Switching into rads

[switchbacking]

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Hi all,

I'm a upper-year general surgery resident (in my research years, two clinical years left) at a top program, and I have been debating switching out of surgery for a few years. I've finally decided to make the switch, but I was hoping to get advice on how to approach the process.

I initially debated between gen surg and radiology in med school, but I ended up choosing gen surg with a solid degree of naivete without really knowing the lifestyle and job prospects. I started out enjoying residency but quickly grew tired of operating and just was not intellectually stimulated anymore. I initially thought it was just that I didn't like surgical residency, but I have now realized it is much more about not enjoying operating. After a month of IR, I started to really consider radiology (but not simply for the love of IR but rather the morning rounds of reading scans). On Pedi Surg and Trauma, I was drawn more to reading the scans at rounds than actually taking them to the OR. I finished my junior-level years and am now in my "research" time. During this time, I also started having a bunch of back problems (as do a few other residents in my program), and it just doesn't make sense anymore to stay in surgery simply because of the years I have invested in it. I've known other surgeons that have had to stop operating and go into administrative roles because of back problems. I also recently started a family, and I can't risk having further physical problems down the road that jeopardize my livelihood and providing for them.

My program has a decent amount of attrition (2 per class usually end up leaving for anesthesiology, none that I know of for radiology), and our program director is typically pretty supportive. I haven't yet approached my PD (which I know is one of the first steps), but I plan on doing it in the near future. I am in very good standing at the program with great evals and in-service exam scores, and it will probably come as a shock to them.

I think I'm pretty competitive to go through the match again. Both Step I and II around 250, AOA, top-10 med school, and a few publications (none radiology-related though). I have a bunch of good relationships with radiologists at my program , but I haven't spoken to them (since it's not public yet that I want to switch). But, I think I wouldn't have a problem getting letters from a couple of them.

I've looked through old posts about people making this kind of switch, but I was wondering if there are people out there that can help me out (i.e. how they went about navigating the process). I had some questions about years of residency funding remaining issues, matching into PGY2 spots, talking to nearby program directors, etc. My wife and I are also interested in leaving the area, but she's in academia so it will be a challenge to co-align her getting another job with my next program.

Thanks so much!

 

[samsoniter]

Though I have not switched, it appears as though you would be an ideal candidate for it. The biggest problem I foresee is funding- the accepting program would probably foot the bill for at least 2 yrs (I think). I would talk to your PD asap as it sounds like you have put a lot of thought into this and are pretty sure about it, your PD, along with rads PDs will be your most reliable resource, good luck!

 

[switchbacking]

Thanks, samsoniter. That will definitely be a question I ask the PDs. Does anyone here know the specifics of that? I've heard it thrown around a bunch. There's also a question of timing with this as well. Although they are not paying my salary during my research years, they might be getting funding since I am technically still a resident (although I'm not sure). I have a second research year coming up in July, so I probably should switch out beforehand in case I lose another year of funding.

 

[samsoniter]

There is a PD on here, usually in the general residency forum that seems very knowledgeable about the funding stuff....I think s/he goes by AProgDir or something like that, the handle says pasta-farians unite which I have found both appetite stimulating and curiously funny. If you PM him/her and get to the bottom of the pasta thing please enlighten us, cheers.

 

[XerxesOfPersia]

Off topic but for samsoniter: http://en.wikipedia.org/wiki/Pastafarianism

 

[XerxesOfPersia]

For the OP - I'll just echo what samsoniter said. Your best resources are the PDs, both rads and gen surg. Switching is not uncommon. You could end up having to apply with ERAS so your timing for next cycle might be right on, but not sure about that.

I think there are a few people on this forum that switched from other specialties so they could be of help too.

 

[shark2000]

Hi all,

I'm a upper-year general surgery resident (in my research years, two clinical years left) at a top program, and I have been debating switching out of surgery for a few years. I've finally decided to make the switch, but I was hoping to get advice on how to approach the process.

I initially debated between gen surg and radiology in med school, but I ended up choosing gen surg with a solid degree of naivete without really knowing the lifestyle and job prospects. I started out enjoying residency but quickly grew tired of operating and just was not intellectually stimulated anymore. I initially thought it was just that I didn't like surgical residency, but I have now realized it is much more about not enjoying operating. After a month of IR, I started to really consider radiology (but not simply for the love of IR but rather the morning rounds of reading scans). On Pedi Surg and Trauma, I was drawn more to reading the scans at rounds than actually taking them to the OR. I finished my junior-level years and am now in my "research" time. During this time, I also started having a bunch of back problems (as do a few other residents in my program), and it just doesn't make sense anymore to stay in surgery simply because of the years I have invested in it. I've known other surgeons that have had to stop operating and go into administrative roles because of back problems. I also recently started a family, and I can't risk having further physical problems down the road that jeopardize my livelihood and providing for them.

