Switch into Radiology as an attending?

[insearchofwisdom]

Hello, I am currently an internal medicine subspecialist and have been an attending for 3.5 years. I am quite unfulfilled at my job, physically/mentally/emotionally worn out. I have been trying to pay close attention to what is making me feel this way because hard work is not something I have trouble with and have come to really identify it's patient interactions/expectations. If I'm honest with myself, in hindsight, I've been burned out since right after intern year and have not really enjoyed talking to patients. I thought residency and fellowship and being a new attending were "supposed to" feel like this but I'm realizing I think I'm ignoring a problem that's very real. I love talking to people but I can't stand person after person complaining 90% of the time and dealing with their entitlement/anger/depression/anxiety/noncompliance. It's exhausting and I'm not well-suited for it.

I have been contemplating a switch to radiology because I still love the medicine part of things and thrive on discovery/diagnosis/anatomy. I know that means a 4 year residency +?fellowship, a pay cut, and tremendous delay in actually working. I did shadow a radiologist recently and was amazed at how calming the work was. Not to say there isn't stress involved, but being able to provide clinical care without dealing with all the emotions was so freeing.

Do you think this is crazy? Has anyone ever heard of anyone else switching to radiology as an attending? Is this "grass is greener" syndrome? Please enlighten me on what I don't know about radiology.

Thank you.

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[SeisK]

You are not crazy. This is like the least crazy thing a potential applicant could say probably.

I love the science of medicine more than anything else. I also love talking to people, but the aspect of interpersonal interaction that I enjoy the most is 1) the pleasantness of the interaction and 2) the potential of developing a longlasting cordiality/friendship with the person I’m interacting with. I quickly found out that talking to patients often doesn’t satisfy 1, and never satisfies 2 (or does so only very weakly). The relationships you develop in radiology, however, are among you and other healthcare professionals you see much more often than you see patients in the outpatient care setting, and you also develop a strong relationship with your colleagues you see in the reading room.

I was burnt out with all of the secretarial nonsense of clinical medicine. I detest managing social work, trying to figure out ways to get the patient to understand their choices are bad ones, begging them to take care of themselves, and writing notes upon notes upon notes. I detest how many hours a day are tossed away over all of this BS, and how little actual medical science you end up doing. Radiology is fantastic because every f*cking day most all of your hours are spent problem solving what is going wrong with this patient by integrating imaging data, laboratory data, and historical data other people have gathered for you, and then coming to a conclusion. Radiology is medicine for those with the scientific mindset.

The downsides to radiology are: in private practice settings (where most people go post-graduation) your responsibility, first and foremost, is list clearing. You want a 600k salary? You better put in the work for it, and that means 8-12 hours a day you are busy all, of, the, time. It’s like taking Step 1 or 2 every day (without the pretest anxiety). Academics is a little more protected from this, but even they sometimes/often feel the crunch of list clearing—but that’s okay, because much of their day is spent teaching or on other obligations, so despite the lower salary, they are much less pressured (usually).

I’m so happy I chose this field. I was like you in medical school, burnt out, feeling hopeless about where I was going, and then radiology which I had shrugged off at the start of med school became more and more and more and more appealing. I can do anything I want: miss clinic? go into mamo. Miss the OR? Go into IR, NIR, body, or MSK. Want to make a **** ton of money in private practice? I can do that. Want a lifestyle specialty where I can do something different every day of the weak? Go into academics.

I can do research in the coolest stuff you’ll find in medicine: oncology, pathology, biomedical engineering, physics, computer science, mathematics. I’m still exploring what’s going on in the cutting edge of the applications of physical/quantitative sciences and I’m discovering something mind blowing and new like every week, and I CAME INTO this with a pretty hefty background already.

I’m happy for you for discovering this about yourself.

 

[insearchofwisdom]

Thank you for your thoughts and response. I’m going to ask you a few more questions:

1) did you practice direct patient care outside of med school or was your frustration with notes, etc only in med school? I’m always trying to figure out if people actually switch into radiology later in their path

2) if I’m honest, I’m non-stop now anyways so being non-stop at work is no different than what I’m already doing but at least I don’t have to “beg people to take care of themselves” as you put it (accurately) and handle all their emotions and I could get paid better! Also I actually really enjoy discussing cases so having contact with other physicians sounds pleasant to me.
However, my ideal would be 1 week on/1 week off which I know some radiologists are doing. It could give me a chance to use other parts of my brain on the off weeks (maybe entrepreneurial/volunteer/travel/startups/consulting/side gigs/advocacy). The combo of this sounds like an ideal to me and far more fulfilling. You think that’s feasible or am I being too idealistic?

