specialty choice thread: IM vs rads

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Wow. This thread hits hard. Considering radiology vs IM as well. Due to COVID haven’t had a chance to do a radiology rotation but on IM rotation I loved looking at pictures and made me consider the field.

I still have no idea what I want and I’m about to end MS3. Thought it was cards but I saw the lifestyle. Loved my cardio electives albeit.

another thing is I’m probably not a competitive candidate for DR. 233 step 1, canadian citizen attending USDO.

so many questions .....
I wouldnt count yourself out. DR has a high step IQR, but it's because it naturally draws high scorers for whatever reason, not because of competitive pressure. US DO seniors with step scores in the 220s still match >90% of the time.

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That does seem like the reason integrated IR is highly competitive while fellowship DR-->IR isnt: a senior rads resident is a lot less likely to be enamored with the proceduralist lifestyle, compared to an MS3.
Sounds about right. Also explains the crazy attrition in surgery. Young docs just don't know any better.
 
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Sounds about right. Also explains the crazy attrition in surgery. Young docs just don't know any better.

That, and they realize they can satisfy their procedure fetish through other radiology subspecialties. I thought I was going to go into IR, but chose body imaging instead because they could do biopsies, drains and tumor ablations, etc. without the more hardcore lifestyle. We just don't do the advanced vascular stuff.
 
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I like that stuff. I actually like the really nerdy stuff in internal medicine. I will talk someone's head off about mixed acid-base disorders, strong ion difference, Frank-Starling curves, how to properly auscultate the heart or how to work up hypophosphatemia.

But I hate doing the IM busywork of charting, which I am now living through as a redeployed COVID doc. Can't wait to be back in radiology.
was this your reaction?
 
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Maybe consider the worst aspects of each specialty ?
IM
Getting dumped on from ER and other services .
Dealing with social issues for dispo.
Trending lab values and claiming they have an impact on outcomes even when they are within the margin of error for the lab.
Being a generalist and not the expert on many pathologies.
lower end of the pay spectrum.


DR
Dark room
Grinding images
Reading unnecessary tests , or wrong tests for the question.
No gratefulness from patients.
liability
This is exactly how I approached it.

As a minor aside: is reading unnecessary/wrong tests always a bad thing? I guess for the patient it is

“Why yes, primary team, I’d love to read that totally normal spine MRI and rake in some sweet, sweet RVU’s”
 
was this your reaction?


Nah, I actually volunteered to go back to IM if my hospital needed any extra manpower. My fellow IM folks were apparently ecstatic I was coming back.

But after 2 weeks of wrestling with the EMR, having trouble sending prescriptions to pharmacies, getting countless errors when trying to complete discharge summaries for patients (going home, not to the grave), and getting ulcerations on my skin for wearing PPE for too long, I think I need a break.
 
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This is exactly how I approached it.

As a minor aside: is reading unnecessary/wrong tests always a bad thing? I guess for the patient it is

“Why yes, primary team, I’d love to read that totally normal spine MRI and rake in some sweet, sweet RVU’s”
to me it would be, if I am actively participating and enabling bad behavior and profiting from it , all the while causing unnecessary financial harm to patients. Things like that would grind on my soul.
 
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BTW, the biggest mistake I made as a med student was not pursuing derm based on the fact that I, too, found the rotation boring. It is, but derm is a business. Looking back, the attending I shadowed would walk into a room and basically start the exam immediately as the patient talked, then cut in after one minute, state the diagnosis and treatment matter-of-factly, "ask" (but not really) the patient whether (s)he had any questions, then walk out the door and tell the scribe what to write.

If you can swing derm, do derm. Secret: 97%of people in the field know just as well as you do that it's boring. They've just figured out the game of life earlier than most other med students.
This had been a nagging concern of mine in the back of my head about Derm. Spending an entire month immersed in derm clinic put that to bed for me. Not only do I find it boring, I find it disgusting, and most of the residents were a very different personality type (like 75% ladies who put a lot of effort into their appearance and talk a lot about dating TV shows). It sounds great to have no weekend call shifts, but I could only spend a short while looking at moles, infected crevices, and freezing off warts before I lost my mind.
 