My program has a decent amount of attrition (2 per class usually end up leaving for anesthesiology, none that I know of for radiology), and our program director is typically pretty supportive. I haven't yet approached my PD (which I know is one of the first steps), but I plan on doing it in the near future. I am in very good standing at the program with great evals and in-service exam scores, and it will probably come as a shock to them.

I think I'm pretty competitive to go through the match again. Both Step I and II around 250, AOA, top-10 med school, and a few publications (none radiology-related though). I have a bunch of good relationships with radiologists at my program , but I haven't spoken to them (since it's not public yet that I want to switch). But, I think I wouldn't have a problem getting letters from a couple of them.

I've looked through old posts about people making this kind of switch, but I was wondering if there are people out there that can help me out (i.e. how they went about navigating the process). I had some questions about years of residency funding remaining issues, matching into PGY2 spots, talking to nearby program directors, etc. My wife and I are also interested in leaving the area, but she's in academia so it will be a challenge to co-align her getting another job with my next program.

Thanks so much!

1- I am a pp radiologist with MSK fellowship and almost a body fellowship with lots of procedures. I am doing more and more minor procedures including biopsies, drains, spine pain injections, arthrograms, nerve blocks and kypho/vertebro. Doing ablation once in a while. I probably do 30 percent procedures.

2- I like radiology, so I am biased towards it. So, think about it and talk to people yourself rather than seriously following what some unknown poster like me say on a forum. but I hope my points below are helpful.

3- The nice thing about radiology is the broad scope of its practice that make it suitable for many. Youncan do a purely diagnostic work or you can do heavy procedures. Even if you like procedures, you are likely able to choose between light ones versus heavy demanding ones. You can do TACE or you can do just biopsies and joint procedures or you can avoid all of them.

4- I recommend you to switch. Funding should not be a big deal. We had a co-resident who was board certified internist. Funding is not an issue with big programs. Mostly, small programs and community hospitals are dependent on it.

5- If and only if you are sure about switching, talk to your program director. Most of them are fine with you switching. Try to make connections with the Radiology department in you program.

6- You should be able to explain the ason for switching in a very convincable way. The first q that they will ask u is why switching?

7- Go for it and you will enjoy it. Even if you do not like 100 percent DR, IR is a great option. You will be able to do most of what vascular surgeons can do plus tons of other procedures. And doing DR on your non procedure days. I forgot to say that if you get tired of time consuming procedures, you can do a job similar to mine with some more procedure time. And if you get tired of the whole procedure thing, you can do DR. Or you can open a mammo clinic or a vein cilinic. You can do MSK for 10 years and then do Neuro or Body or chest. Options are endless.

8- life is not very long to do what you hate.

Good Luck.

 

[Taurus]

This is a good place to start:

http://www.apdr.org/employment_available.cfm

Because of the difficult radiology job market, it has scared off many applicants and some people have quit.

This in my opinion is a great opportunity for anyone wanting to get into radiology. I wish that I were applying for radiology at this time. It's like buying a stock or house at the bottom of the cycle.

Once the job market picks up again and it will, this opportunity will be gone because people will rush back into radiology once they see how Obamacare will screw the primary care physician.

 

[bronx43]

This is a good place to start:

http://www.apdr.org/employment_available.cfm

Because of the difficult radiology job market, it has scared off many applicants and some people have quit.

This in my opinion is a great opportunity for anyone wanting to get into radiology. I wish that I were applying for radiology at this time. It's like buying a stock or house at the bottom of the cycle.

Once the job market picks up again and it will, this opportunity will be gone because people will rush back into radiology once they see how Obamacare will screw the primary care physician.

Radiology job market may or may not improve. It may very well be structural at this point.

How exactly is OC going to screw the PCP any worse than they are already? If bundled payments or PCMH go through, everyone is screwed.

 

[shark2000]

Radiology job market may or may not improve. It may very well be structural at this point.

How exactly is OC going to screw the PCP any worse than they are already? If bundled payments or PCMH go through, everyone is screwed.

Agree.

This is my prediction of future. It happens not because of Obamacare or any other healthcare plan. It is just a result of non sustainable high healthcare expenditure in this country. There is no money in the system to continue corrent model of practice. It includes everthing from MRI to joint replacement to end of life care to cancer treatment to stent placement.
We are doing too much relative to other developed nations, but honestly we are not doing better. The system is spending huge money on healthcare. Probably half of what we do has short term impact or no impact.

