Month: April 2019

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The Radiology Job Market Cycle: Don’t Enter At The Bottom!

market cycle

Last month, one of my favorite fellow radiology bloggers, Eric Postal at Diagnostic Imaging, wrote a piece entitled Where Did You Enter The Job Market? In it, he described some of the issues of entering the job market at different points of the radiology job market cycle. And, he painted a relatively even-handed picture of the situation.

Now, I don’t want to be Negative Nancy or David Downer, but, unfortunately, I have to give a less rosy assessment of the situation. Sometimes, you have to describe it like it is: The residency graduate at the bottom of the job cycle sometimes may never completely recover.

Fortunately, for anyone who is entering the job market at this current “high point” of the cycle, you will not have to experience any of these issues if you find the right job at the outset. But, for those of you who entered the job market cycle at less desirable times, you will understand precisely what I am saying. So, let me tell give you a summary of the reasons why job applicants in the nadir of the cycle may permanently feel the pain.

It Takes Years To Recover From The Personal Financial Losses

Once again, the magic of compound interest only works when you can maximize the earnings of your earliest working years. Unfortunately, working at 20 vs. 25 years at maximal salary makes an enormous difference. And, if you find a barely adequate job when you first start, you will have lost out on that opportunity. You may have delayed partnership by three, four, five, or more years. Or maybe, you chose a second fellowship instead of going out into the job market. Either way, those lost years can become more significant than you might initially think. In the end, a loss of this amount of time can lead to millions of dollars of decreased savings as a radiologist!

You May Have To Root Up Your Family From A Locale

So, you don’t like the circumstances of your first job due to its location or circumstances. Well, it may not work out so well for you and your family. Perhaps, you have children in elementary or middle school. In this situation, you may have to pack up your bags and take your whole family with you to another town. Imagine the trauma of moving for your children to a new school in a different city. It is happening right now to many of you that entered the job market toward the negative end of the cycle!

Forced To Practice In A Specialty Area That You Don’t Like

OK. You did that fellowship in mammography because you thought that it would help with obtaining a job in a medium sized city, even though you did not enjoy it that much. Now, your skills have atrophied in other areas in radiology. What do you do, now that you want to switch jobs? Another fellowship? Well, at your stage in your life, it’s not so easy to pick up and start another training subspecialty again, once you’ve been out and working for several years, is it? Your decision may stick with you, forever!

More Likely To Have Multiple Jobs

Anyone that starts a so-so job during a downturn will become more likely to leave their job when the market improves. Perhaps, you need to go because the practice has become so oppressive. But, who wants to pick up and start anew again? Moving can be such a drag. And, all those connections that you have made in the community, utterly lost!

Academic Career Rewards Delayed

Maybe, you have set your sights on an academic career, possibly becoming a chairman. But, wait. Since you entered at the bottom of the cycle, your department may not promote you as rapidly. Why? Because you have nowhere else to go. They can get away with it, of course!

Entering The Job Market At The Bottom Of The Cycle

No matter what other authors may say, there is no way around it. Nor, can I sugarcoat it. Entering the job market at the bottom of a cycle can become a permanent disadvantage to your career, finances, and future. But, I am glad to say these issues no longer apply for those starting after completing residency and fellowship now. Let’s continue to hope that for all of the future job applicants; the good times continue to roll!

 

 

 

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What It’s Really Like To Be Pregnant During Radiology Residency!

Dear Dr. Julius,


I am writing in response to the post that I recently saw on the Radsresident.com blog regarding pregnancy in radiology residency. While I commend you for your efforts to assist aspiring radiologists in their search to balance the stresses of training with life-altering decisions such as family planning, I must admit that the responses seem overly simplified and downplay the stresses that one faces while enduring this transition.

