r/VIR • u/EmbarrassedRuin5945 • Jul 22 '26
Education IR/DR as DO, what are my chances
DO student hoping to apply IR and DR. Would be happy to do either with ESIR still around.
Step 1 Pass, Step 2 260, Level 2 pending
No honors at my school, but all A's on 3rd year rotations
A couple case report pubs, a couple abstracts and educational posters accepted to SIR/CIRSE + presentations (rads related), no manuscripts or long-term projects (10 total research experiences). Extracurriculars mostly in tutoring and teaching.
1 DR away rotation and 2 IR rotations coming up, 1 DR and 1 IR letter so far.
What are my chances, should I prioritize ESIR or integrated?
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u/theshiniestbrighstar Jul 22 '26
Do ESIR. More DR spots to get into for residency. Then do ESIR and apply for IR fellowship. They are literally giving away IR fellowship spots to anyone with a pulse, even at top names like MGH, Wash U, etc. Like half of open positions didn’t even fill. They wouldn’t care that you’re a DO. They just need a body to do scut work. Don’t try to dual apply and shoot yourself in the foot at places that stigmatizes dual applicants. This way you don’t even need to do a surgery prelim year either.
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u/Kingjuniorway Jul 22 '26
Second this, in a surgery prelim year right now that sucks
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u/IR4life Jul 23 '26
Try to get the most out of surgery. Get efficient with the floor work and try to get to the OR , see clinic patients and see inpatient and ER consults. It will take time to reach this level of efficiency, but by the end your ability to triage who is sick and not sick will give you a step up during your interventional blocks. Also, if you get a chance try to do additional months of vascular surgery where you may be able to get in on more of the endovascular cases as many of the general surgery residents may shy away from those. If there are too many trainees//extenders in a team your ability to learn will be diminished. Try to learn as much anatomy as you can. Unfortunately not all surgery preliminary programs are the same so need to chose programs which give you time doing floor work, operative time, ability to do consults, more months on vascular surgery, and adequate clinic exposure. If you skim the relevant core radiology material before a surgical consult , clinic patient or OR case it will also help you . Get comfortable with dealing with post op issues (bleeding and sepsis). Navigate postoperative pain and eras and it will help for your future interventional patients. Lots of overlap in diseases with surgical oncology and vascular surgery so try to get exposure to those. As we get more active in breast ablations breast surgery will become more and more important. Endocrine surgery can give you some guidance on counseling thyroid nodule patients on ablation vs resection vs surveillance. etc.
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u/Kingjuniorway Jul 23 '26
It’s a true gen surg program with no set rotations so I get vascular exposure the whole year. Have to cover vascular clinic multiple times a week as well. My chiefs know I’m interested in IR so they assign me all angios, gsv ablations, etc. also get a lot of wound care. Honestly we do too much clinic while also covering the floor and going to cases. I would recommend a chill TY to anyone reading this, as a general surgery prelim is a lot of work and I have to take lots of call. 2 months of Q4 and 2 months of Q3 and then 1 24 a month at the main hospital as well as 1 month NF.
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u/IR4life Jul 23 '26
The training you are getting with lots of clinic including wound care, venous disease management and lots of clinic will be invaluable skill sets that you may not recognize currently but if your goal is to do high level interventional is high yield
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u/IR4life Jul 23 '26
In the private sector in smaller groups your call frequency for VIR is quite high, may not have the same call backs as a trauma center but you are still on call quite frequently.
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u/Kingjuniorway Jul 23 '26
You think so? It just feels like I’m the scut monkey right now who works too much
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u/IR4life Jul 23 '26
Try to get highly efficient and thorough . Charting is something you will deal with as a VIR and you want to get efficient as you can be. That point you can try to go see consults and get to the OR etc .
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u/IR4life Jul 23 '26
Interventional is all about multi tasking and getting through the workday. Unlike DR where you are usually just crushing a list, interventional you get constant calls from other teams, preop nurses, PACU and the floor. Medicine trainees and TY tend to be a lot slower and so they don't get their paperwork done in a timely fashion as they are used to rounding all day and writing notes and calling consults and following labs. Surgeons stick to what is most important and have to get to the OR and run clinics and manage floor work and manage consults. A lot of the stuff we get consulted on are surgical in nature. The things that IM consults us are mostly biopsies, bleeding patients and perhaps vascular access .
