What Roles Do DRs Perform Other Than Reading Images (biopsies?)

[DubbiDoctor]

I am very curious about diagnostic radiology as a career, and think I may want to pursue it. However, I have a few questions about the daily responsibilities of diagnostic radiologists. Are they mainly reading images, and sending to the consulting physicians their report of what the scans indicate? (Don't get me wrong - I believe properly interpreting medical images requires a great amount of training and problem solving ability, and can be very fulfilling). Or do they also spend a significant amount discussing treatment plans with the consulting physicians and performing biopsies, etc? Do only interventional radiologists perform biopsies? Are there any procedures diagnostic radiologists perform? Since interventional radiology is now distinguishing itself as its own specialty (rather than subspeciality), will these procedural responsibilities be taken up more and more by interventional radiologists? I know it's a controversial topic, but as someone who wouldn't become an attending diagnostic radiologist for around a decade if I succeed in pursuing that route, I'm compelled to ask: would DRs still have a job if AI progresses to the point where its sensitivity and specificity for all tests exceed those of DRs?

Also, what is the best way to go about shadowing a radiologists if you don't have any family or personal connections to one? Thanks!

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[Cognovi]

Are they mainly reading images, and sending to the consulting physicians their report of what the scans indicate?

Yes.

Or do they also spend a significant amount discussing treatment plans with the consulting physicians and performing biopsies, etc?

Yes.

Do only interventional radiologists perform biopsies?

No.

Are there any procedures diagnostic radiologists perform?

Yes. Image-guided biopsy and drainage.

Since interventional radiology is now distinguishing itself as its own specialty (rather than subspeciality), will these procedural responsibilities be taken up more and more by interventional radiologists?

Maybe. But there are five times as many DRs as IRs and probably more small procedures that need to be done than IRs to go around.

would DRs still have a job if AI progresses to the point where its sensitivity and specificity for all tests exceed those of DRs?

The computer didn't put accountants out of business.

Also, what is the best way to go about shadowing a radiologists if you don't have any family or personal connections to one? Thanks!

Email some, particularly those with an education leadership role.

 

[loljkttyl]

Some diagnostic radiologists also perform:
- breast biopsies
- thyroid biopsies
- hysterosalpingograms
- image-guided lumbar punctures
- arthrograms to evaluate joints
- fluoroscopy to evaluate gastrointestinal tract

 

[loljkttyl]

Given that you are SUNY Downstate class of 2022, the easiest way would be to email any radiology attending at your institution (e.g., residency or fellowship director or anyone who seems to have an interest in education, has won education awards in the past, etc.) and ask if you can shadow for a bit. It doesn't have to be long or very formal...just enough to get a sense of what day-to-day activities are like.

For example, as a first year medical student, during one of my days off, I shadowed a radiology attending for 2 hrs, then on another day shadowed an anesthesiologist for 1 hour. Actually, the anesthesiology one was supposed to be for 4 hrs, but I realized I could not see myself in an operating room for the rest of my life and left after 1 hour!

Later in my clinical years, during my elective time, I spent time with different subspecialties of radiology, which is what I would recommend you do too. There are so many facets of radiology that almost anybody can find some aspect that suits their personality. For example, you can spend 1 day in body imaging, 1 day in musculoskeletal imaging, 1 day in neuroradiology, 1 day in women's imaging, and 1 day in pediatric imaging.

Good luck with everything!

 

[dr seuss]

Are they mainly reading images, and sending to the consulting physicians their report of what the scans indicate? Or do they also spend a significant amount discussing treatment plans with the consulting physicians and performing biopsies, etc? Do only interventional radiologists perform biopsies? Are there any procedures diagnostic radiologists perform?

Physicians call or come into the reading room to ask questions and go over scans, and you may spend some time in tumor board, but the majority of your time is spent reading images unless you are an interventional radiologist. Some IRs in the community do biopsies, but where I am all biopsies are done by diagnostic radiologists (except transjugular liver biopsies). The body radiologists place drains and do lung/liver/kidney/etc. biopsies; the MSK radiologists do bone biopsies and joint injections; the neuroradiologists do lumbar punctures, myelograms, and head/neck biopsies; the mammographers do breast biopsies. Where I am everything is specialized, but if you are a general radiologist in the community you can do everything.

I know it's a controversial topic, but as someone who wouldn't become an attending diagnostic radiologist for around a decade if I succeed in pursuing that route, I'm compelled to ask: would DRs still have a job if AI progresses to the point where its sensitivity and specificity for all tests exceed those of DRs?

