ESIR Programs: Let The Buyer Beware
Radiology programs, radiology program directors, Early Specialization In Interventional Radiology (ESIR) directors, and residents interested in interventional radiology are dealing with a mini-crisis. For years, programs have allowed residents to make a choice to start an interventional fellowship several years into residency. Instead today, new residents face the crunch of having to make this decision to join up with ESIR programs right away. And, they should not take this decision lightly. Why? Well, that is exactly what we are going to discuss today!
So, What’s The Urgency, Huh?
Like anything else in the world, when you have limited supply and excess demand, you create bottlenecks. And, unfortunately, in many programs across the country, the number of ESIR spots available does not equal the number of residents interested in the program. Therefore, this problem exists in some programs, right here right now.
So, if a program has two residents interested in this program, but it only has one spot available, the program director needs to make the final decision by either one of two methods. First, the program can decide on a first come first serve policy. But, let’s say that you have two residents that decide they want to join a program at the same time. Well then, that leads us to the other way to decide. And, that would be a long drawn out application process to determine the most “qualified” applicant.
Either way, this puts pressure on the applicant and the program to make a decision pronto. As you now understand, the resident and program need to make rushed decisions together.
Why Can This Decision To Join ESIR Have Permanent Implications?
OK. First, I will mention the positive. ESIR programs allow residents throughout the country to decrease the number of years of a fellowship from two to one. And, these residents will be able to hit the proverbial ground running at their interventional fellowships from the very beginning. But, at what cost?
Here comes the tough part. ESIR programs need to allow residents to complete approximately one year of interventional related activities during radiology residency. So, where does the time come from? It has to come from somewhere, right? Well, here is the rub. Programs need to draw the time allotted to ESIR from the normal diagnostic radiology activities. So, residents that complete an ESIR program have less overall experience in the standard rotations like MRI, ultrasound, etc. And therefore, the training of an ESIR resident is not truly equivalent to a standard diagnostic radiology resident.
So, what are the implications of this? In the workforce still, most practices need radiologists that can perform interventional radiology (IR) but can also help out with some of the general work. Well, residents that start a typical IR job will not have the same experience and comfort level with general radiology practice. As you can see, this creates a serious problem for the ESIR graduate.
Unfortunately, the problems do not end here. Let’s say that you start the ESIR program. And then, you then apply for fellowship toward the end of residency. Due to the changes in allocated slots for interventionalists with new DR/IR programs, ESIR programs, and “independent fellowships”, fewer residents can easily drop out of interventional radiology during residency. So, fewer spaces become available for interventional programs throughout the country. And therefore, you, as an ESIR applicant to fellowship, may have a lower likelihood of gaining admission to an interventional radiology fellowship than residents applying in prior years.
So, who is to say for sure that you can obtain an interventional fellowship after residency as an ESIR applicant? In this case, theoretically, ESIR programs have now doubly screwed this resident. First, they completed a program for which they have a real chance of not completing the required CAQ certification. And second, they have less diagnostic radiology experience.
Many folks that want to do interventional radiology really do not know what they want to do until they have completed several IR rotations. So, what happens if the ESIR program resident decides that they do not like interventional radiology toward the middle or end of their residency? Well, they potentially have prevented another interested applicant from getting a spot. In addition, they have again decreased their own training in diagnostic radiology- a lose-lose situation. They will potentially graduate as a “second-rate” diagnostic radiologist.
Bottom Line For The Applicant To ESIR Programs
For those of you applying to ESIR and know for sure that you want to do interventional radiology, well then, go for it. But, I have a sneaking suspicion that many ESIR applicants are not in this category. So, if the program offers you a choice to apply for an ESIR program, make sure to think twice. The implications of joining this program can be far-reaching for the rest of your career!