How to Become a Radiologist

Overview

What is a Radiologist?

A radiologist is a medical doctor who specializes in using medical imaging technologies to diagnose and promote healing in patients in one of the following categories:

• Interventional Radiology and Diagnostic Radiology
• Diagnostic Radiology
• Radiation Oncology
• Medical Physics

Interventional Radiology and Diagnostic Radiology

The American Board of Interventional Radiology defines an Interventional Radiologist (IR) as one who utilizes highly specialized imaging techniques and procedures which are minimally invasive as well as peri-procedural patient care to treat both benign and malignant masses located in the abdomen, pelvis, extremities and thorax (not including the heart).

Notably, Interventional Radiologists are considered experts in the field of Vascular Disease. An IR is a physician who is Board Certified by the American Board of Radiology(ABR) and has received extensive training in vascular diseases; how to perform diagnostic techniques, affect treatments and manage various conditions involving vessels which conduct and circulate fluids. A few of the therapies and methods used by Interventional Radiologists include:

1. Radiofrequency Ablation (RFA): A technique which is image-guided and utilizes heat to destroy cancer cells.
2. Angioplasty: In this procedure a thin catheter attached to a small balloon is inserted into a blood vessel. Threaded by guidance from X-ray imaging, the catheter reaches the blocked artery and the balloon is inflated thereby opening the artery.
3. Stent Placement: Stent Placement is a way of enabling circulation in previously blocked arteries. A stent is a small metal scaffold which is subsequently inserted to maintain the newly increased blood flow.
4. Thrombus Management: If an artery is blocked by a blood clot, an IR inserts a catheter and injects thrombolytic drugs which will dissolve the clot and restore a healthy blood flow.

One exciting change for doctors in the field of Interventional Radiology and Diagnostic Radiology is the official recognition of their field as a unique medical specialty. In 2012, the American Board of Medical Specialties (ABMS) approved a certification process which awards a new IR/DR Certificate.

Diagnostic Radiology

By using methodologies involved with electromagnetic radiation, x-rays, ultrasound and radionuclides; Diagnostic Radiologists facilitate the diagnosis and treatment of injuries and diseases.  According to the AMBS, if a Radiologist desires to subspecialize within the field it is required that they first become a certified Diagnostic Radiologist. Each of the subcategories require additional education and training.

Some of the subspecialties which are available to certified Diagnostic Radiologists are:

• Nuclear Radiology: By using radionuclides (radioactive substances) to produce images, Diagnostic Radiologists can provide crucial data for assessing and treating patients. Relevant procedures include SPECT (single photon emission computed tomography) as well as PET (positron emission tomography) and scans.
• Pediatric Radiology: Babies with congenital abnormalities (present at birth) are treated by Pediatric Radiologists to ensure that childhood diseases (particular to infants and children) do not cause impairments in adulthood.
• Neuroradiology: Interventional techniques, MRIs, myelography and angiography are used by specialists to treat disorders of the brain, nervous system, sinuses, spine and spinal cord, just to name a few.
• Hospice and Palliative Medicine: These specialists work with patients who suffer from a terminal illness or disease. Together with associated agencies, they are highly trained to relieve the discomfort patients with life-limiting conditions commonly experience.

Educational Track

Becoming a Medical Doctor (MD) is the entry-level educational requirement for becoming a Radiologist.

Step-by-Step Educational Path of a Radiologist

The Bachelor’s Degree

You must earn a bachelor’s degree before going to medical school.

Accreditation: For aspiring medical students is imperative that a bachelor’s degree is received from an accredited college or university. Although the United States Department of Education does not accredit colleges; the law requires the Secretary of Education to oversee accreditation as well as publish a list of colleges and universities which have been accredited. It's also important to verify that the college chosen for the bachelor program will be acceptable to any medical school. Utilize the student academic counseling center to review what the various medical schools look for in an undergraduate degree program.

