Why 4 years (5 total) for radiology?

[.surgical.]

I'm a current MS-III with a strong interest in radiology and I have been trying to do some research on the field. I was just wondering why diagnostic radiology has one of the longest residencies, relatively speaking? Are most programs split into anatomical categories/type of imaging procedure? Is there a good reason why it can't fit into 3 years (plus 1 TY)?

Before anybody gets defensive, I mean no disrespect and I did do a forum search, this is meant to be a legitimate question.

I look at all the residency programs that are on a shorter timeline and wonder what requires radiology to be longer. Is it truly as simple as "there is just more to learn?"

3 yr:
EM
Fam
IM
Peds
Path

3+1 progs:
Gas
Neuro
Optho
PM&R

4 yr:
Med-Peds
OB-GYN
Psych

4+1 progs:
Radiology (dx or onc)
Ortho
Uro

5 yr:
Surg
ENT

5+1 progs:
Neurosurg

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[jake2]

Is it truly as simple as "there is just more to learn?"

Ummm... yes.

Questions asked just today on my ultrasound rotation: What is the name of the white matter tract that runs next to the septum pellucidum? By what factor does an echogenic cardiac focus increase your odds of aneuploidy on pre-natal US? What are the radiographic findings of adenomyomatosis of the gallbladder? What gauge needle is appropriate for a thyroid biopsy? Describe the different types of cystic adenoid malformation.

Takes a while to learn how to converse intelligently with all the other specialists in medicine. Most radiologists actually take a fellowship year since they feel they still aren't learned enough.

Good luck negotiating a three year program. 😀

That being said, there are a few academic programs that let you take time out for research, though you still have to take call and such during your off years.

 

[NYyanx28]

I'm a current MS-III with a strong interest in radiology and I have been trying to do some research on the field. I was just wondering why diagnostic radiology has one of the longest residencies, relatively speaking? Are most programs split into anatomical categories/type of imaging procedure? Is there a good reason why it can't fit into 3 years (plus 1 TY)?

Before anybody gets defensive, I mean no disrespect and I did do a forum search, this is meant to be a legitimate question.

I look at all the residency programs that are on a shorter timeline and wonder what requires radiology to be longer. Is it truly as simple as "there is just more to learn?"

3 yr:
EM
Fam
IM
Peds
Path

3+1 progs:
Gas
Neuro
Optho
PM&R

4 yr:
Med-Peds
OB-GYN
Psych

4+1 progs:
Radiology (dx or onc)
Ortho
Uro

5 yr:
Surg
ENT

5+1 progs:
Neurosurg

Keep in mind, those that do Medicine, Peds usually do an additional 3 years in fellowship training to become specialized. Also, those doing general surgery, although a 5 year program, are often required to do 2 years of research, and then consider fellowship AFTER those 7 years!

 

[fun8stuff]

I'm a current MS-III with a strong interest in radiology and I have been trying to do some research on the field. I was just wondering why diagnostic radiology has one of the longest residencies, relatively speaking? Are most programs split into anatomical categories/type of imaging procedure? Is there a good reason why it can't fit into 3 years (plus 1 TY)?

Before anybody gets defensive, I mean no disrespect and I did do a forum search, this is meant to be a legitimate question.

I look at all the residency programs that are on a shorter timeline and wonder what requires radiology to be longer. Is it truly as simple as "there is just more to learn?"

3 yr:
EM
Fam
IM
Peds
Path

3+1 progs:
Gas
Neuro
Optho
PM&R

4 yr:
Med-Peds
OB-GYN
Psych

4+1 progs:
Radiology (dx or onc)
Ortho
Uro

5 yr:
Surg
ENT

5+1 progs:
Neurosurg

You learn more in radiology residency than you do in med school.

