Radiology vs Urology

[ConfusedGunner]

Hey all, third year med student here about to go into my fourth year electives in a month or so having some serious career indecision. Now, I know that Radiology and Urology are very very different specialties but I’m having a genuinely hard time deciding which to apply for.

Radiology:

Pros:
- I love anatomy, physiology, pathology. Radiology to me is medicine without all the BS, no SW/PT/OT, no dispo planning. 
- Radiology allows for lots of small procedures (biopsies, therapeutic thoraco/paracentesis) and options for more procedures through IR. I love these. 
- Radiology allows for better control of hours and flexibility as you get older. It’s easier to downscale your practice. 
- If I had to choose between Diagnosis vs Management I’d choose Diagnosis (it’s like being a detective, putting together pieces of info)
 

Cons:
- Radiology is definitely a slog, the hours are no joke and my impression is a lot of your money is made on call (you’ll be working nights, and there’s no break on your shifts, it’s go go go); I personally enjoy that style of work during the day, but at night not so much 
- I really do like taking quick histories granted this is not something that I did before med school and I was still happy. I know radiology involves lots of interaction with other doctors/staff with protocoling studies, reviewing images. But sometimes I think I’d miss the H+P. 
- I know AI won’t likely take jobs away, but I think you can’t go into Radiology right now without accepting that you need to be aware of it and capable of integrating it into your practice; I don’t think I’m capable of becoming an AI expert or want to frankly 

Urology:

Pros:
- Urology is also a good mix of medicine, and anatomy; its similar honestly to radiology in the sense that Urologists do a lot of their own imaging under fluoroscopy (VCUG, RUGs) and can directly visualize pathology via cystoscopy 
- Urology has a strong clinical practice that basically always has 60-80 patient lists; I absolutely love grinding through Urology clinic patients, quick but effective histories 
- While there is a medical component, it’s pretty simply; when you get consulted at 3AM for something dumb you can see it in the morning or kinda run on autopilot
- Urology has great diversity of stuff; bread and butter community urology with TURPs, TURBTs, lap and robotic assisted nephrectomies, prostatectomies are all fun procedures in my eyes along with stone removal

Cons:
- Surgical training is really really intense. I was extra keen on my urology rotation and was easily clocking 70 hour work weeks not including the weekends. I felt super dead at the end of my rotation I had not taken a single weekend off and also was studying for my exam. If 4 weeks did that to me, 5 years scares the crap out of me even though I know it gets better as you go along. 
- Urology has good lifestyle for surgery but it’s still bad compared to basically everything else. 
- While I do vibe with the people, I don’t really feel like other urology gunners who know they want surgery. I actually found urology through IR. 
- Surgical culture IMO is still very much “sacrifice your life for surgery”; that’s not me 

To be frank, I’d enjoy myself in both I think and won’t regret my decision to pursue either. I’d really appreciate help with the following:

1. Please correct my impressions of either specialty! 
2. If I were to do 4 Radiology and 4 Urology electives, would that red-flag most Canadian residency programs for either program. My CV reflects significant interest in both (Pubs, Presentations, Patents). I think I’ll look confused and get less interviews, they’re both really competitive.
3. How do you think I should decide between the two? 
 

any help would be super appreciated!  

[1D7]

Quote

Radiology:

Cons:
- Radiology is definitely a slog, the hours are no joke and my impression is a lot of your money is made on call (you’ll be working nights, and there’s no break on your shifts, it’s go go go); I personally enjoy that style of work during the day, but at night not so much 
- I really do like taking quick histories granted this is not something that I did before med school and I was still happy. I know radiology involves lots of interaction with other doctors/staff with protocoling studies, reviewing images. But sometimes I think I’d miss the H+P. 
- I know AI won’t likely take jobs away, but I think you can’t go into Radiology right now without accepting that you need to be aware of it and capable of integrating it into your practice; I don’t think I’m capable of becoming an AI expert or want to frankly 

In large centres call is very busy. Some community radiology practices are giving up call because the volume is beyond their capability and having a 3rd party teleradiology group take the overnight cases, though many still cover call themselves.

Most radiologists do not miss doing a H&P. During the day I briefly chat with patients during consent and procedures, and that's enough for me. The rest of the interaction is with techs and the occasional doc. Overnight I just want to get my work done with minimal interruptions and doing work that matters (which is pretty much what everyone wants, although most shifts don't look like it).

