Radiology versus Surgery - Conflicted......

[washu]

So I am a 3rd year student, and I have been pretty set on radiology for about a year now.

I am currently finishing up my core rotations (on surgery now) and I am starting to have some serious doubts in my decision. I love a lot of things about radiology and I think it would be a very good fit for me, but surgery has by far been my favorite rotation. Drawbacks as I see them are obviously lifestyle and some of the personalities that the field attracts.

My doubts are stemming from the fact that all of the attendings I have worked with always read their own films and either "secondarily" agree with the radiologists final reads or just flat out disagree with them (if it doesn't mean a huge change in their further workup or treatment). Basically they treat the radiologists like they are just adding a very small additional piece of information to the patient's diagnosis and they aren't really needed. I'm not saying this to offend anyone (again, I love radiology, and in all likelihood it is what I am going to end up doing), but I don't know if this is just an institutional thing or what.

I realize there are way more intricacies in imaging interpretation than a general surgeon could ever pick up on, but at least right now they are trying to convince me that rads are not even really needed or necessary. I also really enjoy doing procedures (which I know radiology has plenty of opportunity for that as well), but they are telling me that this will not be the case for radiologists in the near future.

I think I'm probably just spending too much time right now with surgeons, and someone needs to show me the light again (or... dark, I guess).

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[radman123]

So I am a 3rd year student, and I have been pretty set on radiology for about a year now.

I am currently finishing up my core rotations (on surgery now) and I am starting to have some serious doubts in my decision. I love a lot of things about radiology and I think it would be a very good fit for me, but surgery has by far been my favorite rotation. Drawbacks as I see them are obviously lifestyle and some of the personalities that the field attracts.

My doubts are stemming from the fact that all of the attendings I have worked with always read their own films and either "secondarily" agree with the radiologists final reads or just flat out disagree with them (if it doesn't mean a huge change in their further workup or treatment). Basically they treat the radiologists like they are just adding a very small additional piece of information to the patient's diagnosis and they aren't really needed. I'm not saying this to offend anyone (again, I love radiology, and in all likelihood it is what I am going to end up doing), but I don't know if this is just an institutional thing or what.

I realize there are way more intricacies in imaging interpretation than a general surgeon could ever pick up on, but at least right now they are trying to convince me that rads are not even really needed or necessary. I also really enjoy doing procedures (which I know radiology has plenty of opportunity for that as well), but they are telling me that this will not be the case for radiologists in the near future.

I think I'm probably just spending too much time right now with surgeons, and someone needs to show me the light again (or... dark, I guess).

Spend a day with a radiologist in a typical community hospital setting away from academia where most radiologists practice. There is a wide range of specialist skill in image interpretation, but in general every specialist including surgeons barely make a treatment decision without my input. Specialists may look at the imaging themselves but are often biased and have tunnel vision. Ask the surgeons where you are, for example, if they ever take an appendix to surgery these days without a positive radiologist report?

If you have any doubts about being a surgeon than you should not go into surgery. It is brutal and I only spent time in it as a med student. You really gotta love it. Radiology has a ton of its own problems as outlined in previous threads but will be a better choice for someone who wants to have a better lifestyle and still play an important role. The job can be very stressful in its own right. The work day in many settings is non stop for many hours, there are weekends which are worse than regular work days, holidays, nights etc. but at least your schedule is controlled. There are few surprises schedule wise.

But you gotta be ok with sitting in a dark room, grinding through studies with hundreds/thousands of images non stop for many hours while dealing with interruptions. You have to be ok with letting go of significant patient contact. Dealing with a tough customer- the referring physician. Dealing with inevitable mistakes while knowing that mistakes can lead to lawsuits. But you gotta read fast because the bean counters are looking closely at your productivity and the list keeps growing and growing because they scan them much faster than you can read em these days.

Who knows what the job market will be like when you finish, but remember that radiology has had two disastrous markets recently (now and in mid to late 90s). It is a long haul of 6 years with some doing 7 these days. Salary is still good for those established like myself but much lower for those coming out now and in the future. Be careful looking at those surveys saying rads make x amount. This includes those in practice for many years. Desirable places to live are always competitive and it is hard to find a good/fair/stable practice in these places. If living where you want is really important than consider something like family practice. In 7-8 years the salary differential between primary care an radiology will be narrower.