Having entered radiology residency with a child, who I had given birth to at the end of my third year of medical school, I certainly am not an expert on the stresses of having a first-time child during this portion of the training. I did, however, decide to have my second daughter during residency training. And, she was born towards the end of my R1 year.  If you were so kind as to indulge me, I would like to add some insight into the questions previously posed now that I am about the finish my R4 year keeping in mind the lessons I have learned along the way.

Is pregnancy in radiology residency doable?

Short and long answer: Yes. Starting or expanding a family in residency is ultimately a choice.  It is doable, but that doesn’t mean, you will not have to make sacrifices. Some days you will feel like a great mom and other days you will feel like a great resident. Every once in a while, you will feel both. Your time will be stretched; your attention will be split. You will have to work hard just like anyone else who has personal issues they are dealing with at home. If you commit though, you can make it work and not just survive residency but also thrive. I would also argue that my children have helped me keep perspective through this all, and I don’t believe I would be as good as I am if not for my desire to show them the rewards of working hard.

Are programs supportive of students who expand their family during residency?

The answer to this question depends but generally the answer is yes.  Most programs have some form of leave for residents. However, this does not mean that the program will pay for the entire time off. The Family Medical Leave Act (FMLA) should guarantee that you receive up to 12 weeks of time off if you need/want it, but this does not mean that you will be paid for the entire time. Additionally, the program may expect you to use your vacation time during your maternity/paternity leave. So, consider this when planning.

Some programs like mine have built in time for new parents (both male and female), which is up to 6 weeks PAID leave in addition to any vacation time you want to use up to the 12 total weeks off. However, standards may vary, and the best people to ask would be the residents themselves. As per the NRMP, programs cannot legally ask you about your family plans during an interview unless you ask questions that open the door to this subject. However, this doesn’t mean you cannot probe the current residents about their experiences (and honestly you should).

Are there radiation exposures that I would need to avoid in a diagnostic radiology residency?

As Dr. Julius said, the only potential for significant exposure you will face is during fluoroscopy or interventional radiology rotations. If you find out you are pregnant, you can alert your radiation safety officer and officially declare the pregnancy. Once a pregnancy is declared, you will receive an additional radiation badge that tracks the radiation you receive over your pelvis (the badge goes UNDER your lead). The badge measurement should represent an estimated amount of exposure to the growing fetus.  The most important time to avoid radiation exposure is during the first 12 weeks when organogenesis and rapid cell division is highest. However, you do not have to perform IR or fluoro duties later in the pregnancy if you don’t want to.

I had my IR rotation early on, so it wasn’t an issue. But, I ended up shifting my fluoro rotation to another academic year because I didn’t want any unnecessary exposure. Your program and the chiefs should be willing to work with you. If you feel comfortable talking to the chiefs ahead of time, you may even be able to coordinate those rotations earlier/later to avoid having to cause scheduling changes later on. Of note, some women choose not to declare their pregnancy and continue to work. I know of IR attendings who worked during their pregnancy the entire time. But the point is, it is your right to decide how much potential exposure you will receive. You need to feel comfortable.

Is there a typical year of residency easier to have a baby than others?

I think this sincerely depends on the program and how it distributes residents among services. I would agree that the R4 year may have more flexibility due to elective time. But, R1 year is also relatively light given the lack of call. In my hospital, R2 year is especially difficult and demanding, but the toughest year can vary depending on the program.

I tried to time my pregnancy on purpose towards the end of my R1 year. By doing this, I was able to take advantage of the six weeks of paid leave offered by my hospital. In combination, I was also able to take two weeks of vacation from R1 year and tack it on to 2 weeks of vacation from R2 year for a total of 10 weeks off. I will be finishing on time. And, I did not have to remediate any rotations except the few weeks of fluoroscopy I missed during an R4 elective.

Timing is not always doable, and you may experience stresses related to just trying to get pregnant during training – just something to keep in mind. I even met a girl last year who was eight months pregnant while taking her boards examination. She passed. Life goes on. Ultimately, there’s no perfect time to have a child, and the program should help you work through your needs as you encounter new challenges.

