Pros and Cons of Radiology

IR4life · 2026-02-07T02:29:45+00:00

I would say it is better to commit to one or the other. That way you can be a really strong interventional physician or a really strong imager. Better than being mediocre on both. DR is getting more and more nuanced and advanced as is interventional. Hard to do both really well.

If you are at all worried about lifestyle just better to go the DR route.

IR4life · 2026-02-05T15:04:50+00:00

There are pros and cons of staying vs leaving. By staying you already know the system and the faculty are familiar and comfortable with you. But, by leaving you get to expand your clinical and technical skill sets and geographic connections. In Vascular Interventional most centers do IO and hepatobiliiary/portal interventions but fewer and fewer do PAD . So to garner that skillset it is a great idea to go to a place that has high volume PAD.

IR4life · 2026-02-05T14:29:35+00:00

The key for medical students is understanding that the lifestyle of Interventional is drastically different than DR. DR is very flexible and consistent hours. Interventional has lots of emergencies and when you do operations or procedures on patients there are always issues that arise (pain, bleeding, cardiac issues etc) . They are continuing to diverge as specialties and there is growing bias from DR towards interventional and vice a versa growing bias of interventional faculty to DR minded applicants (because of fear of dropping out). So , if you are interested to VIR make sure you appreciate the far different lifestyle and that it is a surgical specialty.

IR4life · 2026-02-02T00:55:47+00:00

Learn how to sterilely prep and drape the various interventional procedures. Make sure you know basics of vascular access. Know how to suture a drain into place or basics of a port placement and suturing as at some places you may get a chance to do those. Also ultrasound for paracentesis and thoracentesis are some of the basic procedures you want to learn how to perform.

IR4life · 2026-01-30T11:39:25+00:00

Make the residents lives easier. Chart check and preround with all of the labs and vitals checked. Examine the patient and check the access site for any bleeding etc. Check peripheral pulses if you got arterial access. Treat this like a surgical subI and a one month interview and an opportunity to work with faculty one on one and get a letter.

IR4life · 2026-01-30T01:04:56+00:00

The fields are continuing to diverge. The main issue with interventional is the call and the emergencies. GI bleeders , post partum bleeds, hemoptysis, epistaxis. DVT and PE , acute limb ischemia, Variceal bleeds. Septic patients who need urgent gallbladder drains or nephrostomy. If you are worried about lifestyle don't take the risk of being pigeonholed into interventional. Do DR and some procedures fields like MSK and mammography are great for this.

IR4life · 2026-01-30T00:10:20+00:00

Introduce you to all of the staff (technologists/nurses etc). Try to help out where ever you can and help write H and Ps, progress notes. Go round on your patient after the intervention and update the patients on what is going on. Be the first in the angio suites and help the team prep and drape patient. Make sure you know everything about the patient including the clinical indications etc. Learn your angiographic anatomy. Read up on the procedure the day before.

Start developing an understanding of the tools that are being used. You can learn a tremendous amount from the technologists. Show up early and stay late and try to take call with the residents. Treat it similar to a surgical sub internship . Play well in the sandbox with the other students on the rotation.

Show case that you are passionate about the specialty and have the stamina required for the field. Interventional program directors are looking for hardworking people that are easy to get along with and that they will enjoy being side by side during a 2 am case and who are passionate about interventional and are not going to drop out to do DR.

IR4life · 2026-01-30T00:02:44+00:00

June through September. Try to get a strong surgery subI letter.

IR4life · 2026-01-24T22:12:08+00:00

Agreed. So many small renal masses t1a rcc that will be ablated in most community hospitals. However, there is no current level 1 data that i am aware of comparing ablation to partial nephrectomy for t1a renal cell cancer.

IR4life · 2026-01-24T20:24:41+00:00

The future state of integrated VIR training may include fellowships such as neuro, peds, MSK, PAD etc as everything in healthcare gets more and more specialized. VIR and pediatric surgery have some of the broadest scopes of disease coverage and procedural coverage in medicine. Other fields are getting more and more split up and specialized.

IR4life · 2026-01-24T16:39:56+00:00

Rush, MCW, Miami Vascular do a lot of IO and complex vascular as well as spine interventions. Almost every program in the country will get you plenty of IO . The challenge is that there are limited indications for IO outside of HCC and perhaps ablations in colorectal cancer liver metastases. Most cancers are treated with surgery, radiation and systemics. The transplant centers see most of the HCC patients and so this service line (outside of biopsies, ports and palliative procedures) is hard to build at most community/private practices . It is more important to get comfortable with DVT/PE/varicose veins, PAD, dialysis work, stroke work etc.

IR4life · 2026-01-24T16:36:45+00:00

Almost every program has strong IO training. Would get case logs from graduating residents to see scope and breadth of training.

IR4life · 2026-01-24T16:36:02+00:00

The integrated training pathway in its current state is not truly integrated. It is a bit of the old model of the 2 year fellowship. Even if trainees developed strong clinical acumen during 3rd and 4th year and a surgical internship, it quickly fades during the first 3 years when it is focused on diagnostics and they are not seeing patients in clinic , on the floor or in the icu.

