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. If you want to vote in upcoming polls to decide what future specialties we cover, make sure you’re subscribed to our YouTube channel.
So you want to be a radiologist. You like the idea of sitting in a dark room, looking 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.
What is Radiology?
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 common 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 leveraging the power of 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.
Reading Room vs Patient-Facing
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.
Academic vs Private Practice
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.
How to Become a Radiologist
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 a 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 240s. 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 240s and an average Step 2CK in the mid 250s. 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.
Subspecialties within Radiology
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 neuro-interventional fellowship afterward 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 & Body MRI
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.
What You’ll Love About Radiology
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 outpatient 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.
What You Won’t Love About Radiology
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.
Should You Become a Radiologist?
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 post. 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 our Services page.
If you’d like to see what being a radiologist looks like, check out my personal YouTube 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.