3) you think I can secure a radiology spot or will this be tough? Do you have any clue if there’s any way to reduce the years if I’ve already been clinical for 14 years now (incl training and med school)?

4) is it ok if I send you some more messages as I proceed?

thanks in advance and I appreciate your help/insight.

 

[Lifeman]

You are not crazy. This is like the least crazy thing a potential applicant could say probably.

I love the science of medicine more than anything else. I also love talking to people, but the aspect of interpersonal interaction that I enjoy the most is 1) the pleasantness of the interaction and 2) the potential of developing a longlasting cordiality/friendship with the person I’m interacting with. I quickly found out that talking to patients often doesn’t satisfy 1, and never satisfies 2 (or does so only very weakly). The relationships you develop in radiology, however, are among you and other healthcare professionals you see much more often than you see patients in the outpatient care setting, and you also develop a strong relationship with your colleagues you see in the reading room.

I was burnt out with all of the secretarial nonsense of clinical medicine. I detest managing social work, trying to figure out ways to get the patient to understand their choices are bad ones, begging them to take care of themselves, and writing notes upon notes upon notes. I detest how many hours a day are tossed away over all of this BS, and how little actual medical science you end up doing. Radiology is fantastic because every f*cking day most all of your hours are spent problem solving what is going wrong with this patient by integrating imaging data, laboratory data, and historical data other people have gathered for you, and then coming to a conclusion. Radiology is medicine for those with the scientific mindset.

The downsides to radiology are: in private practice settings (where most people go post-graduation) your responsibility, first and foremost, is list clearing. You want a 600k salary? You better put in the work for it, and that means 8-12 hours a day you are busy all, of, the, time. It’s like taking Step 1 or 2 every day (without the pretest anxiety). Academics is a little more protected from this, but even they sometimes/often feel the crunch of list clearing—but that’s okay, because much of their day is spent teaching or on other obligations, so despite the lower salary, they are much less pressured (usually).

I’m so happy I chose this field. I was like you in medical school, burnt out, feeling hopeless about where I was going, and then radiology which I had shrugged off at the start of med school became more and more and more and more appealing. I can do anything I want: miss clinic? go into mamo. Miss the OR? Go into IR, NIR, body, or MSK. Want to make a **** ton of money in private practice? I can do that. Want a lifestyle specialty where I can do something different every day of the weak? Go into academics.

I can do research in the coolest stuff you’ll find in medicine: oncology, pathology, biomedical engineering, physics, computer science, mathematics. I’m still exploring what’s going on in the cutting edge of the applications of physical/quantitative sciences and I’m discovering something mind blowing and new like every week, and I CAME INTO this with a pretty hefty background already.

I’m happy for you for discovering this about yourself.

Don't mind me asking but are you a resident or attending?

 

[CherryRedDracul]

Not unheard of. Jeffrey Galvin, one of my chest radiology heroes, was a pulm/crit attending working in the ICU before he made the switch into radiology. He hasn't looked back.

 

[changeofheart2016]

Am I the only one that would argue against this switch? Being in radiology, you have no control over whats ordered. On call, youre sick of reading your 20th CT brain neck chest abdomen pelvis for "trauma"? Too bad, here's another one ordered by the ED for patient falling down from standing height. Here's another ct cap for cancer staging as a bonus.

At least as medicine attending you have control of your own patient and management.

Yes, you will make money, but at what cost?

 

[colbgw02]

Not unheard of. Jeffrey Galvin, one of my chest radiology heroes, was a pulm/crit attending working in the ICU before he made the switch into radiology. He hasn't looked back.

His lectures at AFIP were amazing.