 

[Gute]

as mentioned before, you won't do more than 6 years after med school to become a fellowship trained radiologist.

as mentioned before, there is a ton of reading. perhaps your medical school has brandt and helms in its e-library. its a monster of a book, and is only a fraction of what you are supposed to read and know as a 1st year radiology resident.

radiology has a number of distinct modalities and is a field that spans pathology across the entire human body. i don't think it would be feasible to compress it anymore than it already is. remember, there is a reason why radiologists do fellowships: 4 years isnt enough

 

[.surgical.]

Interesting. Thank you to everyone for the information. Perhaps the field will actually see an expansion of the length of residency in the future.

 

[sideways]

brb crossing radiology off my list.

EDIT: in all seriousness, it sounds like a VERY BOOKISH residency. I imagine if you don't LOVE sitting down with a dense medical textbook for hours on end, you'd be in hell.

Would this be a fair assumption?

 

[fun8stuff]

brb crossing radiology off my list.

EDIT: in all seriousness, it sounds like a VERY BOOKISH residency. I imagine if you don't LOVE sitting down with a dense medical textbook for hours on end, you'd be in hell.

Would this be a fair assumption?

Spend time at home reading at your own leisure or spend time in the hospital playing social-worker/scut and depriving yourself of sleep.

 

[durfen]

Spend time at home reading at your own leisure or spend time in the hospital playing social-worker/scut and depriving yourself of sleep.

I think people underestimate the amount of reading medicine residents have to do. A Lot. And all of it will become obsolete in 2 years, so you have to keep up. You have to know NEJM back-to-back to know all the latest fad treatments and pet diagnoses. For people like me, the reading is just tedious. Reading rads stuff is quite different. I guess you have to like the knowledge in the specialty to like that specialty.

Here is my facetious version of all other specialties listed.
Fam - see/talk to the pt, send to ER
EM - don't see the pt, order imaging studies, call radiologist
IM - see the pt each morning, after EM gets dx from rad. Discharges pt with imaging followup.
Peds - see pt, whine about radiation dose, order an MR without anesthesia.
Path - A specialty that does some mind work - dx'es path exactly after rads points out where the lesion is and surg takes it out. This is needed so that IM-onc can put that patient 'on a clinical trial' so they can try all available treatments w/ or w/o evidence.

Gas - Scopes people, but after ordering UGI series.
Neuro - Does physical exam, orders imaging anyway. Whatever imaging says, goes. Follows patient by imaging and cursory physical exam during inevitable long decline.
Optho - Can't think of anything....Order orbit MR/CT or similar expensive test?
PM&R - rehabs patient after long stay in hospital due to surgery of incidental finding on unnecessary, unindicated CT ordered by ED.

OB-GYN - See pt, order ultrasound or do it themselves. Refer to surg or take it out themselves. Another specialty that actually does work.
Psych - Orders battery of imaging studies to r/o organic causes of psych issues. Then tries to help patient, actually with some evidence. This specialty actually does some work.

Radiology (dx) - I'm biased, no comment.
Radiology onc - Cure cancer, cause cancer. Now, cure everything brain related by zapping that part of the brain. Great you're now not OCD, but you have a glioma where your OCD used to be.
All surgical specialties - There is a fracture. I need to fix it.

 

[Taurus]

Keep in mind that the vast majority of radiology residents do at least 1 fellowship.

So radiology is more like 1+4+1 = 6 years.

 

[KeratinPearls]

I'm a current MS-III with a strong interest in radiology and I have been trying to do some research on the field. I was just wondering why diagnostic radiology has one of the longest residencies, relatively speaking? Are most programs split into anatomical categories/type of imaging procedure? Is there a good reason why it can't fit into 3 years (plus 1 TY)?

Before anybody gets defensive, I mean no disrespect and I did do a forum search, this is meant to be a legitimate question.

I look at all the residency programs that are on a shorter timeline and wonder what requires radiology to be longer. Is it truly as simple as "there is just more to learn?"