 

[survivordo]

My advice is always this: If you can see yourself going into ANYTHING but surgery and being happy than don't go into surgery. Sounds like you would be happy in rads, maybe interventional? I wouldn't let your current rotation sway you. (although it is true that we read pretty much all of our own films)

Survivor DO

 

[radman123]

"(although it is true that we read pretty much all of our own films)"

As long as the radiology report is available before you make any management decisions based on your reads

 

[washu]

If living where you want is really important than consider something like family practice. In 7-8 years the salary differential between primary care an radiology will be narrower.

Thanks for your response.

I keep hearing the above, and I am okay with it.

But then I think to myself "man I could do a family medicine residency, be done in 3 years, and basically make the same amount as a radiologist with a much easier job?!?!"

I'm just worried about where exactly the bottom is going to be for radiology. I'm not all about money, but it's definitely an important factor in my decision.

 

[dhavalp]

(although it is true that we read pretty much all of our own films)

Survivor DO

I have noticed a lot of specialists saying that they can perform their own reads, but "official" reads on the studies continue to be done by radiologists. I am very interested in radiology but this is something that scares me. What is preventing specialists from performing their own "official" reads? What if they do start reading studies themselves...

 

[radman123]

I have noticed a lot of specialists saying that they can perform their own reads, but "official" reads on the studies continue to be done by radiologists. I am very interested in radiology but this is something that scares me. What is preventing specialists from performing their own "official" reads? What if they do start reading studies themselves...

In hospitals credentialing committees require completion of a residency in diagnostic radiology to issue final reads on most studies. Most radiologists are either employees of hospitals or are a part of a group that has exclusive rights to issue reads for the hospital.

In the outpatient setting, you can do anything but the almighty US malpractice system puts enough fear in most specialists to not read their own studies. Their is a lot of risk for them for the relatively low pay out. There some exceptions however.

 

[badasshairday]

Yes they look at films, after the ED or internist calls them for appendicitis, sbo, subtle uncal herniation noted on imaging study. Then they look at the film with their expert tunnel vision. They do not sift through imaging studies with the only a vague clinical hx which is either abd pain, headache, motor vehicle accident. They have an actual surgical or probable surgical diagnosis before they are even called. It is totally different to actually read a film that could be anything versus one that is already known as a surgical case or probable surgical case.

 

[badasshairday]

What if they do start reading studies themselves...

Go for it I say. Read every abd radiograph, ct chest abdomen and pelvis that comes through the ED with clinical indication of abd pain or MVA or nausea.

 

[washu]

Go for it I say. Read every abd radiograph, ct chest abdomen and pelvis that comes through the ED with clinical indication of abd pain or MVA or nausea.

Good point... Sometimes it is tough for us to get the full perspective when we are spending 2 months with surgeons and only seeing one side of it.

 

[survivordo]

Yes they look at films, after the ED or internist calls them for appendicitis, sbo, subtle uncal herniation noted on imaging study. Then they look at the film with their expert tunnel vision. They do not sift through imaging studies with the only a vague clinical hx which is either abd pain, headache, motor vehicle accident. They have an actual surgical or probable surgical diagnosis before they are even called. It is totally different to actually read a film that could be anything versus one that is already known as a surgical case or probable surgical case.

Agreed, we use them for clinical correlation while rads is looking at them with a blank slate and is expected to pick up any pathology.

Survivor DO

 

[neolynx]

Critical rule for choosing a specialty: NEVER take advice about a specialty from someone who has never actually worked in that specialty.

Surgeons say radiologists are not necessary, they say "surgery is internal medicine on steroids," and they say ER docs don't know how to do a physical exam. ER docs, internists and radiologists say surgeons are just trained monkeys with pointy objects and bad attitudes. The fact is that the right hand doesn't know what the left hand is doing in medicine, and any perspective you get from someone who's outside of that field is going to be highly biased and mostly incorrect.

I recommend doing a sub specialty radiology rotation like pediatrics, chest, abdomen or IR (since it sounds like you enjoy procedures). In a general radiology rotation as a med student you see what radiologists do, but you often don't spend enough time in one place to really appreciate what the work is like. On a sub specialty service you'll not only get a better feel for what the job really is, but you'll hopefully build up enough knowledge in the area and rapport with the faculty to be able to really understand the process and hopefully do some of the work yourself.

