A radiology residency is not as popular a residency for med school graduates as a or even though radiology is instrumental in saving lives. If you’ve ever taken an x-ray, CT scan or MRI you’ve been in the care, albeit briefly, of a radiologist, but the field also goes beyond those diagnostic tools. Radiologists form part of a healthcare team that helps diagnose ailments from broken bones to cancer, and, as such, you don’t have a lot of one-on-one, direct patient experience. But, since radiology is a key component of all diagnostic imaging, it has many different applications in many different healthcare settings. You typically work in a hospital-based environment, but radiologists treat different population groups in other settings, such as hospice care, where they play an important role in diagnosis but also pain management. This article will explore what it takes to be a radiologist, and give you ways to improve your application for a radiology residency.
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A radiology residency, in both the US and Canada, typically lasts between four and five years, but you can add more years if you decide on pursuing a afterward in any one of the many subspecialities in radiology. You could also take a before, which would also increase the number of years you spend training, and is a requirement for some programs. A radiology residency is where you ultimately decide which subspecialty you want to pursue within this field, although many people decide that diagnostic radiology – the most common radiology specialty – is what they want to do. The other subspecialties within radiology that you can pursue in both the US and Canada are:
- Hospice and Palliative Medicine
- Nuclear Radiology
- Pain Medicine
- Pediatric Radiology
- Vascular and Interventional Radiology
These varied specialities should give you some idea of how far-reaching the field of radiology can be. It is not simply taking x-rays or using an ultrasound machine. Radiologists participate in surgeries and other operations, which try to be as minimally invasive as possible to reduce recovery time and pain.
Radiologists also use radiation and nuclear medicine to treat forms of cancer. A radiation oncologist is a highly specialized role that is open to you as a radiologist resident, where you do have more direct patient experience, as you treat various cancers with radiation therapy, but, of course, requires years of extra training.
A radiology residency is also where you deepen your knowledge of radiology and all the new developments and breakthroughs that have emerged thanks to advances in diagnostic technology. Given the highly technical nature of radiology, if you are interested in medical technology and the development of new methods to diagnose and treat patients, then radiology may be the right medical specialty for you.
But there are also a lot of different scientific disciplines involved in radiology. So, if you are especially inclined to the sciences, such as physics, or even something like engineering, then the challenging nature of radiology and the knowledge required to work through those problems and contribute to new discoveries and diagnostic techniques may appeal to you.
In the US, you can follow many different paths into more specialized fields, or stay within the highly valued role of a diagnostic radiologist when you enter a radiology residency. Many of the radiology residency programs in the US, and Canada, for that matter, use diagnostic radiology as the entry point for residents, as it presents the fundamentals of radiology and prepares them to enter other subspecialties.
They do this because radiology is not often a required rotation during medical school. As a medical student, you must complete set of core rotations, which you know beforehand to help you , but you’ll often find that radiology is offered as an elective, which means you may choose it or not. But, think about it, what other medical specialty has as many interactions with other medical disciplines than radiology?
Sure, there are a lot, but the diagnostic power of radiology means that almost all medical fields use it, from psychiatrists and internists to pulmonologists and cardiologists. A chest x-ray is one of the most fundamental and basic tools in helping diagnose ailments affecting your heart, lungs, spine, and stomach, and learning how to read one is an art that takes time, but, again, this only goes to show you how fundamental radiology is to all aspects of medicine.
But even that is not enough to make it a core rotation at many medical schools. So, if you have your heart set on a career in radiology, then you need to pursue it by taking radiology electives, both on-site and off-site to prepare yourself for a radiology residency.
Here’s where radiology stands out among other medical specialties, as you have to meet many more academic requirements to enter a Diagnostic Radiology residency than many others, such as a . Let’s use the Diagnostic Radiology residency program at NYU Grossman as an illustrative example, even though we looked at a lot of programs and found many similarities.
To apply to most Diagnostic Radiology residency programs in the US, you need the following:
- Having taken and passed the
- Medical Student Performance Evaluation ()
- Official transcripts
- Between three and four letters of recommendation
- ERAS application form
- Transitional year residency (program-dependent)
The requirements are even tougher for , who must also take and pass the often with a minimum score to be considered. But what about other qualities and requirements? What are radiology residency program directors looking for in applicants?
Radiology residency program directors want to see your interest in radiology, and passion for it. We don’t want to disparage radiology as a discipline or medical field, but from what we’ve heard from other residents is that radiology rotations are a lot of sitting and watching someone else either examining a CT or MRI scan or some other medical image. You have to be truly energized by radiology to endure moments like those, which will happen as part of your training.
If you truly have a passion for radiology, you should make that clear from your choice of electives, your transitional residency year, your personal statement and letters of recommendation. But also, things such as shadowing a radiologist during your rotations and research into radiology.
