 year old Community program (Program B).

Both have incredible volume and diversity but I like the community Program B a bit more because they have private practice Rads who have reduced responsibilities and have dedicated time specifically to teach the residents. Apparently the residents at Program B love this about it.

To me the programs do not seem very different (however residents coming out of academic Program A have been known to be a bit overworked but come out excellent Radiologists). It seems like both programs have good didactics, super volume/diversity, solid hospital reputations, similar call schedules, great fellowship matches. One caveat is that Program B is a level 2 trauma center. However, at Program B you get to rotate for 2 months at Program A’s Level 1 center.

I know that it’s hard to say when you don’t know the programs but I want to understand what I might be missing by choosing a community program vs academic in general. I keep hearing how many programs will train you well enough and that it is mostly how much you put into it as a resident (reading at home, taking initiative to learn as much as possible, etc.).

Thanks so much!

 

[RadiologyPD]

I have previously written about what I think applicants should look for in a program: post #21

I believe the most important question an applicant should consider is whether or not he/she feels the program can inspire them to be the best version of what that person wants for himself/herself and also help him/her achieve those goals, while at the same time keeping him/her emotionally happy and mentally engaged.

I have previously written that I believe an individual's "radiology ability" is mostly influenced by factors the individual brings to the table, not the program: work ethic, study habits, emotional IQ. Post #284

I agree that that there probably aren't a lot of differences between program quality within "tiers" (see post #139). Which is why I think these program "rankings" are suspect in the first place. Look, what's the biggest difference between the so called "#1" program and the so called "#50" program?...the recruiting class, that's what. Your "radiology ability" at the end of 4 years of residency is mostly influenced by YOU, your work ethic, your study habits, your emotional IQ, YOU (again, see post #139). At the end of 4 years, if you took the residents who went to #1 program and instead made them train at the #50 program, they would be better than the residents who were supposed to go to the #50 program who ended up training at the #1 program. If you took the recruiting class at the University of Kentucky basketball team and had them play together at Wichita State--well, all of a sudden, you've got a national championship at Wichita State.

Forget about Schulze rankings and conventional wisdom--kick the tires, consider the factors that are important to you, and make your decision on where you want to be, rankings be damned.

But your question is a good one. Here are some factors I think differentiate programs (in no particular order). I highlight the few items where academic programs might have an advantage:

1. Geography: not an issue for you--both in the same city, you said

2. Faculty: I think subspecialization and experience are key metrics. Residents who train in programs where faculty are not subspecialized have less nuance in their skills. For residents who are lucky enough to be at a program where the faculty are subspecialty experts, residency becomes a 4 year opportunity to learn from "masters". You can't get that from books. The lectures are better, the "viewbox" instruction is better.

In general, academic programs have more faculty who are subspecialized and experienced. May not be the case in your comparison, if the private practice is a behometh organization like Advent Florida.

3. Pathology: You will be reasonably skilled at diagnosing appendicitis after seeing 5 cases on CT on call. If that's all you are seeing, you won't be very good at recognizing appendiceal carcinoid. You said case volume was the same, but it is not about volume, it is about pathology diversity. After you have seen 5 typical DVT studies, you are done learning from typical DVT studies, so it doesn't matter if you end up dictating 50 every night on call.

In general, academic programs have academic referral patterns from clinical departments, so see more variety of disease and more unusual presentations.

By the way, I personally think the trauma center stuff is overvalued (and I trained at a trauma center). It can overwhelm the breadth of your experience. Most radiologists do not work at trauma centers.

4. Organization of the residency: Dedicated program coordinator who makes your life easier, adequate support services, resources to attend meetings and network, all the ways the program makes your life easier/better. Not necessarily better at an academic program.

5. Brand: You get to ride the brand wave for the residency you complete. You finish as a below average resident at UCSF, no one outside UC knows that 5 years later when you apply for a job, they presume you are a star. You finish as the best resident ever at KPC Health in Hemet, CA, no one knows that 1 year later when you apply for a job, they think you are average at best.

