Radiology fellowship info

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speedyxx626

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Hey all. I was fortunate enough to match into an awesome program this cycle and I'm now starting to think about fellowship possibilities. Clearly, it's very early to start thinking about what fellowship I'll be doing but I just wanted to see if anyone could provide more info on the different specialties. In other words,why did you choose the fellowship (and mini fellowships) you did? What are the bread and butter cases? What modality are your reading the most? Are there any recent major changes in your field of interest? What do you think is the future direction of that specialty? What other info would be important to consider for someone going into that specialty? Any info would be appreciated!

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Hey all. I was fortunate enough to match into an awesome program this cycle and I'm now starting to think about fellowship possibilities. Clearly, it's very early to start thinking about what fellowship I'll be doing but I just wanted to see if anyone could provide more info on the different specialties. In other words,why did you choose the fellowship (and mini fellowships) you did? What are the bread and butter cases? What modality are your reading the most? Are there any recent major changes in your field of interest? What do you think is the future direction of that specialty? What other info would be important to consider for someone going into that specialty? Any info would be appreciated!

Im in the same boat and have a similar personality of knowing my options early. Unfortunately, its hard to without doing it (things changed a lot third year). But compensation wise in private practice your options are Body, MSK, Neuro, Mammo
 
I'll chime in that mammo is probably the only subspecialty (with a few exceptions of course) that will allow a truly M-F/4 days a week, no call (weekends, evenings, nights, holidays), strictly outpatient based practice with no real emergencies, unless you consider a breast abscess or post biopsy complication an emergency. Besides the work itself, your actual work life balance is important to consider. The absence of incessant phone calls during the day from inpatient services and the ER is something I never considered before.

Back when I was applying, mammo was very competitive and probably still is today. If you are interested, it would behoove you to get started early! (i.e. find a mentor, research project, etc.)
 
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I'll chime in that mammo is probably the only subspecialty (with a few exceptions of course) that will allow a truly M-F/4 days a week, no call (weekends, evenings, nights, holidays), strictly outpatient based practice with no real emergencies, unless you consider a breast abscess or post biopsy complication an emergency. Besides the work itself, your actual work life balance is important to consider. The absence of incessant phone calls during the day from inpatient services and the ER is something I never considered before.

Back when I was applying, mammo was very competitive and probably still is today. If you are interested, it would behoove you to get started early! (i.e. find a mentor, research project, etc.)


Mammo is competitive? I thought so many programs went unfilled
 
I'll chime in that mammo is probably the only subspecialty (with a few exceptions of course) that will allow a truly M-F/4 days a week, no call (weekends, evenings, nights, holidays), strictly outpatient based practice with no real emergencies, unless you consider a breast abscess or post biopsy complication an emergency. Besides the work itself, your actual work life balance is important to consider. The absence of incessant phone calls during the day from inpatient services and the ER is something I never considered before.

Back when I was applying, mammo was very competitive and probably still is today. If you are interested, it would behoove you to get started early! (i.e. find a mentor, research project, etc.)
This is the kind of insight I was looking for! Thanks! Do most mammo radiologist read only breast studies?
 
Mammo is competitive? I thought so many programs went unfilled

Mammo is not competitive. It probably has one of the most consistently relatively good demand for the job-seeker, but for good reason -- most radiology residents don't find mammo very interesting work compared to the rest of radiology and choose other fellowships instead. But it does attract people who are attracted to the nice call-free lifestyle and good hours, which tends to be a decent sized chunk of radiology residents.

In fact, not sure about non-match fellowships like MSK, but of all radiology fellowships in the match (mammo, neuro, IR), IR is the only one that has more applicants than fellowship spots. The other specialties are a buyer's market.
 
Do a fellowship in whatever interests you the most. If you go into private practice, you will probably be reading a little bit of everything, but mostly in your subspecialty. Everything comes and goes in waves in terms of popularity. If you choose something which you absolutely have no interest in, you will be stuck reading it for the rest of your life!
 
