Tag: specialties

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No Procedures Please! I’m Sick Of Interruptions In My Workflow

no procedures

Question:

I’m happiest when I’m just plowing through cases at the workstation, as I find procedures are a considerable nuisance. Unfortunately, there seem to be in every subspecialty, but which ones give me the best opportunity to find a job with few/no procedures required?
Regards,
The Anti-Procedure Student

Answer:

Specialties Without Procedures

Fortunately for you, lots of areas within radiology require minimal to no procedures. Here is my list of the career paths I would be thinking about: Non-interventional neuroradiology, MSK outpatient radiology, heavily weighted academics, teleradiology, emergency radiology (depends on the hospital and their requirements), and informatics. Also, body imaging with an outpatient bent could be non-procedural weighted as well. (assuming that there is no fluoroscopy on site).

Non-Procedure Weighted Specialties

Moreover, let me give a pitch for thoracic and cardiovascular imaging. Many of those rads do not perform manual work. However, at some academic institutions, the thoracic imagers will perform the biopsies. And, at other places, you may get interrupted to supervise Cardiac MRIs and CTAs. That all depends on the workflow.
Nuclear medicine (my specialty) does involve iodine treatments and radiotherapies for other cancers. So, you will need to sit with patients and play doctor. And, you may need to perform lymphoscintigraphies. (Our residents do most of them!)  Also, at some institutions (not mine), you will need to stand and monitor the cardiac perfusion scans. However, you will find that we do not perform that many long involved procedures. Manual work is not our thing!

Procedure Heavy Specialties

Hopefully, you have figured out that breast imaging and interventional radiology does not work well for someone not interested in procedures with all the biopsies and/or vascular work. Also, women’s imaging, in general, is not a place for you with hysterosonograms and HSGs. And, finally, pediatric radiology is also chock full of procedures as well. You have intussusception reductions, VCUG, barium enemas, hands-on ultrasounds, and more. I would avoid that specialty!

My Final Summary

Now that I think about it a little bit more, about half of radiology does not emphasize procedures. You can easily find a path that will take you in that direction when you decide to pursue your career!
Good luck following your “procedureless” path!
Barry Julius, MD
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USMLE Step III- An Impediment For Radiologists?

Over the past few years, we have been witnessing a new phenomenon that I don’t think is unique to our diagnostic radiology residency program. Incoming residents are either delaying or failing their USMLE Step III examinations. Some of this new reality may be related to the decreased competitiveness of radiology. However, what is interesting is that some of the residents that fail or delay the examination are not toward the bottom of their respective classes but rather are high performing residents with a good fund of background knowledge in radiology. That got me thinking. What is going on with the new USMLE Step III examination? And, should the examination be a prequalifying factor for obtaining medical licensure prior to becoming a radiologist?

According to the USMLE Step III website, “Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.”

If you actually take apart the content of this summary statement of the Step III boards, you will see that the goal of the examination is in no way applicable to the intellectual goals/medical knowledge necessary for being a good radiologist. Based on the responses of many of my residents that have already taken the test, the questions, and content of the test have limited applicability to the practice of radiology. Very few questions are radiology related and have clinical scenarios that would ever be useful background information for a radiology resident/radiologist. So, is it really warranted to have radiology residents pass such an exam in order to practice their specialty? What is its utility?

Furthermore, the concept of having an intern that trains for one year and practices independent medicine is outdated, to say the least. Almost no hospital or clinic would ever hire a physician without some sort of complete residency training in a specialty whether it be internal medicine, psychiatry, or radiation oncology, let alone radiology. The liability of a hiring physician without this training would be enormous. I, for one, would never let any of my family members see a physician with one year of internship training who had merely passed the Step III USMLE examination.

More relevant to us, radiologists and other subspecialists never practice independent general medical care. The clinical situations that undifferentiated physicians encounter is very different from the needs of subspecialist radiologists. So, why prepare a physician for an end goal that he or she is never going to realize?

All these issues, bring me to this final conclusion. Maybe we consider creating a new examination that is actually going to be relevant to the goals of the subspecialist and not the general practitioner. Perhaps, we should create two separate exams, one with a general pathway and the other with the subspecialty pathway in mind. At least, you would create a test with increased relevancy and with a practical end goal for the individual subspecialist that would help with their future career requirements.

It is time to rethink the requirements for resident physicians obtaining medical licensure since the present concept of practicing independent care as a physician after one year is outdated and dangerous. And, subspecialists have different needs from general practitioners. With that, the Step III examination should change accordingly.