With radiology being a male-dominated specialty does this cause strife between residents during maternity leave? (Is there maternity leave?)

I can only speak from personal experience that I had very supportive co-residents. But, I believe this stems from the underlying culture of my program/hospital. I believe that resentment may be a little harsh to describe the sentiments of the other residents. Certainly, if additional/compacted call falls on your colleagues, they may be anxious for your return to mitigate the stress of call.  Not one of my co-residents ever questioned my dedication to the program during or upon my return from my leave. If anything, you may have some challenges with the attendings once you come back. And, you may find yourself having to prove your knowledge in light of a prolonged absence.

I would argue that as long as you are meeting milestones and keeping your major/minor change percentages on par with your colleagues, you should not have to worry. You need to understand, however, that your choice to take time off will require dedication and discipline. Upon your return, you will make up for the time you lost to “catch up.”

How do you decide if a program is family friendly and future-family friendly?

I would advise asking the residents during your time with them on interview day or during pre-interview dinners. Don’t single yourself out, but ask general questions like, “How many residents have families?”; “What’s the program’s family leave policy? Is it paid? Do you have to use your vacation?” As Dr. Julius mentioned, having support nearby or having a supportive partner is probably the most important thing. Radiology residency may be less demanding in terms of physical time in the hospital. However, you will need to read and study during your off time to excel. You will be preparing case conferences during off hours if your program doesn’t give you dedicated time. You will need to carve out time for yourself and your well-being. All this work requires the support of others.

Feel free to allow your readers to contact me directly with questions on Twitter @KVincentiRad.

Thank you for your time.
Kerri Vincenti, MD
Chief Radiology Resident
Pennsylvania Hospital of the University of Pennsylvania
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AUR Update 2019: What’s In Store For Your Radiology Residency?

For those of you that don’t know, the Association of University Radiologists (AUR) annual meeting is the main forum for all radiology residency programs throughout the country to discuss the most critical issues affecting radiology residency programs, GME education, and radiology medical student education. These include anything from the radiology residency match to the job market as well as the hardcore academic issues.  So, once again, I would like to keep you up to date with the AUR update 2019 on what is new in radiology education and the main factors that may impact your training.

Radiology Match/Competitiveness

As I had previously promised in a previous blog on the match, I will provide with a summary of the numbers compared to past years. Slightly different from my experience in the match, the numbers pointed to an overall similar year for radiology residency competition. Compared the previous year, 18 spots were left open (previously ten places). And, the percentage of foreign graduates were also similar (32% vs. 29%). However, the number of applications per resident had increased significantly, perhaps driving somewhat more competitive applicants into the interview spots.

Given the numbers, however, the facts show no significant change in competitiveness from year to year. Interestingly enough, in my experience, the overall quality of the applications was higher. (my experience can differ from the overall statistics!) So, I believe that some increased self-selection has been happening, not measured by the statistics. In terms of competitiveness, one of the hot topics lectures stated that radiology this year was similar in competitiveness to emergency medicine.

The Job Market

Like the previous year, the future has become rosy for new radiology residency graduates. Droves of retiring radiologists and a good economy are leading to the robust job markets for new radiology resident graduates. Also, similar to the last year, there are nearly two jobs available for each diagnostic radiology residency graduate. I would say that is not too shabby!

Furthermore, the needs of practices remain similar to the past. Body imaging, neuroradiology, and interventional are the most common available first jobs. And, the greatest need for radiology practices remains breast imaging, body imaging, and neuroradiology. Most jobs posted are again available in the South and the least in New England.

What I found particularly interesting: 8% of all graduates were able to find a job with no fellowship training. I’m not sure what the statistics were for the previous years (probably a lower percentage in past years), but I have a feeling these folks would still have a hard time finding a position on the populated coasts. However, these statistics bode well overall for all graduates trying to find a job.

