Month: September 2018

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How To Deal With The Negligent Technologist

negligent technologist

Just like not all physicians make caring clinicians, not all technologists fulfill their obligations to the patient. And unfortunately, at some point in your career, you will likely encounter one of these medical team members. Perhaps, the negligent technologist always leaves at 4:00 PM regardless of whether they are evaluating a patient for a STAT study, like a pelvic ultrasound for a ruptured ectopic. Or, maybe, they see an MRI sequence with many artifacts and decide to do nothing about it. One of these situations will likely occur as a resident or attending. Therefore, it is essential to know what to do. To clarify the rules of the road, I will divide the blog into the four strategies outlined below.

Don’t Beat Around The Bush (Be Direct)

Open communication is one of the essential ingredients to prevent recurrent episodes of negligence. If you discover an issue, why wait to address it when it is no longer fresh in anyone’s mind? Maybe, the tech was not passive-aggressive when he made the error in judgment. Instead, perhaps, he did not realize that neglecting to correct the MAs for body weight would cause a problem with the film. You must talk directly with him to find out. Sometimes confronting the issue head solves the problem permanently. Of course, that does not always happen, which brings us to the next heading!

Talk To Your Program Director

Regrettably, you still have not solved the problem by directly talking with the technologist. So, who better to discuss the issue with than the program director? Perhaps, she can guide you to what you should do next. Or even better, maybe, she can take care of the entire situation for you. Many times this simple action will solve the problem.

Document, Document, Document

Rarely talking to the technologist or the program director does not solve the problem. So, what to do next? Well, if you find that the offenses are recurrent, you must document each of the episodes. Only when you have objective data can you use it to change the situation, primarily as a resident. Why? For the most part, the technologist has likely been working for many more years than you at the institution. Therefore, the technologist’s word will often carry more weight than yours.

Why else is the technologist in a better position than the radiology resident? The institution has more to lose when a negligent technologist leaves instead of a resident because it is more costly. So, you will need to keep a written or electronic log. And be specific. Accurately state what happened, how it occurred, and when it transpired. Make sure that you can confirm the information as quickly as possible.

Discuss With Administration

OK. Direct communication has not worked to change the behavior. Nor was the episode a “one-off” event. So, what do you do next? If you need the behavior to cease, discussing the matter with the administration is imperative. Each hospital may have a different administration member to help with this. Typically, it may be a hospital liaison/radiology manager or the DIO (head of GME).

And what can they do with the documentation that you provide? It can serve as a basis to change the offending behavior of the technologist. Also, the hospital can use it to help decide whether to remediate, train, or fire. Whatever the case, when things become that dangerous, you need to address the event to the “higher-ups.”

Dealing With The Negligent Technologist

Often, the most challenging part of playing the role of the resident is not the technical work. Instead, the hard part usually comes down to how you negotiate with other human beings. So, follow the strategies that I have provided. First, communicate directly. Then, talk to your program directors. And finally, rarely, if all else fails, document everything yourself and speak with the hospital administration. These strategies are a logical approach to dealing with the negligent technologist.

Moreover, it should work to remedy most problems. Most importantly, however, you should never neglect to deal with a negligent technologist. Remember, you took the Hippocratic oath. Patient care comes first!

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Radsresident.com- Happy 2nd Year Birthday!!!

It’s now been two years of radsresident.com weekly articles, posts, and ask the residency director questions. In total, we have almost 200 posts (194 to be exact!) on all sorts of topics dedicated to radiology residency. And, it seems that my readers want more! Moreover, the site continues to grow significantly from its humble beginnings, and its viewership had almost quadrupled from the months when it first started.

So, let’s talk about a bit about what has been going on for the past year or so. To do that, I will discuss the three segments of viewers that take an interest in this website. Overall, they are evenly divided. To categorize them, I would separate the viewers of radsresident.com into those interested in radiology residency application advice, general residency advice, and finally, post-residency advice. Within each group, the readers gravitate to some of the more popular resources on radsresident.com. And, I will show you some of the articles on each of these topics as I list the most popular posts on this website. Additionally, we will talk about some of the plans for the up and coming year and where we are heading.

Let’s start by showing you what articles have been the most popular over the course of the past year and for all-time. Here are the pieces that the most people find helpful (and entertaining I hope!) After the title, you will see that I categorize each into one of the three segments above.

