what drew you to radiology?

i wanted a challenging highly intellectual field that still allowed me to see my wife more than once a week and allowed me to eat, drink, scratch myself, piss, and/or BM when i wanted instead of being on my feet all day without food or water while i achieved hemostasis or having to spend 7 hours a day writing and talking about extraordinarly long progress notes that include the differential for nausea and not having to deal long-term with patients that either 1) are seeking drugs, or 2) have a diagnosable psychiatric condition (read: personality disorders).

most conjunctions ever.

 

This question often gets asked about this time of year...sometimes I wonder if its because people are fishing for help on their personal statements.

Anyways, I'll bite.

Medicine is fascinating to me...but the health care system sucks...its a no win situation. So I wanted a speciatly that was as involved in as many different aspects of medicine as possible....because a little of each specialty is interesting...but I wouldn't want to do internal medicine, surgery, or emergency medicine my whole life....

It's difficult to find a specialty where you can know so much about different fields and still be considered an "expert"...and not have to wait around for lab tests, consults, social issues for your patients like placement, etc.

Radiology IS that specialty....unless you like Pathology I guess...but no thanks. Quick cases, more or less, in all different aspects of medicine, that are good for those who get bored easily...like me.

Staying power....it will always be a field that is interesting, in demand, and gives you time to enjoy things outside of medicine. I doubt I'll be one of those doctors who wants to retire early....I'd get bored anyways.

I'm only a first year resident but its already much better than anything in med school or internship....but yes, I'm a new first year so I have no weekends and no call for 6 months....I might change my tune after December. Typical day involves reading out with attending in the morning, sometimes after a 8am multi-disciplinary conference, then Noon conference/Lunch, then dictating studies in the afternoon, with possible procedures mixed in, then 4pm conferences. Most of the day is all learning, and no scut, unlike internship.

I am a much happier person since starting radiology residency and the next four years should be very enjoyable.

 

1. I love the diversity of radiology. You are a consultant to all the other specialties. Think about it...there is an imaging exam for every organ system and covers all ages and demographics of patients. That doesn't necessarily mean the clinician should be ordering them all the time (thats another issue).

2. Less BS: social work, paperwork, idle time, no clinical worries... When I am working I am working. There isn't a whole lot of down time during the day. But if I need to take a few minutes to get a cup of coffee or use the restroom, I can do that, no big deal. At the end of the day I am DONE! I don't have to worry if Mr. So-and-so will pull through the night. Furthermore, radiology probably demands the least paperwork of any specialty because everything is dictated!

3. If you like procedures, but don't like marathon cases-- there are lots of short procedures in IR which keeps it interesting. Some emergent cases can extend into hours though. The procedures you do can really make a difference in someone's life. Embolizing a bleeder. RFA/Chemoembo can give a few months to a cancer patient who is not a candidate for surgery, etc. Vertebroplasty for back pain related to insufficiency fractures. Doing a CT guided abcess drain can save a patient an open surgery. Dialysis grafts-- sure they are guaranteed to fail every few months, but unless they get a renal transplant, they are screwed-- its up to you to help them. There are only so many access points for dialysis.

4. Radiology is at the forefront of technology in medicine. Nuff said.

I love my job!

 

My best friend is an anesthesiologist. She is encouraging me to go into radiology. She says that you can work from home if you have a fast enough computer connection like a T1 line and practically never have to go into the hospital yet you can make good money. I have no reason to doubt her as she has been practicing for over a decade and I haven't even started medical school but this seems to good to be true. Can you work from home and if so what percentage of the time?

 

I know a recently graduated resident from my program who moonlighted for a teleradiology firm (during his last year of residency) based out of LA that furnishes you with a diagnostic quality workstation and a broad band T1 or T3 line. This IS possible, not mainstream, but definitely available right now.

 

i'll second what everyone has said. plus $$$

hans, you're a babe judging by your pic!

 

DITTO - acs vs. somatoform gets my goat these days.

 

Wow...sounds too good to be true!

(Actually, I would hope it isn't true. If this is the case, what's to prevent hospitals from shipping their films to the cheapest possible radiologists?)

 

You don't even need a t1 or t3...cable or dsl (any always on connection) works just fine...heck when it first started they used dial up! It took like an hour to load the stuff but yea...kept those guys from running into the hospital 5 times a night. In fact a t1 might be overkill to a degree....considering they are recommended for up to 50 users at a time and range from 350 to 1200 dollars a month depending on region.....sorry..dork here. Back to the convo I'm not qualified for.

 

Having the ability to arrive at the diagnosis is a reinforcement in itself. I enjoy the anatomy of the human body and to find what is wrong is analogous to doing puzzles. It is truly a fascinating field.

What bothers me are the numerous incidentalomas that are followed up or require additonal examinations.

 

I agree! The 3D color reconstruction of a 64 Slice CCT Angiography showing the vasculature of the heart is gorgeous. You can flip the image around to find stenotic arteries and calcifications. It is essentially pulling the heart out of a patient and analyzing the patient's heart pathology.

I can't wait until Toshiba releases the 256 slice CT in 3-4 years that will show real time cardiac imaging with each heart beat. You will be able to analyze the heart's perfusion during systole and diastole while it happens. Too bad the price tag will be $5 million dollars.

