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Analyze this: Radiology rewards problem solvers

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Radiology ties with orthopedic surgery as the top-paying medical specialty, with radiologists earning an average income of $315,000 a year, according to a 2012 Medscape survey. But no one should pursue radiology primarily for the pay, caution leaders in the field.

“Those who choose the specialty based on money will be disappointed,” says George E. Erbacher, DO, the immediate past president of the American Osteopathic College of Radiology (AOCR).

First, reimbursement for radiologists is declining as the U.S. health system shifts toward a payment model that emphasizes primary care. Between 2010 and 2011, radiologists’ compensation decreased by 10%, the Medscape survey notes.

Second, requiring many years of training, radiology is one of the most demanding specialties. Students match into a linked internship in their fourth year of medical school followed by a four-year diagnostic radiology residency. Most radiologists then complete one or more fellowships in such subspecialties as interventional radiology and pediatric radiology or in specific imaging processes and anatomical areas.

Interventional neuroradiologist Wade Wong, DO, for one, served three fellowships beyond his diagnostic radiology residency: two years of neuroradiology, two years of interventional radiology and one year of interventional pain management.

Third, radiologists put in long hours, so this is not the best specialty for those who seek work-life balance, despite the norm of six to eight weeks of paid vacation a year. Most diagnostic radiologists have a 10- or 12-hour work day, work some weekends and take call. Interventional radiologists work even more, says Dr. Wong, who has experienced many nights with little sleep during the course of his decades-long career.

“For many years, it wasn’t unusual for me to have a 12- to 14-hour day, then be on call and have to get up in the middle of the night for a patient who had a brain stroke,” points out the AOCR’s president-elect. “And often I’d be up the rest of the night and have to work a full day the next day.”

But radiology is richly satisfying for those who love to solve problems, make differential diagnoses, and advise other physicians on treatment options. And interventional radiologists, who have considerable contact with patients, are at the vanguard of using noninvasive procedures to combat cancer, life-threatening blood clots and other disease processes.

“We’re the doctor’s doctor,” says Dennis P. Vollman, DO, the director of the AOA-approved diagnostic radiology residency at Garden City (Mich.) Hospital. Constantly interacting with physicians of different specialties, writing report after report, radiologists need excellent oral and written communication skills. Even diagnostic radiologists spend time with patients when doing procedures, so interpersonal skills, compassion and empathy are important.

Dr. Saenz

Diagnostic radiologists like Rocky Saenz, DO, spend time performing procedures, such as CT-guided biopsies, and interacting with patients. (Photo courtesy of Dr. Saenz)

As for cognitive traits, individuals with a strong science background and top-notch analytical abilities tend to do better in radiology, Dr. Vollman says.

Radiology appeals to detail-minded individuals who like detective work, notes Dr. Wong. “You need a good understanding of anatomy and curiosity about what makes the body tick,” he says.

Visual acuity—the knack for finding the proverbial needle in a haystack—is crucial for radiologists, adds Rocky Saenz, DO, who directs the AOA-approved diagnostic radiology residency at Botsford Hospital in Farmington Hills, Mich.

For example, when magnetic resonance imaging (MRI) is used, a radiologist may look at more than 1,000 images of an anatomical area, of which only two show any abnormalities. “And those two images may have just one little spot on them that is abnormal,” Dr. Saenz says. Medical students who as kids could easily find the bespectacled namesake of the Where’s Waldo? books may have sharp enough eyes for this specialty, he says.

Fierce competition

Diagnostic radiology is one of the most competitive specialties. With roughly 35 funded positions each year in 14 AOA-approved residency programs, the number of slots falls far short of demand. Most programs have dozens of applicants per position.

“On average, we get between 70 and 100 applications for one or two positions a year,” says Garden City Hospital’s Dr. Vollman. Botsford Hospital receives approximately 100 applications for its three annual radiology openings.

Slightly more than half of DO radiology candidates enter diagnostic radiology programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), of which there are more than 180. Many of these programs are much more competitive than the AOA-approved programs. For example, the University of California San Diego Health System has as many as 1,500 applicants for eight radiology residency positions a year, says Dr. Wong, who is the system’s chief of neurointerventional spine radiology and previously served on its radiology resident selection committee.

To maximize their chances of matching into an AOA-approved or ACGME-accredited radiology residency, many osteopathic medical students take the United States Medical Licensing Examination as well as the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)—USA. High board scores are a must for radiology applicants.

Osteopathic medical students who matched into diagnostic radiology as their first-choice specialty in 2011 had an average score of 574 on Level 1 of COMLEX-USA and 543 on Level 2-Cognitive Evaluation, while 100% passed Level 2-Performance Evaluation on the first attempt, according to Osteopathic GME Match Report—For the 2011 Match.

Garden City Hospital requires that all candidates for its radiology slots score at least 500 on COMLEX-USA Level 1 and be in the top half of their class, Dr. Vollman says. Applicants who make that cut receive points based on their scores, class rank, letters of recommendation, personal statement and community service.

“I consider community service important because I want to see that applicants are well-rounded people and team players,” Dr. Vollman explains. “Are they going to raise the boat of the residency, or are they going to be off on their own in a life raft?”

Dr. Saenz

“We’re looking for caring, compassionate, excellent clinical physicians,” says George E. Erbacher, DO, the program director of the interventional radiology fellowship at Oklahoma State University Medical Center in Tulsa. (Photo courtesy of Dr. Erbacher)

In 2011, 96% of radiology candidates who matched into AOA-approved programs had volunteer experience, with an average of six volunteer activities per candidate, according to the Osteopathic GME Match Report.

Research experience is important for students who hope to match into competitive ACGME-accredited radiology residencies such as the one at University of California San Diego Health System, Dr. Wong says.

But for AOA-approved diagnostic radiology programs, research experience holds less weight than volunteer experience. In 2011, 65% of applicants who successfully matched into osteopathic radiology programs had research experience. These candidates had two separate research experiences on average.

At Botsford Hospital, a panel of three attending radiologists vets the radiology residency applications. “I have one attending who spends all of his time on the personal statements,” Dr. Saenz says. “If a personal statement has a grammatical error, he will tell me not to invite the applicant for an interview, even if the applicant has high board scores and grades. Writing skills are important because of all the reports diagnostic radiologists write, and attention to detail is essential in all that we do.”

3 Responses

  1. Richard Lynch on Feb. 1, 2013, 4:34 p.m.

    People trying to decide on Radiology need a good background in clinical medicine first. This will assist greatly in dealing with patients and clinicians.
    Those trying to decide on Radiology as a career need to realize it is a 4 year residency and cover s11 major topics which one will be tested on for certification. It takes a lot of studying,reading a lot of varied films during your residency, and trying to do your best on every rotation to make you a complete radiologist.The physics part of Radiology is crucial to learn about radiation safety to your patients and you.
    I have practiced both Diagnostic Radiology and Interventional Radiology for 40 years and loved every minute of my practice of Radiology.Go for it is a great specialty!!

  2. Residency: Prepare Early on Feb. 14, 2013, 11:54 a.m.

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  3. Pat on May 11, 2013, 1:31 p.m.


    I am currently a 3rd year DO student, and this month I am doing an elective in Radiology. I am enjoying it much more than I had expected, to the extent that I have recently contacted every osteopathic residency program in the US to try and setup 4th year electives/audition rotations. I am worried that by this point most rotation spots will already be filled. I am curious as to what happens if I do not match into a residency program, and the steps I need to take from there to get into a residency.

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