why radiology?

[BobCat3]

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im a MS3, considering radiology, read through lots of forums and just wondering if peope could let me know why they want to become a radiologist (ie: the advantages/pros of choosing the specialty) and the cons of choosing to become a radiologist, thanks.

 

[discontinuebed]

Con: Possible decrease in currently fabulous salaries. Some say inevitable. (i.e. Probably shouldn't do it solely for the money)

 

[UnderDoc]

The perceived pro's and con's of radiology, or any specialty for that matter, are highly individualized. The best advice I could give you would be to spend some time in your institution's radiology department shadowing residents and attendings.

Here are some attributes of radiology that I personally enjoy:
-The best radiologists are profoundly knowledgeable in a vast swath of the medical terrain with some degree of expertise in virtually all fields of medicine, save perhaps dermatology and psychiatry. Though there are many proclaiming the death knell for general radiology given the spectacular breadth and depth of knowledge required, radiologists will continue to be among the smartest physicians out there. It's great to be trained in such a diversity of pathology. A good radiologist is an incredible asset to the treating physician.
-The technology that we get to interface with every day is amazing, approaching the realm of science fiction. It's easy to lose sight of the technical achievements embodied by an MR scanner or ultrasound probe, but virtually everything we do is dependent on some of the most sophisticated technologies on the planet.
-There is tremendous growth potential in the field. Aside from the double-digit year-over-year growth in clinical imaging, research and converging technologies are enabling an even more exciting future. Molecular imaging -- the ability to produce maps of physiologic activity on the protein and biochemical level -- is fast becoming a reality. Combined with advances in protein and gene-targeted therapy, radiology will remain on the razor's edge of medical innovation.
-There is great diversity to the opportunities available in radiology. You can do teleradiology from halfway around the world, work part-time, become a full-time interventionalist or live the purely outpatient lifestyle. Fellowship opportunities in radiology are plentiful (even overabundant) and assuming you're at a decent training program, relatively easily obtained.

And some of the things I enjoy less:
-The practice of radiology can become quickly monotonous and isolating. Dictating through queues of ICU plain films or a stack of mammograms alone in a dark room isn't a very exciting or pleasant experience.
-There have been significant reimbursement cuts to radiology, and there will be more coming down the pike. While cuts are being proposed (and in many instances, instituted) across the board, radiology is being unfairly targeted due to charges of over-utilization.
-Some select clinicians, especially surgeons, like to treat you like their imaging / biopsying bitch. You may often find yourself in uncomfortable ethical positions, approving studies or doing procedures of questionable medical validity to assuage the referring physician and maintain their business.
-I'm finding that radiology can be extremely stressful as a resident, especially in the chaos of the ED, where you are expected to interpret complex imaging studies at breakneck speed despite limited experience, making diagnostic decisions that are often central to patient outcomes.

 

[old_boy]

The practice of radiology can become quickly monotonous and isolating. Dictating through queues of ICU plain films or a stack of mammograms alone in a dark room isn't a very exciting or pleasant experience.

Yikes! Sounds depressing. UnderDoc - From your previous posts you seem very thoughtful. If you had to do it all over again, would you still choose rads?

 

[OHMAN0125]

I don't know what UnderWear is talking about. Monotonous? Isolating? Biopsy bitch? Stressful? No offense UnderWear, but you sound like a pansy. You need to grab your crotch and be a man and suck it up.

One of the best things about rads is that you can hang out alone and work when you want, take a break when you want, jump on the net, get it on with a tech, spank your monkey, whatever. Surgeon's bitch? WTF are you smoking bro? Radiologists RULE the surgeons and their managment. We are like the generals in the tent and they are the privates on the front lines doing what we say. Stress? C'mon you weaknut, seriously you need to grow some pubes -- sure we're busy at times but please, nothing a good, fast, hairy-chested rad can't handle.

Are you at some rad program for "special people" UnderWear?

Apache, I'm on ur side regarding most things radiology, but LMAO. Are you even "real"? haha...are you like this in real-life? If so, you're either a real funny guy and ppl love you or ppl mostly hate you.

 

[Taurus]

I posted before with links that rads are #1 in overall happiness and in top 5 of pay. Do a search if you want the links.

 

[Bahamian Doc]

Apache is the man.

 

[Fireboy]

I posted before with links that rads are #1 in overall happiness and in top 5 of pay. Do a search if you want the links.

Taurus... would you be so kind as to post the links... I searched and couldn't find 🙁

 

[VoiceofReason]

The perceived pro's and con's of radiology, or any specialty for that matter, are highly individualized. The best advice I could give you would be to spend some time in your institution's radiology department shadowing residents and attendings.