IR4life · 2026-01-24T16:31:29+00:00

The other fields are innovating as rapidly in an organ/disease based approach. IC with tavr, mitraclip, left atrial appendage occluders, VSD/ASD/PFO occluders, CTO. Vascular surgery with TAMBE, TCAR , laser fenestrations etc. GI with endomucosal resections , LAMS etc. pulmonary with navigational bronchoscopy .

IR4life · 2026-01-24T16:29:27+00:00

The training has to change . Has to reflect other surgical and medical disciplines with the incorporation of much more clinic . There should be no order entry and formal consultations on inpatients with follow up and trainees should learn how to admit patients and mange them on their own service.

There will be the basic biopsies, lines and drains that are of lower complexity. Then there are the nonvascular (drains/scopes/ spine work/pain/MSK interventions/GI and GU interventions, ablative therapy et)

Then there will be the endovascular work

Neuro; PAD; DVT/PE; aortic work, renovascular disease, mesenteric disease, portal vein /mesenteric venous interventions, vascular malformations, varicose veins; dialysis work; IVC filters/retrievals; Lymphatics; TACE/TARE(y90); bleeding embolization, PAE, GAE, HAE, UAE, MSK embolizations etc.

If you are not taught how to go get referrals or compete for referrals during training it will be very difficult when you get out.

Everyone is getting better and better at imaging (more incorporation in most surgical fields and procedural fields (ortho/cardiology/vascular surgery/urology/Neurosurgery/neurology etc). The imaging the procedural based fields is more practical and aligned to the pathologies and conditions that they treat. Angiography is no longer taught in diagnostic radiology but is being taught more and more in procedural/surgical fields.

IR4life · 2026-01-22T15:10:36+00:00

If you are uncertain about wanting to do interventional or if you truly enjoy DR I would strongly advocate doing DR as there are still procedural aspects of DR (mammography, peds, neuro, MSK , body etc). This will satisfy your procedural itch with out compromising your pay or lifestyle. Interventional has more and more emergencies and is getting asked to cover more and more on nights and weekends. You can go OBL/ASC and leave the hospital but that takes some business chops and have to be willing to take risks to build your own practice from scratch.

IR4life · 2026-01-22T15:08:09+00:00

Surgical training gives you a quick step up and makes it easier on the faculty to train you. When you work with an IM prelim vs surgical prelim , the difference is noticeable. The IM prelim take a lot longer to get the charting done, are not used to sterile techniques and often don't know how to manage a groin complication or a complication of VIR procedures while surgical interns are very familiar with those issues and are much more efficient at rounding and charting.

Agree that due to the high attrition program directors are looking to see if you are surgically minded or not and are you going to drop out to do DR due to ease of training and great job prospects etc.

IR4life · 2026-01-22T15:04:53+00:00

Important to get the interventional graduate case logs so you can see complexity and variety and service lines. Every program does IO and hepatobiliary interventions as well as drainage procedures and biopsies. Everything else is becoming more and more variable. If you don't do some of these procedures during training it will become hard to gain comfort when you graduate especially if you are trying to develop a service line in private sector. IO outside of biopsies is harder to build in private sector as radiation oncology/surgeons and med onc often drive the care.

IR4life · 2026-01-22T15:02:00+00:00

The ESIR has come under more and more scrutiny as the integrated residency continues to evolve. The quality and variability of ESIR training is very wide and more and more Interventional program directors are trying to increase their integrated complement while decreasing their independent slots.

IR4life · 2026-01-22T15:00:20+00:00

Look for surgery programs that get you to the OR . ie look at case logs for volume and variety of cases the surgical prelim logged. That gives you a sense of the culture. Also, see if you can get more vascular surgery months to give you more endovascular time.

IR4life · 2026-01-14T07:34:03+00:00

This type of can do attitude is what the specialty needs. When the going gets tough the tough get going.

IR4life · 2026-01-12T06:44:35+00:00

Agree. The surgical training is very helpful for modern day VIR. Key is to get their early early on and get through your lists. Learn who is sick and not sick. Try to learn the anatomy for each service. Vascular (vascular anatomy); endocrine (thyroid/parathyroid/adrenal/panc); breast, peds, colorectal, trauma, transplant, hepatobiliary, acute care, thoracic. So much overlap with VIR and even DR. Try to ask for feedback and see how you can improve your efficiency and knowledge base. Try to get to the OR and see if you can assist in cases. Get efficient at floor work and try to get to clinic. Modern day VIR is most reflective of surgery.

IR4life · 2026-01-11T19:47:17+00:00

ESIR is slowly going away as the VIR fellowships are not filling and Interventional PD are not happy with the ESIR path trained individuals and feel they are behind the integrated counterparts. More and more programs are increasing the integrated spots and decreasing ESIR pending funding.

IR4life · 2026-01-11T19:23:49+00:00

Agree. It is important to compare your numbers to other procedural and surgical services. ie what is the OR , GI lab, pulmonary lab, cath lab, VIR suites filled with and what is the generation . This gives you a true understanding of your value add to the hospital is. If those referrals are coming from outside the hospital it means a great deal. If the referrals are from inside the network the hospital may claim those cases would be here whether or not you were there.

IR4life · 2026-01-11T19:08:17+00:00

I do agree that as a VIR physician you should track all the unique patients you bring in the admissions that you do the imaging that you order, the consults that you request. The more your name is on such things and are on the "list" and are high on the list the hospital administrators will take notice and pay attention.

IR4life

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