Tag: fellowship

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Are You Ready?

ready

The middle of June begins the annual season of change for radiology residencies. The first graduates start to move out as they have held their last few weeks of residency vacation to dedicate this time to move. And new residents prepare to find housing in the area and prepare for the new academic year. Even the first-year residents have an enormous transition from readers and observers to active participants in night shifts and calls. Since so much happens now, let’s discuss a checklist of some items you may not think about or forget before starting the new year. Don’t worry. I have you covered!

Bone Up A Bit On The Basics To Get Ready Before Starting

Whether you are about to start residency, call, or fellowship, why not take the time to read a bit before starting. Many fellow interns and residents say not to do anything before starting your new phase. But, many of them are not radiology trainees. We have more reading than most other specialties out there. So, get cracking. 

Suppose you are an intern. Read some anatomy atlases (if you haven’t done so already!). If you are about to take overnight call, consider some case review series, especially for ER radiology. And, if you are a fellow, start reading about some of the critical areas within your newfound subspecialty. Any bit of reading can give you a headstart.

Find Housing Close To Your Residency Program

You have limited time to get out there and find housing with all the pressures upon you. But, if I have to give one sagely piece of advice, you are usually best off living fairly close (optimally within a ten-minute radius)—the less time in the car or some form of transport, the better. You will have more time for studying and, perhaps just as importantly, more time for yourself. This advice comes from someone who has lived near and far from their line of work. It’s not worth the pain to live farther away!

Remember To Start Up Your Savings And Investments

Some of you will have the option of starting up 401ks with matches or making automatic contributions to Roth IRA. Regardless, before starting, don’t forget to automatize all these investments. As residents, you will not have as much time for a hands-on approach. So, start up those automated investments into those stock index funds before beginning. Trust me. Your future self will thank you many years from now!

Start-Up Car And Renters Insurance

Many of you are moving. So, don’t forget to change up all your insurances. Sure it can be a pain in the neck, especially if you are moving to a new state. But, it is a necessary evil. The last event you need is to start residency after a theft that you can’t recover or have issues with your car once you have already started. Make sure all these insurances are in place before you start.

Make Sure You Have Your Medical Licenses And Credentialing Ready To Go

Some of you will need your state medical license before beginning residency. Others will be able to use the hospital license. Either way, you will still have much to do to ensure that you get it processed and ready to go. Credentialing in all forms can be more arduous than you might think. And, it pays not to worry much about it after you start. So, get everything in as soon as possible, so you will not worry about the details during your residency!

J1 Visas, Etc…

Finally, for foreign graduates, don’t forget to ensure that all the paperwork you need to stick around is complete and ready to go. We have seen a few folks that had a problem getting back into the United States because they did not finish their paperwork. It happens!

Are You Ready? Get Psyched For The Change!

So many errands to do before starting and so little time to do them. Here is a bit of a nudge to get you going so you can start the year with a bang. Before starting, take a gander at this list and ask yourself, what did I forget? This list can help you recall what you need. But, most importantly look forward to the next academic year. Change is exciting and will be here before you know it!

 

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Best Add-on Subspecialties As A Radiology Attending

add-on subspecialites

Have you ever thought about what would happen if you decided to specialize in an area different from your fellowship? Well, believe it or not, many radiologists commonly accomplish this feat after starting in practice. Maybe they want to try their hands on something new. Or, perhaps the group needs a sub-specialist that they don’t cover well. In any case, it happens all the time. So, what add-on subspecialties are the most conducive to on-the-job training and why? Here is a list of what I think attendings are most successful at tackling after fellowship.

MSK MRI

For many new attendings who already know other forms of MRI, taking up the requirements for MSK MRI is just a little more. There are great sources available. You can find loads of excellent MRI MSK outside courses. It’s relatively easy to find cases to overread at most institutions. Additionally, although present, the legal issues for MSK MRI are lower than for other areas, such as having misses in neuroradiology or a complication from an intervention. All these factors make MSK MRI an excellent modality to start to pick up after you finish your training.

