Radiology Qs

[Guest noncestvrai]

I'm a bit interested in radiology, or at least enough to do an elective in the field but in the US, can someone shed some light on this for me? I heard from a PGY-3 in rads, that UCSF was among the best places to do it. What is the timeline I should think of? I might have one during 3rd year and at beginning of 4th year. Also, any other places you would recommend?

 

I already work for a radiologist at my home university, should I do an elective here, or would this be a waste of elective?

 

What is the length of the training in the states? Can I come back to work in Canada or Quebec, and if so what would I need to do?

 

Thx a lot,

 

noncestvrai

[Guest Ian Wong]

Good for you. Radiology is a wonderful field!

 

I would do an elective at McGill if the person you work for is unlikely to be able to get you in on their recommendation alone. Ideally you want to make a good impression on the people who can vouch for you during the committee meeting when they make up their rank list. The majority of radiology residents match to their own institution, so I would pursue that avenue as option #1.

 

In the US, you do a year of internship, followed by 4 years of Radiology residency. If you did a Canadian residency, you'd be eligible to sit for the US boards at this time. Luckily, the converse is also true, if you do a US residency, you'd be eligible to sit for the Canadian boards at this time. Obviously, that could change at any moment, so I'd suggest that whichever country you envision yourself working in be the one that you devote the most attention towards (under the supposition that if you did your residency in that country, they can never deny you from working there).

 

The caveat is that the Royal College has certain expectations about the number of months you spend on each subspecialty, so if you match to a US program, you need to make sure that you use your elective months to ensure that you've got three months of mammography, three months of peds radiology, etc.

 

As long as you take your LMCC parts 1 and 2, are eligible for and pass your Canadian Royal College radiology board exam, you should have no problem with coming back to Canada to work following US radiology residency.

 

The interesting shift is that the telerad companies can allow you to live in Canada, yet read studies in the US. The compensation packages that they are offering are absolutely insane right now; you can work 26 weeks a year for a salary that starts somewhere around $300,000 US a year. The con to doing this is that you'd be working predominantly during the evenings and overnights; this is the reason many US telerad companies have set up shop in Australia and Europe, to take advantage of the time difference.

 

Anyway, I would do an elective at a place that you have the possibility of matching to. McGill is well-known in the US, but particularly so in the Northeast. Therefore, consider doing an elective somewhere in the Northeast to maximize this "name" advantage. As well, interviews tend to be given regionally, so the programs that are most likely to interview you will be Northeast programs (unless you can show them you have a tie to Texas, or Arizona, etc).

 

My final piece of advice is that it's a HUGE benefit if you get hooked up somehow. So, if you have any faculty members who've recently done residency/fellowship/worked as faculty at a US institution, hit them up for advice, and if they're willing to help you out, consider doing your elective at that institution. The fact that you already "know" someone when you get there will help you out tremendously (as long as that individual left on good terms!).

 

The elite programs in the US include:

 

UPenn (in Philadelphia)

Mass General/Brigham and Womens (two of the three Harvard programs in Boston)

Johns Hopkins (Baltimore)

NYU/Columbia/Cornell (New York City)

Duke (in Durham, North Carolina)

Mallinckrodt (aka Washington University in St. Louis)

Mayo Clinic (in Rochester, Minnesota)

UCSF (San Francisco)

Stanford University (Palo Alto)

U of Washington (Seattle).

 

The trouble is that unless you've got really strong USMLE scores and hopefully something else unique, like a strong research background, cracking into those programs is going to be tough.

 

There's a number of other very strong programs out there which are a tier below, which would include:

OHSU (Portland, OR)

UCLA (Los Angeles)

UCSD (San Diego)

UTSW (Dallas, Tx)

U of Utah (Salt Lake City)

U of Colorado (Denver)

U of Michigan (Ann Arbor)

U of Wisconsin (Madison)

Medical College of Wisconsin (Milwaukee)

Northwestern University (Chicago)

University of Iowa (Iowa City)

Indiana University (Indianapolis)

Beth Israel Deaconess (the third Harvard program in Boston)

U of Pittsburgh (Pittsburgh)

Thomas Jefferson University (Philadelphia)

U of North Carolina (Raleigh)

Wake Forest University (Winston-Salem)

Yale University (New Haven, Connecticut)

U of Virginia (Charlottesville)

Vanderbilt University (Nashville, Tennessee)

U of Alabama (Birmingham)

Emory University (Atlanta)

 

I think that most people in the US would place any of the above programs within the top 30-40 programs (out of approximately 200), after the elite programs.

 

If you are interested in applying to the US, I would strongly advise heading over to www.auntminnie.com and reading the discussion forums there. They have an abundance of discussions regarding radiology, including the application process, residency itself, and current issues facing the practice of radiology from a US perspective. Just remember that a lot of the stuff posted there needs to be taken with several grains of salt, but there's a LOT of worthwhile stuff there if you're willing to sift for it. Aunt Minnie is by far the most active radiology discussion forum out there, and they've got a great series of cases of the day, which you can use as an educational resource.

 

www.auntminnie.com

 

Ian

[Guest ploughboy]

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Quote: "The interesting shift is that the telerad companies can allow you to live in Canada, yet read studies in the US. The compensation packages that they are offering are absolutely insane right now; you can work 26 weeks a year for a salary that starts somewhere around $300,000 US a year. The con to doing this is that you'd be working predominantly during the evenings and overnights; this is the reason many US telerad companies have set up shop in Australia and Europe, to take advantage of the time difference."

 

 

Hey Ian,

 

In fields such as software engineering, customer support etc there has been a huge push to offshore jobs to places like India and China. Do you worry about the same thing happening with rads, or will licensure requirements etc mean that this is unlikely to happen?

