Radiology Residency - Call Schedule and Hours

[queryradiology]

I am almost 100% interested in nuclear medicine as a clinical specialty. However, both Canada and the US are pursuing a dual certification model (5 years Radiology, 1-2 years nuclear medicine) for centers to hire them.

I am primarily concerned about the lifestyle for Radiology residents. While nuclear medicine does not have heavy call schedules (the only emergent scan I can think of is a V/Q scan at night), my understanding is that the call in Radiology is similar to that of surgery. I have eliminated several specialties because of heavy call schedules (e.g. internal medicine) because I find it difficult to function when working 24 hours straight.

Someone please give it to me straight how difficult a Radiology residency is based on hours and call schedule. I am quite concerned that electives as a medical student will not reflect how difficult a residency will be as medical students in radiology do not have full exposure to the residency experience.

[prettysun]

Current radiology resident here. If you choose to do radiology, you should understand that you'll be expected to grind. The majority of programs retain the 24 hour call model. The volumes and autonomy expected of you, even early on in residency, are very high. The stakes for patient care are also high. Misses can cause severe harm. There is very rarely, if ever, sleep, and if there is, it will be fragmented as you will inevitably get paged. Your elective as a med student cannot and will not reflect the challenges of residency and staff life. Staff life as a radiologist also entails responsibility that other specialties could easily defer to their residents, again something you only really appreciate when you understand the ins and outs of the specialty.

[1D7]

Most Canadian programs have 24 hr call, and the few that don't are usually higher frequency. Call frequency is easy to calculate at your home program... see how many people are on call per night in that program and how many residents they have. The smallest programs have about 1 person on call per night, medium about 2 or 3, and large ones will cover per hospital basis.

Call frequency is lower than surgical specialties (because radiology residencies are a bit larger on average). You will be a lot busier than most surgical specialties on an average night, though you aren't working postcall.

[queryradiology]

1 hour ago, prettysun said:

Current radiology resident here. If you choose to do radiology, you should understand that you'll be expected to grind. The majority of programs retain the 24 hour call model. The volumes and autonomy expected of you, even early on in residency, are very high. The stakes for patient care are also high. Misses can cause severe harm. There is very rarely, if ever, sleep, and if there is, it will be fragmented as you will inevitably get paged. Your elective as a med student cannot and will not reflect the challenges of residency and staff life. Staff life as a radiologist also entails responsibility that other specialties could easily defer to their residents, again something you only really appreciate when you understand the ins and outs of the specialty.

Thanks for the input.

Not concerned about staff life as my plan is to do primarily nuclear medicine after training, not radiology. It is right now deciding whether I can live with 4 years of radiology (and 1 year of rotating off service). I also mentioned that I understand the limitations of electives as a medical student, which is why I'm asking for input on resident life on call.

[rmorelan]

20 hours ago, queryradiology said:

Thanks for the input.

Not concerned about staff life as my plan is to do primarily nuclear medicine after training, not radiology. It is right now deciding whether I can live with 4 years of radiology (and 1 year of rotating off service). I also mentioned that I understand the limitations of electives as a medical student, which is why I'm asking for input on resident life on call.

I should mention you have to be a bit careful about that as one of the main reasons nuc med is folding it seems more and more into radiology (everywhere except Quebec where there are some pretty specific rules keeping it alive......although that seems just general fragile to me) is simply groups that hire want people to help with the radiology call pools. Nothing pisses off a group of radiologists ha faster than someone not having to share in the pain as it were with the evening and weekend work. Particularly when some of those staff remember the "good old days" when radiology was a true lifestyle specialty. It isn't a trivial thing to escape that more and more. 

Not to mention there is a often down time during nuc scans (the rate limiting step is often the machinery and prep - it isn't like CT scanning where you can push a much higher case volume through). During that down time the argument would go is the perfect time to start picking up those radiology studies. If you were hiring someone into many practices there is a strong argument of how much will this person produce. 

There are always ways around things of course, but you should have have an eye on what the nuc med job market is going to be likely in 5-10 years as well as the field is continuing to shift quite a bit. Where exactly are you planning to work, and in what fashion? 

