Category: Ask The Residency Director

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DO Friendly Programs- Should I Bother To Apply?

do friendly

Question About DO Friendly Programs!

 

Hello! Thank you so much for this website; it has helped me out immensely. What is your take on small community programs with lots of DO residents? They seem to have a pretty good fellowship match (IR in some top programs, a pretty good mix of fellowships overall).

 

Thanks a bunch,

Low Tier

 

Answer:

 

I am somewhat biased as our program has welcomed both DO and Caribbean medical school graduates for years. And, yes, folks consider us a “community” program. (although that will change with our impeding merger)

 

My philosophy on radiology education is that a residency is only as good as what you put into it. Regardless of the name, if you work hard and read a lot, you will come out of your residency as a great radiologist. The big difference some of the more popular programs afford is additional subspecialty work that you might not get elsewhere and hardcore research that you may or may not want. However, all is not lost if your residency does not fit this category. Indeed, you can get some of these experiences during your fellowship. And, most residents complete a fellowship after residency.

 

In terms of being a DO friendly program, I have no problem with that. As long as education is of high quality and the program’s resources are adequate, it should not matter if the residents are Caribbean, foreign, or DO. In our residency, some of our best residents tend to be Caribbean grads, for one reason or another. That should not dissuade you from applying to a program if you know that the program’s quality is high, and you will receive the training you want. We have had excellent residents from American, Caribbean, and DO residencies alike.

 

Hope that helps,

Barry Julius, MD

 

 

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Didn’t Take The USMLE And Still Want To Apply To Radiology Residency!

USMLE

Question About Applying Without The USMLE

Hello,

Currently, I am starting the intern year as a categorical surgery resident. I know I would be happier as a radiologist, but now I am in a tricky situation. I am a D.O. with decent scores. Unfortunately, I did not take the USMLE (I entered medical school thinking of pediatrics, and my advisor told me to focus on just one examination). Even though I have not taken the USMLE, I have published research from undergrad in pediatrics from an excellent medical school. Moreover, I was a part of the medical honor society, a tutor during medical school, had prior work experiences, and plenty of volunteering/club involvement. I know the radiologist I worked with would be willing to write me a persuasive letter of recommendation.

As a student, I initially applied for general surgery due to a passion for anatomy, and because I enjoyed working with breast cancer patients. I thought I wanted to be a breast surgeon. However, I had the pleasure of working with a radiologist working in breast/women’s imaging. I loved it. Being able to detect subtle changes in breast tissue was fascinating. From the mammograms, stereotactic biopsies, and needle localizations, the days would seem to fly by. I couldn’t get enough of it. Never did I think I would be so interested in radiology, but without any prior exposure in the field, I would have never known. 

I guess at this point I am unsure what to do. The current hospital I am at does not offer a radiology residency but is a part of a healthcare system that is about an hour away. What is the best advice you have for someone in my position? Any help would be much appreciated.

Thank you for your time!

What To Do?

 

Answer

Dear Applicant,

As an intern in surgery, you are well within the window to change specialties from the standpoint of government medicare funding. But, if you make your decision to enter radiology too late, that may no longer be the case. Applying later will reduce the number of residencies that will give you an interview. So, there is no better time than now to apply for radiology, as that is your area of interest.

Also, you may not want to hear this. The best way to ensure that you will get a spot in radiology would be to take the USMLE Step I and II exams. Many residencies disregard the COMLEX scores. Now that the AOA has merged with the ACGME, the USMLE tests are the standard throughout the country. A good score on the USMLE Step I would go a long way to giving your application some more “street cred.” (Eventually, in 2022 the USMLE Step II will be more critical exam since Step I will be a pass/fail test only). 

If you only have the COMLEX exam, you will be limiting the number of residencies that will seriously examine your application. I would try to take these exams as soon as possible so that the residency programs will have your scores. (Not sure if you can fit it in before this application cycle ends, but if you can, that would be great!)

All the other stuff that you have done, such as research, tutoring, and volunteering, is excellent. But, everyone else applying for radiology residency has done the same. So, although you need to add it to your ERAS application, it’s not going to differentiate you.

A recommendation from a radiologist within a health care system that has a residency can still support your application. Even if there are no other residency programs within the healthcare system, it will still help a little bit (but not as much).

