Tag: interventional

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Are All Radiologists Destined To Have Chronic Back Pain?

back pain

After walking my dog a while back and pulling a back muscle (thankfully, I recovered), I started to think about the risk of lower back pain and radiology. Am I more prone than others to having back issues? What are the chances that I can permanently have back pain from my day-to-day work? And, are the risks related to what kind of radiology you practice?

According to the literature, if you are a radiologist who sits and reads lots of films from a PACS workstation or an interventionist who always wears lead shielding and does procedures, your back may not thank you. Based on reality in the field, the human body was not meant to sit for many hours or stand in one place with heavy weights. So, let’s drift into the nitty-gritty data on radiologists and back pain. Then, we can discuss some standard solutions to remediate our woes.

The Hard Data About Radiologists And Back Pain

Here is some of the information to support these radiology-specific related back issues. In one study in the JVIR, the mean prevalence of the general population was around 31 percent for everyone. Then, when you look at the radiology community more specifically, you even get more stark statistics. Within the interventional radiologist population alone, 20.1 to 24 percent have back and neck pain limiting work. Additionally, the same study reported a prevalence of lower back pain in the general radiology population of 52 percent and back and neck pain in interventional radiologists at 60.7 percent. If you believe this study, the prevalence of back pain in radiology is nearly double the general population. This number is not small. It is the majority of us!

Another JVIR article states that the prevalence of back pain gets worse with age, especially among those who complete interventional procedures. (We all have something to look forward to!) That makes sense because of the extra weight that interventionists need to bear. The only saving grace is that radiologists have less back pain than nurses and techs. But that does not change the fact that we have a very high prevalence of back pain as radiologists.

The Only Solution: Prevention!

The last thing that radiologists want to do is get into a situation where you need back surgery. We all know that is the last resort. Heck, many of us read many spine X-rays and MRI horror shows. Some of the solutions espoused in the JVIR papers are reasonably simple. Taking a break is the best plan of action. If you notice that your back is beginning to hurt, you must take a break. Repetitive motions can exacerbate back pain. Exercises involving strengthening the back muscles may prevent significant injuries.

Others are more immediate and easy to do, including lifting slowly, sleeping on your side, and avoiding rapid bending movements. Stretching can also potentially prevent some forms of back injury (I’m a big proponent of this one!)

Finally, ergonomics helps with the situation. That means appropriately positioning equipment and monitors, back supporting seats, clearing the floors of obstructions, and custom-fitted garments for the interventionists among us.

Let’s Face It: Chronic Back Pain Is The Radiologist Bugaboo!

For surgeons, needle stick injuries are a big concern. For psychiatrists, their most significant issue is mental wear and tear. But we, as radiologists, face chronic back pain as our most prevalent job hazard. Furthermore, based on my recent back issue and this short survey of the literature, we need to take the prevention issues seriously. As the old Benjamin Franklin quote goes, an ounce of prevention is worth a pound of cure. Don’t let your imaging centers and hospitals convince you otherwise!

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What Do Interventional Physician Assistants Do?

Interventional physician assistants

Question About Interventional Physician Assistants:

Hello!
I am a physician assistant student at a large American University. Presently, I’m in the middle of my clinical year, and I’ve just completed my 4th rotation. I have spent the last four months in and out of hospitals. Recently, I have been exposed to interventional radiology. Moreover,  I was very impressed with the role that physician assistants play in this field of medicine.

Until recently, I had never even considered interventional radiology. However, I want to work in a field that is procedure driven. To that end, I am good with my hands and spent 13 years as a firefighter/paramedic which is very procedure driven. So naturally, I found myself very intrigued about interventional radiology as a possible career for a PA. Is there any way you could put me in contact with someone to answer some questions about a PA’s role within IR?  Thank you for this website. It has been incredibly helpful, and I hope to hear from you soon!

Regards,

Future Possible Interventional Assistant

Radsresident Answer For A Future Interventional Physician Assistant:

I agree that the best resource would be to talk to a PA that does interventional radiology. We do not have an interventional PA in our program to which to refer you. However, I have worked with a few interventional physician assistants during my residency and at a previous job a while back and I could shed some insight into what they do.