Change In Board Pass Rate Minimums

From an associate residency director of a “smallish” program, ACGME board passing changes have the potential to make some issues for smaller radiology residency programs. No longer is the minimum requirement an 80% pass rate for residencies by the end of the residency.  Instead, each program needs either an 80% first-time core examination pass rate or be over the 5th percentile for all residencies (that makes up about seven programs) with a look-back of five years. If you happen to have a “freak” year or two of a lower pass rate as a smaller program, the ACGME can target your residency for a new site visit. And, that can wreak all sorts of havoc!!!

Radexam

Now that the monthly evaluation exam has matured a bit, we have more details on this evaluation system. You can expect the availability of a more sophisticated assessment of individual scores and more customizable examinations to different institutions. You will see new exams in fluoroscopy, GI, and GU. Even the AIRP plans to have a distinct test to confirm that residents have attended the conference!
Also, they have instituted a new overall R3 level assessment test for these residents before going into the core exam. The examination will be available until June 20 and may be a great way to assess the progress of the resident for the core. We will see!

Unconscious bias

The quality of the speakers at the meeting varies widely. But, this year the AUR meeting provided us with a treat. Straight from the NPR news station, Shankar Vedantam gave an excellent lecture on unconscious bias and how that can affect radiologists when it comes to issues like the selection of diverse radiology residency applicants. No, it did not provide us with a formula for maintaining diversity in our residencies. But, it did give a new perspective on how we make the decisions that we do. If not this year or next year, I would expect some future changes in the rules for the overall process of residency selection and evaluation to incorporate some of the principles from this talk.

AUR Update 2019 and Change

The one constant in all radiology residencies is “change.” And, this year with the AUR update 2019 is no exception. Between the match, the improving job market, changing pass rate standards, an evolving Radexam, and new perspectives on unconscious biases, I foresee that our program, as well as all programs across North America, will have to roll with the punches and continue to adjust!

 

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Can I Practice Radiology With Color Blindness?

color blindness

Question:

Does having partial red-green color vision deficiency hamper the chances of a resident to pursue Interventional Radiology? Or will it even prevent me from applying for the post of a professor after completing MD Radiodiagnosis?

Color Blind Future Radiologist

Answer:

Dear Color Blind Future Radiologist,
Fortunately, most interventional procedures, you can view in black and white. And, that same rule also applies for most of the radiology field, interventional and non-interventional. Usually, we look at images without color overlay when reading CT scans, plain films, MRIs, and fluoroscopy.
Moreover, you can change the color settings on the software of most equipment such that you can avoid the pitfalls of red-green color deficiency. Even color doppler ultrasound and nuclear medicine (the most color driven modalities) usually have different color settings. In these colorful modes, you should be able to set it so that you see the information appropriate for your eyes.  So, you should be able to get around the problem.
However, there is one caveat. It is critical to notify your faculty about your color blindness to ensure that they change the settings on the equipment. Don’t be shy about bringing this issue to their attention. You will only be hurting yourself. If you let them know up front, you can look at the images in a color scheme that you can read. In the end, it is possible to become a full-fledged radiologist with a partial color blindness deficiency!
Instead of worrying about color blindness, most importantly, now you can concentrate on improving your application. Since IR has become so competitive, you can spend your time on what matters, garnering a spot in a field with few positions. And, no longer do you have to worry about how partial color blindness will affect their selection of you as a candidate!
Regards,
Barry Julius, MD

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What Is This Hang Up About Ivy League Applicants?

ivy league

Hovering over the shoulders of program directors throughout the country right after the NRMP match, sponsoring hospital and medical school administration eagerly monitor the match results and statistics from each radiology residency. And, what excites these bureaucrats?

First and foremost, they love it when you’ve matched all your spots, a legitimate achievement. Second, these administrators want to see how far down the rank list you went. Now, I believe this to be a bogus statistic because many of our best residents have been ranked farther down the rank list. But, OK, I will give them that statistic willingly (although I think it’s silly!)