3 yr:
EM
Fam
IM
Peds
Path

3+1 progs:
Gas
Neuro
Optho
PM&R

4 yr:
Med-Peds
OB-GYN
Psych

4+1 progs:
Radiology (dx or onc)
Ortho
Uro

5 yr:
Surg
ENT

5+1 progs:
Neurosurg

Path is a 4 year residency and most do at least one fellowship, sometimes 2 fellowships!!!

5-6 years.

 

[Gute]

brb crossing radiology off my list.

EDIT: in all seriousness, it sounds like a VERY BOOKISH residency. I imagine if you don't LOVE sitting down with a dense medical textbook for hours on end, you'd be in hell.

Would this be a fair assumption?

not many residencies do you get to AVOID reading dense medical textbooks. some might not have as much reading as radiology, but have more malignant hours/lifestyle.

the last thing I would want to do in surgery residency would be to spend my limited spare time reading, but you know where im going

 

[fun8stuff]

I think people underestimate the amount of reading medicine residents have to do. A Lot. And all of it will become obsolete in 2 years, so you have to keep up. You have to know NEJM back-to-back to know all the latest fad treatments and pet diagnoses. For people like me, the reading is just tedious. Reading rads stuff is quite different. I guess you have to like the knowledge in the specialty to like that specialty.

Trust me, having done an prelim IM year I can tell you rad residents do WAY more reading. There's just way more to know. The only other specialty that even compares is path. Rads residents usually read a different textbook every month. IM residents are lucky to get through Harrison. In fact, the radiology board review (summary) book is bigger than the Harrison IM book. The information in radiology is liking changing at the same rate, if not faster than IM so that really is irrelevant.

Oh and you should try and compare JAMA or NEJM to a radiology journal some day... not only do the rad journals have bigger pages, but they are about 2-3x thick.

 

[p53]

Medical students are clueless. Lets put it this way 40% of medicine and ped residents do fellowships. In fact the number of fellowship for medicine residents has gone down since after 3 years of residency you can work 26 weeks a year with 26 weeks of vacation and make 200 to 300 k. Many hospitalists pick up extra shifts during the 26 weeks off and clear 300k. Hospitalists jobs are everywhere in every city. In comparison, 90% of radiology residents do a fellowship after 5 total years of 40k a year as a resident. The reason is because there is more information to know in radiology than any other field. In fact radiologists have to know more than pathologists because they have to know all of the disease processes to provide an accurate differential diagnosis. Furthermore radiologists have to know physics cold. No wonder rads is so long. Also many rads do two felllowships to get jobs. Ask any radiology resident about the job market now. Jobs are hard to find.

Trust me, having done an prelim IM year I can tell you rad residents do WAY more reading. There's just way more to know. The only other specialty that even compares is path. Rads residents usually read a different textbook every month. IM residents are lucky to get through Harrison. In fact, the radiology board review (summary) book is bigger than the Harrison IM book. The information in radiology is liking changing at the same rate, if not faster than IM so that really is irrelevant.

 

[p53]

For those that are gunning for money thus go into radiology. Good luck. 1st year of radiology has the steepest learning curve of your life. Nothing you learned in med school or undergrad prepares you for radiology residency. In fact you will throw away all of the knowledge you gained in medical school in radiology with the exception of anatomy. All of that stuff you learned in med school and internship is wasted in radiology. Radiology residency is very humbling and you will realize 5 years is not enough to .learn radiologu. In fact that is why 90%+ do fellowships. After a rads residency, a radiologist is like the family doctor of medicine. Jack of all trades and master of none. All radiologists are scared of lawsuits because of the huge liabiliy and knowledge required in radiologu. Think about it. You have the smartest med students match into rads, why do 90% of these smart students do a fellowship after 5 long years of making 40k a year. Answer. You have to do a fellowshio to get a job and limit the knowledge to one subspecialty. Welcome to radiology! Where you will read more than any other specialty in medicine. It is mentally the toughest specialty of them all.