After you've done this, you'll be in a much better position to decide whether surgery or rads is a better fit for you. But seriously, you shouldn't let the surgeons talk you out of radiology any more than you should let us radiologists talk you out of surgery if that's what you really want.

 

[shark2000]

If you are choosing between Radiology versus Surgery, either you don't know yourself or you don't know these fields.

Spend more time to: 1- Know yourself and your interests 2- Know radiology, surgery and medicine.

 

[MossPoh]

I always chuckle to myself when a non-radiologist says they can read their studies as well as a radiologist, especially when you see the comparison studies.

Anyway, look 20 years down the road and try to imagine which you'd be happier doing. I loved surgery, but couldn't see myself being too stoked doing thousands of lap choles or colon resections.

 

[IJL]

nm

 

[fun8stuff]

So I am a 3rd year student, and I have been pretty set on radiology for about a year now.

I am currently finishing up my core rotations (on surgery now) and I am starting to have some serious doubts in my decision. I love a lot of things about radiology and I think it would be a very good fit for me, but surgery has by far been my favorite rotation. Drawbacks as I see them are obviously lifestyle and some of the personalities that the field attracts.

My doubts are stemming from the fact that all of the attendings I have worked with always read their own films and either "secondarily" agree with the radiologists final reads or just flat out disagree with them (if it doesn't mean a huge change in their further workup or treatment). Basically they treat the radiologists like they are just adding a very small additional piece of information to the patient's diagnosis and they aren't really needed. I'm not saying this to offend anyone (again, I love radiology, and in all likelihood it is what I am going to end up doing), but I don't know if this is just an institutional thing or what.

I realize there are way more intricacies in imaging interpretation than a general surgeon could ever pick up on, but at least right now they are trying to convince me that rads are not even really needed or necessary. I also really enjoy doing procedures (which I know radiology has plenty of opportunity for that as well), but they are telling me that this will not be the case for radiologists in the near future.

I think I'm probably just spending too much time right now with surgeons, and someone needs to show me the light again (or... dark, I guess).

A lot of surgeons (general, neurosurg, urologists) are pretty good at reading xray and CT for their bread and butter cases, but not for picking up rare, subtle or incidental findings (that can sometimes be very important). They have an excellent working knowledge of the local anatomy and common pathology on the basis of their training but not so good with rare pathology or complications that radiologists may see a few times a month/year and they only see once in their career or in a book (just due to the volume of patient imaging radiologists see).

Radiology isn't going anywhere though. A majority of studies are orderred by primary care and ER docs who know close to zero on interpreting imaging exams (i.e. 50% of our neuro cases are orderred by primary care). Radiologists make the diagnosis before the subspecialist has seen the patient and often times will be the basis for whether or not the subspecialist is consulted. This will only get worse as more people get insurance and we turn to NPs and PAs to do the majority of primary care work. They have even less knowledge of imaging (as i that is even possible)... yet will rely more heavily on imaging due to lack of clinical experience and physical exam skills.

On regarding whether or not to choose radiology, radman puts it best. Radiology work is non-stop and you have to appease the clinicians (who can be very demanding). You have to know the most important (and least important) pathology from every field. IR can be the exception as their work-flow is similar to surgery. Personally, what I liked most about medical school was learning about the pathology and making the diagnosis. I did not enjoy talking with patient over and over throughout the day. While I still think it is satisfying and I enjoy helping people, I got/get bored with treatment because it is usually cookbook and very repetitive.... and have the same feeling about IR as I did about surgery. It's fun for a month or two, but after 20 choles or colon resections (or DEB-TACE, G-tube), it gets quite mind numbing.... but I know who who feel the same way about their 20th CT/MR/CXR....

 

[switchbacking]

So I am a 3rd year student, and I have been pretty set on radiology for about a year now.