Most Popular Posts Over The Past Year

  1. How Much Work Is Too Much For A Radiologist? (Think RVUs!) – Post-residency advice
  2. Up To Date Book Reviews For The Radiology Core Exam – Residency advice
  3. How To Create A Killer Radiology Personal Statement – Application advice
  4. Top Traits Of Great Radiologists (They Might Not Be What You Expect!) – Residency advice
  5. A Common Radiology Applicant USMLE Misconception – Application advice
  6. How To Choose A Radiology Fellowship – Post-residency advice
  7. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”? – Post-residency advice
  8. What To Look For In A Radiology Residency? – Application advice
  9. Five Reasons Why The First Year Of Radiology Residency Can Be The Most Difficult – Residency advice
  10. How To Make A Good Impression As First Year Radiology Resident – Residency advice

Most Popular Articles Of All Time

  1. How Much Work Is Too Much For A Radiologist? (Think RVUs!) – Post-residency advice
  2. Up To Date Book Reviews For The Radiology Core Exam – Residency advice
  3. Top Traits Of Great Radiologists (They Might Not Be What You Expect!) – Residency advice
  4. How To Choose A Radiology Fellowship – Post-residency advice
  5. A Common Radiology Applicant USMLE Misconception – Application advice
  6. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”? – Post-residency advice
  7. Radiology Residency And The SOAP Match – Application advice
  8. How To Make A Good Impression As First Year Radiology Resident – Residency advice
  9. The Struggling Radiology Resident– Residency advice
  10. What To Look For In A Radiology Residency? – Application advice

So, you may notice that the viewership is pretty much evenly divided among the segments and is broad regarding radiology residency related interests. Therefore, I will continue to write articles with these factors in mind.

Population Using Radsresident.com

How are you folks arriving at the posts and articles on this website?

  1. Organic search (Google, etc.) – 69%  of readers
  2. Direct (typing in radsresident.com) – 17% of readers
  3. Social (Facebook, Twitter, etc.) – 14% of readers
  4. Referral (Links and websites)-  2% of readers

From where are my readers?

  1. The United States – 65%
  2. India – 8%
  3. Canada- 2.5%
  4. United Kingdom – 1.9%
  5. Malaysia- 1.25%
  6. Australia – 1.24%
  7. Philippines – 1.18%
  8. Pakistan – 1.05%
  9. Saudi Arabia – 1.01%
  10. Brazil – 0.86%

How many individual users have frequented the website over the entire past year? (based on Google analytics)

59,348 individual users (22,084 the previous year)

129,902 page views (around 55,000 the previous year)

What Else Has Happened Over The Past Year?

In addition to the useful articles and posts, we have continued to give you the case of the week. I hope you are enjoying these cases. Moreover, you may have noticed updates and edits on many of my older articles to make them easier to read and access.

More recently, I have become a Doximity Author. Over the next several months, you may notice many of these and new articles featured on the website.

Finally, I am still in the process of editing my new ebook called The New Attending Physician Guidebook as you can see in the cover below. This ebook should be out for release in several weeks to a month on Amazon.com. I will update you all on the official release date when I know.

 

 

 

 

 

 

 

 

 

What Else To Expect Over The Course Of The Next Year On Radsresident.com?

To continually improve and make this website as helpful as I can to you, the readers, you may notice a few changes here and there. First of all, over the next several months you may begin to see fewer Wednesday posts and newsletter emails.  Instead of a weekly feature on all Wednesday evenings, we will dedicate Wednesdays evenings to sponsored posts, guest posts, ask the residency director questions, Doximity authored posts, and special event posts only. I am doing this to devote more time to maintenance of the website since it has grown substantially over the past two years (it has become a big job having close to 200 posts!)

However, I will continue to post regularly scheduled articles every Sunday as well as the weekly e-newsletter on this day. Additionally, I will still post the case of the week on Sundays on the e-newsletter, Instagram, Facebook, and Twitter. Like before, I will continue to publish the case of the week answers to the website each Wednesday evening.