I can't see AI progressing to the point where radiologists are completely replaced. What is capable of now is greatly exaggerated. I think more likely it will be used for specific things that can be overlooked - lung nodules, subtle metastases, etc.

Also, what is the best way to go about shadowing a radiologists if you don't have any family or personal connections to one? Thanks!

Before you know the anatomy and pathology, shadowing a radiologist isn't very worthwhile. I would say wait until at least 2nd year of med school.

 

[loljkttyl]

I do not think you need to know any anatomy or pathology or even be a medical student to shadow a radiologist. Just by spending a few minutes with a radiologist, hospitalist, surgeon, etc. or even a non-medical field such as lawyer, I-banker, whatever, you get a gut feeling. At the very least, you will know what you don't want to do. When you are shadowing, ask yourself, can I see myself doing this? or not doing this? for the REST OF MY LIFE? It might even be good focusing on the worst aspects of the job. Can I deal with (fill in the blank)? Maybe you don't like sitting in a dimly lit room so radiology is not for you. Maybe you don't like the smell of the operating room or standing all day so being a surgeon is not for you. There are many advantages to shadowing first year. Once you have an idea of what you want to do, you can start tailoring your future application from day one. For example, you can start joining activities related to your future field of interest, becoming a gross anatomy teaching assistant as a second year student or attending radiology-related conferences as a fourth year student. If you know you are deciding between 2 fields such as radiology and orthopedics, you can start do research in a topic that blends both aspects such as musculoskeletal imaging, then when it comes time to write your personal statement you have a narrative that you can capitalize on regardless of the specialty you choose. Sure everyone always says, you can do research in any field, which I completely agree with. But if you have an opportunity to figure it out earlier, why not do it? It's so simple too, in terms of time commitment. No one is asking you to dedicate several hours each week for the entire year. All you need to do is pop in for like 1 hour during one of your breaks or days off to get a sense of what day-to-day activities are like in the day of a (fill in the blank).

 

[Gadofosveset]

I do not think you need to know any anatomy or pathology or even be a medical student to shadow a radiologist. Just by spending a few minutes with a radiologist, hospitalist, surgeon, etc. or even a non-medical field such as lawyer, I-banker, whatever, you get a gut feeling. At the very least, you will know what you don't want to do. When you are shadowing, ask yourself, can I see myself doing this? or not doing this? for the REST OF MY LIFE? It might even be good focusing on the worst aspects of the job. Can I deal with (fill in the blank)? Maybe you don't like sitting in a dimly lit room so radiology is not for you. Maybe you don't like the smell of the operating room or standing all day so being a surgeon is not for you. There are many advantages to shadowing first year. Once you have an idea of what you want to do, you can start tailoring your future application from day one. For example, you can start joining activities related to your future field of interest, becoming a gross anatomy teaching assistant as a second year student or attending radiology-related conferences as a fourth year student. If you know you are deciding between 2 fields such as radiology and orthopedics, you can start do research in a topic that blends both aspects such as musculoskeletal imaging, then when it comes time to write your personal statement you have a narrative that you can capitalize on regardless of the specialty you choose. Sure everyone always says, you can do research in any field, which I completely agree with. But if you have an opportunity to figure it out earlier, why not do it? It's so simple too, in terms of time commitment. No one is asking you to dedicate several hours each week for the entire year. All you need to do is pop in for like 1 hour during one of your breaks or days off to get a sense of what day-to-day activities are like in the day of a (fill in the blank).

It's hard to understand what make DR interesting to DRs until you have some understanding of the game they are playing. That involves advanced anatomy, knowing what kind of questions DRs are trying to answer, and what restrictions they work against. Just sitting there watching them work without understanding the game is almost worthless. I did a DR rotation in my 4th year of med school and (in retrospect) had no clue what the job was like. I found it boring to watch them and wanted to do IR. I'm a DR now and quite happy with it, but my "gut feeling" in 4th year was all sorts of uninformed. My understanding of IR was also kind of half-baked.

An analogy is like deciding that you may want to learn how to read a book. So you go shadow some people at a library... looks horribly boring, these torpid people sitting there for hours. You may have missed what's going on.

People make a big deal about the dimly-lit reading room. Who f'in cares? I don't even think about it any more. It just makes my job better. If a dimly-lit room is enough to turn one off a profession, then one's judgment criteria might be exceedingly shallow (same for the smell of the OR).

It's tough for a med student to get a good idea of what DR is all about. Shadowing is probably the best(/only way readily available, but understand its limitations. If you can, shadow a resident on call who is willing to show you how she or he works. That's probably the best way to get a feel for the thought processes and challenges.