Most radiologists are nowhere near "AI experts" status and will never have to be. There are a few that are very interested, and they help educate the broader radiology community on a conceptual level. Any released software will be released in a physician-friendly format, probably integrated into PACS.

Quote

Cons:
- Surgical training is really really intense. I was extra keen on my urology rotation and was easily clocking 70 hour work weeks not including the weekends. I felt super dead at the end of my rotation I had not taken a single weekend off and also was studying for my exam. If 4 weeks did that to me, 5 years scares the crap out of me even though I know it gets better as you go along. 
- Urology has good lifestyle for surgery but it’s still bad compared to basically everything else. 
- While I do vibe with the people, I don’t really feel like other urology gunners who know they want surgery. I actually found urology through IR. 
- Surgical culture IMO is still very much “sacrifice your life for surgery”; that’s not me 

Residency/training is short relative to your remaining career, although we all have our own personal thresholds for what is acceptable x 5 plus yrs.

Quote

2. If I were to do 4 Radiology and 4 Urology electives, would that red-flag most Canadian residency programs for either program. My CV reflects significant interest in both (Pubs, Presentations, Patents). I think I’ll look confused and get less interviews, they’re both really competitive.

It is generally disadvantageous to apply to more than 1 specialty, although that is a very common trend nowadays.

Quote

3. How do you think I should decide between the two? 

There is very little overlap in the day-to-day of a diagnostic radiologist and urologist.

Can you tolerate a surgical residency?

Do you want to read imaging in a quiet office and do the occasional procedure, or do you want to work in the OR and run clinics?

Do you want ownership of patients? This means having clinic follow-up and fixing your complications.

Do you need external gratification? Rarely are your efforts recognized in radiology except when one of your colleagues notices a great catch.

IR in some ways is similar to surgery but you are still a radiologist in that you are rarely if ever taking complete ownership of a patient. Most IRs outside of academics have diagnostics as part of their practice. You may have a follow-up clinic for certain cases but that's really mainly for academics and outside of that it is heterogeneous.

 

Just for your reference, I chose radiology. I liked seeing disease processes rather than the tedious concepts of hyponatremia. I enjoy short procedures. I was fine working in the OR but I could vaguely imagine that I'd probably enjoy sitting down and reading imaging more. There is more flexibility in radiology from a career perspective than the surgical specialty I was interested in, and since I entered radiology that gap has increased. I can get by without a patient thanking me or directly seeing the impact I made (knowing I made the right call and seeing confirmation in the OR note/path is satisfying enough for me). I don't want direct patient ownership. I was willing to do a surgical residency but at the time (and still) the job market in that surgical specialty was poor and I had little interest in a graduate degree. I'm fine with and occasionally enjoy making high impact/high acuity calls.

 

[anonymouspls]

Consider rad onc too, it has all of the pros you listed. Work with imaging when you contour, mixed with patient interaction in clinic time, you can do brachytherapy if you want to do procedures, very light call load compared to almost every other specialty, paid more than most surgeons but less than radiology. 

[RagnarOdinson]

On 8/5/2023 at 5:51 PM, ConfusedGunner said:

2. If I were to do 4 Radiology and 4 Urology electives, would that red-flag most Canadian residency programs for either program. My CV reflects significant interest in both (Pubs, Presentations, Patents). I think I’ll look confused and get less interviews, they’re both really competitive.

What I will say is that parallel-planning with two very competitive specialties is kind of a risk these days. Take a peek at the stats for radiology last cycle, and you'll see why it's risky. Adcoms aren't dumb, they can see if you are clearly going for 2 separate specialties, and if they have dozens of other clear radiology or urology gunners, it's more likely they take them over you. Unless you are a top, top applicant I just don't think it's worth the risk and while not impossible, you may be setting yourself up to go unmatched. I don't envy your position, it's not an insignificant decision you have to make. 

[ConfusedGunner]

12 hours ago, RagnarOdinson said:

What I will say is that parallel-planning with two very competitive specialties is kind of a risk these days. Take a peek at the stats for radiology last cycle, and you'll see why it's risky. Adcoms aren't dumb, they can see if you are clearly going for 2 separate specialties, and if they have dozens of other clear radiology or urology gunners, it's more likely they take them over you. Unless you are a top, top applicant I just don't think it's worth the risk and while not impossible, you may be setting yourself up to go unmatched. I don't envy your position, it's not an insignificant decision you have to make. 