Medical students are clueless. Lets put it this way 40% of medicine and ped residents do fellowships. In fact the number of fellowship for medicine residents has gone down since after 3 years of residency you can work 26 weeks a year with 26 weeks of vacation and make 200 to 300 k. Many hospitalists pick up extra shifts during the 26 weeks off and clear 300k. Hospitalists jobs are everywhere in every city. In comparison, 90% of radiology residents do a fellowship after 5 total years of 40k a year as a resident. The reason is because there is more information to know in radiology than any other field. In fact radiologists have to know more than pathologists because they have to know all of the disease processes to provide an accurate differential diagnosis. Furthermore radiologists have to know physics cold. No wonder rads is so long. Also many rads do two felllowships to get jobs. Ask any radiology resident about the job market now. Jobs are hard to find.

 

[gonogo]

Yes, radiology is 4 years. And what makes it really challenging is that even after 4 years you won't be as good as many subspecialists when it comes to interpreting films. For example, an ortho guy will always be better at MSK films than a general radiologist. This is why the format of residency is changing and the 4th year can be used to start subspecialization.

 

[jake2]

O come on guys, it's not THAT bad. Yes there is a lot to learn and there is a steep learnig curve, but a lot of it is the same stuff from med school again, just learning how it looks like on various imaging modalities. Most of what I'm calling is still pulmonary edema, sbo, fracture, etc. that isn't exactly rocket surgery.

It's the 20-30% of stuff that seems to turn out to be really rare crap (corpus callosum lipoma? Really?) that you don't want to mistake for something else that gets to you. Yes, rare stuff would seem by definition to come up rarely, but if you count the thousands of rare things you can get, turns out to happen pretty often. Knowing the radiologic presentation of all those things and calling them is where we earn our fee, and why it's a 5 year program.

 

[durfen]

Trust me, having done an prelim IM year I can tell you rad residents do WAY more reading. There's just way more to know. The only other specialty that even compares is path. Rads residents usually read a different textbook every month. IM residents are lucky to get through Harrison. In fact, the radiology board review (summary) book is bigger than the Harrison IM book. The information in radiology is liking changing at the same rate, if not faster than IM so that really is irrelevant.

Oh and you should try and compare JAMA or NEJM to a radiology journal some day... not only do the rad journals have bigger pages, but they are about 2-3x thick.

You won't read as a prelim because you're trying to survive. Agree with p53 above.

 

[fun8stuff]

You won't read as a prelim because you're trying to survive. Agree with p53 above.

well I wasn't talking about how i read practically nothing, but that I made enough IM friends to know how much they read. Sure, they have to read and continue their education... particularly fellows in the certain subspecialty fields, but it is still nothing compared to the burden in radiology radiology. Nobody else in medicine will even come close to reading a different textbook every month (on top of journal articles and interesting cases).

 

[indya]

.

 

[Charles_Carmichael]

For those that are gunning for money thus go into radiology. Good luck. 1st year of radiology has the steepest learning curve of your life. Nothing you learned in med school or undergrad prepares you for radiology residency. In fact you will throw away all of the knowledge you gained in medical school in radiology with the exception of anatomy. All of that stuff you learned in med school and internship is wasted in radiology.

Just curious, but if this is truly the case, then what's the point of wasting four years (and lots of money!) going to medical school? Why aren't radiologists pushing for the dissociation of radiology from medical school and internship?

 

[fun8stuff]

Just curious, but if this is truly the case, then what's the point of wasting four years (and lots of money!) going to medical school? Why aren't radiologists pushing for the dissociation of radiology from medical school and internship?

I wouldn't say that it is all a waste, at least not much more than other specialities. Third and fourth year are kind of a waste, but I think they are important in radiology in that it teaches you how the system and how other fields work and relate to radiology. Intern year is pointless. The first 2 years of med school are just as relevant to radiology as they are to any other specialty though, if not more because they give you an introduction to the vast majority of disease- many of which you will need to know something about in radiology.

