What do I "need" in order to match diagnostic radiology?

[dgu334]

MS1 just ended and so far I have:

- passed all classes (got around 80% on all tests) in P/F US allopathic school
- 2 publications throughout the year + 1 pub prior to med school but all of these are in a different specialty and not radiology related
- working at a summer research internship this summer, also not radiology related
- contacted and plan on working with a radiology resident (not from any of my school's affiliated hospitals tho) on rads research that I can help with remotely from computer
- involved in a couple of interest groups and volunteer clubs (I know residencies don't really care about this)


What else should I be doing or think in of doing? What kind of step score do I need to get and how many clinical Honors would I need later on? Also, is scoring about 80% on all my tests first year indicative of a strong step 1 performance or do I need to be studying more? Thank you!!

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[IlDestriero]

Average step 1 and a pulse.

 

[charmiedermie]

MS1 just ended and so far I have:

- passed all classes (got around 80% on all tests) in P/F US allopathic school
- 2 publications throughout the year + 1 pub prior to med school but all of these are in a different specialty and not radiology related
- working at a summer research internship this summer, also not radiology related
- contacted and plan on working with a radiology resident (not from any of my school's affiliated hospitals tho) on rads research that I can help with remotely from computer
- involved in a couple of interest groups and volunteer clubs (I know residencies don't really care about this)


What else should I be doing or think in of doing? What kind of step score do I need to get and how many clinical Honors would I need later on? Also, is scoring about 80% on all my tests first year indicative of a strong step 1 performance or do I need to be studying more? Thank you!!

Apparently from what I've heard: a pulse and average to maybe slightly below average Step 1. There seem to be more than enough spots, about 1:1.

 

[BillrothI]

Has diagnostic radiology become less competitive in recent years? I remember it being one of the more lucrative specialties back in the mid-2000s, but I'd be interested to hear if things have changed.

-Bill

 

[WingedOx]

less and less every year, apparently.

 

[miamiheatfan]

If 80% is average to below average predicted Step, then what percent demonstrates an above average (not spectacular) Step? Also if I apply for residencies in the 2018-2019 school year, do you think a 230 Step will still be considered a decent score? For moderately competitive specialties such as EM and General Surgery. Do you think 240 will still be the “magical desired number” 3-5 years from now?

Sorry for getting on someone else’s thread but I don’t want to start a thread at this point haha!

 

[BillrothI]

less and less every year, apparently.

Is that a consequence of outsourcing? Or are there other reasons why diagnostic radiology has become less competitive?

Thanks,
Bill

 

[charmiedermie]

If 80% is average to below average predicted Step, then what percent demonstrates an above average (not spectacular) Step? Also if I apply for residencies in the 2018-2019 school year, do you think a 230 Step will still be considered a decent score? For moderately competitive specialties such as EM and General Surgery. Do you think 240 will still be the “magical desired number” 3-5 years from now?

Sorry for getting on someone else’s thread but I don’t want to start a thread at this point haha!

If I'm reading correctly, the 80% correct OP was talking about was on course exams. I don't know about @IlDestriero, but when I said average Step 1, I meant the current national average, which is 230 in 2014.

 

[Slack3r]

If 80% is average to below average predicted Step, then what percent demonstrates an above average (not spectacular) Step? Also if I apply for residencies in the 2018-2019 school year, do you think a 230 Step will still be considered a decent score? For moderately competitive specialties such as EM and General Surgery. Do you think 240 will still be the “magical desired number” 3-5 years from now?

Sorry for getting on someone else’s thread but I don’t want to start a thread at this point haha!

The average step 1 score this year was 228. So 230 in a few years will likely be an average-below average score. The 2014 Charting Outcomes shows that the average Step 1 for matched General Surgery and Emergency Medicine applicants was 232 and 230, respectively. An average score is fine for most specialties if you want to match SOMEWHERE, although "top" and academic programs will be more difficult regardless of the field.

 

[miamiheatfan]

If I'm reading correctly, the 80% correct OP was talking about was on course exams. I don't know about @IlDestriero, but when I said average Step 1, I meant the current national average, which is 230 in 2014.

Yeah OP meant course exams, I worded what I said poorly, my bad! And ok thanks!

The average step 1 score this year was 228. So 230 in a few years will likely be an average-below average score. The 2014 Charting Outcomes shows that the average Step 1 for matched General Surgery and Emergency Medicine applicants was 232 and 230, respectively. An average score is fine for most specialties if you want to match SOMEWHERE, although "top" and academic programs will be more difficult regardless of the field.

Oh wow, so I should definitely want to try to score 240 at least for “top” programs in the moderately competitive specialties. For something like PM&R, 230 would be good for an “above average” program; I would want to go for a fellowship if I followed this route. Either of you or anyone can answer, are Step 1 and 2 still considered heavily or at all for fellowships? Sorry if these questions are dumb, this is new to me. No more questions haha. Thank you both again.