In general, academic programs carry more brand weight than community programs, but it depends. That may not be true head to head in some rare markets.

So--I can't say about the head to head match up you are contemplating between the academic residency and the community residency you are contrasting, but those are the generalizations about academic programs vs. private practice programs that I think matter.

Your narrative had NOTHING in favor of the academic program. To me, it sounds like your decision is easy.

 

[RageQuitter34]

Hi @RadiologyPD

When you were still PD, did it matter to you if a school's MSPE reported their student's shelf score national percentile? Eg, would it make a difference to you if a student had a "pass" for say example Peds but their shelf score was reported to be a 99%ile.

 

[RadiologyPD]

Hi @RadiologyPD

When you were still PD, did it matter to you if a school's MSPE reported their student's shelf score national percentile? Eg, would it make a difference to you if a student had a "pass" for say example Peds but their shelf score was reported to be a 99%ile.

We would sometimes (not commonly) look for this sort of info when a student wasn't doing as well in clerkship grades as we might have expected and were diving into the details more. So many schools now have a shelf exam score threshold be part of the hoops a student must jump through to get "honors" that we more commonly see students who would have great "write ups" in the MSPE on rotations with great comments but not getting great grades--or the infamous "student achieved clinical honors" but then the clerkship grade is high pass or pass--and then realize the student wasn't the best test taker. As I've mentioned before, there is some value to being a good test taker in becoming a radiologist, but it isn't the "be all, end all" trait for success as a radiology resident (or radiologist). So we might give someone some leeway for that.

Otherwise, we typically glance at the overall rotation grade, skim quickly the narrative, looking for any weird red flags. What you describe is someone whose clinical performance was so average that it brought down his/her grade from the shelf exam which was at 99% (the opposite of what I describe above). This might be a red flag.

The scenario you lay out could have a ton of explanations, BUT one explanation that might worry me or my reviewers is that the individual does great at the book stuff but works poorly in a team, or somehow doesn't impress those who are assessing the individual in person.

Another scenario: we might look at the shelf exam scores is to analyze someone who looks interesting but has a relatively low USMLE score that they are trying to explain away as an anomaly--due to circumstances, stress, whatever. If the shelf exams are better than the USMLE score, that supports the premise.

So, the answer regarding MSPE reporting of the shelf score--yes, it's a data point that we sometimes look at in specific situations, but not usually.

 

[Doctor_Strange]

Hi @RadiologyPD ,

I am a PGY-1 in IM who has been contemplating a speciality switch for at least four months by now. I chose IM sort of out of process of elimination and with the hopes of pursuing a sub-specialty, like Heme-Onc. Over time though, I feel that IM is not suited for me. In med school, I had considered Rads, specifically IR, but never jumped for it out of immature and myopic reasons. Last week, I took the plunge and emailed the Rads PD at our institution. His response is bolded:

Happy to meet and talk when I return. Have you talked to [my IM PD] at all yet about your thoughts of switching?

Then his assistant asked to send me my ERAS and updated CV to her.

When I replied saying I had not told my IM PD just because the chances it seemed of internally switching specialties was low, he replied:

one of the first steps will be to loop in [my IM PD]... Go ahead and reach out to him this week so when I do so next week its not a surprise.

What do you make of this? The Rads program just expanded next year's R1 class by one, and looking at their residency classes every class has 5 residents except the R3 class so maybe they have some funding left over? I just worry despite my PD being an overall nice and supportive guy, it may be awkward if I cannot transfer and then have to remain in IM. FWIW, I do not hate IM, I just feel my personality is more geared towards Rads than I initially realized.

Thank you!

 

[RadiologyPD]

When you say "next year's R1 class", I'm not clear as to whether you mean they have an open spot for an R1 position starting July 2022 or July 2023.

If July 2022, then the PD can fill with whomever he can find outside the Match. This is because there is no possible way to use the NRMP's Match to fill this spot, the Match for this year is done. If this is the case, you have a legit shot at "switching". This is a rare scenario.

