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I posted this on reddit/r/medicalschool a few months ago but feel like this is when MS3 start to make decisions about specialties. Hope this helps!
Background: I’m a chief resident, PGY-5, at a mid tier academic program in a big city. Traditional route med student who didn’t know they wanted to do rads until the beginning of 3rd year. Love the field and think there’s a lot of misconception among med students of what it entails.
Radiology years:
PGY-1: Intern year- can do a preliminary medicine, surgery or transitional year. Do the easiest thing you can, and if it’s in the same city as your advanced, sweet.
PGY-2: Radiology R1- The ACGME says 1st year residents can’t take call, making this possible the easiest year on your entire training hours wise. You will be overwhelmed by a completely new way of looking at medicine, but you won’t work nights or any (or very many) weekends. You should be studying to prepare you for….
PGY-3: Radiology R2- The hardest year of residency work wise. Very call heavy. I worked almost 3 months of night float, and more weekends than I can count. However, this is still better than what people in a surgical or medicine residency go through!
PGY-4: Radiology R3- Boards. So radiology does this weird thing where you take a monstrous CORE exam at the end of this year, which is actually only a “Board Certifying exam”. It’s incredibly difficult, requires months of preparation, with a 80-90% pass rate (but remember, this is a group of nerds with a Step average of 240+ you compete against). There’s an annoying physics section. Time “off” to study is variable per program, but you will be studying several hours a day starting in the winter. The actual “radiology boards” is taken 18 months after residency (during your actual job), and is a joke with close to 100% pass rate. Most programs also allow residents to go to Washington DC for a month (paid for) for AIRP, a radiology pathology lecture course. It’s like being a med student with no responsibilities and no tests for a month. Great for those who don’t have a family to leave behind.
You will also apply to fellowship this year. Most fellowships are going towards a match (except Body, Chest), and you will apply and interview second half of the year.. Annoyingly during boards prep time. You also find out where you match a couple days after you take boards. Vast majority of fellowships are 1 year, and everyone does one.
PGY-5: Radiology R4- Boards behind you and majority of call behind you. Most programs let you dictate your schedule, with “mini fellowships” of 4-6 months in your subspecialty of choice. Usually in something to compliment what your actual fellowship is in.
Typical day:
An example of a typical day of a resident on a diagnostic rotation, such as Musculoskeletal.
8:00 AM Arrive and start “dictating” the studies on the list, which would be plain extremity x-rays or MRIs (knees, shoulders etc) depending on your seniority. This involves dictating a preliminary report of the study, that won’t go out until the attending reviews it.
9:00 AM Go perform a joint injection (fluoroscopic guided hip or shoulder injections mostly, for steroid and pre-MRI arthrogram). These occur anywhere from 2-5x a day, and usually take 15-30 minutes depending how fast you are. You do all the set up and the attending will come to watch when you’re actually injecting.
10:30-Noon Go “sign out” the studies (xrays, MRIs) you’ve read with the attending. This is usually sitting next to them while they look over the study and your reports, going over findings and occasionally pimping you.
Noon-1pm: Conference, half are pure didactic and half are case based. Radiology makes it really easy to have a hundred images of different pathologies and going around the room having residents work through them/answer. Radiology is also much heavier on conferences than other specialties, averaging around 5 hours a week in most programs. This will go way up for R3s during board studying time.
1pm-5pm: Repeat of the morning
Other diagnostic rotations would include Neuroradiology, Ultrasound, Body CT, MRI, Breast etc and they all have their own procedures including lumbar punctures, myelograms, thyroid biopsies, breast biopsies etc. There are a lot of procedures outside IR, something I wasn’t aware of before residency. This varies by institution however.
Call: Overall hours wise as a resident you will not be there that long unless call is involved. Call schedules vary so much among programs that saying mine won’t really help, but R2 year is the busiest with around 1-2 months of night float, and 10-15 weekend day coverage. Radiology doesn’t have separate residents on for different specialties for call (such as a MICU night float, cardiology night float etc) so at most you will have 1-2 residents in the hospital covering ANYTHING radiology related. This includes for us
1. Dictating every study done on hospital inpatients (minus ICU chest xrays), everything coming through the ED & multiple satellite urgent cares. A car crash with 4 passengers at once? You’ll have 4 CT Chest abdomen pelvis, CT Heads, CT c-spines and an xray of every extremity that hurts on your list at once, with the ED calling you asking for results. It’s overwhelming and exhilarating (for some)
2. Answer calls/pages for anything radiology related, including review studies with surgeons on call, questions about what to order etc.
