What do I not know about radiology that you can only know by being a radiologist?

[insearchofwisdom]

I am a nontraditional applicant to radiology. I have spoken to numerous radiologists and many people who have switched from other specialties into radiology (like I'm trying to do). I have done some shadowing. I have read every article about radiology burnout I can get my hands on. When I've done shadowing, I've often been like "OMG, you guys get paid to do this?!" It is just such a different world than what we do all day and I love anatomy and I love correlating it with the clinical side of things that I have seen for years. I am going to sum up what I understand so far (with some of my own comments) and have a few questions. Can you guys help me figure out what I'm missing? I am trying to avoid grass is greener and make sure I am truly trying to do my own diligence.

1. Going back to residency sucks
BUT it sounds like weekend calls are relatively rare, you do some nights (but not akin to the q4h you do in IM residency). Overall, it's daytime hours Mon-Fri with occasional evenings/weekends. How many hours on average per week are you working?

2. You feel like a cog in the wheel and are constantly pressured to produce more
This is true in almost every specialty in medicine so frankly this is no different than what most of us experience in other parts of medicine. I'm also efficient. So when I'm at work, I kind of like to get stuff done.

3. The interruptions are frustrating and it can be annoying to talk to the ordering providers
I can see how interruptions can be annoying and slow you down. As a current ordering provider, I think this draws me in because I like working on a team. I can understand the entitlement is not fun but I think I'd rather have entitlement from other physicians than from patients. Is it really THAT bothersome?

4. You don't get any of the credit
I can see how feeling this way sucks but it's kind of tradeoff for not having to soothe patients all day (if I may be so honest). You almost have to choose one or the other if you want to stay in clinical medicine. Would you rather discuss cases with patients or with doctors? For me, the latter as far as I can tell.

5. There is a lot of anxiety about missing something. Malpractice concerns are high.
I'm less surprised by this since you are caring for higher volume of patients. Higher volume = higher chance of mistakes. Also, I know the pressure to produce more doesn't help here. How much has this affected your life day-to-day? Really interested in understanding this.

6. Job market is hit or miss? Salary is getting worse.
My understanding of this is that it ebbs and flows and with teleradiology available now, might be more options.
I can understand salary reduction being a nuisance but overall, still better than many other specialties in medicine


Some burning questions:
A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

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[Cognovi]

1. Going back to residency sucks
BUT it sounds like weekend calls are relatively rare, you do some nights (but not akin to the q4h you do in IM residency). Overall, it's daytime hours Mon-Fri with occasional evenings/weekends. How many hours on average per week are you working?

Average 55 hours a week

2. You feel like a cog in the wheel and are constantly pressured to produce more
This is true in almost every specialty in medicine so frankly this is no different than what most of us experience in other parts of medicine. I'm also efficient. So when I'm at work, I kind of like to get stuff done.

Agree with you. When you're at work, you're not waiting around or walking around, you're putting your mind to use constantly.

3. The interruptions are frustrating and it can be annoying to talk to the ordering providers
I can see how interruptions can be annoying and slow you down. As a current ordering provider, I think this draws me in because I like working on a team. I can understand the entitlement is not fun but I think I'd rather have entitlement from other physicians than from patients. Is it really THAT bothersome?

Agree with you. Each referrer phone call is a call for help from someone who is an expert in their own field and a golden opportunity to demonstrate my added value.

4. You don't get any of the credit
I can see how feeling this way sucks but it's kind of tradeoff for not having to soothe patients all day (if I may be so honest). You almost have to choose one or the other if you want to stay in clinical medicine. Would you rather discuss cases with patients or with doctors? For me, the latter as far as I can tell.

Agree with you. Patients don't judge you or recognize you by how smart you are, but fellow doctors do.

5. There is a lot of anxiety about missing something. Malpractice concerns are high.
I'm less surprised by this since you are caring for higher volume of patients. Higher volume = higher chance of mistakes. Also, I know the pressure to produce more doesn't help here. How much has this affected your life day-to-day? Really interested in understanding this.

