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Hello all,

This is such a under-discussed specialty in my program, I don't think I've met a single nuclear doc so far as a M2 at Western. It seems like my classmates barely know this specialty exists, and it's extremely difficult to get facetime with physicians in nuclear medicine.

Doing some reading on these forums over the past decade, it seems like a lot of people were advising people to stay away from nuclear med, or do a rads + nuclear med combined residency. I'm just wondering if anyone has any recent experience in this since things can change a lot over the years. Should we stay away from doing a solo nuclear meds residency? It's also a very uncompetitive specialty residency wise given that (imo) I think nuclear medicine is actually pretty cool from what little I know. What are the general things that is keeping people away from the specialty? I'm very interested in both rads and nuclear med but I don't think I want to be resident into my late 30s, so the combined residency program is out for me unfortunately. Does this pretty much rule out nuclear med for me?

Thanks

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I don't know much about the field besides that there are poor job prospects and you need to do a fellowship/and potentially a graduate degree to have a chance at a job. So you're looking at 7 years of training post-medical school. So if training time is a consideration for you, you need to be ok with that.

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There are very few dedicated NM physicians. The majority of NM programs have integrated with radiology to become a fellowship; the remainder feel academic in nature to me. As noted above, job prospects are often difficult and rely purely on word of mouth & retirees. Over the years the bread-and-butter of the specialty has been taken over by radiology (and cardiology for the heart).

This does not mean nuclear medicine is becoming less important. PET/CT has or is becoming standard of care for malignancy staging (e.g. look at how recent PSMA PET/CT is and how quickly it has revolutionized screening for prostate mets). These new modalities however are controlled by radiology because the rad has the ability to compare across X-ray/US/CT/MR/PET and can stay productive in between NM cases by helping out with the general radiology workflow. Even without the 2-year fellowship, a rad can still often read the relevant nuclear medicine imaging in their subspecialty (you get a couple blocks of NM in residency plus whatever you pick up during fellowship).

My honest recommendation is to pursue radiology with the 2-year fellowship. It may sound like more time, but if you end up needing to do a graduate degree or work locums/unfavourable job area, you'll ultimately take a longer path.

The best people to speak to will probably be residents within the program itself. At Western it is still a separate program so there are people you can speak to. Beware speaking to attendings who may be incentivized to keep a residency program running.

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NM is rather "big" in Quebec. 

Nucleists got their hands on PET/CT and for historical reasons, a lot of nuclear tests are being done where a non-nuclear test would be done outside of Quebec. For example, a lot of Quebc trained clinicians order Bone & Gallium scans for bone infections where an MRI would be ordered elsewhere.... 

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On 10/12/2020 at 4:11 AM, anonymouspls said:

Hello all,

This is such a under-discussed specialty in my program, I don't think I've met a single nuclear doc so far as a M2 at Western. It seems like my classmates barely know this specialty exists, and it's extremely difficult to get facetime with physicians in nuclear medicine.

Doing some reading on these forums over the past decade, it seems like a lot of people were advising people to stay away from nuclear med, or do a rads + nuclear med combined residency. I'm just wondering if anyone has any recent experience in this since things can change a lot over the years. Should we stay away from doing a solo nuclear meds residency? It's also a very uncompetitive specialty residency wise given that (imo) I think nuclear medicine is actually pretty cool from what little I know. What are the general things that is keeping people away from the specialty? I'm very interested in both rads and nuclear med but I don't think I want to be resident into my late 30s, so the combined residency program is out for me unfortunately. Does this pretty much rule out nuclear med for me?

Thanks

well the combined one where it is offered is 1 year post radiology residency - that is the same length of time as most of us do it anyway as a fellowship in something is almost a requirement - that assumes you get into one of the rad + nuc combined residency programs. Even if you don't it is exactly one year more than average. Not to dismiss that but in the long range point of view it is a year (6 vs 7 - that isn't exactly pushing you a ton into the future - ha face it, any route you take will be a long time. ). 

The problem with nuc med is that rad + nucs exists ha. If only nucs could do it then it would be amazing. Great hours, relatively high pay per hour, no really call.....it basically is what radiology was 20 years ago and you are right back on the ROAD line again. Unfortunately it is limiting now as community groups that used to have to have a nucs solo because you just have to do it, now can get a rad + nucs and that person can help with the regular radiology - including the weekend/call coverage which is the real sticking point. Nothing is more annoying than a colleague getting out of all the call ha. The shear venom shot at nucs from rads in some places is almost comical. 