Every radiology residency program in the US uses the to accept and review applications, while the National Residency Matching Program (NRMP) is the that ties you to your preferred programs, as they appeared on your .
Like with all residencies, your first years as a radiology resident requires you to pass through several core rotations, in other disciplines, even if you have completed a transitional year residency. But one unique feature of radiology residency programs in the US is the number of exams and certificates you need to successfully earn your board certification on the way to taking and passing the .
Radiology in the US is highly regulated by the American Radiology Board (ARB), which administers all qualifying exams for all the various subspecialties within radiology, as well as the Diagnostic Radiology certificate. As such, you will find that a lot of your initial training in the first three years will be centered on the knowledge you need to pass the Qualifying Exam given by the ARB.
The Qualifying Exam is a mandatory step to becoming a radiologist and, yes, it takes place over three-days! The QE focuses on all aspects of radiology so you will have to know as much about radiation and physics, as will have to know about medical science and different parts of the body.
Some of the core rotations you will have to take during your first, second and third years in preparation for your QE include:
- Body imaging
- Pediatric radiology
- Emergency radiology
- Abdominal imaging
- Nuclear medicine and nuclear radiology
- Musculoskeletal imaging
The Qualifying Exam is for all radiology residents, even if you decide on the other track offered by most radiology residency programs, which is the Integrated Interventional Radiology Residency track. Interventional radiology is a subspecialty tied to surgery and removal of things that a diagnostic radiologist might find in a CT scan or MRI. Depending the program, the IIRR track is something that you apply for after completing three years of your DR residency, and successfully obtaining your certificate from the ARB, so you do not enter it during your first residency year.
The way radiology residencies are structured in Canada is a little different than in the US. The length is longer, as most Canadian programs last for five-years, which can be even longer if you decide to do a research fellowship or receive more specialized training in Interventional Radiology. However, while there are various regulatory bodies and associations in Canada that oversee practicing radiologists, there are no central, mandatory Qualifying Exams for Canadian radiology residents, other than the to gain a medical license.
Instead, like all residents in Canada regardless of their specialty, you must pass through a new, universal assessment scheme for nearly all residency programs called Competence by Design (CBD) conceived and implemented by the Royal College of Physicians and Surgeons of Canada. The CBD model streamlines all assessments for progression through your residency by making you perform Entrustable Professional Activities at four separate stages during your residency.
Basically, you need to accomplish specific tasks and sub-tasks to demonstrate your competency, rather than studying for and writing exams, as is the case in the US with the ARB, to make it to the following year. We’ll talk a little more about CBD and how it relates to your radiology residency, but for now, let’s talk more about what you need to get into a radiology residency program in Canada.
In Canada, as in the US, Diagnostic Radiology is the main point of entry to radiology. There are Interventional Radiology residencies available in Canada, if you want to pursue that field, but an admission requirement of most IR programs in Canada requires completion of the full DR residency.
- Official transcripts
- 3 or more letters of reference
- Medical Student Performance Record
But the things that residency directors are looking for most in potential radiology residents include:
- Interpersonal skills; whether you can be part of a team
- Communicaiton skills; whether you are a good listener and know when to speak
- Leadership abilities; can you lead a team and inspire them to strive for excellence?
- Clinical skills; which is something you can address with LOR
Working on your residency personal statement?
There are only 83 radiology residency positions in Canada compared to the nearly 1200 radiology resident positions in the United States. The Canadian number is down from 85, which means that less and less students are interested in radiology. But even with that number of positions, there is not a lot of competition for them. It should be easy for you to match into a radiology program in these circumstances, as all 83 positions were filled last year so a radiology residency in Canada has a 100% match rate. You have to apply to all residency programs in Canada through CaRMS, but to enter the Interventive Radiology residency, you apply to the school directly.
The introduction of the Competence by Design model we talked about before has had a ripple effect on all residency program curriculums in Canada. While some things, such as core rotations, are still in place, many schools are still assembling other parts of the residency curriculum, including the final year of residency where you ascend to, or are awarded, the rank of .
In the CBD model, as we’ve already explained, you have to perform or achieve certain milestones to continue onto the next year. When you complete these “milestones” on your own, it means you can be trusted to perform it in the real world with a real patient. These milestones come at four distinct stages during your radiology residency:
- Transition to Discipline
- Foundations of Discipline
- Core of Discipline
- Transition to Practice
We numbered them here, but they are self-explanatory in terms of chronology, meaning which stage comes first and last. Let’s use the Diagnostic Radiology residency program at the University of Toronto as an example so you get the idea. The first rotation you do as a new resident is a Chest Radiology.