 

[charmiedermie]

Yeah OP meant course exams, I worded what I said poorly, my bad! And ok thanks!

Oh wow, so I should definitely want to try to score 240 at least for “top” programs in the moderately competitive specialties. For something like PM&R, 230 would be good for an “above average” program; I would want to go for a fellowship if I followed this route. Either of you or anyone can answer, are Step 1 and 2 still considered heavily or at all for fellowships? Sorry if these questions are dumb, this is new to me. No more questions haha. Thank you both again.

The Charting Outcomes in the Match in 2014 says the average U.S. senior medical student who matched into PM&R in 2014 had a Step 1 score of 220, but remember they took Step 1 in 2012. If you have a 230, I think you'll be fine to match into PM&R, if not a very good PM&R program.

http://www.doctorsintraining.com/blog/usmle-step-1-average-match-scores-by-specialty/

 

[DeucesHigh3]

Ok I know you got a pile-on from people in non-radiology fields, but I'll do my best to answer as a recently-matched 4th year. There are a few answers to your question, depending on how you want to match.

1. On one hand, rads was basically the least competitive specialty this last year. If you are content to match *anywhere*, you need a non-failing Step 1 and a pulse (even a thready pulse would probably do). These are the programs that are malignant and filled with FMGs these days.

2. If you want to match to a top 15 program, or to an academic program in California, you need a 255+ Step 1, majority 3rd year Honors, and published research, preferably in the field. Also helps to be from a top ranked medical school, and have a solid LOR from a major name in the field. This is unchanged, and I understand it's pretty much the case for powerhouse programs in any field, no matter how uncompetitive in general. I personally know people who were a bit disappointed in the match this year because they were shooting for the stars, even though they were amazing applicants.

3. However, for the middle ground of very quality academic programs that are suddenly finding themselves bereft of quality applicants, it's a great time for applicants. Research? Totally unnecessary. Honors in 3rd year? At least a few would be a good idea, but just don't have your transcript contain a solid bunch of Pass and High Passes. Step 1? Still needs to be in the 240+ range. The reason that so many programs were unfilled in the pre-SOAP match is that the radiology boards are difficult, and programs would rather have stellar-but-disappointed Ophtho or Ortho applicants SOAP into radiology and then thrive, than accept marginal applicants who might fail the Core exam.

Ok, as for what to do now, in addition to what you already have done (or have planned). Something that's a good idea at this stage is to join the RSNA (free for med students). They mail you a cool monthly mini-journal (RSNA News), plus you get access to the Radiology and RadioGraphics journals online. Similarly you can join ARRS, which gets you access to the American Journal of Roentgenology for free. For some reason I never got around to joining ARRS, but there are interesting and accessible articles that you can't really get even through my med school's library. In addition to seeing whether those sorts of journals are something you could envision yourself reading over a career, it's a nice touch for your ERAS application to be able to show that you've been interested in rads since MS1.

Anyway, those are just my thoughts. Perhaps other recently-matched MS4s, residents, fellows will chime in. @Gadofosveset (a fellow) usually notices these threads pretty quickly and will have good advice.

 

[collegestud2013]

Is that a consequence of outsourcing? Or are there other reasons why diagnostic radiology has become less competitive?

Thanks,
Bill

It can't easily be outsourced due to regulations that only allow American-trained radiologists to bill U.S. insurance (so those in other countries are useless in terms of being able to generate revenue from it), even though the technology to do it is already there. There are, however, American-trained radiologists who are reading images from American patients in facilities at other countries (eg India being the main example) but are paid similar to American radiologists. Of course these people could have just gotten jobs directly the the U.S., so they are not technically being outsourced. This is done mainly to take advantage of the time difference (since it's generally more expensive to get radiologist coverage during the night).

Radiology has become less competitive because of significantly decreased insurance reimbursements from Medicare as a result of the federal government wanting to reduce spending (since imaging technology spending has been one of the major causes of bloated increased healthcare spending in the past few decades) This is especially true for diagnostic radiology but it seems like IR has taken less of a hit. The decreased Medicare reimbursements mean private insurance can push down reimbursements as well and still find physicians willing to take the insurance. The decreased reimbursements mean existing radiologists are working more hours and working harder during those hours to take on more volume so they can generate the same amount of revenue as before. This alone puts the good lifestyle of radiology that it once had out the window. Since existing radiologists are taking on more patients than demand for radiology services can keep up with, this means there are less numbers of radiologists that are needed in the market and hence why it's very difficult to find a job for new radiologists (and also more difficult to start your own private private), especially those who were trained at a lower tier program. That's why it's not hard to match into ANY program, but you still need to a very strong app to get into the top programs.