I'll chime in that mammo is probably the only subspecialty (with a few exceptions of course) that will allow a truly M-F/4 days a week, no call (weekends, evenings, nights, holidays), strictly outpatient based practice with no real emergencies, unless you consider a breast abscess or post biopsy complication an emergency. Besides the work itself, your actual work life balance is important to consider. The absence of incessant phone calls during the day from inpatient services and the ER is something I never considered before.

Back when I was applying, mammo was very competitive and probably still is today. If you are interested, it would behoove you to get started early! (i.e. find a mentor, research project, etc.)

False information.

In most groups, if you want to become a partner you have to participate in call schedule similar to other partners.

With the same logic, you can find an outpatient only MRI center and read MRIs for them if you are MSK or neurorad and I know a few people who do that.
I know a few people who are IR trained and work 8-5 jobs doing lines for HD centers.

Academic world is a different beast.
 
False information.

In most groups, if you want to become a partner you have to participate in call schedule similar to other partners.

With the same logic, you can find an outpatient only MRI center and read MRIs for them if you are MSK or neurorad and I know a few people who do that.
I know a few people who are IR trained and work 8-5 jobs doing lines for HD centers.

Academic world is a different beast.

The mammo only, no call positions are typically employee/non-partnership track positions in a private practice group. Of course anyone on a partnership track will be required to participate in the call pool. There are also organizations which solely focus on breast imaging (or have breast imaging divisions), and employ all of their breast imagers as employee/W2, with no weekends/evenings/holidays. These no call type of positions are just more common in mammo than the radiologists you know who have been able to secure outpatient only gigs such as Neuro, MSK or IR. Kudos to them for finding those positions. Not saying they don't exist, just describing what I've seen as more common in the job market. YMMV.

Besides the private practice opportunities I've described, of course academics and also the VA are additional options if lifestyle is a priority.
 
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The mammo only, no call positions are typically employee/non-partnership track positions in a private practice group. Of course anyone on a partnership track will be required to participate in the call pool. There are also organizations which solely focus on breast imaging, and employ their breast imagers as employee/W2, with no weekends/evenings/holidays. These no call type of positions are just more common in mammo than the radiologists you know who have been able to secure outpatient only gigs such as Neuro, MSK or IR. Kudos to them for finding those positions. Not saying they don't exist, just describing what I've seen as more common in the job market. YMMV.

In addition to academics, the VA is another option if lifestyle is a priority.
How common are VA jobs?
 
False information.

In most groups, if you want to become a partner you have to participate in call schedule similar to other partners.

With the same logic, you can find an outpatient only MRI center and read MRIs for them if you are MSK or neurorad and I know a few people who do that.
I know a few people who are IR trained and work 8-5 jobs doing lines for HD centers.

Academic world is a different beast.

Bolded is the key. If you don't care about being a partner, then a regular 4 day a week mammo job with no call is certainly possible. We have several who do that in our group.
 
How common are VA jobs?

USAJOBS - Search

Right now there are 14 VA postings nationwide. The popular cities tend to be posted once briefly, then disappear. Most of the ones available right now are positions they have had trouble filling and are in the South or rural. I've seen a lot more VA job postings come and go over the past 1-2 years, and in some coastal cities that you never used to them, due to the job marketing loosening up significantly.

And VA teleradiology centers in Bay Area, CA and North Carolina are always hiring.
 
USAJOBS - Search

Right now there are 14 VA postings nationwide. The popular cities tend to be posted once briefly, then disappear. Most of the ones available right now are positions they have had trouble filling and are in the South or rural. I've seen a lot more VA job postings come and go over the past 1-2 years, and in some coastal cities that you never used to them, due to the job marketing loosening up significantly.

And VA teleradiology centers in Bay Area, CA and North Carolina are always hiring.

WTF is with those salaries? I just looked up IR positions and they start at, like, 100k.
 