The bottom line is that all is not lost. It will take a bit of work to study for the USMLE Step I and start your application soon. If you can’t get those USMLE scores before the application cycle, you can try to apply regardless. However, the chances of getting into radiology residency will be a little bit less. I think it is still worth a shot because you don’t want to lose out on government funding. Alternatively, you can take off a year of residency and find a job in research. That would potentially postpone the medicare funding issue and allow more time to study for the USMLE. When there’s a will, there is a way!

Good luck,

Barry Julius, MD

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Do IR-DR Programs Hold Grudges Against DR Applicants?

grudge

Question About IR-DR Program Grudges Against DR Applicants:

Hi, Dr. Julius!

Thank you so much for creating such an excellent resource for students who are interested in Radiology as a profession. I am interested in applying to Interventional-Diagnostic Radiology (IR-DR) as my preferred specialty this Fall. I am still confused by applying to IR-DR and Diagnostic Radiology (DR) at the same time. To give some context, I currently live in the United States, and my husband is an Orthopedics resident who will complete his training in 2023. We have a young son, and so location is very high on my considerations as it pertains to different programs. I love IR and want to pursue an integrated residency. However, since you can still get into IR-DR from DR, location is more important to me than an integrated program.

I guess my real question is that specific DR programs will hold it against you that you applied to their attached IR-DR program and will not grant you an interview. Considering that the match rate for IR-DR is only around 50-60%, I cannot risk applying only IR, but will program A’s DR program still consider me if they know that I have sent applications to residency A’s IR-DR program as well? Thank you so much for your input!

Sincerely,
Future Interventionalist

 

Answer:

Dear Future Interventionalist,

According to my experience over the past few AUR meetings, unfortunately, some residency programs hold grudges against residents who apply to both DR and IR-DR programs. However, most don’t. For those that do, from what I gather, they will often take residents that apply to IR-DR programs if they believe that they are good anyway. So, I would not let that stop you from sending applications to both sorts of residencies simultaneously. As you have stated, IR-DR is competitive, and you are better off applying to both programs. DR programs still have a pathway to get into IR-DR. The numbers game makes it not worth your while to worry about individual programs’ grudges!

Good luck!

Barry Julius, MD

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Now USMLE Step I Is Pass-Fail, What Do I Need To Do?

pass-fail

Question About Pass-Fail Step I USMLE:

Hello,

I’m going to be starting medical school this coming August and was interested in DR. Still, with Step 1 becoming Pass-Fail, I am not sure how to strengthen my application to Radiology Residencies. Do program directors value research/community research more than other metrics? Step 2 will likely become the new objective score by which program directors may filter applicants. I was looking for any other advice you might have for applying to a Radiology Residency once Step 1 becomes Pass/Fail. 

Thank you!

Answer:

First of all, I will direct you to my article on this topic called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective! – RadsResident

That should give you a bit of background on what I think will happen over the next few years. But, in your particular case, for a typical applicant from a regular U.S. Medical School, the most important criteria for acceptance to a program is and will continue to be the dean’s letter. So, anything that you can do to boost your performance in medical school will help the most.

As you have alluded to, the USMLE step II will continue to be important as long as there is a significant correlation between testing scores and the core examination. So, programs will most likely continue to use USMLE step II scores because they will most likely have some relationship with test-taking abilities. That will ensure that the residents in the program are more likely to pass the core exam. (Not that I like either the USMLE or the core exams in particular!)

Once you have taken these factors out of the equation, research becomes essential. Why? Because it shows that you are interested in radiology and took the time to complete a project to prove it. And, then all the other tangible and intangible factors play a role in our decision for acceptance (recommendations, other extracurriculars, interviews). And lastly, the personal statement is the least powerful of the admissions criteria.

The bottom line: Other than the test criteria changing from USMLE I to II, I don’t see much else changing in the selection process at the current time.

Good luck!

Barry Julius, MD.

 

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How To Prepare For Radiology Residency, Starting In High School!

high school

Question From High School Student

Hello!
I’m a 14-year-old 9th-grade student, very interested in becoming a radiologist! I’m aware that this is more of a university-level website, but would you, by any chance, be able to give some tips on courses you recommend and what to do in high school to help me to get accepted to medical school. Also, what courses will allow me to do well there?

