Research in Intern Year

[Nesir]

Hi,

I was lucky enough to match my prelim medicine year at the same institution that I matched for my radiology years. Would I be crazy if I wanted to start some light clinical research my intern year (get IRB, other approvals, etc)?

Thanks.

---

Members don't see this ad.

 

[colbgw02]

Not crazy, but not really necessary either. If research is your thing and you plan on getting something published in Radiographics that will take years, then go for it. If your goal is just to check the research box for residency graduation requirements, then I'd say that extra time during internship is better spent relaxing or sleeping.

 

[JoshSt]

Yes, I think that'd be a great idea and you have the perfect attitude for it. You're not going to have crazy free time to DO research but, as you said, you can get the ball rolling on IRBs (which are a @#$@#$ pain if you don't have help). This would set you up in prime position to start when you're ready in R1 -- without all those dumb approvals

 

[shark2000]

What are your goals for the future?

If you want to end up in academics in a big university, these days having a good research background is very important and it is the time to start.

Otherwise, no don't waste your time. If your goal is pp, nobody cares.

 

[JoshSt]

What are your goals for the future?

If you want to end up in academics in a big university, these days having a good research background is very important and it is the time to start.

Otherwise, no don't waste your time. If your goal is pp, nobody cares.

Shark -- does anyone do research in pp? I know it doesn't help the bottom line and won't advance you through a partner track. I know if one desired to take the time they certainly could do it but have you actually seen anyone doing it?

 

[shark2000]

Shark -- does anyone do research in pp? I know it doesn't help the bottom line and won't advance you through a partner track. I know if one desired to take the time they certainly could do it but have you actually seen anyone doing it?

There are some pseudoacademic places that a pp group has its own residency program and also does some research. I also know a nephrologist who is working in pp and does some research. Doing top notch research needs a lot of time, energy and resources. It is a tedious slow process. Don't expect to go to MGH one day a week and become a well published researcher in a few years.

If you are into research and want to do a genuine high end research, you can not do it without being in a top academic center. As a pp person, at most you can publish a review article or a pictorial essay somewhere or an abstract in RSNA. More importantly, there is not EXTERNAL incentive to do it in pp and sooner or later you will put it away. However, in most academic places publications give you some privileges like promotion, free travel or less clinical work if you get a grant.

PP is all about business. The business side of pp is more than a full time job itself.

 

[JoshSt]

There are some pseudoacademic places that a pp group has its own residency program and also does some research. I also know a nephrologist who is working in pp and does some research. Doing top notch research needs a lot of time, energy and resources. It is a tedious slow process. Don't expect to go to MGH one day a week and become a well published researcher in a few years.

If you are into research and want to do a genuine high end research, you can not do it without being in a top academic center. As a pp person, at most you can publish a review article or a pictorial essay somewhere or an abstract in RSNA. More importantly, there is not EXTERNAL incentive to do it in pp and sooner or later you will put it away. However, in most academic places publications give you some privileges like promotion, free travel or less clinical work if you get a grant.

PP is all about business. The business side of pp is more than a full time job itself.

Thanks, those insights are very much appreciated.

As an MS3, I'm a long ways away from making the decision of academics vs pp. However, as the MS4 OP posts the question with shark's response of deciding academics vs pp, a general idea of how you plan to spend your career does influence your residency course (e.g., doing research and getting pubs [academics-based] vs getting uber-efficient at reading and making cognizant efforts to make connections where you'd like to do pp]) and perhaps even residency location/choice of program.

I do have an interest in research and the academic environment (less the political BS) that I do believe is genuine and beyond the med student jitters stage. However, what really made an impression on me was, I believe one of the medscape surveys that said academics made $160K vs pp rads made $320K. I know those surveys are flawed, reimbursements will fall, there are no jobs in radiology except for part-time telerads on the moon, etc -- however, investigating rads salaries in my med school's area show even a more dramatic gap with pp>>academics. I'm not all about the money, but if you train for so long and know that your downtown, non-ivory tower colleague is making twice as much as you, I could see where that could be perceived as frustrating as one gets to be an old geezer nearing retirement. Furthermore, if the gap remains and pp does make twice as much as an academic -- the pp could literally pay a PhD's or academic MD's salary to do research for them. Not that simple and wouldn't ever happen, I know, but my overall point is to express my perception of the whole situation.

Anyone have any thoughts on choosing academics as a career and finding self-satisfaction?

Any others on pp perspective?

 

[colbgw02]

Very few residents get "uber-efficient" at reading studies. In a year, even highly motivated residents read about a quarter of what a busy private practice radiologist can expect to read. For the overwhelming majority, efficiency doesn't develop until fellowship, but mostly early on as an attending.

