Anyone who loved physiology, pharmacology, labs, ekgs, etc that went into radiology anyway?

[Maybedoc1]

Soon to be MS4 applying to residency in September. I’ve had a rough time figuring out my specialty but at this point I’ve narrowed it down to IM + subspecialty or radiology I think.

I’ve posted before but I really like the knowledge base of IM, but I kinda hate the day to day of it.

Without writing a personal statement I started gaining interest in radiology during my clinical year (second year for my school). It started with looking at the imaging of some of my patients and then evolved to me reading every imaging report I could and being blown away by the complexity of what the radiologist was saying and how it guided treatment. I still remember a very well known and accomplished trauma surgeon asking an overnight resident whether this patient needed to go to the OR based on what he thought.

I’m finally on a radiology elective now and even though everyone keeps saying “rads is super boring to watch, but great when you’re doing it” I’m still finding myself pretty engaged and fascinated most of the time. In the last two weeks I’ve seen so much cool **** (so many tumor boards, esthesioneuroblastoma, MRA lymphangiography, VHL hemangioastomas in the spinal cord, congenital cardiac imaging, and so much more). I’ve been blown away by the attendings knowledge base not just with anatomy and rare pathology, but with their knowledge of management of diseases too. Things like surgical approaches for elbow fractures, different approaches for imperforate anus. How angioinvasive fungal sinusitis presents and how this subtle finding can clue you in versus this other subtle finding. Super rare diseases I’ve never heard of before, temporal bone anatomy and how x ENT procedure will work or won’t depending on this or that, etc.

Radiology is becoming more and more intriguing to me by the day, but it still feels like a big leap of faith since we don’t really learn much about radiology in med school. Sure we get shown the most obvious pneumothorax in existence on exams, but that’s not what being a radiologist is about. Meanwhile we learn a lot about the nuance of IM in med school. The 18 different causes of hyponatremia. How an elevated creatinine could be ATN, AIN, postrenal, a vasculitis, etc. How an elevated bilirubin could be alk hepatitis, criggler-najar, hepatitis B, autoimmune hepatitis, shock liver, etc. EKGs, murmur characteristics, preload, afterload, pulmonology, immunology, infectious disease, pharmacology, etc.

At this point I don’t care about patient interactions as I could take it or leave it. I just worry about missing labs, physiology, pharmacology, ekgs, etc if I do radiology. If you told me that I would find low sodium interesting prior to med school I would have laughed at you, but I would have never known about this if I wasn’t taught it. Im sure there’s a bunch of radiology things that are super nuanced and interesting too that I haven’t been exposed and could replace physiology and pharmacology for me, but I probably won’t know unless I take a risk and do it.

Was anyone else in a similar position?

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[collegestud2013]

Soon to be MS4 applying to residency in September. I’ve had a rough time figuring out my specialty but at this point I’ve narrowed it down to IM + subspecialty or radiology I think.

I’ve posted before but I really like the knowledge base of IM, but I kinda hate the day to day of it.

Without writing a personal statement I started gaining interest in radiology during my clinical year (second year for my school). It started with looking at the imaging of some of my patients and then evolved to me reading every imaging report I could and being blown away by the complexity of what the radiologist was saying and how it guided treatment. I still remember a very well known and accomplished trauma surgeon asking an overnight resident whether this patient needed to go to the OR based on what he thought.

I’m finally on a radiology elective now and even though everyone keeps saying “rads is super boring to watch, but great when you’re doing it” I’m still finding myself pretty engaged and fascinated most of the time. In the last two weeks I’ve seen so much cool **** (so many tumor boards, esthesioneuroblastoma, MRA lymphangiography, VHL hemangioastomas in the spinal cord, congenital cardiac imaging, and so much more). I’ve been blown away by the attendings knowledge base not just with anatomy and rare pathology, but with their knowledge of management of diseases too. Things like surgical approaches for elbow fractures, different approaches for imperforate anus. How angioinvasive fungal sinusitis presents and how this subtle finding can clue you in versus this other subtle finding. Super rare diseases I’ve never heard of before, temporal bone anatomy and how x ENT procedure will work or won’t depending on this or that, etc.

