Why does everyone talk about how super competitive Radiology is?

[78222]

I hear a lot on this forum and from my classmates about how competitive rads is. Why does this keep getting repeated when the numbers seem to state otherwise?

From Charting Outcomes 2007:
US Applicants:
Matched
(n=831)
Did Not Match
(n=84)

USMLE Step 1 score:
Mean:
Matched 235
Did not Match: 212

ok, clearly it is more competitive than IM/Peds/FM and even Gas/EM. Sure the average STEP I score is on par with the most competitive specialties. However, when 91% of applicants are matching and there are tons of slots, I don't think "very competitive" is an accurate description.

Btw, as a sort of disclaimer, I don't think competitiveness of any given field matters in the slightest and this is in no way meant to mean that radiologists are any less smart than the uber competitive specialties. I just find it rather odd that people tend to rank radiology as one of the most competitive specialties despite the numbers.

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[howelljolly]

Self selection.
Only people who are already competitive tend to apply.
It also probably depends on more than the Step1 score... research, away rotations, electives, AOA, etc.

 

[MrBurns10]

I guess it depends on what you mean by "super competitive." I don't think anyone has put it at the level of plastics, derm, rad onc, or the surgical subspecialties (which to me are "super competitive"). But 235 is a very high average step 1 score, and it's even higher if you just consider university programs (though there are many good community programs).

Self-selection plays a role, as does how many programs you apply to. If you ever peruse the Aunt Minnie forums, it seems that the norm # of programs for a "competitive" applicant to apply to is upwards of 30-40.

 

[Droopy Snoopy]

Radiology is on a relatively non-competitive swing right now, but go back 10-15 years and it was super tough. Go back another 20 and I've heard you couldn't give a rads spot away. Surgery, gas, ER, most specialties really are the same way, everything ebbs and flows.

Agree with the previous poster in that I've never heard it claimed as the end-all top of the pile. Still, if you think of things as either low, medium, or highly competitive you'd have to put Rads in the top bracket wouldn't you? 235 is nothing to sneeze at after all; it means their average is (roughly) an sd higher than the overall average.

 

[DwyaneWade]

To be fair, one could argue that the most competitive Rads spots (MGH, UCSF) are THE most competitive spots in any specialty.

 

[meister]

Seems like most people who work for it in school are awarded with a spot. Where that spot is who knows, but it's nice to know if I work hard and get a decent step 1 I won't have to sell a kidney to get a spot somewhere.

Derm's lack of spots is the difference here, obviously.

 

[Blesbok]

Even a 91% match rate isn't that high considering the number of slots and the fact that most specialties have an abundance of slots compared to applicants.

 

[Dirt]

It certainly does seem to be on a downswing. People just seem to say Rads is tough just because. I feel like Rad Onc took its place in the upper echelon.

 

[MrBurns10]

It certainly does seem to be on a downswing. People just seem to say Rads is tough just because. I feel like Rad Onc took its place in the upper echelon.

Just curious why you think rads is on the downswing. If anything, I think it's become more popular nowadays because our generation is very lifestyle-driven (not saying that's a bad thing, but I think some people who otherwise wouldn't consider rads are doing so because of the lifestyle).

 

[badasshairday]

Just curious why you think rads is on the downswing. If anything, I think it's become more popular nowadays because our generation is very lifestyle-driven (not saying that's a bad thing, but I think some people who otherwise wouldn't consider rads are doing so because of the lifestyle).

Still on a down slope even when considering life style. This downslope isn't very steep, but it is there. Rads, like Gas is now approaching 60 hours a week. Also with the imaging cuts hitting Rads hard, to pull the same Radiology salary of 5 years ago is going to require putting in more work. This is probably part of the reason why Rads is becoming slowly less competitive (but still very competitive, ~235 avg!). I think a few years ago it hit its pinnacle in terms of being competitive.

 

[MrBurns10]

Still on a down slope even when considering life style. This downslope isn't very steep, but it is there. Rads, like Gas is now approaching 60 hours a week. Also with the imaging cuts hitting Rads hard, to pull the same Radiology salary of 5 years ago is going to require putting in more work. This is probably part of the reason why Rads is becoming slowly less competitive (but still very competitive, ~235 avg!). I think a few years ago it hit its pinnacle in terms of being competitive.