Lastly, I want to express my appreciation to all of you for utilizing this website as you have been doing over the past year. To continue to do that, you can continue to support this website by buying books through amazon.com, signing up for grammarly.com, and clicking on my reputable sponsors/partners including Contract Diagnostics, The Disability Doc, Residency Swap.org, and Splash Financial. By continuing to click on these links, and signing up for these services, you help to fund this website and provide the opportunity for me to keep giving you the great content you have come to expect. Once again, thank you to all my readers for a fantastic year!

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Which Radiology Practices Are Ripe For A Buyout?

buyout

When they start in practice, most new radiologists fear one thing more than most. Will a private equity firm buy out my practice even before I make partner? For one, this lousy timing can lead to the abandonment of the promise of partnership. Or even worse, it can cause the loss of a job. We discussed a bit about private equity buyouts in a previous blog. But, this week, one of my residents asked a great question. Is it possible to tell which practices are headed for a private equity buyout? So, I thought that would be an excellent topic for today. (Residents come up with the best ideas!) More importantly, I think this will be helpful for many of you in deciding on which practice to join.

How Old Are The Partners?

You might think that age has no boundaries. But that aphorism does not strike true in the world of ownership. If you are looking into a practice where most or all partners are over 50, you may want to think twice.

Think of it this way. Why would someone over 50 not want to receive a premium buyout when their work life may only last another 5 to 15 years? If you, as a partner, had the option of taking a payout of a few million dollars, you would undoubtedly want to consider it, especially since you can continue to work in the same practice, perhaps at a slightly lower income level. But that does not matter. You have received a flush payment that you can add to your investments for your retirement. You would probably come out way ahead of the game.

On the other hand, if most of the partners are under 50, a private equity buyout would not benefit them as much. Why? These folks would be losing out on a higher annual income than owning one’s practice brings. And these radiologists have many more years of work ahead of them.

Location

Depending on the location, a practice may or may not be enticing to a private equity firm. So, what kind of sites would stimulate these companies’ appetites? If I were a private equity firm, I would want to ensure that the practice has a good payor mix. Therefore, the more affluent the community, the more likely a private equity firm would swoop in and buy an imaging business.

Also, if I were a private equity firm, I would want to ensure that I could rapidly recruit radiologists for my practice if the former employees were to leave. So, I do not wish to choose a very rural location where it may be hard to attract on-site radiologists. Or, I do not want to pick a place that may seem undesirable to radiologists.

Age Of The Practice

This factor is likely one that you probably have not thought much about. However, the age of the practice itself can affect how quickly a private equity firm can buy it out. Suppose a radiology business has had long-standing contracts with a hospital or imaging center. In that case, it is much harder for a private equity firm to swoop in and make a hostile takeover. You may have heard of something called goodwill. If a practice has had a contract for, say, fifty years, the price of that goodwill becomes very high. And guess what? The private equity firm would likely have to pay that price to buy out the practice. Private equity firms don’t like to shell out more money than they need.

What Is The Market For The Other Practices In The Area?

So, if you are looking at a practice and you notice that private equity firms have already bought out most of the other imaging centers in the area, well then, likely, the business you are interviewing at will be next. Generally, it is not a good sign when you are talking to the last independent practice in a neighborhood. Likely, that independence won’t last too long!

Partner Dissatisfaction

Finally, you should get a sense of the “esprit de corps” of the partners in a practice. Who wants to let go of a good thing if everyone is happy? Probably no one. So, if the partners seem satisfied, that goes a long way in preventing the business from getting bought out. So, be careful to interview the partners and talk to colleagues to find out how the partners feel about where they work. Smiles can make all the difference in the world.

What Is The Moral Of All This Talk About A Buyout?

Well, it naturally comes back to due diligence. Joining a practice is a significant decision you should not take, especially when you plan to work there for the next 10, 20, or 30 years. Therefore, the possibility of a private equity buyout should be another factor to consider when you are targeting where to interview. You certainly do not want to be left in the dust as an employee when you find out the partners have taken a deal!

 

 

 

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How I Made My Decision To Go Into Radiology

decision

This post is different from most. I am going to discuss my start in this field. By writing about my beginnings, I hope to either help you with your specialty decision or keep you going in your residency if you are still unsure once you have started.

