“Radiologist – To be or not to be?” – is indeed a hot topic of debate today. The internet is flooded with misleading articles about the dependant nature of this speciality, the role that computers / Artificial Intelligence(AI) play in reporting and the never ending hoopla of “Saturation” of this speciality today. Who better to address this conundrum than Young entrepreneur-cum-Dynamic Radiologist – Dr Swapnil P. Yewalkar ( Dr. SPY – as we call him…!). He – is whom we consider a true prodigy  –  cracked his entrance in his very 1st attempt and had the option to opt for any speciality in any premier institute in this country….and he chose Radiology. Will he justify doing the same today ? Are there any hitches involved? What about the Lifestyle? Jobs? Opportunities? Money? Well….know from the man-of-moment himself! Proud and privileged to present to you the 1st in the Rad-Blog series….by Dr Swapnil Yewalkar – Director of Shree Diagnostics and Shashwat Imaging Clinic, Pune.

Love and Regards
Dr.MAK

Hi guys!!!
How is the preparation going? Ready to rock the exams and clear it with flying colours ??
I am sure you would….. and then which branch would you opt for? Do you want to be a messiah by showing miracles of “Medicine” ? Or feel the adrenaline rush of a surgeon’s life ? Or do you want to be a Radiologist as almost every topper wants ? (Radiology, believe it or not, is seldom a pre-decided choice but after getting a much-coveted Radiology seat everyone claims that I always wanted to be a one..I also did the same….: – )
You must be thinking how many questions this guy is asking us. To simplify your life I shall tell you my story how and why I became Radiologist. Also I shall tell you what exactly one does in this branch and how life in it is. (Few practical points which no one tells you until you opt for it and realize by yourself)
From my school days, I was a very sincere and intelligent kid (Dream of every parent), always doing great academically (sort of a nerd or geek). I managed to secure my Govt. Medical College seat for MBBS but not in a premier institute. I did my MBBS in GMC Kolhapur and I am very proud of it. But at that time, nearly a decade ago, we did not have PG seats in our college since it was a relatively new college and at a relatively remote place. We passed the University finals with flying colors, and officially became a Doctor. However in absence of any PG entrance passed seniors as far as PG preparation was concerned, we were relatively greenhorns. The two theories prevalent at those times around us were to either read reference books for preparation or opt for highly compact MCQ books. Those were confusing times. Luckily I opted for a transfer of internship at J.J Hospital (GMC, Mumbai) and here it dawned upon me how hard others are studying for it. Every student was involved in a tug of war for that coveted PG seat. I accepted the challenge and plunged into the uncharted ocean of PG entrance preparation with MCQ books as my support. I didn’t leave any stone unturned and managed to get good score in both the State as well as All India Entrance Exams (No NEET at that time !) in my internship – 1st attempt. Then, however, I faced the ultimate dilemma of choosing the specialty branch for post-graduation. I was in a position to opt for any branch in any of the premier institutes. I did a basic analysis about few branches and some introspection about my personality. I realized few things which helped me to choose my branch. Here are a few excerpts –

  • “Surgery or allied surgical branches” are not my cup of tea since I knew very well that my hands are not made for such fine skills and I am good with my brains only…
  • I don’t want to spend another 3 – 4 years after PG for preparing for Super-specialty exams and then pursuing my DM /MCH. So no scope of choosing Medicine.
  • Then I thought about Radiology and why everyone is running for it and points which came to my mind are
  1. Early settlement.
  2. Very few emergencies (So no compromise on sleep!)
  3. Corporate lifestyle / White collar job (Usually 9- 5 pm)
  4. Good – though not great – money
  5. All of the above

Now as all of us know very less about Radiology in undergraduate days (atleast in our days when there weren’t many coaching classes and teachers like Dr. MAK). I shall tell you in brief what a Radiologist does:

  • Conventional Radiology – X ray, Procedures like IVP, Barium studies, MCU, RGU etc.

Though many of the conventional procedures are becoming obsolete today, still radiography is the workhorse of any Radiology Department. The information obtained from some conventional studies like MCU, HSG, BMFT etc. is irreplaceable. These modalities often require direct patient interaction.

  • Ultrasound – Abdominal, Obstetrics, MSK etc.

The ultrasound practice is bread and butter for most of the radiologists. The new advanced techniques in fetal medicine and musculoskeletal radiology are helping radiology achieve new heights every day. Direct patient interaction is involved.

  • Cross sectional imaging – CT scan, MRI, PET

Availability of many fellow ships and short courses helps one to do specialization in cross sectional imaging in any particular system of the body – MSK, Neuro, Cardiac etc…

  • Interventional Radiology – Novel and dynamic stream of Radiology

It is breaking the myth of Radiology of being a para –clinical branch. We can actually treat and help in management of a patient with USG / CT guided interventions. To list a few –

– Radio-frequency Ablation (RFA) of varicose veins.

