Tag: radiology

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Why Radiology?

why radiology

Interestingly enough, at this point, we at radsresident.com have published around 500 posts on all sorts of topics. Yet, I have never addressed why radiology might be the right fit for you. Strange. Well, better late than never!

Let me also direct you to my previous post on how I decided to go into radiology (which certainly was not a straight path!). As a supplement to this article, hopefully, it will allow you to understand that you can enjoy a specialty even though you may not know what you want to accomplish in your career yet!

Now, with all that background, we are ready to go through some radiology features that present unique reasons for new students to consider entering the field.

Intellectual Stimulation

If you like intellectual challenges, radiology offers more than most specialties. To this day, I remember presenting the topic of histiocytosis X (eosinophilic granuloma) as an internal medicine resident and hearing jeers from my general medicine colleagues because the disease was “too rare” for a presentation. Well, in radiology, we are all about the rare and unusual. That is what makes our specialty tick. We love our cases of eosinophilic granuloma, Henoch-Schoelin purpura, and more. For us, seeing all these zebras is not a burden but a reward. And, with the number of films that radiologists read in the tens of thousands per year, we are much more likely to see many of these rare birds than our fellow medical colleagues and specialists. Welcome to our world!

Flexibility- Business, Hours, Location, Etc.

Radiology has some of the most flexible working environments. If you want to work from home, you can. Want to read films from California yet live in New York? No problem. We can more easily work remotely than most other specialties. If you like late-night shifts, go for it. Or, if you want to own your practice, it is still possible. The world is your oyster and the flexibility and ways we can practice dwarf most other medical specialties out there.

As Much Patient Contact As You Want (Or As Little!)

We’ve got specialties like mammography, interventional radiology, radiopharmaceutical treating nuclear medicine physicians, and more for those who love to see patients. Yet, for every track with significant patient contact, several do not. And, when Covid-19 came around, some radiologists were as happy as a clam to sit on the sidelines. Others had the opportunity to become a central part of treating Covid patients. Regardless, all these possibilities can allow you to practice how you want without being drained by constant patient care or insufficient patient contact.

Lots Of Contact With Fellow Physicians

There is no doubt about it. We speak and consult with more of a smattering of all physicians than almost all other medical specialties. I talk to physicians in every subspecialty for cases I have read (even the occasional dermatologist and psychiatrist!). Most other specialties cannot boast about the wide range of medicine that we cover as we can.

You Don’t Have To Be All In (Like A Surgeon)

Radiology is one specialty that allows you to practice medicine without living and breathing daily. Unlike a surgeon who must be on all the time because of the hours and pressure, many radiologists can practice as little or as much as possible. I know many senior radiologists who read films a few days a week. Likewise, if you want, you can also work a ton. The opportunities abound!

Relatively Decent Compensation

OK. We may not make as much as some orthopods or neurosurgeons. But, we certainly make a respectable income compared to most other specialties. (Check out the Medscape compensation survey from 2020) Of course, that can change on a dime. But, as it stands now, we are in relatively good shape. If you compare the highest and the lowest-paid specialties, it has never been near the bottom!

Can Be Academic Or Non-Academic

Some medical specialties are conducive to either academic or non-academic medical practice. In ours, we have a choice. Want to become the “supersubspecialist” who writes tons of papers? Practice as a neuro-interventionalist or an academic pain medicine MSK radiologist, and you’ll have many opportunities to publish. Or, if you want to work as a generalist and never see a student again, go for it! In almost any radiological subspecialty, there are many opportunities to practice in either setting!

First Clinician Users Of High Tech

Finally, we often adopt new complex technologies before almost all the other medical specialties. Whether it’s artificial intelligence, new MRI contrast agents, better PET-MR equipment, and more, we usually get the privilege of operating these bad boys before anyone else gets a hold of them. And for the tech-savvy among us, it can be a dream come true!

Why Radiology?