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This had been a nagging concern of mine in the back of my head about Derm. Spending an entire month immersed in derm clinic put that to bed for me. Not only do I find it boring, I find it disgusting, and most of the residents were a very different personality type (like 75% ladies who put a lot of effort into their appearance and talk a lot about dating TV shows). It sounds great to have no weekend call shifts, but I could only spend a short while looking at moles, infected crevices, and freezing off warts before I lost my mind.
What about derm -> Mohs or derm path? Could help make things more interesting than just moles, infected crevices, and freezing off warts.
 
What about derm -> Mohs or derm path? Could help make things more interesting than just moles, infected crevices, and freezing off warts.
I did shadow Mohs and didnt find it very stimulating. Plus that still means a Derm residency, very competitive fellowship match, and a lot of Mohs people do partly general derm clinic too because it's hard to book full weeks of only Mohs patients.
 
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You should be honest with yourself. You should pursue a field that you truly enjoy doing. You said that seeing radiologists in the dark room was depressing for you. I can tell you that this feeling won't go away. If you enter the dark room you will be depressed and feel FOMO of clinical medicine. You should only pursue Radiology if you really truly enjoy reading images all day, are fascinated by imaging technology, you don't mind studying complex physics for the board exam, and don't enjoy constant patient interaction.

You should ask yourself why you went into medicine in the first place. Is it because you saw yourself as a "doctor" - physically taking care of patients everyday? Or are you more interested in physics, engineering, computers, and cutting edge technology, while putting traditional clinical medicine on the back burner?

IM is a very versatile field with many different options to pursue. The social work aspect can be tedious, but if you have good support staff, it isn't very difficult.
 
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Wow. This thread hits hard. Considering radiology vs IM as well. Due to COVID haven’t had a chance to do a radiology rotation but on IM rotation I loved looking at pictures and made me consider the field.

I still have no idea what I want and I’m about to end MS3. Thought it was cards but I saw the lifestyle. Loved my cardio electives albeit.

another thing is I’m probably not a competitive candidate for DR. 233 step 1, canadian citizen attending USDO.

so many questions .....
Be careful making a judgement call on "lifestyle" from 1 or 2 experiences. Lifestyle varies greatly depending on your practice set up and group size (academic vs private), how much call you take, how many patients you see, and geographic location. What I'm trying to say is that, as an attending you are as busy as you want to be (the more you work, the more you earn).
 
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Maybe consider the worst aspects of each specialty ?
IM
Getting dumped on from ER and other services .
Dealing with social issues for dispo.
Trending lab values and claiming they have an impact on outcomes even when they are within the margin of error for the lab.
Being a generalist and not the expert on many pathologies.
lower end of the pay spectrum.


DR
Dark room
Grinding images
Reading unnecessary tests , or wrong tests for the question.
No gratefulness from patients.
liability

I think you missed the biggest downside to DR.
All the technological advancement have increased the efficiency of radiologists . . . Aka they will need to do more for less money. I don’t think AI will leave them out of a job, but they will have to do more.

I know I’m an internists, but calling DR a diagnostician is silly. I have a lot of respect for radiologists, but they never have the patient. Shoot, they called a DVD on a plain CT scan of an abd/pelvis recently. I could never have done that. I look at most of my images. I enjoy it, but I think I‘d crazy if I had to do that for 8 hours a day and have only minimal interaction with people. If I had to write the same bull**** read on a CXR that probably didn’t need to be ordered in the first place. . . . No thanks.

Our IR guys are excellent physicians (of course they are refusing to see COVID patients right now so I’m kinda miffed) but they aren’t exactly a lifestyle speciality. Surgery teams dump their messes onto IR because they don’t want to mess with it, too.
 
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I think you missed the biggest downside to DR.
All the technological advancement have increased the efficiency of radiologists . . . Aka they will need to do more for less money. I don’t think AI will leave them out of a job, but they will have to do more.

I know I’m an internists, but calling DR a diagnostician is silly. I have a lot of respect for radiologists, but they never have the patient. Shoot, they called a DVD on a plain CT scan of an abd/pelvis recently. I could never have done that. I look at most of my images. I enjoy it, but I think I‘d crazy if I had to do that for 8 hours a day and have only minimal interaction with people. If I had to write the same bull**** read on a CXR that probably didn’t need to be ordered in the first place. . . . No thanks.