As a general surgery resident trying to make the switch into radiology, hopefully I can be of some use (from the surgery side). I debated the two fields during med school but became enamored with the "ego" side of surgery. As one poster noted, only going into surgery if you CANNOT even comprehend being happy doing anything else. It's really only a field of exclusion. You deal with an inordinate amount of garbage (especially as a general surgeon) and have to "clean up" a lot of messes. Of course, that can be offset if you truly love operating every day (and love big cases). General surgery call can be painful and really dull (SBOs, appys, choles, etc.). Specializing can avoid some of the painful GS in-house calls but you trade that off with 7-10 years of training and then being tied to your pager 24/7/365 for the rest of your working years (usually).

The fact that surgeons "read" their patient's imaging should not impact your decision at all. Almost exclusively, we will review the images with the radiologists. I've never encountered a surgeon who doesn't rely on radiologists.

Speak to as many surgeons/senior-level surgery residents you can find. That would be my best advice. Junior-level residents tend to still be naive and don't fully have a grasp of their profession, so just try to get a wide breadth of opinions.

 

[washu]

As a general surgery resident trying to make the switch into radiology, hopefully I can be of some use (from the surgery side). I debated the two fields during med school but became enamored with the "ego" side of surgery. As one poster noted, only going into surgery if you CANNOT even comprehend being happy doing anything else. It's really only a field of exclusion. You deal with an inordinate amount of garbage (especially as a general surgeon) and have to "clean up" a lot of messes. Of course, that can be offset if you truly love operating every day (and love big cases). General surgery call can be painful and really dull (SBOs, appys, choles, etc.). Specializing can avoid some of the painful GS in-house calls but you trade that off with 7-10 years of training and then being tied to your pager 24/7/365 for the rest of your working years (usually).

The fact that surgeons "read" their patient's imaging should not impact your decision at all. Almost exclusively, we will review the images with the radiologists. I've never encountered a surgeon who doesn't rely on radiologists.

Speak to as many surgeons/senior-level surgery residents you can find. That would be my best advice. Junior-level residents tend to still be naive and don't fully have a grasp of their profession, so just try to get a wide breadth of opinions.

Thanks for the response.

Unfortunately, regarding the bolded part above, the hospital that I am currently training at does not have any surgery residents so I am working directly with attendings. I think this is also majorly influencing my thoughts about surgery because I am first assisting on almost every single case so it still seems exciting. It would be nice to get the residents perspective, but that's not an option for me currently.

I know I would be miserable in surgery, but it's just fun right now. I'll eventually come to my senses.

 

[copes]

Thanks for the response.

Unfortunately, regarding the bolded part above, the hospital that I am currently training at does not have any surgery residents so I am working directly with attendings. I think this is also majorly influencing my thoughts about surgery because I am first assisting on almost every single case so it still seems exciting. It would be nice to get the residents perspective, but that's not an option for me currently.

I know I would be miserable in surgery, but it's just fun right now. I'll eventually come to my senses.

You might have to do an away rotation in surgery to know for sure whether or not surgery is for you. You can talk to as many people as you want but in the end the only opinion that matters is your own. I would never go into general surgery but I am sure it fits some people really well. My friends who chose demanding specialties all decided that it was most important for them to do something they loved doing despite the sacrifices that they'd have to make. I'm not saying people can't love radiology but it typically doesn't evoke the same type of passion as surgery, and for many people who go into it it's more of a smart decision. I've never seen anyone regret going into radiology though, while there are a ton of them in surgery. But you also don't want to start radiology residency regretting you didn't pursue possibly the specialty of your dreams because of what people said on a forum.

 

[RadOncDoc21]

I want to take this time to truly say thank you to all the radiologist. We base all our treatment plans on imaging and take it from someone who has to interpret films all the time... I would be screwed without you!

Radiation Oncologists love you

 

[Kablammo]

Thank you Rad Onc Doc- obviously we wouldn't be anywhere without our RadOncs either. I'm fortunate to work with a number of enlightened RadOncs at a large cancer referral center and our multidisciplinary conferences are like going to medicine revivals- FP's, RadOncs, Surgeons, Pathologists, Radiologists and Nurses all working together on one patient at a time. Truly the best medicine, we should strive to do this with more patient scenarios.

To the student- be wary of anyone who tries to talk you into or out of any particular field- they all have their ups and downs, and you will gravitate towards the right field if you are honest with yourself and your values in life and medicine. If a superior trashes another field, smile/nod and try not to be influenced too much- this is a person who really doesn't get it.