Why Every Medical Student Should Consider Radiology

“I should have considered radiology more seriously as a medical student”.  As a practicing radiologist, I have heard this phrase numerous times from various physicians. Whether earnestly proclaimed, or simply spoken in passing, I believe this message is true—every medical student should seriously consider radiology before finalizing what residency area they will enter.

It is commonplace for many radiology residency programs to see residents transfer into radiology from other residency specialties.  To leave any residency program early to switch into another speciality is not easy, and such decisions are not made lightly. Thankfully, I have not yet witness any resident who transferred into radiology end up regretting this decision.

To be balanced, I have (on two occasions) seen radiology residents transfer out of radiology as well—one leaving for psychiatry and the other to pursue internal medicine and pulmonary critical care.  Nonetheless, from my own experience, the number of transfers into radiology far exceeds the number of transfers out of radiology.

This points to a potential lack of appreciation for radiology during medical school that prevented these residents from selecting radiology in the first place. Radiology is a subspecialty that every medical student should seriously consider.  Here are some reasons I believe this is true:

1. Radiology is one of the most adaptable specialties in medicine.  

A career in radiology can be adapted to fit many areas of interest and nearly any desired lifestyle. If a medical student’s primary interest from an organ-group or disease perspective is neurological, oncological, musculoskeletal, gastrointestinal, pediatric, women’s health, urological, emergency/acute care, or cardiovascular diseases, radiology has a subspecialty tailored to fit that interest through subspecialty training.  Do you like procedural work?  Radiology has that covered, whether through diagnostic radiology (diagnostic radiologists perform many procedures) or interventional radiology.  Do you like the idea of being more general and seeing a very broad spectrum of diseases?  No problem in radiology for those who enter a more generalist job in private practice.  Are you interested in unraveling the mysteries of diseases like Alzheimer’s disease or autism, finding ways to beat cancer, or contribute to our collective understanding of nearly any disease?  You can research almost any area of medicine in academic radiology.  Do you like being involved with the care of the most complex patients in your healthcare system?  For patients with complex diseases it is nearly assured that radiology will be heavily involved. Are you interested in Healthcare Informatics? If so, radiology is a great fit.

Oh yeah, do you like patient contact?  No worries (for real). Radiology can help here too. 

2. Radiology can offer patient contact. Conversely, if you don’t like patient contact radiology can help there too.

It is an extremely common misconception that radiologists do not see patients.  I personally attest that this is false.  I am a radiologist—and I see A LOT of patients on a regular basis, primarily because I am a breast and nuclear radiologist.  Other radiologists see patients on a consistent though less frequent basis and other radiologists may see no patients at all.  Regardless, radiology can provide legitimate and numerous patient interactions, particularly in breast imaging and other radiology practices with a focus on minor procedures (such as image-guided biopsies) or a heavy emphasis on ultrasound.

For example, let me discuss the professional life of a breast imaging radiologist, for which I am fellowship-trained. On the diagnostic breast imaging service, a radiologist sees. many patients per hour on service, takes a focused history, performs a targeted physical exam, uses diagnostic imaging to answer the medical question at hand, gives a medical recommendation on the most appropriate next steps of management, and performs a biopsy or other image-guided procedure when appropriate. When individuals present with findings consistent with breast cancer on imaging, a breast radiologist is the first physician that discusses this with the patient.  These are important conversations to get right and require excellent doctor patient communication.  If a finding is concerning for malignancy, a breast radiologist is trained to perform a biopsy, compare the results from pathology with the imaging findings, and then communicate the result and next steps of management with the patient, breast surgeon, and breast oncologist, if cancer is found.  Throughout this process, the radiologist is also communicating and coordinating with breast imaging technologists and breast imaging nurses to address all aspects of patient care on the breast imaging service.

What I just described is the diagnostic workflow for a breast imaging radiologist. On other days, a breast radiologist may focus on interpreting screening mammograms. These days mirror the more traditional role of “radiologist sitting alone in a dark room interpreting studies”. This variety of patient-heavy diagnostic and procedural days, intermixed with screening mammography days where one can mentally focus simply on imaging interpretation, adds variety that can be welcome during a decades-long career.  This remarkable mix of patient interaction, procedures, and imaging with mammography, ultrasound, MRI, and other emerging modalities, is what draws many radiologists to breast imaging. Breast imaging also has few off hours and weekend emergencies to address. Some breast imaging radiologists also take general radiology call on nights and weekends.  Others have little or no night or weekend work.  Therefore, breast imaging provides patient contact, procedural work, diagnostic imaging work, and can be adapted to fit a desired lifestyle.  