Our IR guys are excellent physicians (of course they are refusing to see COVID patients right now so I’m kinda miffed) but they aren’t exactly a lifestyle speciality. Surgery teams dump their messes onto IR because they don’t want to mess with it, too.
Not sure why calling DR diagnostician is silly...
 
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It would be so interesting to see how integrated GI/cards would fare in competitiveness compared to the surgical subs.
They will definitely be up there in term of competitiveness with the surgical subs.
 
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You guys idk about referring to interventional radiologists as interventional. They never do real surgery.
 
You guys idk about referring to interventional radiologists as interventional. They never do real surgery.

You could make the same argument for interventional cardiologists, then. I think "interventional" is just a general term for non-surgeon proceduralists.
 
You could make the same argument for interventional cardiologists, then. I think "interventional" is just a general term for non-surgeon proceduralists.
Joking about how the above poster says diagnostic radiologists dont diagnose
 
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Joking about how the above poster says diagnostic radiologists dont diagnose

I also think that his statement goes to show that if you need to be looked at as a god and aren't able to do work behind the scenes without getting much credit, rads might not be right for you
 
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Wow. This thread hits hard. Considering radiology vs IM as well. Due to COVID haven’t had a chance to do a radiology rotation but on IM rotation I loved looking at pictures and made me consider the field.

I still have no idea what I want and I’m about to end MS3. Thought it was cards but I saw the lifestyle. Loved my cardio electives albeit.

another thing is I’m probably not a competitive candidate for DR. 233 step 1, canadian citizen attending USDO.

so many questions .....

We had university rads matches this year in the 230s. Apply broadly and I think you’re chances are very solid personally. You’ll likely match DR or IM. Now which one you end up wanting I don’t know, but your scores shouldn’t give you pause on either.
 
We had university rads matches this year in the 230s. Apply broadly and I think you’re chances are very solid personally. You’ll likely match DR or IM. Now which one you end up wanting I don’t know, but your scores shouldn’t give you pause on either.

Serious question. Can I play to DR and IM at the same university? Or is this a bad idea...
 
Serious question. Can I play to DR and IM at the same university? Or is this a bad idea...
Yes, but you have to make sure your LOR are worded appropriately (either different letters or more vague wording like "will be a great resident" not "will be a great internist / radiologist" ) and you have to have a separate personal statement. If you do that, no will know at the application stage. However, if you interview for both programs at the same university they might find out. There is some cross talk between radiology dept and IM dept because of coordinating prelim interviews and spots so you can't apply to prelim medicine at a program where you also apply categorical medicine as that will tip your hand as a dual applicant. Suffice it to say it's a pain to dual apply. Much better to pick one specialty if you can.
 
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Yes, but you have to make sure your LOR are worded appropriately (either different letters or more vague wording like "will be a great resident" not "will be a great internist / radiologist" ) and you have to have a separate personal statement. If you do that, no will know at the application stage. However, if you interview for both programs at the same university they might find out. There is some cross talk between radiology dept and IM dept because of coordinating prelim interviews and spots so you can't apply to prelim medicine at a program where you also apply categorical medicine as that will tip your hand as a dual applicant. Suffice it to say it's a pain to dual apply. Much better to pick one specialty if you can.
Thanks for the great reply. Man this is hard. Have a late interest in rads but had my first rotation in fourth year postponed due to COVID. Now looking for another July Rads audition. No idea what my letters say. Might have to ask.
 
Is everyone on this site agoraphobic? Sitting in a dark room with a bunch of people dictating their findings out loud is my version of hell. Give me a patient on the wards any day over that.
 
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Is everyone on this site agoraphobic? Sitting in a dark room with a bunch of people dictating their findings out loud is my version of hell. Give me a patient on the wards any day over that.
i mean if you enjoy the subject matter, they have a much better gig than us in IM. comparable salaries to Gi, cards. pretty easy to get it. relaxed lifestyle.
if they were paid/job market was like path then probably wouldn't be as popular but right now good gig
 
Is everyone on this site agoraphobic? Sitting in a dark room with a bunch of people dictating their findings out loud is my version of hell. Give me a patient on the wards any day over that.
And by patients on the wards, you mean sitting in front of a screen all day charting in the workroom?