Unlike what you might have thought by reading my blogs, I was not initially gung-ho about radiology from day one. In fact, like many medical students, when I first began, I had no clue. As a student, I planned on going into internal medicine after a stimulating rotation in medical school during my third year. I loved my instructors, the academic discussions, the grand rounds, and the camaraderie of it all. I like to say that if you associate with the right people, any task or job could be fun. And that was what happened during that third-year rotation. The stars aligned. Perhaps, I would complete a residency in internal medicine and become a cardiologist.

My Subinternship

And then, wham! I started my subinternship in medicine, a fourth-year rotation at my medical school. On day one, my resident micromanaged everything. And, attendings loved her because her notes were over three pages long. On the other hand, if you worked under her as an intern or fourth-year medical student, you entered an alternate reality. She could not decide what to do next on the simplest of matters. It could be the difference between Tylenol or generic acetaminophen in a healthy patient. No matter. She could not handle the small decisions. We left unnecessarily late every single day.

Moreover, if you did something on your own, exhibited any independence in a decision, she would stare at you with a frown on her face. And, later that same day, she would go to her attendings complaining about her underlings. So, you would hear about what you did wrong. Ahh, the pain.

But, if that was all, I noticed that I spent more time spending hours on the phone with insurance companies and burnt out attendings than any patient-related matters. Additionally, the patient matters that I did take care of were not intellectually challenging. Instead, I worked with the mundane issues of uncompliant patients or patients complaining about the same problems over and over again (obesity, diabetes) but not doing anything to improve their status. Between my team and the actual work, I realized I could not do this for the rest of my life.

Enter The Radiology Rotation

So, I completed my subinternship depressed that my initial career choice did not fit my requirements for what I wanted to do for the rest of my life. Luckily, I had the opportunity to begin my radiology rotation next early in my fourth year. No, there were no epiphanies/signs from above to let me know that radiology was right for me. (although you would never know that from my personal statement!) Instead, I mildly enjoyed my rotation. Looking at images and making interpretations seemed to be the better option than a life of hell in internal medicine. And, what else was there that I wanted to do at the time? So, I started with the ERAS process to create an application for a residency in radiology. A few months later, I matched at Beth Israel Medicine for preliminary medicine and Brown University for radiology. I was mildly enthusiastic.

Prelim Medicine Year- Second Thoughts

Like many of you out there, as I started my internship year in preliminary medicine, I began to question my original decision to go into the field of medicine in general. As the year progressed, I became even more disenchanted with medicine. My disenchantment eventually bled over to my initial thoughts about becoming a radiologist. Was I making the right decision?

Once again, in the dead of winter, I can remember being in a rotation in infectious disease with another crazed medical resident as my supervisor. This time, he was exceptionally aggressive and irritating. He had reported me to the program director for insubordination. Fortunately, that complaint did not go anywhere. But, it left a bad taste in my mouth. After that situation, I thought about interviewing for financial jobs and even completed one. However, I realized that with the excessive debt that I had from medical school, it would probably not end well. So, I stuck it out and made it through to my first year of radiology residency.

Radiology Residency- A Hellish First Year

Again, you would think that I started radiology, and everything became as smooth as a diamond. But, you would be entirely wrong. I began my residency reading a lot. But, it did not show during noon conferences. Nor did it manifest itself on rotation. As I like to say in some of my other posts, I committed the cardinal sin of reading as a first-year in radiology. I did not emphasize the pictures but instead read through mostly text without the images. So, when it came time to interpret pictures, I was somewhat clueless.

Also, I was not so “procedurally inclined.” One of my instructors (who shall remain nameless!) made sure to make that well-known. He would talk about me behind my back. Instead of helping me to become better, for the first time, I found out about this on an evaluation six months later. To this day, it left a bad taste in my mouth.

As the year progressed, I can remember the faculty’s pressures, not believing that I would be able to perform well on call. Should they even let me? Fortunately, I barely passed the precall quiz. And, my adventures in the second year would subsequently begin.

The Rest Of Radiology Residency- I Could Do This As A Career!

So, when did my outlook on radiology change? My new world order started once I began taking calls at the start of my second year. For the first time, I had some control over the environment. I could make my own decision, and it mattered. Every night, I found that I became more intellectually challenged. With each call, I discovered difficult cases. Even the attendings were unsure about them. And I would enjoy looking at the images and arriving at appropriate differential diagnoses. Finally, I gained the respect of my faculty as a decision-maker and a colleague. I felt part of the team. The rest was history.