– Chemical/ thermal ablation of tumours

– Intravascular Stenting of stenosed vessels / Aneurysm coiling / Pre-operative tumour embolization for instance a Juvenile nasopharyngeal angiofibroma.

– USG / CT guided biopsies.

Now let’s consider some ‘Pros and Cons’ while opting for Radiology.

Pros –

  1. Super-specialization after MD Radiology – Superspecialization is not a must for survival as compared to the other medical / surgical branches, though you can do DM Neuroradiology / Interventional Radiology. Many fellowships and short courses are also available (in MSK / Obstetrics / Pediatric / Chest imaging).
  2. Earnings –  Any radiologist can earn a decent salary immediately after passing out, though you can never compare your earning with your Surgeon / Orthopedic friends once their practice flourishes. If you are doing a job as a radiologist you can get a fixed salary or variable remuneration according to patient turnover. If you have entrepreneurial skills then – Sky is the limit!
  3. Work timings: You can choose your working hours according to your need (and greed!) unless you are working in a Dedicated Obstetric or Trauma centre – be prepared for emergencies in such situations.
  4. Challenging job– Though you are not directly treating a patient, the fact is that your associated Physicians / Surgeons / Gynecologists depend on your skill and expertise for the appropriate management of the patient. In a sense they cannot do anything unless you provide them with an insight into a diagnosis.
  5. Tech savvy job – Working on advanced CT / MRI / Intervention workstations is a thrilling experience aesthetically too. You keep on learning new technologies as you strive to remain abreast of the advancements in imaging modalities.
  6. Teleradiology– As “work from home” culture is rising similar to IT industry. Reporting of X- ray, CT and MR scans from remote places can be done from home/ other working place. It can be source of additional income or sole source of income working from home.
  7. Scope for practicing abroad –
    • FRCR (Fellowship of Royal college of Radiology, London)- We can practice in UK, Singapore and in many other countries after passing FRCR exam.
    • Even Indian degrees also fetch good salaries in many gulf countries.

 

Cons –

  1. Dependant practice – If you are starting your own clinic, you have to depend on others to send patients to you. (At least in early days of practice until you establish yourself).
  2. Cut Practice / Kickbacks – Though no one will accept this openly, it still thrives in practice. It is the ugly side of our profession and is not exclusive to Radiology. Pathologists, even Surgeons and Physicians may resort to these practices. You can still live with dignity without indulging in these malpractices, if your self confidence and morale is high.
  3. High investment cost –
    1. A stand-alone US + X ray unit project cost would be somewhere between – 30 – 50 Lakhs ( Depending upon the kind of equipment you choose)
    2. CT / MRI machines – Will run into crores.
  4. Legal issues / PCPNDT Law- Though this has noble intentions like all other laws in India it is also used by few high handed government officials to harass innocent doctors. Radiologists in few states like Maharashtra, Haryana etc. have faced the heat of over-zealous and irrational legal enforcement.
  5. Encroachment by other specialities – Everyone from other branches is doing some radiology related work making you less relevant and increasing your competition. For instance it is Cardiologists who perform Cardiac imaging or Echocardiography, Gynecologists commonly do Ultrasounds, Neurologists perform Neuro-interventions.
  6. Artificial Intelligence and Computer-Aided-Diagnosis: There is indeed a lot of hoopla currently with forecasts that Computers will take up reporting of Imaging modalities in near future. Though nothing can be irrefutably discarded, it appears to be an overstatement at present. There have certainly been advancements in this domain, however all such softwares actually help the radiologist do his job better, rather than replace him. When self-driving cars start plying on our roads, when time machines are invented, when man inhabits the Mars……this may come true in Radiology. As of now I can say with conviction, not in the near future!

Future of Radiology –

All said and done Radiology is set to evolve and flourish like anything in future. Newer and newer technologies will make it a different experience altogether. In coming decades Artificial intelligence (AI) and deep learning algorithms working hand-in-hand with clinical experience of radiologists, are going to make a significant difference in Radiology practice.

So guys while preparing for your entrance exams do think about which branch you want to opt for. Do not just let your rank decide your future, you decide and act to create your future. Indulge in some introspection, some fact checks. What is the kind of life that you want? What is your aptitude? Doing what will give you that Adrenaline rush and eventually help you lead a satisfied and happy life?

I shall be privileged to welcome you in our esteemed faculty of Radiology.

Let’s Rock these Entrance exams!!

Love and Regards

Dr. Swapnil Yewalkar
MD DNB Radiology
Director – Shree Diagnostics, Pune and Shashwat Imaging Clinic, Pune
Consultant – Sahyadri Speciality Hospital, Pune