Thus pure nucs is often only at academic places (and even there rads is creeping in - in part because lets face it PET-CT and PET-MRI basically imply you have rad level of skill, and now BMD scans are not done using original nuc med techniques. Plus rads is starting to play with radiation in more ways any way - like radioactive biopsy markers in breast. Nucs is basically a sitting duck - all the advances creep onto the more powerful radiology space. Oh and also well no one is doing nucs residency so you cannot hire a Canadian grad often for a solo nucs position because it is hard to even find one). 

In Quebec it is different purely for political reasons - there you CANNOT hold two specialities at the same time (was supposed to reduce the issue of double billing to start with). Thus you cannot be a rad + nucs - it is one or the other. That has created a stronghold for the field - but I should point out that could be erased with a single policy change and eventually you would think that would happen. It will be fought of course, but it is hard to plan a future around that. 

any these reasons are why nucs alone is not popular. The job market is limited, rads + nucs are always coming for you, if you have rads + nucs you make a lot more money (nucs has a ton of down time - studies take forever to do. Nucs just sit there waiting ha. Rads + nucs read imaging and make money). Nucs is actually an amazing field and the new stuff is amazingly interesting as well (molecular imaging anyone? Imagine not imaging anatomy alone but actually imaging pain for instance. The actual problem is highlighted - awesome ).  Still I would definitely personally lean towards combining the two, and if interested seriously target the 6 year combined rads plus nucs residency programs - get both specialties in the same amount of time as a standard rad + 1 year fellowship route. 

 

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On 10/14/2020 at 12:13 AM, rmorelan said:

well the combined one where it is offered is 1 year post radiology residency - that is the same length of time as most of us do it anyway as a fellowship in something is almost a requirement - that assumes you get into one of the rad + nuc combined residency programs. Even if you don't it is exactly one year more than average. Not to dismiss that but in the long range point of view it is a year (6 vs 7 - that isn't exactly pushing you a ton into the future - ha face it, any route you take will be a long time. ). 

The problem with nuc med is that rad + nucs exists ha. If only nucs could do it then it would be amazing. Great hours, relatively high pay per hour, no really call.....it basically is what radiology was 20 years ago and you are right back on the ROAD line again. Unfortunately it is limiting now as community groups that used to have to have a nucs solo because you just have to do it, now can get a rad + nucs and that person can help with the regular radiology - including the weekend/call coverage which is the real sticking point. Nothing is more annoying than a colleague getting out of all the call ha. The shear venom shot at nucs from rads in some places is almost comical. 

Thus pure nucs is often only at academic places (and even there rads is creeping in - in part because lets face it PET-CT and PET-MRI basically imply you have rad level of skill, and now BMD scans are not done using original nuc med techniques. Plus rads is starting to play with radiation in more ways any way - like radioactive biopsy markers in breast. Nucs is basically a sitting duck - all the advances creep onto the more powerful radiology space. Oh and also well no one is doing nucs residency so you cannot hire a Canadian grad often for a solo nucs position because it is hard to even find one). 

In Quebec it is different purely for political reasons - there you CANNOT hold two specialities at the same time (was supposed to reduce the issue of double billing to start with). Thus you cannot be a rad + nucs - it is one or the other. That has created a stronghold for the field - but I should point out that could be erased with a single policy change and eventually you would think that would happen. It will be fought of course, but it is hard to plan a future around that. 

any these reasons are why nucs alone is not popular. The job market is limited, rads + nucs are always coming for you, if you have rads + nucs you make a lot more money (nucs has a ton of down time - studies take forever to do. Nucs just sit there waiting ha. Rads + nucs read imaging and make money). Nucs is actually an amazing field and the new stuff is amazingly interesting as well (molecular imaging anyone? Imagine not imaging anatomy alone but actually imaging pain for instance. The actual problem is highlighted - awesome ).  Still I would definitely personally lean towards combining the two, and if interested seriously target the 6 year combined rads plus nucs residency programs - get both specialties in the same amount of time as a standard rad + 1 year fellowship route. 

 

The six year combined program sounds really interesting. I am aware Dalhousie has a program like this. Do you know of any other schools in Canada which have a similar program?

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