So, What Was The Point Of Telling You How I Made My Decision?

Well, I think it is critical that every one of you, whether in medical school, internship, or the start of residency, should realize that you will find a light at the end of the dark tunnel of medical training. Don’t expect that the long road will match your expectations along the way. Having doubts during the process of residency is OK. Nevertheless, try to give radiology a chance and stick it out for the long run. I think that most of you have probably made the right decision for your career. It was an excellent fit for me. And, I believe that if you can persevere, you will find that radiology as a career will reward you as well! Until next time…

 

 

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Radiology Golden Niches: Do What Others Don’t Want To!

golden niches

What do the following jobs have in common? Garbage Workers, Oil Cleanup Crews, Sewage Treatment Workers, and Doggy Pickup Services. No, it’s not just that they all clean the environment and serve essential functions in our society. These are jobs that very few people want to perform. And therefore, those that do can charge high rates to complete the services. And, you know what? It is harder to find employees for these professions. I call these sorts of jobs: golden niches.

How is this relevant to radiology? It’s simple. Find an area (or even better, more than one!) that no one else in practice wants to do, and make it your life’s work. Then, you have a job for life (assuming that the business is not bought out or downsized!)

So, this brings me to the topic for today, the golden niches. What radiology specialties are ripe for a new radiologist to practice that can lead to this extraordinary situation and why? Well, we will go through several radiology procedures and modalities that can potentially qualify for one of the golden niches. However, not all practices are the same. And therefore, I must put in this qualifier, golden niches in one hospital or imaging center may not be so in another. You may find that you may have many MRI MSK readers in your practice, and in another, you may have a few. Or, some centers have little need for some of these golden niches. I will point you toward some modalities and procedures that you should think about reading and performing when you interview for your next job!

MRI Cardiac/Cardiac CTA

In our practice, we have limited numbers of radiologists that read these modalities. It is also costly and time-consuming to learn if you did not complete a fellowship. So, if you come aboard and have lots of cardiac work, you can be the hero!

Cardiac Nuclear Medicine

During residency, many residents do not get a chance to dictate these cases since the cardiologists perform them. And, at some centers, they require their radiologists to be nuclear trained. Therefore, fewer radiologists tend to read these studies, allowing you to take over!

MSK Musculoskeletal MRI and Ultrasound

Still, many radiology residencies throughout the country provide limited MSK MRI experience and even fewer MSK ultrasound. So, you may be one of a few in the practice that feels comfortable with these modalities!

Facet Injection For Pain Management

In some centers, practices farm out these cases to the anesthesiologists or the pain medicine physicians. However, in some hospitals, radiologists do the work. And you know what? Only a few MSK radiologists feel comfortable with this procedure.

Informatics

How many of you know the latest about pdfs, HLA, and more? I thought so. And, some practices need these radiologists to run the show!

Virtual Colonoscopies

Most residents are not trained well in this modality during residency. And, even fewer take courses when they finish up. So, you want to run a virtual colonoscopy program in an institution that has the demand. Here’s your niche!

Nuclear Medicine Therapies

Drug companies have developed loads of new nuclear medicine therapies like Xofigo. Moreover, many radiologists do not feel comfortable treating even the old standby of I-131. So, here is an opportunity for you to take charge!

MR Spectroscopy/Perfusion Studies/Neck CTAs

MR spectroscopy/perfusion/neck CTA studies tend to be more esoteric modalities reserved for the neuroradiologists. So, if you have trained as a neuroradiologist, make sure not to skip out on instruction in these areas. You can become instrumental!

Complicated Neck/Temporal Bone Work

Have you ever noticed the remaining cases at most imaging centers and hospitals? It tends not to be the head and body CTs. Instead, no one wants to pick up the CT soft tissue neck and temporal bone studies. So, don’t forget to learn about these topics during residency and fellowship!

Neurointerventional

To feel comfortable performing neurointerventional procedures, you generally need one year of diagnostic neuroradiology and two years of interventional radiology training. That limits the playing field for this work. Need I say more?

Breast MRI

Almost universally, non-breast imagers want nothing to do with these procedures. You have liability issues and inexperience that prevent many from wanting to read these cases. Time to step in!

