Month: April 2018

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Work Expectations For New Attendings: How To Know If You Meet Them

work expectations

Every career stage has its difficulties. And you thought figuring out the ropes as a resident was difficult? Working as a new board-certified radiologist in your career of interest is no different. Just like you have in the past, you will worry about both the quality and quantity of your work. So, how do you know what you do is enough to make a good impression on your future partners and colleagues? Some would say that if you have to ask this question, you are probably not reading enough. But I think that answer is way too simplistic. Instead of relying on aphorisms, let’s go through some work expectations for completing enough studies at each early stage during the first few months and years before starting as a partner in a practice.

First Few Months Of Work Expectations

At the beginning of your first employment opportunity, most practices tend to give new employees a bit more leeway (although not all!). Rather than focusing on quantity, most practices would want you to concentrate your efforts on maintaining the quality of your work. That said, if you garner a reputation of working slowly as a slug, that is not likely to do wonders for your likelihood of becoming a partner or a long-term employee within a practice. Most practices have unstated minimum work expectations. And as a new employee, you should expect to try to take as much work as you can reasonably muster so long as you are not overdoing it and you are not sacrificing the quality of your work.

You should always try to help by taking extra cases, performing as many procedures as possible, and becoming the “invaluable go-to guy or gal.” Don’t let yourself get stuck in the mind frame of “that is not my responsibility.” Of course, if the folks that run the practice are assigning you duties that you have not trained for and cannot complete, you need to say something. But for the most part, you should welcome the additional responsibilities and expectations the owners have given you.

So, what are some signs that you are not reading enough to maintain weight and meet practice work expectations? If you notice the partners are frustrated that they have to take over much of your work because you are not working fast enough, then maybe you need to consider taking it up a notch. Fortunately, most practices, however, will give you a little bit of leeway at this point in your career.

First Few Years

After the initial probation period, you really have to consider whether you are keeping up with the appropriate amount of RVUs and meeting work expectations. No longer can you rest on your laurels because you are the new gal in town. It’s not just about quality anymore!

At this point, your colleagues expect you to pull your weight by completing your assigned lists, which is why they hired you. In addition, you should be helping out with others; if the day ends at 5 pm and you can help others complete their work after this time, by all means, go ahead. Especially when you have your sights on the partnership, you should put your best efforts forward. At most practices, your performance still counts toward your group’s chances of adding you to their fold.

Which candidates will your practice cut during the first few years? Essentially, any partnership track employees who did not fulfill the expectations of their initial reasons for hiring. If you feel that this includes you in this category, beware!

In addition, those folks on the chopping block include employees that cannot adapt to workload changes and work expectations. Practices are not stagnant. Instead, you can’t expect to read the same amount of studies in any given year. Working conditions can become busier, or your practice may add new modalities and procedures. So, always ask if you are keeping up with their expectations even after your first few months. You are not quite at the end of the tunnel until the group has officially voted you in!

Final Thoughts On Work Expectations

Working at a job where you intend to stay for years is more of a marathon than a sprint. Therefore, your mentality needs to be one of “what can I add to the practice?” rather than “why should I do extra work?” or “it’s not my job!” If you maintain this attitude toward your work, you will not only form good employment habits, but you will also think of your role as part of a team effort, not just pulling for oneself. And in the end, that is what most partnerships expect. So, go forth and put your best foot forward. Then, you, too, will find success!

 

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Can We Learn Anything From Fast Food Industry Slogans About Radiology Residency?

slogans

We hear many catchy slogans for fast food restaurants on television. Although not so healthy for our waistlines, these restaurants’ advertisements motivate millions to go there in droves and bring in billions of dollars each year. So, if these slogans can stimulate so many customers to buy their food, these same slogans may drive radiology residents to improve. For that reason, I have decided to take it one step further. What can we learn from these slogans that we can apply to radiology residents? Well, I am here: to make connections where you think none have ever existed! So, let us go through some ten famous fast food slogans and see how we can apply them to our daily work!

 

Your Way, Right Away (Burger King)

I think this one is self-explanatory for most of you already in or have completed radiology residency. But, we live in a world where the demands for immediate readings of imaging studies have become intense. So, I think it is fair to say we live at the mercy of the ordering clinicians. And it always seems to be your way right away!