You have a rude awakening ahead of you if you think there is less political BS in academic radiology. It's the polar opposite. That's not to say private practice is immune from these issues, particularly large practices, but academic radiology departments are quite notorious for their office politics.

Research aside, remember that when someone chooses academics or private practice, they're probably factoring in their career's longevity as well. That is, the PP radiologist may be making 2X as compared to the academic rad, but if the PP guy gets burned out and retires after 15 years, while the academic guy practices until he's 70 with a nice pension to go with retirement, who is really coming out ahead?

This is true among private practices as well. One group may offer you 5X, but you'll work for it. Then another offers you 3.5X, but it's a 'lifestyle' group. Which would you choose? You may have heard the statistic about the ridiculously high percentage of new radiologists that don't stick with their first job. Well, part of that is because many people chase the money early on, only to get into a bad situation, and eventually realize it's not worth it. To me, it's better to take an Aristotelian perspective and chase happiness. If that happens to mean making as much money as you can, then so be it.

 

[Baller MD]

Very few residents get "uber-efficient" at reading studies. In a year, even highly motivated residents read about a quarter of what a busy private practice radiologist can expect to read. For the overwhelming majority, efficiency doesn't develop until fellowship, but mostly early on as an attending.

You have a rude awakening ahead of you if you think there is less political BS in academic radiology. It's the polar opposite. That's not to say private practice is immune from these issues, particularly large practices, but academic radiology departments are quite notorious for their office politics.

Research aside, remember that when someone chooses academics or private practice, they're probably factoring in their career's longevity as well. That is, the PP radiologist may be making 2X as compared to the academic rad, but if the PP guy gets burned out and retires after 15 years, while the academic guy practices until he's 70 with a nice pension to go with retirement, who is really coming out ahead?

This is true among private practices as well. One group may offer you 5X, but you'll work for it. Then another offers you 3.5X, but it's a 'lifestyle' group. Which would you choose? You may have heard the statistic about the ridiculously high percentage of new radiologists that don't stick with their first job. Well, part of that is because many people chase the money early on, only to get into a bad situation, and eventually realize it's not worth it. To me, it's better to take an Aristotelian perspective and chase happiness. If that happens to mean making as much money as you can, then so be it.

Now that the radiology job market is bad, what is your perspective on government (e.g. VA) jobs? My impression is that you don't get paid as much but does the better hours (?) and pension make it a worthwhile route to pursue?

 

[colbgw02]

Regarding the VA, it's difficult to speak in generalities, as there is tremendous variance in the quality of these jobs. Some VAs are associated with high-quality university programs, so you are - for all intents and purposes - a faculty member. Then there are VAs that are so horribly run and in undesirable locations that it requires one to live in a state of quasi-dissociative fugue just to make it through the day. That can be difficult to do, especially considering it could take you up to 30 years to get your pension.

The production expectations at a VA are undoubtedly lower, and it's virtually impossible to fire someone after making it through the 1-year probationary period, so job security is about as good as it gets. That said, there's a stigma attached to working at a VA, so you may find it more difficult to switch to private practice if you ever decide to leave.

The only other major federal player in radiology is the military, and most of those positions are for independent contractors as opposed to employed positions. The production requirements and bureaucracy headaches are similar to the VA. The pay tends to be better, but the trade-off is that job security is virtually nonexistent. That's not to say that government contract radiologists are routinely let go, just that they could be.

With respect to the pension, I think that's an undervalued part of the equation. The conventional wisdom is that it takes $1MM in the bank to generate $40K per annum in perpetuity for retirement without touching the principle. So, just to use easy numbers, a $100K/yr. government pension is worth about $2.5MM. So, again using easy numbers, the private practice radiologist making $500K/yr. would have to save EVERY SINGLE PRE-TAX DOLLAR more that he's making than the $250K/yr. VA radiologist for a decade in order to match the value of the pension. Given how progressive tax brackets work and the tendency of people to adjust their lifestyle to their income, that's extremely difficult to do. Obviously, it's more complicated than that, because the PP radiologist doesn't have to save the full $2.5MM assuming his investments will grow. But on the other side, that pension is pegged to inflation and backed by the full faith and credit of the U.S. government, so that $100K at age 65 could be $130K by age 85.

 

[shark2000]

Regarding the VA, it's difficult to speak in generalities, as there is tremendous variance in the quality of these jobs. Some VAs are associated with high-quality university programs, so you are - for all intents and purposes - a faculty member. Then there are VAs that are so horribly run and in undesirable locations that it requires one to live in a state of quasi-dissociative fugue just to make it through the day. That can be difficult to do, especially considering it could take you up to 30 years to get your pension.

