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:
- Most radiologists have had some training in this specialty before working as an attending.
- 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.
- 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!