Mammography

You may ask why it is reasonable to start practicing mammography after fellowship when it has the highest frequency of lawsuits from any other specialty. Although true, it also has some of the other lowest barriers to entry:

  1. Most radiologists have had some training in this specialty before working as an attending.
  2. The differential diagnosis is limited (though case management can be relatively complex but learnable on the job). And, it is relatively easy to overread your colleagues’ films. Many courses are available that can give you a refresher on the basics of tomography, MRI, and more.
  3. Most practices require additional coverage in this area.

Cardiac/Thoracic Imaging

Although some rads have completed fellowships, most folks who read cardiac studies such as Cardiac CTAs, calcium scorings, lung screenings, and Cardiac MRIs are not fellowship-trained. So, it is a doable add-on to your current skills. Courses are readily available, and the baseline knowledge needed for calcium scoring, lung screenings, and Cardiac CTAs is moderate. To become a cardiac MRI reader is a bit more time-consuming, but this area is wide open for folks that want to learn. Plus, most practices would love to have an additional reader or two.

Nuclear Medicine

I am not too proud as a nuclear radiologist to admit that nuclear medicine is one of those options conducive to an encore in your career. PET-CT is relatively easy to learn, aside from some artifacts and subtleties. After reviewing and over-reading some nuclear medicine studies, most general nuclear medicine is very doable. Cardiac perfusion imaging can be a challenge for some. But, I know of many radiologists who went to take a course and then came back to read additional cases with a radiologist. And they were excellent with their reads. If you are considering practicing nuclear medicine at any point, pay attention during residency!

Informatics

For this topic, all it takes is significant interest to become the go-to computer person in your group. Typically, by default, you, too, can become the guru. These folks like to play around with computers and are keenly interested in becoming part of the hospital information committees. Also, they are hobbyist programmers and closet geeks who love technology. All you need to do is read a lot and love all the nitty-gritty details of your PACs and information systems. With all this interest, you will have a leg up on the world of informatics and can become an expert in your practice. You don’t necessarily need a fellowship!

The Best Add-on Subspecialties To Practice

I firmly believe that no subspecialty in radiology is out of the realm of possibility once you become a full-fledged radiologist. However, some add-on subspecialties are more challenging when you are out in practice. Nevertheless, MSK MRI, mammography, cardiac/thoracic imaging, nuclear medicine, and informatics have lower entry barriers and are doable if you take an interest and there is a need. Something to consider if you want to try something new and you are out in practice!

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ABNM-ABR Pathway Completed: Do I Need A Breast Fellowship?

abnm-abr

Question About ABNM-ABR Pathway And Breast Fellowship

Hi,

I am a 4th-year radiology resident graduating from the ABR-ABNM 16-month dual certification pathway in June. I matched fellowship in breast imaging starting July. However, I am liking nucs and am considering bagging the breast fellowship and working in nucs.

Can you help me think through if this would be advisable?

Thanks,

Nucs Versus Breast

 

Answer

Dear Nucs Versus Breast,

 

If you are graduating from an excellent ABNM-ABR dual certification program, you have completed a “fellowship.” So, if you can find a job in nuclear medicine or nuclear radiology that you like, I don’t think it would be unreasonable to forgo the breast fellowship. Especially nowadays, the market for all sub-specialist radiologists is excellent (nucs included).

 

However, some breast fellowships rely on their fellows a lot. So, bailing out just before the start of the fellowship year may not be the best way to make strong connections in radiology. Of course, this is especially the case if you have already committed and signed on the dotted line. So, make sure to discuss the issue with the breast fellowship director if that is what you want to do. See if they can find another fellow easily and if it will be a hardship on the program if you decide to leave before starting. But before you do anything, make sure you have a job (with a contract in hand) before you talk to anyone about canceling the breast fellowship!

