The Role Of A Radiologist:
Are you a medical student or foundation doctor scanning through the plethora of possible fields you could specialise in? If you also happen to have a keen eye and a passion for high-tech gear and gadgets, clinical radiology may be your calling.
This article aims to provide you with great insight into radiology as a profession and guide you on your journey to becoming a radiologist.
A radiologist’s job is to use images to diagnose, treat, and manage diseases. Radiologists are integral in the accurate diagnosis of many medical conditions. Common imaging technologies include X-ray, ultrasound, CT, MRI, PET, fluoroscopy, molecular imaging – e.g. CT perfusion, dual-energy CT, optical imaging – as well as nuclear medicine techniques.
Furthermore, radiology has been at the forefront of minimally invasive techniques; this is known as interventional radiology, whereby X-Ray, ultrasound, MRI and CT are utilised for guided procedures to diagnose and treat diseases in almost every organ system (1).
There is a wide range of interventional techniques performed by radiologists, including (1):
Biliary drainage and stenting
Treatment of internal bleeding by injecting a clotting substance
Treatment of arteriovenous malformations
Contrary to popular belief, radiology involves lots of contact with people. Although radiologists spend most of their time writing imaging reports, they also play a crucial part in multidisciplinary meetings and their expertise is highly valued; they work alongside radiographers, medical physicists, and other specialist doctors.
There is a fair amount of patient contact in radiology, and some aspects offer more patient contact than others; for instance, ultrasounds, fluoroscopy, or breast imaging involve a good proportion of direct patient contact (1).
Apart from the necessary skills employed by all doctors, aspiring radiologists should demonstrate certain qualities and traits. Good observation and analytical skills, as well as attention to detail are central in this specialty. The job also requires a high aptitude for problem-solving and solid grounding in anatomy, physiology, and pathology across all specialties.
The interventional component also necessitates manual dexterity. As radiologists are always part of and managing a team, they must also demonstrate excellent teamwork and leadership.
Owing to constantly evolving technology, a number of conditions can now be diagnosed and treated more swiftly by radiologists, thus making this a highly rewarding specialty (1). Whilst still male-dominated, radiology has witnessed an increasing proportion of women.
Although, disparities remain between subspecialties; interventional radiology remains severely underrepresented with women comprising only 11% of the workforce, whereas in diagnostic radiology it is 41% (2).
A Typical Week:
A normal working week usually offers a mix of writing imaging reports, performing diagnostic and interventional procedures, reporting on cases and providing follow-ups, teaching junior staff, as well as managing at least one multidisciplinary meeting.
Some time is allocated to clinical governance. Your exact schedule depends on your chosen special interests. On-call commitment varies but is often between one in seven and one in eight weeks.
Most consultants are on-call out-of-hours at district hospitals where there are no specialty trainees. On-calls can get busy as they may require travelling between sites and involve emergency procedures, writing reports and communicating results to medical colleagues.
With the proposed 24/7 imaging a week, the demand could increase in the future. Nevertheless, the majority of radiologists believe a good work-life balance is possible. The EU Working Time Directive limits the working week to 48 hours (1).
The Route To Becoming A Radiologist:
Interested undergraduate medical students can join the medical society at their university and attend conferences for an opportunity to explore the specialty and network with potential future colleagues. You may also want to consider joining associated societies, institutes or professional bodies such as the British Institute of Radiology (BIR) and the Royal College of Radiologists (RCR) (1).
During your foundation years, contact the radiology department at your hospital and ask to sit in on reporting and multidisciplinary meetings. Try to get involved in radiology audits/research and attend courses offered by the RCR (1).
After completion of your foundation programme, you do not have to complete core medical training (CMT) or equivalent, but instead can commence specialty training beginning at ST1 and running through to ST5; this means there is no ST3 application process (1). However, due to the high level of competition – 3.63 applications per ST1 post (3) – you may want to consider gaining experience in radiology clinical practice and/or research first rather than applying directly from foundation training.
Some applicants have even completed training in other medical specialties before applying to radiology (1). Since selection panels look for evidence of commitment to the specialty, awards, prizes, research, publications and presentations will strengthen your application.
Be ready to move to a different location as certain hospitals – such as Guy’s and St Thomas’ Hospital, King’s College London – are renowned for their excellence in this specialty and would prove beneficial to your career prospects (4).
The curriculum comprises three years of general radiology, including training in each radiology subspecialty, followed by two years of special interest training. During specialty training, you must also sit and pass the examination leading to the Fellowship of the RCR (FRCR).
Since radiology is a rather academic medical specialty, you may want to consider completing an Academic Foundation Programme (AFP) rather than normal foundation. Many radiologists pursue a research degree, usually an MD (2-3 years) or a PhD (3-4 years), before or during specialty training.
Should you choose to follow the academic training pathway, you will normally be appointed as an academic clinical fellow during ST1-2 and as a lecturer at ST3 onwards. At the end of training, you will be awarded the certificate of completion of training (CCT) to go on to work as a consultant radiologist (1).
The only subspecialty within radiology recognised by the GMC is interventional radiology, for which you should express interest during specialty training as you will have to complete an additional year (ST6).
Nonetheless, consultant radiologists often develop special interests in areas such as (1): Breast, cardiac, emergency, gastrointestinal, head and neck, musculoskeletal, neuroradiology, oncology, paediatric, radionuclide, thoracic, uro-gynaecological, vascular
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
Consultant radiologists may also wish to run private practices to supplement their salary; a “purely” private consultant is rare in the UK. On average, private radiologists can make a profit of an additional 44% of their NHS salary by working in the private sector (5). In 2018, private radiologists made a profit of £117,000; this is higher than most specialties, only second to orthopaedics (£128,000) (6).
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
If you are interested in deepening your knowledge in radiology, you may find it useful to consult relevant journals, such as the ones listed below:
British Journal of Radiology
European Journal of Radiology
Physics in Medicine and Biology
Computerized Medical Imaging and Graphics
The following societies and institutes offer a wealth of information on conferences, podcasts, essay prizes, research, tutorials, courses, and learning resources relevant to radiology
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
1. Clinical Radiology [Internet]. Healthcareer | NHS. [cited 2020 Aug 15]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/clinical-radiology
2. Clinical Radiology UK Workforce Census 2019 Report [Internet]. The Royal College of Radiologists. 2019 [cited 2020 Aug 15]. Available from: https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-radiology-uk-workforce-census-2019-report.pdf
3. Specialty Recruitment Competition Ratios [Internet]. Specialty Training | NHS. 2019. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Competition Ratios 2019_1.pdf
4. Clinical Radiology [Internet]. King’s College London. [cited 2020 Aug 16]. Available from: https://www.kcl.ac.uk/lsm/study/training/iat/careers/radiology
5. Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D, et al. Analysis of consultants’ NHS and private incomes in England in 2003/4. J R Soc Med [Internet]. 2008 Jul;101(7):372–80. Available from: http://journals.sagepub.com/doi/10.1258/jrsm.2008.080004
6. No Title [Internet]. Independent Practitioner Today. [cited 2020 Aug 16]. Available from: https://www.independent-practitioner-today.co.uk