I don't think malpractice risk makes radiologists lose sleep, but it probably discourages some from reading higher risk modalities like obstetric ultrasound and mammography, and it probably encourages many more to hedge in reports and/or recommend low-value follow-up studies. I'm just a resident so I don't know more. In my view, malpractice risk is a fact of medicince, radiology tends to fall near the middle of the pack for malpractice risk/payouts, and we shouldn't let malpractice fear drive down our value.

6. Job market is hit or miss? Salary is getting worse.
My understanding of this is that it ebbs and flows and with teleradiology available now, might be more options.
I can understand salary reduction being a nuisance but overall, still better than many other specialties in medicine

This is also my outlook. Market forces are difficult to predict but historically radiology has done above average.

A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

I think the spectrum of practice is wide, so you'll be able to find a place that is suited for you in terms of speed.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

I don't know since I'm still a resident, but it seems to me that a field that is so heavily dependent on technology will evolve a lot, on top of evolving as knowledge of medicine advances, so there will be much to learn over a career. You have to like learning about medicine, broadly, and have a techy inclination.

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

You can check out job postings (eg, ACR) and see that there are jobs that advertise they have a different telerads group cover nights and evenings and many advertised jobs are exclusively nights/weekends so that the other people in the practice don't have to do it.

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

Your visual skills as a radiologist do not generalize to being better at other visual search tasks like Where's Waldo.

 

[guytakingboards]

Some burning questions:
A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

The answer for most of your burning questions is: it depends.

Radiology is one of the few specialties where jobs options run the gamut from making a million per year in PP (taking a ton of crushing call) to making $300k at a VA (with no nights or weekends) and everything in between.

A) At a busy PP, your cortisol is probably gonna be elevated all call shift. The burnout comes if you do too many call shifts back to back. In my practice, I don't feel a huge pressure to grind the list constantly when I sit down *on a day shift*. I can take breaks here and there. Plenty of VA and academic jobs the faculty are completely unstressed by the clinical work.

B) Yes. But that's any job. General radiology is actually fairly challenging as being competent on all modalities and disease processes is really tough. That keeps you engaged when you're constantly having to look stuff up.

C) Most jobs are gonna be a weekday- daytime with occasional evenings/weekends. Few are gonna have overnight calls. Shifting from full time to part time is feasible in most settings. If you wanted to get a cush outpatient imaging gig with no evenings or weekends, expect the salary and vacation to be lower.

 

[Dryad8212]

The answer for most of your burning questions is: it depends.

Radiology is one of the few specialties where jobs options run the gamut from making a million per year in PP (taking a ton of crushing call) to making $300k at a VA (with no nights or weekends) and everything in between.

A) At a busy PP, your cortisol is probably gonna be elevated all call shift. The burnout comes if you do too many call shifts back to back. In my practice, I don't feel a huge pressure to grind the list constantly when I sit down. I can take breaks here and there. Plenty of VA and academic jobs the faculty are completely unstressed by the clinical work.

B) Yes. But that's any job. General radiology is actually fairly challenging as being competent on all modalities and disease processes is really tough. That keeps you engaged when you're constantly having to look stuff up.

C) Most jobs are gonna be a weekday- daytime with occasional evenings/weekends. Few are gonna have overnight calls. Shifting from full time to part time is feasible in most settings. If you wanted to get a cush outpatient imaging gig with no evenings or weekends, expect the salary and vacation to be lower.

Is call in radiology 24 hour coverage or is until a certain time like 9pm or something? Noob asking sorry. I dont care about money up to a certain point but how many call hours per week would one have to take in order to gross a mil ?

 

[maxxor]

Is call in radiology 24 hour coverage or is until a certain time like 9pm or something? Noob asking sorry. I dont care about money up to a certain point but how many call hours per week would one have to take in order to gross a mil ?

