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  • Career path related question!!

    Posted by rauscher_626 on December 2, 2020 at 7:16 am

    I am currently a R2 who enjoys procedures and diagnostic aspects of radiology. Due to high volume and complex IR cases exposure I have been exposed good IR as well. Most of the body IR procedures are done by IR at my hospital.

    Now, trying debate IR vs Body IR or even mammo as fellowship as I enjoy procedures. I am more big of fan of body IR kind of procedure and bread and butter IR. We dont have high level mammo exposure.

    If I plan to practice in private setting mostly, which fellowship will be advantageous?

    Appreciate any advices! Thank you.

    ljohnson_509 replied 3 years, 5 months ago 14 Members · 26 Replies
  • 26 Replies
  • JohnnyFever

    Member
    December 2, 2020 at 7:58 am

    If you can do body procedures and breast, you will be marketable. You could do one of those as a fellowship and try hard to train up in the other during residency.

    IR only if you want to do lots of high level cases and don’t mind call

    • btomba_77

      Member
      December 2, 2020 at 8:45 am

      I tell everyone 
       
      “If you actually like breast, do breast.”
       
      You can become a mamms diva and get a no weekends no call gig.

  • ruszja

    Member
    December 2, 2020 at 8:50 am

    Quote from DBZGK

    If I plan to practice in private setting mostly, which fellowship will be advantageous?

    Depends on the size of the practice you want to be in. Larger groups tend to be fully subspecialized. If you have a ‘left wrist’ fellowship, that’s what you read. In a smaller group practice the member who can go from a MR guided breast biopsy to a US liver biopsy, remove a chest tube and go back to a mixed stack* of shoulder MRs and C/A/P from the cancer center is king.
     
     
     
     
     
     
     
     
    * [size=”1″]use of the word ‘stack’ betrays the fact that I am old and still visualize workload in the shape of a stack of folders sitting on a cart next to your workstation. By the thickness of individual folders, you had a good idea whether it would be a day of oncology and failed back surgeries (thick folders) or screening CXRs from the state prison (thin folders).[/size]

    • Unknown Member

      Deleted User
      December 2, 2020 at 9:23 am

      Agree with above.

      Breast imaging is easier than IR.

      whatever you choose, prepare yourself to read everything, OB ultrasound, CT temporal bone, MRI wrist, etc.

      That willingness opens up the doors for more job opportunities when you job hunt, and is easily the difference between being able to live on the area you want vs. not. And living where you want is a big deal for your happiness IMO.

      • zoranaciricmd_377

        Member
        December 2, 2020 at 9:54 am

        Id recommend body with ability to learn ct and us procedures as well as read mr abdomen and pelvis well.

        Then do 3 months extra mammo in 4th year. Thats enough to build on IMO.

        The more versatile you are the better. This is for small to medium pp though. Large practices likely will be subspecialized so it may not matter. I think above route offers most options. Good luck

        • forgottenegao_866

          Member
          December 2, 2020 at 11:05 am

          Here is my two cents for what is worth (full disclosure I am an IR myself)

          I would do IR if that is the only thing you can see yourself doing. IR is a rapidly evolving specialty and starting to make a name for itself. There maybe a time in the not so distant future where IR is no longer a part of dx or are separate divisions( not here to start a war over this just stating a on going reality within the IR realm)

          Otherwise I would do something that lets you do lite procedures like mammo( only if you like breast) or do body somewhere that does bx abscess drains etc.

          My two cents for what its worth.

          • Unknown Member

            Deleted User
            December 2, 2020 at 4:50 pm

            Breast Imaging is like a homely woman
             
            Who nobody wants at first glance
             
            But once you know her, you see her real beauty
             
            Even rocket science is not rocket science, but let’s be honest
             
            Breast Imaging *truly* is not rocket science

            • rauscher_626

              Member
              December 3, 2020 at 6:48 am

              Thank you everyone for advice! I am not keen on big IR cases or calls so looks like that will be out of choice. Will do pros n cons for bodyIR and mammo. Meanwhile, gotta learn everything 🙂

              • Unknown Member

                Deleted User
                December 3, 2020 at 9:35 am

                Body fellowship is a good choice. Good interaction with clinicians, diversity of pathology and modalities and light procedures on the side. 

                • ruszja

                  Member
                  December 3, 2020 at 10:28 am

                  Is Body now ACGME accredited ? If not, you may be able to fashion something like 9 months of body with 3 months of mammo. We had some people join who did those kinds of hybrids, Body+Nucs and Body+,peds iirc.