Take the Medical Colleges Admission Test (MCAT)

The MCAT is a standardized, multiple choice test given over a 4 ½ hour period. Applicants taking the MCAT will be test in the following areas according to the AAMC:

• Biological and Biochemical Foundations of Living Systems
• Chemical and Physical Foundations of Biological Systems
• Psychological, Social, and Biological Foundations of Behavior
• Critical Analysis and Reasoning Skills

The skills and knowledge that will be tested are: the ability to solve problems, the ability to think in a critical manner, fluency in concepts relating to the social sciences, and knowledge necessary to effectively study medicine.

Become a Medical Doctor: 3 Options

You must become a medical doctor before becoming a radiologist.

There are 3 options to choose from when deciding upon medical degree programs.

The Medical Degree (M.D.)

A Medical Degree (M.D.) focuses on traditional methods of diagnosis, treatment and medicinal therapies.

Doctor of Osteopathic Medicine (D.O.)

A medical degree that focuses on care and studies of the musculoskeletal system.

Combined Program: The Doctor of Philosophy (Ph.D.) + Medical Degree (M.D.)

A significant number of medical schools offer a combination degree: a Medical Degree plus a Doctor of Philosophy (Ph.D.). According to the AAMC, the benefits of a dual degree program are:

1. Psychological Gratification: The combined degree is unique because it enables the graduate to be both a physician and scientist. The result can be exceptionally exciting as well as a source of passion because the doctor is able to participate in both the healing of patients as well as the engaging in the research which may ultimately lead to a breakthrough in the field.
2. Two Careers: The M.D.-Ph.D. has the advantages of simultaneously following two career paths. Ultimately, the dual paths ultimately fuel success in both. As a trained researcher, the Ph.D. graduate has acquired and continues to amass expertise regarding mechanisms underlying disease; as an M.D. the physician can continuously engage in applying the knowledge in a clinical setting.
3. Financial Support: Dual programs typically give participants tuition scholarships as well as a stipend.
4. Fast Track: There are medical schools which offer a 3-year M.D. program to Ph.D. graduates saving them literally thousands of dollars and time. Institutions like NYU School of Medicine even extend offers to Ph.D. applicants which guarantee them a spot in their residency programs.

The 3^rd and 4^th years of medical school include clinical rotations throughout the medical specialties while being supervised in working with patients. Early in the 4^th year the radiology specialty will be declared.

Take and Pass the United States Medical Licensing Exam (USMLE) or the Comprehensive Osteopathic Medical Licensing Exam (COMLEX).

In order to be licensed to practice medicine in the United States a candidate must take and pass the USMLE or the COMPLEX, depending on the choice of medical programs. The Federation of State Medical Boards (FSMB) is the licensing agency which represents the 70 medical and osteopathic boards within United States as well as its territories; they determine the standards and processes which must be adhered to regarding the exams.

Complete a 4-year Radiology Residency Program

There are approximately 218 Radiology Residency programs in the United States offering approximately 890 residency positions per annum.

Residency requirements and programs will depend upon the area of radiology you will be pursuing. According to the American Board of Radiology:

1. Interventional Radiology and Diagnostic Radiology: The training for IR/DR consists of at least 3 years of Diagnostic Radiology and 2 years of Interventional Radiology.
2. Diagnostic Radiology: The candidate is required to complete one year of clinical work (PGY1) followed by 5 years of radiology training.

If the candidate sub-specializes the following are additional requirements:

a. Pediatric Radiology: An additional 2 years comprised of 1 year of a fellowship plus 1 year of practice or additional approved training.
b. Neuroradiology: An additional 2 years comprised of 1 year of a fellowship plus 1 year of practice or additional approved training.
c. Vascular and Interventional Radiology: Requires 2 additional years—1 year of a fellowship and 1 year of approved training or practice.
3. Nuclear Radiology: Training required is 5 years: 1 year of clinical work, followed by four years of radiation oncology training.
4. Radiation Oncology: Five years total: A year of clinical work and an additional 4 years of radiation oncology training.