Sometimes You’ve Got To Break The Rules (Burger King)

As radiology residents, we can’t always follow the rule books. And for that reason, we need to tweak protocols and situations for individual patients to ensure they get the proper test. And Burger King has known this fact for years. Therefore, maybe we should follow their advice as well. Burger King, once again, you are wise!

You Deserve A Break Today (McDonald’s)

Radiology residency can lead to severe studying and hard work every time we are on call or every day we work. But, as McDonald’s says, sometimes, you need a break. Maybe, you go on vacation or get lucky as the electricity turns off all the equipment in the middle of the night. Or perhaps, you work on a lovely snow day preventing anyone from arriving at the hospital. Sometimes, we need a break from the difficult work of radiology residency.

I’m Lovin’ It (McDonald’s)

We often don’t appreciate where we are and how we arrived here. Well, we need to sit back and smell the roses. We have picked a great profession with multiple exciting challenges and a decent income. McDonald’s once again has it right. Sometimes, we need to say I’m Loving It!

Where’s The Beef? (Wendy’s)

When we perseverate about our cases, we should heed Wendy’s slogan. What should we focus on in these situations instead of worrying about all the extraneous information? We should concentrate on the matter’s meat (or “the beef”). So, I take Wendy’s slogan to heart. Whenever we look at a case, do what Wendy’s would do. Make sure to think about “Where’s The Beef?”

Makin’ It Great Again And Again (Pizza Hut)

We cannot be great just once. If we make a fantastic call and miss many others, our patients will sue us often. So, we need to be on our best game, not just once but repeatedly. Thanks, Pizza Hut, for allowing us to remember!

Little place, BIG TASTE (Checkers)

On any given day, you may think about our role in the scheme of things as little as you understand your place as a radiology resident. But, when you miss something, the impact can become great. Therefore, although you feel like you play a small role in the clinical world, in reality, you leave a large footprint behind you!

Think Outside The Bun (Taco Bell)

Taco Bell has it right. We can’t always emulate our fellow clinicians, who sometimes merely use a checklist to ensure they have worked up the patient appropriately. Instead, we have to think about our patients differently to give them the most appropriate care. Who knew that Taco Bell was such an excellent example for radiology residents?

Eat Fresh (Subway)

When we come into work, we owe it to ourselves and our patients to work as efficiently as possible. Well, how do we get to that point? On that point, Subway recommends we “eat fresh.” And I can’t agree more. We have to ensure that we provide our bodies with the nutrients that we need to use our brains and get as much sleep so that we can be “fresh” for the next day. Good point, Subway!

We Don’t Make It Until You Order It (Jack In The Box)

Now, this one is crucial. Clinicians, please. You can’t expect us to complete an imaging study for you unless you have ordered it first. Like Jack In The Box, we don’t perform the procedure until you call it. Don’t forget!

Fast Food Slogans And Radiology Residency

See, I bet you can’t believe how prescient these slogans are for the average radiology resident. These slogans send important messages to residents that they should take to heart. So, the next time you hear a fast food restaurant slogan, instead of thinking about running to the restaurant for some food and increasing the size of your waistline, think about how it can make you into a better radiology resident!

 

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How To Avoid The Radiology Comparison Culture (Don’t Become A Victim!)

comparison culture

Type A personalities, typical graduates from medical schools, tend to compare themselves to others in their residency classes. These residents often ask the following questions: Am I performing better than everyone else on the in-service examinations? Do I read films as fast as everyone else? Have I written more papers than my colleagues? These questions asking how you perform relative to your colleagues make up what I call comparison culture.

Do you further your career by joining the comparison culture and comparing yourself in this way to others? Sure, it can stimulate some friendly (or unfriendly!) competition. You can work hard to make sure your in-service score beats all others. And yes, you can write your umpteenth paper to shove it in your colleague’s face. But, these motivations only improve metrics that do not correlate with qualities that make a better radiologist, such as the desire to learn continually. And over the long term, a resident cannot sustain these motivations. I mean, who wants to study for the sake of getting a higher in-service score year in and year out? It’s a recipe for misery and burnout.

