Radiology!!!

[paulos]

Thanks Ian, for your insight on teleradiology.

It is good that you are so optimistic about the future of teleradiology.

 

Somewhere I heard that many US hospitals restrict their outsourcing of teleradiology cases to residents who were trained in-house, i.e., board certification doesn't count.

 

Could you comment on this please?

 

Thank you.

[BlackJack]

So Ian, when and how did you figure out that you wanted to be a radiologist?

[radmanjohn]

As a Radiologist..in the community ...thought I would update those that think that this is a dying field....

 

There are way too few Radiologists right now in North America, there are many jobs almost in every city....This is a very exciting and growing specialty....For those that were questioning income.. I believe the average income is about 450K before expenses....conferences, corporation legals, computers, etc...there are some Rads, that earn more than 1 mill but they are working extermely hard most Rads do work hard, and generally get paid well... I attend about 5 conferences a year..mostly in USA, and the situation in the states is at this time not as good as Canada... but just a little behind...

 

By being at the forefront and making the diagnosis to aid clinicians Rads will always be at or near the top of the heap and value to the medical community.

 

 

John:)

[tooty]

What kind of liability must radiologists accept when interpreting images? What if the radiologist makes a mistake that ends up harming or even killing the patient?

[Kirsteen]

What kind of liability must radiologists accept when interpreting images? What if the radiologist makes a mistake that ends up harming or even killing the patient?

Hi there,

 

Radiologists can certainly be held liable for morbidity/mortality incurred by misinterpretation of images. To wit: a radiologist was one of the doctors named in the lawsuit by John Ritter's ex-wife after he died as a consequence of a late aortic dissection diagnosis.

 

Cheers,

Kirsteen

[Ian Wong]

We would fall in the category of an intermediate liability specialty.

 

Here's the listing of annual malpractice premiums from the CMPA (Canadian Medical Protective Association. There are links for both 2007 and 2008 costs.

 

http://www.cmpa-acpm.ca/cmpapd03/pub_index.cfm?FILE=MEMBER_FEES&LANG=E

 

High liability includes most surgical specialties, but particularly neurosurgery and OB/GYN. High liability specialties pay more each year for their malpractice coverage.

 

Radiology is intermediate risk for a few reasons. The first is that we are typically involved in the workup for most complicated patients in the hospital. If you have a sore throat, chances are good you aren't getting imaged unless there's clinical signs of something more sinister, like a peri-tonsillar abscess. Most patients with sore throat get better just fine. Patients with peri-tonsillar abscesses have a significantly higher morbidity.

 

Since we deal with the complicated patients, who by definition are more likely to have a poorer outcome, there's increased risk in that fashion.

 

A second reason is that unlike most other specialties, our mistakes are easily available for review in retrospect. Images are forever.

 

A family physician who documents no suspicious breast findings on physical exam last year probably isn't going to be on the hook when that patient presents with a "new" breast cancer. On the other hand, chances are good that last year's mammogram shows subtle findings that in retrospect, might have been suspicious for very early breast cancer.

 

A third reason is that we are involved with lots of patients. While an office-based clinician might see 40-50 patients a day, the average radiologist might crank out 100-200 dictations in the same time. More patients = more overall risk.

 

On that same note, we deal with imaging (at least in the US), of two areas with high medicolegal significance, that being mammography and OB ultrasound. Both of these areas have the potential for very high malpractice payouts if there is a significant "miss" that leads to a delay in the diagnosis of breast cancer, or leads to a complicated pregnancy/delivery with a developmentally delayed child. For this reason, lots of radiologists in the US actively try to avoid reading mammograms and OB ultrasound. The reimbursement isn't worth the liability.

 

If you were able to remove these two areas of radiology, the malpractice rate would decrease significantly. Overall however, the malpractice environment in Canada is MUCH better than that in the US.

 

Ian

[tooty]

Here's an interesting little article.

 

http://www.cmaj.ca/cgi/content/full/176/1/21

 

I had no idea the demand for radiologists is so high...

