Go into an IM subspecialty.
You haven't stated specifically what it is that draws you towards nuc med, that is, what specifically about nuc med appeals to the "heart". It sounds like you want to use nuc med as a springboard into cardiology.
Nuc med might give you a slight edge when applying to cardiology (better to ask on the cardiology board though). It doesn't make sense to spend two years of your life trying to get a slight edge. However, it is important to understand that due to recent changes in reiumbursement, nuclear cardiology is far less profitable in the outpatient cardiology setting, and as a result, many cardiologists have simply sold their practices and work for the hospital. Without the profits from technical fees, I suspect cardiologists will find doing nuclear cardiology far less attractive.
There is one simple fact - nuclear medicine is part of radiology in vast majority of institutions. No radiology practice, whether private practice or academic, would hire a non-radiologist over an equally qualified radiologist. The only reason pure nucs has some jobs in academics is that radiologists do not want these positions, they go into private practice where the income is higher. Very few radiologists would even consider a VA nuc med position because of the low pay. On the most fundamental level, you would be trying to enter a specialty where the majority of the clinical work is controlled by ANOTHER specialty,and your potential work consists in doing what the other specialty doesn't want to do. Common sense should tell you that is not a good idea.
Being an internist will not make much of a difference, it is really more helpful in terms of having a fallback. IM nuc med people do tend to be stronger in my experience than straight med school people though. The thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research.
Dear Dr. heidegger1:
Wow, great analysis. Everyone who wants to pursue nuclear medicine, regardless of background, should read this.
Any doubt, question, hesitation, unreal speculation should be solved.
I do disagree with one argument.Quote: "the thing that would help the most - which it doesn't sound like you have - is a PhD which would allow you to do high level molecular imaging research."
Nobody is doing a medical residency just simply for a high level research. A Ph.D. is more than enough, to me.
Dr. heidegger1, thanks again for your great insights and contribution to this open discussion.
-------
To
md2456:
I want to discuss on two issues:
1. We do see people win lottery. By mathematics, that is small probability event. By its definition, it is considered it will never happens practically.
2. Nuclear medicine is very boring, if you do it as pure nuclear physician. One reason that it is boring is it is probably the easiest specialty. Of course, if you have a stable job with good pay, that is good thing. The reality is nobody is going to hire you to do simple and easy things with big pay.
The academic centers do hire. But to me, the trend is they want to hire dual board certified radiologist too. You can check recent John Hopkins, Emory's, University of Coloroda,'s nuc med job ads. I believe Emory's ad is still alive.
Another issue concerns me is how stable the job is even if you get a nuc med job. I really doubt that. The technology advances so fast. The nuc med residency doesn't prepare you for that, based on what I know. Just like Dr. heidegger1 said, the knowledge base is not that great in Nuc, practically.
I don't know how you figure out that nuc med is very interesting. It may look like. But it is not. It consists of imaging part, nuclear cardiology, treatment part, research part. Imaging part is mainly dominated by radiology. The patient volume is going down, at least here. They cut tech and physician positions dramatically. I don't want to tell you how many the nuc physician read daily. But it is far less than the number that the radiologists do in the same institution. You may not know that nuc exams are very very very easy to read, per my personal experience. The treatment part really doesn't create job for nuc physician. I heard the endocrinology is taking over. The nuc cardiology(stress test) is controlled by cardiology in many states. PET/CT is very interesting. But it mainly falls into radiologist's hands. Now you should know how much is left for you. It is interesting specialty. But what falls in your hand is really not. Research is never exciting for US medical students.
Probably it will survive as an independent specialty. But by my opinion, it should be only for people who don't have choice, or who is desperate, or who have backup plan and do it as hobby, or who plan well and take it as a step stone knowing the risk, or who is naive, like me.
-------------------------
Sorry, shouldn't say this much.