Why do radiologists need to be full MDs?

It seems like overkill. Whats the thinking?

How so? Are you thinking of an X-ray technician? The radiologists I know are some of the most knowledgeable medical professionals I’ve ever met.

I don’t know about you, but I was happy that the person reading my son’s MRI and X-ray to differentiate if his severe leg pain was a broken bone, a tumor, or a bone infection was a doctor.

It was a bone infection and he was in the hospital for days on IV antibiotics trying to avoid surgery. The diagnosis was based on blood work and subtle evidence of edema around his leg close to the bone, visible on X-ray and verified by an MRI.

Now the radiologic technician, who has expertise in setting up the X-ray, ct scan, or mri has a different degree, generally an associates or BS. Their skill set is completely different.

Radiologists need to be knowledgeable about medicine to correlate clinical information, generate differential diagnoses and ultimately draw conclusions that clinicians rely on.

Interventional radiologists perform surgical procedures, for example CT-guided biopsies which involve sticking long needles into body cavities to precise locations in order to diagnose tumors or other pathologic processes. I’d want those folks to have a pretty good idea of what structures they are traversing on the way to their targets.

A radiologist needs to know a lot of medicine to correlate images with what might be going on. In addition to a detailed knowledge of anatomy, physiology, pathology and how these change by age and other factors, they need to understand a lot of details about any information they can glean from the image that will be of practical value to the physician or provider that ordered it. A surgeon or ER doc usually wants to know the problem, the likeliest causes, the most critical possible causes, associated complications, unsuspected occurrences, whether surgery would help, how things have changed, staging information, whether there is anything unusual about the clinical picture, etc. and not just “this is probably so and so”.

When I worked at the big hospital, I sometimes went on rounds with the residents, and one time, they put up an x-ray because they were trying to figure out if the person had pneumonia, or pleural effusion (or possibly both). One of them distinguished them apart by saying, “One is fluffy, and the other is floofy.”

Knowing the difference between fluffy and floofy takes experience.

And knowing how to take that x-ray, etc. requires a lot of training. Their educational level approximates that of an RN/BSN.

As part of our pre-med education, we shadowed a radiologist for six hours.

OmiGAAAAH, what a boring day!

He had very little actual contact with patients (five minutes in the morning, fifteen after lunch), plus a quick "walk into a patient’s room, glance at the X-Rays up on the wall, “Yep, that’s broken.” then walk out)

Even consulting with doctors and nurses was minimal. He spent most of his time “In Radiology” (a darkened X-ray room, staring at a light table), all by himself.

We left as quickly as we could, and the air in the parking lot smelled of sweet freedom.

(As it turned out, none of us became doctors. A sportswear executive, a slush rug mogul, a minister and an art teacher, but no doctors…)

The most obvious reason that radiologists have to be full M.D.s is so they can get access to the doctors’ lounge for donuts and sammiches.

Doctors sandwiches, nasty things always cut into triangles, are poor recompense for years of study.

They do things that other doctors do, such as diagnose illnesses, even though they do not meet with patients. Similar for pathologists.

Hmm. One of my closest friends is a diagnostic radiologist, and he does meet and interact with patients, so I don’t think that’s universal. Incidentally, it’s also one of the highest compensated medical specialities, so I suspect it’s not as easy as just any ol’ schlub reading some x-rays or CAT scans.

My bad. I have never interacted with any radiologist who read my results so I didn’t realize that it happened.

radiologist did a biopsy on me using ultrasound to guide him

Hospital librarian here. I’ve done a lot of information gathering for radiologists over the last 20 years. These people are whip smart, excellent diagnosticians. They need to be able to distinguish the tiniest bit of shadow. My favorite radiologist was reading an image of something, called me for a specific article Asap! and had me look at the image. He pointed out the cancer that he found, even though the image was not for cancer diagnosis. Radiologists read more than xrays. Ultrasounds, nuclear medicine tests, MRIs, CTs.

in the past the techs learned radiology and ultrasound but now some only do ultrasound .

Rad techs do NOT interpret results. They perform the tests, but the MDs read the results.

Rad techs do not interpret the result for legal and hierarchal reasons. But they are often very smart especially if they have years of experience, and some are particularly good at reading ultrasounds. If you have worked in a place where radiology reports take days, asking the advice of a tech is not always a bad thing to do.

Radiologists are very capable in their area of practice. Like some specialists, they are often are lagging in GP type “general knowledge” - along the lines of what is a good blood pressure drug to use these days, which is reasonable.

Thanks for the edification.

A few years ago I had kidney surgery. On the first day a radiologist put a lead in through my back to the kidney. The next day the urologist used the lead to place a tube into my kidney through which the surgical instruments were fed.

I waited a couple of weeks for the surgery to be scheduled because my urologist was very selective about which radiologist was used.

However, if they see something that warrants a doctor’s immediate attention, they can summon him or her.

It’s along the lines of “nursing diagnosis” - nurses can’t diagnose unless they are an APRN, etc. but an RN can list symptoms and then tell the doctor what they think is wrong with the patient. (LPNs cannot do that.)