In the future, 5-10 years, most physicians will make 150-300. Family doctors will be around 150. Non-procedural specialties like Neurology, nephrology, ... will make around 200k. Procedural non surgical fields like radiology, GI or cards will make around 250k. Surgical fields make around 300k. There may be outliers like Spine sugeons making more.

Many may disagree. But this system does not have the capacity to have 800 thousand physicians and pay them the current numbers.

We see trend towards these numbers theses days. Though once things adjust, the workload will also decrease proportionaly. These numbers are close to what you get paid in academics in big cities these days and it works for them.

80s, 90s and early 2000s was a 25 year period of eception for medicine salaries in this country. It also resulted in a huge system of insurance called Medicare, which is a sick system and is not sustainable. People in those days used to laugh at European health care system, but it seems we are also going towards that system, seemingly more stable.

 

[cbtk18]

Physician salaries are not what makes the current system unsustainable. Not by a long shot.

 

[speeddemon]

Agree.

This is my prediction of future. It happens not because of Obamacare or any other healthcare plan. It is just a result of non sustainable high healthcare expenditure in this country. There is no money in the system to continue corrent model of practice. It includes everthing from MRI to joint replacement to end of life care to cancer treatment to stent placement.
We are doing too much relative to other developed nations, but honestly we are not doing better. The system is spending huge money on healthcare. Probably half of what we do has short term impact or no impact.

In the future, 5-10 years, most physicians will make 150-300. Family doctors will be around 150. Non-procedural specialties like Neurology, nephrology, ... will make around 200k. Procedural non surgical fields like radiology, GI or cards will make around 250k. Surgical fields make around 300k. There may be outliers like Spine sugeons making more.

Many may disagree. But this system does not have the capacity to have 800 thousand physicians and pay them the current numbers.

We see trend towards these numbers theses days. Though once things adjust, the workload will also decrease proportionaly. These numbers are close to what you get paid in academics in big cities these days and it works for them.

80s, 90s and early 2000s was a 25 year period of eception for medicine salaries in this country. It also resulted in a huge system of insurance called Medicare, which is a sick system and is not sustainable. People in those days used to laugh at European health care system, but it seems we are also going towards that system, seemingly more stable.

Do you think anything will be done about student loans under this new system? Taking out 300k in high interest loans to make 150-300k means medicine would be a much more middle class profession going forward.

 

[bronx43]

Physician salaries are not what makes the current system unsustainable. Not by a long shot.

The issue is multi-factorial. It's not the actual salary of the physician that really plays into it, but the payment model, which incentivizes volume. So, even though the take-home pay may not be exorbitant for physicians, FFS leads to overuse of services that ultimately contribute to the lack of sustainability.

 

[shark2000]

Physician salaries are not what makes the current system unsustainable. Not by a long shot.

Decreased physician salary will be the natural result of doing less.

Imagine a system where we don't do chemotherapy for end stage cancer to increase survival by 6 months. This will decrease the cost of the system significantly by eliminating 20 course of chemotherapy, hospitalization, nephrology consult for renal failure and 5 PET scans that we do. But the indirect result will be decreased salary of oncologist, radiologist, surgeons,...

We will reach a point where we have resources to either treat pneumonia in 50 healthy kids or treat one GBM to increase survival for 4 months. We will not be able to do both and we have to choose one.

 

[bronx43]

Do you think anything will be done about student loans under this new system? Taking out 300k in high interest loans to make 150-300k means medicine would be a much more middle class profession going forward.

Student loans have the potential to be the next subprime loan disaster. Default rates are already starting to go exponential due to the overall lack of jobs for college grads. I think the government's hand will be forced in the next few years on this issue.

 

[Taurus]

Radiology job market may or may not improve. It may very well be structural at this point.

How exactly is OC going to screw the PCP any worse than they are already? If bundled payments or PCMH go through, everyone is screwed.

You need to differentiate yourself clearly from a midlevel. If you don't, then you will be paid like one.

Craig Samitt, M.D., president and chief executive of the Dean Health System in Madison, Wis., further suggested Medicare should reduce doctor's pay by 15 percent for services better left to APRNs or PAs, reported MedPage Today.​

 

[Taurus]

In the future, 5-10 years, most physicians will make 150-300. Family doctors will be around 150. Non-procedural specialties like Neurology, nephrology, ... will make around 200k. Procedural non surgical fields like radiology, GI or cards will make around 250k. Surgical fields make around 300k. There may be outliers like Spine sugeons making more.

