rads vs ophtho- med student style.

[anatomyaddict]

I know there is a pretty big thread about this posted by a premed but I have a new set of questions. So I have managed to think that if you like both fields and find general pros in both, there are only two things you can look at to seal the deal are: 1.the cons and 2.the EXTREME pros

so...here's what I have seen so far as a third year....

1. ophtho:
-cons-
-very very focused, reimbursement is going down the drain (although still great for a specialist)
-optometrist threat
-lots and lots of genetics and molecular biology involved- basically deal with a lot more of the basic sciences on a daily basis and have to keep that straight along with the clinical
-have to see a lot of volume to feed your surgical practice
-not crucial to the medical system. I know, I know, vision is ridiculously important, but the lack of an ophthalmologist does not really affect the hospital on a daily basis
-clinic can get really tedious
- have to have business sense to make a good living

-EXTREME PROS:
-surgeon for the most delicate organ in the body...that's pretty badass.
-patients are in love with you
-get to be a surgeon without the surgical lifestyle

I don't know a lot about the real world workings of radiologists- so can you point out some cons and extreme pros? I know this is a rads forum and most of you love what you do, but i really want to know whats the sweetest and worse parts of this field are: more specifically-


1.working from home- how many people actually manage to do this? will it get harder to swing a deal like that in the future

2. I understand there is a big push for volume now...how bad is it getting? do you guys feel a constant daily pressure to go by the clock? do you feel like its compromising the quality of your work?

3.does working knowledge of anatomy really correlate with imaging anatomy?

4.the most tedious aspect of the field? what is it that could potentially cause you to burn out in the future?

5.how does the job market and reimbursement look for future radiologists?

6.what do you wish you had known before you picked rads?

thanks so much!

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[bronx43]

Um... yeah, ophto is a nice little field, but they're surgeons in name only. There really isn't such thing as surgery without the surgical lifestyle.

 

[anatomyaddict]

from what i've seen, I am pretty sure that is false. They are surgeons, maybe not in the blood and guts kind of way, but they are pretty badass in their own little niche. I've met plenty of general surgeons that cringe at the thought of operating on the eye and admire ophtho's for doing it. If they consider them surgeons thats good enough for me

but regardless of that, any thoughts on the questions about rads??

 

[bronx43]

from what i've seen, I am pretty sure that is false. They are surgeons, maybe not in the blood and guts kind of way, but they are pretty badass in their own little niche. I've met plenty of general surgeons that cringe at the thought of operating on the eye and admire ophtho's for doing it. If they consider them surgeons thats good enough for me

but regardless of that, any thoughts on the questions about rads??

Everyone's badass in their own little niche, and there's always someone who cringes at whatever someone else does. In most surgeons' eyes, you have to at least do a surgery intern year to be considered a surgeon.

As far as radiology, there are plenty of threads about the pros and cons of it. Most people agree that diagnostic radiology will see some pretty big cuts in the future, but that really isn't any different from any other field in medicine. There'll be parity amongst specialties, so just pick something you enjoy doing.

 

[Isoprop]

your EXTREME PROS are very weird.

In any case, I would think that rads have a lot more basic science knowledge than most other fields. For DR, you're mostly working in the background so patients don't fall in love with you. And since the general population will get a radiologist confused with a tech, your baddassery with the most non-physicians is pretty nil.

 

[Just Applied]

Everyone's badass in their own little niche, and there's always someone who cringes at whatever someone else does. In most surgeons' eyes, you have to at least do a surgery intern year to be considered a surgeon.

As far as radiology, there are plenty of threads about the pros and cons of it. Most people agree that diagnostic radiology will see some pretty big cuts in the future, but that really isn't any different from any other field in medicine. There'll be parity amongst specialties, so just pick something you enjoy doing.

Uhm...So the ophtho residents that did a surgical intern year vs the ones who have not are surgeons and the latter are not. Strange concept. Anyways, ophtho does have some bad ass surgeries and your patients will fall in love with you if that has any impact on your decision. The fact is if you really want that "thank you doctor, I am so happy I found you" you will get it with Ophtho not so much with rads. I also like the fact that the technology is so advanced and is only getting better. Same with rads too though. Pros for both.

Big Con is reimbursements are getting cut, but that is with most of medicine as well (cards got hit 40%) so don't let compensation guide you.

The deciding factor between rads and ophtho was that I wanted to directly impact their life and not just be seen as a tech which does matter to some people.