Well, I hope you're right about the less competitive thing since I'll be trying to match in a year. And while I agree that radiologist salary is going down, it's going down for all specialties...and I think radiology will continue to be one of the higher-paying specialties, albeit not where it was years ago. New imaging technologies are coming out every few years and rads usually has first crack.

Money is not the reason to go into any field because things change and you have to love what you do. But the career flexibility radiology offers is incomparable, in my (biased) opinion, so I'm not sure how much of a down-swing we'll see.

 

[Blesbok]

Still on a down slope even when considering life style. This downslope isn't very steep, but it is there. Rads, like Gas is now approaching 60 hours a week. Also with the imaging cuts hitting Rads hard, to pull the same Radiology salary of 5 years ago is going to require putting in more work. This is probably part of the reason why Rads is becoming slowly less competitive (but still very competitive, ~235 avg!). I think a few years ago it hit its pinnacle in terms of being competitive.

It is also becoming saturated. There was a huge deficit a few years ago and that deficit has been filled by the lifestylists. I would bet in the next few years that the number of residency positions gets cut because there just isn't the demand anymore.

 

[MrBurns10]

because there just isn't the demand anymore.

Actually, quite the opposite. People are getting imaging studies now more than ever...for example, I don't know how many times I was on medicine and we "had to" get a spiral CT to rule out PE even though the chances the patient had one was like 2%. The CT scan is the new physical exam. That's why rads are having to work harder now, because there are much more studies being conducted.

And in response you may comment on telerads, but a lot of that is done within the US and the overseas reads can only be preliminary reads (a US radiologist still has to give the final read). Plus, as I mentioned earlier, new technology crops up pretty frequently.

 

[Blesbok]

Actually, quite the opposite. People are getting imaging studies now more than ever...for example, I don't know how many times I was on medicine and we "had to" get a spiral CT to rule out PE even though the chances the patient had one was like 2%. The CT scan is the new physical exam. That's why rads are having to work harder now, because there are much more studies being conducted.

And in response you may comment on telerads, but a lot of that is done within the US and the overseas reads can only be preliminary reads (a US radiologist still has to give the final read). Plus, as I mentioned earlier, new technology crops up pretty frequently.

I am not talking about the number of studies being done, I am talking about the number of attending positions vs the number of residency graduates. A few years ago there just weren't enough grads to fill all the positions, this is becoming much less of a problem with all the current grads.

 

[MrBurns10]

I am not talking about the number of studies being done, I am talking about the number of attending positions vs the number of residency graduates. A few years ago there just weren't enough grads to fill all the positions, this is becoming much less of a problem with all the current grads.

ah, gotcha

 

[braluk]

% matched usually doesn't correlate with competitive-ness. Other posters here said self-selection, which is particularly true. Not to mention med school advisors are pretty good with giving you a heads up about how you'll fare matching into a particularly specialty, and deter you if your scores aren't high enough to begin with.

 

[Dirt]

Just curious why you think rads is on the downswing. If anything, I think it's become more popular nowadays because our generation is very lifestyle-driven (not saying that's a bad thing, but I think some people who otherwise wouldn't consider rads are doing so because of the lifestyle).

Yeah the downswing is from the one of the A-1 specialties, to an A-2 specialty. In the past when asked what the hardest match was, Rads came to mind for most people, that just isn't the case anymore. A lot of it has to do with reimbursements. Rads has been getting more cuts than most fields in the recent past. Derm and Plastics are the top two mainly because they are essentially cash for service fields mostly immune to pay cuts (not economic collapses however 😀) Everyone says that you shouldn't choose a specialty based on pay but for the vast majority it is a very important factor.

 

[howelljolly]

I am not talking about the number of studies being done, I am talking about the number of attending positions vs the number of residency graduates. A few years ago there just weren't enough grads to fill all the positions, this is becoming much less of a problem with all the current grads.

Is this only with radio, or with all the specialties? I get the feeling that current grads are having more difficulty finding jobs now. It seems like the doctor shortage that everyone is predicting is not a real concern.

Also, I dont know about all fields, but I know that at least in psychiatry, some of the top programs will rather not fill their seats than take what it considers a sub-par applicant

 

[Droopy Snoopy]

Also, I dont know about all fields, but I know that at least in psychiatry, some of the top programs will rather not fill their seats than take what it considers a sub-par applicant

Some top programs can do this occasionally, but it's by no means common in all fields or programs because it results in lost Medicare funding and eventually the loss of the spots themselves.