So, what motivations should we seek to make ourselves better radiologists who love our chosen profession? Let’s go through some long-term motivators to avoid the pitfalls of the comparison culture.

Love Learning

After years of testing and the comparison culture, many students forget or never learn what it is like to enjoy learning. When I read, I do it because reading helps me in some way with my practice or because a specific topic interests me. Reading and studying should not be about getting one up on our colleagues. Instead, understanding is a reward in and of itself.

Solve Great Questions

Nothing is more rewarding than solving that bizarre case or coming up with a twist that leads the clinicians to take a different direction than they had initially expected. Call me crazy, but there is something special about being that “go-to” person when anyone has a problem that needs to be solved. And solving interesting questions begets more interesting questions from your fellow clinicians.

Work To Improve Patient Care

For many radiologists, the ultimate satisfaction comes from improving our patients’ lives. Even though many of us are in the background, we can feel the difference we make when clinicians treat patients appropriately because of our calls, improving patients’ lives. Many of us derive immense joy from the vital work we perform.

Embrace The Excitement Of New Technologies

Many of us, as radiologists, went into the field because we like more significant and sophisticated toys. Whether it’s that new SPECT-CT or the latest and greatest 7T MRI, we should derive pleasure from learning these technologies’ significance and applying them to patient care. It pays to keep a youthful spirit and keep our eyes wide open in amazement as we conquer the next great technology for the betterment of others. Heck, we can even make a career out of it!

Enjoy Playing Part Of A Team

And finally, many of us enjoy our roles in forming a team and operating flawlessly as a unit. Only through interaction among team members that we come up with our best ideas and perform to our fullest. Working by yourself limits us to boundaries instead of expanding our knowledge. Playing a role in a team defeats the hazards of the radiology comparison culture.

Avoid The Comparison Culture

Ultimately, the comparison culture only gives radiologists and trainees a short-term benefit. Instead, loving to learn, solving our colleagues’ clinical dilemmas, embracing new technologies, and playing an essential role in a team can help us derive long-term happiness from our work. Avoid the comparison culture to love what you do. Radiology is a marathon, not a sprint.

 

 

 

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How To Add A New Modality To Your First Practice Fresh Out Of Fellowship

modality

The most significant controversies in private practice often stem from workload/relative value unit (RVU) or differences in “earnings” among physicians. Anytime one physician “works more” or earns less on a daily rotation, partners and employees interpret that difference as unfair. Even more so, radiologists heighten this perception when one physician performs this rotation more than others. So, imagine starting and attempting to introduce a new procedure or imaging modality to a radiology practice right after graduating from a fellowship. Often, this will tip the workflow balance for an entire radiology business. So, how do you incorporate this new work into a practice’s current workflow? And what might you need to do to sway your partners to change the workflow for this new procedure in your practice? Today, we will delve into what you need to know as a new radiologist fresh out of fellowship who wants to start a new program or modality.

Show That The New Modality Increases Practice Value

To begin the process, you need to demonstrate that the new procedure adds value to the practice. What do I mean by that? Well, your job (if you choose to do so) becomes to convince your partners that your procedure or modality will eventually increase or at least maintain business.

How do you go about this process? One of the easiest ways to accomplish this goal is to give a practice-wide presentation. To do so, you need to show that your new modality will provide revenue above and beyond what the practice brings in. If this is not the case, you should demonstrate how the new procedure may act as a loss leader or at least increase ties with the hospital for all to benefit.

Another option to increase the buy-in of the partners would be to perform the art of “politicking.” Talk to your partners individually to get them to understand what the new procedure/modality will bring to the practice. So, when it comes time to discuss adding your new procedure to the daily rotations, each radiologist will be on board.

And finally, you need to consider what the practice will need to add and the costs to start the new procedure or modality. Is this procedure going to take away from other businesses in the practice? Or, in the case of new high-tech equipment, are the costs prohibitively expensive? These items are crucial to think about before beginning the new procedure.