Well, I think these reasons say enough about why radiology can be an excellent choice for you. Our specialty may be an ideal match if you like flexibility, intellectual stimulation, reasonable compensation, high tech, and many options. Think about it. And don’t let the primary care-biased medical school Deans sway you from pursuing this specialty if these are the career options that you want. As far as I know, you only live once!

 

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Forgot To Look At The Priors? Disasters Can Happen!

priors

There are a few tenets in radiology that are unbreakable. One of these doctrines is to always look for priors. So, what are some real stories about what can happen to you if you forget them? To bring home this point, I will give you four examples of what can happen if you leave out the prior exam. The results speak for themselves. And these are just the tip of the iceberg!

The Phlebolith That Just Gets In The Way

New radiologists, especially, will often have a disease called happy eye syndrome. They make a diagnosis and forget about everything else. One of these critical steps they forget is remembering to look at priors. And, one such resident happened to do just that. One night, a resident saw a calcification probably in line with the ureter. And the urinary tract collecting system was slightly prominent. And, she called it an obstructing 6 mm stone.

The next day, the overnight attending looked at the case and saw the same calcification at the same location four years ago on a previous with and without contrast CT scan. And, it was not even associated with the ureter!

So, what happened to the patient? The surgeon sent the patient for surgery. But fortunately for the patient, they never got to operating suite. A well-placed phone call from the morning attending prevented an unnecessary operation. But, that was surely a close one!

The Overnight V/Q Scan- Not Just A Harmless Test!

Very commonly, the resident at nighttime use the V/Q scan as a means to sharpen their skills. But, it is not necessarily a safe test if not used the right way. One night, a resident called multiple mismatches at both lungs with a negative chest x-ray as a study highly suspicious for pulmonary embolus. And, correctly so, of course, if they didn’t have the priors!

So, the overnight physician started the patient on a course of coumadin. Guess what? The next day before the attending came into the hospital; this patient developed a change in mental status. And, the CT scan showed a focal hemorrhage. Now, whether the cause of the bleed was this coumadin dosage is debatable. But, once again, it demonstrates the power of the prior!

The Angry Oncologist (And Patient)

Typically, oncologists order studies to decide whether or not their patients should get a change in chemotherapy. In one such case, one attending read a lung cancer oncology chest, abdomen, and pelvis. There were lesions in the bone, liver, and lung. He reported the results, never bothering to check the script and the request for comparison to priors.

It turns out this patient was on an experimental protocol that demanded precise timepoint interpretations compared to the previous study. Due to the lack of description of change on the CT scan compared to the priors, the oncologist could not determine what to do next. Since the new results did not come back until after the deadlines, the study removed the patient from the treatment protocol! Bye-bye successful therapy!

The Thyroid Nodule From Hell

Thyroid nodules seem to be a common indication for a thyroid ultrasound. And, many of us consider ultrasound to be a relatively benign informative examination. But, so not so much for this next unfortunate bloke.

One radiologist interpreted an ultrasound thyroid examination as a suspicious 1.5 cm nodule at the right lower pole of the thyroid. And, he decided to recommend a biopsy. Of course, in small letters at the bottom of the technologist’s report, the technologist said the patient has two different MR numbers, and please compare these to the priors. Unfortunately, the radiologist missed this statement.

So, the endocrinologist sent the patient for a biopsy. Also, unbeknownst to the interventional radiologist, the patient never knew that the patient had priors. Well, what happened? Of course, the radiologist completed the biopsy, and the patient developed a large hematoma in the neck with associated complications. And, only afterward, the referring physician realized that the patient did have another study. Guess what, the nodule was stable all along and didn’t need a biopsy. The patient was stuck with a needless nasty hematoma!

Priors: Don’t Forget Them!

I think you get the point. But as painful as it may be to hear the same recommendation again, it is worth repeating over and over, don’t forget the priors. These are just a few of the potential disasters that lie in wait for you if you break this tenet of radiology. And, it’s a great way to disrupt the chain of excellent patient care!