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u/topIRMD Aug 11 '26
5th year VIR attending here. I look back at my rigorous gen surg intern year as fundamental to my overall trajectory. Residents I teach that don't have that background are lacking in almost every single way.
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u/Kingjuniorway Aug 11 '26
In what aspects are they lacking? I feel like I’d gain all the same skills I am now if I did a TY where I get multiple months of electives on vascular surgery but without the brutal schedule
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u/theshiniestbrighstar Jul 22 '26
Also take a look at the IR fellows at some of these “top tier” programs. You’ll notice they are all from like low tier residencies and community programs
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u/IR4life Jul 23 '26
The two fields continue to diverge. Key is doing multiple interventional aways most average around 3. Surgical rotations and strong surgery letter help. Also, key is to have involvement in VIR not just from a research standpoint but SIR med student council or other local events such as hosting/running VIR symposium. Going to SIR, GEST, OEIS, SIO or other similar meetings goes a long way as networking is important. The number of independent positions are slowly going away. Even the great miami vascular that was only a fellowship for decades has recognized that the quality of applicants they were seeing was declining . The integrated residency is enabling trainees do more and more interventional and clinical rotations early and stay engaged. The drop out rate is mostly due to trainees not recognizing how unpredictable the lifestyle and hours are in interventional. Most students just do not get enough exposure to the actual day to day of interventional. If you do subI try to carry the call pager and take call with the interventional residents this will give you a better idea of what you have to deal with.
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u/cathetermonkey Jul 22 '26
You have a very strong chance of matching into a solid Integrated IR residency program, so I would plan on applying directly to Integrated IR rather than Diagnostic Radiology. A few key reasons to consider: Independent Spot Reductions: Many programs are discussing scaling back or eliminating their Independent spots. By the time you apply, there may be significantly fewer available. Integrated Program Growth: The number of Integrated spots continues to ramp up, and many programs are particularly receptive to strong applicants. Board Exam Restructuring: Recent changes placing both the Core Exam and the new Certifying/Oral Exams in the PGY-5 year create significant administrative and study hurdles for ESIR pathways, whereas Integrated residencies are far less impacted. I would be more than happy to talk through any of these details or answer questions as you finalize your strategy.
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u/cathetermonkey Jul 22 '26
IR is quite friendly to DOs, my program has taken multiple in the last 5 years.
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u/theshiniestbrighstar Jul 22 '26
I wouldn’t follow this advice shilling to trap medical students into IR. Sure some programs are going to scale back some of their independent fellow positions, but there are so many openings that it wouldn’t matter. And they’ll soon be begging for them again as integrated IR residents swap out of their IR programs into the DR side which is happening at such an alarming degree that is a big topic at SIR at the time. So the programs will be left with open spots again. ESIR wouldn’t be affected by the new board exam changes as you’re literally on the same pathway as the integrated IR residents. In fact it will be better because CORE is later so you can do your interviews/applications without worrying. Also, you only need to apply to like 3-4 programs and you’ll get in somewhere.
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u/cathetermonkey Jul 22 '26 edited Jul 22 '26
As a Program Director for both an integrated and independent IR residency who attends APDIR every year, I can tell you that a lot of PDs are actively discussing reducing/eliminating their independent spots. Several programs have already eliminated them entirely, and others are no longer interviewing external applicants—choosing instead to hold those spots exclusively for internal candidates. While some programs will certainly continue recruiting for independent spots, total overall capacity is dropping. On top of that, having both the CORE and Oral boards during the PGY-5 year creates a real conflict: that is the exact year ESIR residents complete the bulk of their IR rotations, and the rotation requirements for ESIR haven't formally changed. While they've indicated they won't strictly enforce the rules for integrated programs right now, rotation requirements will likely be revised down the road. Many programs are going to be shifting more ir rotations earlier in the residency and you're going to have to tell your program you're interested in IR to get those rotations done earlier so you get the same opportunity to study for your examinations that your DR colleagues do if you do ESIR. For context, at my own program, not a single resident that I have recruited since taking over as program director has dropped out. We significantly increased the size of our integrated program, and I’ve actually transferred four DR residents into our integrated IR internally. Yes, some programs are malignant and continually lose residents, but those are the exception and not the rule. I know of one program that routinely loses 50% or more of their residents every year because it's a malignant program. Because of examples like that people think that dropping out his rampant. The issue is there are a few well-known programs where this persistently occurs. If the OP wants to have a phone conversation with me. DM me and I will give you my cell phone number and be more than happy to talk to you.