Make A New Schedule That Is Fair For Everyone

Next, you need to think about not just the procedure value but also you should develop ways to incorporate the new procedure into the schedule reasonably. The less onus on the partners to establish a new schedule, the more likely you will be able to add the new modality to the practice. So, come up with ideas about how to add the new procedure. Perhaps you want to first tack it on to a current rotation. Or maybe, it is worthwhile to go full-steam into a new daily or weekly rotation. You must consider working out these factors before “going live.” If you cannot accomplish this, the chances of creating a new addition to practice dramatically decrease.

Be Aware Of The Politics

Sometimes beginning a new venture can wreak havoc on a practice or hospital system. For instance, adding a new SPECT/CT to one site may take away business from another within the system. This new equipment and procedure may decrease the employment opportunities for technologists within the site that does not have the latest technology. And, you may get a lot of pushback when you try to add it to the site. Therefore, taking the politics of the practice and hospital before beginning the new procedure is crucial.

Don’t Overwhelm The Decision Makers

These steps listed above are instrumental to creating something new in your practice. However, you have to tread very carefully. Frequently, your partners may be busy with lots of other practice requirements. So, try not to overwhelm them. What do I mean by that? Ensure the new procedure will not burden the partners and employees significantly. In the beginning, consider taking on much of the excess work yourself to get the new modality started within the schedule. Remember, you are the champion of this new procedure. So, it would help if you put in additional work to begin up front. If not you, then who else will do it?

Bottom Line For Starting A New Procedure Or Modality

Whenever you want to start something new within a practice, it is not enough to jump right in and begin. You need to put in much forethought and work before beginning. Starting something new not only affects the person initially responsible for developing the initiative. Instead, incorporating new procedures into the schedule affects the entire practice due to its effect on workflow. So, show that the modality increases practice value, demonstrate how to incorporate it into the schedule reasonably, be aware of the politics, and take on much of the initial grunt work yourself at the beginning. If you can accomplish these steps, you markedly increase the chances of starting a new procedure or modality within your practice for the benefit of all!

 

 

 

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Tracking Net Worth As A Resident: Does It Make Sense?

Every once in a while, I like to discuss resident finances because understanding how to manage money must begin early. Why? Because small mistakes as a resident become large errors later on in your career. At the same time, many of you have little or no practical know-how about financial matters. Part of it likely relates to the lack of experience. And, the other part connects to the lack of education about finances for residents. I get it. However, I will pitch to you why I think it becomes incredibly important to start tracking your budget, credit, and investments when you have less than nothing, so early in your career. In order to do so, first I will go through the definition of net worth. Then, we will discuss why it is so important to follow it. And finally, I will give you some simple tools for monitoring net worth.

 

net worth

 

What Is Net Worth?

The official financial definition of net worth is assets minus liabilities. That may not mean much to some of you. So quickly, we will define the terms.

Assets are anything that you own of value. That would include investments like stocks and bonds. Or, palpable things like real estate, cars, jewelry, baseball cards.

Liabilities are anything that you owe to others. For most of you, the first type of liability you probably think about is student loan debt. But, credit card debt, personal loans, and car loans count as well.

So, in order to come up with your present net worth, you need to subtract the liabilities from the assets. And, for a good chunk of you, that number is going to be negative. But, don’t worry! That is entirely normal any time during residency or as an early radiology attending.

Reasons For Tracking Net worth

The Trend Is Your Friend- Are You Becoming Richer Or Poorer?

Like anything else in medicine, the trend is often more important than the absolute value.  What do I mean by that? Well, let me give you an example of PSA levels in a patient with prostate cancer. If you look at one PSA level without any context it essentially becomes meaningless. PSA levels can relate to prostate inflammation, other nonspecific biochemical properties of the body, as well as cancer. However, if you perform serial PSA levels and notice an increase over time, well, that takes on some significance. You worry about recurrent prostate cancer or metastatic disease. Likewise, tracking net worth works in much the same way.

As a resident, if you notice that your net worth is negative, it’s not a big deal (everyone has a negative worth!). However, just like PSA levels, if you notice that your net worth significantly declines month over month and year over year, well, that could mark that you need to change your financial habits. Maybe, you need to spend less. Or, maybe you should consider taking that moonlighting gig if available. Bottom line. You do not know what actions to take unless you begin to track your own net worth.

