From Practicing Radiologist to Trainee

Thirty years ago, medical subspecialty was relatively uncommon. This was true for all areas of medicine, including radiology. But, today, the playing field is shifting. A growing number of radiologists are opting to complete fellowships before they hang a shingle, join a practice, or sign on with a hospital-based group.

A fellowship-trained radiologist’s expertise often proves invaluable to patients and referring physicians alike. An impact that can be enticing to radiologists already in practice who might be looking to expand their skill set, prompting them to pursue fellowships long after their school days are behind them.

To discover why an active radiologist would step away from a thriving practice to, once again, become a student, and what challenges and benefits doing so poses, Diagnostic Imaging spoke with three providers who opted for additional training mid-career. These are their stories.

General Radiologist to Breast Imager
For Jeri Sue Plaxco, MD, radiology was an instantaneous fit from her first rotation during her fourth-year of medical school.

“I didn’t like rushing from patient-to-patient, from room-to-room,” she said. “I didn’t like that aspect of medicine, so once I experienced my radiology rotation, I’ve never looked back.”

It was 2009 when Plaxco joined a private practice as a general radiologist. For five years, her responsibilities varied widely: emergency department coverage, women’s imaging, PET/CT scans, non-vascular interventional procedures, fluoroscopy studies, and pediatric work. She soon realized, though, that she wanted a more specific focus, and with a mentor’s guidance, she’s selected breast imaging.

Not only was she – as the only woman – already the only provider in her practice conducting breast imaging, but the subspecialty offered her greater contact with technologists and the opportunity to do more hands-on procedures while interacting with and educating patients. It’s also a challenging field, she said.

But, choosing to pursue a fellowship at the University of Texas M.D. Anderson Cancer Center was a challenge unto itself. Not only did she move her family to a new location, she had to learn a new hospital system, a new subspecialty, and establish new relationships with patients and referring physicians.

“It wasn’t an easy decision to leave a great practice and a fantastic job,” Plaxco said. “But, it felt like the right decision for me.”

Having several years of practice under her belt was a benefit during the fellowship, she said, because she was confident in the work she completed independently during night call. And, today, the extra training enables her to give patients a more thorough, expert level of care.[[{"type":"media","view_mode":"media_crop","fid":"42147","attributes":{"alt":"radiology subspecialties","class":"media-image media-image-right","id":"media_crop_4697652937523","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4533","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 199px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Now, instead of completing a breast imaging scan two-to-three times a month, breast imaging is Plaxco’s primary responsibility and keeps her constantly engaged.
 

“Just when you think you’ve seen it all, you realize you haven’t,” she said. “This is what makes breast imaging so interesting and challenging to me.”

Third Time’s the Charm
Much like Plaxco, Marc Johnson, MD, was hooked on radiology from the beginning.

“Everything that ends up diagnosed comes through radiology,” he said. “And, I think from a variety of perspectives, radiology is really kind of hard to beat.”

Johnson’s professional path launched in 1992 after he finished a residency with the University of Kansas City in Missouri. From there, he spent 15 years as a general radiologist with a private practice in Pueblo, CO. He enjoyed his job, but a deteriorating relationship with hospital administration prompted him to consider a change of pace – a musculoskeletal fellowship.

The timing was right, he said, with both children off to college, so he applied for and accepted a fellowship position with the University of Indiana at Indianapolis. He, too, experienced challenges. Financially, it was difficult to return to a resident’s salary after so many years as a private-practice partner, and it was equally tough to be separated from his wife while they were selling their house.

The biggest adjustment, he said, was integrating into a new system of learning.

“If I questioned something, the first thing I did was look at the textbook. My classmates were more computer savvy and turned there,” Johnson said. “I began to learn in a different way, but it still took time to get accustomed to a new computer system that was largely voice activated.”

While he learned new study methods, his years in private practice largely affected what he studied. Through experience, he knew how common a musculoskeletal disease or condition is among patients, so he was able to better target his study efforts.

After completing the fellowship, he accepted a musculoskeletal position with an Indianapolis private practice, but his winding path through radiology didn’t stop there. Shortly after joining the team, a breast imaging position opened up, and it played to Johnson’s long-standing interest in mammography. So, he switched subspecialties again seven years ago.

Johnson has read mammograms throughout his career and enjoyed it. Although it doesn’t use the sexiest modalities, such as CT or MRI, he said, it gives the radiologist the opportunity to work directly with patients, discussing their health care in detail. Consequently, Johnson said he’s pleased with where his career has led him.

“I happened to stumble upon breast imaging, and it’s been the highlight of my career,” he said. “We’re catching smaller and smaller cancers, and it’s very clear that we’re making a difference in women’s lives.”

ACR Chairman Turned Trainee
For James Borgstede, MD, former chairman of the American College of Radiology (ACR) Board of Chancellors, a medical career didn’t even start in radiology. Instead, he spent his first year post-medical school and residency as a family medicine practitioner. That year, he said, was invaluable.

“Looking back as a radiologist, that year in family medicine taught me to think like a referring physician,” he said. “That’s really key for a radiologist in any specialty area.”

He soon realized, however, that radiologists had the opportunity to work with and consult with almost every specialty. So, he hit the pause button and returned to school, completing a radiology residency from the University of Colorado in 1978. For the next nearly 28 years, he practiced general radiology in Colorado Springs and taught radiology at the University of Colorado.

After his tenure with the ACR, he faced a critical decision – should he retire? He opted, instead, in 2007 to embark on a new challenge – an MR fellowship at the University of California at San Diego. It was a significant transition from teaching faculty and ACR leadership to full-time resident.

He faced the same challenges Plaxco and Johnson experience – uprooting his family, taking a pay cut, and encountering a variety of intellectual trials. But, at every turn, he followed the same path as all other residents.

“I couldn’t say I wouldn’t take night call or do conferences. I wanted a regular fellowship like everyone else,” he said. “I wanted all the pressures, the need to make decisions, and the need to study.”

And, the benefits to his knowledge base and practice were many, Borgstede said. In addition to honing his MR skills, he learned how to be interactive and how to navigate the present-day academic environment even more successfully. In addition, he developed a greater interest in academic research, and he has confidence that he practices with the most up-to-date knowledge about MR available.

Though a radiology fellowship can be a good idea after several years of private, group, or hospital-based practice, Borgstede said, it isn’t a decision anyone should make lightly. There are many things to consider.

“You must make a careful decision about why you want to pursue a fellowship,” he said. “What do you want to get out of it? What will you do with your skills after you complete the training?”