Here are some attributes of radiology that I personally enjoy:
-The best radiologists are profoundly knowledgeable in a vast swath of the medical terrain with some degree of expertise in virtually all fields of medicine, save perhaps dermatology and psychiatry. Though there are many proclaiming the death knell for general radiology given the spectacular breadth and depth of knowledge required, radiologists will continue to be among the smartest physicians out there. It's great to be trained in such a diversity of pathology. A good radiologist is an incredible asset to the treating physician.
-The technology that we get to interface with every day is amazing, approaching the realm of science fiction. It's easy to lose sight of the technical achievements embodied by an MR scanner or ultrasound probe, but virtually everything we do is dependent on some of the most sophisticated technologies on the planet.
-There is tremendous growth potential in the field. Aside from the double-digit year-over-year growth in clinical imaging, research and converging technologies are enabling an even more exciting future. Molecular imaging -- the ability to produce maps of physiologic activity on the protein and biochemical level -- is fast becoming a reality. Combined with advances in protein and gene-targeted therapy, radiology will remain on the razor's edge of medical innovation.
-There is great diversity to the opportunities available in radiology. You can do teleradiology from halfway around the world, work part-time, become a full-time interventionalist or live the purely outpatient lifestyle. Fellowship opportunities in radiology are plentiful (even overabundant) and assuming you're at a decent training program, relatively easily obtained.

And some of the things I enjoy less:
-The practice of radiology can become quickly monotonous and isolating. Dictating through queues of ICU plain films or a stack of mammograms alone in a dark room isn't a very exciting or pleasant experience.
-There have been significant reimbursement cuts to radiology, and there will be more coming down the pike. While cuts are being proposed (and in many instances, instituted) across the board, radiology is being unfairly targeted due to charges of over-utilization.
-Some select clinicians, especially surgeons, like to treat you like their imaging / biopsying bitch. You may often find yourself in uncomfortable ethical positions, approving studies or doing procedures of questionable medical validity to assuage the referring physician and maintain their business.
-I'm finding that radiology can be extremely stressful as a resident, especially in the chaos of the ED, where you are expected to interpret complex imaging studies at breakneck speed despite limited experience, making diagnostic decisions that are often central to patient outcomes.

First of all thanks for taking the time to write your thoughts down for us. I'm curious about the bolded points though: would it be accurate to say that as a radiologist you are trained to understand a ton of disease processes, but only ever encounter a small boring set?

I really like the idea of radiology because I think that diagnostics is the most important part of clinical medicine. And I like the idea of learning a huge breadth and depth of pathology, but I would also really like to actually use that knowledge. So can anyone elaborate on this aspect a little?

 

[f_w]

would it be accurate to say that as a radiologist you are trained to understand a ton of disease processes, but only ever encounter a small boring set?

You'll encounter a ton of different diseases, the problem is that in between those exciting* cases there are plenty of fracture follow-ups, sinus-CTs for stuffy nose and screening mammograms.

The spectrum of diseases you'll encounter depends a bit on your practice setting. A 700 bed referral center will yield a higher number of interesting cases than a suburban outpatient practice.





*exciting in radiology usually means that someone is going to die

 

[VoiceofReason]

You'll encounter a ton of different diseases, the problem is that in between those exciting* cases there are plenty of fracture follow-ups, sinus-CTs for stuffy nose and screening mammograms.

The spectrum of diseases you'll encounter depends a bit on your practice setting. A 700 bed referral center will yield a higher number of interesting cases than a suburban outpatient practice.





*exciting in radiology usually means that someone is going to die

Thanks. This seems like it would be true of any specialty, a few interesting cases and many routine ones. Would you say that is true? In your opinion, is there any specialty or set of specialties that offers a marked variety not really found in the others? Like I said, I don't like the idea of my knowledge not being put to use, or even worse, atrophying because I don't really use it. Or is that inescapable and it really doesn't matter what specialty you choose in that respect?

 

[f_w]

a few interesting cases and many routine ones. Would you say that is true?

Let's see, what is this mornings crop:
- new diagnosis stage IIIC renal cell
- C4 fracture
- internal hernia with incarcerated bowel
- probable DCIS on a mammogram

But in between those, plenty of knees for DJD, ovarian cysts for follow up....

In your opinion, is there any specialty or set of specialties that offers a marked variety not really found in the others?

Yes, Radiology !

(and pathology)

 

[osli]

Why Radiology? Here's a great answer from one of our forum's great contributors...

Radiology is an immensely rewarding specialty for the reasons, you've already mentioned. The nature of the field entails using new technologies and improvements in existing technologies for medical diagnosis.

