JustinMcWilliamsMD

Good question! I wonder this myself when I'm walking around the grocery store looking like a drug dealer. I think it is because we need a cheap device that doesn't lose contact in hospital basements and other locations lacking cell service. Sat phones are too expensive to give us, I guess. I do have all my pages go to my cell phone as well, though, so I don't have to carry that thing everywhere I go...

I stand next to an X-ray beam almost every working day, so I am definitely concerned. Not so much about becoming sterile or anything, since that takes really high doses, but about small incremental risks of cancer, particularly leukemia or lymphoma. I'm hoping that instead, I will develop cool mutant powers like Spider Man, but I am told that is really really unlikely.

I wear a lead kilt and lead vest that make me look like a really slow Scottish warrior, and it protects from about 90% of the scatter radiation that I experience. I also wear a radiation badge that gets turned in every month, and radiation safety officers write me scary sounding emails about how many milliGray I was exposed to, but never really equate that to how much risk I'm exposed to. Fortunately I've done my own research, and it seems that the cancer risk from my occupational radiation exposure is fairly small in the grand scheme (cancer risk for the general population is 40%, but for me might be 40.5% or 41% after a lifetime of working in IR).

Interesting is that there are reports out there of cardiologists having tumors grow on the left side of their brain or face - this is more common because cardiologists typically stand with the radiation beam on their left side (same as me). I typically protect against this by hiring fat fellows (block a lot of X-rays) and standing behind them as much as possible.

Wow tough question. One was a TIPS (which is basically a shunt placed through the liver under semi-blind X-ray guidance, used to relieve pressure in the portal system in patients with cirrhosis) that I was doing in a patient who was actively vomiting blood, bucking around on the table and generally trying to die. Another was a patient with a massive pulmonary pulmonary embolism who was 500 pounds and I was trying to navigate a catheter through the lung arteries to suck out the clot as their blood pressure was tanking and they were coughing blood and I had to decide whether to keep trying or call the surgeons to crack her chest. Both turned out OK, the TIPS patient survived and got a liver transplant a few days later, and the PE patient I was able to suck out enough clot to get them out of the woods, and the next day she was sitting up in the ICU eating french toast. Win.

Definitely start by not having any mis-spellings in your application or personal statement.

A strong application is the combination of a few things:

1) Good med school transcripts. Try to get some letters of distinction, or honors, or whatever your school offers. Work hard and be the first one there and last one to leave. It will be noticed.

2) High board scores. Especially step 1. It sucks to study for it but it is well worth it. A high score here can carry you a long way.

3) Good letters of recommendation. These get more important the farther along in training you get. If you are working hard and studying hard, and you aren't a total a-hole, then this should work itself out.

4) Research experience. Especially for academic institutions, they want to see one or more projects that you have carried through to the end. First author on a paper, or at least on a poster or conference presentation.

5) A really beautiful head-shot. Just kidding. Kind of.

Notice I didn't include a great personal statement. These all read basically the same to me, so I just skim them, looking for any signs that you are a mass murderer or serial rapist. Otherwise they don't make much difference, at least to me.

Residency wasn't bad, in fact pretty sweet. Internship can be tough (like 60-80 hour weeks) but once you get into the diagnostic radiology years, the work hours are more like 50 hours a week, though you have to do a lot of reading and studying at home as well. During fellowship, you are limited to 80 hour work weeks by the ACGME, but I'd venture to say that some fellows work well over that at times (never at my program, in case ACGME is reading!), maybe up to 100 hours a week especially during busy call weeks.

Now as an attending, you have a lot of control over your life and your hours. Some of my friends work at the VA and work about 30 hours a week with 2 days off, some work in private practice where they work hard when they're on, but get 14 weeks of vacation a year, and then there are the truly mis-led like myself who take a job in academics because they like teaching and research and feel like it's a noble thing to do but then spend basically their entire waking life doing work-related things to the point where they are unable to have pets because they would die of neglect. That's pretty much where I'm at, but I am OK with it because I love my job and I get to help people every day. I'm probably between 60-70 hours/week most weeks but more if you count all the time I spend at home working on lectures, research, answering emails, etc.