Become Board Certified

Becoming a Board Certified Radiologist is imperative to a reputable and prosperous career as a radiologist. Certification requirements can be found at the American Board of Radiology’s website. Certification exam timelines (in terms of residency programs) can be found there as well as information on becoming Board Certified in a subspecialty.

Career Path

Potential Employers & Work Environments

1. Public and Private Hospitals: While patients commonly assume that a radiologist works for the facility where the radiological imaging takes place; the majority of Radiologists do not technically work directly for the hospital (hence the separate billing that follows). Although the Radiologist is typicality not a hospital employee, they do work within the hospital confines using the hospital’s radiology equipment as well as the radiology technologists on the hospital’s staff.
2. Staffing Agencies: Facilities such as private and public hospitals and clinics, as well as diagnostic imaging centers form partnerships with staffing agencies to fill the increasing demand for Board Certified Radiologists. The following are benefits to doctors listing with an agency:

• Radiologists receive competitive salary ranges
• Agencies may pay for licensure
• Incentive programs are typically offered
• Compensation can be received on a weekly basis
• Direct Deposit as an option
• 401k Plan Benefits

3. Medical Groups: Radiologists can form partnerships with other physicians to form a medical group/clinic/practice by way of a corporation, partnership or some form of a limited liability company.
4. Private Practice: The private practice option is always available.
5. Teleradiology: Beginning sometime around 2000, Radiologists began to work from home as Teleradiologists. These doctors work within a group, individually, for an agency and conduct business apart from facilities at which the imaging occurs. This new branch of practice is typically support-based, but comes with many benefits including mobility, flexibility in hours abd elimination of patient-related stressors.

VII. Improving Opportunities for Employment

The following credentials, achievements and qualities are optimal for securing the most favorable employment options in the United States:

• United States Medical License/Doctor of Osteopathy
• Board Certification
• US Radiology Residency
• US Fellowship
• Experience
• Active Membership in Industry-Related Associations, Groups, Agencies etc.
• Specialty Certification
• Academically and/or Clinically Recognized Achievements

Job Outlook

Although the United States Department of Labor does not publish statistics indicative of medical specialty; using their data combined with a job search is a reliable way to achieve accurate, locale-sensitive, current results.

The DOL segregates projected job growth rate into two categories: physicians/surgeons and health diagnosing and treating practitioners. Their findings report that between the years 2012-2022, jobs for physicians/surgeons will increase by 18%; those involved with health diagnosing and who are treating practitioners are projected to enjoy a 20% growth rate. Since the average growth rate for all occupations is 11%; the statistics for these medical categories is promising.

One factor which can be encouraging to physicians intending to specialize in radiology is the aging of a segment of society commonly referred to as the Baby Boomers. Many of the accompanying aspects of geriatric health, i.e. heart attack and cancers; demand the expertise of physicians specializing in Radiology.

A Medscape report entitled “Radiologist Compensation Report 2013” published the following encouraging findings:

• Radiologists are the 3^rd highest paid medical specialty.
• The average income of a Radiologist was $349,000.
• 16% of Radiologists earned $500,000 or more.
• Top earners were in “single-specialty and multispecialty group practices.”
• The average compensation of working in a hospital was $354,000.
• The majority of Radiologists feel that they are fairly compensated—58%. This is in contrast to physicians reporting that only 48% are satisfied with their earnings.
• The majority of Radiologists spent less than 30 hours with patients.
• In comparison to other medical specialties, Radiologists have the least amount of paperwork and “cumbersome chores.” Over one-third of Radiologists (37%) spent only 1-4 hours on paperwork and administrative duties. Next ranking was 29% who spent 5-9 hours per week.

Learning how to become a radiologist is packed with several years of education, on-the-job training and continual educational research. The key to any successful career in the medical field is maintaining focus, being dedicated to working hard and retaining a positive outlook. With advancements in technology and expanded career opportunities opening every year, the career outlook for becoming a radiologist is positive.

Additional Resources

• American Board of Radiology
• American Association for Women Radiologists
• American College of Radiology
• American College of Nuclear Medicine
• American College of Nuclear Physicians

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