 

Also, just because you are not doing a breast fellowship doesn’t mean that you can’t practice breast imaging when you leave. I have been reading screening mammos and diagnostic mammos for some time now without a fellowship. And, you will likely have the opportunity to do interventional mammo as well if you want to go in that direction, with or without a fellowship. Completing a fellowship only implies having some additional expertise. It does not mean that other radiologists cannot be excellent breast imagers!

 

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Do CAQ Fellowships Add Any Additional Benefits?

caq

Have you ever wondered why some subspecialties have a separate certificate of added qualification (CAQ) while others don’t? Are there any advantages to getting these added certificates? Or is it just another degree? If you hate taking additional tests, why would you even bother with another examination to get one? I know that these are some of the questions that I have thought about a bit. And this is a great forum to answer them!

The Main Subspecialty Certificates Of Added Qualification

What are the officially recognized CAQ specialties by the American Board of Radiology (ABR) certificate of added qualification? As listed in the link above, the three most common that radiologists typically complete (from most popular to least popular) are neuroradiology, pediatric radiology, and nuclear medicine. The ABR also lists Vascular and Interventional radiology as a CAQ specialty. But, in reality, it is now a distinct full-blown specialty with a separate board and residency program. And then finally, it also lists hospice and palliative medicine as well as pain medicine as two more options. I don’t know of any radiology residents who have completed these subspecialties CAQ after a radiology residency. But, I am sure there are a few out there somewhere.

How Did Some Subspecialties Become CAQ Subspecialties And Others Did Not?

For the CAQ subspecialties, an academic cohort of individuals decided to make specific qualifications for their subspecialties. Sometimes, it was to limit encroachment from other specialties upon their turf. Or, it was to protect the subspecialty’s interest and maintain minimum standards.

Other subspecialties that do not have a CAQ, never had enough members to put in the effort to create a CAQ. It takes a bit of work and money to create an entirely new CAQ exam and all the bureaucracy that accompanies it!

What Are The Privileges/Disadvantages That CAQs Provide?

Financial/Job Advantages?

Sometimes, practices and hospitals ask to have certain subspecialists on their staff. And, in particular, they often want CAQ subspecialists. Why? Well, because frequently, other physicians or hospital administrators demand them. This demand may give you a slight advantage when you eventually go out into the job market. You may find that these subspecialties can add a few dollars to your starting salary when you begin to look. For instance, interventional radiologists and mammographers have commanded a higher salary in the recent past out of the starting gate.

Moreover, some hospitals require credentialing in specific subspecialties for their staff members. You can often see these in job board descriptions if you look at any online radiology job site. If you don’t have these credentials, you will be unlikely to get that job!

Legal Advantages (Or Disadvantage)

As a CAQ holder, you have the privilege (or disadvantage!) of the legal world considering you an expert in these fields. What does that mean? First of all, the courts hold your reads to a higher standard than other Joe Shmo general radiologists out there. In a positive sense, your subspecialty read will carry more weight in the court of law. On the downside, it also means that there will be a lower threshold for misdiagnosis than a typical diagnostician.

Additionally, the CAQ will allow you to have some “street cred” if you decide at some point to go ahead and perform expert legal work. Lawyers love having subspecialists on their payroll to convince jurors one way or another in malpractice lawsuits.

Pigeon Holing

If you are neuroradiologist and hold a CAQ, you are more likely to work at the facility, and complete neuro reads. Of course, this work can be great if it is the lot that you have chosen in life and you are happy doing it. However, it may pigeon hole you into becoming a neuroradiologist even if you are not so fond of the subspecialty work. So, beware of the subspecialties that you choose!

Surveys

If you like making some extra dough on the side, becoming a CAQ subspecialist opens up a few doors to get these subspecialty surveys. Typically, these surveys pay a little bit better than more general ones because of the laws of supply and demand. You are now less one of a fewer number, so you are needed more!