I more or less agree. Most physicians will be employed and make around $250-300k at the high end. I don't think that ortho, neurosurgeons, spine, or pain docs are going to escape the net of the govt. They won't make much more than $300k. The IPAB will make sure there are no significant outliers. Plus, remember that much of what spine surgeons do is not scientifically validated. I've seen many studies over the last few years showing how conservative management or acupuncture is just as effective. The IPAB will use that information to drastically slash reimbursements to spine. As one of my neurorad attendings pointed out to me, neurosurgeons make 20% from brain and 80% from spine work. So both neurosurgeons and ortho spine will be hit hard.

Given this situation, would I recommend people to go into radiology? Yes. Consider it this way. Do you want to work a lot harder and take a lot more call during residency and practice by going into cards, GI, surgery, neurosurg, ortho to make the same or a little more than radiology? Radiology residency, even call, is not that bad and pretty humane. During most of my residency, I work around 40 hours per week. I take 20 days of vacation pretty much whenever I want. I go to 2-3 weeklong conferences per year - that's on top of my vacation time. Many of the fellowships I've looked at have the same or even better lifestyle with less call than during residency. Bottom line, one of the major factors for me for choosing radiology is that I didn't want to kill myself for medicine. For what? Reimbursements are dropping for everyone. I would be pretty pissed off if I killed myself for cards, GI, neurosurg, ortho only to see my salary drop to the same level as radiology. Do you want to be on call every 4 nights taking cards, GI, neurosurg, ortho call? Do you want to be up at 3 am taking care of that MVC or small bowel obstruction?

Would I choose medicine again? That's a different topic. But if you've gotten this far, then you need to choose a residency.

I'm not saying that working as a radiology attending is a cakewalk. Some jobs will be very high stress and volume. However, if you want an easier lifestyle, then go into academics, VA, etc. You'll make less money but you won't be stressed out. It will be up to you what you want.

 

[bronx43]

You need to differentiate yourself clearly from a midlevel. If you don't, then you will be paid like one.

Craig Samitt, M.D., president and chief executive of the Dean Health System in Madison, Wis., further suggested Medicare should reduce doctor's pay by 15 percent for services better left to APRNs or PAs, reported MedPage Today.​

Midlevels are actually infiltrating subspecialty care at a far higher rate than primary care, so I'm not sure why you think primary care is somehow more implicated in this than anyone else. Nothing in the article mentions specific fields. Furthermore, even if this goes through, I would hardly call this the end of primary care physicians. It simply puts pressure on sub-par primary care physicians who practice like mid-levels by referring out management that a fully trained MD should be able to manage. I would actually support such a change.

 

[Taurus]

Midlevels are actually infiltrating subspecialty care at a far higher rate than primary care, so I'm not sure why you think primary care is somehow more implicated in this than anyone else. Nothing in the article mentions specific fields. Furthermore, even if this goes through, I would hardly call this the end of primary care physicians. It simply puts pressure on sub-par primary care physicians who practice like mid-levels by referring out management that a fully trained MD should be able to manage. I would actually support such a change.

How comfortable does an NP feel about adjusting diabetes or BP meds without any physician input? That's part of their basic training. The NP's are already proclaiming that they provide better primary care than physicians.

How comfortable does an NP feel about doing open heart surgery? How comfortable does an NP feel about reading a CT or MRI? Those things are not at all part of their training. Most of radiology is not part of NP training and vast majority have no skill in it.

The fields most in danger of midlevel infiltration are primary care, ED, hospital medicine, and anesthesia. Fields like radiology and surgery are least affected.

There is one silver lining for radiology to having more midlevels in medicine. They're so clueless about diagnosis that they take a shotgun approach to ordering radiology studies. They order many more tests than physicians. This, more imaging techologies in the pipeline, and 30 million more people in the system mean that the volume of imaging studies will increase not decrease in the future. That's why this difficult job market is just temporary. I just wonder when the job market will break open again.

 

[bronx43]

How comfortable does an NP feel about adjusting diabetes or BP meds without any physician input? That's part of their basic training.

How comfortable does an NP feel about doing open heart surgery? How comfortable does an NP feel about reading a CT or MRI? Those things are not at all part of their training.

The fields most in danger of midlevel infiltration are primary care, ED, and hospital medicine. Fields like radiology and surgery are least affected.

Oh, I agree that surgery and imaging would be entirely insulated from the midlevel threat. The threats to those fields aren't mid-levels. I'm more referring to the medical subspecialties.