Radiology is becoming more and more intriguing to me by the day, but it still feels like a big leap of faith since we don’t really learn much about radiology in med school. Sure we get shown the most obvious pneumothorax in existence on exams, but that’s not what being a radiologist is about. Meanwhile we learn a lot about the nuance of IM in med school. The 18 different causes of hyponatremia. How an elevated creatinine could be ATN, AIN, postrenal, a vasculitis, etc. How an elevated bilirubin could be alk hepatitis, criggler-najar, hepatitis B, autoimmune hepatitis, shock liver, etc. EKGs, murmur characteristics, preload, afterload, pulmonology, immunology, infectious disease, pharmacology, etc.

At this point I don’t care about patient interactions as I could take it or leave it. I just worry about missing labs, physiology, pharmacology, ekgs, etc if I do radiology. If you told me that I would find low sodium interesting prior to med school I would have laughed at you, but I would have never known about this if I wasn’t taught it. Im sure there’s a bunch of radiology things that are super nuanced and interesting too that I haven’t been exposed and could replace physiology and pharmacology for me, but I probably won’t know unless I take a risk and do it.

Was anyone else in a similar position?

Getting excited about complex pathology and rare diseases is largely confined to medical school and residency/fellowship for the most part, assuming your training is done at an academic medical center. Unless you stay in academic medicine after training (which is the minority of physicians), the majority of physicians are in community practice where these you will rarely see rare conditions. So would not use this to figure out what your long-term career would like. You should try to determine whichever specialty you see yourself doing as a job on a day-to-day basis the longest; especially given the ever increasing burnout rates among physicians across the board.

Radiology tends to fit well for those who liked the pre-clinical classes more than 3rd year, and like taking tests. Lifestyle is still decent for DR given its shift-based work and not having to deal with issues associated with direct patient care like angry patients or dealing with insurance companies, and somewhat more flexibility to work from home (though telemedicine is becoming much more common now in the COVID era). However, the volumes of imaging that radiologists are expected to read have gone higher and higher, and now of course hospitals imaging 24-7 so someone will have to work nights and weekends. Also medico-legally there's very little room for error so you can't ever have a bad day and BS your way though any study. Both pay and training time right now are comparable to the higher paid IM subspecialities (6 years usually after med school, with pay comparable to GI, cards, and heme/onc) though there's a high chance that with the rapid expansion of AI the job market will take a big downturn by the time you finish training.

IM +/- subspecialities probably offer a mix of everything including patient interaction +/- pathology and procedures; if you somewhat liked your IM rotation in 3rd year more than preclinical years. You have to deal with the usual headaches of direct patient care, and unless you are strictly a hospitalist (whether general IM or subspecialist hospitalist) you have to deal with the challenges of running an outpatient practice as well like floods of inbox messages, prior auths with insurance, overnight call which are all common contributors to physician burnout. As patient-facing specialties (and they "own" the patient in the outpatient setting), they are also much less prone to job disruptions from AI technology; however, the rapid rise of midlevels is a whole other issue.

 

[NewtonPAC]

Soon to be MS4 applying to residency in September. I’ve had a rough time figuring out my specialty but at this point I’ve narrowed it down to IM + subspecialty or radiology I think.

I’ve posted before but I really like the knowledge base of IM, but I kinda hate the day to day of it.

Without writing a personal statement I started gaining interest in radiology during my clinical year (second year for my school). It started with looking at the imaging of some of my patients and then evolved to me reading every imaging report I could and being blown away by the complexity of what the radiologist was saying and how it guided treatment. I still remember a very well known and accomplished trauma surgeon asking an overnight resident whether this patient needed to go to the OR based on what he thought.

I’m finally on a radiology elective now and even though everyone keeps saying “rads is super boring to watch, but great when you’re doing it” I’m still finding myself pretty engaged and fascinated most of the time. In the last two weeks I’ve seen so much cool **** (so many tumor boards, esthesioneuroblastoma, MRA lymphangiography, VHL hemangioastomas in the spinal cord, congenital cardiac imaging, and so much more). I’ve been blown away by the attendings knowledge base not just with anatomy and rare pathology, but with their knowledge of management of diseases too. Things like surgical approaches for elbow fractures, different approaches for imperforate anus. How angioinvasive fungal sinusitis presents and how this subtle finding can clue you in versus this other subtle finding. Super rare diseases I’ve never heard of before, temporal bone anatomy and how x ENT procedure will work or won’t depending on this or that, etc.