Call is locally defined but I generally mean it to mean “working a set period of time that would generally be considered ‘nights, weekends, or holidays’”

 

[Clean7795]

Some burning questions:
A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

A) Varies but in general you're working and not stepping away for prolonged periods. I know this sort of sounds like any other medical specialty but in the natural workflow of surgery and medicine there are built in inefficiencies that lead to breaks. The equivalent would be if you had a conveyor belt that brought all patients (consults, inpatients, outpatients) straight to you, which sounds nice at first but soon enough this increased efficiency leads to you filling up your scheduled with two or three times the number of patients. This also means that your "cognitive load" becomes much heavier and even tiny interruptions will be much more bothersome.

There's usually still time to go grab a coffee or takes a leak (on a normal day) of course. On call it may be different as a resident.

B) All work becomes a bit repetitive. Most people who enter radiology enjoy it so reading about new developments in their subspecialty or developing a new imaging program or adding some interventional work can be rewarding.

C) This varies a lot depending on geography. Some groups may be very large and have infrequent call. Others may have a telerad group cover overnight. Others work like they were in residency because they prefer a small lean group.

D) You'll learn how little most physicians know outside their immediate specialty (and sometimes within their specialty)! I'm kidding, sort of.

But for real, radiology is a humbling specialty. You'll frequently see crazy **** and complications from surgery/medical management that make you much more aware of how human other physicians are in their capabilities. Your own misses will also keep you grounded.

 

[giguerex35]

The answer for most of your burning questions is: it depends.

Radiology is one of the few specialties where jobs options run the gamut from making a million per year in PP (taking a ton of crushing call) to making $300k at a VA (with no nights or weekends) and everything in between.

A) At a busy PP, your cortisol is probably gonna be elevated all call shift. The burnout comes if you do too many call shifts back to back. In my practice, I don't feel a huge pressure to grind the list constantly when I sit down *on a day shift*. I can take breaks here and there. Plenty of VA and academic jobs the faculty are completely unstressed by the clinical work.

B) Yes. But that's any job. General radiology is actually fairly challenging as being competent on all modalities and disease processes is really tough. That keeps you engaged when you're constantly having to look stuff up.

C) Most jobs are gonna be a weekday- daytime with occasional evenings/weekends. Few are gonna have overnight calls. Shifting from full time to part time is feasible in most settings. If you wanted to get a cush outpatient imaging gig with no evenings or weekends, expect the salary and vacation to be lower.

is a million actually a possible number for a radiologist or is this hyperbole

 

[clutch21]

is a million actually a possible number for a radiologist or is this hyperbole

Possible, albeit rare.

 

[guytakingboards]

is a million actually a possible number for a radiologist or is this hyperbole

Possible but uncommon to rare. I know anecdotally of a least a few groups in that range year-in/year-out. They're usually notable for a ton of call, busy call shifts, busy day work and lots of partner divorces.

 

[Dryad8212]

Possible but uncommon to rare. I know anecdotally of a least a few groups in that range year-in/year-out. They're usually notable for a ton of call, busy call shifts, busy day work and lots of partner divorces.

Does radiology take call overnight coverage or can it end say at a time like 9pm?

 

[guytakingboards]

Does radiology take call overnight coverage or can it end say at a time like 9pm?

Any group that covers ER and inpatient services is likely a 24/7 coverage group. How they choose to cover that 24 hour period is up to highly variable.

-Some groups choose to send out all evening and overnight cases to a teleradiology service.
-Some groups choose to cover X amount of evenings and/or Y amount of overnights and then send the rest out to telerad
-Some groups entirely internally cover their evenings and overnights, whether as call or having separate evening/overnight teams.

It depends on the size of the group and the financial desires of the group/partners. The more cases that get sent out to telerad, the lower the partner salary.

That being said, in academics generally you won't cover overnight shifts unless you're specifically hired for that.