Bragging Rights

And, then, of course, you have the added benefit of bragging rights. If you happen to work at an academic facility, these bragging rights become more important to maintain your status in the field. And these institutions base promotions on their credentials. And, yes, the CAQ counts as another hoop in this game!

Testing

Finally, you will need to pass a qualifying exam in whatever CAQ subspecialty that you choose. For those of you who have had enough testing over the years, this added test may be more than you can bear.

Do Non-CAQ Specialties Have Any Meaning?

With all these inherent characteristics of CAQ specialties, do fellowship specialties without any CAQ have any meaning? Of course, they do! The point of any added subspecialty training, regardless of subtype, is to get additional training in areas of interest. And if you are telling me that a fellowship in Cardiac MRI holds no value because there is no ABR CAQ, you are suffering from CAQ delusions of grandeur. Fellowship training with CAQ or not is only as useful as what you learn during your fellowship. And, there are lots of imaging procedures to learn with or without an official CAQ!

My Whirlwind Tour Of The CAQ World

So, there you have it. Now you know what you need to know about the basics of the CAQ subspecialties. Being CAQed certainly has its privileges and its downsides as well. Make sure to enter this data into your choices when/if you decide upon a fellowship!

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The Best Radiology Subspecialties To Retire Early!

retire early

For some residents and radiologists, radiology is a calling. And, for those folks, retirement is the last thought on your mind. But, for others, it is just a job. And I get both points of view. But, regardless of which camp you are in, many of us have other hobbies and second careers that we would like to accomplish before it is too late. And, radiology has been an excellent medical specialty so that you can retire early.

So, let’s try to figure out from two different perspectives, early partial retirement or full retirement, which subspecialties within radiology are the best. Why? Although it is possible to partially or fully retire from any radiology subspecialty, certain ones lend themselves to early partial or full retirement more than others. And, many of you are trying to figure out which specialty to choose for your future career. So, after hours of deliberation, let me give you my clear winners in both departments. If you are on the fence, maybe, I can sway you in one direction or the other!

Best Radiology Subspecialty For Early Partial Retirement

So, you are considering coming into work two to three days a week later on in your career. And, you still like practicing radiology. It might not be so bad to have four or five day weekends every week, right? Here is the specialty I chose that is most conducive to this path and why.

General Radiology/Body Imaging

I believe there is one clear winner for this category. If you had to pick one subspecialty that would most likely keep you in the game, even at an older age, it would have to be general radiology/body imaging. And, this choice may be in contrast to what others may tell you. But, radiologists that are general imagers tend to have the most extensive array of experiences and training. So, this training allows them to continue practicing radiology at a high level, even at a ripe old age. And, you are less likely to become an anachronism when you have many skills. If one imaging modality goes out of style(i.e., pnemocephalography!), you have many others to bank on.

Best Radiology Subspecialty for Early Full Retirement

In this pathway, the goal is to make as much money as quickly as possible. Then, you can pack it away so that you can do whatever else you want at a spry young age! Here is the subspecialty I believe is most favorable to this track.

Neurointerventional Radiology

Sure, this field can be a pressure cooker. And, it is not for the faint of heart. Clinicians will wake you up late at night to perform critical procedures on their patients. However, you are more likely to command top dollar for your services when you are actively practicing. And, while in practice, you will become difficult to replace. Of course, this will allow you to take that money and funnel it into retirement as soon as possible!

To Retire Early Isn’t Everything!

Now, most of you are going into radiology, not to retire early, but to have an exciting and fruitful career. However, it is nice to know that if you tire from the day-to-day work, and want something else out of life, you can. So, go into a particular subspecialty not to retire, but for what interests you the most. And, if you are not sure which subspecialty to pick, maybe these ideas will persuade you!

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Considering An MBA: When Is The Right Time?

MBA

Recently, one of my residents asked an excellent question about both whether to pursue an MBA and the timing of getting one. And, I have a sneaking suspicion that many other radiology residents and radiologists have been taking an interest in starting MBAs with all that has been happening in healthcare lately. So, let’s talk about how and why an MBA can be useful. And, then we’ll talk a bit about the timing and the advantages/disadvantages of each.

