Currently, I am an 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 break down the ESIR pathway and transferring to 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 interventional radiology at the present time. First: the “old-fashioned’ way that involves a 4-year residency. But instead of needing a 1-year fellowship (as it was formerly), you now will need a 2-year fellowship. They call this the independent pathway. Second: the ESIR pathway that you referred 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. Third: the DR/IR integrated pathway, an entirely separate residency program for 5 years. Essentially, the DR/IR program has 3 years of general radiology and 2 years of interventional related rotations.
Specifically, regarding your situation, most residents who initially say that interventional radiology interests them usually find another subspecialty fellowship. So, if you aren’t entirely committed to interventional, chances are, 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: A. Multiple residents may take an interest in ESIR. B. The residency may only accommodate one or two people because of scheduling requirements. C. 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 of 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 his belt. Also, programs have been limiting their two-year independent fellowships for those that do not follow the ESIR pathway.
More About IR/DR
If you attend a program that has an IR/DR program or an ESIR program, it is possible to transfer in and out of one program or another. However, IR/DR programs give the resident less flexibility. Remember, the IR/DR program maintains independence from radiology residency with its own program director and scheduling. Its 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, you may not have enough rotations available to meet the residency requirements. Although unlikely, you theoretically may need to find a residency slot elsewhere.
If you are not completely sure that interventional radiology interests you, I would recommend you think about finding radiology residencies with an ESIR program rather than an IR/DR program. Why? Simply, an IR/DR program commits to you the process of becoming an interventionalist. If you go to an ESIR program, you will more likely have a little bit more time to decide upon entering into interventional radiology later on. (but you should still make a decision as soon as possible). And, the ESIR program fits within the confines of the diagnostic program. This allows more transfer flexibility.
Remember, if all else fails, you can still complete interventional radiology by going to a standard DR program without ESIR. However, 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!!!