This all goes out the door when you consider IR which is another specialty on its own.

-JA

 

[anatomyaddict]

Thanks for the replies guys. I guess this is my line of thinking: I want a good family life and have a significant interest outside of medicine which I also find fulfilling. I love anatomy and I love procedures and I am really good with patients
I have been looking into ophtho becuz of the shorter surgeries but its seeming too narrow and the fellowship I would want (oculoplastics) is near impossible to get.

Radiology is def closer to the meat of medicine and to my interests. So I figured if I cd land a job where I can do a couple of days of ir a week and then do diagnostic readings from home would be ideal for me.

So:
1.is a job setup like this even possible?
2.with reimbursement cuts are we talking less than 200k a year?

Thanks!

 

[a winner is you]

So I figured if I cd land a job where I can do a couple of days of ir a week and then do diagnostic readings from home would be ideal for me.

No group is going to hire you to do IR procedures 2 days a week, when the guy next to you is willing to do 5-6.

 

[badasshairday]

No group is going to hire you to do IR procedures 2 days a week, when the guy next to you is willing to do 5-6.

True that.

 

[fun8stuff]

Thanks for the replies guys. I guess this is my line of thinking: I want a good family life and have a significant interest outside of medicine which I also find fulfilling. I love anatomy and I love procedures and I am really good with patients
I have been looking into ophtho becuz of the shorter surgeries but its seeming too narrow and the fellowship I would want (oculoplastics) is near impossible to get.

Radiology is def closer to the meat of medicine and to my interests. So I figured if I cd land a job where I can do a couple of days of ir a week and then do diagnostic readings from home would be ideal for me.

So:
1.is a job setup like this even possible?
2.with reimbursement cuts are we talking less than 200k a year?

Thanks!

it may be possible to have that type of schedule doing other non-IR procedures, such as body (mainly biopsies, drains), ped's (fluro/gi stuff), GI (barium), mams (biopsies, needle loc), neuro (LP, facet injections, nerve blocks, epidurals).

 

[eyeMD6299]

been an ophth for almost 15 yrs. somewhat disappointing but subject matter/daily work is what interested me then and now. do which one you really are interested in doing every day for decades since gov't and ins cos gonna get both of these specialties in the long (and short) run

 

[davidjones]

I'll help too from an IR prespective, particularly if you like ophtho

Pros:

1)cutting edge of medicine, things in the pipeline like autologus islet cell transplants into portal vein for diabetics/CF/chronic pancreatitis; Transarterial chemotherapy for high grade retinablastoma; cryoablation/RFA for bone met palliation (several large studies going on comparing that and EBRT, with outcomes similar, but achieved quicker with percutaneous ablation); TACE for hepatoblastoma in kids (many cases of 2+ years remission in Asia)

2)get to be a pioneer just by showing up to work, many things IR does now was invented and validated by an IR who had a good idea one day

3) get to be an early generation of a new field (sort of like #2); but opportunities like this don't come around very often, chances are most people who do IR now will come up with some majorly useful technique, management recommendation etc.

4)lots of acute stuff where if you're successful patient gets better right away: traumas, GI bleeds, post-partum bleeds etc


Cons:
1)Have to do DR residency ; though a DR/IR dual certificate (like med/peds) may be approved this year by ABMS

2)Everyone wants a peice of your pie: mostly in PAD/neuro stuff, but oncology is strongly within IR, and to be perfectly honest all an IR has to do to keep this stuff is work hard, don't expect 12 weeks vacation and 500k for doing 3 angiograms a day; 30% of PAD work done by IR, many institutions it is only done by IR; a good example is Brown where cardiologists have to go elsewhere to get their PAD training; a successful IR has a surgeon's lifestyle, which is my many people who go into rads don't do it, it's mostly people who go to rads specifically for IR, or surgeons who switch to rads

3)the current training paradigm is insufficient to learn all of the IR procedures: vascular, oncologic, pain, CT/US guided stuff and all of the clinical management, how to run a clinic; that's changing though, but it may not be early enough to make a difference in your training and you will have to come by this knowledge somehow, likely as an attending



to answer your original question; you may be able to do teleradiology and IR and swing a decent salary if you are in a small town; impossible if you want to live in a big city, that kind of set up doesn't exist

also when a group hires an IR, these days they expect you to develop a practice: meaning if there is already not a free standing clinic, an oncology service/consult service etc it will be on you to develop these things otherwise you bring no real value to the group as they likely already have at least one or two people who do biopsies, drains, and come in in the middle of the night for trauma, bleeding, strokes

