Year: 2016

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Radiology Moonlighting: A Taboo?

moonlighting

Rarely do chairmen and radiology program directors in academia utter the word “moonlighting” to their radiology residents, fellows, and employed attendings. Yet, moonlighting is a mainstay for many neophyte and seasoned radiologists. Why is the subject so taboo? Academic stakeholders want to know that their residents and practicing physicians dedicate themselves entirely to their primary responsibilities as learners and their duties at their daily jobs. To these stakeholders, moonlighting implies that their workers work toward other endeavors that may “interfere” with their primary roles. Concerns such as duty hours and sleepiness during the day job can arise. Even worse, the stakeholders perceive these workers to be competing with their primary business.

Why You Should Consider Moonlighting

But I would like to argue against both of these notions. First, it is unusual that the worker moonlights more than she can handle. Of course, anything taken to an extreme can harm the practitioner. Too much sugar causes tooth decay. Too much water causes hyponatremia. And, too much moonlighting can theoretically distract from the day job or training. However, it turns out that this impression is a widely perceived misconception.

I harken back to my days as a radiology resident and fellow. As a resident, I remember reading CT scans in a quiet room in the evening next to the CT technologist’s workstation. I would preliminarily provide initial interpretations by fax to satisfy the demands of the ER physician and provide coverage that would otherwise would ordinarily not be available. Also, I would rapidly scan the plain films that attendings left from the afternoon shift. We made sure no impending disasters lurked in the morning as we searched for occult pneumothoraces, free air, pneumatosis, portal venous gas, and more.

Instead of interfering with my role as a radiology resident at the time, I found the experience to allow me to read more quickly and accurately. It supplemented my day job and, subsequently, my career. My moonlighting enhanced my performance during my daytime residency position. We can only achieve skills such as rapidly and accurately reading films by having had the experience to do so. Moonlighting experience easily fits the bill.

Second, you will perform most moonlighting gigs at a subsidiary of the primary institution or a local group. Usually, these opportunities may require temporary coverage due to staffing needs. It would be undoubtedly unusual for a moonlighter to “poach” cases from their primary residency program or day job.

Discordant Views Of Moonlighting- Academics Vs. Private Practice 

Even more interesting, practices consider moonlighting a badge of honor for the applicant to private practices, one he can display to his future employers. And, concordant with this view, the typical private practice employer considers moonlighting an asset. When interviewing for private practice jobs, the stakeholders would specifically ask if I had done any moonlighting. For these private practice stakeholders, moonlighting implies that the trainee has the experience and wherewithal to handle the daily pressures of a bustling private radiology practice. The typical skeptical chairmen and residency director’s impressions of moonlighting differ from this view.

Given the importance of moonlighting for a budding radiologist from both a training and future employment perspective, program directors should actively discuss the topic instead of suppressing the information. Therefore, for the rest of this discussion, I will discuss where to find exceptional moonlighting experiences, what to avoid, what you need to do before obtaining your first gigs.

Where Do I Find Moonlighting Opportunities?

First of all, if you are fortunate enough to have a moonlighting opportunity embedded in your residency or fellowship program that the institution supports, I would say this is the best situation. You don’t have to worry about “stepping on anyone’s toes.” And, your institution will likely already insure you for the task. These opportunities are the simplest and best for the trainee.

I am aware, however, that many programs do not have these opportunities on hand. So, I would recommend you ask either former or current residents and fellows about the options in the area. When you interview for your fellowship, make sure to get the phone number or email of the current fellows. Ask them if they moonlight and what exactly they do. Usually, the current trainees know the local environment for moonlighting the best.

Let’s say, however, the current residents or fellows are not moonlighting. What else could you do? You may want to call the local groups and find out if they have any temporary staffing needs. The local group may often need a warm body to “babysit” a magnet or give preliminary reads in the evening. This moonlighting experience would be your opportunity…

Lastly, if all else fails, you may want to either search employment websites or ask a locums company to help you to find moonlighting opportunities. I would reserve this option for last because the companies that use these agencies charge a fee that may lower your pay rate.

What Moonlighting Experiences Should I Avoid?

In the recent past, residents would finish their residency training, take and pass their oral boards. Subsequently, they would be board certified in radiology. No longer is this the case. This fact leads to some new technical issues with moonlighting as a fellow. In the past, I would have said, by all means, go ahead and give final reads as a moonlighting fellow. Instead, as a typical radiology resident or fellow, I would consider reserving final reads until after you have passed your boards. Find moonlighting opportunities to give preliminary reads or work for a senior attending that is ultimately responsible for the final readings.

Why do I feel this way? Well, if you miss a finding and it goes to court, legally, you may have a more challenging time defending your miss. If the plaintiff’s attorney asks you if you were board certified at the time of the reading of the study and you say no, they can theoretically question your judgment at the time of the interpretation.

It is also essential to check that your malpractice insurance for your residency or fellowship is compatible with the moonlighting site. If not, you should obtain the correct insurance, or the opportunity should be off-limits for the prospective candidate. If you provide final reads for a practice or don’t have an occurrence policy, you should consider tail insurance.

Also, make sure you do not commit too much time to the moonlighting job. As discussed before, you certainly don’t want your moonlighting to interfere with your day job.

What Do I Need To Do Before Moonlighting?

1. Months before the prospect of moonlighting, it would help if you started getting the prep work done. The first thing to consider, make sure you get all the necessary state licenses that you may need. It can take a lot longer than thought to get a state medical license. Have all that paperwork ready.

2. Keep your CPR and ACLS certifications up to date. Some opportunities require the applicant to have satisfied this requirement.

3. Before accepting any offer, make sure you feel comfortable with the requirements of the job. If they need someone to overread MSK MRI and do not have experience with this, it is probably not the best situation. Be thorough when you ask the employers about what they require.

4. Let your residency or fellowship program know that you are going to be moonlighting. The program needs to record your hours worked “off-campus” as part of the duty requirements of the ACGME. If the program catches you working too many hours, the ACGME can penalize the program. It’s probably not worth the risk of jeopardizing your residency or fellowship.

5. Once you have pinpointed the opportunity, you need to make sure your malpractice insurance covers the employment opportunity. Also, you must proceed rapidly with hospital credentialing as this process can be very time-consuming. Hospital credentialing also includes sending off the malpractice insurance information to the hospital medical staff office.

Summary

Moonlighting can be a fantastic experience that supplements your residency and fellowship education. It can enhance your prospects for future employment, can allow you to gain speed and confidence at your daytime job, and let you more rapidly pay down your student debts. I highly recommend moonlighting if the opportunity is available, you are so inclined, and it is allowed by your residency or fellowship program.

Good references/links to find out more about moonlighting

Moonlighting for Extra Money: Tempting, but Watch Out

Radiology resident moonlighting: A necessary evil?

 

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Staying Healthy for Residency (And Life)

“The only insurance of your health are the choices you make every day.” – Leonard Morneau, MD

Residency is arguably one of the most grueling times of a physician’s career/life. You’re working long hours (80 hour weeks can be the norm), usually don’t get enough sleep, and barely have time for yourself. At times residents can get so focused on the health of their patients that they forget about their own health and well-being. This is a very sad turn of events. Physicians are supposed to be leaders in healthcare and it’s my personal belief that the only way to lead is by example. Now you may be saying, but I don’t have time to be healthy! I barely get enough sleep, there’s no time for exercise! But the fact is that you can still be healthy even while working such strenuous hours. This is especially important for Radiologists that spend most of the day sitting in a chair. A previous post does a great job explaining the importance of exercise and the different types you can do to stay active, even with minimal time. The main focus of this post will be on other healthy lifestyle choices to make.