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WTF is with those salaries? I just looked up IR positions and they start at, like, 100k.

They're not accurate - never have been. Like a lot of things with the government, their website doesn't possess the flexibility to reflect anything other than garden variety job postings. My best guess it that the salaries indicate whatever GS grade is being offered, without taking into account step level or market pay, much less bonus pay.
 
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They're not accurate - never have been. Like a lot of things with the government, their website doesn't possess the flexibility to reflect anything other than garden variety job postings. My best guess it that the salaries indicate whatever GS grade is being offered, without taking into account step level or market pay, much less bonus pay.

Gotcha. That makes sense. I know very little about how the military/government works, but have friends working at the VA as general rads and nucs and they make (a decent amount) times that.
 
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Bolded is the key. If you don't care about being a partner, then a regular 4 day a week mammo job with no call is certainly possible. We have several who do that in our group.

It doesn't make mammo special. There are a good number of outpatient imaging centers that you can work 4 days a week with no call or no weekend as an MSK or Neurorad. But obviously the pay system is different.

My whole point is that don't expect to do mammo fellowship but getting paid like a full partner without any call.
Also don't think that if you do neuro fellowship you are doomed to take call.

There are many groups that hire a neurorad or MSK rad to read their outpatient imaging studies but pay them a fraction of what partners make.
 
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Do I have a reasonable chance of matching a neuroradiology residency, at least a semi-impressive program, with NO research and no plans on doing research?

Thanks.
 
Do I have a reasonable chance of matching a neuroradiology residency, at least a semi-impressive program, with NO research and no plans on doing research?

Thanks.

In my experience except for the top top programs radiology fellowships are not very competitive. I actually think they are kind of a scam. You show up as a PGY-5 to do the work of 1/2 an Attending at 1/5 the pay.
 
In my experience except for the top top programs radiology fellowships are not very competitive. I actually think they are kind of a scam. You show up as a PGY-5 to do the work of 1/2 an Attending at 1/5 the pay.
And yet they are essentially required, no?

And ignorant question: how does one even bolster their app without research. Are good LORs from PD and staff all you need for radiology fellowship???
 
And yet they are essentially required, no?

And ignorant question: how does one even bolster their app without research. Are good LORs from PD and staff all you need for radiology fellowship???

Yes there is near 100% of ppl doing fellowships because they recently changed the rule so you can't even sit for the boards until 16 months after residency. I don't know any of field that does this...it makes no sense...until you remember that they made the rule to force everyone to do a fellowship.

A good LOR (especially a phone call...off the record) goes extremely far and is way underestimated. At the end of the day these programs want someone who is pleasant and well-trained who works hard.
 
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And yet they are essentially required, no?

And ignorant question: how does one even bolster their app without research. Are good LORs from PD and staff all you need for radiology fellowship???

There's plenty of other things you can do to bolster your app without research.
1) Chief residency
2) Teaching (with departmental/GME teaching awards)
3) Admin (serving on departmental/GME/hospital committees)

Yes, fellowships are basically required.

Great references will probably get you somewhere good, but if you're gunning for a top program in a competitive field with limited spots you'll probably want some sort of hook.
 
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There's plenty of other things you can do to bolster your app without research.
1) Chief residency
2) Teaching (with departmental/GME teaching awards)
3) Admin (serving on departmental/GME/hospital committees)

Yes, fellowships are basically required.

Great references will probably get you somewhere good, but if you're gunning for a top program in a competitive field with limited spots you'll probably want some sort of hook.
Correct me if I'm wrong, but my understanding was that the idea that every radiology resident needs to do a fellowship was a byproduct of the 2009 recession and is no longer the case, granted most still do (I think I remember seeing 80%). Certainly for some fields you definitely need one but what about if you want to be the mammo/light IR guy in PP? How hard is it to find a position like that if you're geographically flexible? I don't care about academics or living in big cities. I'm just really anti-fellowship by principle and think residency training has become a runaway scam for cheap labor.
 