 

[90sportsfan]

I am a nontraditional applicant to radiology. I have spoken to numerous radiologists and many people who have switched from other specialties into radiology (like I'm trying to do). I have done some shadowing. I have read every article about radiology burnout I can get my hands on. When I've done shadowing, I've often been like "OMG, you guys get paid to do this?!" It is just such a different world than what we do all day and I love anatomy and I love correlating it with the clinical side of things that I have seen for years. I am going to sum up what I understand so far (with some of my own comments) and have a few questions. Can you guys help me figure out what I'm missing? I am trying to avoid grass is greener and make sure I am truly trying to do my own diligence.

5. There is a lot of anxiety about missing something. Malpractice concerns are high.
I'm less surprised by this since you are caring for higher volume of patients. Higher volume = higher chance of mistakes. Also, I know the pressure to produce more doesn't help here. How much has this affected your life day-to-day? Really interested in understanding this.

In several different PubMed studies that have done analyses, Radiology is frequently classified as a "High Risk" specialty. One of the studies shows that about 75% are sued at some point. It is always less than OBGYN and Surgery, but it is usually the next specialty (depending on the study) and is frequently higher than EM and Anesthesiology.

I've asked about how true this is in the "real world" on this site before and very few respond (which leads me to think it's not something Radiologists like to discuss, which is fair), but by the lack of response, I'm guessing there is some truth to it being a higher risk specialty.

Since I am considering radiology, I have networked with a private practice Radiologist and he told me that he has been "named a couple of times," but was ultimately dropped from the suit. He did tell me that there have been some Radiologists he knows who have had "big misses" and have been sued successfully.

I have not discussed it with any of the Radiologists at my academic institution (and probably won't), so I still don't have a good sense of how bad malpractice is in radiology "in the real world" (only an N=1), but from everything I have read, it seems to be on the "higher end" of specialties, which is a little nerve-wrecking.

 

[Pier]

What is the aftermath when sued? What if you lose? Is it like getting into a crash with your car (you'll just pay more annual insurance) or something worse than that?

 

[90sportsfan]

What is the aftermath when sued? What if you lose? Is it like getting into a crash with your car (you'll just pay more annual insurance) or something worse than that?

Only a med student, so take that with a grain of salt. But from what I have heard, very few cases make it to trial if you have documented well and performed standard of care. The issue with radiology, which makes it higher risk than most specialties, is that "a miss is a miss" and it's right on the image. Assuming it leads to harm, there's no defense for that. Malpractice insurance should cover most cases, assuming it's not a really huge miss that leads to severe morbidity/mortality. The bigger issue will be the need to report it throughout renewal of credentialing/licensure.

Radiology is one of the higher risk specialties that seem to get sued more than most, and they are still out there practicing. So I'm guessing, outside of the very rare egregious lawsuits, it's not too big of a deal long term (i.e. most won't be permanently done after being sued). And if you are sued but you are eventually dropped from the lawsuit, I've heard it's more of just an inconvenient hassle (waiting to get dropped and then documenting what happened on any licensing/credentialing when it asks if you have been sued).

 

[radsresident-US]

1. Going back to residency sucks
BUT it sounds like weekend calls are relatively rare, you do some nights (but not akin to the q4h you do in IM residency). Overall, it's daytime hours Mon-Fri with occasional evenings/weekends. How many hours on average per week are you working?

It all depends on the program, generally with bigger programs having less call because of more residents to take it. There are some programs that may be large but have a lot of small hospitals to cover, which can lead to multiple residents on a call shift at one time, which leads to a lot of call.

Outside of the call, I would say most programs are in the 8-5, 45 hour work week range

2. You feel like a cog in the wheel and are constantly pressured to produce more
This is true in almost every specialty in medicine so frankly this is no different than what most of us experience in other parts of medicine. I'm also efficient. So when I'm at work, I kind of like to get stuff done.