The MOST important thing, by far, is the choice of what food you put into your body. I’ll be honest; the cards are stacked against you here. It’s one of the main reasons we have the obesity epidemic and millions upon millions of people who suffer from completely preventable diseases. Our bodies have been engineered to desire sugar, fats and other bad food choices. Why? Thousands of years ago when food was scarce it was good to have fats to store energy for later use in case of famine or not being able to find food. So the human brain was trained to crave those sorts of foods. Fast forward a few thousand years and those impulses are still here, but food is plentiful (in most places).

In my personal opinion, most of the food choices we have today are very unhealthy. They’re packed with sugar, preservatives and other things that are simply not good for the human body. Yet this is the majority of food that’s produced, is heavily advertised and can be as addictive as a drug. Multiple studies have shown these addictive properties and that sugar specifically activates the same receptors in the brain as cocaine and heroin… 1, 2, 3 This is why “dieting” is so hard; it’s like trying to tell someone addicted to drugs that they need to stop. Easier said than done.

INSTEAD, what must be done is not to think of things in terms of this diet or that diet, but living a healthy LIFESTYLE. There is no magic pill. It is the choices you make every day. Now, here’s a list of some things you can do to start living healthier:

1) Water
I recommend only drinking water (preferably hydrogen enriched water).
Nearly all beverages are loaded with sugar, so ALWAYS check the nutrition facts. I’ve seen a “green juice” marketed to be healthy with “no sugar added” that contained almost 40g of sugar… And sugar is immediately converted to fat if it’s not utilized by the body (which is most of the time, unless you just finished a tough workout). This is one of the easiest things you can do that will drastically improve your health. A good starting point is ½ your body weight in ounces of water daily.

2) Eat More Greens
No one ever got obese by eating too many vegetables. Vegetables are nutrient dense foods (high in nutrients and low in calories) and they fill you up faster. For those of you complaining about them not tasting good enough for you, there’s a ton of different ways to prepare veggies that taste amazing. I do it every week in my meal prep. Also, growing more plants for food consumption would be better for the environment and help slow the pace of global warming as well.

3) Avoid The Aisles

When you go to the grocery store, the majority of your food should be purchased from the periphery of the store. Most of the food in the aisles of a typical grocery store is all processed, full of sugar and bad for you. Always check the nutrition facts before you buy something, you’ll be amazed at what you’re actually eating.

4) Prep For Success
Take one day a week to prepare most of your meals, at least lunch. This way you’ll have healthy meal choices ready during the week. I’ve been doing it for years and it is definitely one of the main reasons I’ve been able to stay so healthy.

5) Avoid Fast Food
Restaurants like McDonalds, Burger King, Wendy’s, etc… should be avoided like the plague. Compare eating fast food to using drugs like cocaine and heroin in your mind (after all they have a similar effect) and you’ll be less likely to eat them. (I haven’t been to one in nearly 4 years, so yes, it’s possible).

6) Have A Cheat Day
With all the new changes to your diet, you’re likely to crave those old foods that you love. Try and save them for one day of the week only. This will make it easier to eat healthier during the week when you know you have a reward coming at the end of the week. The less you consume these food choices, the less you will crave them.

7) Track It
Many people find that they’re not aware of how much they’re eating until they make a note of it and calculate out how many calories they take in. Try using an app just one day a week to see how much you consume in a typical day. It may be the eye-opener you need to kick-start a new lifestyle.

8) Snack Healthy
Instead of going for that cookie or other sweet in the mid-morning or afternoon, try having a healthier option like a handful of almonds or nuts.

9) Keep A Balance
Think of health as a bank account. Every good health decision you make, like eating vegetables and exercising, is a deposit. Every time you eat unhealthy or make such decisions you are making a withdrawal. Keep a tally of your deposits and withdrawals like you would your bank account. Just like it takes time to build wealth, good health is only obtained from making these deposits every day. If you withdraw more than you deposit, you’ll go into debt and suffer the consequences. How does your account balance look?

It may seem difficult at first, but the habits you form today determine who you will be tomorrow. Keep the end goal in mind and you’ll be able to do more than you ever though imaginable.

Just as in airplane safety videos they always tell you to put your oxygen mask on before your children’s mask; why? Because you’re no good to that child if you’re dead. Similarly, we must make our own health our first priority because without it, we won’t be able to take care of others; which is the whole reason we got into this profession in the first place.

 

1. Spangler, Rudolph, Knut Wittkowski, and Noel Goddard. Opiate-like Effects of Sugar on Gene Expression in Reward Areas of the Rat Brain. N.p., 19 May 2004. Web. 14 Nov. 2016.
http://www.sciencedirect.com/science/article/pii/S0169328X04000890

2. Colantuoni, C., J. Chwenker, and J. McCarthy. “Excessive Sugar Intake Alters Binding to Dopamine and Mu-opiod receptors in the brain : NeuroReport.” LWW. N.p., 16 Nov. 2001. Web. 14 Nov. 2016.
http://journals.lww.com/neuroreport/Abstract/2001/11160/Excessive_sugar_intake_alters_binding_to_dopamine.35.aspx

3. Avena, Nicole, Pedro Rada, and Bartley Hoebel. Evidence for Sugar Addiction: Behavioral and Neurochemical Effects of Intermittent, Excessive Sugar Intake. Neuroscience & Biobehavioral Reviews, 2008. Web. 14 Nov. 2016.
http://www.sciencedirect.com/science/article/pii/S0149763407000589

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Physician Burn Out- Is An Inadequate Medical Education System The Fundamental Cause?

We read article after article about the complete dissatisfaction of physicians throughout the United States and how it affects patient care.  Since it makes a good story to cover the woes of physicians, the general press seems to covers this topic as dogma. But it is not just the general news. Even Medscape, one of my favorite radiology news/blog sites, has multiple articles and surveys on this topic.

Many different reasons are espoused for the cause of physician burnout. But, I believe there is one major factor that is not addressed. It all has to do with our medical school system and how the system is not made for the student/trainee but rather to support the folks running the schools.

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My First Real Radiology Job- Do I Want Partnership?

partnership

Every once in a while, a resident or fellow will ask me, “Should I take a partnership track versus an employed position?” Or, “What questions should I ask about partnership when I interview for a job?”. These can be somewhat tricky questions to answer since there are so many variables involved. I will tackle some of these issues here. I will also answer some common questions and clarify some misconceptions.

To make this post somewhat structured, I will first talk about the features of employed positions and ownership/partnership track positions. Then, I will determine whether it makes sense to be a permanent employee or on a partnership track. Finally, I will elaborate on the questions you should ask if you are fortunate (or unfortunate) to be placed on a partnership track. So, let’s begin…

To Be Or Not To Be– A Partner!!!

What are the initial differences between jobs that are permanent employee versus partnership tack positions? First of all, no hard and fast rules exist. Some employed roles have features of partnerships, and others have characteristics of employed positions. For the sake of simplicity, I will ignore these nuances and instead talk about the general features of each type of employment situation. You can further determine how the different components of your particular job offer apply to you.