 

[sirus_virus]

Why do we keep ignoring the people on the other side of any statistic? 91% of people matching means 9% had to scramble. 9% is still a whole lot.

 

[Taurus]

http://forums.studentdoctor.net/showpost.php?p=7146057&postcount=1

I wouldn't feel sorry for radiologists. They're among the top earners, even more than anesthesiology and ENT. Ortho has them beat, but they have to live in the hospital to do that.

Nothing ever stays the same. Just look at i-banking. Just 6 months ago, it was still white hot. Now, people are begging to just keep their jobs.

Go into a field because you like it, not because of the potential payoffs.

 

[RxnMan]

Why do we keep ignoring the people on the other side of any statistic? 91% of people matching means 9% had to scramble. 9% is still a whole lot.

92% (1157/13263) of US seniors who applied in the 2007 Match were successful. The 91% Match rate for Rads is not much different.

 

[RxnMan]

To be fair, one could argue that the most competitive Rads spots (MGH, UCSF) are THE most competitive spots in any specialty.

To be fair, one can argue anything. And those places attract the tip-top characters in every speciality.

% matched usually doesn't correlate with competitive-ness. Other posters here said self-selection, which is particularly true. Not to mention med school advisors are pretty good with giving you a heads up about how you'll fare matching into a particularly specialty, and deter you if your scores aren't high enough to begin with.

I agree that there is an element of self-selection. But if you fit into that speciality (via step score and/or AOA), what more do you need? You look at the NRMP, and if you fit the profile for the speciality you like, you're going to match somewhere.

I think these "specialty X is VERY competitvie" statements are perpetuated by two types of folks:
1) Kids who don't fit the stats and fight their uphill battle by dissuading others
2) Higher-ups trying massage their egos/sense of speciality importance by declaring how hard it is to match.

 

[Blesbok]

Is this only with radio, or with all the specialties? I get the feeling that current grads are having more difficulty finding jobs now. It seems like the doctor shortage that everyone is predicting is not a real concern.

Also, I dont know about all fields, but I know that at least in psychiatry, some of the top programs will rather not fill their seats than take what it considers a sub-par applicant

There is going to be a doctor shortage in primary care after the current generation retires. More than 50% of primary care doctors are >50 years old. They can't practice forever.

Also, general surgery and CT are probably going to have a shortage in a few years. Both had their number of residencies reduced a while back which is going to lead to a mild shortage, but nothing like primary care.

 

[mikedc813]

Also, I dont know about all fields, but I know that at least in psychiatry, some of the top programs will rather not fill their seats than take what it considers a sub-par applicant

Rad onc doesn't have this problem because of the ratio of available positions to applicants. I can't speak for other specialties, but I suspect that it would be uncommon for a program to not have enough satisfactory applicants to leave open positions.

 

[sirus_virus]

http://forums.studentdoctor.net/showpost.php?p=7146057&postcount=1

I wouldn't feel sorry for radiologists. They're among the top earners, even more than anesthesiology and ENT. Ortho has them beat, but they have to live in the hospital to do that.

Nothing ever stays the same. Just look at i-banking. Just 6 months ago, it was still white hot. Now, people are begging to just keep their jobs.

Go into a field because you like it, not because of the potential payoffs.

Good point. I am about 100% sure the way different specialties are compensated will change 2 - 3 times before the end of the career of any present medical student. Rads has all sorts of potential for a bubble burst, and I am not sure what the next big thing will be.

 

[DwyaneWade]

Good point. I am about 100% sure the way different specialties are compensated will change 2 - 3 times before the end of the career of any present medical student. Rads has all sorts of potential for a bubble burst, and I am not sure what the next big thing will be.

As long people's basic needs are fulfilled in this country, vanity will always be motivating people to pay dermatologists and plastics surgeon.s

 

[JacobSilge]

As long people's basic needs are fulfilled in this country, vanity will always be motivating people to pay dermatologists and plastics surgeon.s

While the only real threat to plastics right now is ENT's and other surgeons competing for their patients, the belief that the ascension of Derm is primarily due to cosmetics is a bit of a misconception, as cash-payment makes up a majority of relatively few derm practices. Rather, Derm is so profitable because they of high throughput of patients (racking up this 99203's) coupled with quick procedures like skin biopsies that are highly reimbursed relative to the time they take. All it would take is CMS figuring out that they shouldn't pay the same for a 5 minute derm visit and a 1 hour neuro visit and a slash to skin biopsy reimbursement and derm would be quite changed.