IMO, the interesting part of internal medicine of the old days was the detective work- using the physical examination and the history to arrive upon a diagnosis. Of course this was before the days of advanced radiology and immunologically based labs, but the days of detective work in IM (IMO) are largely diminished. Now you have to worry about paper work, HMOs, social issues, which are peripheral to the art and science of medicine (again all IMO).

Now-a-days the detective work is done in radiology. You look at the organs, in effect you are literally performing a visual physical exam, making the findings and arriving on a differential- thats fun. Its really cool when you make a diagnosis, sometimes an improbable one, and you're right about it. The other day when I was on call, we diagnosed a jejunal diverticulum (pretty rare) which had perforated, and looked like a loop of colon filled with stool (to the untrained eye). We notified the surgeons, and they were perhaps a little skeptical. One of the surgeons stopped me in the hallway a few days later to tell me they ended up taking the patient to the OR and we were dead on about the dx!

Contrary to popular belief you DO interact with people. Those people are other physicians-- your peers. Instead of explaining to a patient why they need to lose weight, stop smoking, and be compliant with their meds, as a radiologist talk to your peers about the things that interested you to go to medical school, in the first place. You interact with all specialties: internists, pediatricians, general surgeons, specialty surgeons alike. Your knowledge base means you can comfortably talk shop with virtually any specialist.

Now... which contributor? Either f_w or hans... can't remember!

 

[AD2020]

Thanks, osli, for re-posting those thoughts on why radiology is great. That is almost exactly my main motivation in doing rads, because I think diagnosis is the pinnacle of problem-solving in medicine. Without diagnosis, we are practicing cookbook medicine and deserve to be called technicians.

Halfway through 3rd year, I started my IM and surg clerkships, and I was able to compare them with a 2 week rads elective. Although I followed a few really fascinating cases in IM and surg where tough diagnoses were made, I felt like I saw a lot more successful diagnostic thinking on a daily basis in radiology. (This was surprising to me because IM docs are often given credit for being the best diagnosticians.)

This kind of discussion, where we're talking about our intellectual motivations for going into rads, is a breath of fresh air after reading through the "is radiology going down?" thread, where everyone disparaging any specialty other than what they're going into 🙂thumbdown). All specialties are necessary (more and more often, collaboratively) to take the best care of patients, and no specialty as a whole can claim moral high ground over another.

 

[PeepshowJohnny]

This was surprising to me because IM docs are often given credit for being the best diagnosticians.

Well, I think it depends. The thing about an IM guy is he has all the options in the world to make the diagnosis. He needs to know when its proper to order imaging, but also a whole other galaxy of other tests available to him. So a badass IM doc may diagnose a porphyria or Wilson's disease with a few send off blood tests.

However, we all know the real world imaging is ordered willy nilly and in practice radiologists are given a lot of diagnostic responsibility.

 

[MrBurns10]

Random question- do non-IR radiologists do any procedures? I don't mean doing CT scans, MRIs, etc. but like actual procedures.

 

[Zweihander]

Random question- do non-IR radiologists do any procedures? I don't mean doing CT scans, MRIs, etc. but like actual procedures.

What do you define as a "procedure"? Do you mean something invasive? The most invasive thing I've seen non-IR folks do is fluro-guided lumbar punctures done by neuroradiologists (again, NOT neuro-IR). Other than that, I consider fluoro studies in general "procedures" even though they are not invasive because it requires the radiologist to be in the room manipulating the patient's position, taking images, and judging their adequacy with respect to number and quality in real-time. It's not cutting someone open or sticking a needle in them, but it's certainly more involved than running someone through a scanner or taking plainfilms is.

 

[MrBurns10]

What do you define as a "procedure"? Do you mean something invasive? The most invasive thing I've seen non-IR folks do is fluro-guided lumbar punctures done by neuroradiologists (again, NOT neuro-IR). Other than that, I consider fluoro studies in general "procedures" even though they are not invasive because it requires the radiologist to be in the room manipulating the patient's position, taking images, and judging their adequacy with respect to number and quality in real-time. It's not cutting someone open or sticking a needle in them, but it's certainly more involved than running someone through a scanner or taking plainfilms is.

Thanks for the response, Z. What about CT guided abcess drainage or joint drainage/aspirations, that sort of thing...would that just be IR?

 

[Zweihander]

Thanks for the response, Z. What about CT guided abcess drainage or joint drainage/aspirations, that sort of thing...would that just be IR?

I'm not sure. I've only ever seen IR do that sort of thing, but radiology residents DO get trained in it as part of their general education so I don't see any reason why an attending couldn't do it if he so chose (aside from being uncomfortable with it or the institution being squeamish about liability issues).

 

[f_w]

Random question- do non-IR radiologists do any procedures? I don't mean doing CT scans, MRIs, etc. but like actual procedures.

