After all of the hype about the new IR/DR programs, I am not surprised that it has become so attractive for medical students. However, most applicants don’t realize what happens to the typical resident’s desire for interventional radiology after they begin their residency. Of course, these programs don’t tell them that! It’s bad for business. So, I will give you the lowdown.
On the interview trail, at least since when I became a program director, and before the new IR/DR programs existed, a large percentage of medical students have always claimed interventional radiology was their top choice for fellowship. But, as soon as they would arrive at the program, some of these former desires became a wist of memory. And, the other rarified few would make it to their first, second, or third year and then suddenly drop off of the IR bandwagon. Very few who initially wanted interventional would make it to the end of the residency. Why did that happen? Well, I have some theories.
Constant Consents/Too Much Patient Contact
One thing most residents like to complain about (myself included back in the day): scut. And, in the world of interventional radiology, you can find no lack of scut in any corner. Patients need consents. They complain about their symptoms.
Moreover, as a “real” IR doctor, you need to listen. That can become real old quickly if you cannot stand performing these critical patient duties. It’s not why most residents signed up for radiology.
Lifestyle Is Not What They Thought It Would Be
Overall, which radiologist subspecialist awakens the earliest in the morning? Well, that’s easy- the interventionalist. And, who often leaves the latest? The same. Also, some interventionalists may get called in for all hours of the night at any time on their lonesome. Now, radiology may not be the lifestyle specialty that it was years ago in any subsegment of radiology, let alone interventional radiology. Regardless, this sort of long day in interventional does not attract many radiology residents to the field. You may be the only one in your residency!
Risk Of Needlesticks
In any medical field, you will encounter physical dangers. But notably, the interventionalists have a higher likelihood of bodily injury. Most critically, these folks use lots of sharp needles. And, guess what? When you utilize lots of needles, you increase your chances of a needle stick and the good stuff that comes with it- Hepatitis, HIV, and more. Many residents think about this only after they start their residency. And, walla, they make their decision not to enter the field!
You Can Perform Procedures As A DR Graduate
No. Interventionalists are not the only ones that can perform procedures. If you decide to take a rural job or practice as a general radiologist, you will likely be responsible for some of these. I know of many “non-interventionalists” that perform all sorts of biopsies, vascular work, and interventional oncology. So, why bother if you don’t need that extra certificate of qualification?
Not As Glamorous As They First Thought (PICCs and Ports)
Nowadays, most interventionalists perform all sorts of procedures. And, most likely, it will not be many of those stent placements in the neck or embolization of the liver. Most techniques are much more mundane. You will probably have done a lot more PICC lines and Portacaths than any high tech complex procedure out there. Yes, you will be a critical member of the team. But no, you will most likely perform more garden variety interventional procedures than complicated ones.
In some “fancy” institutions, they have made sure that each interventionalist needs to wear anti-gravity lead before any procedure. But, more likely than not, you will need to wear a regular lead uniform most of the time. And, unless you maintain yourself in excellent shape, many lead garments tend to cause back and muscle pain. In fact, at a certain age, it is not uncommon for many interventionalists to switch to a DR specialty because of the wear and tear on their bodies. Most new radiology residents do not realize the long term consequences of wearing a heavy uniform until they hear the complaints of their mentors.
Bottom Line: What Does This Mean For The Future Of The IR/DR Programs?
After all of these issues, and as much as I like the field of interventional radiology as a profession, I find it fascinating that the IR/DR residency has become one of the most popular and competitive specialties out there. I think many residents have not done their research and have fallen for all the hype.
Now, call me crazy, but I believe that one of two things may happen since residents are signing up early before they get to know the specialty. Either, the attrition rate for these IR/DR residencies may become more significant than the founders realized or the programs will have created lots of disenchanted and unhappy IR/DR clinicians. Only time will tell. I hope I am wrong!