 

[dgu334]

Are there any specialties out there other than derm, ent, ophtho who's forecast is POSITIVE? It seems like literally every specialty is facing one problem or another and getting worse and worse every year...

 

[Roxas]

Are there any specialties out there other than derm, ent, ophtho who's forecast is POSITIVE? It seems like literally every specialty is facing one problem or another and getting worse and worse every year...

I'd guess EM, PM&R, and Psych?

 

[operaman]

I think there will still be room for positive happenings in all specialties, but the opportunities will get more and more scarce in each. Whereas once you could be any old radiologist and be just fine; now, you probably want to be a radiologist from a good program with a good fellowship as well. You see similar things in all the fields. I think the best advice is to give it your best so you have as many options as possible down the road.

 

[colbgw02]

It can't easily be outsourced due to regulations that only allow American-trained radiologists to bill U.S. insurance (so those in other countries are useless in terms of being able to generate revenue from it), even though the technology to do it is already there. There are, however, American-trained radiologists who are reading images from American patients in facilities at other countries (eg India being the main example) but are paid similar to American radiologists. Of course these people could have just gotten jobs directly the the U.S., so they are not technically being outsourced. This is done mainly to take advantage of the time difference (since it's generally more expensive to get radiologist coverage during the night).

Radiology has become less competitive because of significantly decreased insurance reimbursements from Medicare as a result of the federal government wanting to reduce spending (since imaging technology spending has been one of the major causes of bloated increased healthcare spending in the past few decades) This is especially true for diagnostic radiology but it seems like IR has taken less of a hit. The decreased Medicare reimbursements mean private insurance can push down reimbursements as well and still find physicians willing to take the insurance. The decreased reimbursements mean existing radiologists are working more hours and working harder during those hours to take on more volume so they can generate the same amount of revenue as before. This alone puts the good lifestyle of radiology that it once had out the window. Since existing radiologists are taking on more patients than demand for radiology services can keep up with, this means there are less numbers of radiologists that are needed in the market and hence why it's very difficult to find a job for new radiologists (and also more difficult to start your own private private), especially those who were trained at a lower tier program. That's why it's not hard to match into ANY program, but you still need to a very strong app to get into the top programs.

Second paragraph is well put and sums things up nicely, but your first paragraph isn't quite complete.

CMS requires that any reimbursement be done for work performed within the United States. As a practical matter, this means radiologists located on foreign soul cannot provide final reads because it's impractical to have one person reading Medicare patients and another reading non-Medicare patients.

So, teleradiologists outside of the U.S. provide only preliminary reads, which then must be overread and finalized by a radiologist in the U.S., usually the next morning. Although still relatively common, this is becoming less popular as, in the face of declining reimbursements, groups are unwilling to pay for the preliminary read.

There are some foreign radiologists, who may or may not be U.S. trained, who provide "preliminary" reads that are then rubber-stamped later by a U.S. radiologist without an actual overread. This is done so that the U.S. radiologist can bill for an enormous number of studies, paying the foreign guys a small fraction, and making bank. This is not common, largely because it is illegal, so if whenever see a radiologist who "reads" something like 60K studies per year, I'm pretty sure he's running some sort of scam.

 

[BillrothI]

Thank you for your insight, @collegestud2013 and @colbgw02. That is very helpful. It certainly sounds like there are valid reasons why the field is no longer as competitive as it once was. Granted, a lot of specialists seem to be taking financial hits, but radiologists may have gotten it the worst.

-Bill

 

[Slack3r]

Are there any specialties out there other than derm, ent, ophtho who's forecast is POSITIVE? It seems like literally every specialty is facing one problem or another and getting worse and worse every year...

Derm is saturated in major markets, and has over trained dermpath and Mohs specialists. Ophtho is extremely saturated in pretty much all markets and has very low starting salaries due to older ophthos employing young physicians for peanuts.

Medicine, in all fields, is much different today than it was 20-30 years ago.

 

[Shipping News]

Ok I know you got a pile-on from people in non-radiology fields, but I'll do my best to answer as a recently-matched 4th year. There are a few answers to your question, depending on how you want to match.

1. On one hand, rads was basically the least competitive specialty this last year. If you are content to match *anywhere*, you need a non-failing Step 1 and a pulse (even a thready pulse would probably do). These are the programs that are malignant and filled with FMGs these days.

2. If you want to match to a top 15 program, or to an academic program in California, you need a 255+ Step 1, majority 3rd year Honors, and published research, preferably in the field. Also helps to be from a top ranked medical school, and have a solid LOR from a major name in the field. This is unchanged, and I understand it's pretty much the case for powerhouse programs in any field, no matter how uncompetitive in general. I personally know people who were a bit disappointed in the match this year because they were shooting for the stars, even though they were amazing applicants.