 

[colbgw02]

Hello, I am currently an internal medicine subspecialist and have been an attending for 3.5 years. I am quite unfulfilled at my job, physically/mentally/emotionally worn out. I have been trying to pay close attention to what is making me feel this way because hard work is not something I have trouble with and have come to really identify it's patient interactions/expectations. If I'm honest with myself, in hindsight, I've been burned out since right after intern year and have not really enjoyed talking to patients. I thought residency and fellowship and being a new attending were "supposed to" feel like this but I'm realizing I think I'm ignoring a problem that's very real. I love talking to people but I can't stand person after person complaining 90% of the time and dealing with their entitlement/anger/depression/anxiety/noncompliance. It's exhausting and I'm not well-suited for it.

I have been contemplating a switch to radiology because I still love the medicine part of things and thrive on discovery/diagnosis/anatomy. I know that means a 4 year residency +?fellowship, a pay cut, and tremendous delay in actually working. I did shadow a radiologist recently and was amazed at how calming the work was. Not to say there isn't stress involved, but being able to provide clinical care without dealing with all the emotions was so freeing.

Do you think this is crazy? Has anyone ever heard of anyone else switching to radiology as an attending? Is this "grass is greener" syndrome? Please enlighten me on what I don't know about radiology.

Thank you.

I was in the military for a decent bit and worked at two of their residency programs, both as a resident and then staff. There was a quite high percentage of people who were in radiology after being fully trained in another specialty or, occasionally, subspecialty. I'm reminded of one of my attendings in residency who was a former pediatric cardiologist that got the best of a guest lecturer when she tried to pimp him too hard on congenital heart disease. He wasn't snooty about it in general, so there's no way she would have known, but when she pressed him too much he went into a 10 minute lecture in front of the whole room that ended with, "but none of this matters because they're just going to get an echo." But, I digress...

Point being is that, relatively free from the financial penalties of re-entering training, it's pretty common for physicians to retrain in radiology and be a lot happier for it. I say "relatively free from financial penalties" because, in the military, there's not nearly as much variation in pay between the specialties or between attendings and trainees as there is in the civilian world. Military physicians in residency also still accrue time toward rank and retirement, further lessening the financial costs. I mention this because I think that's where you need to focus your decision making - the finances - which is of course what keeps most physicians unhappy with their field from switching. Assuming you've done your due diligence and research, there's little reason to think you'll be unhappy as a radiologist.

 

[CherryRedDracul]

Am I the only one that would argue against this switch? Being in radiology, you have no control over whats ordered. On call, youre sick of reading your 20th CT brain neck chest abdomen pelvis for "trauma"? Too bad, here's another one ordered by the ED for patient falling down from standing height. Here's another ct cap for cancer staging as a bonus.

At least as medicine attending you have control of your own patient and management.

Yes, you will make money, but at what cost?

Every field has its mundane. Whenever I think about radiology mundane and wish I was somewhere else, I think about internal medicine mundane, and I snap out of my daydream.

Of course, there are some people who would prefer IM mundane over radiology mundane, and that's totally OK.

 

[Cognovi]

I’m always trying to figure out if people actually switch into radiology later in their path

It's definitely a well-trodden path.

As noted above, Jeffrey Galvin is a prominent example since he lectures at AIRP; he was a pulmonologist/intensivist, now chest radiologist at U Maryland.
Another AIRP lecturer is Christopher Hunt, formerly a neurologist subspecialized in neurophysiology/neuromuscular, now neuroradiologist/nuclear radiologist at Mayo.

At my residency program alone, I know of at least four attendings who trained in a different specialty before radiology (medicine x2, pediatrics, neurology). I just looked up the current physician directory at my medical school and also found at least five radiology attendings who trained in something else first (medicine x2, pediatrics, surgery, neurology).

It would probably most helpful to talk with someone who made the switch.

However, my ideal would be 1 week on/1 week off which I know some radiologists are doing. It could give me a chance to use other parts of my brain on the off weeks (maybe entrepreneurial/volunteer/travel/startups/consulting/side gigs/advocacy). The combo of this sounds like an ideal to me and far more fulfilling. You think that’s feasible or am I being too idealistic?

This is definitely possible. In hot job markets such as the present, you can even find 7 on/7 off daytime jobs that are considered full time, but these are likely in less desirable locations and expect high volume reads. In less hot markets, 7 on/7 off is primarily for nights jobs. In the present market, there are many listings for 7 on/7 off for evenings (eg, 1p-10p, 3p-11p, 3p-12a, 5p-2a), 7 on/14 off or 5 on/10 off for nights (eg, 11p-7a, 10p-8a).