I also am a practicing nuclear radiologist, being dual-subspecialty trained.  Although less common than breast imaging, I see patients on the nuclear radiology service as well.  However, nuclear medicine (sometimes termed nuclear radiology as well) allows one to be a treating physician in the truest sense of the word.  I know this is contrary to popular belief that a radiologist (with the exception of interventional radiology) would treat a patient.  Yet, I it is true.  

Radiotherapies with agents like radioactive iodine, Lutetium 177 Dotatate or PSMA, Radium 223 dichloride, and other existing radiotherapeutic agents allow nuclear radiologists to treat diseases such as thyroid cancer, hyperthyroidism, neuroendocrine tumors, and prostate cancer.  PSMA theranostic agents are currently transforming prostate cancer therapy for many patients.  Many nuclear radiologists foresee a potential future for full-time work in treatment clinics to be possible.  Some academic centers already have build large nuclear medicine treatment clinics to meet current and future demand for nuclear medicine therapies. 

Additional examples of patient interactions found in radiology include but are not limited to:

-Musculoskeletal radiologists performing joint injections and aspirations and musculoskeletal ultrasound for diagnostics

-Neuroradiologist performing lumbar punctures or head and neck biopsies

-Abdominal or chest radiologists performing CT guided biopsies or fluoroscopic studies

-Pediatric radiologists reducing a child’s intussusception, performing a VCUG, or scanning a child with ultrasound for appendicitis

-On call radiologists performing various image-guided procedures such as lumbar puncture, thoracenteses or paracenteses

-Obstetric radiologists performing and discussing ultrasound findings with patients on high-risk pregnancies or overnight obstetric emergencies

-Radiologists of all sorts evaluating and treating iodinated contrast reactions during CT imaging

-General radiologists doing all of the above plus more.

-The list goes on. 

Beyond patient interaction, radiology also have a lots of other in-person interactions that are also an important part of our work. We have frequent (sometimes hourly) interactions with imaging technologists to discuss imaging related questions. Many radiologists also speak on a consistent basis with referring physicians from essentially all areas of medicine who contact us to discuss imaging results, or other imaging-based questions.  Radiologists also play an important role at most multidisciplinary tumor boards and are important members of many treatment planning conferences and care committees. 

On the other hand, you can choose a career in radiology where you will not see patients.

This is part of why radiology is SO adaptable—if you are somebody who prefers to not see patients directly, and to have minimal interactions with others following training, radiology can be adapted to make this possible. I trained with a skilled co-resident in radiology who simply wanted to work from home and be free of the frequent drop-in consultations, phone calls, and patient interactions that happen during radiology residency and fellowship training.  He accepted a teleradiology position straight from fellowship training that made this possible. He currently works from a remote cabin in the wilderness and seems very satisfied with his life and career as a physician—while never seeing patients in person or interacting face-to-face with technologists or clinicians.     

To be balanced, there are certain types of patient interaction that radiology can’t offer.  For example, longitudinal patient contact is very hard to find in diagnostic radiology, but can be found in interventional radiology.  Diagnostic radiologists typically do not round in the hospital and (at least currently) we have very infrequent phone calls or emails with patients. If you like rounding on patient wards, or like getting to know patients that you will see over many years, diagnostic radiology may not be the ideal fit.

The key message is this: if medical students do not consider radiology because radiologists “do not see patients”, they should think again. Several Radiology subspecialties offer frequent and meaningful patient encounters.   

3. A career in radiology can fit almost any desired lifestyle in medicine. 

Do you want to work full time, part time, or have the flexibility over several years to work a mix of these schedules?  Do you want to work every other week?  Do you want a career that offers plentiful vacation time? Would you rather prefer to maximize your income and work as much as possible?  Do you like the workflow and occasional excitement of evening and overnight work with corresponding acute emergencies or do you never want to work a night or weekend after you complete training?  Do you want a career that will lead to administrative and leadership/practice ownership roles, or would you rather be an employed physician with little administrative demands?  Do you want to live in urban, suburban, or rural settings?  Do you want to live and work completely off the grid (with the only major requirement being a reliable internet connection)? Do you want to work from home? Do you want to be a highly-focused subspecialist or more of a generalist?  Do you want to be part of academic medicine, find a hybrid academic-private practice, or be a non-academic private practice physician?  Do you want to conduct medical research, work with private industry, or be part of a health system IT team?  Do you want to work with artificial intelligence/machine learning?  Any of the above can be found in radiology.  Indeed, I think this speaks to radiology as being one of the most adaptable specialties in medicine.  

4. Radiology has minimal requirements for patient charting.

The potential joy that this could bring you in your life as a physician is self-evident. Although you will spend the majority of your day in front of a computer as a radiologist, you will be performing tasks that are mentally engaging and not of the busy-work/charting variety.