If July 2023, then the PD has to fill through NRMP's Match which runs in March 2023, by having an "R" position. This is the agreement that programs make with the Match when they sign up. Of course, if the program does not use the Match then this is moot. However, I'm not aware of any programs that don't use the Match (there were rare programs who went this route a while back). If this is the case, you still might be a successful candidate but it doesn't involve a "switch", it requires you to sign up for the Match, then interview for this position (and others), then wait until next March to find out. This would mean a gap year in which you'd have to figure out what you do.

Here's the rub. You might think you can make this "get out of IM" decision after July 1, 2022 and plan to stay on as an IM resident for a 2nd year to keep salary/benefits/etc-- but doing so could impact your funding. The program that takes you cannot rely exclusively on federal funding, otherwise they would not take you as you won't have full federal funding anymore having used up 2 years for IM. Many but not all programs have a supplemental funding source that makes this moot. Many programs do not.

In scenario 1, you are quitting your IM residency at the end of June 2022 and filling an open position outside the Match. In scenario 2, you might need to quit your IM residency at the end of June 2022 and match to an R position in the next Match. In either case, once you've decided on this route, you need to tell your IM PD. The IM residency has a hole either way, and the IM PD probably has a better chance to fill the hole the sooner you tell him/her.

If you've decided you are going for rads, you should tell your IM PD. If you aren't sure, you should discuss with your IM PD. After discussing, if you decide you are staying for IM, I don't think the discussion is going to hurt you.

 

[Doctor_Strange]

When you say "next year's R1 class", I'm not clear as to whether you mean they have an open spot for an R1 position starting July 2022 or July 2023.

If July 2022, then the PD can fill with whomever he can find outside the Match. This is because there is no possible way to use the NRMP's Match to fill this spot, the Match for this year is done. If this is the case, you have a legit shot at "switching". This is a rare scenario.

If July 2023, then the PD has to fill through NRMP's Match which runs in March 2023, by having an "R" position. This is the agreement that programs make with the Match when they sign up. Of course, if the program does not use the Match then this is moot. However, I'm not aware of any programs that don't use the Match (there were rare programs who went this route a while back). If this is the case, you still might be a successful candidate but it doesn't involve a "switch", it requires you to sign up for the Match, then interview for this position (and others), then wait until next March to find out. This would mean a gap year in which you'd have to figure out what you do.

Here's the rub. You might think you can make this "get out of IM" decision after July 1, 2022 and plan to stay on as an IM resident for a 2nd year to keep salary/benefits/etc-- but doing so could impact your funding. The program that takes you cannot rely exclusively on federal funding, otherwise they would not take you as you won't have full federal funding anymore having used up 2 years for IM. Many but not all programs have a supplemental funding source that makes this moot. Many programs do not.

In scenario 1, you are quitting your IM residency at the end of June 2022 and filling an open position outside the Match. In scenario 2, you might need to quit your IM residency at the end of June 2022 and match to an R position in the next Match. In either case, once you've decided on this route, you need to tell your IM PD. The IM residency has a hole either way, and the IM PD probably has a better chance to fill the hole the sooner you tell him/her.

If you've decided you are going for rads, you should tell your IM PD. If you aren't sure, you should discuss with your IM PD. After discussing, if you decide you are staying for IM, I don't think the discussion is going to hurt you.

Thanks for the reply. Ah sorry, an additional R1 spot was added for the July 2023 class.

I am holding out hope that the Rads PD has funding available, perhaps more-so from IME funding given our county hospital status (at least that is my understanding).

 

[Doctor_Strange]

When you say "next year's R1 class", I'm not clear as to whether you mean they have an open spot for an R1 position starting July 2022 or July 2023.

If July 2022, then the PD can fill with whomever he can find outside the Match. This is because there is no possible way to use the NRMP's Match to fill this spot, the Match for this year is done. If this is the case, you have a legit shot at "switching". This is a rare scenario.

