2018 - Page 3 of 9 - RadsResident

Posted on October 14, 2018January 26, 2023 by Barry Julius

Radiology Residency Rank Lists: Are They More Than Just Entertainment?

Like many, I enjoy browsing the U.S. News And World Report Medical School rank lists yearly to see which programs are top. (Usually in a line at the supermarket!) Even more so, I enjoy reading the Aunt Minnie and Doximity radiology residency rank lists each year. And I love reading and writing about them as much as the next guy. But, we need to be careful when we rank schools, residencies, and other educational institutions. So, why am I such a “Debbie Downer” when it comes to ranking residencies and educational institutions, and in our case, specifically radiology residency? (And no, it’s not related to my role as an associate residency director at a small radiology residency program). Well, as you guessed, I will give you my reasons for our topic for today!

One Size Does Not Fit All

When you rank multiple programs in one list, you cannot consider all the variables that would make one program great for a particular type of personality and terrible for another. Moreover, looking at the rankings, you will see categories like best teaching, research, and clinical experiences. Some folks learn best on the job, and others retain better in a lecture format. How do you rank that? Or, you want to become a great clinician and don’t take a research interest. Would a Mass General work well for you? It doesn’t do justice to the individual.

A Majority Of Residents Want To Work In Private Practice

Many of the rank lists assume that applicants want the same thing: a high-powered research and teaching program. But, 90% of all radiology residents go into private practice. So, the rank lists usually do not follow the end career results of its participants.

Development of Vicious/Virtuous Circle

Rank lists tend to have a pile-on effect. If a program is ranked highly, it sticks in all the readers’ minds. They will say to their colleagues, “Oh, XYZ school is great.” Likewise, if an article ranks a residency low on the list, that remains in the mind of its readers. I call it a “self-fulfilling proposition,” not based on the truth.

Emphasis On Larger Programs

The larger the program, the more graduates know about it. Therefore, the lists show bias toward bigger residencies just by the sheer numbers. So, if you have a program that contains 20 residents per year, these residents will tend to vote for their programs, right?

Each Site Within A Residency Program Can Be Different

Even within a program, experiences can vary widely. Sometimes, residents barely see each other and do not rotate through all the sites within a system. And one resident may spend more time at the V.A. hospital versus the academic center. So, what may be an excellent experience for one resident may not even resemble the reality for the remainder of the residents within the program.

Residency Experience Is So Dependent On Individual Colleagues/Faculty Members/Mentors

I always like to say the following: if you go to an OK residency program, but like the folks you work with, it will seem excellent. On the other hand, if you attend a program that by all the rankings is fantastic but hate working with all your colleagues, it will become terrible. So, how do you measure one person’s experience versus another when the program’s culture varies widely in any given year?

Do Residency Rank Lists Have Any Merit At All?

Based on these legitimate reasons, residency ranking tends to have very little relevance for the average radiology resident to choose his rank list. Instead, like the U.S. News Report Annual rankings of colleges, it primarily serves as a great way to grab the attention of its readers and create a bit of buzz. Therefore, it performs an essential purpose, but the goal is not necessarily to help out the audience that reads it. So, what is my conclusion based on the evidence? I’m not saying that you shouldn’t read a rank list of the best programs. Instead, take the results with a grain of salt and realize that a “top program” may not be top for you!

Posted on October 11, 2018November 25, 2023 by Barry Julius

How To Switch Gears From Orthopedic Surgery To Radiology As A Medical Student

Question About Switching To Radiology From Orthopedic Surgery:

Hi Dr. Julius,

I’m a 3rd-yr med student with a growing interest in radiology. I’m in the middle of core clerkships and have come to appreciate how vital radiology is in all fields and how broadly it covers different parts of the body and aspects of medicine.

My issue is that up till now, I have been pursuing orthopedic surgery, doing research, and making connections exclusively in that field. If I switch to seeking DR (maybe IR), what can I do to improve my ERAS application in the eyes of residency directors when I apply next year?

Background information (in case it helps): BS in engineering, currently at a top 25 med school, Step I – 233

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Answer:

Unfortunately, you can’t change what you’ve already done in orthopedic surgery. However, you still have time to get involved with research opportunities in radiology. Find a radiologist who needs some help with her research. At least, that shows some interest in the field. That is the low-hanging fruit that can help your application a little bit. It will also demonstrate some increased interest in the DR or DR/IR field. Even better, if you are interested in IR, I would find an interventionalist to work with and do research. That way, they could become your “mentor” and give your application even more relevance.