I would say though that radiology and pathology are somewhat unique in that because we are effectively performing consultations without patient interaction, there is no upper limit to our volume. I.e. a rheumatologist can and probably does get pressure to see more patients/do more consults, but they need to actually spend some time with the patient or patients will complain, which effects various metrics the bean counters care about. So if you need to spend a minimum of 10min per patient encounter, with 5 min in between encounters, theres effectively a limit of seeing 4x8 = 32 patients in an 8hour day. No such limit exists in radiology. Some groups want RVU's of 100+ per day, (lets say 100 CT A/P per day) with people reading at that volume very unsafely and probably never being comfortable at that volume. Of course you can find low volume groups as well. Point is, if an average rheumatologist sees 30 patients, an extremely efficient one might see 45, or 1.5x. There are radiologists with 6-7k RVU's/yr and others with 20k+, a 3 fold difference. This I feel is truly unique to radiology

3. The interruptions are frustrating and it can be annoying to talk to the ordering providers
I can see how interruptions can be annoying and slow you down. As a current ordering provider, I think this draws me in because I like working on a team. I can understand the entitlement is not fun but I think I'd rather have entitlement from other physicians than from patients. Is it really THAT bothersome?

I generally don't get annoyed by this and enjoy being a consultant, as long as the group understands this is nonbillable time. I.e. a telerad group is not going to care if you are discussing cases with providers, the time you spend on this will just decrease your rvus and make you stay later. Hospital and private practice jobs may account for time you spend on this in some way.

4. You don't get any of the credit
I can see how feeling this way sucks but it's kind of tradeoff for not having to soothe patients all day (if I may be so honest). You almost have to choose one or the other if you want to stay in clinical medicine. Would you rather discuss cases with patients or with doctors? For me, the latter as far as I can tell.

Never even considered this as a downside.

5. There is a lot of anxiety about missing something. Malpractice concerns are high.
I'm less surprised by this since you are caring for higher volume of patients. Higher volume = higher chance of mistakes. Also, I know the pressure to produce more doesn't help here. How much has this affected your life day-to-day? Really interested in understanding this.

I think it's not really sustainable to be considering your malpractice risk on day-to-day basis. You pretty much just read your cases and do you best, and hope you don't miss anything big, even though statistically you will at some point. Then you get the peer review or feedback you missed something, feel bad about it for awhile, and move on. Maybe you get sued, maybe not. I think the main fear has to do with extremely high volume practices that force you to read at unsafe volumes, and you then have to consider your malpractice risk

6. Job market is hit or miss? Salary is getting worse.
My understanding of this is that it ebbs and flows and with teleradiology available now, might be more options.
I can understand salary reduction being a nuisance but overall, still better than many other specialties in medicine

Teleradiology has been around forever and I don't see any reason for it to increase, the technology and groups that utilise it are already active. Job market has been pretty good in radiology, despite a lot of specialties taking a hit with COVID, rads are still in high demand. Boomers are getting older and sicker, and in general the culture of medicine has shifted to imaging every complaint in some way, especially with NPs/PAs that have been shown to utilize imaging more.

Some burning questions:
A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

Depends on the practice. Rads are in high demand enough you can probably find a group that is lower volume, although sacrificing other factors. A high volume practice, can be anywhere from 50-60 cross sectional cases a day to 100+, which is frankly an insane speed. I think a large proportion of radiologists including myself feel that they could never safely practice at that speed, but some are forced to. Theres not much to say about it, if you cant read that fast, you leave the group and find another job. Other jobs are out there.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

Not really, its diverse enough and genrads requires knowledge of so many specialties and fields, you are always learning things and looking up stuff.