If July 2023, then the PD has to fill through NRMP's Match which runs in March 2023, by having an "R" position. This is the agreement that programs make with the Match when they sign up. Of course, if the program does not use the Match then this is moot. However, I'm not aware of any programs that don't use the Match (there were rare programs who went this route a while back). If this is the case, you still might be a successful candidate but it doesn't involve a "switch", it requires you to sign up for the Match, then interview for this position (and others), then wait until next March to find out. This would mean a gap year in which you'd have to figure out what you do.

Here's the rub. You might think you can make this "get out of IM" decision after July 1, 2022 and plan to stay on as an IM resident for a 2nd year to keep salary/benefits/etc-- but doing so could impact your funding. The program that takes you cannot rely exclusively on federal funding, otherwise they would not take you as you won't have full federal funding anymore having used up 2 years for IM. Many but not all programs have a supplemental funding source that makes this moot. Many programs do not.

In scenario 1, you are quitting your IM residency at the end of June 2022 and filling an open position outside the Match. In scenario 2, you might need to quit your IM residency at the end of June 2022 and match to an R position in the next Match. In either case, once you've decided on this route, you need to tell your IM PD. The IM residency has a hole either way, and the IM PD probably has a better chance to fill the hole the sooner you tell him/her.

If you've decided you are going for rads, you should tell your IM PD. If you aren't sure, you should discuss with your IM PD. After discussing, if you decide you are staying for IM, I don't think the discussion is going to hurt you.

Just to follow up:

I met with the Rads PD at my institution last week. They have a spot open and are looking for applicants outside the match. I was the only one interviewed in person, and the rest will be via Zoom. I am already a categorical IM and he said the fact that I am already a resident there would make it easier for me to be switched into the program as he said. He obviously will be interviewing other applicants. Per residency explorer, my Steps 243/237 fall within the 50% of their average for their matched residents. I have a few pubs as an intern, otherwise not much in the way of Radiology research. My interview was laid back and engaging. Fingers crossed it works out. I am sure I am going up against some pretty stiff competition. The position, however, is not being advertised so hopefully there is not a sea of applications he has to sift through lol

 

[Hippocrates II]

Just to follow up:

I met with the Rads PD at my institution last week. They have a spot open and are looking for applicants outside the match. I was the only one interviewed in person, and the rest will be via Zoom. I am already a categorical IM and he said the fact that I am already a resident there would make it easier for me to be switched into the program as he said. He obviously will be interviewing other applicants. Per residency explorer, my Steps 243/237 fall within the 50% of their average for their matched residents. I have a few pubs as an intern, otherwise not much in the way of Radiology research. My interview was laid back and engaging. Fingers crossed it works out. I am sure I am going up against some pretty stiff competition. The position, however, is not being advertised so hopefully there is not a sea of applications he has to sift through lol

I think you've found yourself in just about the most ideal situation you could. You have an in and probably quite a bit less competition than you would have had in the traditional match. I had a few classmates (DO) fail to match with 240s-250s this year. I had 260s/260s and I matched the specialty I ranked ahead of rads, but I really don't know if I would have matched rads because none of the programs (that I can see who announced their matches) took a single DO. Seems like it was a total toss-up of a year if you didn't have an immaculate app. Good luck!

 

[RageQuitter34]

I think you've found yourself in just about the most ideal situation you could. You have an in and probably quite a bit less competition than you would have had in the traditional match. I had a few classmates (DO) fail to match with 240s-250s this year. I had 260s/260s and I matched the specialty I ranked ahead of rads, but I really don't know if I would have matched rads because none of the programs (that I can see who announced their matches) took a single DO. Seems like it was a total toss-up of a year if you didn't have an immaculate app. Good luck!

What specialty did you end up matching in if you don't mind sharing?

 

[tinzleton]

Quick question: applying rads. have two rads letters (one by a DC and one by a PD) . I've seen the DC letter, its personal. the PD letter I have not seen. Now, I also have to strong other specialty letters. Can I send four? most programs say they want three but dont specify if its min or max

 

[Noemata]

I believe I sent four back when I applied. Should not be an issue.