You’ll complete this rotation after you perform eight EPAs, such as these, to name a few:
- Navigating information systems used in Diagnostic Radiology
- Using the dictation system
- Recognizing normal anatomy in radiography and CT imaging
The EPAs get progressively harder as you pass each one, and the final EPAs for Chest Radiology overlap with the next stage of your residency, the Foundations of Discipline. Get it?
This is the norm now in Canada, for every specialty and discipline. Your main rotations during the first two years will focus on other medical specialities such as
- Computed Tomography (CT)
- Emergency Medicine
- General Surgery
- Internal Medicine
- Obstetrics & Gynecology
- Orthopaedic Surgery
But as you continue through to the final stages of residency – Core of Discipline and Transition to Practice – your time as a resident is divided between the more specialized rounds you have to complete, which include:
- Nuclear Medicine
- Interventional Radiology
- Pediatric Imaging
- Obstetrical Imaging
Take Radiology Electives
The simplest way to prove you are interested in radiology is by taking as many radiology electives as possible during medical school. This is the clearest indication that you have an interest in the field and that you want to know more. All radiology residency program directors will see this as a positive, even though it is a low bar to clear. You also need to show motivation and initiative, so go beyond what’s required and shadow a radiologist or ask to help in a research project by an attending radiologist, which will then reflect well on you in your letter of recommendation.
Do Radiology Research
This is important in various fields, but if you have devoted a lot of time to researching radiology and have, even better, published your work or have participating in someone else’s research, then that will go an extra-long way to show how committed you are to radiology. Some programs even make it a soft requirement (recommended, but not required). You can reach out to physicians you meet on rotations or senior residents from a variety of programs or attend radiology conferences and speak directly to investigators there to ask about possible research positions.
Get Amazing Letters of Recommendation
Again, this is something you should do for every program, but letters of recommendation are especially important in residency admissions because they are an objective account of things that are hard to measure otherwise. Things such as how you work with other people, your clinical skills, the extent of your knowledge in your field, and finally, your resiliency. You have to learn a lot in a short time, and your ability to stick it out for the endless hours of study will show that you have what it takes to endure more.
Get High USMLE Scores
Some programs have minimum scores and others do not, but regardless, like with your , GPA and other academic metrics, its best to have competitive scores when applying for a radiology residency. You should try to shoot for at least a 250 for your USMLE Step 2 CK and a little less for your at 240.
Prepare for Your Interview or CASPer
Interviews are key for all residencies, but again, the niche nature of radiology means you should have good reasons for wanting to enter such a challenging residency, and you should be able to handle typical . Find out all you can about your favorite programs and try to find the connections between what your interests are and what the program, and teaching hospital are involved in.
1. How long are radiology residency programs?
In the US they typically last four years, but some programs may ask you to do a preliminary or transitional year residency so you can expand your knowledge of radiology. In Canada, because radiology is such a dense and all-encompassing discipline, many programs last for five years, which are categorial residencies that also include rotations in non-radiology specialties such as internal or family medicine.
2. Are radiology residency programs competitive?
In Canada, it is not a competitive field, as there are often more positions available than applicants so there is not much competition. In the US, the competitiveness of radiology residencies changes, but it is experiencing a similar trend as in Canada where the number of positions is high, even though fewer and fewer graduates are choosing it as a first choice.
3. How much do radiology residencies pay?
Every radiology residency program in the US and Canada has its own pay structure and residency salaries typically increase with every year. One radiology residency program in the US offers $80,388 as a starting salary that goes up to $91,652 in your fifth year. The average salary for a Canadian radiology resident is $62,227, but it can increase to $84,534 in later years.
4. How much do radiologists make?
In the US, the median salary for a neurologist is $ 329,080. In Canada, the median salary is $390,195. These are both entry-level salaries, and your salary may increase further in your career.
5. Do radiologists have long hours or poor work-life balance?
Radiologists in both countries do experience symptoms of burnout, but in the US, many radiologists are finding it hard to find the right work-life balance. Almost 50% of radiologists are experiencing some other stress in their life, while over 70% are having to care for more people than other specialties. In Canada, 46% of diagnostic radiologists said they were overworked, but, again, almost 70% said they were satisfied with their professional life, even though only 48% said they had achieved a satisfactory work-life balance.
6. Do radiology residency programs include research components?
Typically, all residents in all fields are encouraged to participate in research in their discipline, but whether research is an integrated part of the curriculum at your residency program depends on the program.
7. Do radiology residency programs value certain parts of the application more than others?
Yes, since radiology is such a niche field and category, if you are applying to a radiology residency you have to demonstrate a genuine interest in the field by taking radiology electives in medical school and having been mentored by a senior radiologist, or resident.
8. Do MDs fare better than DOs in getting into radiology residency residencies?
Yes, MDs do often do better against DO applicants who want to get into a radiology residency, but DOs do have a chance at getting matched as radiology positions often outnumber the number of applicants each year.