 

[DubbiDoctor]

People make a big deal about the dimly-lit reading room. Who f'in cares? I don't even think about it any more. It just makes my job better. If a dimly-lit room is enough to turn one off a profession, then one's judgment criteria might be exceedingly shallow (same for the smell of the OR).

When you're reading images, do you also assess additional information in the patients' history and medical records to help make diagnoses and recommendations?

 

[CyrusHabs7695]

Given that you are SUNY Downstate class of 2022, the easiest way would be to email any radiology attending at your institution (e.g., residency or fellowship director or anyone who seems to have an interest in education, has won education awards in the past, etc.) and ask if you can shadow for a bit. It doesn't have to be long or very formal...just enough to get a sense of what day-to-day activities are like.

For example, as a first year medical student, during one of my days off, I shadowed a radiology attending for 2 hrs, then on another day shadowed an anesthesiologist for 1 hour. Actually, the anesthesiology one was supposed to be for 4 hrs, but I realized I could not see myself in an operating room for the rest of my life and left after 1 hour!

Later in my clinical years, during my elective time, I spent time with different subspecialties of radiology, which is what I would recommend you do too. There are so many facets of radiology that almost anybody can find some aspect that suits their personality. For example, you can spend 1 day in body imaging, 1 day in musculoskeletal imaging, 1 day in neuroradiology, 1 day in women's imaging, and 1 day in pediatric imaging.

Good luck with everything!

Sorry to be the guy who asks about the money, but is there large pay differences between the different rads subspecialties? Like does specialty x 95% of the time make more than specialty y? I couldn't really find this stuff on the internet.

 

[Gadofosveset]

When you're reading images, do you also assess additional information in the patients' history and medical record to help make diagnoses and recommendations?

Usually. The amount of time you spend with chart depends on a few factors.

Ideally, you would look at the full history on everyone before reading a study, but you have to weigh it against the time it takes to read the chart. Part of being a mature DR is knowing when you have to go to the chart and when it's not important. This is partly weighted by the complexity of the imaging modality and the complexity of the patient. It's a tough skill to learn. I'm not sure I have it completely down yet.

 

[Gadofosveset]

Sorry to be the guy who asks about the money, but is there large pay differences between the different rads subspecialties? Like does specialty x 95% of the time make more than specialty y? I couldn't really find this stuff on the internet.

There's some differences. Pediatric radiologists tend to make less than neuroradiologists, as an example, for various market reasons that have little to do with the value of the profession to patient care. The salary difference between specialities is usually outweighed by your geographic location, what kind of deal you get/make with your group, and how much you work.

 

[CyrusHabs7695]

There's some differences. Pediatric radiologists tend to make less than neuroradiologists, as an example, for various market reasons that have little to do with the value of the profession to patient care. The salary difference between specialities is usually outweighed by your geographic location, what kind of deal you get/make with your group, and how much you work.

Makes sense, thanks! Assuming you're a radiologist, what is your opinion on the tele radiology companies like Vrad? I like to ask every radiologist I meet.

 

[Gadofosveset]

Makes sense, thanks! Assuming you're a radiologist, what is your opinion on the tele radiology companies like Vrad? I like to ask every radiologist I meet.

I understand why some people might want to work for vRad, but my take on it is that, over the long term, the vRad philosophy is not in line with patient care or radiologists' best interests. vRad is better for administrators and owners of vRad than for radiologists, referring physicians, and, ultimately, patients. It's not for me.

 

[loljkttyl]

Sorry to be the guy who asks about the money, but is there large pay differences between the different rads subspecialties? Like does specialty x 95% of the time make more than specialty y? I couldn't really find this stuff on the internet.

interventional radiology probably makes slightly more
pediatric radiology probably makes slightly less
everything else is in between

the biggest determining factors are probably more:
private practice pays more than academics
partners get paid more than employees
less desirable locations pay more than more desirable locations
jobs with higher volumes pay more than jobs with lower volume
jobs with less vacation pay more than jobs with more vacation
jobs with more call pay more than jobs with less call
full time pays more than part time (e.g., mammo has more options for part time)

 

[loljkttyl]

I understand why some people might want to work for vRad, but my take on it is that, over the long term, the vRad philosophy is not in line with patient care or radiologists' best interests. vRad is better for administrators and owners of vRad than for radiologists, referring physicians, and, ultimately, patients. It's not for me.

I completely agree with this.

 

[loljkttyl]

It's hard to understand what make DR interesting to DRs until you have some understanding of the game they are playing. That involves advanced anatomy, knowing what kind of questions DRs are trying to answer, and what restrictions they work against. Just sitting there watching them work without understanding the game is almost worthless. I did a DR rotation in my 4th year of med school and (in retrospect) had no clue what the job was like. I found it boring to watch them and wanted to do IR. I'm a DR now and quite happy with it, but my "gut feeling" in 4th year was all sorts of uninformed. My understanding of IR was also kind of half-baked.

