How to Become a Radiologist

By: Andrew Colucci, MD

Last Updated: Jun 29, 2021

Radiologists are specialist physicians who utilize a wide array of advanced techniques in medical imaging to diagnose and, in certain cases, treat patients with all types of illness. These imaging modalities include X-rays, ultrasound, CT, and MRI examinations. Like all physicians, radiologists have completed medical school and have obtained their M.D. degrees.

To help patients and their primary care doctors arrive at the correct diagnosis in a timely fashion, radiologists correlate patient medical histories, physical exam findings, and laboratory values with their own interpretations of imaging exams. A growing subset of these specialists called interventional radiologists performs surgical procedures under imaging guidance in order to minimize damage to healthy tissue. The training to become a radiologist is long, competitive, and intense, but the payoff of helping hundreds of patients every week makes the journey well worth it.

While early radiologists had only film radiographs (“X-rays”) to work with, modern professionals have a variety of tools at their disposal.

Radiologists generally work behind the scenes analyzing studies, making diagnoses, and consulting with physicians. In some cases, they get involved in the procedure in order to help prepare the patient or outline further instructions to the technician.

Interventional radiologists take imaging technology a step further by using it to treat certain diseases and conditions. These professionals create electronic maps to guide their instruments as they insert catheters, remove malignant tissue and perform other delicate procedures. This gentle approach allows patients to recover faster and with fewer complications.

If you thrive on intellectual stimulation, you may find radiology an especially rewarding area of practice. Given the constant state of flux and continued innovation in radiology, there is always something new and exciting to learn. These specialists are among the first to pilot cutting-edge imaging technologies and procedures developed in clinical and translational research laboratories. Radiologists also enjoy the challenge of interpreting complex studies and putting together medical clues to arrive at an accurate diagnosis, ultimately for the patient’s benefit.

Workplace Details

Though most radiologists still work in hospitals and outpatient diagnostic centers, advances in digital technology now allow imaging studies to be transmitted electronically. This practice, which is known as teleradiology, means radiologists can now practice in any location equipped with a computer, high-resolution monitor, and internet connectivity. Teleradiology helps emergency departments and intensive care units obtain emergency consultations after hours. Teleradiology also promotes consultation among experts around the globe.

Unlike most other physicians, radiologists have limited patient contact. In fact, some go weeks without a face-to-face consultation. Instead, these specialists spend their time analyzing image results and formulating diagnoses.

Radiologists who work in the hospital work long, irregular shifts that include nights, weekends, and holidays. Those employed by outpatient centers are more likely to work regular business hours. However, depending on the specifics of a given radiologist’s employment contract, overall hours worked and length of vacation are often balanced against the amount of compensation.

Hover over any state to explore local income and job growth data.

The U.S. Bureau of Labor Statistics states that the mean annual salary among specialist doctors (a group that includes radiologists) is $218,825. Meanwhile, Medscape’s 2019 Radiologist Compensation Report found that the average annual pay of radiologists was $413,000.

Earnings increase with experience and vary by location and subspecialty. Additional variations can be seen between employed radiologists (who work for large hospitals), versus private practice radiologists (who work for an independent radiology practice).

According to the Bureau of Labor Statistics, the job outlook for physicians, in general, is strong, with growth rate of 4% expected between 2019 and 2029. This is average growth. Radiologists may find their job prospects better than other physicians due to the needs of an aging U.S. population.

A high GPA, above average MCAT (Medical College Admission Test) scores, multiple letters of recommendation, volunteering and leadership experiences, and exposure to basic and/or clinical research are essentially required to move on to the next step.

After obtaining an acceptance to an M.D. or D.O. medical school, the student must complete the rigorous 4-year curriculum while still remaining toward the top of the class. While in medical school, students will learn all of the anatomy, physiology, pharmacology, pathophysiology, and pathology that are expected of all graduating physicians. Students must also study for, take, and perform highly on the United States Medical Licensing Examinations (USMLE), Steps 1 and 2. In the final year of medical school, applicants will apply to their postgraduate residency programs in various specialties, including radiology for those who aspire to become future radiologists.

Following graduation from medical school, you are awarded an M.D. (or D.O.) degree, you can apply for a limited medical license, and you’re considered a physician. However, the true hands-on training must now begin. Radiologists are required to spend their first year as a resident – also known as “intern year” – practicing general medicine, surgery, or a combination of both. This includes taking care of patients in the emergency department, as well as inpatient and outpatient settings.

At this point, trainees are introduced to their specialty of radiology, beginning a 4-year training program in the field. During these four years, the radiology resident will spend many hours, both day and night, in the hospital interpreting tens of thousands of imaging studies, counseling patients on their results, communicating results with other clinicians, and performing many image-guided procedures and interventions. Toward the end of training, the residents must take and pass multiple sets of examinations.

The vast majority of graduating residents will then apply to and accept a 1- or 2-year fellowship program in a subspecialty of radiology. These include neuroradiology, musculoskeletal radiology, and interventional radiology, among many others. During this period, the radiology fellows undergo the final steps of training, learning the most advanced imaging and procedural techniques within their subspecialty.

