at x-rays, and steering clear of patient contact. Let's debunk the public perception myths

of what it means to be a radiologist, and give it to you straight. This is the reality

of radiology.

Dr. Jubbal, MedSchoolInsiders.com.

Welcome to our next installment in So You Want to Be. In this series, we highlight a

specific specialty within medicine, such as radiology, and help you decide if it's a

good fit for you. You can find the other specialties on our So You Want to Be playlist. If you

want to vote in upcoming polls to decide what future specialties we cover, make sure you're

subscribed.

If you'd like to see what being a radiologist looks like, check out my second channel, Kevin

Jubbal, M.D., where I do a second series in parallel called a Day in the Life. We'll

be doing a Day in the Life of a Radiologist soon.

When a patient comes in with a specific complaint, unless that problem is skin deep, you can't

actually see what the problem is with your own eyes. For example, only a few causes of

the commonly presenting complaint of abdominal pain can be diagnosed with just history, physical

exam, and lab tests.

Fortunately, the field of diagnostic radiology exists, whereby we can use powerful machines

to visualize what is occurring inside the body. Radiologists are experts in interpreting

these images and leverage the power of these machines to both diagnose and treat disease.

Imaging modalities are used by most physicians in most specialties. Any time a non-radiologist

physician orders an imaging study, a radiologist will analyze the images and provide their

assessment, which helps the ordering provider guide the appropriate care to the patient.

But radiology isn't just about reading images. Some radiologists use these imaging technologies

to improve the precision of certain procedures. For example, a suspicious mass in a patient's

kidney can be sampled through an ultrasound-guided needle biopsy, rather than surgical excision.

And while the common stereotype suggests radiologists are shy, socially awkward, don't like talking

to people, and just sit in a dark room all day, that's far from the truth. Radiologists

aren't isolated and sitting by themselves in reading rooms. While not as high energy

as the hospital floor or operating room, physicians regularly visit or call the reading room for

assistance with their patients. And because radiology is a comparatively low-acuity field

compared to other specialties, reading rooms are often laid-back and jovial in nature.

But radiologists' work isn't confined to just reading rooms. While most spend their

time in reading rooms, they can also perform several procedures, ranging from life-saving

procedures such as embolizing or ablating cancers with radiation-infused particles,

to management-defining procedures such as taking a biopsy of a mass in deep areas of

the body that no scalpel can safely reach.

There are a few ways to categorize radiology.

Thanks to a flexible job market, radiologists can choose to be more reading-room focused

or patient-facing.

Non-procedural radiologists choose to spend the large majority, if not all, of their time

in the reading room.

On the other hand, you can choose to be heavily procedural, as every subspecialty within radiology

involves procedures and provides the opportunity to be patient-facing either in the procedure

suite, at the bedside, or in clinic. Procedures are particularly common amongst breast radiologists,

interventional radiologists, and musculoskeletal radiologists.

As an academic radiologist, your responsibilities will include a combination of reading films,

teaching residents, and conducting radiology-related research. Many academic radiologists also

have their own clinic where they evaluate and manage patients. Your clinical duties

will generally be at a slower pace compared to private practice to accommodate time for

teaching, research, and clinic.

In private practice or community based practices, the large majority of your time will be spent

in the reading room and your primary responsibility will be in completing reads of imaging films

in an accurate and timely manner. You'll be spending less time performing procedures

related to your subspecialty training.

After four years of medical school, radiology residency is a total of 5 years. The first

year, or the intern year, is either a preliminary or transition year, whereby you obtain clinical

training focused on various internal medicine or surgical rotations. This internship is

often performed at a different institution. The subsequent 4 years are dedicated to your

radiology training.

This means as a PGY-1, or post-graduate year 1, you'll be an intern, and as a PGY-2,

you'll be in your second year out of medical school, but in your first year of radiology

training, or R-1.

We call these “advanced” programs, as they provide training beginning with your

PGY2 year. Other specialties that include advanced programs are anesthesiology, ophthalmology,

radiation oncology, and dermatology. Most other specialties include “categorical”

residency programs, whereby you spend your entire training period at one institution,

and begin training in your intended specialty in the first year. For example, when I was

in plastic surgery residency, it was a 6 year program all at one institution, and I had

plastic surgery exposure even in my first month.

Diagnostic radiology is middle of the pack in terms of competitiveness, with an average

Step 1 in recent years around 240 and an average Step 2CK in the mid to high 240's. From

our competitiveness comparison table, radiology ranks at 14 out of 22. If you go directly

to an interventional radiology residency program, it's a bit more competitive, with average

Step 1 in the mid 240's and an average Step 2CK in the mid 250's. Considering board

scores and other factors from the NRMP official data, this places interventional radiology

at 7 out 22 in terms of competitiveness.

Medical students that typically apply to radiology are friendly, laid-back, and humble individuals

who understand the importance of work-life balance. These are also often the intellectual

and curious students, as diagnostic radiology is heavy on thinking and light on the clinical

application of medicine. If you enjoyed your preclinical years of medical school more than

your clinical years, you may prefer the intellectual aspect of medicine.

After radiology residency, you can subspecialize further with fellowship, all of which are

1 year in duration, except for IR.

Interventional radiology, or IR for short, is the most procedure-heavy radiology subspecialty.

