So I am a rising MS4. Because of scheduling conflicts, my school wasn't able to let me rotate in my specialty of interest (IR) till the second rotation of MS4. From the glimpses I've seen from shadowing at a non-academic center in the community thus far, I was always very interested in it. However, the rotation with the residency program was probably of the hardest for me in terms of lifestyle, even harder than general surgery. Residents often had cases added on late, so I would find myself getting to the hospital at 5:30a and leaving close to 7p. Unlike surgery, there was hardly any breaks during the day nor significant time to read up on the cases, nor did I know when I was coming home. I was fascinated with the procedures themselves for what its worth, and would be gung ho if it weren't for the hours. Now with ERAS deadline approaching, I have no idea what I want anymore specialty wise. I like DR, but also want to have hands-on skills for various reasons. Basically I want to do procedures with good lifestyle. I was researching some more variations in the practice of IR, and it appears the 50% DR/50% IR job would have been perfect for me, but some says those jobs are disappearing. Could this just been the residency program itself? I felt like a lot of this was artificial to try and get a surgical lifestyle out of IR. At other institutions, residents would have an academic half-day for lectures, but with this institution, they had an hour lecture every single morning, which pushed things back
Second thoughts regarding interventional radiology
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At least from my experience, surgery had a set schedule with maybe one additional case, and depending on when it would occur it could be the responsibility of the night team.
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Well why just not do DR, and then choose a different sub specialty ? Breast has procedures, for example .
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ok , well what else do you want to do? You have to apply somewhere.
Surgery?
Surgical subspecialties?
OB/GYN?
Urology?
Anesthesia?
IM?
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"Procedures with a good lifestyle" means outpatient elective procedures with rare if any inpatient or emergency cases, and minimal post-op admissions you need to round on. That means small procedures on conditions that have low morbidity/mortality. The main ones are ophthalmology and dermatology. Some subspecialties have good lifestyle but the residency training is not good for lifestyle. For instance: general surgery to breast surgery; otolaryngology to rhinology, otology, or facial plastic surgery; anesthesiology to interventional pain. If only MDs could do dentistry or podiatry, those would also fall in this category.
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DR has a ton of procedures. On my rotations, I followed my residents/attendings around doing endless biopsies, lumbar punctures, drain placements, etc. May be location dependent, but especially if you decide to work in a non-teaching hospital and don't have residents or fellows, you're going to be doing a ton of them. I'd say we often did 5+ procedures/day in the DR rotation I did that was preceptor-based. Some days way more, some day less.
And IR is also going to vary a lot from location to location as far as what you do and what your day to day job is like. Just finished a teaching DR away at a place with IR and now I'm doing a teaching IR away - the IR could not be more different between these facilities. First facility has two integrated + two independent students per year, so there are eight dedicated IR residents/fellows at any given time... so they each do call one day. So call is one day every eight days. Where I'm rotating now, the residents are on call for a FULL WEEK STRAIGHT... and they still have to come in every day. The guy I was working with last week (who is a DR rotating in IR for what it's worth) said he hadn't slept more than three hours in a row all week. No thanks, no way. Would have taken the place off my app list for that alone, except...
The DR place was also more advanced IR while this IR rotation is more IR-light. We've done a ton of biopsies/drains/whatever in IR that I had done in DR the previous month. I've see a grand total of *one* procedure that I'd consider a "true IR" procedure that DR could not do all week long. I saw more "true IR" procedures in one day popping up to IR on my DR rotation than I've seen here all week long. Tremendously disappointing/disheartening and I'm currently not planning to apply to this program for IR at all. I don't want to be stuck doing mostly paracentesis and biopsies that DR residents are more than capable of doing when I'm in my IR years. I would actually like to do more things that only IR does so I know how to do them when I get out.
So basically I'm just getting at the fact that what procedures they commonly do in IR, what the schedule is like, etc. seems to have almost zero standardization from facility to facility. See who you can talk to at another program to make sure it's not just your program.
And IR is also going to vary a lot from location to location as far as what you do and what your day to day job is like. Just finished a teaching DR away at a place with IR and now I'm doing a teaching IR away - the IR could not be more different between these facilities. First facility has two integrated + two independent students per year, so there are eight dedicated IR residents/fellows at any given time... so they each do call one day. So call is one day every eight days. Where I'm rotating now, the residents are on call for a FULL WEEK STRAIGHT... and they still have to come in every day. The guy I was working with last week (who is a DR rotating in IR for what it's worth) said he hadn't slept more than three hours in a row all week. No thanks, no way. Would have taken the place off my app list for that alone, except...
The DR place was also more advanced IR while this IR rotation is more IR-light. We've done a ton of biopsies/drains/whatever in IR that I had done in DR the previous month. I've see a grand total of *one* procedure that I'd consider a "true IR" procedure that DR could not do all week long. I saw more "true IR" procedures in one day popping up to IR on my DR rotation than I've seen here all week long. Tremendously disappointing/disheartening and I'm currently not planning to apply to this program for IR at all. I don't want to be stuck doing mostly paracentesis and biopsies that DR residents are more than capable of doing when I'm in my IR years. I would actually like to do more things that only IR does so I know how to do them when I get out.