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

Part time is still relatively hard to come by, but not impossible. There are jobs without forced call, some groups are even moving to per diem call shifts even if internally. Based on my job search, part time is only really offered by high volume PP groups who make you read more cases in exchange for fewer shifts. So its a give and take. I have not found any jobs that are relatively low-speed/low-volume, and also part time


D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

Radiology involves an awful lot of judgement. Every imaging study has many findings which are almost certainly nothing or benign, but could be disastrous. You need a refined sense of judgment to know when to suggest possible abnormality, knowing that you may be wrong 99% of the time, even if you call it, and thats ok to not miss the 1/100 case. You make alot of decisions because of how much imaging is relied upon, and therefore face the consequences of wrong decisions. This is what make radiology so high risk. If this scares you, maybe radiology is not the right field

 

[90sportsfan]

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

Radiology involves an awful lot of judgement. Every imaging study has many findings which are almost certainly nothing or benign, but could be disastrous. You need a refined sense of judgment to know when to suggest possible abnormality, knowing that you may be wrong 99% of the time, even if you call it, and thats ok to not miss the 1/100 case. You make alot of decisions because of how much imaging is relied upon, and therefore face the consequences of wrong decisions. This is what make radiology so high risk. If this scares you, maybe radiology is not the right field

I think this is the one thing that I have a little trepidation about. It seems like there could be lots of artifacts on images, but the fear that it could be something seems like it could make me paranoid, and constantly wondering (did I miss something, lol). Given my neurotic personality, I'm worried about constantly being paranoid over potential misses would make me miserable in radiology. Pathology seems like it could have the same issues, since you are making critical calls.

Is this something that's normal with residents to begin with that eventually fades away?

 

[guytakingboards]

I think this is the one thing that I have a little trepidation about. It seems like there could be lots of artifacts on images, but the fear that it could be something seems like it could make me paranoid, and constantly wondering (did I miss something, lol). Given my neurotic personality, I'm worried about constantly being paranoid over potential misses would make me miserable in radiology. Pathology seems like it could have the same issues, since you are making critical calls.

Is this something that's normal with residents to begin with that eventually fades away?

In general, the anxiety fades over time but it shouldn't ever fade to zero. A person with zero anxiety about their reports is someone who isn't worried about outcomes or repercussions, and that's probably a dangerous rad.... or someone really close to retirement (or both).

It'll go in waves, with graded autonomy.
-1st year: you know nothing and you're gonna miss a ton of ****. Fortunately, everyone knows that and your report won't go out until an attendings seen it.

- 2nd-3rd year: first time taking independent/semi-independent call. a ton of people worry about missing stuff and rightfully so, there's a lot they haven't seen before. a ton DOES get missed by overnight residents. hopefully it doesn't harm the patient in a particularly onerous way, but probably most residents have had a call case where they missed something and the patient had a bad outcome.

-Upper-level residency/fellowship/early attending-hood: at some point you'll start signing off final reports in your name and yes you will worry about missing ****.

As you get comfortable with the repetition, your misses will go down, your search pattern will get better and you'll mostly master the "can't miss" findings..... then as you start to get comfortable you miss something and get reminded to stay vigilant in your approach.


Shorter answer: by the time people become attendings they aren't overcome by their fear of missing stuff. I've only ever anecdotally heard the rare person who couldn't handle radiology for that reason.

 

[Radology]

Man I disagree that you need a level of anxiety to be a functional radiologist

you should be motivated by professionalism and altruism, not by fear of missing something and getting in trouble. Obsessive over calling causes emotional and sometimes physical damage too.

Be confident and concise. Referrers want the person who calls it like he sees it with reasonable accuracy over the one giving 10 differential diagnoses for every indeterminate finding and recommending a follow up or biopsy for every probable benign finding.

You will make mistakes no matter how hard you try and how much you know, that is true of every field of medicine and you need to accept it

 

[vm26]

I am a nontraditional applicant to radiology. I have spoken to numerous radiologists and many people who have switched from other specialties into radiology (like I'm trying to do). I have done some shadowing. I have read every article about radiology burnout I can get my hands on. When I've done shadowing, I've often been like "OMG, you guys get paid to do this?!" It is just such a different world than what we do all day and I love anatomy and I love correlating it with the clinical side of things that I have seen for years. I am going to sum up what I understand so far (with some of my own comments) and have a few questions. Can you guys help me figure out what I'm missing? I am trying to avoid grass is greener and make sure I am truly trying to do my own diligence.