Room is brighter, I guess, but they take 50% off your pay for that.
 
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Yup...this is valid reason for sure. If your goal is to just coast in residency, not compete with anyone, then rads is better suited for you.

You can't coast into being a good radiologist. Radiology is very broad and residency requires a significant amount of studying compared to other specialties.

The radiology workday might be 8 AM - 5 PM, but it is mentally exhausting work. If you read images on cruise control, you will miss findings, some which may be important. Radiology requires constant/intense visual and mental focus. Call is very busy and volumes are usually high. I was more fatigued post-radiology call than almost every call shift in my internal medicine year.

That said, I enjoy radiology. I chose it over internal medicine and I have no regrets. I love the subject matter of internal medicine, but was not a fan of the social work, documentation, rounding, mental masturbation, endless clinic and sometimes difficult/non-adherent patients. I figured it would get routine and boring quickly. I also do not need patient interaction to feel good about my work.

Radiologists do make imaging diagnosis. The problem these days is that imaging is abused/over-utilized, especially for pathologies that can be diagnosed clinically. For example, a patient has no fever, no flank pain, normal BMP and a normal urinalysis, why request a CT abdomen or renal ultrasound to rule out pyelonephritis which is itself a clinical diagnosis? Why request a CT angiogram runoff of the lower extremities because of pain with walking when an ABI or PVR has not been performed, and instead the patient's complaints are due to knee osteoarthritis? This tends to be more of an issue with NPs and PAs, but it is getting worse amongst our MD/DO colleagues.
 
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You can't coast into being a good radiologist. Radiology is very broad and residency requires a significant amount of studying compared to other specialties.

The radiology workday might be 8 AM - 5 PM, but it is mentally exhausting work. If you read images on cruise control, you will miss findings, some which may be important. Radiology requires constant/intense visual and mental focus. Call is very busy and volumes are usually high. I was more fatigued post-radiology call than almost every call shift in my internal medicine year.

That said, I enjoy radiology. I chose it over internal medicine and I have no regrets. I love the subject matter of internal medicine, but was not a fan of the social work, documentation, rounding, mental masturbation, endless clinic and sometimes difficult/non-adherent patients. I figured it would get routine and boring quickly. I also do not need patient interaction to feel good about my work.

Radiologists do make imaging diagnosis. The problem these days is that imaging is abused/over-utilized, especially for pathologies that can be diagnosed clinically. For example, a patient has no fever, no flank pain, normal BMP and a normal urinalysis, why request a CT abdomen or renal ultrasound to rule out pyelonephritis which is itself a clinical diagnosis? Why request a CT angiogram runoff of the lower extremities because of pain with walking when an ABI or PVR has not been performed, and instead the patient's complaints are due to knee osteoarthritis? This tends to be more of an issue with NPs and PAs, but it is getting worse amongst our MD/DO colleagues.

Probably should improve your reading skills.
That was said in the context of obtaining a GI/Cardiology fellowship during IM. Obtaining those fellowships require you to continue to be the best in your class, do a lot of research, network, present at many conferences and still be at risk of not getting in.
Not sure why this has to be pissing contest between radiology and IM, but I will contribute to it.
Honestly, radiology was the most boring field that I came across during my rotations. Half of the reads were to rule out PE that you guys spend a lot of time reading but really all of us glance for a second to see if our question is answered.
Would thousand times prefer opening a blocked artery (cards), scoping a bleeder (GI), managing a cirrhotic and liver transplant (hepatology), resuscitating someone on verge of dying (pulm-crit), saving a cancer patient (onc), and much more as an IM subspecialist. Each field has its own set of BS.
Oh I can also read most of my imaging I order in cards, so don't really need much radiology consultation for the field I am going into.
 
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Oh I can also read most of my imaging I order in cards, so don't really need much radiology consultation for the field I am going into.