Many general or 'body imager' rads will do the straightforward stuff like biopsies (random liver, liver lesions, random kidney, thyroid, breast, lymph-nodes) using either CT or ultrasound guidance. Also, depending on level of comfort, many 'non-IR' rads will drop a drain into an abscess or a small-bore chest-tube into an effusion. Fluoro guided joint aspirations or arthrograms are part of general radiology.

Diagnostic angiography is not the exclusive realm of IR trained rads either. In smaller practices, everyone has to be able to do basic stuff like a runoff for a cold leg or a visceral angio for a tagged cell positive GI bleeder.

This is the world of community radiology I am talking about. Not the 'planet academia' where you have subspecialized people for everything.

 

[MrBurns10]

Many general or 'body imager' rads will do the straightforward stuff like biopsies (random liver, liver lesions, random kidney, thyroid, breast, lymph-nodes) using either CT or ultrasound guidance. Also, depending on level of comfort, many 'non-IR' rads will drop a drain into an abscess or a small-bore chest-tube into an effusion. Fluoro guided joint aspirations of arthrograms are part of general radiology.

Diagnostic angiography is not the exclusive realm of IR trained rads either. In smaller practices, everyone has to be able to do basic stuff like a runoff for a cold leg or a visceral angio for a tagged cell positive GI bleeder.

Awesome, thanks for the responses. I like the idea of doing these procedures but don't think performing AAA repairs and the like are for me (I saw a couple while on my vascular/general surg rotation and I was bored stiff by how tedious it was), so I was just curious.

 

[osli]

I've seen a radiologist in a smallish hospital (one of three in a town of ~45,000) called relatively often to stick a variety of tubes into people for various reasons.

 

[btlwhulka]

Apache, I'm on ur side regarding most things radiology, but LMAO. Are you even "real"? haha...are you like this in real-life? If so, you're either a real funny guy and ppl love you or ppl mostly hate you.

Yes, Apache is awesome. His name reflects his "grow some nuts" approach to life. just remember, if he truly is apache, then his blood boils at a lower temperature than others' and he will pierce your soul with his eyes--a true warrior. Apache, you rule, god bless. The only people who fight as hard as apaches are comanche, sioux and pawnee.

 

[MossPoh]

Fact #2: job satisfaction after 5+ years s/p residency --> Again rads, also derm, gas
.

Apache, I was under the impression that this one was not the case. There is actually a quite large glut of unhappy radiologist. Primarily the ones who went into it strictly chasing dollars. I believe it was a radiographics article last year, although I can't recall off the top of my head.

Don't get me wrong. I still think radiology is one of the coolest specialities around. 😉 I've just read something contradictory to that.

 

[f_w]

Apache, I was under the impression that this one was not the case. There is actually a quite large glut of unhappy radiologist.

Lol, don't let facts get in the way of hype.

 

[Taurus]

Apache, I was under the impression that this one was not the case. There is actually a quite large glut of unhappy radiologist. Primarily the ones who went into it strictly chasing dollars. I believe it was a radiographics article last year, although I can't recall off the top of my head.

Don't get me wrong. I still think radiology is one of the coolest specialities around. 😉 I've just read something contradictory to that.

I posted a few months ago the link to results of a survey showing that radiologists were the #1 in happiness and #3 in pay. Not bad.

 

[fun8stuff]

I posted a few months ago the link to results of a survey showing that radiologists were the #1 in happiness and #3 in pay. Not bad.

link please? i think i looked for this before and couldnt find it...

 

[Taurus]

link please? i think i looked for this before and couldnt find it...

Do a search of all my posts for past 4-5 months, not just in this forum.

 

[TurdFerguson4]

Yes, Apache is awesome. His name reflects his "grow some nuts" approach to life. just remember, if he truly is apache, then his blood boils at a lower temperature than others' and he will pierce your soul with his eyes--a true warrior. Apache, you rule, god bless. The only people who fight as hard as apaches are comanche, sioux and pawnee.

Please tell me you guys don't take yourselves this seriously..."true warrior"?!? You're freakin RADIOLOGISTS.....a requirement for big brains -- yes. A requirement for big nuts -- not so much.

To the OP, UnderDoc brings up a good point about (for the most part) independent work in a dark room getting monotonous. Don't get me wrong, you couldn't pay me enough to change specialties -- there are many uniquely intellectual aspects to this job that are rewarding. However, go into it with your eyes open to the good and the bad. On the whole I find my fellow radiology residents to be a nice but, how shall we say, overly intellectual bunch. The EM and ortho residents are a hell of a lot more fun to get a beer with (this can be program specific, however).