Rank List Guidance

[okiedokie]

I'm having one hell of a time trying to order my rank list. Location is semi important, but so is my significant other's preference (couples matching into peds). I also know that I want to do an IR fellowship. I have narrowed down my top 6 to:

UPMC
Cincinnati
U Illinois - Chicago
Einstein (PA)
U South Florida
Mt. Sinai (SLR)

Any thoughts?

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[Radz123]

IR Programs
Mt Sinai > USF >> UPMC = Cincinnati. Don't know the other programs.

Pediatric Programs
Cincinnati >>>>>>>>>>>>> Everyone else.

 

[deleted564680]

UPMC is the best on that list for overall DR training by quite a bit but I agree with radz for IR.

 

[tco]

Honestly, you're going to learn IR in IR fellowship. You're going to learn the basics of needle control and maybe get a few research papers in residency. Make your SO happy. Happy wife (or husband, but it doesn't rhyme)= happy life >>>> IR-centered residency program.

Edit: I'm not saying to go to a bad program to make your SO happy. If I had a choice to make a compromise, I'd go as far as mediocre in both IR and DR to make my SO happy. You've got better options than that on all of your choices. If you're having a hard time deciding, that means that you probably liked all of those programs.

From my experience, it felt like Cincinnati was the "worst" for IR on that list. They put me off a bit with their attitude towards resident education during IR on interview day by basically saying, "Your job is to put in lines." No, my job is to learn the basics of managing patients and needle control, which can be contributed through placing lines, but also should involve drains and assisting on more complex procedures. /endrant

 

[LurkerOnHigh]

Anyone entering Rads from July 2017 onwards, will not be able to do an IR fellowship as it is going away as of July 1, 2020. You'll only have options of ESIR or the Independent residency; unless you interviewed for the IR residency.

 

[cowme]

You can call it an independent residency all you want, but since it requires a precursor radiology residency, it's really just a 2 year fellowship

 

[IR4thewin]

You can call it an independent residency all you want, but since it requires a precursor radiology residency, it's really just a 2 year fellowship

Totally agree, only difference is that we won't be able to call ourselves fellowship trained interventional radiologists. I'm already having nightmares thinking about having to explain this to referral sources in my first few years out from 'residency.'


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[Fab5Hill33]

Just to clarify: ESIR isn't a different pathway than doing the independent residency. There's only 2 pathways to IR: integrated and independent.

And I agree, independent is basically a 2-year fellowship.

Anyone entering Rads from July 2017 onwards, will not be able to do an IR fellowship as it is going away as of July 1, 2020. You'll only have options of ESIR or the Independent residency; unless you interviewed for the IR residency.

 

[IRorBustguy]

Just to clarify: ESIR isn't a different pathway than doing the independent residency. There's only 2 pathways to IR: integrated and independent.

And I agree, independent is basically a 2-year fellowship.

theoretically ESIR can take a year off so you only do a 1 year independent pathway

 

[tco]

Anyone entering Rads from July 2017 onwards, will not be able to do an IR fellowship as it is going away as of July 1, 2020. You'll only have options of ESIR or the Independent residency; unless you interviewed for the IR residency.

Please cite the source. As of SIR 2015, they were insistent on having an alternative means to produce IR trained physicians, which involved a 2 year fellowship or ESIR plus a one year fellowship in addition to DR/IR.

 

[IR4thewin]

Please cite the source. As of SIR 2015, they were insistent on having an alternative means to produce IR trained physicians, which involved a 2 year fellowship or ESIR plus a one year fellowship in addition to DR/IR.

I think you are stuck on semantics. You basically have the pathways right but there is no association with the word 'fellowship' any longer.


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[tco]

I think you are stuck on semantics. You basically have the pathways right but there is no association with the word 'fellowship' any longer.


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This is one of the few times that semantics actually matters. If you say "there's not going to be any fellowships," it implies that the only way to get into IR is to do DR/IR.

 

[IR4thewin]

I agree. Was just trying to say that if you replaced the word 'fellowship' with the words 'independent residency' your post would be right on with the current pathways. 3 total pathways moving forward 1. Integrated IR/DR 2. DR with ESIR + 1 year Independent residency 3. DR without ESIR + 2 year Independent residency.


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[PL198]

calling independent a residency is semantics

 

[DrBowtie]

Totally agree, only difference is that we won't be able to call ourselves fellowship trained interventional radiologists. I'm already having nightmares thinking about having to explain this to referral sources in my first few years out from 'residency.'


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Interesting unintended consequence. Two groups I'm aware of pay different based upon if you are a fellowship trained radiologist. I guess they'll have to rework their pay structures for the IR guys.

 

[IR4thewin]

I personally think the 'independent residency' term makes us look stupid. Look at our counterparts in vascular surgery, you can either train through the integrated vascular pathway or do a surgery residency followed by a vascular Fellowship, which is 2 years.