I personally think ophtho is also a great field, but like eyeMD said, everything gets boring after a while; I know a lot of you ophtho people and they all love it and can't imagine it getting old, likewise I can't imagine anything in IR getting old; but as you get older, have a spouse and kids, your priorities will change, so really think hard about what will get you out of bed in the morning in your 40s; do you want to be coiling GI bleeds at 3 AM then?

also, I'm sure you know this, but absolutely, positively DO NOT PICK A SPECIALTY BASED ON PERCIEVED PRESTIGE, LIFESTYLE, MONEY, or anything else other than "I can't imaging doing anything else"

hope that helps

 

[johnmcdonald]

Hi, I wanted to play off of this thread instead of completely starting a new one.

I'm interested in both specialties too and am thinking of applying to both this next cycle. My problem is that I'm not totally sure how to handle it. My CV so far is filled with ophtho-related activities since forever, I haven't done Rads research since undergrad and wont have my elective until next month. I've heard Rads LORs aren't entirely important for the application but the only other letters I have would be 1 IM and the rest ophto. I don't need anyone to tell me that an ophtho letter would be a terrible idea for a Rads app, so I guess I desperately need to get that radiology LOR.

--How bad will it look to have so much ophtho in my application to Radiology?

 

[PistolPete]

An ophtho letter wouldn't necessarily be bad, as long as it speaks to your character and ability to perform in residency. Of course you wouldn't want an ophtho letter for radiology residency that states you will be a great ophtho resident. I'd say 1 ophtho max, use your 1 IM, try to get 1 rads and maybe 1 other one from 3rd year (FP? Peds? Surg?)

 

[MissAmanda]

Along with this ... If I prefer to know a lot about and be good at one thing (and don't mind repetitiveness on a day to day basis), than to have to know a lot about everything (encyclopedic knowledge). Is ophtho a better fit in this respect?

 

[PistolPete]

I'm no ophthalmologist or radiologist, but it seems to me that ophtho=know a lot about one thing, radiologist=know a lot about a lot of things.

If you prefer to concentrate on one area, ophtho may be a better fit, but you have to go with your gut and what you are really passionate about.

I will defer to residents for their opinion.

 

[MrBurns10]

I can't speak for ophtho, but you need to know A TON in radiology. Truthfully, I'm a bit overwhelmed by how much there is to know. Once you finish residency, you can choose to be as subspecialized as you want if you stay in academics (but if you go out into PP, you'll still have to know pretty much everything).

 

[cowme]

Med students change ideas all the time. There's no shame in switching from optho to rads at the last minute. If it's a good optho letter, use it

 

[EeePC1005PR]

Hi Anatomyaddict

Love your questions. I previously had similar questions to yours but within 3 seconds in my head I knew radiology was definitely the way to go. Mind you though these are only my very personal preferences and you'll have your likings ofcourse. I got two really clever friends who are overjoyed to get an offer in ophthalmology, so that's them.

Some points not yet raised by others is this: are you interested in computers and constantly updating high tech equipments? When I watched Robocop and Star Wars, I day dreamed if I ever went into problems eg. from a major MVA, that I can be turned into half computer. I almost switched profession from Medicine to Engineering, and computers, physics, maths really interest me. I noticed myself reading computers & radiology related journal articles at 2am for the joy of it, and conducting radiology related projects etc. None of these feelings I get from ophthalmology. So for me the decision was literally 3 seconds. Never needed to revisit it again.

In addition I also liked anatomy - the way it's so structural, precise, what you see is what you get; sure there are variants but still what you see is what you get and variants only make things more interesting. Sure you get anatomy with ophthalmology too but it's all too confined in a tiny area, not my cup o tea. Plus with radiology you get to be involved closely with all specialties. Nearly everyone gets some sort of imaging. All specialties order imaging, some are not that sick, some area really sick. That sort of interaction, diversity and challenge is something to look forward to and enjoy. Also IR is only going to get fancier in the decades to come. Minimally invasive, image guided procedures is very exciting and promising.

The degree of appreciation from patient towards you tend to be lower for radiology. Radiologists work in the background but hey I'm doing this job because I like the job, not because of whether people appreciate me or not (or I might as well go work for them).