Radiology is becoming more and more intriguing to me by the day, but it still feels like a big leap of faith since we don’t really learn much about radiology in med school. Sure we get shown the most obvious pneumothorax in existence on exams, but that’s not what being a radiologist is about. Meanwhile we learn a lot about the nuance of IM in med school. The 18 different causes of hyponatremia. How an elevated creatinine could be ATN, AIN, postrenal, a vasculitis, etc. How an elevated bilirubin could be alk hepatitis, criggler-najar, hepatitis B, autoimmune hepatitis, shock liver, etc. EKGs, murmur characteristics, preload, afterload, pulmonology, immunology, infectious disease, pharmacology, etc.

At this point I don’t care about patient interactions as I could take it or leave it. I just worry about missing labs, physiology, pharmacology, ekgs, etc if I do radiology. If you told me that I would find low sodium interesting prior to med school I would have laughed at you, but I would have never known about this if I wasn’t taught it. Im sure there’s a bunch of radiology things that are super nuanced and interesting too that I haven’t been exposed and could replace physiology and pharmacology for me, but I probably won’t know unless I take a risk and do it.

Was anyone else in a similar position?

Go interventional radiology. The way it is proceeding it will be the best of both worlds for you. Next question.

 

[irwarrior]

Challenge with interventional radiology is the emergent nature of the field. It requires taking a lot of call and dealing with a lot of patients that are hemorrhaging such as post partum, GI bleed, epistaxis, hemoptysis, spontaneous RP bleeds, pseudo aneurysm post Cath, trauma bleeds etc. More and more IR/VIR are dealing with DVT/PE and strokes. Not to mention more and more use of IR to stabilize patients with acute cholecystitis cholangitis, pyelonephritis, diverticular abscess, post op abscess, empyema etc. The patients interventional sees are too sick for open surgery and anesthesia (bad CHF, brittle DM, ESRD, high MELD liver disease). If your patient has a complication you have to stay there until it is sorted out and follow up on it even if you are not on call.

This is so fundamentally different from the lifestyle of a DR who can read remotely and do shift work and don't have much in the way of direct patient care.

 

[NewtonPAC]

Challenge with interventional radiology is the emergent nature of the field. It requires taking a lot of call and dealing with a lot of patients that are hemorrhaging such as post partum, GI bleed, epistaxis, hemoptysis, spontaneous RP bleeds, pseudo aneurysm post Cath, trauma bleeds etc. More and more IR/VIR are dealing with DVT/PE and strokes. Not to mention more and more use of IR to stabilize patients with acute cholecystitis cholangitis, pyelonephritis, diverticular abscess, post op abscess, empyema etc. The patients interventional sees are too sick for open surgery and anesthesia (bad CHF, brittle DM, ESRD, high MELD liver disease). If your patient has a complication you have to stay there until it is sorted out and follow up on it even if you are not on call.

This is so fundamentally different from the lifestyle of a DR who can read remotely and do shift work and don't have much in the way of direct patient care.

but that’s also what makes it exciting and interesting is the complexity of medical and interventional decision making for sick patients.

I will say that IR does get a bit of the short end of the stick currently. GI doesn’t want to come in, call IR. Surgery doesn’t want to operate call IR or doesn’t want to do a procedure as an outpatient, call IR.

However as IR continues to develop their own niche and outpatient panels I think this will change when they are not dependent on the hospital for patients. But even if it doesnt change right away you can always practice more DR heavy if that’s better at a time in your life. And since Radiology is effectively a 6 year residency and fellowship anyways, you really aren’t losing out on income potential going IR even if you ended up practicing more DR for the flexibility.

 

[hopefulraddaddypls]

Day to day is very important. Sure learning about the heart is interesting, but seeing cards patients in the clinic is nauseating

 

[hopefulraddaddypls]

Getting excited about complex pathology and rare diseases is largely confined to medical school and residency/fellowship for the most part, assuming your training is done at an academic medical center. Unless you stay in academic medicine after training (which is the minority of physicians), the majority of physicians are in community practice where these you will rarely see rare conditions. So would not use this to figure out what your long-term career would like. You should try to determine whichever specialty you see yourself doing as a job on a day-to-day basis the longest; especially given the ever increasing burnout rates among physicians across the board.

Radiology tends to fit well for those who liked the pre-clinical classes more than 3rd year, and like taking tests. Lifestyle is still decent for DR given its shift-based work and not having to deal with issues associated with direct patient care like angry patients or dealing with insurance companies, and somewhat more flexibility to work from home (though telemedicine is becoming much more common now in the COVID era). However, the volumes of imaging that radiologists are expected to read have gone higher and higher, and now of course hospitals imaging 24-7 so someone will have to work nights and weekends. Also medico-legally there's very little room for error so you can't ever have a bad day and BS your way though any study. Both pay and training time right now are comparable to the higher paid IM subspecialities (6 years usually after med school, with pay comparable to GI, cards, and heme/onc) though there's a high chance that with the rapid expansion of AI the job market will take a big downturn by the time you finish training.

