Meet Dr. Nicole Hindman

What are the different subspecialties within radiology?

I do body radiology (general radiology), which includes the abdomen, pelvis and vascular system. We look at anything involving the trunk of the body, including the liver, spleen, kidneys, uterus, and reproductive organs. Breast radiologists do imaging and procedures like biopsies of breast cancer. Neuroradiologists study the brain. They read MRI and CT perfusion studies to look for strokes. Bone radiologists image joints and do bone biopsies. If you have psoriasis or other diseases like arthritis, they’ll stick a needle into your joints, inject a pain reliever, and that will help you to get pain relief. It’s both treatment and it is diagnostic. Nuclear medicine doctors read your PET CTs for staging of cancer. Diagnostic and interventional radiologists do vein ablations of your varicose veins and biopsies of your liver. They can actually treat cancers of the liver by injecting sclerosants or chemotherapy into the tumor to help it shrink.

In my department at NYU, we have 234 radiologists, and we have people that specialize in almost every aspect. I’m a body radiologist, and my focus is on genitourinary, which includes the kidneys and reproductive organs.

When and how did you become interested in medicine?

I became interested in medicine in junior high. Before then, I was interested in pharmaceuticals; I had always dreamed of going to the rainforest and finding plants that would cure diseases, which still sounds fascinating to me!

During the summer after 11th grade, I got a summer internship at the National Institutes of Health (NIH). I worked in the NIDDK (National Institute for Diabetes and Digestive Kidney Disease) for Dr. Simeon Taylor’s lab. We had patients who had types of diabetes on one part of the hallway, and in the other parallel hallway, researchers were working on finding more information about their diseases. That experience was really eye-opening for me because I directly saw the impact that the research was having on a patient.

Why did you choose radiology as your medical specialty?

Most people who go to medical school want to have direct patient interaction. You never really think about fields like pathology, radiology, or non-patient facing fields.

During my third year of medical school, I thought maybe I wanted to do reproductive medicine and OB/GYN. However, when I was rotating through wards, I realized that in medicine and surgery, all of the doctors would go down to the radiology reading room and ask these darkroom physicians what they thought.

The radiologists would look at the film and then magically, without ever seeing the patient, tell us what was wrong. I realized that these brilliant radiologists were solving a lot of the problems that we couldn’t solve during rounds. How can you just look at a film and figure out so much about a patient? I wanted to know more, so I took a radiology elective. I also am a very visual person, so I felt like I just clicked with this field.

Radiology has a lot to do with pattern recognition of disease entities. We say that radiologists become very skilled by putting on the “retinal miles”, meaning that you see things over and over again to the point where you can recognize a wide range of what is considered normal and what is considered abnormal.

What does the timeline look like after college to become a radiologist?

• 4 years of medical school
• 1 year surgical/medical internship
• 4 years of radiology residency
• 1 year fellowship (which many of us do)

It’s a long path, but after 4 years of med school, you’re paid each year. After your fellowship, you can do either private practice or academics. I’m an academic radiologist, so I give talks at national meetings, publish papers, and work with residents and medical students.

Does your major in college matter if you want to go into medical school?

There are plenty of humanities majors that get into med school, but the problem is balancing that major with doing well with all of the pre-med requirements (which are mostly science classes). That is why almost everyone who is pre-med majors in biology. The downside is that most pre-medical undergraduates major in biology which makes it a little bit harder to stand out to the admissions committee.

If you did not take any pre-med classes in undergrad, you always have the option to do a post bac, which is a two-year program at a freestanding college that allows you to complete your pre-med requirements.

Why did you choose to major in chemistry?

At Brown University, my pre-med biology classes were the most backstabbing, cutthroat classes. People were vicious; they’d hide the textbooks you needed in the library.

So, I went to the chemistry department, and there were only 20 people majoring in chemistry. The professors would have these wonderful small group sessions, and it just felt like a very close knit community.

What would you say is the most rewarding aspect of being a radiologist?

It’s really great when the clinical team or the patient has a question, and they have no idea what’s going on. You would go through a film, systematically look at what is going on by piecing together your knowledge of anatomy and of disease processes, and then say that this is the most likely diagnosis.

The way we read can actually have huge impacts on the outcome of the patient and what the team does. Some people have personality types that are not well suited for radiology. One of my mentors told me that if you’re never right, you’re never wrong, so you have to actually be willing to commit to something or otherwise you’re not helping. You have to be definitive. Even if you will be wrong sometimes, it’s still better to give some most likely diagnosis.

Is there anything that surprised you about radiology upon entering the field?

Going to medical school, I thought radiology would be a boring field because we sit in a dark room and look at images. But, it’s actually great for people that like to solve puzzles or who enjoy being very visual/artistic. Often, the medical team has no idea what’s going on with the patient, and by looking at the films, you can actually diagnose the patient and solve the clinical puzzle.

At first, it looked horrible because it seemed like there was no patient interaction. But, once you’ve had all of the prerequisite training, you can finally understand what the radiologists are talking about, and it becomes really exciting.

There is often some stigma attached to radiology with people saying we are not “real doctors”. But, radiology is actually an incredibly valuable field. As a radiologist, you will provide a lot of service, but you often will not get recognized.

What is one thing you wish someone had told you before you started your career?