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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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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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Radiology Should No Longer Be Just An Elective: Get With The Times, Medical Schools!

elective

As the 2020 interview season begins to wane, I have noticed a continued pattern among many medical schools. They still consider radiology to be just an “elective.” So, why do medical schools not take the specialty of radiology seriously enough to make it a requirement? Well, I have a few theories. Maybe, they want to limit exposure to medical students to shunt them toward the primary care track. (Yes, they do get government and private funds for doing so!) Perhaps, it’s a bit of inertia that schools don’t like to change. Or, it may take the place of education in other specialties since there is only so much time.

Regardless, they are making a big mistake for several reasons.  First, of course, radiology insinuates itself into almost every medical specialty. And then, let’s face it, all students should learn a bit of radiology to be a well-rounded clinician. But, most importantly for society, however, radiology is one of the most expensive cost centers in health care for patients.  So, let me give you a few good reasons for why medical schools should make radiology into a requirement instead of an elective and how it increases the cost of patient care.

Incorrect Orders

As a radiologist, if you haven’t noticed all the incorrect orders that flow through the system, you are probably living under a rock! Daily in breast imaging alone, I see at least a few ordering mistakes come through the department. For instance, the doctor orders a bilateral breast ultrasound when the patient only needs a unilateral breast ultrasound. Or, a clinician requests an ultrasound of the breast when a mammogram is in order. Sometimes, I can catch these mistakes before the imaging ensues. But other times, the study is completed before I even had time to decide on appropriateness. And, yes, doctors sometimes order these studies incorrectly because they have not had experienced a radiology rotation! Imagine the decreased costs of getting these orders correct?

Repeat Tests

Along with the theme of incorrect orders, clinicians wind up reduplicating their efforts because some don’t know what they are ordering. Let me go back to the example of breast imaging. Typically, we do a mammogram first in older patients when they say they feel a lump.  If you do the ultrasound first before a mammogram, you are more likely to have to do two ultrasound exams instead of one. Why? Because you are more likely to find other findings on the mammogram that you will need to image with ultrasound. If the ordering clinician knew this, he would have been much more likely to save the extra test. And, this is just one example among many!

Wrong Disease Pathways

Then, of course, ordering the incorrect test leads to working up incidental findings. You gotta love those incidental findings! Noninvasive imaging is not benign. Why? Because it can lead to invasive procedures. How about that thyroid nodule that you incidentally detect on an unindicated MRI of the cervical spine? Or, you find a benign lung nodule on a CT chest that the doctor should have ordered as a regular chest film. You now need to work it up! All these incidental findings add undue costs to the system!

Lack Of Understanding of Reports

And finally, without adequate training in radiology, you can blow the significance of findings out of proportion or shove them under the rug. For instance, I have reported on a Schmorl’s node in the lumbar spine (intravertebral disc herniation) with little clinical significance. And I have received phone calls asking what to do for the patient with this diagnosis, biopsy, or not! (Absolutely nothing, of course!) Likewise, I have seen patients with new cortically active bone lesions that a clinician may ignore due to a lack of understanding of its significance. Nevertheless, in both situations, the costs of acting or being inactive incorrectly can rapidly add up for the patient and the system!

For The Sake Of Society- Make Radiology A Requirement, Not An Elective!

Unfortunately, these examples are just the tip of the iceberg. Inadequate radiology education as only an elective allows physicians to skip out on radiology in medical school.  And, since radiologists do not control the flow of imaging exams, incorrect orders from poorly trained physicians will continually slip under the radar.  So, the solution is simple yet bold. Make sure that all medical students receive a basic education about radiology and ordering radiological tests.  We will markedly decrease the cost to the health care system and improve patient care. You got that, medical school administrators!

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Diagnostic Certainty: Can We Ever Get It Just Right?

certainty

How confusing is this? You speak to one attending who tells you that you should come down hard on a diagnosis in your impression. No differential, please. (usually a more senior attending) And, then, the next one tells you to make sure to put all the diagnostic possibilities in your dictation with impunity. (most likely the attending that has been sued several times!) Well, if you are a resident, this situation most likely applies to you. Why? Because every attending sets their threshold for certainty. And, each does it based on their experience and insight. So, where do you set your limits for diagnostic confidence as a radiology resident?