IM +/- subspecialities probably offer a mix of everything including patient interaction +/- pathology and procedures; if you somewhat liked your IM rotation in 3rd year more than preclinical years. You have to deal with the usual headaches of direct patient care, and unless you are strictly a hospitalist (whether general IM or subspecialist hospitalist) you have to deal with the challenges of running an outpatient practice as well like floods of inbox messages, prior auths with insurance, overnight call which are all common contributors to physician burnout. As patient-facing specialties (and they "own" the patient in the outpatient setting), they are also much less prone to job disruptions from AI technology; however, the rapid rise of midlevels is a whole other issue.

wrong

 

[Ho0v-man]

Most people could do multiple specialties and be satisfied. There’s not one specific specialty anyone is destined for or whatever. Liking something else doesn’t mean you can’t like something more.

I’m in rads and laugh at the thought of ever doing IM or a subspecialty despite liking all the stuff you describe.

 

[Maybedoc1]

Thanks everyone for taking the time to reply. I’m glad to see that I’m not the only one who felt similar and it seems like practically all of you are happy with radiology.

 

[Maybedoc1]

Challenge with interventional radiology is the emergent nature of the field. It requires taking a lot of call and dealing with a lot of patients that are hemorrhaging such as post partum, GI bleed, epistaxis, hemoptysis, spontaneous RP bleeds, pseudo aneurysm post Cath, trauma bleeds etc. More and more IR/VIR are dealing with DVT/PE and strokes. Not to mention more and more use of IR to stabilize patients with acute cholecystitis cholangitis, pyelonephritis, diverticular abscess, post op abscess, empyema etc. The patients interventional sees are too sick for open surgery and anesthesia (bad CHF, brittle DM, ESRD, high MELD liver disease). If your patient has a complication you have to stay there until it is sorted out and follow up on it even if you are not on call.

This is so fundamentally different from the lifestyle of a DR who can read remotely and do shift work and don't have much in the way of direct patient care.

How is the acuity and emergence (?) in IR? I actually really like acuity, emergent situations, and sick patients and would more than likely do a critical care fellowship if I did IM. Honestly a downside to DR for me is the lack of acuity that it has and while I’ve mostly gotten over it, every now and then I still wonder what if (although don’t get me wrong I’ve seen many a ED doc, trauma surgeon, and intensivist trying to get their sick patient into a scanner and the radiologist on the phone ASAP).

Prior to medical school I worked in EMS and I basically went to medical school to do EM. Along the way I also spent a lot of time on trauma surgery and considered it, but outside of emergent ex laps and the ICU, I cannot stand bread and butter general surgery. I also considered anesthesia for the emergent situations and critical care, but also decided not to do it and likewise with EM. I really do like high acuity, but I think making a career out of liking trauma activations, mass transfusion, and pressors isn’t wise and I’m trying to pick a specialty not for 30 year old me, but for 50 and 60 year old me. Now if IR offered some acuity, sick patients, and treatments, that combined with what I love about DR could be perfect for me.

 

[HuskyMD Emeritus]

Here's my biased opinion as a as a pulm-crit person. There is a lot of physiology, pharmacology, taking care of very sick patients who often can't interact with you in the ICU. There is a lot of nuance as well, such as why this vasopressor or neuromuscular blocking agent instead of the other. The ICU encompasses almost all medical specialties, so you won't miss the fun of the other specialties.
If you want less sick patients, in pulmonary, there is pulmonary function testing and cardiopulmonary exercise testing (CPx). CPx is all physiology.
You also get to read a lot of CXRs and CT scans, and get to put the findings in clinical context. While the radiologist reads and describes the findings, you get to apply them to the patient, that's where the nuance comes in as well. Over the years, I have found much that was missed by the radiologists.
In the ICU, it's not just CXRs and chest CTs, but also brain and abdominal/pelvic imaging that you have to read and interpret. Often, you see the studies before the radiologist do. You also get to do the ultrasounds and echocardiograms.
IR is important, I rely on my IR colleagues often, but it's you who will be sending them the patients, and you who will manage their complications.