1. Going back to residency sucks
BUT it sounds like weekend calls are relatively rare, you do some nights (but not akin to the q4h you do in IM residency). Overall, it's daytime hours Mon-Fri with occasional evenings/weekends. How many hours on average per week are you working?

2. You feel like a cog in the wheel and are constantly pressured to produce more
This is true in almost every specialty in medicine so frankly this is no different than what most of us experience in other parts of medicine. I'm also efficient. So when I'm at work, I kind of like to get stuff done.

3. The interruptions are frustrating and it can be annoying to talk to the ordering providers
I can see how interruptions can be annoying and slow you down. As a current ordering provider, I think this draws me in because I like working on a team. I can understand the entitlement is not fun but I think I'd rather have entitlement from other physicians than from patients. Is it really THAT bothersome?

4. You don't get any of the credit
I can see how feeling this way sucks but it's kind of tradeoff for not having to soothe patients all day (if I may be so honest). You almost have to choose one or the other if you want to stay in clinical medicine. Would you rather discuss cases with patients or with doctors? For me, the latter as far as I can tell.

5. There is a lot of anxiety about missing something. Malpractice concerns are high.
I'm less surprised by this since you are caring for higher volume of patients. Higher volume = higher chance of mistakes. Also, I know the pressure to produce more doesn't help here. How much has this affected your life day-to-day? Really interested in understanding this.

6. Job market is hit or miss? Salary is getting worse.
My understanding of this is that it ebbs and flows and with teleradiology available now, might be more options.
I can understand salary reduction being a nuisance but overall, still better than many other specialties in medicine


Some burning questions:
A) When people talk about speed, how fast are we talking here? This is maybe the thing that is making me the most nervous. Is it fast enough that your cortisol is spiking through the roof every time you're working/on call, or fast enough that you need to be on your A game but can totally handle it without burning out each shift? Is the high speed mostly occasional or this is constant everyday? I know this varies by job but I am genuinely worried about this. I'm a pretty efficient attending but don't want to feel like I'm about to pee in my pants all day the way some posters describe.

B) Do you get bored after some years? Does this impact your work? How do you stay interested?

C) Do you pretty much have to find a job where you're working evenings/weekends or it's reasonable to find a job where you work mostly weekday hours? Also, is part-time fairly realistic down the road or hard to come by? Even if you did experience burnout, did switching to part-time help? So far, the most burned out radiologists I've spoken to weren't willing to reduce their hours so seemed like a self-defeating cycle.

D) MOST IMPORTANTLY: What else do I not know that you could only know after being a radiologist?
Thank you so much and I just want you all to know how appreciated you are in the clinical world!!

The field is infiltrated by P/E, and apparently the ACR (radiology advocacy) has also been infiltrated by P/E so by the time you graduate, the market will likely be tight and your options will be limited to P/E, where you are making money for board members/share-holders, or cr*ppy PP groups where the senior partners need more cash to retire after divorce #3 and will make this by underpaying you for your work.

With that said, working for an equitable, democratic PP these days is actually still a great gig. If want to make big bucks you can, but you will work your a$$ off for it. If you want work/life balance, you can find that as well. Realistically speaking I think these opportunities will become scarce.

Getting sued s*cks, even if the case is dropped before going to trial. The sting will linger for a while but you recover and carry on.

I would recommend becoming a NP/PA. Good luck.

 

[radsresident-US]

I think this is the one thing that I have a little trepidation about. It seems like there could be lots of artifacts on images, but the fear that it could be something seems like it could make me paranoid, and constantly wondering (did I miss something, lol). Given my neurotic personality, I'm worried about constantly being paranoid over potential misses would make me miserable in radiology. Pathology seems like it could have the same issues, since you are making critical calls.

Is this something that's normal with residents to begin with that eventually fades away?

