Ian Wong

I am a full-time community (aka private practice) radiologist. Have been practising full-time since finishing training. There's been several changes over time, but I think the bigger picture remains similar. Here's a few thoughts: 1) I love my job. If I was in med school again, and doing it all over, I'd still pick radiology. This job and specialty fits me extremely well, and I can't think of any other specialty I'd rather do. 2) Radiology is an extremely flexible specialty. Here in the Lower Mainland, many/most of the radiology groups have a mixed practice, which includes both hospital and clinic work. There are some radiologist practices which are solely hospital or solely clinic-based, and there are pros and cons to each. With a hospital-based practice, you don't have the overhead requirements of running a clinic-based practice. However, you lose the benefits of running your own practice. You are not in charge of hiring/firing. You can't expand or contract your services or hours of operation. You also have to take call (this is the big one!). Clinic-based practices typically have no call. You set your own hours. You have control over which staff you hire and promote. However, you are fully responsible for clinic overhead, which is some of the highest in medicine, including maintenance and purchasing of radiology equipment and IT services. 3) It is a shift-based speciality. There aren't many in medicine; others include EM, pathology, anesthesiology, hospitalist, walk-in medicine. I'm sure I've missed some. Shift-based practice is amazing. When you are off, you are truly off. No paperwork to complete after-hours, consults to call/follow-up on, etc. 4) Workload is increasing every year. Every single year, the imaging volume increases. This includes outpatients, inpatients, ER patients, ICU patients, oncology patients, whatever patients. The worst from the lifestyle point of view is the ER. As the primary care system buckles, and more people seek care through the ER, the ER needs a way to triage and dispo patients. This often comes in the form of imaging. As well, many specialists refuse to come to the ER to see patients unless a CT has been performed. The volume of urgent, after-hour scans has never been higher, and shows no sign of stopping. Most radiologists are fee-for-service, and are not on salary, so this extra workload means increased reimbursements, but it also leads to burnout. Our on call volumes have never been higher. Most radiologists are already working at the upper limits of their comfort level due to the high volumes of work, and there's no slack remaining. As well, every year without fail, a clinical specialty comes out with a new ER triaging tool, that inevitably requires a CT scan to be done. When I started practice, we often tried ultrasound to diagnose appendicitis in relatively young patients. Many of them are now getting CT's. All kidney stone patients get a CT KUB. No more renal ultrasounds, even in young people. CT chest to R/O PE is almost a joke at this point (if you think about a PE, you should rule it out...). CT something for every elderly senior citizen who falls down. The big one now is Neurology, where every patient with any symptoms needs an urgent CT angiogram of the head and neck to rule out everything. We are picking up more and more incidental findings, many of which require continued CT follow-up. Another trend is that as more primary care physicians turn to virtual appointments, and allied-health providers like NP's and PA's gain more practicing rights, we see a heavier reliance on imaging to diagnose and follow patients. 5) AI. No idea how this is going to shake out. We had CAD (computer-aided diagnosis) for mammography for many years. I used it during residency, from 2005-2009. It sucked then, and apparently still sucks now. I suspect the medicolegal issue will be the hardest hurdle to overcome, which is the same reason radiologists haven't yet been replaced by cheap overseas radiologists, even though teleradiology has been widely available in the US since the 2000's. If or when it rolls out, I suspect there will be many other specialties in medicine which will be affected, as well other allied health professions. Ian

Hi all, Please remember to stay professional. This is clearly a strongly emotional discussion, but it needs to stay respectful. Otherwise, the thread will be locked. Thank you, Ian

Hi all, I’ve removed some off-topic replies. Please reserve this thread for interview invites only. Please start a new thread for specific questions. Thanks! Ian

This thread has been locked. It has generated an inordinate number of complaints from multiple individuals. Ian

Hello all, Please keep things civil. We are all trying to help each other. Ian

Hello all, Please remember to be professional and courteous. The application process is an emotional one, but that doesn’t justify unpleasant or hostile posts. Thanks! Ian

The moderators have hidden a few comments in this thread as they were unrelated to the original thread intent. Please keep this thread solely for invite details, and start a new thread elsewhere for everything else. Thanks! Ian

Hello all, Please stay professional on this thread. Thanks! Ian

I’ve removed a recent post for its derogatory language. Any further progression will get this thread locked. Please stay professional. It is possible to disagree respectfully. Ian

Please keep the discussion respectful. Thanks! Ian

Thanks Rob!

Hello!!! Ian

Hello all, I would like to welcome a new moderator to the forums. Symphonie has graciously joined as a new moderator. Thank you for all your contributions to this forum, both in the past and in the future. Ian

I am monitoring this thread. If it devolves like the other one, which it is at high risk of doing so, it will also be locked. Ian

This thread has run its course, and is now locked.