ESIR vs IR integrated
I am a current M3 student most likely applying to radiology next application cycle. I have an interest in IR, but feel I do not have enough exposure to be dead set on an integrated IR residency. I was wondering about your opinions of applying to diagnostic radiology, specifically at programs with ESIR, and how feasible it is to knock a year off of the independent residency that we seem to be switching to through this option. Could you breakdown the ESIR pathway and transferring within an institution from DR to IR. Would this be the best option for someone who is not dead set on IR, or should I apply to integrated programs as well as pure diagnostic and just rank them as I see fit when the match comes?
So, I am going to start by summarizing the three current pathways for becoming an interventional radiologist at the present time. The first is the “old-fashioned’ way which involves a 4 year residency, but instead of a 1 year fellowship (as it was formerly), it is now a 2 year fellowship. This is called the independent pathway. The second way is the ESIR pathway that you were referring to. In this pathway, you need to complete a full year of interventional related rotations during your residency. At that point you can then apply for a 1 year independent interventional fellowship. And, the third way is to apply for the DR/IR integrated pathway which is one program for 5 years. The DR/IR program essentially has 3 years of general radiology and 2 years of interventional related rotations.
The first thing I have to say regarding your situation: In my experience, most residents who initially say the want to go into interventional radiology usually find another subspecialty fellowship. So, if you aren’t entirely committed to interventional, there is a very good chance you will do something else.
If you apply to a program with ESIR, you still need to tell your residency director fairly early on that you are interested in the ESIR pathway. The reasons for this: there may be multiple residents interested in ESIR and the residency may only be able to accommodate one or two people in this program because of scheduling requirements. And, the requirements for ESIR can disrupt the schedule of other residents in your class because of the need for additional dedicated IR time and less time on other rotations.
However, the big advantage to an ESIR program is two-fold. First, it enables the ESIR resident to take the one year interventional fellowship instead of the two year fellowship. And, second it makes the ESIR resident more competitive in the fellowship match because they have some experience under their belt. Also, there may be limited numbers of two year independent fellowships for those that do not do the ESIR pathway.
If you attend a program that ha a DR/IR program or an ESIR program, it is possible to transfer in and out of one program or another. However, there is less flexibility with the IR/DR program. Remember, the IR/DR program is an entirely independent residency from radiology with its own program director and scheduling. It’s sole goal is to create interventional radiologists. (Although it does happen to share the core exam with the radiology program, however). So, it is possible that if you decide to transfer the DR portion of the program, there may not be enough rotations available to meet the residency requirements. Although unlikely, you theoretically may have to find a residency slot elsewhere.
If you are not completely sure that you are interested in interventional radiology, I would recommend you think about finding radiology residencies with an ESIR program and not to apply to a DR/IR program because a DR/IR program commits to you the process of becoming an interventionalist. If you go to an ESIR program, you are more likely going to have a little bit more time to decide upon going into interventional radiology later on. (but you should still make a decision as soon as possible). And, the ESIR program is within the confines of the diagnostic program. This allows more transfer flexibility.
Remember, if all else fails, it is also still possible to do interventional radiology by going to a standard DR program without ESIR, but you may have a much harder time getting into the fellowship. In your situation, that may make more sense than applying to an IR/DR program, only to find out you don’t really like it.
So, those are my two cents. I hope that clarifies things a bit. I wish you good luck in the radiology match process!!!