Rads applicant - Worried I will miss the OR / surgery

[Ray D. Ology]

TLDR: I'm applying to radiology this upcoming cycle but I'm worried that I will miss the OR and patients.
This past week I had a ton of fun with robotic/laparoscopic surgeries, and an attending who knows me well told me my personality and surgery preferences point towards ENT or Urology. He acknowledged I would also fit in well with IR but tried to steer me away from DR.

To summarize my career goals, I need time away from work, I love working with my hands and playing with new tech, I like patients, I tolerate rounding/notes/call/non-procedural clinic, I hate the social work side of medicine.


Surgery considerations:
- On my last day of Gyn surgery this past week, I had this terrible feeling that this may be the last cool surgery I'll ever see. I started off loving Ortho, then saw amazing sinus surgeries in ENT and really neat robotic and laparoscopic surgeries in Gyn. Even tiny skin cancer excisions in Derm get me excited.
- The OR is my favorite place in the hospital but it is certainly not my favorite place in the world. I found surgery hours exhausting and felt like I missed out in my personal life while on surgery rotations.
- I cannot do the same long surgery over and over and over. (A full day of hip replacements was so boring b/c of the repetition.) That being said, I didn't mind repetitive tonsilectomies because they're so quick.
- I have hobbies and I want a few weeks off to vacation each year. The idea of working 60 hours a week at age 40 gives me nightmares. I want to be able to be home for dinner with my family if I'm not on call.
- Urology and ENT-specific pros: 3 days of procedural clinic and 2 days in the OR sounds like a fun balance. Building longitudinal relationships with patients sounds incredibly rewarding.
- Logistics: If I bail to Urology or ENT, I wouldn't be able to fit a sub-i in until August most likely. I'm worried I will not have enough time to get to know faculty or do research before applying in September. I do not want to take a research year.

Rads considerations:
- I love that I will be able to talk medicine all day with other physicians. IR procedures are incredibly diverse and advancements in tech will keep me engaged. IR saves lives on the daily. Patient anatomy varies, meaning even common procedures are slightly different each time. I love that, in DR, I can sit down and crank through work at my own (fast) pace. I love that most rads jobs provide sufficient time off (with the exception of call). I love that I can avoid the social work side of medicine.
- I'm a little worried about missing patients and never building long-term relationships, but this is not a deal-breaker, especially if I'm actively saving lives. The other side of the coin is that very little work needs to be taken home in rads. No writing notes from home or taking calls from patients after hours.
- If I do DR, can I get my procedural fix? Do the occasional procedures and frequent consult calls continue after residency? Or will I be locked in the reading room with other attendings churning out studies forever? More and more I'm starting to hear that DR is not as lifestyle friendly as one may think.
- If I do IR, will the hours as an attending be just as brutal as surgery anyway?
- Splitting a job 50/50 DR/IR sounds ideal. Breaking up the week with different tasks will help me avoid burnout.


Thank you in advance for helping me think through this! Personal anecdotes and links to prior discussions are welcome.

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[brownman23]

Mammography will have a solid amount of procedures. MSK will also have a few procedures every day. Furthermore, most academic radiology departments do their own procedures (neuro does LPs/myelograms, chest does thoracentesis, body does paras and CT guided biopsies, etc).

However, DR is primarily focused on interpreting imaging. From your description, it seems like you enjoy procedures and technology, and not interpreting images. I recommend you to apply to IR, or a surgical subspecialty. The lifestyle will work itself out...IR fellowship and surgical subspecialty residency training will have rough hours, but attendings in IR/Urology/ENT have a solid work-life balance.

 

[LittleFoot]

Based on the order you listed your career goals, I would recommend staying away from surgery and even IR. There is plenty of room to work with your hands in DR. I have similar career goals and I had the same worries as you going into DR knowing that I could probably end up doing IR if I really missed it. Now that I'm in DR residency, although I think the IR procedures are cool, I'm glad I didn't go that route.

 

[RadsRocks!]

you have to like image interpretation to do DR or IR

 

[Ray D. Ology]

you have to like image interpretation to do DR or IR

I definitely love imagine interpretation and everything that comes with DR. Sorry, didn't really get into why I love DR in this post. Was mostly observing that I really love the OR also, and was thinking about how if I only read images for the rest of my career I may feel like something's missing. But I understand why you'd reply with that based on what I wrote lol. Thanks @RadsRocks!

