Switching from rads to IM

[abotttu]

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Almost done with
PGY-1 radiology resident here looking for honest advice.
A few months into training, I’ve realized that I don’t really see myself in radiology. I’ve been seriously considering transferring to internal medicine and have already explored the process and spoke to my PD which is a very supportive and brilliant person but convinced me to stay and give it time. The issue is that I’m struggling to determine whether this is just the normal steep learning curve of early radiology training or a genuine specialty mismatch. I hate going to work although it’s a really chill environment, I don’t feel like I’m productive or beneficial by any means. And don’t feel like a doctor anymore.
If anyone has switched can you give me your honest opinion and insight, and regrets.
I feel lost most of the time when reading studies and often feel like I’m not comprehending what I’m seeing.
At the same time, I keep thinking about internal medicine and feel disappointed whenever I see new IM residents starting their training, as if that’s where I should have been.

Another factor is the growing uncertainty surrounding radiology and AI. I know the “AI will replace radiologists” discussion has been around for years, but I can’t help wondering what the field will look like 10–20 years from now and whether that should factor into my decision.
For those who switched out of radiology (or seriously considered it), how did you know it was a true mismatch rather than just being overwhelmed early in training? Looking back, what signs should I pay attention to before making a final decision? They told me to give it time , but it’s been months and there is no improvement with my feelings at all. I always go to work thinking about switching. I feel very isolated here and out of place

 

[comp1]

Put the AI stuff immediately aside. That is way too uncertain and vague to have any bearing, whatsoever, on this sort of decision at this point in the road. AI has just as much risk in IM, that is, a completely unknown amount. You have some actual sunk cost now and AI is not a valid or reasonable balance to ANY sunk cost. Regarding other stuff, the most important thing, by far, is that you finish SOME residency. You can make being a board eligible radiologist into a lot of different things, many completely unlike whatever you are doing in residency. Heck you could end up training the AI models that you should not, under any circumstances, be thinking about right now. You can't (realistically) make being a non-board eligible anything into something. So if you decide to switch into something, make sure it's a truly guaranteed thing. Assess the other areas of your life. Hobbies, relationships, family, etc. Is everything going really well throughout? If not, could this be a more global issue with you as opposed to the specialty?

 

[dozitgetchahi]

The only reason you should switch is if you feel that IM is something you really, really want to do. Like “I don’t want to do radiology but I REALLY want to do IM”.

Radiology can be a really great specialty from an income and lifestyle standpoint. Only switch if you really feel you need to.

 

[abotttu]

Put the AI stuff immediately aside. That is way too uncertain and vague to have any bearing, whatsoever, on this sort of decision at this point in the road. AI has just as much risk in IM, that is, a completely unknown amount. You have some actual sunk cost now and AI is not a valid or reasonable balance to ANY sunk cost. Regarding other stuff, the most important thing, by far, is that you finish SOME residency. You can make being a board eligible radiologist into a lot of different things, many completely unlike whatever you are doing in residency. Heck you could end up training the AI models that you should not, under any circumstances, be thinking about right now. You can't (realistically) make being a non-board eligible anything into something. So if you decide to switch into something, make sure it's a truly guaranteed thing. Assess the other areas of your life. Hobbies, relationships, family, etc. Is everything going really well throughout? If not, could this be a more global issue with you as opposed to the specialty?

That’s what makes me think it may actually be the specialty rather than a broader issue. Outside of residency, things are going well for me. My health is good, my relationships and family life are good, and I still enjoy my hobbies. The dissatisfaction seems very specific to radiology.
I went into residency expecting reporting to be challenging but also interesting and intellectually engaging. Instead, I often find myself staring blankly at studies and struggling to stay engaged. Even when I was studying for exams, I found it difficult to comprehend and retain the material, which made me question whether I genuinely connect with the subject matter.
On top of that, my program is quite isolating. I can go through an entire workday and barely exchange more than a few words with anyone. People generally keep to themselves, so it often feels like I just come to work, sit in front of a screen all day, and then go home. I realize some of this may be related to the environment, but it has definitely contributed to how disconnected I feel from the specialty.
That’s why I’m trying to figure out whether this is primarily a program issue, a mismatch with radiology itself, or some combination of both.

 

[abotttu]

The only reason you should switch is if you feel that IM is something you really, really want to do. Like “I don’t want to do radiology but I REALLY want to do IM”.

Radiology can be a really great specialty from an income and lifestyle standpoint. Only switch if you really feel you need to.