Such a large portion of cardiology fellowship is spent doing diagnostic radiology that the workflow often has more in common with Rads than IM. Not sure why on one hand you would state that radiology is the most boring field and then in the same post brag about being able to read cardiac imaging in Cards when the process of looking at the image in a reading room and dictating a report is quite literally the same for both. Same thing could be said for IR vs. IC. They are very similar in the principles and techniques as well as day to day flow. In some ways Cards and DR/IR are sister fields.
 
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Such a large portion of cardiology fellowship is spent doing diagnostic radiology that the workflow often has more in common with Rads than IM. Not sure why on one hand you would state that radiology is the most boring field and then in the same post brag about being able to read cardiac imaging in Cards when the process of looking at the image in a reading room and dictating a report is quite literally the same for both. Same thing could be said for IR vs. IC. They are very similar in the principles and techniques as well as day to day flow. In some ways Cards and DR/IR are sister fields.

What I said above: "Not sure why this has to be pissing contest between radiology and IM, but I will contribute to it."

Don't have anything against DR, but if people want to piss on IM because they don't like the subject matter/lifestyle/workflow, I can think lot of pissing can be done on DR as well. Every field has its own set of BS. Pick a field that you like and stop putting down other fields because it didn't suit your personality.

Coming to your question, Reading echos 1-2 days a week is fine if I need to do it to practice other aspects of cardiology that I love. I also don't mind reading the echos that I order for my patients, I think they are an amazing piece of information to know how to interpret. I probably won't enjoy reading echos for everyone in the hospital, but I am okay with that.
Cardiology is much more similar to IM in every way except they interpret their imaging studies and don't need to consult DR. Cards is in no way a sister field to DR. Maybe IR and IC. I think IR is a great field.
 
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Probably should improve your reading skills.
That was said in the context of obtaining a GI/Cardiology fellowship during IM. Obtaining those fellowships require you to continue to be the best in your class, do a lot of research, network, present at many conferences and still be at risk of not getting in.
Not sure why this has to be pissing contest between radiology and IM, but I will contribute to it.
Honestly, radiology was the most boring field that I came across during my rotations. Half of the reads were to rule out PE that you guys spend a lot of time reading but really all of us glance for a second to see if our question is answered.
Would thousand times prefer opening a blocked artery (cards), scoping a bleeder (GI), managing a cirrhotic and liver transplant (hepatology), resuscitating someone on verge of dying (pulm-crit), saving a cancer patient (onc), and much more as an IM subspecialist. Each field has its own set of BS.
Oh I can also read most of my imaging I order in cards, so don't really need much radiology consultation for the field I am going into.

Some of my friends in other specialties think radiology is easy, or that we are usually just coasting in the reading room. You should have clarified what you meant by "coasting" in radiology residency. And don't be so sensitive. I have nothing against IM and its subspecialties or another field of medicine. Every field has its role in patient care and I do not believe that one field is superior or better than another. If you enjoy IM, then do it and ignore what others have to say. You also have the right to think radiology is the worst or most boring specialty, and that is ok. It is a personal decision.

To reading images--a cardiologist with an imaging fellowship in cardiac CT or MRI will generally be better than a general radiologist at cardiac imaging, but would (on average) be inferior to a fellowship-trained cardiovascular/thoracic radiologist when it comes to reading the image, one reason being that the cardiovascular radiologist can read the cardiovascular stuff as well as everything else in the field of view. Similar, a pancreatic surgeon will probably know pancreas imaging and anatomy better than your average general radiologist, but a body-trained radiologist would be just as good at the pancreas, if not better. The body radiologist will also be superior at everything else. Just because you can look for a pulmonary embolus or read cardiac anatomy doesn't mean you don't need a radiologist. You also don't have the training, so I believe you are vastly overrating your skill, even when it comes to reading a chest X-ray.

My experience is that referring teams usually want to have even a prelim read of a study (which includes PE studies) before making clinical decisions. I am at a so-called top 10 hospital where referring physicians routinely review most imaging they order. We have called to inform referrers (including cardiologists, oncologists, etc) of critical findings which they did not see or did not know how to interpret. I always encourage reading your own imaging as you should not need a radiologist to diagnose a saddle embolus or an aortic dissection, but we routinely pick up distal emboli and other important/critical findings which non-radiologists won't appreciate. That said, we miss stuff too, but a 1-2% miss rate (typical in radiology) in any other field would be considered excellent; but a radiologist's misses are documented and signed, which makes them look much worse.
 