SIR should have come out and said that there will be the integrated pathway for IR or a two-year fellowship after DR. Someone please explain why it should be called an independent residency instead of a fellowship? Why create a new term that no one knows what it means instead of using a widely known word that perfectly describes the training.

There is no shame in coming out and saying that IR has advanced and 2 years are now required for a fellowship.


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[irwarrior]

Most of these semantics were driven by the ABMS.

The initial request by Kaufman was for a 5 year IR residency but they would only be boarded in IR and not radiology. The ABMS did not approve this and so after much work, Kaufman and the SIR went back with the Dual certificate (IR/DR) and this finally got approval in 2012. At that time there was plans to slowly phase in the IR residencies, but the ABMS (American Board of Medical Specialties) did not want to have various training pathways for IR. Thus, they wanted fellowships to phase out in 2020. With much difficulty , the SIR group was able to get ESIR approved particularly for smaller programs who did not have IR fellowships (as they potentially would have a harder time recruiting medical students, or that was their fear discussed at AUR ) and with that addition they also were able to get the 1 and 2 year independent residency positions. The question is how many total independent spots will be available?

As more and more convert to integrated residencies, there will be fewer 1 or 2 year independent pathways . Will there be more ESIR graduates compared to 1 year IR independent pathways and if that is the case will these ESIR also apply to 2 year independent pathways to further secure their chances of matching? The future will be very interesting.

A few years ago there were 270 applicants for 220 IR spots and so 50 did not match. I am not sure what the match a rate will be for the various pathways.

 

[IR4thewin]

Thanks for the historical perspective IRWarrior, it is interesting that Dr. Kaufman wanted to have IR separate, just reconfirms my suspicion that IR will split from DR at the first chance it has. Also interesting because I listened to a recorded talk by Dr. Kaufman talking about how crucial it was to have IR joined with DR lol


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[PL198]

if it goes separate IR shouldn't be reading DR.

 

[IRorBustguy]

Have you guys shadowed in IR? Faculty at my institution look at images all day long in planning procedures, looking at treatment responses for y90, making sure embolizations are complete, etc. IR literally cannot exist without DR skills (especially reading CTA).

Also to the poster who is bitter that DR and IR get the same certificate, I hope you realize that because the first 3 years is the same, the certificate follows the CORE exam. Even without DR/IR, in the past, residents could spend a ton of time on IR during R4 and take a bunch of non-interpretive electives.

 

[PL198]

Have you guys shadowed in IR? Faculty at my institution look at images all day long in planning procedures, looking at treatment responses for y90, making sure embolizations are complete, etc. IR literally cannot exist without DR skills (especially reading CTA).

Also to the poster who is bitter that DR and IR get the same certificate, I hope you realize that because the first 3 years is the same, the certificate follows the CORE exam. Even without DR/IR, in the past, residents could spend a ton of time on IR during R4 and take a bunch of non-interpretive electives.

planning procedures utilizing DR and making DR reads are 2 different things. I understand IR people do both, however it is an important distinction. If there is to be a split, I Have no problem with the first, the second is much more questionable.

If the first 3 years are the same, then there is no clinical benefit of the residency itself as anything you do in years 4 and 5 could be accomplished in fellowship with structure changes.If the first 3 years are different then you are obviously sacrificing DR training to learn more IR.

 

[Fab5Hill33]

Old school (my era):
1 year internship + 4 years DR + 1 year IR = 6 years and double boarded in IR and DR

New school:
1 year internship + 3 years DR + 2 years IR = 6 years and double boarded in IR and DR

It's not like interventional radiologists are somehow cheating the system. They're putting the same number of years into training. What's all the whining about???

 

[PL198]

Old school (my era):
1 year internship + 4 years DR + 1 year IR = 6 years and double boarded in IR and DR

New school:
1 year internship + 3 years DR + 2 years IR = 6 years and double boarded in IR and DR

It's not like interventional radiologists are somehow cheating the system. They're putting the same number of years into training. What's all the whining about???

New(and most old) ir have 3 years DR training, even less if youre missing time for icu or outpatient. Fellowship trained DR have 5 years DR training. That's quite a difference

 

[Fab5Hill33]

What's your point? This has been the status quo for literally decades. And it works perfectly fine.

There were DRs back in the day stat started doing IR procedures without any formal IR training, and they're still allowed to practice. You don't see any fellowship trained IR's complaining about those people.

New(and most old) ir have 3 years DR training, even less if youre missing time for icu or outpatient. Fellowship trained DR have 5 years DR training. That's quite a difference

 

[PL198]

What's your point? This has been the status quo for literally decades. And it works perfectly fine.

There were DRs back in the day stat started doing IR procedures without any formal IR training, and they're still allowed to practice. You don't see any fellowship trained IR's complaining about those people.

Status quo is your argument? Status quo was surgeons launching scalpels. How does that work now? Insurance companies are tightening up more and more about who they reimburse. On AM there are companies talking about only paying for fellowship specific reads in some instances. So how do you think it'll work for people with even a less yr of DR training than those non fellowship trained DR guys/gals.