The production expectations at a VA are undoubtedly lower, and it's virtually impossible to fire someone after making it through the 1-year probationary period, so job security is about as good as it gets. That said, there's a stigma attached to working at a VA, so you may find it more difficult to switch to private practice if you ever decide to leave.

The only other major federal player in radiology is the military, and most of those positions are for independent contractors as opposed to employed positions. The production requirements and bureaucracy headaches are similar to the VA. The pay tends to be better, but the trade-off is that job security is virtually nonexistent. That's not to say that government contract radiologists are routinely let go, just that they could be.

With respect to the pension, I think that's an undervalued part of the equation. The conventional wisdom is that it takes $1MM in the bank to generate $40K per annum in perpetuity for retirement without touching the principle. So, just to use easy numbers, a $100K/yr. government pension is worth about $2.5MM. So, again using easy numbers, the private practice radiologist making $500K/yr. would have to save EVERY SINGLE PRE-TAX DOLLAR more that he's making than the $250K/yr. VA radiologist for a decade in order to match the value of the pension. Given how progressive tax brackets work and the tendency of people to adjust their lifestyle to their income, that's extremely difficult to do. Obviously, it's more complicated than that, because the PP radiologist doesn't have to save the full $2.5MM assuming his investments will grow. But on the other side, that pension is pegged to inflation and backed by the full faith and credit of the U.S. government, so that $100K at age 65 could be $130K by age 85.

Very good points. Do you work in pp or academics?

I work in one of the so call super-busy pp groups in a desirable area. Choosing pp was a combination of everything for me. When I got my job I was super-excited about the salary and the practice setting. Now, if my group agrees to pay me 20-25% less for 20% less work, I accept it in a heartbeat. Without mentioning numbers, 20% less than my current salary is more than many doctors and it is still a good money, but my quality of life will be much better. After 15 years of education and low salary/no income, a high salary looks very sexy, but after a year or two other factors become more important. I can not imaging working with the same pace the rest of my career. I will burn out big time in 10-15 years.

Also pension is very important as mentioned above. I have a few colleagues who are in their 60s and they don't have enough savings. You may think there is something wrong with them. But no. It is the human nature. At the age of 35 or 40, very very few people are willing to buy a Toyota rather than a BMW or are willing to choose a cheaper vacation in order to save for their 70s and 80s. To my experience, the best retirement package belong to the people who have worked in a job with a pension package. No matter how much you make, most people don't have the insight to save enough.

VA jobs can be good or bad. Generally speaking, it is a more relaxed easier job with less volume. A lot of them have residents rotating. Most are not level one trauma. Very few are very top academically. For example, Resnick is at VA San Diego.

 

[JoshSt]

Very few residents get "uber-efficient" at reading studies. In a year, even highly motivated residents read about a quarter of what a busy private practice radiologist can expect to read. For the overwhelming majority, efficiency doesn't develop until fellowship, but mostly early on as an attending.

You have a rude awakening ahead of you if you think there is less political BS in academic radiology. It's the polar opposite. That's not to say private practice is immune from these issues, particularly large practices, but academic radiology departments are quite notorious for their office politics.

Research aside, remember that when someone chooses academics or private practice, they're probably factoring in their career's longevity as well. That is, the PP radiologist may be making 2X as compared to the academic rad, but if the PP guy gets burned out and retires after 15 years, while the academic guy practices until he's 70 with a nice pension to go with retirement, who is really coming out ahead?

This is true among private practices as well. One group may offer you 5X, but you'll work for it. Then another offers you 3.5X, but it's a 'lifestyle' group. Which would you choose? You may have heard the statistic about the ridiculously high percentage of new radiologists that don't stick with their first job. Well, part of that is because many people chase the money early on, only to get into a bad situation, and eventually realize it's not worth it. To me, it's better to take an Aristotelian perspective and chase happiness. If that happens to mean making as much money as you can, then so be it.

Thanks for the continuing insights. Y'all are definitely making academics look alot better from my perspective. It may have been miscommunicated from my post, but I definitely realize academics rads do have super-duper political BS, which is my main deterrent for academics in general.

For VA -- from the VA we rotate at, I can't imagine anything good associated with a VA, but I'll have different experiences if the residency program I go to is associated with one. So many government-ty rules in that place. Nice physicians, like the patients, but my oh my they will arrest you if you google something or use a jump drive.

Edit: That being said, I do remember that the rads that worked at that VA were all from top-tier residency programs (p53 top 10's/top 20's; out of proportion compared to where other physicians there trained) and we're in a not too desirable location associated with a mid to lower tier med school. Must be something attractive to rads about the VA