Employed Positions

Basic Issues

Most practices pay employees a fixed salary that makes up the majority of their income. Some employees also may receive a production bonus of some sort, but it tends to be a small percentage of the salary. Starting salaries of employed positions tend to be higher than partnership track positions at the beginning. But, they remain more stable or gradually drift higher for many years to come. If the partnership or practice has a “banner” year, you will likely still get the same negotiated salary regardless of its profitability.

They also tend to be at the mercy of the employing body, whether a hospital system, partnership, or corporate entity. In general, employees have less control over their situation. Employers make the business decisions. If you don’t like the technologist, nurse, or administrator in your practice, you will still have to live with that person. You may not be able to change your PACS system or to set your protocols. Bottom line. You are at the whim of your employers.

Defined Written Responsibilities

Also, in general, employed positions usually have particular sets of responsibilities written in the contract. If you perform a duty that lies outside the realm of your negotiated deal, the practice does not require you to accomplish that task unless your employer pays for it. Being an employee allows you to concentrate on radiology without dealing with the day to day issues of running a practice.

For instance, you don’t have to worry about hiring, firing, buying magnets, billing, capitalizing on radiology trends, attending hospital events, and more. A lot goes into the management of a practice that is not related to day to day radiology. And as an employee, you will likely be a lot less responsible for these activities. But everything comes with a price. You are selling your ability to control the entity for which you are working.

Risks of A Private Equity Buyout

And most importantly, for some, practices treat employees very differently when there are significant changes. In today’s rapidly changing practice environment, groups are merging; hospitals are buying out imaging centers; large corporations are taking over smaller entities. When a significant event such as this occurs, the employee usually does not benefit as the practice’s employer will. Typically, when a radiology practice is “bought out,” the partners or employers will get a large sum of money to pay for the accounts receivable, equipment, real estate, goodwill, and so on/so forth. On the other hand, the employee will typically get nothing. Or even worse, the employee will be the first to be fired if there is a business restructuring.

Partnership Track Positions

Partnership track positions usually pay a lower amount at the beginning than an employed position until you make a “partner.” A partnership track employee can make a substantially different income than a permanent employee. Many starting radiologists do not understand this concept, but it makes a lot of sense. You are paying for the equity/ownership of the partnership in two ways.

Sweat equity

First, there is a concept called “sweat equity.” “Sweat equity’ is essentially a time commitment. This process can last almost any time interval. Most practices have a partnership track period that can last anywhere from almost immediately (in the early 2000s, I knew one fellow offered immediate partnership before finishing fellowship!) to 10 years.

Time to partnership varies depending on multiple factors. First and foremost, these include location. The more desirable the area, the more competitive the partnership spots. And, the more years to partner the practice will charge the partnership track radiologist. Additionally, the time to partnership can be longer if you own equipment, real estate, and other assets. That makes sense because to pay for that share in the partnership, you need to put in more “sweat equity.” Finally, market conditions also affect time until a partnership. Suppose numerous radiologists are looking for partnership positions. In that case, the practice will charge a more extended period of “sweat equity” because of the high demand for a job and willingness of the partnership track position “to pay” for it.

Buy-ins

Second, many practices expect the partnership track employees to buy-in monetarily to the radiology business at the end of the partnership track term. This buy-in may be related to the accounts receivable and the owned assets of the practice. Furthermore, buy-ins can range from a nominal amount to over a million dollars, depending on the assets owned. It can be paid for directly, by a loan, or by increased “sweat equity.” The amount of buy-in can be a critical factor in selecting a partnership track position.

Practice building

Practices also expect partnership track employees to be involved in practice building. You will not just perform your daily duties as a radiologist, but you will be assisting and learning to accomplish other tasks outside of the normal radiologist purview. You may involve yourself with hospital committees, giving grand rounds, attending events outside regular business hours, and other important “non-radiologist” functions. These events are essential training for the partnership track radiologist to learn the business roles of the partner.

Partnership- Not An Obligation

The applicant needs to remember: Practice partners usually do not want to create a partnership position!!! Why? It’s pretty simple. It dilutes the preexisting partners’ equity (meaning that each partner will get a smaller share of the profits). There has to be a significant need to create a partner. These issues include lack of coverage in a particular subspecialty, need for more practice managers, etc. There is no such thing as an entitlement to a new partnership track position. Also, be prepared to work hard to gain a share of the partnership for that period.

What about the Partners?

Usually, practices pay partners a fixed salary. However, they earn a substantial portion of their income from the practice’s excess profits, usually a bonus. Usually, you expect the compensation of the partner to be higher than that of the employee. Why? Partners assume the risk of the practice and also manage practice issues. If reimbursement decreases, partners are affected first. If there is a loss of an employee, the partner needs to cover that position. Or, if there is a lawsuit against the practice, partners need to manage the subsequent issues.

However, the difference in salary between a partner and a non-partner can vary widely depending on the profitability of the practice. Therefore, it behooves the applicant radiologist to determine what the partners are making before joining the practice. You need to “check the books” or talk to the business manager. You certainly do not want to go through the process of “sweat equity” only to find out that your final income is not much different from your partnership track salary.

Does It Make Sense To Be On A Partnership Track?

Believe it or not, there is no quick answer to this question. It all depends on the individual situation and the job. There are also inherent risks to taking a partnership track position versus a permanently employed position. So, let’s evaluate each piece of this equation individually with different questions.

Are you the sort of person that likes running the show, or do you just want to do your work and go home?

A partnership track individual needs to be interested in business and practice building. There is no room for a partner who does not have any interest in building the practice outside regular business hours or is unwilling to perform different roles during the workday outside the normal radiology purview.

Is the job something temporary for you, or do you want this job to be permanent?

It would be best if you did not put “sweat equity” into a job where you think you will be leaving in several years to be closer to family or other needs. Generally, imaging centers will pay less for a partnership position. So, it’s just not worth it. Or maybe, you just need a position, but the practice job description is not exactly optimal, but it is the only thing available in your desired location. In this case, you may also decide a partnership track is not the correct decision. For example, you don’t want to be practicing women’s radiology when your only desire is to be an interventionist!

What is the current business environment in your location?

In some practice locations, hospitals are converting private practice jobs to employed positions due to mergers and acquisitions. You do not want to be stuck in a partnership track, only to find out that there is no partnership position at the end of the road. You may never make the “partnership” salary, or even worse, you may be out of a job. Remember, in a situation like this: employees are the first to go.

Have multiple recent retirees received buyouts?

First of all, what is a buyout? It is essentially the opposite of the buy-in. A partner that steps down expects to get the equity back that he put into the practice. Every once in a while, a practice may have many former partners retiring with enormous buyouts. Large buyouts can affect the partners’ salaries dramatically depending on the circumstances. It would help if you looked into all the specifics for yourself.

Is there a tiered partnership?

Some partnerships have separate buy-ins for the professional portion of the practice and the practice’s technical ownership. Others may give you only a small percentage of ownership compared to a “full partner.” You may become a partner one day. But, the partnership may not be what you thought it would be. Some practices are more equal than others!!! It is imperative to get all the facts correct before starting that partnership track.

Should Student Loans Affect The Decision To Be On A Partnership Track? 

I will try to tackle this question separately from all the others because it is becoming an important issue for residents/fellows before the partnership decision, given their enormous loan burdens. The difference between an employed position and a partnership track position can also seem substantial at the beginning. It may or may not be more financially savvy to take the initially lower-paying partnership track job. Here’s where it is vital to try to glean the specifics of your future career. And, this decision can be complicated. You have to plug in the numbers for yourself and make the calculations. To show you, we will take a specific circumstance under consideration. I will give you the example below.