Why Get An MBA?

First of all, how can an MBA help a radiologist’s career? Well, if you think about it, radiologists have so many years of training (counting college, we are talking typically 14 years of post-high school education)! But, in the entire 14 years of schooling, many radiologists have not had a lick of financial or management training whatsoever. Hell, I know of a few radiologists that can barely balance their budget! Additionally, many of these folks aspire to practice outside the typical clinical confines of radiology. Some may want to take up hospital or practice administration.

Then, when you look you check out the literature on those hospitals that are most successful, you will find that physicians typically run these health care enterprises. So, an MBA may be of great benefit to those of you who want to take this pathway. Take a look at these links supporting these claims here:

https://www.kevinmd.com/blog/2018/08/5-reasons-you-should-put-physicians-in-charge-of-hospitals.html 
https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors

So, if you want to run a tight ship and get into hospital administration, you, as a radiologist or radiologist-in-training, are well-positioned to be successful with the right financial/management education. And, for those of you in this boat, an MBA can make a lot of sense. Just make sure that you are doing it for the right reasons. At some point, the current pandemic will end, and we will return to a state of more normalcy. Don’t make your decision to choose an MBA only on the current poor radiologist job market!

MBA Before, During, Or After Fellowship?

So, all of this talk begs the question, when should you get an MBA? This part of the equation is a bit harder to answer, but I will give you my thoughts about the advantages/disadvantages of each.

Before Fellowship?

I like to consider this pathway, the path of least resistance. By far, logistically speaking, it is the easiest route to take. You are already training in medical school, and many programs offer MD/MBA pathways during their stay. What’s another year of education when you are already paying for your training, right?

However, I have witnessed many residents having pursued this extra degree before entering our program. And, a good chunk of these folks has no interest in utilizing their education toward the goal of healthcare management and practice finance. Although some may take a few nuggets from their MBA training with them into practice, the return on investment can be small.  Why? Because they never created an action plan on how to use this degree.  An MBA is only worth the time and money if you know what to do with it. And, herein lies the most significant disadvantage of completing an MBA early on in your training.

Instead Of A Fellowship

Out of all the ways you can complete an MBA, this pathway is the rarest. And I don’t know any radiologists in my program who have completed an MBA instead of a fellowship. For most of you, it is a difficult time to complete an MBA. First of all, your accumulated debt upon graduating residency often feels like a gazillion dollars. Then, of course, most of you are ready to embark on your career as a radiologist after all the training that you have completed.

In terms of timing, if you did not have to worry about money or the time it takes to complete while having to pay loans, it may make some sense. By this point, you have a better idea of your career goals. And, you can better focus on the goals that you want to achieve when you complete your MBA. However, many of you, by this time, still have not had the working experience to utilize your MBA teachings fully.

After Fellowship

Finally, in terms of convenience, completing an MBA while working is probably the most disruptive. Now, many of you have families and lifestyles that are less conducive to completing another degree. But there are courses and university programs that are willing to work within the confines of your life. These programs are often called executive MBAs and allow you to finish the degree while working. I know of several radiologists that have taken this pathway. Of course, you can also opt for a more traditional 2-year degree.

For those of you that complete an MBA after your fellowship, you most likely have a laser-focused reason for completing an MBA. Maybe, you know that the leadership of your practice may need a new change and wants someone with business experience. Or, perhaps you want to begin working for hospital administration at an available position. At this point, an MBA is usually the most meaningful since you most likely have a targeted application for the degree.

Considering A Business Degree? Taking It All Into Consideration

Well, for those of you mulling the MBA route, all this information is a lot to think about. But think of the MBA as a tool. If you utilize your degree for the right reasons, it can pay off “big-time.” It will allow you to pursue your selected area and have the knowledge to do so. On the other hand, a poorly thought out mission to complete this degree can lead to becoming cash poor with little to show for it. So, be careful choosing this pathway and when you decide to pursue this degree. And, don’t let the Covid pandemic be your only guide!