How comfortable does an NP feel about adjusting BP meds? Depends on what situation. How comfortable are internists or pulmonologists at reading run-of-the-mill CXRs and chest CTs? Very comfortable. How comfortable would they be if they had to pick out something rare, small, or not the exact finding they were searching for? Probably not very. The same goes for mid-levels. Anti-hypertensive adjustment in a healthy 30 year old? Cake. In a 62 year old with multiple co-morbidities? Not so much.

 

[Taurus]

How comfortable would they be if they had to pick out something rare, small, or not the exact finding they were searching for? Probably not very.

Because of PACS, everyone looks at the images, but everyone also waits for the radiology report. Everyday I see a study where I call up the clinician and asks them if they saw this or that. Of course they don't. The things they miss could easily kill the patient. One of the most difficult studies to interpret believe it or not is the chest x-ray. Every line means something and it extremely easy to miss something. One time I was call and told the floor team that the patient had enough peritoneal free air to drive a mac truck through it. You could see it on the chest and abdominal x-rays and CT. The chief surgery resident looked at the images himself and didn't believe me. He even wrote it in his progress note! The next morning my attending had to call the floors and confirm the findings and the patient had to be taken to the OR emergently for a perfed duodenum. Lol. I have many of those stories. The smart physicians understand their limitations.

 

[colbgw02]

Oh, I agree that surgery and imaging would be entirely insulated from the midlevel threat. The threats to those fields aren't mid-levels. I'm more referring to the medical subspecialties.

How comfortable does an NP feel about adjusting BP meds? Depends on what situation. How comfortable are internists or pulmonologists at reading run-of-the-mill CXRs and chest CTs? Very comfortable. How comfortable would they be if they had to pick out something rare, small, or not the exact finding they were searching for? Probably not very. The same goes for mid-levels. Anti-hypertensive adjustment in a healthy 30 year old? Cake. In a 62 year old with multiple co-morbidities? Not so much.

I'm not sure how your example illustrates a threat to radiologists from subspecialists. If anything, unless there are sea changes to our medicolegal system, it shows how we'll be more or equally relevant since pulmonologists, to use your example, won't be willing to risk mis-reading unexpected findings and/or complex studies. They're welcome to offer their input and/or ignore our reports, but that's a far cry from assuming the responsibility of putting one's name at the bottom of the report. What's more, if President Obama's recent budget proposal is any indicator, then the trend is toward closing these self-referral loopholes, making it less feasible for clinicians to obtain, read, and bill for imaging studies independent from radiologists.

 

[bronx43]

I'm not sure how your example illustrates a threat to radiologists from subspecialists. If anything, unless there are sea changes to our medicolegal system, it shows how we'll be more or equally relevant since pulmonologists, to use your example, won't be willing to risk mis-reading unexpected findings and/or complex studies. They're welcome to offer their input and/or ignore our reports, but that's a far cry from assuming the responsibility of putting one's name at the bottom of the report. What's more, if President Obama's recent budget proposal is any indicator, then the trend is toward closing these self-referral loopholes, making it less feasible for clinicians to obtain, read, and bill for imaging studies independent from radiologists.

I'm not exactly saying subspecialists offer any real threats to radiology. It was simply a parallel drawn from primary care physicians versus midlevels. While non-radiologists and mid-levels may believe they can handle the seemingly simple cases and may often make the right call, there's no way they would be able to or willing to handle the legal responsibility of their more qualified counterparts.

 

[shark2000]

I'm not exactly saying subspecialists offer any real threats to radiology. It was simply a parallel drawn from primary care physicians versus midlevels. While non-radiologists and mid-levels may believe they can handle the seemingly simple cases and may often make the right call, there's no way they would be able to or willing to handle the legal responsibility of their more qualified counterparts.

Virtual colonoscopy (CTC) is a technique that has been out there for a decade. It is less sensitive than optical colonoscopy and was not reimbursed by Medicare in the past. Once a GI doctor said, the only thing that it has done is to decrease the reimbursement for optical colonoscopy. It is true. It is less sensitive than optical colonscopy (90-95 % of it roughly), but if it costs 700 USD compared to 1500 for optical colonoscopy, it will replace it or will decrease that 1500 USD.

NPs and PAs will never replace Family doctors or specialists. But they will decrease the physicians income. The same as CTC.
If an NP or PA can control BP in 80% of cases with a cost 1/3 of a family doctor, they will either replace physicians or will result in decrease reimbursements.

 

[Silent Cool]

Virtual colonoscopy (CTC) is a technique that has been out there for a decade. It is less sensitive than optical colonoscopy and was not reimbursed by Medicare in the past. Once a GI doctor said, the only thing that it has done is to decrease the reimbursement for optical colonoscopy. It is true. It is less sensitive than optical colonscopy (90-95 % of it roughly), but if it costs 700 USD compared to 1500 for optical colonoscopy, it will replace it or will decrease that 1500 USD.