Here are the inputs:
  1. You owe 500000 dollars on student loans.
  2. Student loan interest and long-term investment returns are both 6%
  3. The partnership track lasts three years.
  4. The difference between the salary of a partner and an employee is 150000 dollars.
  5. A permanent employee makes 100000 dollars more per year on average than the partnership track position during the partnership track term.
The calculation:

Theoretically, the salary difference can go to student loan payments if you are in a permanently employed position at the beginning. So, after taxes, you will have 66,000 dollars (100,000 dollars *0.66) per year or about 200,000 dollars (66,000 dollars x 3 years) more principal paid toward the student loans at the end of three years. Given that the loan’s interest rate and that the money you will make after you pay the loan is 6 percent, for a 30-year career, that same amount is equivalent to saving 200000 *1.06^30 or approximately 1.15 million dollars.

On the other hand, if you decide to take the partnership track, you lost out on the 1.15 million dollars you would have made if you were an employee. But, how much more, in the end, will you make to compensate for those years of “sweat equity”? So, let’s subtract the salary difference between a partner and a non-partner and take the taxes out every year. That number would be (150,000 dollars* 66 percent) or 100,000 dollars. Let’s take that 100000 dollars and multiply it by the number of years worked. That number would be 100,000 dollars *27 years (30 years of working minus three years of making less than an employee) or 2.7 million dollars. This number does not even include interest!! In this case, it would certainly make financial sense for the applicant to take a partnership track position.

The bottom line: you need to perform the calculations for yourself. It may make financial sense to take the partnership track position even though the initial salary is less than the permanent employee.

Bottom Line

The decision to become a partner vs. a permanent employee may not be simple due to the applicant’s personality, job-related factors, and monetary considerations. If you are thinking about the partnership route, make sure to know your role and get as much information/specifics as possible so you can leap. A partnership is a long-term decision, just like a marriage. Know what you are getting into!!!!

Please leave in comments below. I would love to hear from you!!!

 

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Investments vs. Savings- A Resident’s Guide- Part 2

As a reminder, last week we went through the difference between savings and investments and talked about why the difference is so important with examples of using savings as an investment and investments as savings as a resident. We also discussed many different ways to put money away for savings. This is all encompassed in the first part of the this series called Investments vs. Savings- A Resident’s Guide- Part 1. Please refer back to this article if you want to review these important concepts. Today, we are going to discuss what many residents are more excited about- what are the common options available for investing money as a resident? In particular, we will emphasize the usual individual types of investments available (stocks, bonds, mutual funds, and ETFs). This post is not going to include other sorts of alternative investments such as peer-peer lending, real estate, MLPs, etc.  Also, I am not going to discuss the  different overarching account types (IRAs, brokerage accounts, 401k, etc.). Both of these latter topics are grounds for another discussion as a full blown article at a later point!!!

To make it easier to follow, I will divide the investment types into the following categories: stocks and bonds. I will give examples of each and examine which places are good places to park your money as a radiology resident. Let’s start with the best place to put your money for most residents: stocks.

Continue reading Investments vs. Savings- A Resident’s Guide- Part 2

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Alternative Careers and Supplemental Income for the Radiologist

Every once in a while, a frustrated resident will say to me, “I’m not sure if I am interested in any of the traditional fellowships in radiology. What else can I do with my life? I am 250,000 dollars in debt and I don’t think I can stomach practicing radiology like everyone else for the rest of my life. I have no choice.”

It is tough to think that after all the money, time, and effort, you have invested into a radiology residency, you may not have a career at the end of the road that you will enjoy. In addition, many radiologists think that if you are not practicing in one of the standard subspecialties, you are a waste to the specialty. And finally, many radiologists do not know all the opportunities out there in the world. Given these biases, it is no wonder this sort of atypical resident would need to address feelings of hopelessness.

Some radiologists and radiology residents just need other outlets for their talents and to find a different path. And, in truth, intellectually rewarding and high paying job opportunities for radiology residents are almost endless. Just remember, it is not an easy journey to get to the promised land of the alternative career opportunity. People that decide to take these alternative pathways may burn the proverbial “midnight oil”. And, it can take years to become an expert in an alternative career. But, if you take an interest in seeking these possibilities, you have come to the right post!!!

Also, some radiologists merely want to supplement their income from other sources in another area they may have interests. We will certainly discuss some of those possibilities as well.

So, I am first going to address where to look for these opportunities. And, in the second half, we will address the opportunities themselves, both the full-time career pathways and the supplemental income pathways.

Alternative Careers- Where to Look?

Dropoutclub.org

All physicians should know that outlets exist for getting information and networking about alternative career opportunities. Let me give you a few that I know. First of all,  check out a website that regularly posts jobs and career opportunities outside of radiology called the dropoutclub.org. This website posts all sorts of jobs that are currently available for physicians. It also contains a forum that discusses different issues for physicians seeking an alternative career.  And, the website contains sections that approach how to interview for certain careers such as consulting.

Seak.com

Also, look out for a website called seak.com that specializes in the area of legal/expert witness testimony. But, the website also contains information on all sorts of alternative career paths. In addition, the website contains links to loads of seminars and opportunities for networking with other physicians in a similar situation.

Recruiters

Some recruiters are actively involved in findings residents and attendings that have interests in other career opportunities. They can sometimes be a helpful resource.  Additional, they may know of available jobs that may be relevant to the physician’s interests. But let the buyer beware! Although many recruiters are legitimate and truly want to help the physician, others just want to make the sale at any cost even though the job or the career path may not be right for the applicant.

Colleagues

Finally, you may know physicians that you work with on a regular basis that perform other activities outside the daily practice of radiology. From my experience, I have encountered some colleagues that have started their own consulting business, invented medical devices, worked as an expert witness. wrote books, or performed other career activities outside of the typical realm of radiology. These people are great resources to learn about how to get a start in some of these alternative careers.  I recommend talking to these people because they will give you a more realistic insight into traveling down these pathways that you may not get from a seminar, website, or recruiter.

What Are Some of the Opportunities?

In the interest of time and space, I cannot go into all the specifics of each career opportunity, but we can certainly paint some broad strokes about many of them. I will divide some of these opportunities into the following sub-segments- Finance, Legal, Political, Consulting/Surveys, Pharmaceutical Companies/Research, Invention/Entrepreneurial. Teaching, and Writing. There are certainly other areas as well, but these are some of the areas that are most familiar to me that I can comfortably talk about.

Finance

Let’s start with finance, an area that lends itself to alternative full-time careers. This area seems to be one of the most “sexy” for many radiologists and radiology residents. You may think high pay, high profile. When you log on to the dropoutclub website, many of the posted jobs are in this realm. There are many hedge funds and large brokerage houses that seek people who can understand how companies operate in the biotechnology and medical world that may not be readily accessible to the typical layperson.

Radiologists have a particular set of expertise in imaging devices and this focus may allow insight into companies that other medical professionals don’t have.  You may be involved in the tasks of research and presenting information to the executives of a company. Or you may be involved in gathering information from clinicians. Some of the positions are geared to the entry-level job and others are geared to the more experienced professional with finance experience. It is important to remember that you will probably be starting out low on the totem pole unless you have a strong finance background. Long hours are the norm. But, there is a very high pay potential. Just like becoming a full-fledged radiologist, it is a long road!!