 

 

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Radiology Fellowship Interviews: What’s The Difference?

radiology fellowship interviews

Question About Radiology Fellowship Interviews:

Hi Dr. Julius,

Thanks so much for the great piece about writing a fellowship personal statement. I recently went through the process myself and can appreciate the truth behind the points you stated.

As a follow-up, do you have any tips when preparing for the fellowship interview, after being shortlisted?

Thanks once again for all the high-quality posts. 🙂

Yours sincerely,
A Concerned Fellowship Applicant

Answer:

 

Thanks for the excellent question. It turns out that I have never delved into the differences between residency and fellowship interviews. And, there are a few significant differences between the two that I should mention. So, I thought that in addition to answering your question, it would make an excellent post.

To begin with, I highly recommend that you take a look at my original posts on residency interviews called How Important Is The Interview, Really? and Ten Ways To Sabotage Your Radiology Residency Interview. These rules still apply. And, once you have gone through some of this essential advice, take a look at some of the other specifics below about what you should look out for on your fellowship interview trail.

Radiology Fellowship Interviews: What’s The Diffference?

First of all, you will notice that different from a residency interview, most fellowship interviews tend to be more intimate. Most of the time you will be the only candidate at the site at this time. So, you will get to know the few interviewers much better than on a typical residency interview day because you will no longer be just another one of ten candidates. In that sense, it will often be a bit less nerve-racking. However, the general rules for interviewing still apply!

Next, the interviewer will expect you to have a background and a specific interest in the fellowship field of choice. So, you cannot have makeshift answers to why you are choosing to train in the field of radiology in general. Instead, you need to get down to brass tacks and come up with specific reasons for choosing this area of specialty.

Moreover, you will need to know more about the individual program to which you are applying. It is not enough to say that this will be a well-rounded program for your radiology training. No. You need to say why this particular fellowship would be an excellent fit for you. So, you should verse yourself in the specific equipment and unique training that this program has.

Also, make sure that you can talk about specific areas of research that may interest you. Fellowships, more so than residencies, tend to expect that you will perform research. So, talk intelligently about some projects that might interest you in this specific facility.

Other than that, it comes down to the same rules for interviewing in general. Be enthusiastic, conversational, well-dressed and groomed, etc.

So there you have it: some additional rules of the road for the residency interview. Let me know how it all goes.

Regards,

Barry Julius, MD

 

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The Fellowship Personal Statement- What’s The Deal?

fellowship personal statement

After the popularity of my initial article called How To Write A Killer Radiology Personal Statement, I’ve had multiple requests to write a post on How To Create A Fellowship Personal Statement. Now, I have to admit that there are lots of similarities between the two. And, many of the same writing techniques still hold. So, I would recommend that you click on the link above to remind you of some of the basics. However, you will find a few unique differences that I will share. Let’s have at it!

The Fellowship Personal Statement- Does It Matter?

Well, to start with, even though personal statements tend to be one of the least critical parts of the application, they are a bit more important in fellowship. Why? First and foremost, fellowship directors have fewer data points than residency directors. For instance, applicants may have a Deans letter and USMLE scores, but they are out of date. And, extracurriculars do not play as significant a role in the fellowship application since residents do not have as much time. Moreover, core examination results do not change the equation at all because they come back too late.

So, what’s left? The application, recommendations, interviews, and then, finally, the personal statement. So, by the sheer decreased numbers of relevant items to peruse, you will notice that the personal statement must play a more substantial role in the decision for fellowship.

To balance that out, however, most radiology fellowships, currently, are less competitive than the same application to residencies. Of course, that statement probably does not include some select programs such as the independent interventional radiology fellowships. But for most applications, if you take the higher weighting and the less competitive nature of fellowships, both factors probably cancel themselves out.