Net Worth Tracking Should Become Habitual

Later on in your career, not knowing your net worth can lead to catastrophe. Many attendings learn too late that they have been spending more than they earn. And, where does that lead you? You will be forced to work longer than you want with shifts that you may hate to earn extra money. Even, patient care can suffer because you become more worried about your next paycheck than what may be best for your patients. Maybe, you read more films than you should.

On the other hand, forming a habit of monitoring what you have now can help you to change your behavior. If you notice a steep decline, you can stem the outflow of assets.  And, if you start tracking your net worth early, you will continue to do so later on in your career when money mistakes can matter even more. Why wouldn’t you want to form these good habits now?

Tools For Tracking

So, what are the ways that you can track your own net worth? First, you can use an old-fashioned excel spreadsheet. I have been doing that for years. And, it certainly helps to keep track of the large assets or liabilities. But, if you want to break down exactly where your cash flow goes, consider one of the online net worth and budget trackers.

The one that I have used for several years that is free is Personal Capital (Yes, I am an affiliate and if you are interested, click on this link!).  I prefer Personal Capital because I have found it to be very useful for the granular tracking of net worth. It is very easy to tie/link investment accounts, credit card accounts, mortgages, and individual assets to the system to make accurate tracking of your net worth fairly easy. And, it adds graphs and easy to use interfaces to capture the trends of what goes on with your finances. That’s exactly what you want from a net worth tracker. (It takes a bit more work to do the same from a spreadsheet)

Bottom Line

Net worth tracking should become a tool in your arsenal to prevent financial mismanagement. Consider practicing it now both to change your current behaviors as well as to maintain good habits throughout the rest of your career. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure”. This certainly applies to tracking your own net worth!

 

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Top Ten Pitfalls Of The Chief Resident Year

chief resident

Traditionally, the chief resident plays one of the most critical roles in the well-being of the resident community. To that end, the chief resident often becomes responsible for much of what happens in her residency program. Unfortunately, in most programs, however, there is no playbook. And for most, the new chief residents learn their role in a “trial by fire.” Since most chiefs do not arrive as experts in this new role, they make many errors (To be expected!) So, what are the most significant blunders you can make throughout your tenure if you catch yourself in a position as a chief resident? I thought maybe we could all learn from others’ mistakes!

Make Different Promises To Residents And Staff

Before starting, many chief residents commonly will tell their classmates one thing only to realize later that the staff will not accept the change. For instance, when scheduling, a new chief may promise everyone that they will have a night float for only ten days. But, when they sit down and create the schedule, he discovers it is impossible. Now, he puts himself in a bad situation. The residents’ expectations differ from reality, and all the residents become upset. Politics is everything! So, be careful what you say!

Set Bad Examples

Unfortunately, as chief resident, you are constantly under scrutiny. What is the easiest way to lose the respect of the residents and administration? Set a bad example for the rest of your residents. Everything you do serves as a model for everyone else. If you don’t show up, who will? Who else will do the same if you decide not to step in when a resident struggles? Once a chief resident does not fulfill the role of a good leader, the rest of the residents will follow suit.

Create The Schedule And Give Yourself The Most Benefits

Chief residents typically play an essential role in scheduling. Therefore, if the program selects you as a chief resident, you will wield a lot of power over giving yourself the best shifts at the expense of others. If you want to piss off your classmates, take those times everyone else wants or vacation on the best months. That will go over well!

Poor Follow Through

Trust can be complicated to establish in any profession. But, as a chief resident, your word is your bond. Perhaps, you do not follow through on reprimanding a resident because they made a mess in a call room and did not clean up. Or, you let a resident off the hook even though they continue to skip out on noon conferences. If you don’t follow through, you lose the respect of your fellow residents and faculty. So, if you promise, make sure you deliver.

Create Cliques

One of the worst feelings in any job- is to feel left out! So, you need to be even-handed and fair. Invite only half your class to a house party. Or, instigate your fellow residents to hate a fellow resident because you don’t like them. These are surefire ways to reduce your chief resident position to rubble!

Perform Poorly

If you want to have others question your capabilities as chief, what is the simplest way? Here are some possibilities: Don’t read; Perform poorly on quizzes; Or fail your core exam. Once you establish yourself as a chief resident that cannot pass the rigors of a radiology residency, should you be a chief resident?