Legal

Let’s split this career pathway into two parts: becoming a litigator and expert witness work. The first pathway involves a full career change. You may hear of physicians that have also obtained their JD degrees to work in areas such as malpractice defense or even patent work. Both of these areas certainly lend themselves to the expertise of the radiology trainee. Getting a JD, may involve another 3 years of schooling with additional significant expense as well as a long path to a partner within a firm. So, this can be a tough road. Alternatively, you can think about doing this later on in your career after you have paid down some student loans. When you have the will there is a way!

More commonly, many radiologists participate in expert witness testimony as a way to supplement their income and maintain a footing in the legal realm. This pathway involves reviewing cases and providing opinions to attorneys. On occasion, you may even become involved in expert witness testimony or a deposition in court. Some physicians exclusively provide support for the defense of physicians and others may work for either side. It can certainly be interesting work and give you a new perspective on the legal side of radiology and medicine.

Political

Ever thought about becoming the next Ben Carson or Bill Frist? If they can do it, you certainly can too. Some residents enjoy politics. They may like being involved in hospital committees and organizations. Or, they may want to take charge of their residency program as chief resident and get involved in liaison work between the attendings and residents. If this is the avenue you want to take, you can certainly find ways of making your future success more probable.

I would recommend residents to look into the Rutherford-Lanty Fellowship in Government Relations, organized by the ACR. According to the website, “it allows residents to gain an understanding of state and federal legislative and regulatory processes and the ACR role therein. It also informs residents about the governmental factors that play important roles in shaping the future of radiology.” This would be a perfect entree into the world of political action. In addition, you can find annual meetings such as the RLI Leadership Summit held annually where residents can learn about health care leadership opportunities.

I also think this sort of resident should get involved in hospital, regional, and/or national organizations and actively seek opportunities to participate in leadership roles. Half of politics is networking. The bigger your network, the more likely you can get involved in a political career.

Consulting

The word consulting is a very broad term. Consulting work incorporates many different entrepreneurial and employed careers as well as part-time work such as surveys. So, I am going to divide it into two parts.

Consulting as a career

I will begin with the full-time career path. There are some companies that specifically hire physicians to provide expert consultation for businesses. One such well-known company is called Mckinsey & Company. In addition, there are niches in which someone with a unique background may have expertise. If you have prior training and interest in software engineering, for instance, you want to utilize your skills to become an independent consultant in the area of software development, PACS, etc. You can potentially leverage this area of expertise to start your own company or work with large companies to assist in product development, increasing efficiency and customer satisfaction, and more. Consulting work is unique to the individual’s talents, opportunities, and imagination.

Survey work

Many physicians, such as myself, will occasionally participate in telephone or internet surveys. Often times, a consulting company will want to get the input from radiologist about new products or the business/political environment. There are a bunch of different companies to which you can sign up and get involved with their surveys. I make sure when I participate in these surveys that the time spent is worth my while.

I have found the following survey/consulting companies to be fairly reliable, compensate fairly well, and have a decent amount of work for radiologists: GLG Group and M3 Global Research. Be careful not to participate in surveys from companies that only offer prizes for a random winner that participates in a survey. It’s probably not worth your while.  You are a professional and your time is certainly worth something!

Pharmaceutical Companies/Research

There are many opportunities for physicians in this realm. Again, you will be starting at the very bottom. You just have to accept that. But, there have been some very interesting opportunities available for radiologists.

At my former job, I participated in the reading of imaging studies for pharmaceutical clinical trials. Many large companies still want physicians/radiologists reading their images to make their studies more powerful and legitimate. You can also get involved in structuring the studies and negotiating with companies to provide these services when you get to a higher level within the company.

Additionally, if you are inclined toward research, there are many opportunities to run a research department in a large pharmaceutical company, typically involved in imaging research. Many pharmaceutical companies give significant opportunities to radiologists/physicians to climb the corporate ladder. Remember though, there is certainly a bit less stability with a pharmaceutical company career, compared to typical radiology careers. But then again, you are reading this because you are not the typical radiologist!

Invention/Entrepreneurial

Maybe you have the next great idea. And, you just need an avenue to implement it. There are many radiologists who have gone down that pathway. Unfortunately, it does take a lot of work including research/development, funding, marketing/advertisement, salesmanship, and so on/so forth. There are also no guarantees that your product/idea is going to succeed. So, it is best to stick with your first career until the idea/product/company becomes large enough to support you full time. But, the rewards can be immense for the hard-working entrepreneur.

Teaching

Many colleges and large universities need quality scientists to teach their courses. Radiologists certainly qualify!!! If interested in these careers, you may consider contacting a school to find out what are their needs. This can begin as a supplemental income or can become a career avenue. In addition, if you have a particular expertise in a certain area of radiology, there are also entrepreneurial opportunities to begin your own course/curriculum/school and build it over time.

Writing

Welcome to my world!!! I am fairly new to the blogging industry. But, it is a great way to get your name out there. In fact, starting a website and writing is a great platform for other careers and business opportunities, whether it be writing a book, consulting, or whatever/wherever your interests lie. Also, if you have a hankering for this avenue, there are also many opportunities to write for others as a freelancer or work for medical organizations that need writers that can translate medical jargon to the general public. The opportunities are extensive. Of course, you can also decide to write the next great novel and become the next Michael Crichton!!!

All These Pathways. So Little Time.

I bet many of you didn’t know that there were so many alternative careers pathways and avenues for supplemental income for the radiologist. So, for those of you that are not sure you want to stick with the typical radiology career, don’t despair! All it takes is a bit of imagination, time, and hard work, and you too can find an outlet for your talents and your loves, whether it be a part-time gig or a full-blown career.

Would love to hear any comments or thoughts!!!

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Investments vs. Savings- A Resident Guide- Part 1

The distinction between investing and savings is not trivial. It can lead to the loss of thousands of dollars if the two ideas are misused or confused. Since most residents do not have business backgrounds, I’m pretty sure there is a high percentage of radiology residents that do not understand the difference between investments and savings. So, I am going to simply define each, show why it is so important to understand the distinction, and then go into more detail about what constitutes savings. Due to time constraints, I will leave a full investigation of types of investments and how to invest in another blog. (Let’s make it part 2!!!)

 

Savings vs. Investment Definition

First off, the definitions. Savings are short-term instruments for keeping/holding onto money, usually for less than 5  years. Investments are long-term instruments for creating wealth.

Why is this the distinction so important? If you are putting investment money into savings, you are losing out on the opportunity cost of making high interest/capital appreciation on your money. Likewise, if you are putting savings money into investments, you are substantially increasing your risk on money that you need, or risking the need for capital preservation.

What can happen if you treat an investment as savings?

Let’s start with a thought experiment: putting investment money into savings. Imagine you have 1,000 dollars that you can afford to put away for a long period of time. Logically, what is the safest way to utilize this money? Many would say put it in an FDIC insured bank account, possibly a certificate of deposit. Wrong, wrong, wrong!!! In fact, the risks to this money become substantial.