For me personally, there are 101+ reasons to do radiology. I guess at 3am in the morning, would you gladly be reading about radiology or ophthalmology? whatever your answer is (be it radiology or ophthalmology), that's probably what you'd want to do for the rest of your life. Good luck.

 

[cowme]

Eh I Dono. You can love reading about glaucoma as much as anyone, but it still takes a special person to sit through a day of glaucoma clinic... Radiology and path are pretty unique in that the science you read about is truly what you are doing all day.

 

[PimpMaster]

I know there is a pretty big thread about this posted by a premed but I have a new set of questions. So I have managed to think that if you like both fields and find general pros in both, there are only two things you can look at to seal the deal are: 1.the cons and 2.the EXTREME pros

so...here's what I have seen so far as a third year....

1. ophtho:
-cons-
-very very focused, reimbursement is going down the drain (although still great for a specialist)
-optometrist threat
-lots and lots of genetics and molecular biology involved- basically deal with a lot more of the basic sciences on a daily basis and have to keep that straight along with the clinical
-have to see a lot of volume to feed your surgical practice
-not crucial to the medical system. I know, I know, vision is ridiculously important, but the lack of an ophthalmologist does not really affect the hospital on a daily basis
-clinic can get really tedious
- have to have business sense to make a good living

-EXTREME PROS:
-surgeon for the most delicate organ in the body...that's pretty badass.
-patients are in love with you
-get to be a surgeon without the surgical lifestyle

I don't know a lot about the real world workings of radiologists- so can you point out some cons and extreme pros? I know this is a rads forum and most of you love what you do, but i really want to know whats the sweetest and worse parts of this field are: more specifically-


1.working from home- how many people actually manage to do this? will it get harder to swing a deal like that in the future

2. I understand there is a big push for volume now...how bad is it getting? do you guys feel a constant daily pressure to go by the clock? do you feel like its compromising the quality of your work?

3.does working knowledge of anatomy really correlate with imaging anatomy?

4.the most tedious aspect of the field? what is it that could potentially cause you to burn out in the future?

5.how does the job market and reimbursement look for future radiologists?

6.what do you wish you had known before you picked rads?

thanks so much!

Read this. Rads is about to get the AXE!!

http://www.ama-assn.org/amednews/201...8/gvl10718.htm

 

[cowme]

Right. So it's on par with cuts Across all medical specialties.

 

[Dusn]

As an ophthalomologist, with a number of radiologists in my immediate family, I might be able to provide a little more info.

The biggest negative to radiology is the lack of feedback. Patients can be annoying sometimes and there are definitely times at the end of a particularly frustrating patient encounter in which I'd rather be sitting in a dark room focusing just on what I was trained to do. But that being said, I can't imagine making diagnoses day after day, without ever finding out if that diagnosis was actually correct or what happened to the patient.

Given that, the only field in radiology that I would consider is IR. IR, in my opinion, is probably a better field than most of ophtho. I love being in the OR and interventional radiologists get to spend more time operating than most ophthalmologists do. IR also gets paid more, is more connected to the rest of medicine, has more job opportunities near big cities because it's currently less saturated (this may change), and, for reasons which I don't understand, it's still not that competitive of a fellowship to get into and is probably easier to get into that most the surgical fellowships out of ophtho (it seems much easier to get into IR than retina for example, and easier to get a job afterwords, especially if you don't have good business skills).

The biggest negative to IR, in my opinion, is the radiation exposure. I don't know how serious this is but it would scare me a little bit. Again, I'm not sure what the cancer risk is but they definitely get radiation-induced cataracts at a much younger age so the radiation is doing something to their bodies.

 

[Lacuna]

In radiology you can get follow up if you want to... Check the medical record or imaging in a few weeks and see what happened. Talk to the surgeons after you call a bowel obstruction to see what the intra-operative findings were. Breast radiologists and IR's get the path reports on the biopsies they do. If you do a lot of GI fluoro you see if the bariatric patients are losing weight because you are in the room with them. On nucs you ablate thyroid ca patients with I-131 and you see them when they come back for follow up. The list goes on...

 

[davidjones]

Actually IR has become very competitive in the past 2-3 years. Though there are still more spots than applicants, the only spots that were left over were from crappy fellowships where you just do biopsies/drains and PICCs all day.

