Why I like my job

[f_w]

Anytime there is something 'interesting' in radiology, someone is going to die.
(son of one of my attendings in residency)

This is the crop since friday afternoon:

- 16yo with 'neck swelling'. CT impression 'Hodgkins' Bx result: Hodgkins, Reed Sternberg cells and all.

- 60yo with 'abd. pain'. CT impression 'mesenteric implants and free fluid in the pelvis, consider ovarian CA. Bx result: gastric CA.

- 57yo with something handed down to me as 'cyst in the right breast' from outside facility. US: probably solid, slight increase in size, recommend US guided Bx. Bx result: invasive ductal ca

- 76yo with 'cough' and faint opacity R apex on CXR --> mass on CT Bx: squamous cell

- 34yo with 'seizure' : MRI: mass medial L temporal lobe ? low-grade glioma.

- 72yo with 'abd pain': CT: 3cm enhancing mass lower pole L kidney. ? RCC

Did I save any lives here, probably not. Was it a morbid kind of fun to be right, sure. Oh, and I do get paid for this.

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[cgscribe]

As an MS1, I think your post sums up what's really intriguing about rads. Lots of path encompassing many fields/ages/parts.

 

[shocker]

You may have not saved any lives as the public sees it (put straw into trachea after crich with butter knife), but you clearly helped those patients.

When I was a pre-med and saw anything cool while looking at films the Radiologist would say we call that a graphic case, not "cool".

 

[PeepshowJohnny]

I feel the same sense of excitement and intrigue when I see some imaging with cool pathology. However, I worry about how I'm going to express that sentiment in a personl statement and interviews without coming off like a sociopath.

 

[hello07]

f_w, scary stuff you mentioned. Is that always the case when you see interesting things in radiology someone is going to die? That is depressing / sad. Are you given any sort of case history with the CT or MRI or simply go bye what you are looking at and all your knowledge and training?

 

[f_w]

Is that always the case when you see interesting things in radiology someone is going to die?

This was the somewhat tongue in cheek impression of a radiologists kid I quoted.

Well, everyone is going to die some day somehow, but now, not every finding leads to death. Realistically, out of the 5 people above, one will probably die, the others will either have curative chemotherapy or surgery.
It was a series of cases where the radiologic findings where typical for the underlying disease and where the biopsy results where congruent with the radiologically suggested diagnosis. You don't get it to fit that nicely very often.

 

[nvshelat]

It seems that in many of your scenarios, the "final word" comes from pathology and for some reason that makes it a bit more appealing to me... anyone else feel teh same?

 

[f_w]

It seems that in many of your scenarios, the "final word" comes from pathology and for some reason that makes it a bit more appealing to me...

Well, if you are the kind of person who allways wants to have the 'final word', sure. Path

The surgeons who did the respective procedures could make the same claim, or the FPs and ER docs who referred them for imaging.

It just illustrates that there is no 'Dr House' who singlehandedly solves medical mysteries. Everyone does his little piece in the process.

 

[hello07]

f_w, thanks for answering my question. I am not a physician but what little or much I know as an optometrist your 6 cases above present difficult odds.
Not that I know more than you b/c I don't, but it seems 5 of the 6 cases seem dismal. invasive ductal ca, low grade glioma, gastric ca and lymphoma ca- very scary stuff.
as a side note, not to sound morbid, but I know 5 people that passed away who had your identical first 5 cases that you wrote. Again, I am not an MD but generally speaking; not specifically, it is very difficult, extremely difficult to stop DISEASE. Again, I know depending on the nature and stage and type but it can be hard. My 2 cents.

 

[f_w]

- invasive ductal ca

She will go for further surgery, typically radiation and possibly chemo and have 7/10 odds of surviving the next 10 years from a breast cancer perspective.

- low grade glioma

Resectable. Might loose more of her memory than she already lost, but not necessarily something to die from.

- gastric ca

Its metastatic. Not much to be done.

- and lymphoma

If I had to choose between different cancers to get, that one would be high on my list (next to testicular). Her odds of surviving this are north of 90%. She is in for a rough year ahead with chemo, but it is not likely that she'll die of thedisease.

- squamous cell

He had a lobectomy. If the hilar nodes are negative he is cured.

 

[MStewart]

The coolest thing about your job is that it can be shipped overseas and save the patients lots of money.

 

[Gravi69]

The coolest thing about your job is that it can be shipped overseas and save the patients lots of money.

ORLY?