Procedures are minimally invasive, performed using wires and catheters. You can cure cancers,

stop life-threatening hemorrhage, salvage critical limbs, and reverse disabling genitourinary

conditions through an incision merely centimeters long.

This is the busiest and fastest-paced of the radiology subspecialties. While you can do

this as a 2 year fellowship after completing your radiology residency, you can also directly

go into an integrated interventional radiology residency after medical school, which is a

6 year path.

Neuroradiology is for those who are highly intellectual, have a passion for learning,

and are driven by curiosity. The job of a neuroradiologist is to diagnose pathologies

involving the brain and spinal cord and guide clinical decision-making. Diagnosing strokes

is one of the most important responsibilities. You can additionally pursue a neurointerventional

fellowship afterwards if you are interested in more procedural interventions with the

brain and spinal cord.

Breast radiology is heavily patient-facing, whereby you'll hold clinic performing mammograms

and biopsies on primarily female patients. If you find a cancerous lesion, you'll refer

to hematology, oncology, or surgical oncology for the next steps depending on the type of

cancer.

This has the best lifestyle of all the radiology subspecialties, as there are no breast emergencies

requiring overnight call.

Pediatric radiology is for those who enjoy the pathology of pediatrics but not necessarily

the clinical aspect. The pathology in this patient population is unique, including intussusception,

whereby the colon telescopes on itself, and as a pediatric radiologist, you'll be administering

the air enema for treatment. You'll also see manifestations of rare congenital diseases,

more so than just about any other field.

With MSK radiology, your responsibilities will revolve around sports medicine and orthopedics

in both diagnosis and management. As a result, you'll be working side by side with the

orthopods. It's a highly procedural field, with joint injections for pain, joint aspirations

for diagnosis, and kyphoplasties to treat vertebral fractures.

Body imaging and MRI is the work-horse of radiology and the backbone of the hospital.

These are the experts in cross-sectional imaging, meaning CT, MRI, and ultrasound, to diagnose

diseases found in the chest, abdomen, and pelvis.

This is a procedure heavy subspecialty, with biopsies, drainages, aspirations, cancer cryoablations,

and cancer radiofrequency ablations.

There's a lot to love about radiology. Radiology is one of the ROAD lifestyle specialties,

standing for radiology, ophthalmology, anesthesiology, and dermatology. It's not hard to maintain

a good work-life balance, and you'll be well compensated for your work, making an

average of $427,000 per year.

As more specialties are relying less on the physical exam and more heavily on imaging

to make a diagnosis or monitor a disease, your input is crucial, and you'll know you're

making a difference and that your voice is being heard.

Given the lower acuity work environment, the atmosphere is lower stress, and colleagues

are more amicable and collegial compared to higher stress specialties.

You may not appreciate this now, but you certainly will the farther along you are in training

– there's less nonsense and bureaucratic sludge to work through. Your daily tasks as

a radiologist have a direct impact on patient outcomes, whether it's helping to diagnose

a disease or provide an intervention. As a consultant, you won't have to deal with

the difficulties of healthcare delivery such as arguing with insurance, sorting out patient

disposition, meaning where they go after they are discharged from the hospital, dealing

with non-compliant patients, or pleading with consultants to evaluate your patient.

Lastly, radiology is an innovative field, and you'll be able to play with new toys

and gadgets. While some are afraid of artificial intelligence replacing the job of radiologists,

it will likely augment and make their job easier rather than outright replace them.

While radiology is a great field, it's far from perfect. You won't be on the receiving

end of gratitude from patients after making the critical diagnosis that allows the primary

physician to best manage them. This is because as a radiologist, you are less commonly seeing

patients in person, but rather remotely through images. If you crave patient interaction or

continuity, radiology won't be able to provide these elements.

Just like its name implies, diagnostic radiology is all about identifying the problem. Much

less often are you the one fixing the problem, as that's the ordering physician's responsibility,

unless you're in interventional radiology. If you like the satisfaction of being the

one to solve the problem or treat the disease, diagnostic radiology may not be able to provide

that for you.

And while the stereotypes that radiologists are introverted and awkward are not necessarily

true, they're unfortunately pervasive in the public eye.

How can you decide if radiology is a good field for you? Those who thrive and are happiest

in the field tend to be curious and enjoy the intellectual aspect of medicine. If you

like puzzles, radiology is essentially that – the diagnosis is right in front of you,

and you simply have to piece together the information to find it.

If you value work-life balance with time outside the hospital and high compensation, you can

have your cake and eat it too with radiology. But make sure you enjoy the day to day of

what radiologists deal with – namely, reading images, which may leave some of the more outgoing

or adrenaline-fuelled individuals feeling unfulfilled.

If you have a big ego, radiology may not be for you. You have to be okay knowing that

you'll often be underappreciated, with many patients not necessarily knowing you were

involved in their care, but your non-radiology physician colleagues will find your help indispensable.

Big shout out to the radiologists at Med School Insiders that helped me in the creation of

this video. If you'd like to work with one of them one-on-one and bolster your application

as a future medical student or radiologist, visit MedSchoolInsiders.com to learn more.

Thank you all so much for watching. If you enjoyed this video, check out our So You Want

to Be playlist, where you can find the three other ROAD specialties, namely ophthalmology,

anesthesiology, and dermatology. Much love, and I'll see you guys in that next one.