3. However, for the middle ground of very quality academic programs that are suddenly finding themselves bereft of quality applicants, it's a great time for applicants. Research? Totally unnecessary. Honors in 3rd year? At least a few would be a good idea, but just don't have your transcript contain a solid bunch of Pass and High Passes. Step 1? Still needs to be in the 240+ range. The reason that so many programs were unfilled in the pre-SOAP match is that the radiology boards are difficult, and programs would rather have stellar-but-disappointed Ophtho or Ortho applicants SOAP into radiology and then thrive, than accept marginal applicants who might fail the Core exam.

Ok, as for what to do now, in addition to what you already have done (or have planned). Something that's a good idea at this stage is to join the RSNA (free for med students). They mail you a cool monthly mini-journal (RSNA News), plus you get access to the Radiology and RadioGraphics journals online. Similarly you can join ARRS, which gets you access to the American Journal of Roentgenology for free. For some reason I never got around to joining ARRS, but there are interesting and accessible articles that you can't really get even through my med school's library. In addition to seeing whether those sorts of journals are something you could envision yourself reading over a career, it's a nice touch for your ERAS application to be able to show that you've been interested in rads since MS1.

Anyway, those are just my thoughts. Perhaps other recently-matched MS4s, residents, fellows will chime in. @Gadofosveset (a fellow) usually notices these threads pretty quickly and will have good advice.

This is all accurate in my opinion. I matched rads last year. The top-tier programs (Cali, MGH, Brigham, etc) are still really competitive and want perfect applicants. It's similar IM where the top programs (Hopkins, UCSF, MGH, Brigham) are relentless rough to match but there's a program for everybody somewhere in IM.

One other thing: if you want to go into radiology, do yourself a favor and get into the best possible program you can get into. Since the job market is tough, all feathers in your cap count. Try to go to the best program in the region, state, or city you eventually want to practice in.

 

[seminoma]

Yeah OP meant course exams, I worded what I said poorly, my bad! And ok thanks!

Oh wow, so I should definitely want to try to score 240 at least for “top” programs in the moderately competitive specialties. For something like PM&R, 230 would be good for an “above average” program; I would want to go for a fellowship if I followed this route. Either of you or anyone can answer, are Step 1 and 2 still considered heavily or at all for fellowships? Sorry if these questions are dumb, this is new to me. No more questions haha. Thank you both again.

No, you will want to try to score at least 250 for "top programs" in any specialty. Higher and with more research for "top programs" in "moderately competitive" specialty. 240 probably wouldn't get you into Psych at Mayo.

 

[Raryn]

Q: What do I "need" in order to match diagnostic radiology?
A: A pulse. Some kind of doctorate in medicine helps as well.

 

[clausewitz2]

No, you will want to try to score at least 250 for "top programs" in any specialty. Higher and with more research for "top programs" in "moderately competitive" specialty. 240 probably wouldn't get you into Psych at Mayo.

It probably would be fine for psych at Mayo, as that particular program is not on anybody's list of a top-notch psych residency. Sub in, I don't know, Columbia and your point is well taken.

 

[calvnandhobbs68]

It can't easily be outsourced due to regulations that only allow American-trained radiologists to bill U.S. insurance (so those in other countries are useless in terms of being able to generate revenue from it), even though the technology to do it is already there. There are, however, American-trained radiologists who are reading images from American patients in facilities at other countries (eg India being the main example) but are paid similar to American radiologists. Of course these people could have just gotten jobs directly the the U.S., so they are not technically being outsourced. This is done mainly to take advantage of the time difference (since it's generally more expensive to get radiologist coverage during the night).

Radiology has become less competitive because of significantly decreased insurance reimbursements from Medicare as a result of the federal government wanting to reduce spending (since imaging technology spending has been one of the major causes of bloated increased healthcare spending in the past few decades) This is especially true for diagnostic radiology but it seems like IR has taken less of a hit. The decreased Medicare reimbursements mean private insurance can push down reimbursements as well and still find physicians willing to take the insurance. The decreased reimbursements mean existing radiologists are working more hours and working harder during those hours to take on more volume so they can generate the same amount of revenue as before. This alone puts the good lifestyle of radiology that it once had out the window. Since existing radiologists are taking on more patients than demand for radiology services can keep up with, this means there are less numbers of radiologists that are needed in the market and hence why it's very difficult to find a job for new radiologists (and also more difficult to start your own private private), especially those who were trained at a lower tier program. That's why it's not hard to match into ANY program, but you still need to a very strong app to get into the top programs.

Another major factor...radiology is one of the few fields where attendings can literally work till they can't see a computer screen anymore. It's one of the least physically taxing fields (definitely the field with the comfiest chairs). Definitely also heard of older attendings working from home/vacation spot a significant part of the year...all you need to do reads are a fast internet connection and some sweet monitors. This obviously doesn't help job prospects for new grads at all.