Medical education in general, is a waste though. 4 years of undergrad is not needed... esp when you only go on to repeat many of the science prereqs during year 1. 4th year of med school is also a huge waste of time. Most people spend that time taking exams/applying & interviewing/vacation.

IMHO, it could all be done with 1.5 years undergrad, 2+1 years of med school. The traditional first year would be shortened to 6 months where most would be a recap of the 2 years of premed courses with a greater emphasis on how they relate to medicine. Then the traditional 2nd year would be mostly the same but start after the first 6 months. At the 1.5 year mark, residents could start the traditional 3rd year. The last 6 months would then be spent as a 6 month "internship" geared toward your planned field (medicine and subspecialties, neuro, ortho, ER for radiology).

Combine Step 1 and 2, as a lot of that basic science crap is tested or could be tested on the MCAT. The materially currently on step 2 that doesnt quite apply to step 1 could be shifted to step 3. oh and step 2 cs is a BS money making scheme.

 

[ringhal]

Edited for double post

 

[ringhal]

Yes, radiology is 4 years. And what makes it really challenging is that even after 4 years you won't be as good as many subspecialists when it comes to interpreting films. For example, an ortho guy will always be better at MSK films than a general radiologist. This is why the format of residency is changing and the 4th year can be used to start subspecialization.

The changes in the residency format seem to benefit academic radiology and at the same time will likely cause big problems for those of us who do not practice radiology at large university centers. Most radiology practices and private/county hospitals do not have enough volume to support every subspecialty. In a few years, my group is not going to want to hire someone who reads MSK fantastically, but feels uncomfortable with a pelvic ultrasound or can't do a barium enema.

It's analogous to tracking general surgeons into breast, trauma, colorectal, oncology or laproscopic pathways. At my hospital, there's 1 vascular surgeon (who does mostly general) and 1 surgical oncologist (who does mostly general). The rest of the general surgeons do everything but the complicated vascular cases.

I think in 5-10 years, those fellowship trained radiologists will still find themselves in smaller places doing mostly general radiology; they'll just have more catching up to do when they start working.

 

[fun8stuff]

The changes in the residency format seem to benefit academic radiology and at the same time will likely cause big problems for those of us who do not practice radiology at large university centers. Most radiology practices and private/county hospitals do not have enough volume to support every subspecialty. In a few years, my group is not going to want to hire someone who reads MSK fantastically, but feels uncomfortable with a pelvic ultrasound or can't do a barium enema.

It's analogous to tracking general surgeons into breast, trauma, colorectal, oncology or laproscopic pathways. At my hospital, there's 1 vascular surgeon (who does mostly general) and 1 surgical oncologist (who does mostly general). The rest of the general surgeons do everything but the complicated vascular cases.

I think in 5-10 years, those fellowship trained radiologists will still find themselves in smaller places doing mostly general radiology; they'll just have more catching up to do when they start working.

After doing a year long fellowship in 1 area of radiology, how does one keep from getting rusty in the other areas??

 

[ringhal]

After doing a year long fellowship in 1 area of radiology, how does one keep from getting rusty in the other areas??

In most fellowships - except IR, Peds and neuro, fellows get farmed out to staff an associated hospital a couple times each month. This is typically general radiology. That helps somewhat, though it often does not involve mammo or neuro.

With the residency changes, people will start focusing earlier on just a couple subjects. That means that not only will they experience a longer period of focused learning before being thrown back into reading everything, but they will have less residency exposure to those other areas; if I spend the last 18 months of residency only doing MSK, neuro and GI, that means I not being exposed to chest, mammo, ultrasound, nucs, GU, peds and IR. In that scenario, someone might go 2+ years without reading certain studies.

That's far from an insurmountable problem but the transition from training to practice is hard enough for some people already. These changes aren't going to make it any easier.