3. Performing any diagnostic radiology procedures, including: septic joint aspirations that need fluoroscopy (hips), fluoroscopy guided lumbar punctures, esophagrams for perforations, intussusception reductions.
4. Fielding IR consults, meaning gathering all the info, consenting, calling in the team and IR attending to perform it. Sometimes we scrub in on these but usually the diagnostic part is so busy we can’t. Some programs with bigger IR sections will have fellows on call to handle this.
Call as a resident is always in house, you will probably never sleep. It is very different that how other specialties handle call. A busier call lets us enjoy a lighter regular schedule.
I love radiology as a field, and try to convince every med student to do it. Here’s some reasons why:
Pure medicine, no BS: I believe the 2 big reasons someone pursues medicine are the humanitarian aspect and the science aspect. I leaned towards the latter, and most people I’ve encountered in radiology are the same. My biggest gripe about intern year was how little medicine you do. Pretty much all the data gathering and analysis, including differential for a service could be done in an hour, but you spend the remaining 12 hours calling consults to regurgitate information, call social services, and essentially act as a secretary. This obviously reduces are you become more senior, but hospitalists still do this. Radiology is just you and a study, trying to get information out of it. Non-compliant patient with crazy abscess? I diagnosed it on CT in 5 minutes and told the clinician, now it’s their problem trying to get him to take antibiotics. Diabetic with necrotic pancreatitis? I diagnosed it on CT in 5 minutes, and wash my hands. You can help so many people, so fast, because you are just doing medicine. Never have to deal with insurance issues, getting someone in a nursing home, trying to get a consult to see a patient. Never have to deal with getting “dumped on” at 5pm, because even if a MRI comes on the list at 4:59? I’ll read it in 10-15 minutes, vs an hour admitting a new patient.
This gets me to the next point: You control your own pace. There are no nurses you are waiting to get labs, no attending sleeping at home you’re trying to get to round (we do have attendings that read out studies slower than others, but magnitudes less painful than rounds, and this disappears when you’re an attending yourself). You don’t have to wait for pancreatitis to resolve to discharge a patient, you just sign the study and you’re on the next one. Never have a million checkboxes to do for the day, just clicking on study at a time (with procedures thrown in).
Interacting with colleagues more than patients: If you love patient interactions, radiology is probably not for you. However, you can still be plenty social in radiology. The only difference is you just spend the entire day talking to coworkers (who are in the same rooms as you) and a bunch of consulting clinicians. I really enjoy talking to clinicians about studies and reviewing them, as opposed to a patient who doesn’t know anything about their care. A perfect medium would be the ability to just review studies with patients who are interested, but don’t think that’s going to be a billable code anytime soon.
Finally: It’s like learning a new language. Every service thinks they can read their own studies (and some can), but vast majority of clinicians have no clue beyond a basic xray. I still remember telling a pulmonology fellow, when I was an R1, that the pneumothorax he was worried about was just a skin fold. Even early in your training, your abilities will surpass that of attendings in other fields and it feels… awesome. To have someone call with a study saying “I have no idea whats going on” and you know what it is 2 seconds in, is a great feeling. This feeling will only get exemplified in private practice, where everyone is more reliant on radiology.
So how do you know if radiology is right for you? Here a some characteristics I think that may be a sign that it’s for you.
You liked the first 2 years of med school more than the 3rd year. I was miserable 3rd year, because most specialties have the social work mentioned above, and you’re never in control of your own time. Even intern year was better, but I didn’t really ever enjoy coming to work till I started radiology residency. I have a great social life, but I really enjoy coming to work and just having it be me and my work, with some interactions with colleagues. It’s very similar to studying a bunch the first 2 years (with more free time).
You are organized/efficient. The people I see struggling most in radiology are those who are slow. This does not mean they make bad radiologist, on the contrary, I would want a slow methodical radiologist to read my scans. But to be able to keep up with the pace that the field demands and enjoy it, you have to have some sense of speed. Being a techy is also related somewhat, but we’re definitely a minority even in radiology.
You do not have an ego. Radiologist will get **** on by every speciality, “clinically correlate” etc etc, and some specialties such as ortho or neurosurgery will pretend you don’t exist. But you have to be ok with not being in the front seat of patient care, and making contributions behind the scenes.