You can only know so much. If you can train 2 less years and claim similar skills in DR, then you're basically dissing the rest of your colleagues who trained 2 more years and their training method.

 

[Fab5Hill33]

Are you dissing your IR colleagues by performing procedures without IR fellowship training? Are you suggesting DRs should no longer do biopsies?
Are you dissing your neuroradiology colleagues by reading MRI brains when you've done an MSK fellowship?
How about if you did an MSK fellowship and then practiced in a group where you read ONLY MSK for 5 years straight. Is it OK for you to change jobs and go to a place where you read everything? Are you still qualified to read a chest xray?
What about someone who did an IR/DR residency then joined a practice where they did everything (50/50 IR/DR). Who's better at reading an abdominal CT? The IR who's been reading body CTs consistently for 5 years, or the MSK trained guy who hasn't touched a body CT in 5 years?

Your argument holds no water.

So what if insurance companies are tightening up? All interventional radiologists have a DR certificate anyway. Whether it's the old system or the new system. Nothing has changed.

Status quo is your argument? Status quo was surgeons launching scalpels. How does that work now? Insurance companies are tightening up more and more about who they reimburse. On AM there are companies talking about only paying for fellowship specific reads in some instances. So how do you think it'll work for people with even a less yr of DR training than those non fellowship trained DR guys/gals.

You can only know so much. If you can train 2 less years and claim similar skills in DR, then you're basically dissing the rest of your colleagues who trained 2 more years and their training method.

 

[PL198]

Are you dissing your IR colleagues by performing procedures without IR fellowship training? Are you suggesting DRs should no longer do biopsies?
Are you dissing your neuroradiology colleagues by reading MRI brains when you've done an MSK fellowship?
How about if you did an MSK fellowship and then practiced in a group where you read ONLY MSK for 5 years straight. Is it OK for you to change jobs and go to a place where you read everything? Are you still qualified to read a chest xray?
What about someone who did an IR/DR residency then joined a practice where they did everything (50/50 IR/DR). Who's better at reading an abdominal CT? The IR who's been reading body CTs consistently for 5 years, or the MSK trained guy who hasn't touched a body CT in 5 years?

Your argument holds no water.

So what if insurance companies are tightening up? All interventional radiologists have a DR certificate anyway. Whether it's the old system or the new system. Nothing has changed.

LP, paras, thoras are different level than y90. I don't think many Dr docs are saying they feel comfortable with the high end stuff. If they were saying they were as good at y90 or tips as an IR, I would say they are in fact dissing IR.

As I said a dr reading out of fellowship still has a year more Dr training than an IR doc does. At some point the difference is training is significant. Then you might say the IR guys are still passing CORE, but the problem there is everyone says the CORE doesn't reflect real practice so being able to pass it doesn't mean much to me in terms of being sufficiently trained to read DR.

I'm not taking an absolute stance, I know a lot of IR docs that are extremely impressive with their DR knowledge. I'm saying as you modify pathways more and more, and add IR training earlier and earlier, that has to end up having an effect on DR knowledge at some point.

 

[Fab5Hill33]

So it's OK for DR to do LPs, paras and thoras. Then how about IR reading an abd/pelvis CT? That's pretty basic. Is that OK? Is 3 years of training sufficient for that? Where do you draw the line? MR elastography? CT colonography?

I'm sure a fellowship trained DR is better at reading films than an IR. Nobody is disputing that. And there's no IR claiming they can read films better than their diagnostic radiology colleagues - I'm certainly not. It seems like there's some DRs who are mistaking the IR/DR certificate as some sort of slight that IRs think they can read films as well as them. That's simply not the case.

LP, paras, thoras are different level than y90. I don't think many Dr docs are saying they feel comfortable with the high end stuff. If they were saying they were as good at y90 or tips as an IR, I would say they are in fact dissing IR.

As I said a dr reading out of fellowship still has a year more Dr training than an IR doc does. At some point the difference is training is significant. Then you might say the IR guys are still passing CORE, but the problem there is everyone says the CORE doesn't reflect real practice so being able to pass it doesn't mean much to me in terms of being sufficiently trained to read DR.

I'm not taking an absolute stance, I know a lot of IR docs that are extremely impressive with their DR knowledge. I'm saying as you modify pathways more and more, and add IR training earlier and earlier, that has to end up having an effect on DR knowledge at some point.

 

[IRorBustguy]

PL198 - no point arguing. IR/DR is the reality. Also - the oral boards are no joke. Say I get the DR/IR certificate - I'll probably be comfortable reading certain DR modalities like CTA and CXRs and Body CT. Am I going to be comfortable reading reading mammo / MSK / neuro / etc? No way. At my institution, some Body attendings won't even touch Body MRI because they were not trained with those skills.

This is no different. Even current DRs that are board certified are not expected 100% of all imagine modalities. I realize you are making this philosophical argument, but reality is different.

Another anology - do you think general surgeons are comfortable with stuff like small bowel transplant? hell no. additional training. Can they do it legally? sure. Do they want to? hell no.