How I Developed My Level Of Certainty (A Bit Of Back And Forth)

In my residency program, the faculty and program director emphasized saying what you mean and meaning what you say. If a study appeared normal, call it normal. Or, if you had a patient with all the findings of an adrenal adenoma, call it such. End of story.

But, as I went along in my training, I began to realize that most normals are not exactly “normal.” And, even the most “certain” diagnoses are not indeed “certain.” Now, in these situations, you will be right 99.9% of the time. However, in that 0.1%, you will discover something different. In essence, by following the philosophy of my residency program, I resigned myself to automatically missing some of those rare zebras. These two discrepant themes played itself over and over, conflicting with my initial training.

So, how did I resolve this conflict? First, I recognized that I would have to be wrong a tiny but real percentage of the time to make the right recommendation for the referring physician. Moreover, I realized if I left some of those rare birds in the dictation, I would lead my referrers astray in most situations. In essence, I would increase costs to the patients and the health care system as a whole. So, calling something normal when you think it is normal did begin to make some sense again. I began to approach my dications from that angle.

But wait, what happened if that Haversian canal was that fracture that you thought unlikely since there was no adjacent soft tissue swelling? Or, what transpired when that stoolball stuck in the middle of the colon turned out to be a massive polyp? Was I setting myself up for massive lawsuits? Herein lies the rub. Over time, I realized I could not be too sure in any report.

How I Resolved (Some) Of The Certainty Conflict

I’d love to say that you can conquer this fight between certainty and uncertainty in one fell swoop. But, to say so would be naive and even worse, outright dangerous. All I could do is to mitigate the potential pitfalls. It has been a slow process to figure it all out.

So, how did I begin to tamp down this conflict to a much lower level? Well, it’s all about probability. I made sure to give a measured response in my dictations about the likelihood of my primary diagnosis versus the most reasonable zebras. That worked 99 percent of the time. It reduced the probability of zebra misses. Likewise, most physicians will use your primary diagnosis and follow the recommendations.

Why Giving Probablilities Does Not Always Work

Here’s the real issue, however. Your audience could be a physician assistant, a nurse practitioner, or a physician. Some may have more or less experience. And, this provider may practice patient care based on your unlikely diagnosis of a zebra instead of the more probable outcome. So, no matter how hard I try to steer the referrer in my preferred direction, that clinician may not use the probabilities in any report as I have intended. We must accept this fact. And, that is a tough pill to swallow.

Feeling Comfortable With Your Level Of Certainty

But, knowing that we cannot control for rogue clinicians, we can only do our best to relay our probabilistic approach without making the misses that can endanger our livelihood. It’s a sacrifice we must make to practice our specialty.  And, we should do it in a manner that will lead the majority of clinicians to the most appropriate patient care as well as mitigate the potential for lawsuits. Remember. We are not here to control the flow of patient care in every patient, but rather to guide it. I can take some comfort in that notion!

 

 

 

 

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When Should I Change My Search Pattern?

search pattern

Heraclitus, a Greek philosopher, has been quoted as saying, “change is the only constant in life.” And that concept also extends to how radiologists should commit to a search pattern. Yes, I have stated that you should affix your search patterns so that you make sure to remember to go through all parts of a study. Of course, we don’t want to forget about the images and organs that we need to report. However, every once in awhile the tide changes and we do need to modify our search strategies to incorporate new information.

Sometimes, protocols change. And other times, how you report disease can vary. Now, that does not mean that you should entirely forego your old search pattern. Instead, you can consider adding the new concept to your old one. Based on this thought process, let’s give you some examples of how and when I have accommodated a new change in my search patterns over my career lifetime. Hopefully, these modifications will provide a better idea of when you should make the change as well.