                  • Unknown Member

                    Deleted User
                    December 3, 2020 at 10:56 am

                    If not interested in angio, then do body with as much body IR as possible. Breast procedures are very basic and easily assimilated, and mammo interp can be learned in a few months.

                    Would still consider IR, and then work as a generalist with IR skills. Many lovely small or midsize university towns have PP wherein you can become invaluable with those skills.

                    • mthx9155

                      Member
                      December 3, 2020 at 11:39 am

                      Speaking from the perspective of an IR-trained rad who also by choice reads and does mammo procedures (group doesn’t require me to read mammo):
                       
                      Mammo has the best job market amongst radiology subspecialties, but that is primarily due to difficulty in finding rads with a specific interest in reading and doing mammo procedures. In terms of actual difficulty of material, it is probably one of the easier ones for a non-fellowship trained rad to pick up. 
                       
                      If you find doing majority or even full-time mammo okay, then from a job market standpoint, it’s a no brainer to do a mammo fellowship. Many groups, even in some of the most competitive geographic areas, are frequently looking for mammo-trained rads. Problem is, the majority of rads I think would not miss mammo much if they no longer had to read it. 
                       
                      IR is the better choice if you absolutely must have some procedures as a routine part of your job outside of mammo-specific procedures. But you also have to be prepared to accept not just doing procedures, but all the clinical management and decision-making that comes along with it. Waking up at 2 am to do an emergent trauma embolization is only one small part of it. You will have to be okay with other clinicians constantly interrupting your workflow to ask if a biopsy or abscess drainage is possible, if a GI bleeder needs an angio or some other study, or if you can do anything for that patient with ischemic rest pain in their legs. You will also have to accept as part of your lifestyle the last-minute 4 PM emergent consult that end up keeping you 2 hours past the end of your shift. Many IRs will tell you that doing the actual procedure is the easy part; the difficult part of IR is in the clinical decision-making and management. Practice-building is another difficult part of IR if you join a group with a relatively fledgling IR division, but I’ve been fortunate in joining a group that already has an established referral pattern for everything from PAD to interventional oncology to fibroids etc, so I haven’t had to worry about that part as much. 
                       
                      I love all procedures, both big and small, from the humble paracentesis to the TIPS, and I love being able to do something about the images I read, so it was a no brainer for me to go the IR route. But personalities differ, and many rads love primarily reading and not having to deal with the headaches of clinical management and decision-making and uncertainties of schedule, let alone the procedure itself. 

                    • Unknown Member

                      Deleted User
                      December 3, 2020 at 4:11 pm

                      As a generalist who has done lots of different modalities and procedures during my career including full gamut of breast imaging and some vascular IR, I have heard for over 20 years from other radiologists that mammo is the easiest subspeciality in radiology to do. But when it comes to practice, it is one of the hardest modalities that you can convince people to do. 

                      So practically radiologists claim that mammo is the easiest thing to do but FOR OTHER RADIOLOGISTS and NOT FOR THEM. 
                       
                       
                       

                    • Unknown Member

                      Deleted User
                      December 3, 2020 at 5:27 pm

                      Quote from Hospital-Rad

                      As a generalist who has done lots of different modalities and procedures during my career including full gamut of breast imaging and some vascular IR, I have heard for over 20 years from other radiologists that mammo is the easiest subspeciality in radiology to do. But when it comes to practice, it is one of the hardest modalities that you can convince people to do. 

                      So practically radiologists claim that mammo is the easiest thing to do but FOR OTHER RADIOLOGISTS and NOT FOR THEM. 

                      Agree with this. My previous post above saying that breast imaging is not rocket science is not to disparage breast imagers or the practice of breast imaging. I’m Harvard trained breast imager myself and my perspective is that of someone who has been doing around 50% mammo for the past 10 years. Personally , I feel that it’s easier than IR, which I don’t do.  

                    • Unknown Member

                      Deleted User
                      December 3, 2020 at 4:13 pm

                      Quote from qxrt

                      Speaking from the perspective of an IR-trained rad who also by choice reads and does mammo procedures (group doesn’t require me to read mammo):

                      Mammo has the best job market amongst radiology subspecialties, but that is primarily due to difficulty in finding rads with a specific interest in reading and doing mammo procedures. In terms of actual difficulty of material, it is probably one of the easier ones for a non-fellowship trained rad to pick up. 

                      If you find doing majority or even full-time mammo okay, then from a job market standpoint, it’s a no brainer to do a mammo fellowship. Many groups, even in some of the most competitive geographic areas, are frequently looking for mammo-trained rads. Problem is, the majority of rads I think would not miss mammo much if they no longer had to read it. 

