Our guest today is Dr. Sahil Mehta, an interventional radiologist. He talks about his specialization, offering plenty of insight and advice to medical students who would like to get involved in the field. He is excited to passionately discuss everything from matching into IR and what a day on the jobs looks like for him.[0:58] Introduction to Interventional Radiology (IR).
Last year, IR was the most competitive match in the entire country. That is exciting to Dr. Mehta, because it means that either the people in the field are doing something right or that the specialty offers a high salary. Interventional radiology is very different from diagnostic radiology, and everyone in the field is excited that IR now has a separate residency and a separate match process. Dr. Mehta did not even know about IR until his third year as a medical student when he saw a fascinating procedure.[4:02] How to Get Interested in Radiology as a Medical Student.
Previously, if a student wanted to do IR, they would do radiology diagnostics and then a fellowship in IR. That has changed with the introduction of IR/DR, which is an integrated program where the student does both diagnostic and interventional radiology, but with a stronger focus on IR. Dr. Mehta thinks this makes the most sense because what an interventional radiologist and a diagnostic radiologist do are vastly different. IR is much more of a surgical field; almost everything done is treatment-oriented.
Because of this, Dr. Mehta thinks the first thing that a student must do is think about if they are interested in IR. If they are, they are probably the type of person who is interested in a surgical subspecialty. On the other hand, if a student is interested in diagnostic radiology, IR is probably not the right fit for them. It is crucial to think hard before committing to IR.[7:25] A Day in the Life of a Practicing IR Doctor.
IR doctors treat a wide range of patients, from children to people who are at the end of life. For instance, the first thing on Dr. Mehta’s schedule for this day was a uterine fibroid embolization for a woman in her 40s. For this procedure, Dr. Mehta will be able to treat the uterine arteries via a small hole in the patient’s wrist. The patient will be able to go home on the same day, whereas the surgical alternative would be to cut open the patient and then have them recover for twelve weeks.
The next case might be an emergency patient, such as a trauma victim who is bleeding from the spleen. Back in the day, that patient would go get surgery; they would get their spleen taken out. Now, it can be addressed by going through a small hole in the wrist or groin to stop blood flow to the spleen.
After that, an IR doctor may get a venous access case; the patient may have cancer and need a simple port placement. There is a large spectrum of things that get treated daily, which Dr. Mehta believes is one of the most fascinating aspects of IR. Another procedure that IR doctors often do is radioembolization, in which that doctor can go right to the blood vessels that are supplying the cancer and inject chemotherapy directly. This is different from traditional chemotherapy which goes all over the body, including to hair follicles (and therefore, causing hair loss).[12:13] Following Up with Patients.
Dr. Mehta sometimes has one day a week that is dedicated to seeing patients in-clinic. These are patients who want to be evaluated for an elective procedure. For example, he treats many patients who have compression fractures of the vertebral body. He will do everything that a clinic visit involves, and then decide if the procedure should be performed. He could then see them for the procedure, and again for multiple follow-up visits.
Dr. Mehta also has some very long-term patients that he sees every month. He feels that he gets the right amount of patient care and interaction, as opposed to some specialties that may get an abundance of patient interaction but no procedures or vice versa.[14:40] What Does a Medical Student Have to Do to Start Preparing for a Career in IR?
If you think you’re interested in it, explore it. Almost all medical schools have some ability to provide exposure to IR, although that doesn’t mean that it is part of the curriculum. Talk to as many people as possible, and then if you feel like IR may be right for you, shadow and be a part of it.
If you then decide that IR is the right choice, research the field and spend as much time with IR physicians as you can. It is still a relatively small field. Program directors want to see someone who is genuinely excited about IR and has explored it as a career. If you can prove that through interactions, letters of recommendation, and research, you will have a good chance of matching into IR.[17:22] The matching process.
The process is changed. Last year was the first time that there was a completely full compliment of IR/DR programs. IR programs have been transitioning over the past few years into integrated programs. As mentioned, people would match into radiology and do a fellowship in IR. Now, in most cases, the IR program can be directly applied for.
If you don’t match into IR but still want to be an IR physician, the best way is to do the diagnostic radiology pathway and then fill a fellowship slot.[19:22] Advice for Osteopathy Students Interested in IR.
The same advice applies including, of course, getting great grades. Apart from that, showing interest is of great importance. If you are an osteopathic student that has three publications in IR, that is the type of student that would be desired. An away rotation would also make an excellent impression.[20:59] Closing Remarks.
There are upsides and downsides to every specialty. Think about the most boring thing about a specialty, and if that thing is exciting to you, then that specialty is for you. In IR, the most boring thing that Dr. Mehta does is a central venous line. He has done thousands of them. For other specialties, a venous line is a rare thing to do. Because of this, Dr. Mehta still enjoys this procedure.