Poor Attendance After Passing Boards

As a chief resident, you wield a lot of power. But absolute power can corrupt absolutely. Just because you have taken and passed your boards does not give you the right to skip out on conferences or take unscheduled time off. In the end, you are still a resident. So, don’t abuse your status. It can bite you if you ever decide to get a recommendation!

Unwillingness To Help Out Faculty

Since you are stuck between the faculty and residents as a chief resident, your role becomes to appease residents and the faculty. So, what does this mean for you? Make sure to follow at least some of the reasonable demands of the faculty, or else you will fast lose respect. It could be as simple as asking residents to participate in a department-wide research project or ensuring all residents take a resident survey. Neglecting the faculty’s demands can upset your superiors and make your chief resident year miserable!

Inappropriate Relationships Within Class Or Faculty

Nowadays, with the “#metoo” movement, you must watch out for your actions. Beware what you say and how you say it. Other residents and attendings can interpret subtle cues as harassment. So, if you want to ruin your chief resident year and possibly your career, follow the rules!

Final Thoughts About The Chief Resident

As chief resident, you play a significant role in running a residency. And, because a proper leadership position such as chief resident is a new experience for most, I can guarantee you will make some mistakes. Therefore, more than others in the residency program, you need to act like a leader without taking advantage of your colleagues and faculty at their expense. Think of this year as a political learning experience. So, heed these ten warnings of what not to do as a chief resident. If you can avoid these mistakes, you will miss most leadership pitfalls. Like becoming an excellent chief resident, learning to perform a leadership role well will be handy for the rest of your career!

 

 

 

 

 

 

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Is Four Years The Right Duration For A Radiology Residency?

years

Since the creation of radiology as a specialty, the duration of radiology residency has slowly increased. When the first “radiologists” began training, a radiology apprenticeship/residency took as little as one year. After the American Board of Radiology (ABR) was formally created, the board decided to increase the number of years in residency to three years in 1940. (1) Finally, in 1982, the ABR set the required years for board certification to 4. (2)

So, what is magical about the “most recent” decision in 1982 to set residency as a 4-year process? And would it make sense to create a different length of time for completion of radiology residency? Using a thought experiment, we will imagine what would happen if the ABR suddenly changed the radiology residency from four years to three or five years. More specifically, we will address the essential benefits and disadvantages of changing the time spent in radiology training if the ABR changes the requirements for a three or five-year residency.

What Would Happen If Radiology Residency Was Three Years?

Biggest Problems

Based on my own experiences, a resident must meet a certain threshold of reads and procedures to establish competency in a given area. In the setting of a three-year residency, I believe that not all the residents will achieve this number in all subjects. Could the job market withstand new trainees with experience? Possibly, if we no longer created general radiologists and only wanted to make subspecialist radiologists. However, the current demand for radiologists seems to be for subspecialists who can practice general radiology. So, the new output of radiologists would theoretically not meet the workforce’s needs.

Furthermore, programs would need to cancel training that we all know as part of radiology residency today. For instance, would residents have the time to structure a one-month rotation at the AIRP if the residency length is only three years? (I found it to be a valuable experience!) Or, how can you substantiate the need for mini-fellowships when you have significantly less time for training? The ABR and residencies would have many of these issues to work out.

And finally, you would create one year when you would have double the number of radiology trainees entering the workforce. You may think that is not a big deal. However, due to the laws of supply and demand, those radiologists that graduated in that year of change would likely have significantly more problems obtaining a job!

Biggest Advantages

With the significant rise in student debt, eliminating a year of residency would considerably impact the lives of new residents. Imagine being able to pay your debts off a year sooner. Furthermore, trainees have already delayed gratification for so many years. Wouldn’t it be nice to start your actual career a year earlier?

From a program director’s perspective, one less year of residency would reduce some bureaucratic burdens upon the residency programs. Naturally, you would need one less year of paperwork to be processed. So, that would reduce some costs on the individual programs. But, this is more of an indirect benefit to residency programs.

 

What Would Happen If Radiology Residency Was Five Years?

Biggest Problems

If we started with five-year residency programs, I think we would first notice increased radiology resident fatigue and burnout. More specifically, this would primarily affect the first class of “outgoing” seniors since they would need to alter their expectations radically. Believe me. An extra year of residency is no minor issue!