I was at a socially-distanced orientation for my daughter, and one of the moms said, “I told my daughter not to do medicine because you’re just going to work too hard…you’ll never be able to have kids in a family, and it’s just not worth it.” I was actually sort of shocked she said that in this day and age.

I think there are a lot of misconceptions over how you can balance your work/life/having a family. People will say that you shouldn’t go into medicine because you’ll never be able to have a family, but it’s not true at all. I found that there’s a lot more flexibility with medicine, and you can do a lot of different things while still making it work. You would be surprised at how reasonable it gets. Usually the first 2-3 years of training are really tough, but then it becomes something you can balance and negotiate in your contracts. There are also different fields of surgery that are actually really nice, for example, breast surgeons usually only have a couple of operative days a week.

What does a typical day in your life (pre-pandemic) look like?

I’m an academic radiologist at NYU. We are based in Manhattan, but we also cover Brooklyn, Staten Island, Long Island, Bronx, and different sites throughout Chinatown.

“Imaging” Day:

• I cover a 7 AM interdisciplinary conference for surgery (once or twice a week). I review all of the scans for the surgical department during their weekly morbidity and mortality conference, where they go over issues that relate to patient care.
• On an average day, I read ~30 CTs, and I may have ultrasounds as well.
• We tend to have separate MRI days. On an average MR day, I read ~30-40 MRIs.
• I teach residents and fellows as I’m going through the studies. My day typically ends around 5:30-6:00 PM.

“Academic” Day:

• I come into the office around 8:30-9:00 AM.
• I write papers, do projects with other clinicians, and reach out to the statistician.
• I review and submit images and papers for publication.
• I sit on the editorial board of a number of our journals, so I also will review papers.
• I prepare talks to give at national meetings as well as my educational courses.
• I can leave by 5:00 PM.

How challenging do you think it is to manage a healthy work-life balance?

Radiology used to be considered a “lifestyle” specialty, but now, most radiologists will say that it’s not as much anymore. My schedule is busier than that of some surgeons. I think part of the problem is that your payment is based on how much you read and how much Congress decides to reimburse each of those films you read. Congress has been cutting reimbursement for radiology studies constantly over the last decades, so to make the same salary, you need to read twice the same number of studies.

What skills aside from the technical skills would you say are important for being a radiologist?

Being a good communicator is incredibly important, which goes along with writing well. Filing a definitive and non-ambiguous report is super helpful to the referring physician. You would not think that being definitive and clear would be so hard to do, but it actually can be very tricky, especially when you’re not completely sure about the diagnosis.

It is also important to have patience and self control because you will get interrupted constantly. You would be reading a film, and your phone would ring because someone wants you to read a different film fast for them. Although your train of thought was interrupted, you have to be kind to the person calling and help them out.

What are some advances in radiology you think will happen in the future?

Radiology is always going to be a very exciting field because of the innovation and partnerships going on.

MRI scans take about 30 minutes in the scanner, and patients may get claustrophobic or scared by the loud noise. People are working on making it faster (the “one-minute MRI”). I work with physicists that develop advanced coil technology for the magnets in MRI scans as well as dual energy CT scanners.

Contrast agents, which is the dye we inject in the vein, has gotten publicity in recent years because one of the contrast agents was discovered in 2006 to deposit in your skin, causing nephrogenic systemic fibrosis. People are now developing new contrast agents that are not associated with that.

In terms of artificial intelligence, our chairman has partnered with Google and Facebook to come up with advanced AI techniques to create imaging databases that can help us radiologists do our jobs better. In the past, people said teleradiology would hurt our field, but it actually has helped it. It allows us to provide more help in places that are less reachable and ultimately provide better patient care. AI always performs better in conjunction with a human being rather than in isolation. I think that it’s important to welcome these new technologies and to recognize the definite benefit of working together instead of taking a nihilistic approach and feeling threatened.

What would you say to a student who is interested in pursuing a career in radiology?

Young people today are so hyper focused on achievement and staying on a straight path. However, roads are never completely cut off. Many of my colleagues had other careers before coming into medicine. One of my residents was a Alaskan fisherman. Another was an Olympian fencer.

I sit on some of the admissions committees for the medical school for NYU. People are all obsessed about getting into an Ivy League school. The key is, it’s not just the name of the school, but instead it’s what you do at that school. For example, if you have more publications and more grants, then they will rank you higher.

One piece of advice I have is to volunteer once COVID restrictions are lifted, for example, in emergency rooms in the hospital. Volunteer as an EMTs. You can even go to nursing homes or get exposed just purely to research. There’s no one right answer. Anything that tells you more about the field you’d like to know is good!

I’d warn about shadowing radiologists before you’ve had the requisite training because it can turn you off from radiology. You’re in a dark room, and radiologists are reading very quickly, so it’s hard to see what’s going on.

But, If you google The American College of Radiology or Radiologist Society of North America, you can find many resources for residents and medical students, which can give you a good idea about the field.

Do you have any book recommendations for those interested in medicine?

• The House of God by Samuel Shem: it’s a very tongue-in-cheek look at residency in internal medicine at Harvard.
• Articles on Henrietta Lacks and HeLa cells: these articles are about how an African American woman and her cervical cancer cells were used without her permission. These are still used today.
• Any book or movie about Marie Curie: she was the first woman to win the Nobel Prize and the only woman to receive two Nobel prizes. There is a lot of feminism and empowerment around books and movies on her.

Learn More:

• The American College of Radiology
• Radiologist Society of North America