Do you know how hard it is to switch between residencies? I know not ideal, but say I get into Radiology and hate it, how hard would it be to switch to IM? 

[ConfusedGunner]

19 hours ago, anonymouspls said:

Consider rad onc too, it has all of the pros you listed. Work with imaging when you contour, mixed with patient interaction in clinic time, you can do brachytherapy if you want to do procedures, very light call load compared to almost every other specialty, paid more than most surgeons but less than radiology. 

I honestly don’t think I can consider anything else at this point. Already too many things being considered.

There is almost 0 diagnostic component to radiation oncology making it extremely different to radiology and most subspecialties in medicine in my opinion. I agree it’s a great job but not for me I think!

[ConfusedGunner]

On 8/5/2023 at 11:28 PM, 1D7 said:

In large centres call is very busy. Some community radiology practices are giving up call because the volume is beyond their capability and having a 3rd party teleradiology group take the overnight cases, though many still cover call themselves.

Most radiologists do not miss doing a H&P. During the day I briefly chat with patients during consent and procedures, and that's enough for me. The rest of the interaction is with techs and the occasional doc. Overnight I just want to get my work done with minimal interruptions and doing work that matters (which is pretty much what everyone wants, although most shifts don't look like it).

Most radiologists are nowhere near "AI experts" status and will never have to be. There are a few that are very interested, and they help educate the broader radiology community on a conceptual level. Any released software will be released in a physician-friendly format, probably integrated into PACS.

Residency/training is short relative to your remaining career, although we all have our own personal thresholds for what is acceptable x 5 plus yrs.

It is generally disadvantageous to apply to more than 1 specialty, although that is a very common trend nowadays.

There is very little overlap in the day-to-day of a diagnostic radiologist and urologist.

Can you tolerate a surgical residency?

Do you want to read imaging in a quiet office and do the occasional procedure, or do you want to work in the OR and run clinics?

Do you want ownership of patients? This means having clinic follow-up and fixing your complications.

Do you need external gratification? Rarely are your efforts recognized in radiology except when one of your colleagues notices a great catch.

IR in some ways is similar to surgery but you are still a radiologist in that you are rarely if ever taking complete ownership of a patient. Most IRs outside of academics have diagnostics as part of their practice. You may have a follow-up clinic for certain cases but that's really mainly for academics and outside of that it is heterogeneous.

 

Just for your reference, I chose radiology. I liked seeing disease processes rather than the tedious concepts of hyponatremia. I enjoy short procedures. I was fine working in the OR but I could vaguely imagine that I'd probably enjoy sitting down and reading imaging more. There is more flexibility in radiology from a career perspective than the surgical specialty I was interested in, and since I entered radiology that gap has increased. I can get by without a patient thanking me or directly seeing the impact I made (knowing I made the right call and seeing confirmation in the OR note/path is satisfying enough for me). I don't want direct patient ownership. I was willing to do a surgical residency but at the time (and still) the job market in that surgical specialty was poor and I had little interest in a graduate degree. I'm fine with and occasionally enjoy making high impact/high acuity calls.

 

I honestly think I won’t regret not doing urology. I’d have major regret not doing radiology. To me procedures are as fun as operating, albeit I do enjoy suturing. I think I’ve basically decided on radiology but I may do some earlier urology electives just to give it one last chance. 
 

My fear towards urology is the hours. If it was slightly less intense I’d do it. I know that “it’s only 80 hour weeks” for two years but like, having worked those hours takes a toll. 

[anonymouspls]

3 hours ago, ConfusedGunner said:

Do you know how hard it is to switch between residencies? I know not ideal, but say I get into Radiology and hate it, how hard would it be to switch to IM? 

Switching into radiology is hard but not impossible. A lot of centres (like where I did my medschool) want more residents than they have spots to cover call, so they frequently accept transfers in. Its usually people from the same school though, that are known to the program and well liked.

 

switching to IM i think is very doable, ive seen lots of people do it from all sorts of specialties, even 2 year family to IM.