The Golden Niches

Well, there you have it. Here were some undesirable (and therefore most desirable!) jobs you should consider performing when you start. And, I’m sure there are a few more that I forgot. In any case, it’s not about love. Instead, it’s about job security, my friends. So, go forward and find your golden niches. You won’t regret it!

 

 

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Is Radiology Still A Career Or Just A Job? And What Does It Mean?

job

What exactly is a career? If you listen to the internet authority, Wikipedia, it is “an individual’s metaphorical “journey” through learning, work and other aspects of life.” And, what is the definition of a job? Again, if you listen to “all-knowing” Wikipedia, a job is an activity, often regular and often performed in exchange for payment (“for a living.”)

So, which definition does radiology meet today, a career or a mere job, a transaction made to make a simple living? Many long-standing radiologists and outsiders would say that radiology is a career. You spend countless years learning and practicing the art and science of radiology. Moreover, when you finish, you live and breathe the profession. You strive for professional excellence. More importantly, it becomes ingrained as part of your persona.

These everyday thoughts are an oversimplified answer to whether radiology is a career or a job. As such, the response has transformed itself over the past ten to 20 years.

Changes To The Equation of Job Versus Career For Radiologists

So, what has changed over the past decade or two that has morphed the answer to this question? First, the landscape of medicine has dramatically shifted. Students that formerly completed school with reasonable amounts of student loans are now graduating with hordes of debt. Additionally, external pressures from governmental bureaucracies have dramatically increased. The number of films radiologists need to read, and procedures they must perform have exponentially climbed. Some may say that the numbers have far surpassed what is safe for patients.

Finally, different demographics have joined the profession. Today, many radiologists want to practice part-time to raise a family or pursue other interests. Years ago, this type of radiologist was much less common.

Individually, each of these factors plays a role in the change. In the following few paragraphs, we will go into more detail about the reason for each.

Reasons Radiology Has Become A Job For Many

Student Debt

Let’s start by talking about the noose of enormous student debt hanging around the shoulder of new radiologists. In the past, radiology residency graduates could afford to pick and choose where and what to practice based on the merits of the post-residency job alone. No longer is that the case. Now, it becomes more important to make sure you can afford the debt service payments and the day-to-day living expenses of the region of practice. For many, finding work is about desperately needing to make ends meet. So, radiology merely becomes a means to this end.

Increased Bureaucracy

We all feel the weight of increased paperwork and regulations we must follow. To that end, maintenance of certification has become more stringent (although, more recently, it has been slightly letting up). Requirements for accreditation have been increasing exponentially. Also, the maze of insurance requirements to complete a study keeps rising. Moreover, these factors are the tip of the iceberg. For many radiologists, many bureaucratic factors lead them to resign themselves to practice radiology as a job.

The Work Treadmill

Nowadays, many radiologists are hostage to the ever-increasing number of studies they need to read. Public expectations for the delivery of results promptly and efficiently have climbed. Also, time to transcription has become the holy grail of the hospital administration. In these conditions, how can some radiologists perceive their work as more than just a cog in the wheel to make ends meet?

Changing Demographics

Finally, we need to also talk about why different radiologists pursue radiology. No longer do all radiologists fit the same mold. For some, their role in raising a family has become more crucial than the position that they may play in running a radiology practice. So, these radiologists merely want to fund their lifestyle and not get involved in the professional aspects of radiology.

What Does This All Mean?

Well, to start with, we know that the most consummate professionals invest heavily in their careers and see their profession as a calling. These are the incredible clinicians, the movers, and the “shakers.” Moreover, they perform groundbreaking research, make improbable diagnoses, teach their residents, and create radiology systems and businesses to promote the profession.

However, based on the new pressures on individual radiologists, we cannot expect all radiologists to see their original “calling” as a “career.” Instead, many other factors play into the equation. Student debt burdens some radiologists. Alternatively, the chains of bureaucracy and increasing workloads prevent the pursuit of their interests and infringe upon the professional lifestyle of a radiologist.

Regardless, we should not talk badly about radiologists who need to work in the profession merely as a job. Many radiologists have excellent reasons for that. Instead, we should work to fix those factors that have changed to make radiology into a job so that we can improve the quality of our profession and return it to a career for all.