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Correct me if I'm wrong, but my understanding was that the idea that every radiology resident needs to do a fellowship was a byproduct of the 2009 recession and is no longer the case, granted most still do (I think I remember seeing 80%). Certainly for some fields you definitely need one but what about if you want to be the mammo/light IR guy in PP? How hard is it to find a position like that if you're geographically flexible? I don't care about academics or living in big cities. I'm just really anti-fellowship by principle and think residency training has become a runaway scam for cheap labor.

I anecdotally heard of a few graduating residents in the recent classes forgoing fellowship because the job market was recent super hot in the 1-2 years pre-CoVid. It was/ still is possible.

That being said, a good portion of practices probably won't consider a non-fellowship trained new graduate. And in the coming down market post-CoVid, that will really put those people at a disadvantage.
 
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Correct me if I'm wrong, but my understanding was that the idea that every radiology resident needs to do a fellowship was a byproduct of the 2009 recession and is no longer the case, granted most still do (I think I remember seeing 80%). Certainly for some fields you definitely need one but what about if you want to be the mammo/light IR guy in PP? How hard is it to find a position like that if you're geographically flexible? I don't care about academics or living in big cities. I'm just really anti-fellowship by principle and think residency training has become a runaway scam for cheap labor.

You are definitely wrong. I can't think of a single resident who did not go on to fellowship. I would be surprised if more than 1% of residents didn't do a fellowship. Also you are wrong about which parts of Radiology need a fellowship. Mammo is the field that benefits most from a fellowship in terms of hiring (IR isn't really Radiology anymore IMO).
 
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Mammo is the field that benefits most from a fellowship in terms of hiring (IR isn't really Radiology anymore IMO).
Can you explain why that is? Is it just that hard to read? Some people have told me that it's hard to ever really be good at mammo just because of the technological limitations with that kind of imaging. Liability just comes with the turf.
 
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Can you explain why that is? Is it just that hard to read? Some people have told me that it's hard to ever really be good at mammo just because of the technological limitations with that kind of imaging. Liability just comes with the turf.

The optics of having a fellowship-trained rad is way better to other docs and to the public. If there are 2 groups in town and one has a fellowship-trained rad and one has everyone do a little of it because no one likes it it is obvious that people will chose the first group.

It's also a very litigious field and I would not want to get sued on a mammo case. I can imagine how that would play out in court "so dave you're a fellowship trained MSK rad and sub into mammo about half day a month when people are on vacation? Would you like to settle now?"
 
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The optics of having a fellowship-trained rad is way better to other docs and to the public. If there are 2 groups in town and one has a fellowship-trained rad and one has everyone do a little of it because no one likes it it is obvious that people will chose the first group.

It's also a very litigious field and I would not want to get sued on a mammo case. I can imagine how that would play out in court "so dave you're a fellowship trained MSK rad and sub into mammo about half day a month when people are on vacation? Would you like to settle now?"

A reasonable defense would be you satisfy all of the MQSA requirements for continuing experience (960 mammograms in the last 24 months) and continuing education in mammography (15 credits in the last 36 months) and therefore meet the standard of care for interpreting mammograms, and that general radiologist arrangements are still more common than majority-mammo jobs.
 
A reasonable defense would be you satisfy all of the MQSA requirements for continuing experience (960 mammograms in the last 24 months) and continuing education in mammography (15 credits in the last 36 months) and therefore meet the standard of care for interpreting mammograms, and that general radiologist arrangements are still more common than majority-mammo jobs.

Nothing about med mal is reasonable.
 
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Can you explain why that is? Is it just that hard to read? Some people have told me that it's hard to ever really be good at mammo just because of the technological limitations with that kind of imaging. Liability just comes with the turf.

Optics-aside, that's also asinine to think mammo fellowship training doesn't make you significantly better at mammo than a general rad.