Coronal/Sagittal imaging

Believe it or not, CT scans at one time were only imaged and reconstructed in the axial plane. In fact, there was a big uproar when we decided to add these images to our studies. The techs, administration, and radiologists said there would be too many images to look at and store. But, it turned out that these reconstructions are critical for the interpretation of CT studies. Often, the appendix only shows up well on the coronal images. And, you can have a challenging time catching many sorts of vertebral body fractures on the axial view. Additionally, I’ve seen a few renal and colon masses that you could only pick up on the coronal view. Scary stuff if you decide to neglect these reconstructions.

So, like most radiologists, I had to add these recons to my search pattern to improve my sensitivity for picking up disease. And, this also goes for other sorts of studies. Remember, different planes can be helpful on MRI to catch glenoid labral tears. So, I no longer neglect the reconstructed images and have added them to my search pattern!

TI-RADS

I figured I would also add an example of a required reporting change that had changed my search patterns for a thyroid ultrasound. Previously, I would only make a brief description of a thyroid nodule’s size and cystic/solid consistency. Now, knowing more characteristics that make thyroid nodules more suspicious for thyroid cancer, I incorporate these findings into my reports. In my mind, I run through all the attributes of each nodule using TI-RADS criterion so that I don’t miss critical descriptors.  Unfortunately, in the interest of time, I can’t always put a TI-RADS rating for each nodule. But, all the nodules have the description needed for the clinician to make that assessment. New reporting systems will often change how you look at and report the images.

“New” Techniques- Diffusion-Weighted Sequences

And, finally, as an example, new techniques and sequences can also alter your search patterns. They force you to look at new images that you had not seen before. In that regard, the diffusion-weighted technique was a game-changer for acute infarct imaging. Naturally, I always look at them first before any other to make sure patients have no acute infarct. Before the advent of this sequence, our sensitivity for detection of acute ischemia was much lower. Anytime a new technique helps with improving patient care; you need to incorporate it into your search pattern.

“Change Is The Only Constant In Life”: An Application To The Search Pattern

Like this great quote implies, we, as radiologists, cannot rest on our laurels. We need to go with the flow to improve patient care. So, when you have new ways of looking at imaging studies that help with diagnosing or treating patients, make sure to add it to your search pattern. Whether it be, different reconstructions, changing reporting systems, or entirely new techniques, our patients will be better for it!

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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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Full-Time Practicing Primary Care Physician: How Do I Get A Radiology Residency Slot?

primary care

Question:

 

Hi.
I am a physician in a primary care specialty looking to go back to residency, specifically in radiology. I have been in practice for ten years and have realized that I do not want to practice primary care for the rest of my life. Have you had a resident in a similar situation? What factors do I need to consider? How does Medicare funding for residency come into play?

Thank you so much for your blog and the book. I realize this is a rather late stage to make a change, and I would appreciate your input.

 

Answer:

So, this is the deal: I would love to have physicians that have previously trained in other specialties. They make the best radiologists because they understand the clinical implications of diagnostic imaging. Some of my best radiologist mentors had completed another specialty first.

However (and this is a big caveat), it does become more challenging to obtain a slot because of the Medicare funding situation. Once you have graduated from a U.S. residency and start to practice medicine, Medicare does not fund the additional years of training.
But all is not lost. If I were you, this is what I would do. Some residencies throughout the country have their spots funded by private sources in addition to Medicare. For instance, I know in New Jersey that University Radiology Group supports several residency slots privately for the Robert Wood Johnson program. These are the slots that you would need to find. You may want to try calling the departments up individually to find out if they would take a previously trained physician. Otherwise, you will potentially waste your time and money applying to places that would not enroll you regardless of how excellent your application.
And finally (and perhaps most critically), you need to be ready to go through the mental and financial hardships of repeating another residency. Depending on your family situation, you need to make sure that all members are “on board” with the change. It’s certainly not an easy four years. But, I can tell you that going into radiology was one of the best decisions I have ever made!
Good luck with the decision process,
Barry Julius, MD