On the financial side, residents would increase their debt burdens by an extra year of relatively lower pay. For those without debt, this probably would not impact you as much. But for most residents, an additional year can add to a significantly increased financial burden.

Less specific to individual residents, the extra year would cause a one-year absence of outgoing trained residents into the workforce. Understaffed private practices would become more severely burdened because many imaging businesses would have to freeze hiring for one year until the typical graduating schedule returned to normal. This is no small matter.

Biggest Advantages

Firstly, radiology residents would have increased experience when entering the workforce after a five-year residency. An extra year means significantly more mammograms, CT scans, MRIs, and procedures before beginning a career pathway. Moreover, the fifth-year seniors would easily be able to run academic radiology departments throughout the country. The prominent academic centers would love this. More “free” labor with more academic time for faculty members!

In that same vein, you would also satisfy the current practice’s needs by hiring subspecialists that can also practice general radiology, the most significant current demand in the private practice workforce. And similarly, you would also be creating fewer super subspecialized radiologists that could only read their subspecialties.

Additionally, you could make an argument to return the board exam to the last year of year residency before graduation. For the individual resident, this would mean more time to study during residency instead of preparing for the certification examination after entering the workforce.

 

My Take

Change is never easy. But, change that can lead to significant improvements for the current residents and workforce makes a lot of sense. In this case, I do not see that the advantages outweigh the problems of changing the number of years of radiology residency. Perhaps, later on, the balance may be altered. But, based on current practices, changes in duration would present undue burdens upon residents, faculty, and private practices without enough rewards to make the change worthwhile. Let’s continue monitoring the situation but keep things the way they are for now!

 

 

 

 

 

(1) https://www.theabr.org/about/our-history

(2) http://radiology.yale.edu/about/history/

(3) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=110650

 

 

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Radiology Acceptance And Increasing Time Since Medical School: A Negative Correlation?

acceptance

Dear Dr. Julius,

Thank you, Dr. Julius, for including me in your network. I understand how difficult it is for you to take time out of your busy schedule, and I do not mean to be a pain. Here’s my question… I applied for radiology and internal medicine. Subsequently, I matched in internal medicine this year (score 247,248, pass). I am keenly interested in radiology and will apply for the match after six years (3 years of residency, three years of J1 waiver, and ten years since graduation). Also, I am working on various research projects in radiology. Will the year of my graduation many years ago negatively affect the possibility of acceptance to radiology residency? I would be highly thankful if you could guide me and give me your insight.

Thank you for your time and consideration,

A Concerned Applicant

________________________________________________________

Dear Concerned Applicant,

Concerning your question, the number of years out does make a difference in the application process and changes the acceptance rate. Unfortunately, some programs have screening criteria that prevent graduates before a specific year from getting an interview. Why does this happen? I think many program directors don’t want to hassle with some issues that come with more experienced candidates. These may be unexplained gaps in time, foreign visa issues, changes in the USMLE tests, and more. That is not to say that all programs have this screening criterion.

More importantly, however, the more significant issue is not the number of years. Instead, it is the number of years you have completed your residency program already. Once you hit the three-year mark, the government may not fund your position. And the lack of funding translates into programs that will not grant you an acceptance due to the costs to the hospital. That is, some residency programs have less need for funding than others due to external sources. So, it is not impossible to find a radiology residency. But it isn’t easy.

In your situation, your best bet is to get to know the radiologists and program directors in the hospital at your residency. Also, as you are doing, participating in research at an institution with a radiology residency may give you more of an inside track. Again, you will still potentially find it difficult because radiology has become more competitive in the past couple of years, especially for foreign grads. Presently, programs can select applicants more discriminately from American medical schools without a J1 status than in previous years.

My recommendation to you is to continue to pursue the possibility of trying to get into a radiology residency if you have the means to do so. On the other hand, go through the application process with a sense of realism that you might not gain acceptance. The good news is that you obtained a residency slot in an internal medicine program! Congratulations! As a J1 visa holder, you have achieved something many others can only dream about. Luckily, now, you have a fallback position.