Thank you so much for your time!
Young But Interested In Radiology

Answer/Advice

Glad to hear that you are enjoying radsresident.com. It’s never too early to start thinking about your career options in life! So, I will give a few of my recommendations to you. First of all, of course, you will need to perform very well in school in all your classes. But, if you are writing this email to me, I have a sneaking suspicion that you are doing that already! You have a slightly better chance of getting into medical school from some of the name brand colleges. However, we get lots of applicants from smaller schools as well. So, if you don’t get into Man’s Greatest University, all is not over. Doing well in your college classes is even more important than high school, regardless of which school you attend.

So, what types of courses are best? I don’t think it matters that much at any stage of the game, except to ensure that you meet the typical medical school requirements- Bio, chemistry, physics, etc. Schools like to see that you have varied interests.

Forgetting about grades and courses, what else should you do? Do a few extracurricular activities that you like and do them well. What do I mean by that? If you love music and you are good at it, take it to a high level. Play for All-State band or at other performance venues. If you are an athlete and like baseball, do it well. Play for college sports and work hard. Or, if you are into student government, make sure that you start small in your school and eventually become proactive in national organizations. Regardless of what you do, please do your best, and do it to its utmost. Don’t be one of those folks that do two hundred different things, is not that interested in any of them, and performs them only superficially. Too many applicants get caught in this trap.

Those folks that get into medical school, ironically, have other interests other than medicine. It’s what admissions counselors like to call the “well-rounded” applicant. So, make sure to enjoy and participate in other activities other than school. And do them to their fullest extent. I would shoot for these goals, not just in radiology, but in whatever goals you decide to pursue.

My two cents,
Barry Julius, MD

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Colleague Recommendation: Can I Use It?

colleague's recommendations

Colleague Recommendation Question

 

Dear Dr. Julius,
Thank you for your tutelage via your blogs. Thank you for all that you do. It is truly inspiring and also hard work to maintain a (very current) blog despite your busy schedule!

I am a Canadian IMG (which counts as a foreign IMG), and I’d like to apply to Radiology in the States. I am currently M3 and doing my core rotations in the US. My step1 score was only 215, NOT stellar. My only redeeming quality is that I had worked in radiology for ten years before I entered medical school, and I was department head for three years. My question is: If I get a Letter of Rec. (LOR) from a Canadian radiologist with whom I’ve worked, would that be a faux-pas? Instead, I would much rather send out a LOR from a referee who has known me and seen me work for 4-5 years than a LOR from a 4-week elective rotation. Given ERAS takes up to 4 letters, do you recommend I include a Canadian letter from a Canadian radiologist who has known me well?

Oh, and if the score of 215 is too low, then forget all that I’ve asked above (haha), but I heard they are doing away with Step1 scores in 2022, and that is when I will be matching!
Thank you!

Answer:

I appreciate the kind words! But, in terms of your questions about which radiology recommendations to choose, I think that a colleague reference from someone who knows you well from work can be an effective letter of recommendation if she writes it well. Who better to see your work ethic than those with which you work?  There is no harm in doing so. You are in a much different situation than a medical student or resident who receives another reference from a colleague of the same level. In those instances, how could a fellow trainee honestly evaluate you? Usually, getting a recommendation like those would be a faux pas. (But that does not apply to you!)

Remember, all letters of recommendation have a bias. So, having one letter with a bias toward you from your former job makes sense. Also, as you mentioned, I would send this in addition to the letters that you would typically get for ERAS. It should not be your only stand-alone recommendation.

In terms of scores, make sure that you try to do well on Step II instead. They will be using this score for assessment of your test-taking skills instead of Step I when Step I board scores are no longer used in 2022.

Hope that helps,
Barry Julius, MD

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Not A Good Test Taker! Can I Make It Through Radiology Residency?

test taker

Question:

Current radiology resident, just finishing up the intern year, with concerns whether I’m cut out for this. I was a miracle match: Low MCAT scores. Pretty much barely passed all shelf exams. I’m not a good test taker.

Am I smart enough to be doing this, or am I kidding myself? If I fail this crazy 80% pass rate core exam, will they fire me? And then what will I do?

Any advice, uplifting stories, anything would be appreciated. Should I transfer out now? Or, should I stick it out and see if I can pull out another miracle? I don’t want to ruin my life here.

Help!

 

Answer:

First of all, you need to separate the following two issues, being a good radiologist and being a good test taker. I know of excellent radiologists who have had to take the core exam or the oral boards with multiple attempts to pass. So, don’t confuse taking tests with being “smart.” It is an entirely distinct skill from working as a radiologist. Moreover, don’t count yourself out. You may find that you are a better test taker than you think when you study material that is more relevant to your future career. You never know; maybe you’ll even pass on the first attempt.