I work in a large, sub-specialized group where a handful of general rads read screeners and occasionally even diagnostics. Near universally the fellowship-trained people complain about the bull**** callbacks and biopsies the general rads recommend.
 
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Optics-aside, that's also asinine to think mammo fellowship training doesn't make you significantly better at mammo than a general rad.

I work in a large, sub-specialized group where a handful of general rads read screeners and occasionally even diagnostics. Near universally the fellowship-trained people complain about the bull**** callbacks and biopsies the general rads recommend.
I'm gonna go out on a limb and assume the general rads in this scenario don't actually give a crap about mammo and cover it begrudgingly. With the current system of PGY5 basically being a fellowship, if one were focused could they develop a decent skillset in that area during that time? I'm ok with living anywhere and don't care about ever being a big wig in the field but I would never be ok with doing a half-assed job. If a fellowship is really a must then I'll consider it.
 
I'm gonna go out on a limb and assume the general rads in this scenario don't actually give a crap about mammo and cover it begrudgingly. With the current system of PGY5 basically being a fellowship, if one were focused could they develop a decent skillset in that area during that time? I'm ok with living anywhere and don't care about ever being a big wig in the field but I would never be ok with doing a half-assed job. If a fellowship is really a must then I'll consider it.

Not entirely true or fair. You're implying they don't care about the quality of their work.

To me, it's kind of a catch-22. If you graduated residency, went out and became a group's mammo guy and read mostly mammo then yea you'd probably become pretty decent at mammo. Flip side, if you're reading mostly mammo then you should probably be fellowship trained anyway.

That being said, there are 6 months mammo fellowships out there. If you could replicate the experience as an R4, doing the same number of tumor boards/procedures/MRIs as the actual fellows, then yea you might could pull it off.
 
The comments about optics are spot on. Most groups (mine included) love to market sub specialist reads. Whether you like it or not, the reality is that with most applicants being fellowship trained you are at a marked disadvantage, especially if you change your mind down the road about where you want to work. Your mobility is limited simply because you don’t look as good on paper.


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A reasonable defense would be you satisfy all of the MQSA requirements for continuing experience (960 mammograms in the last 24 months) and continuing education in mammography (15 credits in the last 36 months) and therefore meet the standard of care for interpreting mammograms, and that general radiologist arrangements are still more common than majority-mammo jobs.


Lol. Listen to the attending on this thread and not the residents or medical students. If you make a miss, have bad outcome, and the patient files a lawsuit, the lawyers will hire an experienced fellowship trained radiologist like me to review the case. They will ask me if there is any wiggle room to let the defendent radiologist off the hook. I will give them my expert opinion. I don't care what the rad's training or background is and it has little relevance. Most of the time, the lawyers won't tell you or even know unless you pry or google. Lawyers don't know what our training involves. I google the radiologist anyways because I want to know their background and the group. If your name is on that report, you are saying you are qualified to read the study. I take several med mal cases per year. If I didn’t do a breast fellowship or have lots of experience doing mammo, I would never do mammo. You’re screwed if you miss a cancer and the 40 something wife and mother of two preschoolers now has stage IV. Most cases I take are from rads who are reading outside their area of expertise, ie, IR rad reading mammo in a small group. When I tell the lawyers you screwed up and there's no wiggle room, then they settle the case. For the rest of your career, you now have to report the settled lawsuit whenever you have to do any kind of credentialing for state licensure or hospital privileges.
 
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I don't care what the rad's training or background is and it has little relevance.
This is the point. You're judged on the case and your report, not your training credentials. The plaintiff lawyer is not going call that out. The point of the fellowship is to gain competence more than it is for the optics of the credential.
 
For Neuroradiology, what's the pay like on a study-by-study or daily basis? How does it compare to the other radiology fellowships? Is it worth putting another 2 years into fellowship for this?
 
For Neuroradiology, what's the pay like on a study-by-study or daily basis? How does it compare to the other radiology fellowships? Is it worth putting another 2 years into fellowship for this?