 

[insearchofwisdom]

It's definitely a well-trodden path.

As noted above, Jeffrey Galvin is a prominent example since he lectures at AIRP; he was a pulmonologist/intensivist, now chest radiologist at U Maryland.
Another AIRP lecturer is Christopher Hunt, formerly a neurologist subspecialized in neurophysiology/neuromuscular, now neuroradiologist/nuclear radiologist at Mayo.

At my residency program alone, I know of at least four attendings who trained in a different specialty before radiology (medicine x2, pediatrics, neurology). I just looked up the current physician directory at my medical school and also found at least five radiology attendings who trained in something else first (medicine x2, pediatrics, surgery, neurology).

It would probably most helpful to talk with someone who made the switch.



This is definitely possible. In hot job markets such as the present, you can even find 7 on/7 off daytime jobs that are considered full time, but these are likely in less desirable locations and expect high volume reads. In less hot markets, 7 on/7 off is primarily for nights jobs. In the present market, there are many listings for 7 on/7 off for evenings (eg, 1p-10p, 3p-11p, 3p-12a, 5p-2a), 7 on/14 off or 5 on/10 off for nights (eg, 11p-7a, 10p-8a).

This is SO encouraging. Could you please share some of the names of the other attendings that trained in a different specialty before radiology please? I completely agree talking with someone who made the switch would be the most helpful. I'm terribly afraid of just ASSUMING things look better on the other side so I'd love to talk to someone who is living it.

 

[insearchofwisdom]

Am I the only one that would argue against this switch? Being in radiology, you have no control over whats ordered. On call, youre sick of reading your 20th CT brain neck chest abdomen pelvis for "trauma"? Too bad, here's another one ordered by the ED for patient falling down from standing height. Here's another ct cap for cancer staging as a bonus.

At least as medicine attending you have control of your own patient and management.

Yes, you will make money, but at what cost?

I hate to say this but so naive you are. Maybe this can be helpful for you to understand but the majority of those scans that are coming in are not because doctors actually believe they're warranted, it's because they're terrified of litigation or patient reviews. When you understand they're trying to protect themselves, you deal with it differently (it's sort of not a choice). Also, in today's world, patients literally dictate their own care much of the time and then you just give in because convincing them otherwise is harder or because then they give you bad reviews. If you can remember that, when you get your 20th CT Brain, it may not be as annoying and also you should be thinking: well that was an easy one. Hope that helps.

 

[insearchofwisdom]

I was in the military for a decent bit and worked at two of their residency programs, both as a resident and then staff. There was a quite high percentage of people who were in radiology after being fully trained in another specialty or, occasionally, subspecialty. I'm reminded of one of my attendings in residency who was a former pediatric cardiologist that got the best of a guest lecturer when she tried to pimp him too hard on congenital heart disease. He wasn't snooty about it in general, so there's no way she would have known, but when she pressed him too much he went into a 10 minute lecture in front of the whole room that ended with, "but none of this matters because they're just going to get an echo." But, I digress...

Point being is that, relatively free from the financial penalties of re-entering training, it's pretty common for physicians to retrain in radiology and be a lot happier for it. I say "relatively free from financial penalties" because, in the military, there's not nearly as much variation in pay between the specialties or between attendings and trainees as there is in the civilian world. Military physicians in residency also still accrue time toward rank and retirement, further lessening the financial costs. I mention this because I think that's where you need to focus your decision making - the finances - which is of course what keeps most physicians unhappy with their field from switching. Assuming you've done your due diligence and research, there's little reason to think you'll be unhappy as a radiologist.

Could you share any of those names for people who switched please?
Thanks.

 

[Cognovi]

Could you share any of those names for people who switched please?
Thanks.