 

[rvarsity]

While the only real threat to plastics right now is ENT's and other surgeons competing for their patients, the belief that the ascension of Derm is primarily due to cosmetics is a bit of a misconception, as cash-payment makes up a majority of relatively few derm practices. Rather, Derm is so profitable because they of high throughput of patients (racking up this 99203's) coupled with quick procedures like skin biopsies that are highly reimbursed relative to the time they take. All it would take is CMS figuring out that they shouldn't pay the same for a 5 minute derm visit and a 1 hour neuro visit and a slash to skin biopsy reimbursement and derm would be quite changed.

I know a few private practice FP's that are getting heavy into derm procedures and making a killing. Why would you refer a patient to derm when you can do the 5 minute "procedure" yourself?

Remember when FP's used to do a whole bunch of OB back in the day? Now it seems like they're getting wise and snagging a piece of the derm pie.

 

[Taurus]

While the only real threat to plastics right now is ENT's and other surgeons competing for their patients, the belief that the ascension of Derm is primarily due to cosmetics is a bit of a misconception, as cash-payment makes up a majority of relatively few derm practices. Rather, Derm is so profitable because they of high throughput of patients (racking up this 99203's) coupled with quick procedures like skin biopsies that are highly reimbursed relative to the time they take. All it would take is CMS figuring out that they shouldn't pay the same for a 5 minute derm visit and a 1 hour neuro visit and a slash to skin biopsy reimbursement and derm would be quite changed.

People need to realize that cosmetics is not regulated like it is in medicine. Both physicians and NP's can open up cash-based shops to inject botox and sell skin cream. Here's an interventional radiologist who does liposuction. As a result, cosmetics is quite cutthroat and it's not easy to start up a lucrative practice.

 

[Taurus]

I know a few private practice FP's that are getting heavy into derm procedures and making a killing. Why would you refer a patient to derm when you can do the 5 minute "procedure" yourself?

Remember when FP's used to do a whole bunch of OB back in the day? Now it seems like they're getting wise and snagging a piece of the derm pie.

This is what I have been saying for years. FP and internists are going to keep more and more simple skin cases and make more bank. They won't be alone. I'm betting that NP's will too.

 

[badasshairday]

Rads may not be as competitive as it was 4-5 years ago. But a 235 Step 1 avg is nothing to sneeze at.

 

[jonb12997]

who wants to sit in a dark room their whole residency anyway? 😉

 

[MrBurns10]

who wants to sit in a dark room their whole residency anyway? 😉

I do, especially when sitting in a dark room lasts from 8-5 😛

 

[MossPoh]

I do, especially when sitting in a dark room lasts from 8-5 😛

You're at a lucky place if it is 8 to 5. My dad gets in around 6 a.m. and leaves around 7 p.m. when he works now. Averages about 150-170 cases a day. A few years ago a busy day was about 90 cases. The new scanners are just so fast and people get pushed through for every headache or abdominal pain to cover the doc's ass. Granted, my dad did a fellowship in cardiovascular, so only 3/4's of his day is in a dark room. 😉

It is an odd speciality and it is something you really have to love to go into. The people that go in thinking they will make bank are miserable. There are few fields that evolve as quickly as radiology and it is a constant struggle to stay educated. I'll just put it in the perspective of my dad, who finished his residency in the late 60s. At that time, you read xrays and lots of them. There were a few crappy diagnostic procedures and not much more. He had about 4 months dedicated to radiation therapy as well. Since then ct, mri, PACS, etc. have all been developed. We are all use to looking at CT now but at the time, it was a completely new way to look at anatomy and required them to relearn everything in a different way. That was also the time span when it was competitive.

Just as others mentioned, it is a thing that flows with the time. I feel like the current times are weeding out some of the people that are strictly lifestyle but I'm sure some new modality will come along that'll bypass everything and make tons of bank and then we'll be back to where we started.

 

[MrBurns10]

You're at a lucky place if it is 8 to 5. My dad gets in around 6 a.m. and leaves around 7 p.m. when he works now.

oh I was just referring to residency, where most days are 730 or 8-5...unless you're on VIR or on night float.

Your dad's schedule is really hectic, though. I hope he gets a lot of vacation to make up for it.

 

[sirus_virus]

I know a few private practice FP's that are getting heavy into derm procedures and making a killing. Why would you refer a patient to derm when you can do the 5 minute "procedure" yourself?