And, finally, they ask to see how many residents came from “Ivy League” institutions. Now, this arena is where I have a real problem. It shows a lack of insight into the residency selection process and medical school training, as well as demonstrates a hubris undeserved of the sponsoring institution. And, let me tell you why.

Medical School Selection Bias

With all this talk about Lori Loughlin and the unfair practices of the university selection process and knowing what I know about the university selection process, I believe that university selection biases also apply to many medical schools. In particular, these issues tend to affect “Ivy League” medical schools more than most because of the aggressive pursuit of applicants (and snowplow Moms!) to get in. Between legacy favoritism and the eternal quest for diversity (not necessarily having to do with the making of a quality physician), these institutions do not necessarily select for the best candidates at our radiology program. Now, don’t get me wrong. There are some great students at these institutions. But, great students sit on the rosters of almost any medical school.

Poor Fit For The Institution?

Many of the candidates that come from “Ivy League” medical school  (not all) want to work in radiology residency programs that have a preference for getting grants and bench research. And, not all programs offer this sort of work. Instead, some residencies provide a solid clinical experience without in-depth bench research. Why would these candidates fit in well with the philosophy of these programs? They do not!

No Difference In Resident Performance

In this realm, I am a bit biased. But, in a look back of all the residents that we have had over the years, our best residents ironically have often come from Caribbean medical schools or have been D.O. candidates. Not to say that the “Ivy League” graduates have been terrible. But, I have not seen standouts of increased performance compared to the other residents in our program.

And this same idea you can also see in the top 20 CEOs in this country. Take a look at the Crain’s Chicago Business article called No One Asks Where The Top 20 CEOs Went To College. (Hint: Only one went to an Ivy League institution) So, why make an increased effort to recruit these applicants when these residents have not performed any better?

Possible Attitude Issues

And finally, as an associate residency director, what is one of the worst things I can do? Well, naturally, recruit residents that do not want to be here. If we are a profoundly clinical residency without that hardcore research component, why would I want to hire an applicant who intends to apply for research grants? These sorts of residents can develop the wrong attitude for a residency program without these resources and will regret being there. Discontented residents make for a miserable residency experience.

The “Ivy League” Applicant

Now, I am not saying that programs should avoid taking applicants from these prestigious medical schools. Indeed, many will make excellent residents. My point is that great residents can come from any medical school. To make accepting these residents into your program as a badge of honor neglects the right reason for the application process in the first place. And what is that reason? It is to find a candidate who thrives and performs successfully over the four years of training!

 

 

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Pregnancy In Radiology Residency

Question:

 

Hi Dr. Julius,

I have a few questions for you about pregnancy during radiology residency that I wanted to know.

Is pregnancy in radiology residency doable?

Are programs supportive of students who expand their family during residency?

Are there radiation exposures that I would need to avoid in a diagnostic radiology residency?

Is there a typical year of residency easier to have a baby than others?

With radiology being a male-dominated specialty does this cause strife between residents during maternity leave? (Is there maternity leave?)

How do you decide if a program is family friendly and future-family friendly?

Thank you!

Sincerely,

Future radiologist

———————————

 

Hi future radiologist,

I have to say I have been getting some great questions from my audience and yours is no exception!

So, let’s start from the beginning… Is radiology residency doable for a pregnant resident? My quick answer is undoubtedly yes. Many have done it before.

But, let me give you a bit of the more detailed response to your inquiry. It’s not whether it’s doable, the question is, do you want to do it at this point in your life? By no means is it a cake walk.

So, what changes? Typically, many pregnant residents will lay off the fluoroscopy and the interventions that involve ionizing radiation. And, depending on how your pregnancy goes, you may feel tired and nauseous at times. But, most get through the residency just fine.

And, of course, you are entitled to pregnancy leave which I believe is usually three months. Depending on how much time off you take, that may extend your residency a few months. Moreover, the additional time can delay the timing of your fellowship.