Anup Shetty | Washington University Physicians

Manu S. Goyal, MD, MSc - Washington University Physicians

wuphysicians.wustl.edu

Marilyn J. Siegel, MD - Washington University Physicians

wuphysicians.wustl.edu

Constance Stone Courtois, MD - Washington University Physicians

wuphysicians.wustl.edu

Michael Lev, MD -

www.massgeneral.org

William Palmer, MD -

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Frederick D. Grant, MD | Boston Children's Hospital

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[meister]

You would be giving up seven figures of earnings, not to mention delay repaying any debt you may already have leftover from prior training. More to life than money but...hope you have a reasonable way to deal with that.

Good news is you’ll be more than adequate at generating moonlighting cash during residency!

 

[Dave1980]

Hello, I am currently an internal medicine subspecialist and have been an attending for 3.5 years. I am quite unfulfilled at my job, physically/mentally/emotionally worn out. I have been trying to pay close attention to what is making me feel this way because hard work is not something I have trouble with and have come to really identify it's patient interactions/expectations. If I'm honest with myself, in hindsight, I've been burned out since right after intern year and have not really enjoyed talking to patients. I thought residency and fellowship and being a new attending were "supposed to" feel like this but I'm realizing I think I'm ignoring a problem that's very real. I love talking to people but I can't stand person after person complaining 90% of the time and dealing with their entitlement/anger/depression/anxiety/noncompliance. It's exhausting and I'm not well-suited for it.

I have been contemplating a switch to radiology because I still love the medicine part of things and thrive on discovery/diagnosis/anatomy. I know that means a 4 year residency +?fellowship, a pay cut, and tremendous delay in actually working. I did shadow a radiologist recently and was amazed at how calming the work was. Not to say there isn't stress involved, but being able to provide clinical care without dealing with all the emotions was so freeing.

Do you think this is crazy? Has anyone ever heard of anyone else switching to radiology as an attending? Is this "grass is greener" syndrome? Please enlighten me on what I don't know about radiology.

Thank you.

Good luck! What subspecialty of IM are you in? I feel like endocrine for some odd reason.

Feel free to PM me if you have any questions about applying for residency/fellowship/jobs.

I know of a really terrible community program that is always in danger of not filling and/or losing people. So if you are willing to be abused for 4 years I may know of a spot for you...not trying to sugarcoat it.

 

[Clean7795]

If you're burnt out, you're burnt out and you need to make a change. Pursuing residency again is quite drastic however... I would recommend trying some other steps first like cutting back hours or changing how you're scheduling patients.

Doing residency again is tough even in the easiest specialties; radiology residency is actually closer to the other end of the spectrum in terms of how busy you are reading and working on call. Finding a position locally will be very tough (I assume you have family/friends that are rooting you down) and may not even be feasible depending on where you live.

But if conservative measures don't work, I think pursuing another specialty like radiology is reasonable. Quite a few radiologists were former medical or surgical specialists. There are downsides, but I think either they are quite obvious (e.g. lack of direct control over patient care) or are ubiquitous to most of medicine (e.g. corporatization & academic consolidation of medicine, increasingly poor consults with midlevel penetration into primary care, etc.).

 

[insearchofwisdom]

If you're burnt out, you're burnt out and you need to make a change. Pursuing residency again is quite drastic however... I would recommend trying some other steps first like cutting back hours or changing how you're scheduling patients.

Doing residency again is tough even in the easiest specialties; radiology residency is actually closer to the other end of the spectrum in terms of how busy you are reading and working on call. Finding a position locally will be very tough (I assume you have family/friends that are rooting you down) and may not even be feasible depending on where you live.

But if conservative measures don't work, I think pursuing another specialty like radiology is reasonable. Quite a few radiologists were former medical or surgical specialists. There are downsides, but I think either they are quite obvious (e.g. lack of direct control over patient care) or are ubiquitous to most of medicine (e.g. corporatization & academic consolidation of medicine, increasingly poor consults with midlevel penetration into primary care, etc.).

Yes, you're right. I'm trying to look at everything to make sure I make the right switch.
Thanks!

 

[Splenda88]

Every field has its mundane. Whenever I think about radiology mundane and wish I was somewhere else, I think about internal medicine mundane, and I snap out of my daydream.

Of course, there are some people who would prefer IM mundane over radiology mundane, and that's totally OK.

I am not a radiologist but I think the mundane stuff in IM/FM is pale in comparison to diagnostic rad. I chose IM because I embrace the mundane BS as being part of the job.