NPs and PAs will never replace Family doctors or specialists. But they will decrease the physicians income. The same as CTC.
If an NP or PA can control BP in 80% of cases with a cost 1/3 of a family doctor, they will either replace physicians or will result in decrease reimbursements.

Shark,

Thanks for your comments. They are always interesting. If you were a med student today, what field would you go into? Would you still pick Rads? An IM subspec? No career is perfect, but, as I see it, medicine is still a great career.

thanx
😎

 

[Doctor D]

How is it that every thread deteriorates into talk about salaries? FWIW top programs do sometimes have PGY2 spots open. While interviewing this year CCF was also interviewing for a PGY2 spot.

 

[deleted116380]

There is one silver lining for radiology to having more midlevels in medicine. They're so clueless about diagnosis that they take a shotgun approach to ordering radiology studies. They order many more tests than physicians. This, more imaging techologies in the pipeline, and 30 million more people in the system mean that the volume of imaging studies will increase not decrease in the future. That's why this difficult job market is just temporary. I just wonder when the job market will break open again.

I don't know all the details on the declining pay across the board, but for radiology specifically, was it ever due to lack of volume? I always thought it was reimbursement per study that made it worse...so 30mm more people and more mid-levels means more studies, but not necessarily more money per study. More work for less pay still imo.

And I think there was something stated earlier about student loans. The reason why it won't be a bubble like housing, even though there is more student debt than credit cards iirc, is that you can't really default like unsecured debt. For MDs, that means your license will be revoked if you don't pay. For undergrads, they'll probably come after your parents since I think they co-sign for that.

It's pretty unfortunate the loans are at a fixed 6.8% and 8.5% with the measly $8,500/yr subsidized now gone. Talk about making incentives for higher education. I remember getting into a debate with one of the people at finaid.org before med school (2009) regarding fixed vs. variable rates. They were so adamant it was the right thing to guarantee the fixed rates at that level vs variable even though I told them rates would fall and stay there for a while (they thought rates would shoot up in a couple years). But nope...Fed reserve recently said will be kept at near 0 til 2015...great. Students are getting ripped off. Only people that should apply to med school in the future imo are kids of rich parents and those getting a full ride. Pretty sad it's coming down to that.

Why spend 10 years of your prime in med school + residency to come out with nothing to show for it but huge debt and some paper while your college buddies have had the time of their life with a house, retirement account, and vacations with no fear of getting sued.

 

[shark2000]

Shark,

Thanks for your comments. They are always interesting. If you were a med student today, what field would you go into? Would you still pick Rads? An IM subspec? No career is perfect, but, as I see it, medicine is still a great career.

thanx
😎

I would choose radiology again.

If this is the way you choose your specialty, you will be miserable no matter what you do or how much you make.
Your choice of a field should not be based on which field is recommended by other people. If you are in doubt between 3 or 4 fields, you can choose the one that looks better on paper. Otherwise, you have to choose what you like.

No matter what you do, most of your time will be spent at work. You have to at least like it or not hate it.

 

[Silent Cool]

I would choose radiology again.

If this is the way you choose your specialty, you will be miserable no matter what you do or how much you make.
Your choice of a field should not be based on which field is recommended by other people. If you are in doubt between 3 or 4 fields, you can choose the one that looks better on paper. Otherwise, you have to choose what you like.

No matter what you do, most of your time will be spent at work. You have to at least like it or not hate it.

Oh, I agree. I'm just curious about your opinion because you have been a vocal poster on here.

thanks again

 

[Enkidu]

Oh, I agree that surgery and imaging would be entirely insulated from the midlevel threat. The threats to those fields aren't mid-levels. I'm more referring to the medical subspecialties.

I suspect that pathology will be the most insulated from both midlevels and medical subspecialties.

Given trends in compensation and job market, it looks like the situation in radiology is going to be pretty similar to pathology - probably a bit higher salary but more stressful and with more call.

Is this where you guys see things headed?

 

[meister]

Nah, imaging volume will keep going up, rads are going to start retiring more. I don't buy the pathology comparison.

 

[qxrt]

I suspect that pathology will be the most insulated from both midlevels and medical subspecialties.

Given trends in compensation and job market, it looks like the situation in radiology is going to be pretty similar to pathology - probably a bit higher salary but more stressful and with more call.

Is this where you guys see things headed?

Not at all. I just finished a pathology rotation at my institution, and PA's do much of the same grossing work that residents do.