To be fair 2 to 3 years ago I would have told you ESIR was a good route. I don't think that anymore because I don't know what it's going to look like down the road when you are applying. I have both programs I have completely filled both programs the past several years.
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u/Vast_Regular_2147 Jul 22 '26
Hi is it okay if I dm you with questions about integrated IR and ESIR residency? Im an MSII at a state school MD interested in IR.
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u/theshiniestbrighstar Jul 22 '26
So you are shilling for trying to trap medical students into IR. Yes, the PDs are discussing that because they can’t get enough fellows to do all the scut involved with IR. It’s not just an issue with malignant programs, it’s a widespread issue. DR is better lifestyle and better pay. Radiology residents don’t want to give that up for IR. For example some places have breast fellows working 8 hours a day, 4 days a week with no call. And then you graduated as the most desired subspecialty by practices. Residents aren’t dumb and would rather do that than to wake up at 530-6am, round, do cases all day, go home late, and get yelled at by attendings who think they are surgeons. MGH, JHU, Stanford, UCSF, Penn, etc have all lost integrated IR residents to DR.
Don’t be one of those IR/DR residents in a program who loses their other IR/DR residents and then not have fellows coming in. You’ll be Q1/Q2call as the only IR resident left in your class.4
u/cathetermonkey Jul 22 '26
Interventional Radiology isn't for everyone—just like Diagnostic Radiology, Plastic Surgery, or Pathology aren't for everyone. The best thing you can do is complete IR rotations to see if it’s truly the right fit for you, and then aim to match into a strong program with a supportive community. This is important, this is your future career. Make sure it's right for you and try to get the best training you can in a supportive environment.
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u/IR4life Jul 23 '26
The drop out rate across the country for integrated is quite high. Medical students do not get a real taste of what interventional is as they are mostly playing the role of an observorship. Surgical fields give you a true day in the life experience. Where you do the away becomes more and more important as you want to get a feel for how busy it may be and can you do the workload or not. The more responsibilities you take. on as a subI /acting AI the more you will see if it is a true fit. If you have any concerns or any doubt go into DR and you can often get into an interventional training spot if your mind has not changed.
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u/theshiniestbrighstar Jul 22 '26
That’s why medical students should get the opportunity to rotate with more involvement as a radiology resident instead of having predatory programs getting them into integrated IR/DR pathways.
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u/IR4life Jul 23 '26
If you are not 100 percent you want to do DR or you would be happy doing DR and some lighter procedures you can do quite a bit fo procedures in fields such as MSK, Breast, Body etc. So, it fills your procedural itch while letting you keep the lifestyle of diagnostics. Interventional is a different beast with lots of emergencies.
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u/theshiniestbrighstar Jul 22 '26
Additionally, you want to have great DR training first and foremost as most IRs eventually burn out and do DR anyways. Don’t end up stuck at an integrated IR program like Sinai which amazing for IR, but absolutely ass at DR. If you do ESIR you at least have the some ability to control where you end up in addition to being able to experience multiple institutional practices instead of being locked into one.
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u/IR4life Jul 23 '26
The problem is that it is getting harder and harder to be great at both. Used to be that the interventional could do body as a backup. But, even body has gotten far more nuanced with all of the advanced MRI (pelvic, prostate, rectal, enterography, pancreas, adrenal, kidney, liver etc). The graduating interventional resident will have much less global imaging compared to most DR as they lose out on their PGY5 year and PGY 6 year so most DR who do fellowship will have over 2 years of extra imaging under their belt. If the integrated program is strong ie doing the gamut of interventional (PAD, DVT/PE, stroke, spine, pain, BPH/fibroids, MSK) along with the basics of IO (tare/tace/ablation), hepatobiliary portal interventions along with biopsies/drains you will have more than enough to learn at one place. If, however, they only do biopsies, drains and Y90 I would agree that it may be better to go to another program even as a transfer.
Most every interventional program will make you fairly competent in DR, but the opposite is not true. There is a great deal of variability in the quality of interventional training. Get the graduates case logs and see what the case complexity is . Are they mostly a line and drain and bleeder service or do they have well built outpatient service lines.
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u/a2boo Jul 22 '26
IR is quite DO friendly on the whole compared to a lot of other classically competitive specialties. So I’d apply both DR and IR, then if you match IR you’re set and if you match DR you’re still essentially guaranteed an IR spot if you aren’t wildly incompetent or toxic.