Mammography will have a solid amount of procedures. MSK will also have a few procedures every day. Furthermore, most academic radiology departments do their own procedures (neuro does LPs/myelograms, chest does thoracentesis, body does paras and CT guided biopsies, etc).

Thanks @brownman23, this is encouraging. I knew mammo, MSK, and body had procedures, but I didn't know to what extent. I also didn't realize that academic rads are more likely to do their own procedures, so thank you!

The lifestyle will work itself out...IR fellowship and surgical subspecialty residency training will have rough hours, but attendings in IR/Urology/ENT have a solid work-life balance.

Based on the order you listed your career goals, I would recommend staying away from surgery and even IR. There is plenty of room to work with your hands in DR. I have similar career goals and I had the same worries as you going into DR knowing that I could probably end up doing IR if I really missed it. Now that I'm in DR residency, although I think the IR procedures are cool, I'm glad I didn't go that route.

@LittleFoot & @brownman23, Really interesting that you two came to different conclusions, I appreciate your perspectives!


I have a 4-week DR elective coming up. I'll request to get exposure to procedures in MSK, body, breast, and neuro if possible. We'll see if it scratches the itch. Thank you everyone!

 

[odyssey2]

Your post basically screams radiology to me. I think the lifestyle concerns in surgery would vastly overshadow your enjoyment of the OR. Just another med student like you but that’s my 2 cents.

 

[brownman23]

I definitely love imagine interpretation and everything that comes with DR. Sorry, didn't really get into why I love DR in this post. Was mostly observing that I really love the OR also, and was thinking about how if I only read images for the rest of my career I may feel like something's missing.

If this is the case, then DR residency will be great! If you feel like you need more procedures (particularly acute procedures), you can always do ESIR and IR fellowship.

 

[RadsRocks!]

Also private practice ENT/Urology surgeons are mostly outpatient based from what I’ve heard. Apparently every second they aren’t in clinic they are losing money as a 1/2 day in clinic generates more money than the equivalent time in the OR.

You’ll see if you like DR over the elective. Hopefully you will have residents, fellows, and attendings who will take a more active role and teach you radiology and go through cases with you instead of you sitting there watching them work.

 

[brownman23]

Have you thought about ophthalmology? It hits a lot of what you seem to be looking for.

 

[Ray D. Ology]

Have you thought about ophthalmology? It hits a lot of what you seem to be looking for.

Thanks for the suggestion! I shadowed a bunch of ophthalmology clinic, cataracts, and retina surgeries during my pre-clerkship years. Nothing against the field but I happened to find it pretty boring/narrow.

 

[littlestar71]

Before the thread gets too old I'd love to hear how your rads rotation went and what you'll ultimately decide on.

 

[qxrt]

Back when I was a med student, I was trying to decide between ENT and IR. It was a conundrum I spent many anxious hours thinking about, worrying that whichever I picked, I would end up regretting it. Somehow, one day I ended up with a rare free day as a med student to shadow any department I wanted, and, not sure which I wanted to shadow, I took a look at the cases planned for both ENT and IR. It was at that moment that I realized that all the IR cases that day looked fascinating and I wanted to see them all, and on the flip side while I was excited to have the chance to put some face time with the ENT attendings, the actual cases planned that day did not interest me at all, and perhaps it was just the thought of being the master of a specific body part and being able to practice both medical and surgical treatments that lured me, not the day to day practice.

It was at that moment that I decided to go IR, and now as an attending several years out who practices both IR and DR, I have never felt other than that I chose the perfect specialty for myself. I would choose it 100% if I were a med student again. Key point is, while I enjoy the big cases like TIPS, embos, PAD, etc., I also enjoy the small cases like the venous access, biopsy, drain, etc which also constitute much of the work. I think people who only focus on the big cases and pooh-pooh the "small" cases have the wrong idea.

