Tag: IR

Posted on by

DR Versus DR-IR Application Questions

DR-IR application

Question About A DR Versus DR-IR Application Dilemma

Hi! Love reading your blog, you’ve been a great source of information,

I’m a current M3 interested in both DR and IR. I genuinely like both fields, but it seems like there is a growing sentiment in both areas to define themselves as separate. I’m currently working on research in IR with my IR faculty, but I don’t want to lock myself out of DR programs, which is what I’m noticing has happened this cycle for some of my M4 colleagues. Applications IR weighted are not receiving much love from DR programs even if they do quite well for IR programs.

What thoughts do you have about the growing divide between fields, and what advice can you give for a medical student interested in both? Should I also do some DR research? I like the way IR is currently practiced, where IR folks will do a mix of IR and DR, but it seems like most IR leadership and PDs are interested in furthering the distinction.

Thank you!

DR And DR-IR Application Weary

 

DR Versus DR-IR Answers:

How To Apply

Having gone to the recent APDR/AUR meeting, I can tell you that you are right about some of your reported sentiments in some programs. Some programs/program directors take it in stride that many folks will be applying to both IR/DR and DR programs. But, other DR program directors did not have such favorable opinions about those applicants that are applying to both. I believe that if you are not sure about which program to choose at this point (as is normal!), the best bet would be to apply to a DR program that has IR/DR and ESIR slots. Applying to DR programs that also have both will allow you to hedge your bets a bit and give you the most flexibility. In these programs, they can usually flip a DR spot to DR/IR or ESIR or vice versa. Also, it doesn’t lock you into the IR pathway if you are not sure you want it. DR/IR is a big commitment and works if you are sure about it. If not, you can regret your decision because you will have less diagnostic radiology, and it will be a tough slog.
Also, DR research can never hurt an application and can only serve to enhance your chances of getting into a program. It demonstrates an interest in the field. And, it gives you a bit of radiology research experience. Who doesn’t want that?

The Growing Divide Between DR and IR

More and more practices are indeed allowing or requiring the interventionalists to do only interventional. However, some imaging companies still have the model of doing DR and IR work (that’s the way our practice works). It is hard to tell how difficult it will be to find a job in a practice with DR and IR in the future. But, I would imagine there should still be a role for these folks in more rural and smaller less subspecialized practices. But if corporatization of radiology takes root everywhere, that model could become rare. It remains to be seen.
My 2 cents,
Barry Julius, MD
Posted on by

Informatics Vs IR: Should I Enter Digital Heaven Or Perform Manual Labor?

informatics

Question About Informatics Versus IR:

 

Dear Dr. Julius

Thank you for this amazing blog; there are many useful topics that we don’t cover during our training. As I am finishing my second year of radiology, now is the time to choose the fellowship. I will be happy to hear your opinion as I am debating between two pathways.
I am making some bullet points for each as pro and cons.

1. IR
• ( + )Higher salary, further as it becomes more competitive, I can imagine that it will become more exclusive and the pay will keep rising.
• ( + )Now, with the introduction of the direct IR residency path, it might be the last time to join, and I should seize this opportunity.
• ( + )With all the hypes of artificial intelligence taking over diagnostic in a decade, this seems to be the long term responsible choice.
• ( – )I like from time to time interventions, but I hardly see myself enjoying it for life, especially considering overnight calls when I have a family.

2- Informatics and diagnostics-

• ( + )I am personally fascinated with all the current potential of informatics. Maybe naively thinking that we are still very early in the artificial phase of our profession, I could enjoy diagnostic, perhaps enjoy the creativity phase of this upcoming technology, and maybe also become a leader in this field.
• ( – ) Diagnostic salary will probably decrease in contrast to IR, and there is a chance in a decade that I might be obsolete
• ( – ) 2 years fellowship without any short term financial benefits
The rational choice will probably be to go to IR, but I feel that I should take a chance with informatics,
I will be happy to hear your opinion.

Answer:

Once again, some great questions. I love my audience!!!!
 