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You should be honest with yourself. You should pursue a field that you truly enjoy doing. You said that seeing radiologists in the dark room was depressing for you. I can tell you that this feeling won't go away. If you enter the dark room you will be depressed and feel FOMO of clinical medicine. You should only pursue Radiology if you really truly enjoy reading images all day, are fascinated by imaging technology, you don't mind studying complex physics for the board exam, and don't enjoy constant patient interaction.

You should ask yourself why you went into medicine in the first place. Is it because you saw yourself as a "doctor" - physically taking care of patients everyday? Or are you more interested in physics, engineering, computers, and cutting edge technology, while putting traditional clinical medicine on the back burner?

IM is a very versatile field with many different options to pursue. The social work aspect can be tedious, but if you have good support staff, it isn't very difficult.
Agreed. I’m a first year radiology resident that struggled with this exact question and still feeling very out place in rads.
 
They are two very different fields. Do which one you love. 500K vs. 300K in medical schools seems like a lot but ultimately you should measure yourself by how good you are at serving your patients no matter what your field is and ultimately how you live your next 50-60 years in the field is worth more than $10-12 million (which isn't even given how taxes work).
 
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I know this is an old thread but wanted to comment as well. I similarly struggled with IM vs rads and ultimately chose IM. For me, it came down to IM having more non-clinical opportunities available down the line. I think the outlook for medicine's future is bleak, and even bleaker for services that don't own their own patients (rads, gas, path, just look at EM), as we increasingly accelerate into a corporate medicine hellscape. Being able to bail on clinical medicine and having the option to do consulting, pharma, becoming a trialist, or research is valuable to me, and I think those avenues are more available to IM trained docs because they're clinicians and rads trained docs are not.
 
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I know this is an old thread but wanted to comment as well. I similarly struggled with IM vs rads and ultimately chose IM. For me, it came down to IM having more non-clinical opportunities available down the line. I think the outlook for medicine's future is bleak, and even bleaker for services that don't own their own patients (rads, gas, path, just look at EM), as we increasingly accelerate into a corporate medicine hellscape. Being able to bail on clinical medicine and having the option to do consulting, pharma, becoming a trialist, or research is valuable to me, and I think those avenues are more available to IM trained docs because they're clinicians and rads trained docs are not.
This confuses me as someone still early on in this process, I'd love for you to expand on what you mean.. how much of this applies specifically to you, and what could be generalized to apply to others and the fields in general as they compare to one another?
 
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Is...is this true? Are people in non-medical fields who are 10 years into their careers just like, "ah f*ck it, my job is boring as $hit but at least I make good money"? I have a brother in tech who's mindset is this tbh, but I always thought he was an anomaly.

I mean, I see the appeal, but also seems like a bleak way to spend 50 hours/week. I guess if you're part time and have other hobbies then it wouldn't be as bad. But is that really what a career is supposed to be like?

There is a reason why Office Space was such a popular movie...
 
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I'm not going to lite--spending 3hrs in the radiology reading room wore me out far more than 13hrs in the ICU. The radiologist sent me home early, and I was so bored/tired I took a 2hr nap every day of my rads rotation.

That's when I learned I'm not the diagnostic rads type. I could see myself doing IR, but frankly I need more leisure time in my day. In inpatient PM&R I get plenty of patient interaction and plenty of chill time in my office, where I can catch up on the news or decide to chat with a coworker for a while. My understanding is that's hard to do in rads now since there are always so many studies piling up (there are always outpatient studies to read!).

But so many out there would be bored sick of inpatient rehab. The biggest threat to your happiness (and income ) is burnout, so chose something you enjoy!
 
This confuses me as someone still early on in this process, I'd love for you to expand on what you mean.. how much of this applies specifically to you, and what could be generalized to apply to others and the fields in general as they compare to one another?