An analogy is like deciding that you may want to learn how to read a book. So you go shadow some people at a library... looks horribly boring, these torpid people sitting there for hours. You may have missed what's going on.

People make a big deal about the dimly-lit reading room. Who f'in cares? I don't even think about it any more. It just makes my job better. If a dimly-lit room is enough to turn one off a profession, then one's judgment criteria might be exceedingly shallow (same for the smell of the OR).

It's tough for a med student to get a good idea of what DR is all about. Shadowing is probably the best(/only way readily available, but understand its limitations. If you can, shadow a resident on call who is willing to show you how she or he works. That's probably the best way to get a feel for the thought processes and challenges.

This post raises a good point. The person you shadow can make a huge first impression. In my institution, there were a few radiologists who had a reputation for being extremely med student friendly. They would explain their thought process and even have a collection of interesting cases to show med students during downtime. It might be a good idea to ask upper year med students who these attendings are. Our med school radiology interest group also had a list of radiologists who were willing to have med students shadow them.

 

[Doctor D]

The volume of procedures performed by non-IR radiologists varies greatly based on the institution and setting. Large private groups have IR doing all the procedures for the most part. Academics is much more split with each section controlling some. This is decreasing with the new IR residency. This is my opinion and obviously some others disagree.

 

[DubbiDoctor]

. Large private groups have IR doing all the procedures for the most part. Academics is much more split with each section controlling some. This is decreasing with the new IR residency.

When you say procedures, are you including biopsies? From what I've read about IR training, IR seems to focused on therapeutic interventions, particular for vascular disorders and cancer. As fascinating and intellectually stimulating as reading images is, I am worried that 30 years from now much of it will be automated. And while I have no craving for physician responsibilities involving direct patient interaction, that will be much more difficult to automate.

 

[Cognovi]

When you say procedures, are you including biopsies? From what I've read about IR training, IR seems to focused on therapeutic interventions, particular for vascular disorders and cancer. As fascinating and intellectually stimulating as reading images is, I am worried that 30 years from now much of it will be automated. And while I have no craving for physician responsibilities involving direct patient interaction, that will be much more difficult to automate.

Yes, even though it's not an intervention. Radiology procedures are any task that involves 1) a radiologist touching the patient, 2) using imaging guidance, and 3) putting a needle or wire into anything in the body for any purpose.

 

[TCOM12]

I would spend your first year getting good grades and listening to patients. Don’t waste your time trying to figure out a sub specialty. If you don’t crush step 1, you won’t be left with much. I say this with a smirk on my face because you can still do radiology if you get a sub 240 step 1. But approach med school and step 1 like you want to do direct plastics or derm. Then if you decide on family med or psych or any of the less competitive specialties, then you can say you did it on your terms.

Also, don’t pick something on what you think is interesting about it. Pick it based on the tolerance of uninteresting things because that is usually what the most common thing is. If you can’t sit there and tolerate reading 40 icu chest radiographs daily, this field is likely not for you. GBM was pretty cool the first time I saw it. But there are few cases that get me going, and the ones that do are usually so rare that they wouldn’t interest a medical student. That being said, I love this field and love when I make a difference in patient management.

Biopsies are fun. Drains are fun. They break up the day. But, once you’ve learned it and done it a million times, then it’s just another thing you have to do while the list builds.

IR will become one of the least happy subspecialties in the next 15 years. Not because it’s not a good field, but because medical students are chosing a very niche field without really knowing what they’re getting into.

IR doesn’t generate as many rvus/hr as a diagnostic reading high end MR. There are very few all IR jobs in private practice.

IR is still a good field. Just giving a reality check.

Go on a 10 hour road trip. That’s sort of what radiology is like. Being attentive and yet not.

AI will not eliminate radiology. I’ve posted about it before.

 

[meister]

To give you an idea of the breadth of radiology procedures, I am a DR and in my group DRs perform all manner of biopsies, drainages, dialysis lines (both tunneled and non-tunneled), LPs, para/thora with a couple old school DRs doing angiograms and fistula work. Nowadays angiograms and fistula stuff is typically reserved for IRs, outside of neurorads doing cerebral angiograms. At the academic institution where I trained IRs and neuro IRs did all of the above, while DRs only did arthrograms.

When I was a med student and junior resident I never thought I'd like procedures or do many of them and here I am. I feel it's a good hedge against whatever AI nonsense comes our way in the future.