I agree that radiology is a great specialty. It offers an excellent lifestyle, flexibility, and work-life balance. My concern is whether I truly enjoy the work. I still struggle to engage with it and miss direct patient care and clinical decision-making. While radiology has many advantages, I’m not sure it’s the right fit for me long term.

 

[dozitgetchahi]

I agree that radiology is a great specialty. It offers an excellent lifestyle, flexibility, and work-life balance. My concern is whether I truly enjoy the work. I still struggle to engage with it and miss direct patient care and clinical decision-making. While radiology has many advantages, I’m not sure it’s the right fit for me long term.

So I will say that I sort of sat in your shoes as a medical student - I liked radiology and IM. Ultimately I went with IM because I felt that being a human slide reader seemed a bit weird, and because I liked the idea of being in clinic talking to patients. Now being a rheumatologist in practice for several years, lemme tell ya…there are times where I’d love to just read some films all day and go home. There are a lot of ups and downs associated with interacting with pts, and sometimes it can be exhausting.

 

[RangerBob]

That’s what makes me think it may actually be the specialty rather than a broader issue. Outside of residency, things are going well for me. My health is good, my relationships and family life are good, and I still enjoy my hobbies. The dissatisfaction seems very specific to radiology.
I went into residency expecting reporting to be challenging but also interesting and intellectually engaging. Instead, I often find myself staring blankly at studies and struggling to stay engaged. Even when I was studying for exams, I found it difficult to comprehend and retain the material, which made me question whether I genuinely connect with the subject matter.
On top of that, my program is quite isolating. I can go through an entire workday and barely exchange more than a few words with anyone. People generally keep to themselves, so it often feels like I just come to work, sit in front of a screen all day, and then go home. I realize some of this may be related to the environment, but it has definitely contributed to how disconnected I feel from the specialty.
That’s why I’m trying to figure out whether this is primarily a program issue, a mismatch with radiology itself, or some combination of both.

I can relate a bit. Radiology was my "toughest" rotation intern year. I was more worn out from it than any other--I napped a few hours everyday! I didn't have to show up until about 8-9 and the attendings sent me home by 12. I had planned to study for Step 3 while on radiology. But I was just so utterly bored/worn out. Sitting in the dark, alone, reading films is not for everyone. I like working alone, but I also like some interaction. Radiologists can certainly walk down to a coworker's office to chat a bit so that's not impossible. But all the pieces put together made it really tiring and honestly I didn't learn much. I was so tired I hardly got any Step 3 studying in.

I genuinely enjoyed my ICU (long hours--13-14hr 6d/week) rotation and ED (horrible circadian rhythm disruption) more than radiology.

Radiology has lots of pros as well. Work-life balance is no small thing, especially once you have a family. I care more about that now, and am thankful I'm in the specialty I'm in. There are lots of cons to IM so if you are seriously thinking about changing, talk with some hospitalists/outpt attendings to see what they enjoy/can't stand to get a better idea of whether it really might be a better fit.

You could work half-time as a radiologist and make as much as a lot of internists. But if you're miserable that wears at you. I think you want a job that you at least find tolerable.

 

[ThoracicGuy]

I agree that radiology is a great specialty. It offers an excellent lifestyle, flexibility, and work-life balance. My concern is whether I truly enjoy the work. I still struggle to engage with it and miss direct patient care and clinical decision-making. While radiology has many advantages, I’m not sure it’s the right fit for me long term.

Have you thought about doing Interventional Radiology? Lot's more direct patient interactions there.

 

[irwarrior]

You trade the lifestyle of DR fora surgical lifestyle with interventional. Interventional residency has a high burnout and drop out rate with most going into DR.

 

[finalpsychyear]

Most people in IM that i know are burned out and had those rosy glasses of what being a doctor was all about. Flash forward 10 years and you will realize if you have a family and kids you want the most balanced career in terms of flexibility and money. Sure you can subspecialize in cards, pulm, heme/onc but those are 6-7 year pathways. Everything gets boring and repetitive. Better hours and higher pay will usually win out.

I work from home and go to the gym daily for my lunch break and have a large social circle to play tennis, happy hours, movies as part of my daily routine. I feel for those that are grinding at the hospital and come home with an empty tank.

Radiology esp the work from home options can maybe give you a similar well balanced life and even if blended with hospital work you will just have a better quality of life vs most IM or its subspecialties on avg.