Even 5 years ago, it used to be easy to get your first choice, though it was always harder to get a fellowship in a place like Northwester, UCSD, Brown, UVA etc, now the best fellowships are hard to get, some places have had 60 applicants for 1 position in recent years. The reason it is so competitive now is
1)it's much easier to get a job in IR anywhere in the country for a good salary out of fellowship than in any other field of radiology

2)IR is awesome: people used to be all down about it because vascular surgeons and cards are diong 75% of the arterial work, but so what, IR still does 25% and 25% of 1.5 million is a lot of PAD work, on top of that we have oncology (TACE/Y-90, ablations technology, mediports, etc), Women's stuff (fibroid embo, pelvic congestion syndrome, post-partum), and the bread and butter (vascular acess, biopsies, drains; all of which can be interesting in their own way)

I think #1 will change, and competitiveness will go down, the reason being that lot of people who are going into IR to get a job are getting in over their heads, some of the more senior residents who interviewed most recently told me they ran into people who have never even done a femoral artery puncture (i.e. they have no clue what an IR does or that they will have to get up at 3 AM to deal with a cold leg, GI bleeder, or trauma patient; or that they have to come in at 6 AM and may not leave til 10 during their fellowship). Also when the economy corrects itself, the number of people who apply to IR will decrease because there will be easier ways to get a job.

As far as ophto vs. IR, I actually really liked both, they both can have quick procedures and both can have long procedures and anything in between. The only problem I see with IR is the 4 years of diagnostic radiology, which frankly sometiems feels like it's not worth it, the benefit of ophtho is you're doing the field to begin with. So going into IR is sort of like starting med school again, you do something you don't particularly enjoy to get to where you want to be. That may change as IR splits further and further away from diagnostic rads, but ultimately you gotta do what you love.

The thing that made me choose IR, was eventually the novelty of a field wears off, and you sort of start going through the motions, but IR is the only field in medicine right now which is advancing in leaps in bounds, and tends to keep you on your toes, it's sort of akin to being a surgeon in the early 20th century when all sorts of new operations and procedures were being created.

 

[nightflight]

Actually IR has become very competitive in the past 2-3 years. Though there are still more spots than applicants, the only spots that were left over were from crappy fellowships where you just do biopsies/drains and PICCs all day.

Even 5 years ago, it used to be easy to get your first choice, though it was always harder to get a fellowship in a place like Northwester, UCSD, Brown, UVA etc, now the best fellowships are hard to get, some places have had 60 applicants for 1 position in recent years. The reason it is so competitive now is
1)it's much easier to get a job in IR anywhere in the country for a good salary out of fellowship than in any other field of radiology

2)IR is awesome: people used to be all down about it because vascular surgeons and cards are diong 75% of the arterial work, but so what, IR still does 25% and 25% of 1.5 million is a lot of PAD work, on top of that we have oncology (TACE/Y-90, ablations technology, mediports, etc), Women's stuff (fibroid embo, pelvic congestion syndrome, post-partum), and the bread and butter (vascular acess, biopsies, drains; all of which can be interesting in their own way)

I think #1 will change, and competitiveness will go down, the reason being that lot of people who are going into IR to get a job are getting in over their heads, some of the more senior residents who interviewed most recently told me they ran into people who have never even done a femoral artery puncture (i.e. they have no clue what an IR does or that they will have to get up at 3 AM to deal with a cold leg, GI bleeder, or trauma patient; or that they have to come in at 6 AM and may not leave til 10 during their fellowship). Also when the economy corrects itself, the number of people who apply to IR will decrease because there will be easier ways to get a job.

As far as ophto vs. IR, I actually really liked both, they both can have quick procedures and both can have long procedures and anything in between. The only problem I see with IR is the 4 years of diagnostic radiology, which frankly sometiems feels like it's not worth it, the benefit of ophtho is you're doing the field to begin with. So going into IR is sort of like starting med school again, you do something you don't particularly enjoy to get to where you want to be. That may change as IR splits further and further away from diagnostic rads, but ultimately you gotta do what you love.

The thing that made me choose IR, was eventually the novelty of a field wears off, and you sort of start going through the motions, but IR is the only field in medicine right now which is advancing in leaps in bounds, and tends to keep you on your toes, it's sort of akin to being a surgeon in the early 20th century when all sorts of new operations and procedures were being created.

The only difference is there is very little turf wars in ophto, only probably from optometrists. But IR may loose all its turf in a few years the way it lost coronary, PVD and now Neuro-IR work.
Now IR doctors are only put PICC, while vascular surgeons and cards are doing EVAR in the room next to them.