Anyway, to answer your specific questions, I am going first to give you my general gestalt about the two fields. Then, I will go through your sentiments for each bullet point (some of which are correct but others are a little off the mark)

 

My Opinions About IR:

 

 

So, when it comes to IR, it is the type of field where you need to invest your life toward that end fully. What do I mean by that? It has more “surgical subspecialty like” qualities than the rest of radiology. If you decide you don’t like to do PICCs and Ports or you determine later on that you are not interested in seeing patients, it can become challenging to extricate yourself from the specialty. And, as you mentioned, it can be hard on the family, not necessarily because of less vacation time (usually interventionalists get more), but instead, you can expect to leave earlier and come home later on a typical workday. Additionally, you may be taking overnight call a bit more often than other areas of radiology. 
 
Furthermore, especially in the beginning, if you decide you want to learn more about informatics independently while doing IR, it will be more challenging to make the time to do so. You need to establish yourself in the Interventional first to become the “go-to” person in the field. That said, anything is possible if you put in the time. It’s just a matter of how much time you want to spend with a family versus work. On the other hand, if you were to decide on another field in radiology, it would be a bit easier to learn more about informatics on top of your regular diagnostic radiology career.

 

My Opinions About Informatics:

 

In terms of informatics, I would recommend you first have some idea about what you might want to pursue within the field before you begin down that rabbit hole. The career options vary more widely than any other subspecialty in radiology. Do you wish eventually to become a CIO of a practice or hospital? Or, maybe you want to become an entrepreneur or work for a private company? Perhaps, you want to be the key “tech” guy within the practice that can fix the PACs systems? I would say before thinking about the specialty as a whole; I would first target a specific area so that you can hone in precisely what you would want from the informatics training before you start. It would be best if you had an idea about what you want before you begin or else the training you receive in informatics may not be as helpful for your career. 
 
As much as I love the specialty of informatics as a career choice, this specialty seems to me to be more like an MBA. It gives you the tools to help you in your career. But, if you don’t know what you are doing, it’s just another title!

 

Addressing The Bullet Points:

 

 
Now for the answers to the bullet points:

 

IR

 

1. IR usually has a higher salary because they work more time, not because they make more per unit worked. The reimbursement for IR procedures is overall worse than many other subspecialties in radiology. Salary is a function of supply and demand. As more people enter the field, you increase the supply and decrease prices.
2. I agree that doing the direct pathway now would save you an extra year of training if you decided to go that route. However, it is more important that you like what you do. So, that would not be my first consideration.
3.  I don’t see AI taking over any subspecialty within radiology during your or my career lifetime. AI is just as likely to take over interventional as any other subspecialty in the field. (you can refer to some of the prior blogs on the topic- especially the one from the RSNA last year)
4. The most valid consideration that you mentioned is the time issue/overnight calls. I agree with that sentiment entirely
 

 

Informatics/diagnostics

 

1. Interest in the field is the most important factor for deciding on a career path. If you enjoy what you do within a radiology subspecialty, you will be successful regardless of the field. Fascination and curiosity are great reasons to enter a field. (especially when you can get paid well for it!)
2. I don’t believe that you will become obsolete in any area within radiology as long as you keep up with the changes. Moreover, it is hard to predict where the salaries will be decreasing the most within radiology. Don’t be so sure that a salary for an interventionalist will be higher in the future than someone who is involved in informatics. It all depends on what you do.
3. From what I have read, you can do a one or two-year fellowship in informatics or any variation in between. Moreover, you can certainly moonlight during the time that you are completing the fellowship to increase your salary for the year or two that you are there.
 
So, there you go. My final summary:  I believe that for interventional radiology, you have to be “all-in.” It needs to be a calling more than any other area in radiology or else you will regret choosing the field. And yes, informatics is only as good as how you choose to use it. Have an idea of precisely what you want before you pick that route.
 
Hope this long-winded summary helps!
Barry Julius, MD
 
Posted on by

Breast Versus IR- The Ultimate Choice

breast versus ir

Question About Breast Versus IR:

 

Hi Dr. Julius,

I am a PGY4 resident and currently ranking my fellowship programs. Right now, I am still debating between an IR and Breast imaging fellowship. I am an active person who likes to deal with patients (within limits) and do procedures. Also, I am a family guy who likes to spend time with family and travel together besides social activities. I love IR, and I see myself in IR, but everyone is warning me of the stressful lifestyle and crazy calls. I know it depends on the practice that I will join. But, sometimes I think about it differently. I mean why I would spend two years in IR fellowship (Non-ESIR) to perform mostly central lines and biopsies. Plus, people tell me that IR will become routine, and I will lose the exciting part and left with the scraps.