[feversugar]

Thank you so much for this post, I am incredibly interested in radiology, I was already before reading but now woww!!

[olecranon]

i guess the shortages are mostly in smaller centres and in less desirable places to live....ultimately if living in a particular place is important like for me to stay in BC there aren't many jobs available especially in the lower mainland

[BlackJack]

Can anyone shed any light on how one would approach switching to radiology? Past experiences? Who to meet etc?

[Lactic Folly]

There is a re-entry program for people who have already started practicing:

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/GetFileAttach/014-4810-99E~1/$File/4810-99E.pdf

Else, I don't have any particular insights beyond what has already been suggested in other threads on residency switching.. I imagine it would involve talking to the receiving program director and program transfer committee at your school, and at some point your home program director. It might help if you are able to spend some time in the department, as on an elective, and become well known and liked there.

[feversugar]

Does anyone know by any chance the job availability in Montreal specifically? xD

[grindsmygears]

Awesome, b/c I loved the physics that we learned in first year physics - well, not electromagnetism, but nuclear physics and waves, were my favorite and I had a pretty good grasp of the content - in fact, I would go so far as to say that I found physics to be the coolest and most interesting science in undergrad - and I would've aimed to become a physicist but I never felt smart enough to grasp it at the senior and espcially the graduate level...

 

The physical principles that you mention - it's what we would see in a first year physics course right?

 

Although I am not at the calibre of some of you (I was only just accepted into med school in Ontario); I did my MSc in Imaging Physics and my undergrad in Physics -- I agree, super cool content! I also took a course offer my UofT med school that teaches the concepts of MRI to aspiring radiologists in med school.

 

What I can say is that most of the radiologists (most of them chairs with sub-specialities ranging from musculoskeletal to interventional) that taught me or that I collaborated with had less knowledge of physics than any of the students with a Physics degree (BSc). For example, they could tell you in a heartbeat what contrast to expect for an adenocarcinoma in a T2 weighted MRI image, but they usually did not have an intimate understanding of why -- they had more of a conceptual understanding (e.g. there are more protons, therefore the T1 relaxation is relatively long, so the image is dark in the cerebrospinal fluid on a T1 weighted image).

 

I think the ability to grasp concepts, rather than derive formulas, is what really matters. You may have to know a few formulas, but they are usually simple and intuitive. I would say the concepts are well beyond 1st year physics, since they touch on quantum mechanics and fourier theory (especially MRI)). CT, Xray are more straightforward (simple attenuation formulas that you learned in grade 12); ultrasound can be a bit difficult because of fluid dynamics, especially doppler ultrasound, but MRI may boggle your mind if you've never taken a quantum mechanics course, but like I said, you likely won't have to have more than a conceptual understanding of how the image is formed.

[boanssi]

Does radiology require a good background in computer science?

[rmorelan]

Does radiology require a good background in computer science?

 

Nope I was surprised how little most radiologist know about about computer science.

[toolband]

Hello, I am a first year medical student and after alot of shadowing, just realized radiology is for me. I ran into some 4th years coming out of their interview and talked to them. They stressed the importance of research. I want to go to Calgary of residency and was wondering if anyone could help me in how I would go about and find a research project with someone to supervise me? It is late in the year and alot of profs have their summer students which sucks. I have done prior research in cell biology and got a paper on the way so i know alittle bit about the game. Hope someone out there can help!

 

Thanks and much appreciated!

[tooty]

Research is overrated imo. Acquiring a strong knowledgebase now, to perform well during clerkship, should be your first priority. If your grades are good, seek out the staff in your own institution. Ask for the high throughput staff members who are fast at publishing.

[Chamilt]

Although I am not at the calibre of some of you (I was only just accepted into med school in Ontario); I did my MSc in Imaging Physics and my undergrad in Physics -- I agree, super cool content! I also took a course offer my UofT med school that teaches the concepts of MRI to aspiring radiologists in med school.