You are a good test taker. Radiology is essentially one big test. Staring at the screen, coming to an answer. This will also help with the CORE exam..
Dismissing some misconceptions about radiology:
AI- I’ve literally never heard a radiologist bring this up as a viable threat. We are 20+ years from this making any significant impact, and when it does, it’ll just make our lives easier. We’ll have a 50% unemployment rate from machines before radiologists are actually put out of jobs. Do not worry about it.
Outsourcing- Also not a real threat. Clinicians want to talk to their radiologists, which is why not every radiologist is a teleradiologist. There’s a handful than get US board certified and go overseas to read US studies, but this is so rare that it’s a non-issue (and doesn’t save that much money). Teleradiology is definitely a big thing (reading studies from states away), but is seen as a last resort by most due to poor compensation.
Some real downsides to the field:
You will work hard. Attending radiology is not a cush 40 hour work week. This exists in some settings (VA especially), but most are pushing 50-60 hours, with 10+ hour days. These days are BUSY, reading studies and doing procedures non-stop. If you want to have a lot of downtime at work, radiology is not for you. To make up for this, most private practices offer 8-12 weeks of vacation, which can only happen because we have no continuity of care to worry about. Working harder for the same amount of pay is universal in medicine however.
You always have to be “on”. You can have a bad day as a hospitalist, maybe half-ass some physical exams and be ok, but if you half-ass some studies, I guarantee you’ll hear about the cancer you missed on the chest x-ray in a few years. Majority of my misses as a resident have been when I’ve been pushing myself to read faster than I should, or was in a hurry to finish. Radiology is unforgiving.
Attending life is harder than resident life. As above, your hours get worse (no nights though, that's usually taken care of a hired nighthawk service) and days more stressful because of all the litigation risk, but the pay and vacation are there for that. I’m sure med students are very interested in pay, but I don’t have information that can’t be found online (see doximity compensation report). Of note, the regional variation is huge and you can make family med money in downtown of a big city vs surgical subspecialty money by going rural.
Hope that helps. I feel like the whole application process and score averages have changed since I applied so not sure how much help I can be of that, but some things: Step 1 is big, research isn’t really (I had nothing). The tier of program only matters if you want to do academics, location is way more important for connections.
Background: I’m a chief resident, PGY-5, at a mid tier academic program in a big city. Traditional route med student who didn’t know they wanted to do rads until the beginning of 3rd year. Love the field and think there’s a lot of misconception among med students of what it entails.
Radiology years:
PGY-1: Intern year- can do a preliminary medicine, surgery or transitional year. Do the easiest thing you can, and if it’s in the same city as your advanced, sweet.
PGY-2: Radiology R1- The ACGME says 1st year residents can’t take call, making this possible the easiest year on your entire training hours wise. You will be overwhelmed by a completely new way of looking at medicine, but you won’t work nights or any (or very many) weekends. You should be studying to prepare you for….
PGY-3: Radiology R2- The hardest year of residency work wise. Very call heavy. I worked almost 3 months of night float, and more weekends than I can count. However, this is still better than what people in a surgical or medicine residency go through!
PGY-4: Radiology R3- Boards. So radiology does this weird thing where you take a monstrous CORE exam at the end of this year, which is actually only a “Board Certifying exam”. It’s incredibly difficult, requires months of preparation, with a 80-90% pass rate (but remember, this is a group of nerds with a Step average of 240+ you compete against). There’s an annoying physics section. Time “off” to study is variable per program, but you will be studying several hours a day starting in the winter. The actual “radiology boards” is taken 18 months after residency (during your actual job), and is a joke with close to 100% pass rate. Most programs also allow residents to go to Washington DC for a month (paid for) for AIRP, a radiology pathology lecture course. It’s like being a med student with no responsibilities and no tests for a month. Great for those who don’t have a family to leave behind.
You will also apply to fellowship this year. Most fellowships are going towards a match (except Body, Chest), and you will apply and interview second half of the year.. Annoyingly during boards prep time. You also find out where you match a couple days after you take boards. Vast majority of fellowships are 1 year, and everyone does one.
PGY-5: Radiology R4- Boards behind you and majority of call behind you. Most programs let you dictate your schedule, with “mini fellowships” of 4-6 months in your subspecialty of choice. Usually in something to compliment what your actual fellowship is in.