Both of the PAs that I had worked with functioned as an assistant in complex cases. Also, they were the primary operators in procedures such as PICC lines and ports. Moreover, they would see patients in “tube rounds.” If you haven’t heard of this term, it means they would talk to the patient and provide updates on the status of their catheters and interventions after the procedure. And, they would write the formal notes in the chart to document the condition of the patients. Also, they involved themselves in morning rounds before seeing the patients for the day. And finally, they performed the consents for procedures to reduce the workload for both attendings and residents during the day. Both PAs that I worked with served an invaluable role in the practices and became a critical part of the team.

Hope that gives you a little bit better insight into what they do,
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!

 

 

 

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ESIR vs IR integrated

ESIR

 

Question:

Hello,

I am an M3 student, most likely applying to radiology next application cycle. I am interested in IR but do not have enough exposure to be dead set on an integrated IR residency. I was wondering about your opinions of applying to diagnostic radiology, specifically at programs with ESIR, and how feasible it is to knock a year off of the independent residency that we seem to be switching to through this option. Could you break down the ESIR pathway and how to transfer from DR to IR? Would this be the best option for someone not dead set on IR, or should I apply to integrated programs and pure diagnostic and rank them as I see fit when the match comes?

Thanks!

Director’s Response:

So, I am going to start by summarizing the three current pathways for interventional radiology at present:

  1. The “old-fashioned’ way involves a 4-year residency. But instead of needing a 1-year fellowship (as it was formerly), you now will require a 2-year fellowship. They call this the independent pathway.
  2. The ESIR pathway that you referred to. In this pathway, you must complete a full year of interventional-related rotations during your residency. At that point, you can then apply for a 1-year independent interventional fellowship.
  3. The DR/IR integrated pathway is an entirely separate five-year residency program.

The DR/IR program has three years of general radiology and two years of interventional-related rotations.

Specifically, regarding your situation, most residents who initially say that interventional radiology interests them usually find another subspecialty fellowship. So, if you aren’t entirely committed to interventional, chances are, you will do something else.

ESIR

If you apply to a program with ESIR, you must tell your residency director reasonably early that you are interested in the ESIR pathway. The reasons for this: A. Multiple residents may be interested in ESIR. B. The residency may only accommodate one or two people because of scheduling requirements. C. The conditions for ESIR can disrupt the schedule of other residents in your class because of the need for additional dedicated IR time and less time on different rotations.

However, the significant advantage of an ESIR program is two-fold. First, it enables the ESIR resident to take the one-year interventional fellowship instead of the two-year fellowship. And second, it makes the ESIR resident more competitive in the fellowship match because they have some experience under his belt. Also, programs have limited their two-year independent fellowships for those not following the ESIR pathway.

More About IR/DR

If you attend a program that has an IR/DR program or an ESIR program, it is possible to transfer in and out of one program or another. However, IR/DR programs give the resident less flexibility. Remember, the IR/DR program maintains independence from radiology residency with its own program director and scheduling. Its sole goal is to create interventional radiologists. (Although it does happen to share the core exam with the radiology program, however). So, it is possible that if you decide to transfer to the DR portion of the program, you may not have enough rotations available to meet the residency requirements. Although unlikely, you theoretically may need to find a residency slot elsewhere.

If you are not entirely sure that interventional radiology interests you, I recommend finding radiology residencies with an ESIR program rather than an IR/DR program. Why? , an IR/DR program commits to you the process of becoming an interventionalist. If you go to an ESIR program, you will more likely have a little more time to decide upon entering into interventional radiology later. (but you should still make a decision as soon as possible). And the ESIR program fits within the confines of the diagnostic program. This program allows more transfer flexibility.

Remember, if all else fails, you can still complete interventional radiology by attending a standard DR program without ESIR. However, you may have a much harder time getting into the fellowship. That may make more sense than applying to an IR/DR program to find out you don’t like it.

So, those are my two cents. I hope that clarifies things a bit. I wish you good luck in the radiology match process!!!