Neurorads fellowship is 1yr in length. Only consider a 2yr Neurorads fellowship if u are thinking about certain top-tier post-training academic jobs. Neurorads pay isn't different from other rads fellowships... your pay varies much more with region, practice setting (Acandemics, small group PP, large PP, corporate, telerads) than with which rads subspecialty you decide upon.

Both neurorads and mammo have been very stable for years, in terms of jobs outlook/marketability. Body seems to get hot and cold, depending on its cycle pr advent of new technology (and really hot right now, given that residents have shied away for some time, and the ever expanding MRI utility within the subspecialty). MSK/Chest have been meh! Trauma/ER had also had its moments.

If you want 1wk on 2wks off night ED gig, you cant go wrong with Neuro. Pay is decent too, given you are off 2/3rds of the time.

In all, choose what you think you like and will be strong in4....leave the rest for the future, which is always uncertain, regardless of which medical field you chose.
 
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I wouldn’t do a two year fellowship unless you absolutely want to do highfalutin academics. You’ll never accrue that lost year of income.
 
2 years is a lot for neuro fellowship unless they teach you interventional Angio. By intervention I don't mean marketing epidural injections and LPs as interventions.

By the end of residency, most residents should be able to read 90% of community level Neuro and one year fellowship should be able to teach you the other 10% plus some academic minutia in addition to higher end imaging that mostly exists in academic jobs (MR Spectroscopy, tractography, functional imaging and complex head and neck cancer imaging).
 
I work in a large, sub-specialized group where a handful of general rads read screeners and occasionally even diagnostics. Near universally the fellowship-trained people complain about the bull**** callbacks and biopsies the general rads recommend.

Ha! The breast imagers I know do that to each other too (behind their backs of course).
 
Lol. Listen to the attending on this thread and not the residents or medical students. If you make a miss, have bad outcome, and the patient files a lawsuit, the lawyers will hire an experienced fellowship trained radiologist like me to review the case. They will ask me if there is any wiggle room to let the defendent radiologist off the hook. I will give them my expert opinion. I don't care what the rad's training or background is and it has little relevance. Most of the time, the lawyers won't tell you or even know unless you pry or google. Lawyers don't know what our training involves. I google the radiologist anyways because I want to know their background and the group. If your name is on that report, you are saying you are qualified to read the study. I take several med mal cases per year. If I didn’t do a breast fellowship or have lots of experience doing mammo, I would never do mammo. You’re screwed if you miss a cancer and the 40 something wife and mother of two preschoolers now has stage IV. Most cases I take are from rads who are reading outside their area of expertise, ie, IR rad reading mammo in a small group. When I tell the lawyers you screwed up and there's no wiggle room, then they settle the case. For the rest of your career, you now have to report the settled lawsuit whenever you have to do any kind of credentialing for state licensure or hospital privileges.
Thanks for this info. I'm a med student interested in Radiology. From what I have heard, Mammo is a big driver of malpractice in radiology. For people who have a Mammo Fellowship, in your experience, does their training better prepare them to avoid mammo-related malpractice (understanding that obviously everyone can be sued, regardless of training)? Also, can you speak about malpractice in radiology in general? I've heard mixed things about Rads being not too bad in terms of malpractice, but have also heard accounts that malpractice is pretty frequent throughout one's career. Thanks.
 
Jena et al. NEJM 2012: Risk of malpractice claim and payout in radiology is close to and slightly lower than average.
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Schaffer et al. JAMA IM 2017: Radiology had higher than average rate of paid claims and higher than average payment amount.
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Miglioretti et al. Radiology 2009: "Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice...Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice."

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Jena et al. NEJM 2012: Risk of malpractice claim and payout in radiology is close to and slightly lower than average.
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Awesome comprehensive info! Taking all the various studies into account, it does seem that Radiology is one of the higher risk specialties when it comes to malpractice. Not at the very top, but definitely a riskier specialty than many. Thanks again for all of the info.
 
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