 

 

[rmorelan]

21 hours ago, 1D7 said:

Most Canadian programs have 24 hr call, and the few that don't are usually higher frequency. Call frequency is easy to calculate at your home program... see how many people are on call per night in that program and how many residents they have. The smallest programs have about 1 person on call per night, medium about 2 or 3, and large ones will cover per hospital basis.

Call frequency is lower than surgical specialties (because radiology residencies are a bit larger on average). You will be a lot busier than most surgical specialties on an average night, though you aren't working postcall.

We are starting to shift a bit at least to shorter shifts, call rotations, and well whatever we can do to help there a bit - it isn't just a function of resident well being - the every expanding call volumes exceed the capacity of any resident and the ER is extremely dependent on radiology for turn around times (which is tied to hospital funding as well). 

All this I would say isn't really making call easier though - it is more that it is maintaining the intensity at a high level but not too high.  

U of T has ER call months for people which helps in some ways and some other places have started doing that as well (so 12 hour call shifts but 5 in a row sort of thing. That helps with the biggest issue I had - I found personally with call is not the duration but rather the constant sleep schedule disruption - I was on call (24 hour shifts) roughly 5 times every 4 weeks in my old program at the beginning - it does tapper a lot later on down. Getting up 2 hours earlier than the time you went to bed the day before is not exactly great for general brain functioning. The yo-yoing was not fun ha, and I am not a morning person to begin with. 

and yeah - some other people may have somewhat more frequent call - but they at least have some hope of getting some rest. If you are on radiology call the only way you are resting is if every other specialty on call is also slow - otherwise they are ordering imaging and you are busy. 

 

[queryradiology]

2 hours ago, rmorelan said:

I should mention you have to be a bit careful about that as one of the main reasons nuc med is folding it seems more and more into radiology (everywhere except Quebec where there are some pretty specific rules keeping it alive......although that seems just general fragile to me) is simply groups that hire want people to help with the radiology call pools. Nothing pisses off a group of radiologists ha faster than someone not having to share in the pain as it were with the evening and weekend work. Particularly when some of those staff remember the "good old days" when radiology was a true lifestyle specialty. It isn't a trivial thing to escape that more and more. 

Not to mention there is a often down time during nuc scans (the rate limiting step is often the machinery and prep - it isn't like CT scanning where you can push a much higher case volume through). During that down time the argument would go is the perfect time to start picking up those radiology studies. If you were hiring someone into many practices there is a strong argument of how much will this person produce. 

There are always ways around things of course, but you should have have an eye on what the nuc med job market is going to be likely in 5-10 years as well as the field is continuing to shift quite a bit. Where exactly are you planning to work, and in what fashion? 

 

 

That's a great answer!

I am looking towards the therapeutics side of nuclear medicine over the imaging side actually. With the advent of 177Lu PSMA 617 and 177Lu DOTATATE, nuclear medicine is in a transition phase towards using radiopharmaceuticals to image and treat cancers simultaneously. There are also new radiopharmaceuticals that are currently in clinical trials that have shown excellent results in other cancers for both imaging and therapy. There's a huge amount of financial investment into radiopharmaceuticals in the last 5 years, even with a downturn of the biotech market. While radiation oncology has some foothold in the therapeutics side of radiopharmaceuticals (e.g. U Toronto), it is highly center dependent, and most centers will want to hire nuclear medicine physicians for these indications based on my informal correspondance with large academic centers in the US and Canada. That is what I'm betting on in the future.

[dooogs]

Late to the party but I’m wondering if residents are able to do call from home ? I believe staff at some point are able to ? How does that work? 

[rmorelan]

On 12/8/2022 at 6:30 PM, dooogs said:

Late to the party but I’m wondering if residents are able to do call from home ? I believe staff at some point are able to ? How does that work? 

Most places it is on site - for one thing that just allows the equipment to be in one place (otherwise you need a station for each resident - that is a lot of stations to have and maintain). There is also issues with what happens if the equipment fails and there is a critical study (which is why as an ER doc I am usually on site for my shifts at night). 

There are also at some sites things you have to do you can only do on site. At Ottawa we had to do joint aspirations and fluoroscopic studies sometimes - rare but could only be done if you are there.