 

Also, no program should fire you for failing a core examination if you are a good resident. Residencies should be looking at other characteristics other than the core exam and test-taking skills to assess their residents. If you do well in your residency, it should go noticed by your program directors and faculty regardless of your testing scores. No one test will ever be the judge of your abilities. And, if needed, you can retake the exam until you finally pass.

 

Finally, I don’t think you need another miracle. You have already accomplished a challenging feat, getting into a radiology residency program. It will just take a bit of hard work, grit, and determination over the next four years to do a good job and get to the next phase of your career!
Regards,
Barry Julius, MD
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Breast Imaging Versus MSK- What’s Better For Marketability And Lifestyle?

breast imaging versus MSK
Hi, Dr. Julius!
Been choosing between breast imaging versus MSK radiology fellowship, what do think is better in terms of marketability and lifestyle?
Yours truly,
Not quite sure
I find your choices of subspecialties of breast imaging versus MSK unusual because I almost consider them to be opposites in some senses. So, what are the particulars specifically about breast versus MSK radiology that you may find enticing or detract you from choosing them?

The Covid Crisis And Breast Imaging Versus MSK

Let’s start with current conditions. Many breast imagers that only perform breast imaging are currently out of jobs. Why? Because elective procedures have dried up entirely. So, you are subjecting yourself to a less diversified specialty in terms of outpatient versus inpatient imaging, that’s one negative for breast imaging. Today, MSK is more desirable in the Covid world because these subspecialists usually perform general radiology and inpatient imaging. But, times are atypical right now, and both specialties will likely return to a baseline (perhaps lower than before the pandemic- check out What’s In The Cards For The New Radiologist Job Market After Covid?).

The Traditional Job Market And Both Specialties

More traditionally, there have been fewer folks that have wanted to go into mammography for several reasons, such as more patient contact, lawsuits, and less diagnostic diversity. For these reasons,  the mammography job market has otherwise remained better than most subspecialties through other recessions. On the other hand, MSK is more conducive to practicing general radiology since it overlaps with other areas in radiology a bit more. So, you will find more cross-coverage, And, for this reason, this subspecialty tends to be more subject to the whims of the radiology job market in general.
In terms of lifestyle, both subspecialties tend to be primarily outpatient. And, both subspecialties can be procedural and usually non-emergent. Mammo folks do biopsies, and MSK folks perform facet injections and bone marrow biopsies/arthrograms. But that’s about where the overlap ends. Mammography is a specialty for those people that like patient interaction. MSK, on the other hand, in general, tends to be a more solitary subspecialty where you can work without having to see patients if you want. I find this to be the most substantial difference between the two subspecialties. You have to figure out if you are a people person or not to make this determination.
So, there you have it. Those are some of my thoughts about the comparison between the two subspecialties in a nutshell.
Thanks for the great question!
Barry Julius, MD
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What Exactly Is The Specialty Of Body Imaging?

body imaging

Body Imaging Question:

Greetings and salutations,

Thanks so much for your educative content. I have benefited immensely. Please, what is body imaging (Radiology sub-specialty)? What exactly does it mean/entail? How is it different from Abdominal Radiology and Gastrointestinal Radiology subspecialties? And, are body imaging specialists privileged to carry out interventional radiology (vascular and non-vascular) procedures involving the part(s) of the body in which they specialize?

Thanks so much,

Possible future body imager

 

Answer:

 

It’s a great series of questions that you have asked because it is more complicated than what you might think at first glance. First of all, let’s talk about body imaging. Body imaging covers many different areas. To that point, some folks say that practicing this specialty is like saying you will practice all of radiology. That is because radiology covers the whole body!