Following the completion of their fellowship, radiologists are finally ready to apply their skills and independently practice their specialty. State licensure is mandatory for all practicing physicians, including radiologists. Most employers also require radiology candidates to hold board certification, which requires passage of a two-part examination covering medicine, anatomy, imaging modalities, and physics.

Radiologists earn excellent salaries throughout their careers. As they advance, many choose a more comfortable lifestyle over pay increases. This usually takes the form of fewer nighttime, weekend and holiday shifts.

Other radiologists advance their careers by gaining new skills and expertise. It is not uncommon for an interventional radiologist to be the only professional in the region performing certain cutting-edge procedures. This allows the person to command a higher income and may present opportunities for leadership, research, and community outreach.

Experienced radiologists sometimes leave the clinical setting to pursue research opportunities, take teaching positions, or move into health care administration.

There are basically three essential steps to becoming a radiologist: earning an undergraduate degree, earning a medical degree, and completing a radiology residency. The majority of radiologists also complete an additional year of highly specialized training called a fellowship. (In fact, many do more than one fellowship.)

That’s a pretty long career path, requiring about 13-15 years. So let’s break it down into manageable steps:

To get into medical school, you first need to earn a bachelor’s degree. You can major in just about anything so long as you complete your med school prerequisites. These vary a bit by school, but usually include classes in English, biology, physics, and (especially) chemistry. For details on specific schools, talk to your pre-medicine advisor or academic advising center.

Some classes you’ll grow to love (or hate) as a pre-medicine undergraduate:

Undergrad is also the time when most students take the Medical College Admissions Test (MCAT). A great score will strengthen your medical school application.

Students typically start applying to medical schools at the end of junior year. This year-long process involves applications, recommendations, and interviews. Your academic or pre-medicine advisor can be a great resource as you navigate the process.

American medical schools come in two flavors: allopathic and osteopathic. They cover the same subjects, but their philosophies are slightly different:

• Allopathic medical schools award M.D. degrees. The curriculum focuses on diagnosing and treating conditions with medications and surgery.
• Osteopathic schools award D.O. degrees. They take a whole-person approach to care that emphasizes prevention and overall well-being.

Either type of program can prepare you to be a radiologist - and even a radiologic subspecialist.

Medical school is divided into two parts. Years 1 and 2 are about classes, practical exercises, and simulations. Expect to spend quality time with:

In years 3 and 4, you’ll spend most of your time in hospitals and doctors’ offices learning from experienced physicians. The curriculum is designed so that you rotate through all the major specialties as well as a few of your choice (like radiology).

One pro tip: if you’re serious about becoming a radiologist, you must work really hard in medical school. Radiology residencies are extremely competitive, so study hard for your medical licensing exams and impress during your clinical rotations.

Congrats! You’ve graduated from medical school and matched with a radiology residency. That’s a pretty big feat.

You’ll typically begin this phase with an intern year in which you practice general medicine under supervision. You’ll then progress to four years of specialty training in diagnostic radiology, diagnostic-interventional radiology, or radiation oncology.

A day in the life of a radiology resident usually starts with case conferences with your attending and fellow residents. Then you’ll spend the morning in practice interpreting studies and performing procedures. Classroom (didactic) sessions happen around lunchtime, followed by more clinical practice time. You’ll also be on call some nights and weekends.

Depending on your focus, you might rotate through the following subspecialty areas:

This isn’t technically required to practice radiology, but it’s probably worth mentioning. Among medical specialties, radiology has one of the highest rates of fellowship-trained physicians. About 90 percent of doctors who complete a diagnostic radiology residency also complete one or more fellowships.

Fellows complete clinical rotations in highly specialized areas of radiology. So for example, if you’re a pediatric radiology fellow, you might spend a few weeks practicing fetal imaging or performing interventional procedures on babies and children. You’ll also participate in lectures, interdisciplinary conferences, and scholarly activities. Many fellowships have a research component.

Board certification is technically optional but highly desired (and often expected) by employers, hospitals, and patients. The following organizations offer board certification in radiology. Not all states recognize all organizations, so check specific requirements in your area:

• American Board of Radiology (member of the American Board of Medical Specialties)
• American Osteopathic Board of Radiology (member of the American Osteopathic Association Board of Specialties)
• American Board of Physician Specialties

To achieve primary board certification, you need to be licensed, complete an approved residency program, and pass oral and written exams. Primary certification is available in the following areas:

• Diagnostic radiology (AOBR, ABR, ABPS)
• Radiation oncology (AOBR, ABR, ABPS)
• Interventional radiology (ABR)
• Diagnostic-interventional radiology (ABR)

Board certification in a subspecialty requires primary certification, completion of a fellowship, and passage of an exam. Some subspecialties have additional experience requirements.

Subspecialties of diagnostic radiology include:

• Hospice and palliative medicine (ABR)
• Neuroradiology (ABR, AOBR)
• Nuclear radiology (ABR)
• Pain medicine (ABR)
• Pediatric radiology (ABR, AOBR)
• Vascular/interventional radiology (ABR, AOBR)

Subspecialties of radiation oncology include:

• Hospice and palliative medicine (ABR)
• Pain medicine (ABR)