Then, finally, you will probably need some help with the kids once you do restart your residency after the pregnancy.

Is it easier or harder to have a baby during rads compared to others?

Comparing radiology to other residencies, I believe it is more doable than some and harder than others. Those long nights with a reversal of sleep schedule can be tough on typical residents let alone pregnant ones. The hospital will constantly bombard you with images with no time to sleep. Psychiatry and derm are some specialties that don’t have those tough calls. But then again you are practicing psychiatry and derm, not where I would want to be!

And, perhaps it is not as grueling as surgery. But, it all depends on what you want.

So, what year would be best to have a baby?

If I had to choose within the current system, I would have to say in most programs the 4th year (after you have passed your boards) would be the best time. It is the least demanding in most residencies (but not all!) Usually, you can fill it with mini-fellowships, electives, and less call shifts than other years (although some have 4th-year weighted call).

Does pregnancy cause resentment?

I will say the following; Whenever you have one person with different sets of requirements from the others, you will have some resentment. Call shifts will increase for your classmates in spurts.  You will have to give them back afterward, so it eventually evens out.

But, in the end, this is a personal decision to make and regardless of what others think it is probably not best to put it off too long because of the increased risks of waiting too long.

Which residency should I choose for a possible pregnancy ?

So, if I were looking for a residency for my wife where she would have the best situation while pregnant, I would say, most critically, pick one near family members that can help out. Next, I would want to find one where the call might be a little bit lighter.  Or, one that has a decent 4th year if that is when you want it. And finally, find a program director that you believe will be able to commiserate with and support you during residency.

I hope this answers some of your questions!

Barry Julius, MD

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Why MD-PhDs and Radiology Residency Sometimes Don’t Mix

Getting an MD-PhD is no small achievement. These candidates often take eight, nine, ten or more years to complete their training by the time they apply to medical school. Meanwhile, their friends and colleagues have long since graduated from medical school. And, working on a thesis as a PhD can be brutal. I admire the tenacity it takes to get through this program.

Now, you would think that with all this training, all these applicants would turn into the most incredible radiologist residents. (of course, some are great) However, based on my own experiences and the sentiments of other program directors throughout the country, nothing could be further from the truth. And, let me tell you why.

Too Detail Oriented

MD-PhD training (especially the PhD part) utilizes a whole different philosophy from medicine. These teachers teach with bottoms up approach. You start from all the details and then work your way upward to the whole. On the other hand, in radiology, you start with the general disease or imaging findings and then work your way into the details. These two approaches clash. Concentrating on the features of a hepatic cyst on a CT scan while an aorta actively ruptures can cause real problems for patient care! Imagine the issues misses like this can create when a resident starts his first call.

Decision Paralysis Because They Know Too Much

With some residents in radiology, the problem is they know too little. That is not true for the MD-PhD graduate. Instead, in a way, often, MD-PhD know too much to make a quick decision. They think about cases too profoundly (which of course, is sometimes a good thing). But, sometimes it also leads to decision paralysis. Harping on one imaging study at nighttime for 45 minutes can lead to a backup of cases for the entire call shift. Imagine the constant phone calls from the emergency department when this happens. Getting bogged down in decision making instead of acting can lead to poor outcomes!

Question Everything

In the MD/Ph.D. world, you need to question everything. By doing so, the art of making questions leads to incredible research. But, in the radiology world, we can query some things. However, we do not have the time to question every detail. That doesn’t work well for radiology residents or attendings. We will be working until the cows come home!

Out Of Clinical Practice

Unlike the standard MD pathway, the MD-PhD approach often involves performing their clinical rotations early. So, by the time these residents apply to your program, they have already had three or four years of PhD work without even seeing a patient. It is not uncommon to forget about how to talk to patients and make them happy. Just like PC Richards, customer service is king for radiologists. You need to have the patient skills to be a consummate radiology resident. And, you know what?  If you don’t use your skills, you lose them!