One word baby! Technology.

The innovations of the brightest minds in physics and medicine is what will continue to drive radiology.

 

Yeah, it is too good to be true. Due to the emergence of the 64 slice Multidector CTs we are on the brink of 24/7 CT image interpretation. Someone will need to be in house to cover all the chest pains that go through the ER. A partner in a radiology group (private practice) and/or an attending (academic practice) will be responsible for covering the night shift.

Also, anyone that goes into radiology because of "lifestyle" will be miserable. Not only are current radiologists overworked but the specialty requires more continuing education than any other specialty. A radiologist has a vast amount of medical knowledge and must continue to learn to keep up with the new influx of information.

Futhermore, if you don't go into radiology for the right reasons you will make a lot of mistakes and will get sued left and right. Volume is the reason radiolgists get sued so often. If you have sat next to a radiologist for a day you will see that they are responsible for more patients in a given day than any other specialty.

Do this exercise....Shadow a radiologist or do a radiology rotation and count the number of patients a radiolgist goes through in one day. Now consider, that any one of them could be a lawsuit. A "miss" is a recipe for disaster. Couple that with laziness and you will have a lot of "misses" that will lead to many lawsuits.

 

I spoke to a radiologist at Shands&UF about this subject. He said that it's already happening, but mainly for the night shifts. He mentioned a place in Tallahassee, FL was already out-sourcing their work to Singapore. I think he said only the head of department there was board certified for the US, but the others weren't. Not sure if this is allowed or not. Some are being sent over state boarders, too.

 

Bangalore, not Singapore.

 

What do ya think radiology will be like 10 years from now?

 

Massive. I think imaging will become a bigger and bigger part of medicine. I know this pisses off medicine docs but it's probably the truth. I'm sure outsourcing will happen to some degree, but countries w/ less technology and stuff probably won't have the infrastructure to keep up with data demands. And I'm sure volume will increase to the point where we'll have to train more rads over here or outsource to get it done. That's a guestimation though. No one but god knows right. I just say thank god for rads or I'd have blown 200k on my education. No other field is as comprehensive, and flexible without most of the BS in medicine. I survived my 1st month of internship and am counting the days.

 

There are plenty of naysayers out there who might have you believe that all of us radiologists should start learning Hindi sometime over the next few years. These dire predictions are generally made by non-radiologist physicians who are either poorly informed, bitter, jealous, or some combination of all three.

Radiology will probably undergo some significant restructuring over the next decade. For example, the currently white hot job market will probably tone down down a few notches in the short term as most fields typically undergo boom-bust cycles (though these tend to be thankfully attenuated in medicine given the cartel-like controls on licensure). Teleradiology, whether domestic or outsourced to foreign firms, will add a new level of competition that may adversely impact compensation per study. And if our dear enlightened leaders continue to drive this country into fiscal oblivion, government cuts to Medicare reimbursement are likely to accelerate.

On the flip side, imaging will incontrovertibly become an increasingly central component to medical diagnosis and treatment. Rapid improvements in computing power have given rise to a generation of imaging equipment that would make Roentgen cream in his lederhosen; and Moore's Law insinuates that the pace of change will rocket geometrically. This, combined with whole new inroads in functional imaging (like using paramagnetically tagged monoclonal antibodies) will make the diagnostic radiologist something of an in situ pathologist. Interventional procedures, like RF ablation of inoperable tumors, and nuclear therapeutics, like using radioactively tagged monoclonal antibodies against specific tumor-expressed antigens, will revolutionize aspects of medical and surgical therapy.

To accomodate these changes, radiology will continue on its path to super-segmentation, giving rise to entirely new fields that may well become their own medical specialties in the not-too-distant-future.

So F the naysayers. Rads is the way to go.

 

I admire your enthusiasm, however not even current radiologists share your optimisim. Granted, you don't have as much time as I do to read about radiology since you are a busy resident. I have read many articles in Radiology, Journal of American College of Radiology (JACR), and American Journal of Roentgenology (ACR) on this very subject. I have even discussed radiology politics with Attendings at Mallinckrodt.

Consider the June 2006 Editorial in JACR by Dr. Ronald Arenson of UCSF. It clearly states that the current state of radiology is in trouble. Radiology is in trouble because of turf battles, loss of patient control, and self referrals. The chief argument is that to maintain viability in radiology, the training programs must train radiologists to be clinicians to control patients.

 

I always thought it makes little sense for IR's to not maintain a clinic. But i'm a simple PGY1. Do you guys think clinics and requisite advertising for such would be more or less helpful in maintaining and increasing a client/patient base and holding on to turf?

 

They are essential if you want to increase your patient base and hold on to turf.

You actually don't need to advertise. Just like any other surgical practice, patients will come to you if you are good (and able to maintain a cheerful and emphatic clinic staff). If you have a clinic, patients recognize YOU as their doctor. The 'downside' is that you sometimes have to go to the extreme and actually treat a patient. During my fellowship, quite a number of patients gave the name of our IR NP as their PCP, and in reality for some of them he was.