                      IR is the better choice if you absolutely must have some procedures as a routine part of your job outside of mammo-specific procedures. But you also have to be prepared to accept not just doing procedures, but all the clinical management and decision-making that comes along with it. Waking up at 2 am to do an emergent trauma embolization is only one small part of it. You will have to be okay with other clinicians constantly interrupting your workflow to ask if a biopsy or abscess drainage is possible, if a GI bleeder needs an angio or some other study, or if you can do anything for that patient with ischemic rest pain in their legs. You will also have to accept as part of your lifestyle the last-minute 4 PM emergent consult that end up keeping you 2 hours past the end of your shift. Many IRs will tell you that doing the actual procedure is the easy part; the difficult part of IR is in the clinical decision-making and management. Practice-building is another difficult part of IR if you join a group with a relatively fledgling IR division, but I’ve been fortunate in joining a group that already has an established referral pattern for everything from PAD to interventional oncology to fibroids etc, so I haven’t had to worry about that part as much. 

                      I love all procedures, both big and small, from the humble paracentesis to the TIPS, and I love being able to do something about the images I read, so it was a no brainer for me to go the IR route. But personalities differ, and many rads love primarily reading and not having to deal with the headaches of clinical management and decision-making and uncertainties of schedule, let alone the procedure itself. 

                       
                      Good perspective.

  • william.wang_997

    Member
    December 3, 2020 at 6:34 pm

    If you end up in a subspecialized group, IR will be doing your body biopsies. If you like breast, choose breast. Especially since you don’t like calls.

    • JohnnyFever

      Member
      December 3, 2020 at 7:12 pm

      IR would be thrilled to offload body procedures in a subspecialties group. You don’t put up with IR call and training to do paracentesis

      • ruszja

        Member
        December 3, 2020 at 10:14 pm

        Quote from RoleCall

        IR would be thrilled to offload body procedures in a subspecialties group. You don’t put up with IR call and training to do paracentesis

        Just depends on the group. In some groups much of the body stuff is done by general rads. In others, IR does anything involving pointy objects.

        • afazio.uk_887

          Member
          December 3, 2020 at 10:33 pm

          Mammo gets a negative rap but imo it is one area where we can make a MASSIVE impact on a persons life, and the life of their entire family. Its important work and most people who denigrate it likely have never had a family member or friend deal with a BC diagnosis or see them go through chemo. Its horrible stuff and its certainly an area where us Rads can make a big impact.

          • Unknown Member

            Deleted User
            December 4, 2020 at 6:43 am

            True, but this is highlighted because of massive marketing. Youll make the same huge difference with imaging of other malignancies.

            • Ali.zavareh

              Member
              December 4, 2020 at 3:10 pm

              I did a 6 month mini breast fellowship and a 1 year MSK fellowship. I do about 30-40% breast currently and its a great fit for me. Makes me feel like an actual doctor many days, speaking with patients, interacting with surgeons/rad oncs, etc. I did the mini to make myself marketable but it has ended up bringing me personal fulfillment above my expectations. Probably doesnt go that way for everyone. Just my experience

              • afazio.uk_887

                Member
                December 4, 2020 at 3:21 pm

                If you talk with women who have been dx with BC and gone through it all they often remember their encounters with their Radiologist, especially if it was a positive experience during a time of extreme stress and anxiety for them. This is one of the few areas of rads where we can make such an impact on a patient directly and I think its a good thing for our field in general.

                • rauscher_626

                  Member
                  February 21, 2021 at 8:51 am

                  Great insides everyone. Thank you. Our residency experience is subpar. We get good exposure to body IR portion. I feel like my weak point will be body MR and mammo and also MSK at some point.

                  Can anyone comment on liability issuses with mammo? I heard they get sued more?

                  • consuldreugenio

                    Member
                    February 21, 2021 at 10:50 am

                    All subspecialty gets sued. ED, mammo, MSK (missed fractures) etc all take a hit. Mammo can somewhat be hidden with proper wording

                    • ljohnson_509

                      Member
                      February 21, 2021 at 11:49 am

                      Getting sued is rare and it often is bs. Dont let that influence what you do. Doing mammo doesnt raise my insurance rates if thats worth anything.

            • consuldreugenio

              Member
              December 4, 2020 at 3:16 pm

              Body fellowship. Can do mammo mini fellowship R4 year, its all you need. Just make sure you get first operator experience in all mammo procedures, including mri breast biopsy. That was basically the route I took and I do mammo without any issue.

              With the body fellowship, you will be way more ready for call, if you join a private practice. There may be too much rust with mammo fellowship route. Plus being a body oncology expert holds weight. Oncologists are just that good interpreting ct imaging. Urologists and surgeons are not confident with prostate and rectal mr.