Good luck with the pursuit of your goals,

Barry Julius, MD

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Do Video Games Make Better Radiologists?

video games

Let’s face it. For some of us, radiology and video games go together like other classic combinations such as peanut butter and jelly or bread and butter. In the radiology profession, these games have enticed many of us since we were young. And, I think it has something to do with our love for technology. Even I enjoy playing an occasional video game on the Nintendo console we bought for the kids. But do they serve a role for the radiologist in training? What are some of the evidence that they may help with brain function? Finally, do they enhance radiology practice in a radiologist’s career? In today’s piece, I will investigate some of these burning questions.

Video Games And Radiology Learning

So, what evidence can we use video games to learn radiology? Well, let’s look at two articles that I found. One of these articles explicitly gives an example of a specific video game dedicated to radiology learning. The other indirectly provides evidence that we can learn radiology with video games.

In one case, I found an article that showed a video about a game developed at a Spanish university meant to teach radiology to physicians called Medgame. (1) At least from the video, it seems to be an enticing and possible alternative way to learn the basics of radiology. For those who love playing, I imagine a video game like this would be a great way to learn new material and reinforce radiological concepts. (If only I had something like this when I was a resident!) Although I can’t say that I have played the game, I would be interested in getting feedback on it.

More indirectly supporting the average video game player, another article from 2013 in the Journal of Molecular Psychiatry shows that you can alter the structure of your brain by playing video games. They claim several sites of increased gray matter thickness in those that played Super Mario 64. Moreover, they also espouse the potential for the increased gray matter to help with PTSD, Alzheimer’s disease, and schizophrenia. (2) In my mind, the increased gray matter should translate to increased neural complexity and networks, likely related to increased learning.

Video Games And Brain Function

More than just learning, some evidence supports increased brain function in video game users. In one article, I found some interesting information about how video games improve brain function in patients with multiple sclerosis. It describes increased thalamic connectivity in patients that played a particular video game. (3) Another study also showed that manual dexterity improved in more heavy video game users than young adults who did not play and those who played less often. Both of these articles provide some supportive evidence of the power of video games to enhance brain function.

Video Games Improving The Field Of Radiology

And then other articles have shown that technologies created for video games also have been found helpful in radiological applications. Thereby, these applications also have significantly improved patient care. One of these motion sensor technologies from an Xbox specifically reduces radiation dosages in X-rays by assessing motion and thickness. (4) Even back in 2008, Microsoft programmers created 3D technologies for video games that subsequently applied to radiology. (6)

These video game technologies are merely the tip of the iceberg. With so much recent virtual reality development for video game users and the great graphics technologies on current games, I believe the applications will become much more numerous. We will see many other applications from video games that improve patient care.

Are There Any Negatives For Radiologists?

With any discussion of video games, we also have to discuss the downside. I don’t know about you. But, when I get into playing an addictive one, it can interfere with other “life activities.” You want to know what will happen next and can easily sit down for hours at a time, passing the time without realizing you have been playing for so long. So, the individual radiologist video gamer must carefully monitor their gameplay usage. However, this situation may not be so bad if the game provides a significant radiological education benefit.

And then, we also need to confirm that video games created to enhance radiology performance do just that. Sometimes at the beginning, creators of products will tout the benefits of technology without evidence to support whether or not it helps. So, we need to justify that these video games truly enhance performance with an evidence base before making claims that the technology improves radiology and healthcare.

Video Games And The Radiologist

In this whirlwind tour through the world of video games and the potential applications to radiology, I believe the preponderance of evidence supports that they will enhance our lives as radiologists. Some of the takeaways include that they can enhance education, may improve brain function, and will continue to improve radiology practice for years to come. These benefits come with limited downsides that I think we can overcome. Nevertheless, the application of video games to radiology is far-reaching. We only need a bit of imagination and the willingness to adapt to new technologies for the betterment of our field.

 

(1) https://healthmanagement.org/c/imaging/news/mir-2015-learning-radiology-through-computer-games

(2) http://www.nature.com/articles/mp2013120

(3) https://press.rsna.org/timssnet/media/pressReleases/14_pr_target.cfm?ID=1879

(4) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=118512

(6) http://www.digitaljournal.com/article/258548