Different Knowledge Base During Medical School Training

A typical MD will emphasize learning about disease processes and pathology during the clinical years. By the time she arrives at the radiology program, she knows the basics about medicine.  On the other hand, MD-PhD grads may have been profoundly learning about focal adhesion kinase enzymes for years before arriving at the radiology residency. Unfortunately, learning about complex biological chemistry is not directly transferable to the clinical duties of a radiologist. And, it shows when these residents first start!

How Can MD-PhD Grad Be Successful In Clinical Radiology When Their Medical School Training Stacks The Odds Against Them? 

Now you can see why some program directors hesitate when they face the decision to accept their next MD-PhD applicant. But, with all of these issues how can you, the average MD/PhD succeed? I mean that is the bottom line, right? If I can’t help out the poor MD-PhD grad than what is the point?

Well, fortunately for the MD-PhD applicant to the clinical radiology program, solving these issues is straightforward. How can you go about making yourself a better candidate? First, you may want to apply to programs that have a bench research component, if that is what you want.

Second, stay connected with clinical medicine. What do I mean by that? Make sure to volunteer to participate in additional clinical rotations when you shift to the PhD portion of your medical school training.

And finally, remember that you need to think a bit differently when you enter your radiology residency program than your PhD training. Creating a connection to the clinical realm will give you an edge!

 

 

 

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I Am A Foreign Grad And Want Interventional Radiology… Help!!!

want interventional radiology

Question For Residency Director

Dear Dr. Julius,

First of all, thank you for writing up this excellent blog. I found the ‘choosing fellowships’ section to be of highly beneficial to me. But even after that beautifully written post, I am still undecided. I am currently a radiology resident in the UK. And, I am keen to apply for a fellowship in the USA(I have completed my USMLE). I like working with my hands. Moreover, I think that I am talented. I understand that the traditional interventional radiology fellowship will no longer be available by the time I am eligible to commence my fellowship (2021).

Now, I am quite interested in neurointerventional radiology. By 2021, I would have completed a five years residency in the UK (3 years in general radiology and two years in neuroradiology). Realistically speaking, what are my chances of getting into a two-year fellowship in neurointerventional radiology being a foreign medical graduate? I understand that it is a competitive fellowship. Also, what kind of interventions do I get to perform by doing a body fellowship?

Many thanks for your help!

 

Answer:

Azygos Lobe,

Unfortunately, all those years in the UK are not directly transferrable to the United States requirements. So, you are stuck with one of two possibilities in the United States. First, you could look to satisfy the alternate pathway requirements. However, interventional fellowships of any sort have become the most competitive of them all in the United States. Even though you may want interventional radiology, getting a slot as a foreign grad may be next to impossible. And, if you were to find one, you may not satisfy the requirements for licensure in many individual states within the U.S. when you completed your fellowship and looked for work here. Therefore, that would be a tough road to choose.

Second, you could theoretically apply to repeat your clinical and radiology residencies in the USA. But, that would mean an additional five years of training.  And, then you could ask for a fellowship in interventional for a year or two (Depending on whether the program has ESIR)

And finally, the most unlikely option, you can apply directly to the IR/DR residencies. But again, only a few accepted applicants were foreigners because it has become one of the most competitive residencies in the match.

To sum up, your options are a bit limited. For your best chances, I would apply to the US residencies and start anew. That would involve many years but would be the most likely scenario to succeed. It would be a tough road to follow.

Body Fellowship For Interventional Practice

In terms of the body fellowship, depending on the location, you may encounter a bit of interventional variability. Some programs do more biopsies and drainages. Others may have a mammo/breast component. And, even others may have a small interventional/vascular element. It comes down to the individual program practice patterns. So, you need to ask around before committing to any particular body fellowship.

Let me know if you have any other questions,
Barry Julius, MD