 

[Substance]

Not at all. I just finished a pathology rotation at my institution, and PA's do much of the same grossing work that residents do.

See, I was under the impression that grossing is to pathology what patient positioning is to radiology. It's just a way to obtain the images, and techs are more than able to do both.

 

[Enkidu]

See, I was under the impression that grossing is to pathology what patient positioning is to radiology. It's just a way to obtain the images, and techs are more than able to do both.

Grossing of biopsies is probably similar to patient positioning in that it takes minimal training. Grossing of larger specimens is a crucial part of the exam and requires a midlevel extender to accomplish it. Actually, most of autopsy (forensic and medical) takes place at the gross level, so clearly gross exam can give an enormous amount of information.

But PAs don't have any role in the microscopic exam, and I don't think that they ever will. That skill takes *much* longer to really acquire. Even after 4 years of residency, most pathology residents don't feel comfortable signing out entirely on their own.

But my main thought was that subspecialists would also never encroach on pathology the way they are with radiology - so far as I know, no subspecialist tries to examine their own tissue and tell the patient their diagnosis before they get the path report, but they do this all the time with radiology - even in my experience as a patient.

 

[Enkidu]

Nah, imaging volume will keep going up, rads are going to start retiring more. I don't buy the pathology comparison.

It kind of seems like the wind is blowing the other way to me - but how is what you're describing not comparable to pathology?

 

[bronx43]

Nah, imaging volume will keep going up, rads are going to start retiring more. I don't buy the pathology comparison.

Why would they retire if they have access to 1000 new shmucks graduating every year to do all their work? That's pretty much the business model in pathology. I don't see why it's not at least partially applicable in rads.

 

[shark2000]

If you like radiology, go for it.

If you hate it, don't do it. Why you want to justify it.

Pathology is a whole different world from radiology. It is like saying CT surgery and OB is the same since both go to OR. The ever changing nature of the field, necessity of interaction with clinicians, procedural part of it, 24/7 nature of work, covering emergency and referral from almost all medical fields esp family doctors and not only surgeons makes the field more dynamic than what people say here.

As a result of many these factors, though in the short term some similar things that happens to pathology may happen to radiology, in the intermediate or long term, these are not sustainable.

 

[Enkidu]

Pathology is a whole different world from radiology. It is like saying CT surgery and OB is the same since both go to OR. The ever changing nature of the field, necessity of interaction with clinicians, procedural part of it, 24/7 nature of work, covering emergency and referral from almost all medical fields esp family doctors and not only surgeons makes the field more dynamic than what people say here.

Interesting thoughts - Radiology and pathology are different in many ways, of course, but I'm not sure that you picked out any relevant (or accurate) ones. If you think that pathology isn't changing and doesn't have to interact with clinicians, then you may have just never rotated through there.

The important similarities between radiology and pathology have nothing to do with their call schedules. They're both dependent upon clinician referrals and both have overtrained. Also, clinicians don't have any particular loyalty to either one, as far as I can see. They're apparently fine with sending a film to India to be read by someone completely faceless to them, just as they're fine shipping their tissue off to a corporate lab.

 

[shark2000]

Interesting thoughts - Radiology and pathology are different in many ways, of course, but I'm not sure that you picked out any relevant (or accurate) ones. If you think that pathology isn't changing and doesn't have to interact with clinicians, then you may have just never rotated through there.

The important similarities between radiology and pathology have nothing to do with their call schedules. They're both dependent upon clinician referrals and both have overtrained. Also, clinicians don't have any particular loyalty to either one, as far as I can see. They're apparently fine with sending a film to India to be read by someone completely faceless to them, just as they're fine shipping their tissue off to a corporate lab.

You did not get my point, or you don't want to.

The pattern of refferal is different: In rad 60-70 percent is from PCPs, ER or oncologists. Though you may say they both depend on referrals, the pattern is very different. It means a certain referrer can not monopolize a radiology group except for hospitals which control all physicians anyway including ED, IM, Cards, Surgeons, ....

Otherwise, every specialist is depedent on referrals. For example most colonoscopies are referred by PCP.

The key is to have referral from NPs, PAs and PCPs that radiology is in a very good position in this regard. Otherwise, you lose your business. The best example is CT surgery. They were the kings of medicine in 1980s. But their main defect was being dependent on referral from another apecialist. Their field went down the drain though is becoming better. Pathology is in the same boat. Barely a PCP or PA sends you sample. Now do you see the problem or difference?

If you are a neuroradiologist in community, only 30 percent of your referrals are from neurologists. The rest is from ED, IM, Trauma surgery, family doctors, rehab doctors, oncologists, OB, general surgeon, .... But if you are a neuropathologist, almost everything is from neurosurgeon. Now, think about it.