Even though I believe every medical student should consider radiology, clearly not all medical students should choose radiology. We need generalists, specialists and subspecialists of all types to have a diversified physician workforce.  Additionally, there are good reasons to NOT enter radiology.  But these may not be the reasons you think.  

Let’s address a few common reasons that exist to not enter radiology that are definitely NOT the best reasons:

1. “I would probably fall asleep in the dark room”.  

I assure you that radiologists do not wake up each morning and ask themselves “how am I going to stay awake today!?”  It is true that I have fallen asleep at the workstation but this has only occurred on overnight shifts, typically at around 4 AM, when there are no cases to be read.  

The practice of radiology is fascinating and your mind will be highly engaged while at work.  Note that shadowing radiologists can be boring.  I still find it boring to watch other radiologists interpret scans.  However, when you are the one interpreting an imaging study, synthesizing these findings in your mind, and creating the imaging report, your mind is highly engaged.  

2. “I want patient contact”.  

This is possibly a reason to choose a specialty other than radiology, but read above to see the types of patient contact that radiology can provide.  And consider this:  From my own experience, radiology provides some of the best patient encounters in medicine. In radiology, while recognizing that your average opportunity for patient contact is less than most other areas in medicine, there are advantages to the types of patient contact that comes our way. . 

In many other areas of medicine, patient encounters can be rushed due to unreasonable time constraints.  Radiology has patient interactions that are very focused with a quick question to be addressed, or a relatively quick procedure to be performed, and you are typically given enough time to perform these relatively quick, focused tasks.  Subsequent charting requirements are minimal.  While radiology may not grant the same quantity of patient interaction as other areas of medicine, radiology does offer a high quality to the patient interactions you can be a part of.  

3. “Radiology is boring.”  

I disagree.  Radiology typically allows you to minimize many of medicine’s most boring tasks such as patient charting and being on hold with insurance companies for payment authorizations.  In radiology, you are privileged to spend the majority of your time performing tasks such as analyzing images and synthesizing complex information according to your long-honed medical knowledge to solve problems for patients and their referring providers.  Performing the work of a radiologist is intellectually interesting and not boring.  Don’t mistake the fact that it can be boring to watch radiologists at work to mean that being a radiologist is anything but intellectually stimulating.  

Reasons why radiology may not be right for you:

1. Radiology requires a lot of book-type learning.  

If you did not enjoy your non-clinical course work in medical school and if you do not enjoy studying on your own time, radiology may not be for you.  Radiology requires that you are a self-motivated learner and that you don’t mind coming home from a full day at work to spend your evening hours studying. To be a radiologist requires a lot of studying on your own time.

2. Although your clinical work directly impacts patient care, patients may not understand that you contributed to their care.  

You have to be ok with this.  Sometimes making a diagnosis may truly place you as a hero in a patient’s journey to health, but it is possible that nobody will notice what you did.  If you need direct validation for the work you do, radiology may not be your ideal fit.  

3. Radiology has a trend for increasing complexity and higher volumes of imaging studies to be interpreted and this will challenge the profession in future years.   

My prediction is that radiology will continue to grow in complexity and volume of work. Pressure already exists to read more studies faster and this will likely continue.  Radiology has always provided a good salary among physicians, but salary growth and earning potential is not as high as prior years. While radiology is adaptable, as I spoke of before, most radiology positions already require serious hard work and if you choose radiology—let alone medicine—hoping for an easy career following training look elsewhere. You need to enjoy what you do in medicine to have your best career and successfully handle the stressors of being a physician. The road is too long to end up in a specialty that you are not happy with.  Therefore, do not choose radiology (or any other specialty) based on perceived expectations of lifestyle and high income if you don’t actually think you’ll enjoy the work.  

How can you kick the tires of radiology to see if this specialty is right for you?

Here are a few suggestions: Join @futureradres on Twitter, watch videos from Yasha Gupta, MD and other radiology residents on YouTube, get to know current and future radiologists at your institution (if you express personal interest in radiology this should not be a difficult task), contribute to a radiology research project, complete a radiology elective, read some chapters in a radiology textbook and ask yourself if what you read is interesting to you, and check out The Radiology Review Podcast and follow @radrevpodcast on Twitter or Instagram to help you understand the breadth of knowledge you must acquire as a radiology resident.  

Whether you choose radiology or not, perform due diligence so that you end up in your best specialty with no regrets.  Medical students: give radiology serious consideration.  No matter what specialty you ultimately enter, make sure you enter fully informed.  Today’s preparation brings tomorrow’s success.    

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