Suppose you have come from a good school with reasonable grades/Dean’s letter. In that case, you should have an excellent shot at a university program for DR. DR/IR is a little more of a crapshoot since it has become highly competitive. But you should still have a good chance as well. As I’ve mentioned, I highly recommend checking your Dean’s letter for any mistakes or “questionable” references. That is the most likely cause for a surprise for not matching where you want on match day. And it is also straightforward to correct if you can.

I hope that helps a bit,

Barry Julius, MD

Posted on October 7, 2018January 28, 2023 by Barry Julius

Are Residency-Wide Meetings A Waste Of Time?

In many radiology residencies, similar to some large private practices, not all residents work at the same site. Perhaps, rarely, if at all, do they remain in the same building simultaneously. Moreover, within the program, individual sites within the residency program may give different lectures to the residents rotating at that particular site. Or maybe, you will have varying experiences in your residency due to the limited spots and rotations. One resident may never even rotate through areas that others do. So, big deal, right? How important can it be to have meetings with all your colleagues in your radiology program? Well, I will convince you today that residency-wide meetings are essential. And we will go through the most critical reasons why!

Uneven Distribution Of Work

For instance, you may work at one location and experience a level I trauma center. At the same time, the colleague you started with spends most of his time in an oncology center. Your fellow resident becomes jealous that he is getting very little on-the-job training in trauma radiology. And, you think that you are not getting enough oncology work. How do you resolve this issue? You may not be able to change the schedule without reaching a consensus. Often, to do that, the only way to address this issue is to meet with your colleagues!

Or, since you are working at a pediatric center with inadequate coverage, you must work night call every 5th night. Meanwhile, your “friend” in the main hospital has plenty of coverage and can work call every two weeks. Now, you can discuss all this with your program director. However, you must lay out the issues first with your fellow residents and faculty at residency meetings so everyone can understand and fix the problem.

Miscommunication

Like the game of telephone, you will likely miss out on the opportunity to communicate on the same wavelength if you do not meet as a whole residency program. Perhaps, separate study groups form, and some residents are not privy to the same information. Or, one group learns a technique for fluoroscopy and never shares it with their colleagues. What happens? The whole residency loses out!

Less Sharing Of Resources Leading To Poor Outcomes

Perhaps, one site has a simulation center for interventional radiology procedures. And the others do not. If the residency does not meet as a whole, how do you know which resources to share? And what happens to those residents that never get a chance to perform procedures on the simulation devices? Well, they lose out on the opportunity to learn interventions. And that is just the tip of the iceberg. Not having regular meetings can lead to poor resident training outcomes!

Lack Of Interresidency Networking

Every person in the residency that you do not know reduces the chances that you will find a great job when you graduate. Why? Maybe, the uncle of one of your fellow residents is a radiologist at a hospital in Walla Walla, Washington. And that is the only place where you want to live. When you lose out on your contacts because you barely meet with colleagues at other sites, you lose another chance to get that next best career opportunity!

Importance Of Residency Meetings

Individual sites cannot remain entirely independent from one another to have a well-functioning residency. Accordingly, resident education will either suffer or, at least, not achieve the best possible outcomes for all its members. Not creating regular meetings for all the residents allows jealousy among residents to fester, uneven work distribution to continue, inadequate sharing of resources, and opportunities lost for resident networking. So, don’t poo-poo the resident meeting. They serve a crucial function!

Posted on September 30, 2018February 4, 2023 by Barry Julius

How To Deal With The 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!

Posted on September 27, 2018 by Barry Julius

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 Articles Of All Time

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

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

From where are my readers?

The United States – 65%
India – 8%
Canada- 2.5%
United Kingdom – 1.9%
Malaysia- 1.25%
Australia – 1.24%
Philippines – 1.18%
Pakistan – 1.05%
Saudi Arabia – 1.01%
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!

Posted on September 23, 2018February 1, 2023 by Barry Julius

Which Radiology Practices Are Ripe For A 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!

Posted on September 16, 2018October 29, 2020 by Barry Julius

How I Made My Decision To Go Into Radiology

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…

Posted on September 8, 2018November 26, 2020 by Barry Julius

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

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!

Posted on September 2, 2018January 12, 2023 by Barry Julius

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

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.