Typical day:
An example of a typical day of a resident on a diagnostic rotation, such as Musculoskeletal.
8:00 AM Arrive and start “dictating” the studies on the list, which would be plain extremity x-rays or MRIs (knees, shoulders etc) depending on your seniority. This involves dictating a preliminary report of the study, that won’t go out until the attending reviews it.
9:00 AM Go perform a joint injection (fluoroscopic guided hip or shoulder injections mostly, for steroid and pre-MRI arthrogram). These occur anywhere from 2-5x a day, and usually take 15-30 minutes depending how fast you are. You do all the set up and the attending will come to watch when you’re actually injecting.
10:30-Noon Go “sign out” the studies (xrays, MRIs) you’ve read with the attending. This is usually sitting next to them while they look over the study and your reports, going over findings and occasionally pimping you.
Noon-1pm: Conference, half are pure didactic and half are case based. Radiology makes it really easy to have a hundred images of different pathologies and going around the room having residents work through them/answer. Radiology is also much heavier on conferences than other specialties, averaging around 5 hours a week in most programs. This will go way up for R3s during board studying time.
1pm-5pm: Repeat of the morning
Other diagnostic rotations would include Neuroradiology, Ultrasound, Body CT, MRI, Breast etc and they all have their own procedures including lumbar punctures, myelograms, thyroid biopsies, breast biopsies etc. There are a lot of procedures outside IR, something I wasn’t aware of before residency. This varies by institution however.
Call: Overall hours wise as a resident you will not be there that long unless call is involved. Call schedules vary so much among programs that saying mine won’t really help, but R2 year is the busiest with around 1-2 months of night float, and 10-15 weekend day coverage. Radiology doesn’t have separate residents on for different specialties for call (such as a MICU night float, cardiology night float etc) so at most you will have 1-2 residents in the hospital covering ANYTHING radiology related. This includes for us
1. Dictating every study done on hospital inpatients (minus ICU chest xrays), everything coming through the ED & multiple satellite urgent cares. A car crash with 4 passengers at once? You’ll have 4 CT Chest abdomen pelvis, CT Heads, CT c-spines and an xray of every extremity that hurts on your list at once, with the ED calling you asking for results. It’s overwhelming and exhilarating (for some)
2. Answer calls/pages for anything radiology related, including review studies with surgeons on call, questions about what to order etc.
3. Performing any diagnostic radiology procedures, including: septic joint aspirations that need fluoroscopy (hips), fluoroscopy guided lumbar punctures, esophagrams for perforations, intussusception reductions.
4. Fielding IR consults, meaning gathering all the info, consenting, calling in the team and IR attending to perform it. Sometimes we scrub in on these but usually the diagnostic part is so busy we can’t. Some programs with bigger IR sections will have fellows on call to handle this.
Call as a resident is always in house, you will probably never sleep. It is very different that how other specialties handle call. A busier call lets us enjoy a lighter regular schedule.
I love radiology as a field, and try to convince every med student to do it. Here’s some reasons why:
Pure medicine, no BS: I believe the 2 big reasons someone pursues medicine are the humanitarian aspect and the science aspect. I leaned towards the latter, and most people I’ve encountered in radiology are the same. My biggest gripe about intern year was how little medicine you do. Pretty much all the data gathering and analysis, including differential for a service could be done in an hour, but you spend the remaining 12 hours calling consults to regurgitate information, call social services, and essentially act as a secretary. This obviously reduces are you become more senior, but hospitalists still do this. Radiology is just you and a study, trying to get information out of it. Non-compliant patient with crazy abscess? I diagnosed it on CT in 5 minutes and told the clinician, now it’s their problem trying to get him to take antibiotics. Diabetic with necrotic pancreatitis? I diagnosed it on CT in 5 minutes, and wash my hands. You can help so many people, so fast, because you are just doing medicine. Never have to deal with insurance issues, getting someone in a nursing home, trying to get a consult to see a patient. Never have to deal with getting “dumped on” at 5pm, because even if a MRI comes on the list at 4:59? I’ll read it in 10-15 minutes, vs an hour admitting a new patient.
This gets me to the next point: You control your own pace. There are no nurses you are waiting to get labs, no attending sleeping at home you’re trying to get to round (we do have attendings that read out studies slower than others, but magnitudes less painful than rounds, and this disappears when you’re an attending yourself). You don’t have to wait for pancreatitis to resolve to discharge a patient, you just sign the study and you’re on the next one. Never have a million checkboxes to do for the day, just clicking on study at a time (with procedures thrown in).