On the opposite side, breast imaging is a good lifestyle. I will see patients (I enjoy seeing patients) and perform procedures. Also, I am willing to do 50% breast and 50% general radiology after fellowship if I complete a breast fellowship. I don’t want to regret not going to IR. Should I risk it better than regretting it? I have to submit my ROL by the end of this month; I appreciate your help.

Thanks

Breast Versus IR

 

Answer:

What you do in IR depends upon where you decide to practice. If you choose the option of working in a highly academic large center that is on the cutting edge, you can be performing many other procedures other than central lines and biopsies. But, of course, you might sacrifice salary if you have a lot of debt. (not all the time but most).
And for the most part, if you are doing IR, you will have more weekends and nights. It is true that you will not be able to leave the department as smoothly during the daytime to take care of issues at home. Albeit, you may get more vacation overall to compensate for the extra time on call. When you are working in IR, you will generally work on your feet a lot for long hours.
On the other hand, breast radiology does allow you to work fewer weekends and nights as well as being able to occasionally escape to do other things during the day if you are reading screeners. And, you can perform procedures (even cutting edge procedures depending on the institution) But, in general, as breast radiologist, the procedures that you complete will be less involved. In both career paths, however, you will get to work directly with patients (and be a real doctor!)
So that is my little summary for you. There is a sort of lifestyle/procedure decision that you will need to make. What I’ve discovered over the years: no field is going to meet every one of your criteria. Those folks that are the happiest can decide which track to choose based on their life priorities.
Hope that helps,
Barry Julius, MD
Posted on by

Transferring From Another Specialty to Radiology: Will I Be Competitive?

radiology

Question:

Dear Barry,

I will be finishing my categorical surgery intern year. I have decided to reapply this year for radiology, with a strong interest in IR. I am aware of the competitiveness of IR and DR in general. I am leaving in good standing. Also, I have good scores and achieved AOA. My radiology mentors in my hospital have encouraged me and feel I am competitive. I don’t have any published research, but I am working on projects. In terms of gauging my competitiveness and having realistic goals, how may I improve my application before September 2017?

———————-

Answer:

Get To Know The Radiology Program Director

In the past several years, several surgical interns have transferred to our department. Both residents came to speak to me about their interests while they were surgical residents (one was a SOAP match candidate, and the other stopped during the year to ask about interviews). I think speaking to the program directors increased their chances of getting into our program. It shows initiative! So, if I were in your shoes, one of the first things I would do would be to get to know the program director for radiology if there is a radiology training program in your hospital.

Also, sometimes spots can open up before the year begins, and showing interest in the radiology program can’t hurt. Therefore, it would make sense to talk to the program director about applications for this year. The biggest problem is that you probably will have to wait another year to secure a spot in a radiology residency program since applications are not for 2018-2019 but for 2019-2020. But you never know; a position can open up for the 2018-2019 R1 year.

Finally, it would allow you to get a feel for the quality of your application at your institution. The program directors will usually have insight into your chances of admission.

Get on The Radiology Bandwagon Now

If you have the fortitude to go through another surgical year and wait for a 2019-2020 spot after interviewing this year in the regular match, that would be the most likely way to secure a radiology spot. As you said, if you are a categorical surgical resident, you will likely be a competitive applicant for a radiology residency (even though the specialties of radiology and DR/IR have been getting slightly more competitive over the past year or two). Nevertheless, I would certainly get on the application bandwagon now because if you wait another year, you are less likely to be able to get government funding for a radiology resident spot. You snooze, you lose!!!

Is No Radiology Research An Issue?

Regarding research, it certainly can’t hurt to have completed a project or two. If you are interested in academic radiology, that will add to your application. In a clinical program, it probably doesn’t matter as much. In either case, most residency programs do not require research before entering. But, it does confirm interest in our specialty. Regardless of whether you have completed a research project, I think most program directors (especially IR/DR PDs) like to take surgical residents who have performed well at their institution and demonstrate an interest in radiology. Surgical residents who serve well can handle stress!!!

Make Sure to Apply To The Correct Programs

Also, since you are interested in IR, I would send out applications to residencies that are DR programs with an ESIR program and the new DR/IR program. Applying to both programs maximizes the probability of getting into a residency that allows you to complete IR without having to do a 2-year independent fellowship.

Let me know if you have any other questions.

Barry

 

 

 

Posted on by

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!!!