Remember when FP's used to do a whole bunch of OB back in the day? Now it seems like they're getting wise and snagging a piece of the derm pie.

Derms need to protect their turf before this gets out of hand. I have always said the most risky scenerio when it comes to job security is having an easy job that pays a lot. Only a matter of time before the sharks encroach. Nothing really stops an FP from grabbing some of those patients waiting 5 months to see a dermatologist for their acne. No risk involved either, and if they want, they can run a cash only system and still make bank.

 

[meister]

At least with radiology NPs and FPs won't have an easy time stealing patient load. 🙂

Sucks to be you derm

 

[PeepshowJohnny]

Radiology isn't super competitive for two big reasons.

A) There are tons of slots. There are three rads slots for every derm slot, six for every rad onc, ten for ever categorical plastics. Rads is a lot like Gen Surg/IM in that the "upper tier" programs can be super competitive, but there are plenty of really solid university and community slots where you can get excellent training.

B) Radiologists are pretty chill people. Probably related to having a lot of slots, but it's not like other specialties where to get interviews/match you are required to rotate at the big academic centers and get letters from famous department heads. If you're a decent dude or dudette with some smarts, radiology is more than happy to have you (Heck, they're always trying to recruit people at my school).

 

[sirus_virus]

Radiology isn't super competitive for two big reasons.

A) There are tons of slots. There are three rads slots for every derm slot, six for every rad onc, ten for ever categorical plastics. Rads is a lot like Gen Surg/IM in that the "upper tier" programs can be super competitive, but there are plenty of really solid university and community slots where you can get excellent training.

B) Radiologists are pretty chill people. Probably related to having a lot of slots, but it's not like other specialties where to get interviews/match you are required to rotate at the big academic centers and get letters from famous department heads. If you're a decent dude or dudette with some smarts, radiology is more than happy to have you (Heck, they're always trying to recruit people at my school).

What? Radiology is as competitive as they come. 235 board average is the true definition of competitive. IMO, anyone planning to match radiology better have his/her stuff together or prepare to scramble.

 

[PeepshowJohnny]

What? Radiology is as competitive as they come. 235 board average is the true definition of competitive. IMO, anyone planning to match radiology better have his/her stuff together or prepare to scramble.

I didn't say Radiology isn't competitive, I said it's not super competitive. Radiology likes smart, strong applicants. It does not demand you be the ubermesnch like Plastics and Derm do.

 

[MOHS_01]

While the only real threat to plastics right now is ENT's and other surgeons competing for their patients, the belief that the ascension of Derm is primarily due to cosmetics is a bit of a misconception, as cash-payment makes up a majority of relatively few derm practices. Rather, Derm is so profitable because they of high throughput of patients (racking up this 99203's) coupled with quick procedures like skin biopsies that are highly reimbursed relative to the time they take. All it would take is CMS figuring out that they shouldn't pay the same for a 5 minute derm visit and a 1 hour neuro visit and a slash to skin biopsy reimbursement and derm would be quite changed.

Somewhat true, at least in principle -- but derms do not bill many 99203's -- that would be rather the exception, actually, with the vast majority being 99201's and 99202's. It requires 6 bullets on the PE to meet 99202 requirements; we rarely meet the requirement for anything higher. Biopsies are paid fairly well for the time that they involve; the reason for this is that procedures are not reimbursed solely upon time and takes into consideration the costs per hour outlay for the specialties who perform the majority of the service.

 

[pseudoknot]

The denominator in the 91% match rate is not all applicants, it is applicants who have ranked programs in that specialty, i.e., those who have gotten interviews. It's not self-selection, it's just normal selection. The match rates for all specialties except derm and plastics are pretty high for this reason. Other stats like Step I score, % filled, % AMG are better measures for competitiveness.

 

[RxnMan]

The denominator in the 91% match rate is not all applicants, it is applicants who have ranked programs in that specialty, i.e., those who have gotten interviews. It's not self-selection, it's just normal selection. The match rates for all specialties except derm and plastics are pretty high for this reason. Other stats like Step I score, % filled, % AMG are better measures for competitiveness.

I see your point. Additionally, the ~9% probably comes from the slop of the the Match algorithm (I'm not saying this is a defect of the Match nor that independents could do better) and not specialty dependent for most specialities. But a fill rate of 94% vs. 96%, or 91% vs 94% is nothing to be amazed about. What real numbers are we talking about? 10-20 people across an entire specialty?