Interacting with colleagues more than patients: If you love patient interactions, radiology is probably not for you. However, you can still be plenty social in radiology. The only difference is you just spend the entire day talking to coworkers (who are in the same rooms as you) and a bunch of consulting clinicians. I really enjoy talking to clinicians about studies and reviewing them, as opposed to a patient who doesn’t know anything about their care. A perfect medium would be the ability to just review studies with patients who are interested, but don’t think that’s going to be a billable code anytime soon.
Finally: It’s like learning a new language. Every service thinks they can read their own studies (and some can), but vast majority of clinicians have no clue beyond a basic xray. I still remember telling a pulmonology fellow, when I was an R1, that the pneumothorax he was worried about was just a skin fold. Even early in your training, your abilities will surpass that of attendings in other fields and it feels… awesome. To have someone call with a study saying “I have no idea whats going on” and you know what it is 2 seconds in, is a great feeling. This feeling will only get exemplified in private practice, where everyone is more reliant on radiology.
So how do you know if radiology is right for you? Here a some characteristics I think that may be a sign that it’s for you.
You liked the first 2 years of med school more than the 3rd year. I was miserable 3rd year, because most specialties have the social work mentioned above, and you’re never in control of your own time. Even intern year was better, but I didn’t really ever enjoy coming to work till I started radiology residency. I have a great social life, but I really enjoy coming to work and just having it be me and my work, with some interactions with colleagues. It’s very similar to studying a bunch the first 2 years (with more free time).
You are organized/efficient. The people I see struggling most in radiology are those who are slow. This does not mean they make bad radiologist, on the contrary, I would want a slow methodical radiologist to read my scans. But to be able to keep up with the pace that the field demands and enjoy it, you have to have some sense of speed. Being a techy is also related somewhat, but we’re definitely a minority even in radiology.
You do not have an ego. Radiologist will get **** on by every speciality, “clinically correlate” etc etc, and some specialties such as ortho or neurosurgery will pretend you don’t exist. But you have to be ok with not being in the front seat of patient care, and making contributions behind the scenes.
You are a good test taker. Radiology is essentially one big test. Staring at the screen, coming to an answer. This will also help with the CORE exam..
Dismissing some misconceptions about radiology:
AI- I’ve literally never heard a radiologist bring this up as a viable threat. We are 20+ years from this making any significant impact, and when it does, it’ll just make our lives easier. We’ll have a 50% unemployment rate from machines before radiologists are actually put out of jobs. Do not worry about it.
Outsourcing- Also not a real threat. Clinicians want to talk to their radiologists, which is why not every radiologist is a teleradiologist. There’s a handful than get US board certified and go overseas to read US studies, but this is so rare that it’s a non-issue (and doesn’t save that much money). Teleradiology is definitely a big thing (reading studies from states away), but is seen as a last resort by most due to poor compensation.
Some real downsides to the field:
You will work hard. Attending radiology is not a cush 40 hour work week. This exists in some settings (VA especially), but most are pushing 50-60 hours, with 10+ hour days. These days are BUSY, reading studies and doing procedures non-stop. If you want to have a lot of downtime at work, radiology is not for you. To make up for this, most private practices offer 8-12 weeks of vacation, which can only happen because we have no continuity of care to worry about. Working harder for the same amount of pay is universal in medicine however.
You always have to be “on”. You can have a bad day as a hospitalist, maybe half-ass some physical exams and be ok, but if you half-ass some studies, I guarantee you’ll hear about the cancer you missed on the chest x-ray in a few years. Majority of my misses as a resident have been when I’ve been pushing myself to read faster than I should, or was in a hurry to finish. Radiology is unforgiving.
Attending life is harder than resident life. As above, your hours get worse (no nights though, that's usually taken care of a hired nighthawk service) and days more stressful because of all the litigation risk, but the pay and vacation are there for that. I’m sure med students are very interested in pay, but I don’t have information that can’t be found online (see doximity compensation report). Of note, the regional variation is huge and you can make family med money in downtown of a big city vs surgical subspecialty money by going rural.
Hope that helps. I feel like the whole application process and score averages have changed since I applied so not sure how much help I can be of that, but some things: Step 1 is big, research isn’t really (I had nothing). The tier of program only matters if you want to do academics, location is way more important for connections.