I don’t think residents have that anxiety at all really, I certainly didn’t. Ultimately, it’s the attendings name on the report. Residents just don’t get sued. You’re never going to get kicked out of a program cause you missed a PE or something.

there’s always going to be some degree of anxiety in radiology practice regarding “what am I missing”. Eventually you get used to it and it doesn’t seem particularly out of the ordinary. You get faster and better while this is going on and have confidence you can do a quick scroll of a ct and see 99% of findings in the first 30 seconds - the rest of the 5 minutes on the study is just describing and covering the 1%.

ultimately I have heard of a few people who did leave radiology because of the anxiety and high risk nature of reading a lot of studies. One ultimately did internal medicine, another was a woman who married an investment banker and didn’t have to work, and I think just became a housewife. It’s extremely rare for people to do this though .

 

[90sportsfan]

I don’t think residents have that anxiety at all really, I certainly didn’t. Ultimately, it’s the attendings name on the report. Residents just don’t get sued. You’re never going to get kicked out of a program cause you missed a PE or something.

there’s always going to be some degree of anxiety in radiology practice regarding “what am I missing”. Eventually you get used to it and it doesn’t seem particularly out of the ordinary. You get faster and better while this is going on and have confidence you can do a quick scroll of a ct and see 99% of findings in the first 30 seconds - the rest of the 5 minutes on the study is just describing and covering the 1%.

ultimately I have heard of a few people who did leave radiology because of the anxiety and high risk nature of reading a lot of studies. One ultimately did internal medicine, another was a woman who married an investment banker and didn’t have to work, and I think just became a housewife. It’s extremely rare for people to do this though .

Thanks so much for this explanation! This is comforting to hear.

 

[TXRads]

The field is infiltrated by P/E, and apparently the ACR (radiology advocacy) has also been infiltrated by P/E so by the time you graduate, the market will likely be tight and your options will be limited to P/E, where you are making money for board members/share-holders, or cr*ppy PP groups where the senior partners need more cash to retire after divorce #3 and will make this by underpaying you for your work.

With that said, working for an equitable, democratic PP these days is actually still a great gig. If want to make big bucks you can, but you will work your a$$ off for it. If you want work/life balance, you can find that as well. Realistically speaking I think these opportunities will become scarce.

Getting sued s*cks, even if the case is dropped before going to trial. The sting will linger for a while but you recover and carry on.

I would recommend becoming a NP/PA. Good luck.

As someone who just matched DR to escape this kind of thing...this is terrible news. Do you think good PP jobs will be available in rural areas in this scenario?

 

[radsresident-US]

As someone who just matched DR to escape this kind of thing...this is terrible news. Do you think good PP jobs will be available in rural areas in this scenario?

I actually think the PP will pretty much only be in rural areas - those are the places where indivual networking with specific providers provides some job stability.

I think there will always be people willing to open their own shop. Question is what is going to change about the market to help or hurt the barriers to entry. I discussed this before but even something as simple as insurance companies streamlining the approval of billing codes from new practices would be a huge decrease in barrier to entry. Likewise, if insurance payments are regulated so that PP reimbursements are forced to be similar to hospital system reimbursements (currently a fraction) that will also encourage small rad shops.

Some of these things may actually go in favor of PP groups but it will come with legislation that usually also drops reimbursement. I don’t know much about the political climate in radiology. But there are things that congress could do which would help PPs (not that they will actually do it)

 

[vm26]

As someone who just matched DR to escape this kind of thing...this is terrible news. Do you think good PP jobs will be available in rural areas in this scenario?

I did not mean to come across as doom and gloom and apologize for this. Maintain a wide skill set (including breast and light IR) and a willingness to move where you need to (within reason), and I think you will be fine.

Rads graduating today who simply must live in a particular area/city like Houston will likely be working P/E and working harder for less while the senior partners (who sold out) will be contemplating how much they want to spend on their 2nd or 3rd homes.