You can argue the logical pros and cons of each specialty all you want, but in the end, probably the most important thing that matters is, when actually faced with a routine workday in that specialty, can you get through it and imagine yourself doing the same thing every day for several decades? That's where shadowing comes in. I am not saying that IR will be right for you. But, when you shadow these specialties, is it the work itself that excites you, or more the thought of being a subspecialist surgeon/proceduralist of a specific variety?

One thing I will say, though: there is absolutely no procedural/surgical specialty that can beat the variety of IR. I ablate or chemo-embolize tumors, recanalize arteries in the legs, stop bleeds, remove clot from dialysis fistulas, clear out pulmonary emboli/DVT, manage portal venous hypertension, stent aneurysms and stenoses, do biopsies/drains, etc. Almost every other surgical/procedural specialty gets herded into a small niche of medicine. Not so with IR.

 

[Ray D. Ology]

Before the thread gets too old I'd love to hear how your rads rotation went and what you'll ultimately decide on.

Hey @littlestar71 thanks for checking in!

I'm still waiting to take my DR rotation but I just finished my IR sub-i and loved it! There were a few things that stood out to me that I wasn't anticipating:

1) The diversity of procedures. It didn't matter how many times I read a list of things IR does, until I felt the diversity of cases in-person I didn't understand what a privilege it is to participate in so many treatments across the entire body.
2) Working on patients who are awake. This is something that makes IR special. I love chatting with patients before, during, and after procedures.
3) Working with oncology patients. Even the bread-and-butter central venous access cases play a significant role in the lives of these patients. I take pride in that.
4) Problem-solving. Oh how nice it is to use my brain and not follow the exact same steps each time. Thank god for variable anatomy and the challenges it brings.
5) Leaving tiny scars. Another thing to take pride in.

Beyond loving IR for its own virtues, over time I'm starting to realize I would probably be unhappy in a clinic-driven specialty anyway. ENT and Urology are very cool and I may miss the robotic and sinus surgeries, but I'm starting to realize I experience a subtle yet visceral dread when I see that another clinic patient has checked in on the schedule. Sure, I know you can tailor your life to more surgeries and less clinic, but I'd rather not dread half of my job. This thought has also helped me let go of Derm.

As long as the DR rotation doesn't scare me away, I'm totally sold on IR!

Back when I was a med student, I was trying to decide between ENT and IR. It was a conundrum I spent many anxious hours thinking about, worrying that whichever I picked, I would end up regretting it. Somehow, one day I ended up with a rare free day as a med student to shadow any department I wanted, and, not sure which I wanted to shadow, I took a look at the cases planned for both ENT and IR. It was at that moment that I realized that all the IR cases that day looked fascinating and I wanted to see them all, and on the flip side while I was excited to have the chance to put some face time with the ENT attendings, the actual cases planned that day did not interest me at all, and perhaps it was just the thought of being the master of a specific body part and being able to practice both medical and surgical treatments that lured me, not the day to day practice.

It was at that moment that I decided to go IR, and now as an attending several years out who practices both IR and DR, I have never felt other than that I chose the perfect specialty for myself. I would choose it 100% if I were a med student again. Key point is, while I enjoy the big cases like TIPS, embos, PAD, etc., I also enjoy the small cases like the venous access, biopsy, drain, etc which also constitute much of the work. I think people who only focus on the big cases and pooh-pooh the "small" cases have the wrong idea.

You can argue the logical pros and cons of each specialty all you want, but in the end, probably the most important thing that matters is, when actually faced with a routine workday in that specialty, can you get through it and imagine yourself doing the same thing every day for several decades? That's where shadowing comes in. I am not saying that IR will be right for you. But, when you shadow these specialties, is it the work itself that excites you, or more the thought of being a subspecialist surgeon/proceduralist of a specific variety?

One thing I will say, though: there is absolutely no procedural/surgical specialty that can beat the variety of IR. I ablate or chemo-embolize tumors, recanalize arteries in the legs, stop bleeds, remove clot from dialysis fistulas, clear out pulmonary emboli/DVT, manage portal venous hypertension, stent aneurysms and stenoses, do biopsies/drains, etc. Almost every other surgical/procedural specialty gets herded into a small niche of medicine. Not so with IR.

Thank you so much for this! Wise words.