The technology already exists. The broadband connections already exist. Why hasn't this happened yet?

Save the patients money? You pay your radiologist in cash directly? How novel.

The "pre-med" moniker under your user name says it all.

 

[f_w]

The coolest thing about your job is that it can be shipped overseas and save the patients lots of money.

- 80% of imaging cost is 'facility cost'. Mainly the money to buy the nice toys to do the studies and to pay the techs that operate them. That part is not going to 'get shipped overseas' to start with. So any 'savings' from outsourcing the professional portion of the service is going to be marginal at best.

- Telerad providers are suffering from tremendous overhead expenses which limit their ability to compete in the marketplace. You might want to follow the stock of nighthawk radiology over the past 6 months. If they keep up their pace, they will be a penny-stock soon.

- As long as the practice of radiology is considered the practice of medicine, you have to be licensed in every state and credentialed at every hospital that you read for. The pool of overseas radiologists able to fulfill those criteria is very small (mostly rads who have done residency/fellowship in the US). This is different from IT where a large labor-pool of qualified providers is sloshing around in china and india.

So no, my job isn't going anywhere.

 

[nvshelat]

When you get these films, do you get any relevant lab work with it, or is it just "Hey I want a picture of this tell me what it is"? For instance, would you be able to look at an electrolyte panel or other lab studies and put together some different pieces of the puzzle? I hope this question makes sense...

 

[unoriginal]

- 80% of imaging cost is 'facility cost'. Mainly the money to buy the nice toys to do the studies and to pay the techs that operate them. That part is not going to 'get shipped overseas' to start with. So any 'savings' from outsourcing the professional portion of the service is going to be marginal at best.

- Telerad providers are suffering from tremendous overhead expenses which limit their ability to compete in the marketplace. You might want to follow the stock of nighthawk radiology over the past 6 months. If they keep up their pace, they will be a penny-stock soon.

- As long as the practice of radiology is considered the practice of medicine, you have to be licensed in every state and credentialed at every hospital that you read for. The pool of overseas radiologists able to fulfill those criteria is very small (mostly rads who have done residency/fellowship in the US). This is different from IT where a large labor-pool of qualified providers is sloshing around in china and india.

So no, my job isn't going anywhere.

well said.

 

[OHMAN0125]

The coolest thing about your job is that it can be shipped overseas and save the patients lots of money.

Wow another premed who thinks he knows about the field of radiology. Why dont u save ur comments until after u start medical school hmm?
I'm surprised FW even replied to ur post. I dont think ur worth the time for an explanation.
Looking at ur recent posts...it looks like u like to fight with surgeons as well.

 

[unoriginal]

- 80% of imaging cost is 'facility cost'. Mainly the money to buy the nice toys to do the studies and to pay the techs that operate them. That part is not going to 'get shipped overseas' to start with. So any 'savings' from outsourcing the professional portion of the service is going to be marginal at best.

- Telerad providers are suffering from tremendous overhead expenses which limit their ability to compete in the marketplace. You might want to follow the stock of nighthawk radiology over the past 6 months. If they keep up their pace, they will be a penny-stock soon.

- As long as the practice of radiology is considered the practice of medicine, you have to be licensed in every state and credentialed at every hospital that you read for. The pool of overseas radiologists able to fulfill those criteria is very small (mostly rads who have done residency/fellowship in the US). This is different from IT where a large labor-pool of qualified providers is sloshing around in china and india.

So no, my job isn't going anywhere.

My only concerns about radiology are 1) reimbursement cuts, and 2) whether or not private practice would be too much assembly-line boring work.

I've done an elective at an academic center, but even as a student I am not sure you really get that good of a feel for what it would be like to do diagnostic radiology in a private practice working 40-60 hrs/week. Is burn out/ boredom something I should be worrying about? What's your take on these issues?

Thanks!

 

[f_w]

1) reimbursement cuts, and

Make that a concern for 'medicine' in general. Yes, rads has seen some specific cuts, but reimbursement is a sore issue for all specialties.

2) whether or not private practice would be too much assembly-line boring work.

Well, there is lots of routine work. Between those 6 cases there where oodles of MRIs for 'back pain' and plainfilms of the knee with 'DJD medial compartment'. Routine-work is the bane of any medical field. For every whipple that was 'really interesting', a GS will cut out lots of moles.

Is burn out/ boredom something I should be worrying about? What's your take on these issues?

It is an issue, but probably less than in other specialties. You do tend to have a lot of time off which helps to compensate for the busier times.