 

What I can say is that most of the radiologists (most of them chairs with sub-specialities ranging from musculoskeletal to interventional) that taught me or that I collaborated with had less knowledge of physics than any of the students with a Physics degree (BSc). For example, they could tell you in a heartbeat what contrast to expect for an adenocarcinoma in a T2 weighted MRI image, but they usually did not have an intimate understanding of why -- they had more of a conceptual understanding (e.g. there are more protons, therefore the T1 relaxation is relatively long, so the image is dark in the cerebrospinal fluid on a T1 weighted image).

 

I think the ability to grasp concepts, rather than derive formulas, is what really matters. You may have to know a few formulas, but they are usually simple and intuitive. I would say the concepts are well beyond 1st year physics, since they touch on quantum mechanics and fourier theory (especially MRI)). CT, Xray are more straightforward (simple attenuation formulas that you learned in grade 12); ultrasound can be a bit difficult because of fluid dynamics, especially doppler ultrasound, but MRI may boggle your mind if you've never taken a quantum mechanics course, but like I said, you likely won't have to have more than a conceptual understanding of how the image is formed.

 

 

 

This is somewhat reassuring, as I too am just a lowly first year student but at 30 years old I have a good idea of what I like and don't like. And thus have recently just become interested in radiology and perhaps nuclear medicine (anyone comment on this very small specialty?). I have been mostly geared towards the more generalist specialties such as FM, IM, EM etc... but I guess radiology has a broad overview as well, just never considered an imaging specialty, although I was really interested in Rad onc when I worked at a cancer centre, although the job market rumours have deterred me, and being limited to working at cancer centres is a big deterrent for me.

 

I was concerned about the amount of physics and understanding of the actual process of image generation that we would need to learn/develop in radiology. Although not a physics/imaging major like the poster above, I did do 3 years of chem and thus have a probably above average understanding of NMR, MRI, spectroscopy etc... but always had to work at understanding the more intimate details of physics/quantum mechanics etc...

 

I'm guessing having this knowledge and background is only beneficial but needing it is not a necessity. i don't know of a ton of med students that were physics/medical physics undergrads, but makes sense that as a resident radiologist you are better off learning intimate details of anatomy and pathology. I guess that's why hospitals have physicists on staff as well!

 

But as mentioned above, there is a lot of info on here about rads and I appreciate all those that have commented. And we appear to have an abundance of mods that are rads residents (rmorelan, tooty and i'm pretty sure there are others) But I'm trying to learn more about nuclear medicine and/or the differences between the two. Besides what I've read on CMA and carms etc...

 

Thanks.

[Lactic Folly]

Consider nuclear medicine more as a field/subspecialty within diagnostic imaging than as a separate entity. Very few people would advise doing nuclear medicine as a sole specialty, versus combined radiology/nuclear medicine. With fusion studies like PET-CT and PET-MR, important to have solid interpretation skills in radiology. Also, much less versatile to be able to do nucs only, versus being able to cover other areas of radiology in a practice. Very interesting field, main differences are functional/physiologic imaging with radiopharmaceuticals and potential to deliver treatments.

 

No need to worry about level of physics required to become certified in radiology, if you can do MCAT level physics. More conceptual and practical/clinical than technical/highly detailed. If taking more of a lead role in MRI in the future, can supplement with fellowship/reading/on-the-job training.

[Chamilt]

Thanks lactic folly. That is pretty much what I thought. Just wanted to understand why someone would pursue nuc med instead of just: rads and a fellowship in nuc med or extra training during residency.

 

Reassuring to know that my physics and chemistry background will be more than adequate for rads.

 

Cheers

[RadsOrBust]

Thank you for this excellent thread of posts regarding the field of radiology.

 

I wonder if Ian Wong, Kirsteen, radmanjohn, Lactic Folly may shed some light in regard to what pre-clinical medical students studying abroad may do to optimize their chances at securing one of the coveted IMG radiology spots in Canada.

 

Thanks in advance and happy holidays.

[David MD]

I want to do radiology as well.

[radiologist1984]

Hello everyone! Are there any Canadian radiology residents/fellows/recent graduates on here? Please PM me. I have a few questions and would greatly appreciate your time and advice. Thank You