More questions about radiology

[Guest CareBear15]

Hi everyone,

 

Just started second year and literally freaking out about career decision-making... but at any rate, I wanted to know a bit more about radiology. Is there much patient interaction? I know that a lot of residents say that this is one of the "perks" of the job, but I myself am very drawn to many aspects of radiology (depth and breadth of knowledge, new technology, interventional procedures) but I also would like to see some patients and not have my clinical skills go to waste!

 

Also, what fellowships are available after residency? Would fetal imaging be one of them? How would one get into interventional radiology? Lastly, what electives would be helpful (besides ones in radiology)?

 

Thanks for all your help and input.

[Guest Ian Wong]

Is there much patient interaction?

Patient interaction is brief and rather superficial. You get more patient interaction on services like Mammography, Pediatrics, or Interventional radiology. Even in general radiology, any time you do a procedure on someone (whether that be placing a PICC line, doing an ultrasound-guided biopsy, or doing a thoracentesis), you need to talk to the patient to get their consent.

 

Your interactions are generally very concise, and focussed. Like many subspecialties, you tend to turf issues out of your field back to the primary provider. (ie. "No, I don't write for pain meds", "No, I can't fill out your disability", "No, I can't give you an estimate on when you might be discharged home".)

 

The pro to this is that you stay out of many messy social situations that tend to ensnare the primary provider (most memorable patients either have a completely dysfunctional personal life, or else their family is completely nuts).

 

The con to this is that you really don't solve any of the patient's problems except perhaps the one the referring clinician wanted you to solve. That might mean placing the PICC line, and that's all. As an example, recently, while I was working a patient up for an interventional procedure, the nurse and I were drawn to some blood on the patient's gown. When we investigated this further, we found a huge fungating breast cancer, that the patient had obviously been neglecting to have seen for several years. My job, as described by my interventional radiology attending, was to notify the patient's clinician, get an appointment set up, and then get consent for the procedure (which was completely unrelated) and get it done. My suggestion to start working up the breast cancer in order to give the clinician a head start (since it would no doubt also be turfed to an oncologist and potentially also a breast surgeon, with associated delays in care) (ie. biopsy, staging via clinical exam and imaging) was vetoed. So, we solved one problem, but did little more than obtain followup for the more serious problem.

I know that a lot of residents say that this is one of the "perks" of the job, but I myself am very drawn to many aspects of radiology (depth and breadth of knowledge, new technology, interventional procedures) but I also would like to see some patients and not have my clinical skills go to waste!

If you want to see patients, and do so more than superficially, then radiology may not make you completely happy. However, the caveat that I will throw in there is that you may be one of a subset of med students who will discover during your clinical years that you simply don't enjoy seeing patients as much as you enjoy the problem-solving, the acquisition of a huge pile of knowledge across all specialties, and the thrill of a visual diagnosis that is offered by fields like Pathology and Radiology. For these individuals, not seeing patients is indeed a "perk". Still, that's a difficult thing to come to grips with because few to no people come into med school to become pathologists or radiologists. Most people have an idea that they want to become a cardiologist, or a family medicine doc, or a surgeon, or a pediatrician, or some other clinical specialty, and letting go of that dream is very difficult.

Also, what fellowships are available after residency?

There are numerous fellowships out there; hopefully I get the majority of them. They are often either anatomically based, or modality-based.

 

Neuroradiology

Neurointerventional Radiology

Chest Radiology

Cardiac Radiology

Abdomen/GI Radiology

Genitourinary Radiology (often Chest/GI/GU are lumped as "Body Radiology")

Musculoskeletal Radiology

Interventional Radiology

Nuclear Medicine

Pediatric Radiology

Mammography/Women's Health

Emergency/Trauma Radiology

MRI Radiology

Ultrasound Radiology

Informatics

Would fetal imaging be one of them?

Fetal imaging is something that you learn during your residency, as far as fetal ultrasounds go. Fetal MRI is something that we are also now seeing. To subspecialize in this, you can do a Women's Health fellowship.

How would one get into interventional radiology?

Interventional radiology is generally a one year fellowship after residency. People who do Neurointerventional radiology usually get there after doing 1-2 years of diagnostic neuroradiology fellowship, followed by an additional 1-2 years of neurointerventional fellowship.

Lastly, what electives would be helpful (besides ones in radiology)?

Many radiology program directors try to emphasize that doing all your electives in Radiology isn't helpful. Rather, a breadth of experiences is supposed to be good. As a result, if you do a Radiology elective, along with a couple of Medicine subspecialties (like Respirology or ICU) or things like Neurology, or surgical subspecialties like Ortho, that is supposed to be good. The caveat is that's just stuff I've been told; I would talk to residents at your particular institution to see what they have to say.

 

Ian

[Guest CareBear15]

Thanks a lot Ian! Your wisdom and advice is always invaluable and much appreciated.

 

Still trying to decide on a career path though...