 

Cheers,

 

pb

 

 

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[Guest Ian Wong]

Hey ploughboy,

 

I think anything is possible, but I would speculate that at least in the US (where the demand for 24/7 radiology is VERY high, and where the bulk of the teleradiology business is therefore generated), this is unlikely to happen.

 

There has already been an attempt to make this work, and it happened at no less an institution than Massachusetts General Hospital, the flagship Harvard teaching hospital. There was a radiologist there by the name of Sanjay Saini who attempted to collaborate with a company in India to supply these overnight reads. This endeavour basically collapsed, and Dr. Saini is no longer with MGH (I believe he's now with Emory University in Atlanta).

 

The problem with this system is multifold. They can be broken down as follows:

 

1) In order to interpret studies, at this time you need to be licensed in the state in which the study is being done. This means having passed USMLE Steps 1-3, and having completed an internship year. You also need to be credentialled at each hospital where these reads are generated. Finally, you also need to be either board-certified or board-eligible in radiology, which generally requires the completion of a radiology residency.

 

There is a back-door method to becoming board-certified/board-eligible (if you have a radiology background), by somehow associating yourself with an academic institution in a "fellowship" role for a certain length of time. I'm very vague on the details, but I don't think this avenue is available for the majority of radiologists educated outside of North America (and radiologists educated within North America don't need this back-door as they are automatically board-eligible on completion of their North American radiology residency).

 

Getting through all these hurdles is the reason you don't see many IMG's entering the workforce in the very competitive specialties. The hardest part is getting that radiology residency position, or otherwise being recognized as board-eligible/board-certified.

 

2) The medico-legal environment. At this time, as far as I am aware, all teleradiology performed for US hospitals is being done so by US board-certified radiologists. The teleradiology companies have been very aggressive about policing themselves in this regard because they know that their reputations are on the line. Radiologists providing reads that they are not licensed to provide put the patient, hospital, and the hospital's primary radiology group in jeopardy.

 

There was initial concern that "radiology sweatshops" might emerge where 20 Indian/Chinese/Russian/whatever radiologists might dictate studies, and they would all be signed off under a US board certified radiologist in order to make things look legit. The problem is that that lone radiologist would be taking all the liability generated by those 20 radiologists, and more importantly, the number of annual reads generated by that lone radiologist would be about 20 times greater than any single radiologist could produce. Things would very quickly be investigated and curtailed by the insurance companies.

 

3) Credibility among clinicians. This is probably the most important point. Radiologists are only as valuable as the trust the clinicians place in their reports. It takes time to build clinician's trust in your work. A surgeon who mistakingly goes to the operating room based on the erroneous results of a CT scan is only going to cut the radiologist slack for so long before going to the administration. An ER doc who discharges a patient based on a negative interpretation, only to have the patient bounce-back (or worse yet, die), is going to think long and hard about continuing to support the teleradiology movement at the next hospital credentialling meeting. I don't think clinicians are going to tolerate having to rely on reports by radiologists who aren't appropriately licensed. I also don't think patients and lawyers would let us get away with it for long either.

 

In summary, I think out-sourcing of radiology was a bigger concern a couple of years ago, until the Sanjay Saini/MGH experiment flopped. I just don't see radiologists as being expendable in today's medical practice, especially not in the US, where hardly a patient goes through the hospital without some kind of imaging request. I suppose if you were extremely concerned about the outsourcing of reads, you could always go into Interventional Radiology, which is physically incapable of being outsourced.

 

Ian

[Guest chilling]

Hey,

For those doing a radiology residency, and in particular involved in interventional techniques, just wondering - is there a large amount of exposure to radiation? I know that all precautions must be taken whenever entering the lab, but in the long-run, even small amounts could potentially be very dangerous. Is this an issue worth considering when considering an interventional profession?

 

Any input would be appreciated.

[Guest Ian Wong]

Interestingly enough, there's a theory of radiation hormesis (feel free to Google "hormesis"), that posits that low level exposure of ionizing radiation can actually be beneficial, in that it prophylactically destroys slightly dysplastic cells and induces DNA repair enzymes, before those cells can turn malignant.

 

Whether you believe that theory or not, the bottom line is that diagnostic radiologists basically have the same level of radiation exposures as the general population. Except for barium-type fluoroscopy procedures, diagnostic radiologists are rarely if ever in the room with the patient when their studies are being performed.

 

For interventional radiologists, their film badges definitely show an increased overall dose of radiation versus the diagnostic guys. Still, a combination of a lead apron and thyroid shield, moveable leaded glass shields, and leaded eyewear go a LONG, LONG way towards reducing your dose. Each month, at my institution, you turn in your film badge. If the amount you get that month, when multiplied by 12 months, would exceed the annual occupational exposure limits, you get a notification, so you have time to change your behaviour before accumulating an excess annual total dose of radiation.

 

Interestingly enough, the folks who often end up running into trouble with radiation are not the radiologists, but rather the other specialty fields that make use of fluoroscopy, such as interventional cardiology, or urology or orthopedics.

 

The major reason being that radiologists get extensive training in radiation safety procedures (there's lots of stuff you can do to minimize dosage such as minimizing magnification, keeping body parts away from the beam, leaving the room during angio runs where the exposure rate goes way up, coning down your field of view, and using as much shielding as you physically can get.)

 

The other specialties often get little to no formal training in any of this, and it's not at all uncommon to see them acting much more cavalier in regards to radiation exposure.

 

Bottom line, I'm personally not worried about radiation exposure. If you know what you are doing, you'll be able to keep your exposure below annual safety limits. If you still get a cancer, while you'll never really know for sure, it probably would have occurred anyway, irrespective of the specialty field you're working in.

 

Ian