 

[Enkidu]

If you are a neuroradiologist in community, only 30 percent of your referrals are from neurologists. The rest is from ED, IM, Trauma surgery, family doctors, rehab doctors, oncologists, OB, general surgeon, .... But if you are a neuropathologist, almost everything is from neurosurgeon. Now, think about it.

In community pathology samples come from a variety of sources. Surgeons obviously supply tissue for surgical pathology, but there is also hematopathology, cytopathology, medical renal/lung, and of course all of the laboratory tests. I'm pretty sure that all physicians send patient samples for laboratory testing.

In any case, my point about being dependent upon referrals wasn't clearly made - Pathology and Radiology are consult specialties that don't control the patients. That's why they are commoditized. Your patient doesn't know you or care who you are. You may provide a critical service, but you naturally have little power over your patients and overtraining will lead to exploitation of this fact in radiology just like it has in pathology.

This isn't a criticism of radiology - I think it's awesome. I just don't see a significant difference between what's happening in radiology and what has been happening in pathology.

 

[shark2000]

In community pathology samples come from a variety of sources. Surgeons obviously supply tissue for surgical pathology, but there is also hematopathology, cytopathology, medical renal/lung, and of course all of the laboratory tests. I'm pretty sure that all physicians send patient samples for laboratory testing.

In any case, my point about being dependent upon referrals wasn't clearly made - Pathology and Radiology are consult specialties that don't control the patients. That's why they are commoditized. Your patient doesn't know you or care who you are. You may provide a critical service, but you naturally have little power over your patients and overtraining will lead to exploitation of this fact in radiology just like it has in pathology.

This isn't a criticism of radiology - I think it's awesome. I just don't see a significant difference between what's happening in radiology and what has been happening in pathology.

I understand that you are not criticizing radiology. But IMO, your statement is self serving here. I assume you are a medical student who wants to choose between radiology and pathology. And you are more inclined towards pathology. OK, go for it. But, you want to convince yourself that you are doing the right thing. If you like pathology, you are doing the right thing. But you want to rationalize your choice.

As a pathologist you get samples mostly from surgery and some from radiology. You never get it from PCPs. Go back and take a look at my post about why it is important. When was the last time you got a sample from an ED doctor? Also radiology has immediate impact on patient care. This is why second opinion usually is not very useful. The patient is in the ED and the decision should be made in 20 minutes. This is different from pathology where you always have room for second opinion or even double reads.

Your statements about commoditization is repeating sth without knowing it. Radiology may be a commodity, but not more than hospitalist, ED, or even GI who is doing screening coloncopies without even saying hello to patients non stop.

Overtraining may be true for pathology, but not radiology. Radiology is 10 times more broad than pathology and needs a deep and broad knowledge. You can not cut it less. Your statement is again some false thing you have heard somewhere. Most of radiologists I work with feel UNDERTRAINED. Yes, undertrained.

Anyway, I am not going to waste my time more on your BSs. If it makes you happy I endorse your statement above that says radiology is like pathology, with more stress and call. So you get your answer, and be happy.

Good Luck .

 

[Enkidu]

I understand that you are not criticizing radiology. But IMO, your statement is self serving here. I assume you are a medical student who wants to choose between radiology and pathology. And you are more inclined towards pathology. OK, go for it. But, you want to convince yourself that you are doing the right thing. If you like pathology, you are doing the right thing. But you want to rationalize your choice.

You're more or less right, I'm interested in pathology and radiology. My sense was that a similar thing is happening in both fields. I'll keep your points in mind, although I have to be honest that I don't fully understand them.

Overtraining may be true for pathology, but not radiology. Radiology is 10 times more broad than pathology and needs a deep and broad knowledge. You can not cut it less. Your statement is again some false thing you have heard somewhere. Most of radiologists I work with feel UNDERTRAINED. Yes, undertrained.

Well - By Overtrained I mean to say that too many radiologists are being trained, not that individual radiologists know too much. My point is that a surplus of radiologists is making the job market difficult, just as in pathology - and that the two fields have other similarities as well.

 

[Boonu]

I'm not sure if this has been mentioned before, but you may be able to get straight into a PGY-2 position and avoid the match all together. Our PGY-1 year is just a Transitional Year after all, I'm sure most PDs would consider your surgery residency more than an adequate replacement for it. Look on boards like auntminnie.com or just start cold emailing residency programs to see if a PGY-2 spot opened up for next year from someone dropping (which seems to happen more often then you'd think).