I'm also a little confused about what you are asking. My point is that they more general you are, the more suited you are to pursue non-clinical endeavors. E.g., if I want to consult for healthcare related companies, I'm valued because I know how healthcare works because I'm there for admission, workup, dx, txt, discharge, and followup for the pt. Radiologists are only there for the dx portion, and only a slim portion of dx's in general. Or if I want to work for pharma, I can build my skillset to become more oriented to trials. Radiologists are never involved in treatment and rarely involved in trials, so their opportunities in pharma are limited. I guess overall, the more your role as a "technician," the less available outside opportunities are.

That's not to say its impossible for radiologists, as there will always be development of new contrast dyes, imaging modalities, etc. But its more limited.
 
I'm also a little confused about what you are asking. My point is that they more general you are, the more suited you are to pursue non-clinical endeavors. E.g., if I want to consult for healthcare related companies, I'm valued because I know how healthcare works because I'm there for admission, workup, dx, txt, discharge, and followup for the pt. Radiologists are only there for the dx portion, and only a slim portion of dx's in general. Or if I want to work for pharma, I can build my skillset to become more oriented to trials. Radiologists are never involved in treatment and rarely involved in trials, so their opportunities in pharma are limited. I guess overall, the more your role as a "technician," the less available outside opportunities are.

That's not to say its impossible for radiologists, as there will always be development of new contrast dyes, imaging modalities, etc. But its more limited.
How do you think pharma companies decide if an oncology treatment works? They scan people and radiologists tell them.
 
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So after having done both rotations and reading countless threads regarding both fields, I am at an impass.

Everywhere I look on sdn/reddit, people say anyone who chooses IM over rads is crazy due to better pay, lifestyle in rads.

However, I am still drawn to IM with the goal of doing PCP outpatient or a chill fellowship like rheum,endo or allergy.

I enjoy clinic with patients and enjoyed my IM rotation. However, as an M3 I am concerned that I didnt have full exposure to the cons of IM which are stated often here, so my perception may be skewed.

On my rads rotation, I thought the subject matter was fascinating and very interesting. However, after seeing the radiologists in the dark rooms all day, it was fairly deppresssing. My concern was that I would get burn out due to lack of patient interaction and no quantifiable effect of my work. It almost felt like doing a desk job which is at odds with why I was drawn to medicine.

My overall goal is to work reasonable hrs as an attending ( 3-4 days a week with minimal call) and I dont mind taking a paycut to achieve this. This seems more feasible in IM ( or fellowship) compared to rads ( rads seems more call heavy, but with much more vacation).

Part of me feels as if I am making the wrong choice if I choose IM over rads due to higher pay and interesting subject matter.

Given my goals, interests, which should I choose? Apologies if I misrepresented either specialty, just going off my experiences and what i've read online

Would love any input
Your first three sentences say it all: you personally are leaning toward IM but are caught up in both others' opinions and the idea of cash.

Sounds like IM is what would make you most happy.
 
I’m in GI…

There may be a time when you want a lack of patient interaction
 
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Yea I gotta say, if I had any doubts at all about missing patient interaction, my PGY-1 medicine year has dispelled them. May be dependent on setting since I'm in a rough city with a terrible average health literacy/adherence and tons of social needs. But I certainly understand now why 9/10 radiologists are happy with their field while 6/10 hospitalists are.
But 99/100 dermatologists are happy with their field and they deal with some crazy patients (jk I love rads but damn why does everyone love skin so much?)
 
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But 99/100 dermatologists are happy with their field and they deal with some crazy patients (jk I love rads but damn why does everyone love skin so much?)
It's funny when I went abroad in Scandinavia and talked to med students/doctors there everyone laughed about how Derm was not a very competitive training path at all for them. It's definitely the fact they make proceduralist money doing clinic, nobody likes skin that much when you take away those incentives
 
Yea I gotta say, if I had any doubts at all about missing patient interaction, my PGY-1 medicine year has dispelled them. May be dependent on setting since I'm in a rough city with a terrible average health literacy/adherence and tons of social needs. But I certainly understand now why 9/10 radiologists are happy with their field while 6/10 hospitalists are.
There’s no way to like this to infinity so I’m just quoting to say “ditto!”

The darkroom can’t get here fast enough. Get me away from these nut bars!
 
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