What’s Your Radiology Subspecialty?

May 9, 2019

Does specializing in radiology actually mean anything anymore?

Now and then, upon hearing that I’m a radiologist, someone asks what my subspecialty is.

Even if we just met, the query clues me in about them a little. Not everybody knows that we radfolk subspecialize. Heck, there are still those who don’t know we’re physicians. Someone who knows to ask has a bit more familiarity with the healthcare game-because of their own work, perhaps elsewhere in the healthcare field. Or they’ve had some healthcare (mis)adventures, personally or via friends/family.

Related article: Subspecialty Training: Needed for a Job But Not on the Job?

Having done my fellowship in Body Imaging, I know there’s a good chance that I’ll not only have to say the name of the subspecialty but then go on to explain what it is. Those not savvy with rads have rarely heard the phrase, and if you think about it, “Body Imaging” sounds like it could refer to any imaging of the body-which could just as easily be a description of Diagnostic Radiology as a whole.

After I explain what’s considered Body Imaging, I often have to go on and explain what some other subspecialties are, because a listener will not uncommonly note that I’m “subspecializing” in more than half of the body parts and imaging-modalities that they can think of. In other words, if BI is considered a subspecialty, what’s left? How are you subspecializing if you haven’t even narrowed your focus by 50%?

Does it still matter?

I’ve come to feel that it’s rather a moot point. Once you’re even a few years out of fellowship, unless your subsequent practice has been restricted to what that fellowship covered, your “subspecialty” is more realistically defined by what you’ve been doing on a routine basis.

For instance, following my one-year fellowship in Body Imaging, the first 6 or so years of my postgrad work was in outpatient imaging centers. Far from an academic environment, and it being a relatively small group, there wasn’t much room for subspecialization. If you were at your post, you did your share of the imaging-studies, no matter what they were (unless it was clearly out of bounds for you, such as mammo for the non-MQSA-anointed or MRI of wrists and ankles for those who had never really learned to read them in the first place).

The strategy laid out by the folks in charge to manage workflow, however, did allocate certain types of study to some of the rads more than others. For whatever reason, I wound up being a mammo honcho. Also the nucmed guy. Carry that out for six years of full-time work, and that caseload starts to characterize me better than a single year of Body fellowship in the receding past. Meanwhile, the Body MR got sequestered with the partners who wanted to be able to say that they had high RVU tallies, so I got none of those cases for a long time.

I would maintain that I remained capable as a Body guy. Even for MR cases, although I only got to see them when reading studies with MR priors for comparison, or during CME. But when your caseload is, say, 40% mammo for a duration of years, at some point or another the sheer volume of your experience with it is going to make it one of your greater strengths-perhaps ultimately outbalancing that one year of Body you did a decade or two before.

Longer-term readers of this column will know that I followed those 6 years of outpatient imaging-center work with 7 years of telerad-which included zero mammo. Poof! Gone were any bragging-rights I might have been able to assert as to my de facto subspecialization in breast imaging, since I’ve done none of it other than occasional targeted sonos for “R/O abscess.” Conversely, to make the most of my telerad worklists, I made a point of reacquainting myself with brain and spine MR, which had also been unavailable to me in my previous work as result of hoarding by the partners there.

Related article: How to Choose a Radiology Fellowship

With that tenure in telerad, another sort of real-world subspecialization crept into my picture. Reading cases in sufficient volumes to make a viable career in tele is a different beast than any onsite-job I’ve encountered. One becomes subspecialized, for lack of a better term, in the arts of efficiency and self-discipline. Perhaps also in troubleshooting technical issues, since in many telerad jobs you only generate income when reading cases, and if you’re sitting helplessly idle while you wait for Support to rescue you, it’ll be that much longer before you’re back up and running.

I thus find it increasingly irrelevant whatever framed documents a rad might have, attesting to fellowships s/he did a decade or three ago. Once someone’s been out in practice for any decent length of time, better to eschew such pigeonholing based on a line of writing on a CV-and let them tell you where their talents currently lie.