What can you get on a 5 year CD? Maybe 2 percent, if lucky.  Now, what is the current inflation rate? It is about 1.86%. (There is handy calculator called the CPI calculator that you can use to calculate the yearly inflation rate). So, you decide to put the 1000 dollars into a 5 year CD. At the end of 5 years, you collect the interest which is 1000 * (1.02^5-1) or about 104 dollars. But wait. The government has to take its fair share of the interest with taxes. Taxes on interest are pretty much the same as your regular income taxes. So, let’s say you are in the 25% tax bracket and you have a 3% state tax on interest, you are now left with 104*(1-(0.25+0.03) or around 75 dollars. So, you have 1000+75 or 1075 dollars after taxes and interest. However, what is 1075 really worth 5 years later? Here, we need to take the prevailing cpi number (for simplicity sake we will assume it is 1.86% each year, the current cpi rate). So we take the 1075 dollars and divide that by the following number- 1.0186^5,  or 1.097, the total effect of inflation over 5 years. So how much is the 1075 dollars in 5 years be worth in present dollars- that would 1075/1.097 or 980 dollars. Think about it. The 1000 dollars that you put into the 5-year cd is really worth only 980 dollars when you take it out. That’s a really raw deal. Your money will be guaranteed to be eaten up by taxes and inflation in this low-interest environment over a long period of time. Don’t put your investment money into savings!

What can happen if you treat savings as an investment?

Alright, let’s take the opposite situation. You have a 12-year-old car that is on it’s last 10-20 thousand miles. You decide to take that 1000 dollars and put it into an S & P index fund. And, you intend to save for a car over the next three years when you think you will need one. It happens to be the year 2006. What happened to the S & P index fund between Jan 1, 2006 and Jan 1, 2009? It fell by 35%. And, you need that money to afford to buy a car in 2009. So, now you only have 1000*(1 -0.35) or 650 dollars in 2009. You may now not be able to afford to buy the car you wanted. Even worse, you may have to take that 650 dollars and use it to buy your car. Think about it. Subsequently, in the period of time afterward from 2009-2016, the stock market went up about 158 percent. That same original 1000 dollars you would have put into the index fund would have been worth over 68% more in 2016 or (1.68*1000) 1680 dollars if you kept it invested. Or that 650 dollars that you used in 2009 would have been worth 1680 dollars in 2016. Hmmm… 650 dollars vs. 1680 dollars only 7 years later, a striking difference.

The problem is you need to use your savings when you need to use your savings. You have little control over timing. Often times, you will wind up selling your investment at a low point, meaning that you will lose the potential capital appreciation of your initial investment. Any money that you need over the short term should not be placed in an instrument with significant risk. Never put your short-term savings into an investment!

Types of Savings

So now you understand why it is important not to take too many risks with your money for short-term needs. But, there are many options. For the uninitiated, this can seem daunting. I think of it as a multilayered approach. Let’s put the type of savings into two different types of buckets: money you may need for something immediately (100 percent liquid savings) and money you don’t need immediately but you will need in the short term future (up to 5 years later).

Liquid Savings Accounts

Which savings instruments are 100 percent liquid? Checking accounts, money market accounts, FDIC insured savings accounts, and money market funds,

I will begin with checking accounts, probably the most familiar. You can establish a checking account at almost any bank or credit union, online or in person. And, you probably have one already. It usually issues almost no interest but allows instant access anytime. I personally have a checking account with a local branch, but an online checking account is likely ok for most people.

Money market funds are safe heavily diversified accounts that invest in large numbers of short-term notes that usually return a nominal amount of interest. They are common at brokerage houses. Some allow you to write checks on the account. They are a good place to park cash temporarily, often as an instrument to buy investments at some point. But, it is safe enough to be considered 100 percent liquid and a savings instrument.

Money market accounts are available at banks and usually also allow instant access to your money, but for a limited number of times per month. You can typically write checks on the account. The advantage of this account: they usually provide a higher interest rate than a checking account and it is also FDIC insured. I would tend to put money in this account for less frequent and larger expenses. Also, if someone steals your checking account information, it provides an additional level of security. Not all of your money will be at the most readily accessible checking account.

And, there are FDIC insured savings accounts. They are very similar to money market accounts but usually don’t allow direct checks against them. You can move money instantaneously in and out of them electronically. Similar to money market accounts, they provide a higher level of interest. I personally recommend looking into online savings accounts because they tend to issue a higher interest rate because these online banks don’t have the fixed costs of local branches. This sort of account can be used to save for short-term larger purchases.

Less Liquid Savings Options

Let’s say you don’t need instant access to your money, but you do need it sometime in the near future. These options provide a slightly higher interest rate with the main intention of capital preservation and not capital appreciation. Remember, these savings instruments should not be seen as means to make tons of money, but rather a means to be able to pay for important/necessary expenses. Many residents have not had much experience with these options. Nonetheless, they are really important to understand. What are some of these options? The main ones are bank CDs, brokerage CDs, short-term Treasuries, “investment grade” short-term municipal bonds, and “investment grade” short-term corporate bonds.

So let’s talk about bank CDs first. The type of bank CDs I am talking about are FDIC insured bank CDs only. These CDs guarantee a fixed interest yearly interest rate for the duration of the time of the CD. You can use the principal and interest without penalty when the bank CD comes due. If you decide to cash in the CD prior to the due date, there is an often an interest penalty that can vary with the bank offering the CD. Bank CDs often range from 3 months to 10 years and beyond. I would recommend using bank CDs in the range of 1 to 5 years. Why? Simply because very short-term bank CDs less than 1 year tend to offer lower interest rates than savings accounts and money market accounts with less liquidity. Bank CDs greater than 5 years break the golden rule of using a savings account as an investment account. Why? Because a CD tends to provide a much lower interest rate than what you can make in an investment.

Bank CDs are very useful for saving for items or events that you will definitely not need until a specified date since they offer a slightly higher interest rate than the standard savings account. You can also use them as a back up to an emergency account. It can be a place where you can save additional money with minimal penalty, if needed, with a higher interest rate.

I would also like to mention brokerage CDs as a similar sort of savings instrument. These CDs operate in a very similar fashion to a bank CD. The big difference is that you can buy these CDs at a brokerage and collect many different CDs from many different banks in one place. These CDs are very good for people that need a large amount of liquid money and don’t want to have to worry about FDIC insurance limits for their money (250000 dollars- Not something for a typical resident to worry about!!!) You can also buy and sell the CDs prior to the due date at a loss or gain depending upon the changes in prevailing interest rates, something that you can’t do easily with a bank CD.

Short term treasury notes are also another option as a safe short-term savings mechanism. The going interest rate at the present time is 1.31 percent for a five-year treasury as of the date that the article is written. This interest rate tends to be somewhat lower than what you can get in an FDIC insured CD. So, I tend not to recommend them. But, it is also backed by the full faith of United States government and is unlikely to default. It is surely a safe means of capital preservation.

The final two less liquid savings options are closer to a hybrid between savings and investments since there is a slightly higher risk of default (meaning there is a theoretical risk that you won’t get all your money back). These include investment grade short-term municipal bonds and corporate bonds.

For the typical radiology resident, municipal bonds are not the greatest deal because they tend to issue a lower interest rate than the other savings interest rates. Moreover,  you do not get the big benefit of the municipal bond, the ability of the instrument to be free from federal taxes. Most residents are in either the 15 or 25 percent federal tax bracket, so the advantage of buying these instruments is typically not there. You really need to be in higher tax brackets (above 35 percent) to take advantage of this instrument. At the current time, the median yield on a 5-year municipal bond ranges from 1.1-1.4 percent depending on the investment quality. If you figure, that the true interest rate including the tax benefit is somewhere around (1.1/0.85 to 1.4/0.75) or 1.29 to 1.86 percent, depending on the bond and your tax rate, there is not much benefit to this sort of bond and it has a very low but real risk of default.