So basically I'm just getting at the fact that what procedures they commonly do in IR, what the schedule is like, etc. seems to have almost zero standardization from facility to facility. See who you can talk to at another program to make sure it's not just your program.
Meh, in my experience there is plenty of downtime on surgery purely due to delays in the OR room turnover. Plus any problems with the patients themselves can be diverted to the
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You probably need to differentiate between lifestyle as a resident and after you’re done with training. These can be really different, and job dependent, in a field like IR.
Can you provide some examples of the potential differences?
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In residency you will most likely be working in an academic tertiary care center that gets a high number of emergency cases. You will work up to 80 hours a week and have little control over your schedule.
The other places you observed were non-academic community so the pace is likely to be a bit slower. I work at a community hospital and the IR guys are great but do not necessarily do all the same kinds of cases that are done at the affiliated tertiary care center. They do still take call and handle emergencies, but not in the same acuity or pace as at a tertiary care center.
It sounds as if you may want to end up working in private practice/community practice when you are done if you found the academic environment distasteful in terms of lifestyle. But your goal in training will be to get as much experience as possible so it is good to work at a busy tertiary care center that gets tough cases.
But this should be something you discuss with IR residents and attendings. It seems as if you have not done a lot of research into the field you initially chose. I understand the scheduling issues you experienced with your rotation but did you not seek out mentors and conversations about the different options available after training?
The other places you observed were non-academic community so the pace is likely to be a bit slower. I work at a community hospital and the IR guys are great but do not necessarily do all the same kinds of cases that are done at the affiliated tertiary care center. They do still take call and handle emergencies, but not in the same acuity or pace as at a tertiary care center.
It sounds as if you may want to end up working in private practice/community practice when you are done if you found the academic environment distasteful in terms of lifestyle. But your goal in training will be to get as much experience as possible so it is good to work at a busy tertiary care center that gets tough cases.
But this should be something you discuss with IR residents and attendings. It seems as if you have not done a lot of research into the field you initially chose. I understand the scheduling issues you experienced with your rotation but did you not seek out mentors and conversations about the different options available after training?
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I did and I learned about all the different lifestyles. I was originally a lot of more content with what they did at the community hospital or as outpatient. But it just seems like the culture with the people I interact with now at my primary home hospital is surgical lifestyle or bust which is making me second guess myself. A resident and attending told me at the end of the rotation if you don't like it here, you won't like it anywhere else because this will be your life
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So did you talk to the people at the community rotation?
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Also @LeLoLa21, you know there is an entire IR forum right? It is against TOS to duplicate threads but I imagine if you ask nicely one of the mods could move this thread there. You might get a lot more help from people who are, you know, actually in the field of IR.
Very few people thereAlso @LeLoLa21, you know there is an entire IR forum right? It is against TOS to duplicate threads but I imagine if you ask nicely one of the mods could move this thread there. You might get a lot more help from people who are, you know, actually in the field of IR.
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Back in the day, I was gearing up for a neurosurgery residency and the peds NS I was interning with and his wife convinced me to do a month sub internship with her doing neuro IR in a busy NYC hospital. Back in the day of non-digital cut film. It was intense and awesome and I matched in DR and planned to go into IR. I ended up loving DR and IR light, specifically joint and spine injections, biopsies and drainages. Non-emergent procedures generally. 20 years later I work in rural private practice, still do 10-20 procedures a week, mostly pain management injections and work from home reading cases. Excellent lifestyle, grateful patients getting off their opioids, and a decent living. I'm not sure the jobs are disappearing. I am having trouble recruiting. It seems like most radiology residents are sub-specializing, going into nighthawk jobs or want to work in big cities. If you are willing to get out of major centers, the jobs like mine are still there. A DR that will do everything including mammo, biopsies, and joint injections is a huge plus to a rural hospital.
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MSK is in general pretty procedure heavy, might want to check that out.
At my school our IR department was much like you described. For us I believe it was because we had outgrown our capacity. We recently got a whole new IR suite and I think things are now better managed. More and more procedures are getting tossed under IRs belt. They are the choke point in a lot of care delivery so sometimes things are going to be balls to the wall.
As already mentioned what you described is kind of just the life of a resident (and attending sometimes too) at an academic center. I followed an IR doc in a private hospital in town and the pace was way different. Like 1 procedure an hour, reading cases on the side, and 10:30 lunch in the physicians lounge that was like restaurant quality.
If you love radiology but are uncertain about IR I'd say go ahead and apply DR. Can always do the fellowship or do the integrated program if your residency program offers it.
At my school our IR department was much like you described. For us I believe it was because we had outgrown our capacity. We recently got a whole new IR suite and I think things are now better managed. More and more procedures are getting tossed under IRs belt. They are the choke point in a lot of care delivery so sometimes things are going to be balls to the wall.
As already mentioned what you described is kind of just the life of a resident (and attending sometimes too) at an academic center. I followed an IR doc in a private hospital in town and the pace was way different. Like 1 procedure an hour, reading cases on the side, and 10:30 lunch in the physicians lounge that was like restaurant quality.
If you love radiology but are uncertain about IR I'd say go ahead and apply DR. Can always do the fellowship or do the integrated program if your residency program offers it.