Defining Body Imaging

But, if you look at most of these fellowships, they cover at least some of the following areas- gastrointestinal, abdominal, MSK, thoracic, cardiac, genitourinary, and breast. Because of this variability, there is no MQSA for these sorts of fellowships. And, if you look under this category or do a google search and see what they include, any one of them may emphasize any of these subspecialties within radiology. So, if you are interested in “body imaging,” you need to look at the fine print. Then, check out what the fellowship covers.
Moreover, a common approach for these advanced specialty programs is to cover six months in one of these areas and another six months in a different subspecialty. Or, it can emphasize more interventional biopsy type of training. Regardless, the topics can vary widely, and what you should look for depends on your interests for practice. As to your other question, abdominal and gastrointestinal radiology are just some of the areas that a fellowship can teach.
To answer your third question, yes, lots of body imagers do perform interventional procedures. And, no, you do not need to be an IR doctor or even a body image trained specialist to do many interventional sorts of procedures. Just make sure you have excellent training during your residency or body imaging fellowship, and that should be adequate for practice!
I hope that helps with your questions!
Barry Julius, MD

 

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USMLE Scores, Fellowship, And Prestige: Are They Linked?

usmle scores

Questions About USMLE Scores, Fellowship, And Prestige:

Hi Dr. Julius,

Thank you so much for making this website and posting all this valuable information to help out medical students/residents in the radiology community. I’ve been following your website for a long time now, and you have no idea how much I’ve learned from your posts.

I’m currently at a university DR program, and I did undergrad and med school at this same university (both undergrad and med school ranked top 20, DR program ranked around 30 by Doximity). I’m between neuro and breast fellowship, haven’t decided which one, but they are both considered pretty good programs at my university. However, I always feel like I could have gone to a better residency program and couldn’t stop wondering what would it be like if I went to a better fellowship. However, my USMLE scores are on the lower side. I do have excellent evaluations from radiology attendings; some of them even wrote “one of the best residents in the class, if not the best.”

My first question is, how vital are USMLE scores in fellowship application? I do have several research projects and have been going to several conferences each year (either with leadership positions or abstract presentations). I’m hoping to submit two research papers early next year (currently PGY3). I’ve also been involved in med student teaching, as well.

The second question is, should I go somewhere else for fellowship, knowing I may not get into a better program than my home program? I admit the number one reason I want to go somewhere else is for my ego. I want to go somewhere even better and well known. For my career path, I think I want to do private practice first then retire to academics later in life. But if I could find a good academic job that pays well, I might go directly into academics (indeed not my program as new attendings are very poorly paid here)- looking forward to your reply.

From the resident who probably overthinks,

Thank you.

 

Answer:

USMLE Scores And Fellowship

To answer your first question, every time you move up another level, test scores become less and less relevant. That said, the fellowship programs would most like to see that you have passed your core exam. Why? Because it will interfere with the year of the fellowship. And, just as critically, the fellowship program is partly responsible for your passing or failure of the exams you take during the time that you are there. Luckily for you, most fellowships don’t know your core exam results because the match is before you take them! So, that is one positive.
Also, most programs will take your USMLE score with a grain of salt (unlike residency) because you have already made it to the level of a resident. Residencies use USMLE scores as a way to discriminate between institutions because it is an equalizer. It allows the programs to figure out if someone coming from a less competitive school has the abilities that someone coming from a more competitive school does. You are pretty much past that point as a radiology resident. You’ve already made it!
On the other hand, over time, recommendations become more and more crucial. The right one will get you a spot in almost any fellowship program. The same for a residency or medical school usually does not have any near as much power.

My Philosophy About Fellowship

Just as an aside, let me give you my philosophy about any training program. Residencies, fellowships, etc. are what you make of it. Better, in regards to a training program, is exceedingly difficult to evaluate. Unless, of course, one is missing the critical equipment, faculty, or resources to teach the subspecialty. But, that is rarely the case. Most fellowships have to meet stringent criteria so that they can teach fellows. A good fellow will be a good fellow at almost any reasonable program.

Fellowship, Prestige, And The Job Market

For the next question, should you go somewhere else for a fellowship? Many residency directors have a different take on this. But this is mine. I believe that the reason to go to another institution has very little to do with prestige. Instead, the best reason to work at another institution is to see how they do things differently in another place. I find that learning multiple distinct approaches to radiology is critical for succeeding as a fully trained radiologist. And, one of the best ways to get that experience is to have worked at multiple institutions.
Prestige plays a more significant role if you want to become a chairman of an academic radiology department. Believe it or not, becoming a chair at a private practice can be not only less competitive but often undesirable because it means a lot of extra work for minimal reward. You have to go to all the hospital meetings and field all the complaints about the department. It can be a thankless job! (Although some like it).
Moreover, in today’s market, the prestige of the training program has little to do with your future private practice job prospects. You will be able to find a great job coming from almost any fellowship as long as you train and do reasonably well.
My two cents,
Barry Julius, MD