Finally, it’s not just my words. Instead, it comes directly from the mouth of several fellowship directors that I know. Most do not put too much stake in the personal statement. (Similar to residency directors!)

So, what’s the take-home point of all this? Well, even though marginally more influential, the personal statement still has little sway on most fellowship applications.

OK. How Should The Fellowship Personal Statement Differ From Residency?

Now that we got that brief introduction out of the way, here is the million-dollar answer to the question. And, it is rather simplistic. In addition to all the general recommendations for a residency personal statement, you need to add why you are specifically interested in this particular fellowship. And, you should also incorporate the reasons and motivations for you to select a fellowship in this area.

Unlike the residency personal statement, you want to rely less on extracurriculars and more upon your experiences in residency, not medical school. And, unless they pertain directly to the fellowship, your statement should not emphasize the motivations that initially led you to go to medical school or residency. Of course, however, if you continued to pursue an impressive extracurricular or motivation that began before residency and is relevant to your fellowship, you can add it.

What should you add to show your interest in your fellowship? It could be a radiofrequency ablation device if you want that fellowship. Maybe, you secretly desire to interview patients and miss close patient contact as a mammographer. Or, it could be your love for untangling wires and hoses as former electrician or plumber (notice the touch of lousy humor- that can be a useful tool!) Whatever you choose, you need to make it specifically known why you have decided upon this career path. And, show not tell why you have made that decision.

Where Does This Information Belong?

If you click on the following template link (Fellowship Personal Statement Template), notice that in the first section, you have the “hook” to reel that program director into your application. (That still counts!) Well, you need to apply the reasons you are interested in radiology to this first paragraph. Makes sense, right? Get to the point!

The Fellowship Personal Statement- Not So Hard Right?

To make a great fellowship personal statement, all it takes is a few steps. First, take a look at my Fellowship Personal Statement Template and the link to How To Write A Killer Radiology Residency Personal Statement. It’s an excellent summary if I say so myself!  Then, make sure to add your specific motivations for fellowship in your first paragraph. And, finally, explain any other extracurriculars or specifics during your residency that may be relevant to your fellowship. There you have it. Now, you have the system that you will need to make that exceleent fellowship personal statement!

 

 

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Fellowship Quality Training Trumps Name (Most Of The Time)

fellowship quality

Question About Fellowship Quality:

 

Hi Dr. Julius,
I have a follow-up question on fellowship.

My situation is a little tricky. My wife just started a three-year fellowship, as I’m beginning my R4. Having a kid, I would hate to leave my family, and there’s no big-name program where I can do my fellowship within a driving distance. So, I signed up for a body fellowship in an excellent facility. However, it does not have a shiny name. Do you think it makes a big difference in the long run if I did my fellowship now, in this place, vs. after completion of my wife’s fellowship at an Ivy League Program?

Regards,
Confused About Fellowships

 

Answer:

Thanks for the excellent question!
In general, fellowship quality trumps name. Why? It is more important that you feel comfortable in the subspecialty you have chosen and have learned what you need to know to become a well-rounded subspecialist radiologist. However, in a depressed job market or regions with stiff competition for jobs, sometimes name recognition does help. Also, academic places tend to weigh name recognition a bit higher. So, the more critical question is: Where do you ultimately plan to practice? If you plan on staying in a more rural area, it probably does not matter one lick. More so, in today’s market, even on the coasts, name recognition does not carry as much weight as it did five years ago. However, if you plan to practice in academia or Manhattan/San Francisco, it probably does.
Another item to remember, it is always possible to complete a second fellowship later on down the road if you wanted additional experience. (unlike residency)  So, I don’t think it is a bad idea to complete this fellowship now and come back later to do another one if you decided on a career with more stiff competition.
Hope this aids in your quest,
Barry Julius, MD
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What Radiology And IR/DR Programs Don’t Tell Applicants About Interventional Radiology!

IR/DR Programs

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.

Heavy Lead

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!