Investment grade corporate bonds can be another interesting way to save money for a fixed period of time. The interest rates at the current time may be a touch higher than the typical high-interest bank CD. However, again there is a real but remote risk of a short-term high-quality company default. I would not recommend it at the current time.

Finally, I would briefly like to mention that there is also the option of short-term bond funds. The reason I don’t like this option for savings is that there is a real risk of loss of principal (albeit not by that much typically), breaking the rule of using savings as an investment.

The Bottom Line

The biggest take-home point is to remember savings are not investments and investments are not savings. Severe damage to your financial life can occur if you break this cardinal rule, even as a resident.

Also, there are multiple ways that you can put money into savings. For most residents, a checking account, money market account, and/or saving account make a lot of sense for the most liquid needs. In addition, I would recommend bank or brokerage CDs to those residents that don’t need their savings for a slightly longer period of time (between 1-5 years) and want to accumulate a slightly higher interest rate.

Well, that’s about it for a summary of pitfalls of savings vs. investments, and the basics of savings instrument. See you back here in a little while for part 2- Investments!!!

 

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Radiology Residency Requirements For International Radiology Residents

Question By: Dr.Himansu Shekhar Mohanty

Do you take international radiology residents for your Radiology fellowships/residency? Is it mandatory to pass the USMLE for applying for fellowships? What score ideally do you suggest to have a good chance to get a fellowship in your department?

Best regards

Director’s Response To International Radiology Residents Question:

So to answer your questions, we have taken international radiology residents in the past. But more often, we take residents who are from the United States or residents that go to medical school in the Caribbean and then return to the United States. Nonetheless, some of our best residents have been foreign graduates!!

If you are coming from a foreign program, passing the USMLE is required. Typically, we use the scores as a baseline cutoff. Most importantly for us, we just need to know that you will be likely to pass the new written radiology core exam.  However, the cutoff varies from year to year depending upon the number of applicants and the overall competitiveness of the specialty for any given year. Usually, above 220 is a reasonable level but again that is a moving target. On occasion, we make exceptions if we know the applicant well, there are special circumstances, or the application is so outstanding that the person still merits an interview.

Hope that helps!!

Barry Julius, MD

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The Difficult Radiology Attending

difficult attending

Fortunately, most individuals in the radiology profession have stable, friendly personalities. But, in any room of 100 people, you will have psychopaths(1 out of 100), narcissists, borderline personalities (6 out of 100), in addition to other difficult personality types. And radiology is likely no different. During your radiology residency, you magnify these issues because you have to sit for a concentrated amount of time with this person. It could be for hours at a time. (Although that can be different now with the Covid pandemic!) So, you need to learn coping mechanisms to deal with these difficult people.

Why Difficult Radiology Attendings Are Not All Bad

Ironically, I found that some of these most difficult attending personalities gave me my best and most intense learning experiences. It’s where I learned to develop a thick skin, become more of an independent radiologist, tighten my dictation style, and listen. These were the formative years for me. If you think of this tough individual as another link in the chain of learning experiences, most of these days, weeks, or months you sit with this problematic attending will seem to have more relevance to your overall education. Your time spent will indeed not be perfect but will be much improved.

Personality Types

This segment will go through 12 different difficult personality types that you may encounter during your residency program. We will also teach you how you can use each problematic personality type to add to your body of experience and build you into a thriving radiologist.

The Narcissist

Everyone knows this individual. I personally always think of that main character from Dragon’s Lair(Dirk the Daring), with the perfect hair, the expensive clothes, and showing off their skills (or lack thereof!!!) to the world. As they say, “God’s Gift to Humanity.” These problematic individuals will often appear overconfident, and some will make fools of themselves. It’s going to be the attending that never uses liver windows because he says he can always easily detect all liver lesions in soft tissue windows. He’s just too good to make that extra effort.

What’s great about working with these sorts during your residency training? When you complete a rotation with this individual, you will learn how to avoid being overconfident and look more carefully in places that the narcissist will miss. Most important, it is a great time to learn how to be humble, an essential feature of a good radiologist. Radiologists cannot always be right!!!

The Know It All

If you were in school, this would be the talkative kid that is always raising his hand. Or think of Hermione from the Harry Potter series. This person can be incredibly annoying but smart and well versed. The know-it-all gives the resident a distinct learning experience but usually takes the thunder away from something that another attending or you may have discovered. As a resident, you have a lot to learn from this person. He or she will teach you all sorts of radiology information that others will not and give you a sense of humility.

The Absent Attending

You know this type of individual, always leaving the department at the drop of a hat. He/she expects you to do all the work for them during the day. And, the person is rarely available when you have pressing questions. I have found that this experience is probably one of the best learning experiences you can have as a resident. It allows you to take charge of a rotation that you usually would be merely following. You will need to look up lots of information on google and ask other residents/attendings what to do. When you finish with the rotation with this sort of difficult attending, you will be able to run the department because you will handle most of the day-to-day issues on your own, related to your experience of having the unavailable attending!

The Smitten Attending (With Someone Else!)

So, you are working in your interventional rotation, and your co-resident or a medical student is very handsome or pretty. Your attending does not seem to want to listen to anything you have to say. The “boss” always goes to the other resident to teach them and ask them questions and forgets about you. What do you do? Well, the answer is simple. You work twice as hard to get their attention. Working hard on this rotation may not pay off concerning getting a recommendation from this individual. Still, it will allow you to put your heart and soul into your work and make the rotation an intense work experience. You will live and breathe the subspecialty rotation. When you go into practice, you will be thankful for the extra time and expertise you may not have otherwise!!!

The Obsessively Detail Oriented Attending

When you come back from dictating a case, this is the sort of difficult attending that will mince every word and tell you why each word and phrase should have been different. Don’t take offense at this sort of mentor. Most of the time, they mean well. But, the experience of having to write the same dictation over and over; overcorrecting every statement until you make it the way he/she wants, can be painful. But, dictation is one of the more difficult elements in radiology to master. So, this experience can be invaluable for honing your reports and making them much more robust and exacting. Believe it or not, consider this person a resource to make them that much better!

The Sociopath

Watch your back! He/she will typically seem to be the friendliest radiologist in the whole department. This problematic attending often will tell you precisely what you want to hear. Until wham! At the end of the month, you find out that your evaluation from the program director is not what it initially seemed. The sociopath will not tell you about what he/she thought of you at the time of your rotation and takes pride in stealthily making the lives of the radiology resident miserable.

The good news is the rotation will seem to be just fine when you are there. It is only the afterglow that causes misery. But your experience with this attending will teach you something invaluable, never assume that everything is ok. Always ask and find out what you can improve and how you can do things better. This experience is a wake-up call for the naive resident!

Bizarro

Out of all the radiology personality types, believe it or not, you will find this one to be one of the most interesting. I can remember one of my former attendings telling me about a mentor who was continually drooling when he spoke and whose eyes were incessantly tearing. He stood at the short height of 4 foot 3. But, when you talked to this person, the passion for teaching and his profession shone through everything. These attendings tend to have some of the most diverse backgrounds and interests.

When you treat these folks as mentors/teachers, you find that they have unique ideas and behaviors that you would not learn from the more typical personality/appearance. I have incorporated their lessons into my daily practice. Also, I have found that their teachings tend to stick because of the unusual delivery and presentation. Typically, you will remember the days fondly that you work with these people and have good stories to tell as well!

The Dictator

You will find this problematic attending demanding and harsh. The dictator treats all his staff with an iron fist. This radiologist will appear unreasonable at times and expects everyone- nurses, technologists, residents- to bow toward every whim. Unfortunately, you will need to do the same or wait for his wrath. The environment may, at times, be unpleasant, and you will need thick skin. Still, I have found that these attendings make the residents more rigorous in their approach to running a department, adopting search patterns, and learning radiology. Use this opportunity to incorporate the dictator’s demands into your routine, and I can assure you, you will become a much better radiologist!

The Gossiper/Talker

You will have some of the best conversations with this attending and will learn about every character in the department. This person talks a lot and can prevent staff from getting their work done, And some of the information you may or may not have wanted to know. However, listen to this person very carefully because they can be an excellent source of information about what is going on in the department, a precious commodity. My advice is to reveal only what you want to expose to this attending, or else your story may become publicized as well!

The Inappropriate Attending

Most people know about this type of personality. He/she may yell at the patients, make off-color jokes with the wrong sorts of people, or maybe a little too touchy/feely. To this day, I use these uncomfortable situations to be instructive of what not to do as an attending radiologist. I use these experiences to remember to model good behaviors to my residents by the allegories/stories that have occurred!!!

The Loner

Many residents feel the need to get instantaneous feedback from their attendings. This problematic attending will not only give you refrain from any feedback, but he/she also may not even talk to you during your shared time. You may be “pulling teeth” to get this attending to teach and speak to you. You may feel like you are always being observed and assessed, but with no response. Remember that the world of radiology is not a specialty of instantaneous feedback. You may find out what you have done right or wrong months or maybe years afterward. This attending personality type truly prepares you for the real world!

The Unintelligible Radiologist

Most residents know this type. It’s the attending with tons of typos in their reports. And, clinicians are continually calling this attending to figure out what he reported in his radiology impressions. So what is the significant advantage of having an attending like this? You will need to learn how to field the clinician’s questions about his cases in a thoughtful, intelligent manner without incriminating its author. It’s a great way to solidify your radiology impressions and learn to communicate with the clinicians!!!

Bottom Line About The Difficult Attending

There are all sorts of personalities that radiology residents will encounter during their four years of training. I have probably just scratched the surface. Problematic characters can lead to trying times on a daily, weekly, or monthly basis. However, the experiences that you will have can be invaluable in your development as a radiology resident. Use these personalities to enhance your reputation and skills as a radiologist. Don’t let these difficult attendings get the best of you!!!

 

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I’m Just A Resident- Should I Really Start Saving For Retirement?

retirement

You’ve just started collecting your first few paychecks or are a more seasoned 3rd or 4th-year resident. Either way, you may think, I only have 50 dollars left over at the end of the month after paying off student loan interest, putting money into an emergency account, and paying off all my expenses. It’s only 50 dollars- Does it matter if I save it or spend it on dinner, drinks, or movies? If you have that thought process month after month, you will seriously damage your future retirement net worth. Let’s run through some calculations.

The Basics of Compounding at Different Ages

Compounding at 26 years old

So let’s assume you are beginning residency and you are 26 years old. And let’s say you will also be working until you are 70. That gives you somewhere around 45 years of working life. Let’s estimate that you can average 8 percent per year in your investments (the stock market has given back close to 10 percent returns over the past century!) So based on the 8% yearly return, your 50 dollars would be worth (50*1.08^45) or 1596 dollars at retirement. Of course, some of that money would erode due to inflation.

Now let’s assume inflation is going to run at 2.5%. That means that the 1596 dollars would erode from inflation and be worth (1596/1.025^45) or the equivalent of 525 dollars in today’s dollars after inflation. So, think about it… For every 50 dollars you spend, you use 525 dollars in “future money” when you are 70 years old. Do you believe that a meal with drinks is worth 525 dollars?

Let’s think about these calculations a little bit deeper. Say you put away those 50 dollars each month for your entire first year of work. That would be 50 x 12 or 600 dollars saved for this year when you are 26. Or, approximately 6,300 “future 70-year-old you” dollars saved (525 dollars x 12) after inflation.

Compounding at 50 years old

How long would it take to save the same amount of money at 50 years old (peak earnings age) at 50 dollars per month? It would be the following calculation for seven years of savings:

600+ (600*1.08/1.025)+ (600*1.08^2/1.025^2)+(600*1.08^3/1.025^3)+ (600*1.08^4/1.025^4) + (600*1.08^5/1.025^5) +(600*1.08^6/1.025^6) +(600*1.08^7/1.025^7) or 5823 dollars after 7 years.

If you add another year of saving at 50 dollars per month, you come up with an additional (600*1.08^8/1.025^8) for a total of 6734 dollars at eight years.

In other words, you would need to save for 7-8 years at 50 dollars per month when you are 50 to come up with an approximate total of 6,300 dollars of future money. This total compares to the spry age of 26 when you only need to save 50 dollars for one year to come up with the same amount at 70.

What does this all mean for you?

So, the bottom line is that even though you will be making a lot more in the future, your future dollars are nowhere near as powerful as today’s dollars. You may be making ten times as many dollars, but each dollar earned will be 7-8 times less potent. This power of compounding is a good reason alone to start investing today.

Another Reason Why Investing is So Important Now- Moderate Prevailing Interest Rates

It turns out that interest rates have significantly improved in the year 2023. But, there is no guarantee that interest rates will return to 8,9 percent or higher for a very long time. So in retirement, you need a significantly larger nest egg than you would have required 30 or more years ago when interest rates were at that level. Today, you can get a maximum “safe” interest rate of 4.5-5% on instruments such as municipal bonds. And the 30-year treasury bond, another safe investment, yields close to 4%. So, if you want a guaranteed income when you get older, you may need to save twice or three times as many years ago when the same interest rates would have been 8,9 percent or more.

Think of it this way- today, you have a million dollars, and you only collect 40 thousand dollars annually. Thirty years ago, with that same million dollars collecting interest at 10 percent, you would have had a hundred thousand dollars yearly. That’s a significant difference in the potential quality of retirement. It behooves all of us in 2023 to become conscientious savers/investors.

The Importance of Basic Investing Habits for Retirement

I would also argue that, as human beings, we tend to do many things habitually. We brush our teeth, go to work, shower, etc. If you don’t develop those habits early, they may never become part of your routine. I would say the same idea goes for putting away monthly investment money.

Those radiology residents who don’t start investing every month early in their career are much less likely to do the same when they are further on. You are likely to want to spend without thinking about the possibility of your future if it is not a habit. Also, you need to develop a comfort level with how to invest. If you don’t start, you will not know the basics and be less likely to contribute. And most importantly, believe it or not. We can’t work forever!!! Who knows how much the Social Security trust fund will leave you when you retire?

What’s the Upshot?

So, the crucial factors of compounding and low prevailing interest rates are important reasons to start saving that extra 50 dollars or whatever you have at the end of the month in an investment account. Start making a concerted effort to plug away at your retirement account. Eventually, investing monthly for the rest of your life will become a habit, and you will feel comfortable doing so. It’s not just 50 dollars per month or 600 dollars per year. It’s a lovely gift of 6300 dollars yearly for your 70-year-old birthday, not just chump change. For your sake and for your retirement’s sake, start putting away money for investment, no matter how small, right now!!!

If you have any comments or questions, please reply below.