Year: 2018

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Coping With The Negative Evaluation (It’s Not Always Straightforward!)

negative evaluation

At some point, you will probably receive a negative evaluation. Most human beings are not perfect! But is there anything that you can do about it? And, what does a negative review mean for your career? To answer these questions, we will classify the different negative evaluations you may encounter. And then, we will answer what you should do about the negative review you receive.

Types Of Negative Evaluations

In my experience, you may encounter two different types of negative evaluations. First, some evaluators mean well and write a negative assessment with the best intentions. What do I mean by that? Your superior genuinely writes down something critical, hoping that you will improve. These sorts of evaluations tend to be specific, helpful, and actionable. In addition, the faculty member has already briefed you on the issues you faced together. So, there are no surprises.

More equivocal; however, there is the second sort of negative evaluation. Typically, the evaluator gives vague generalities about your performance without any particular reason. Nor has he discussed the issues with you. These evaluations may or may not relate to your work quality, and the faculty member bases it on a gestalt or other attending’s opinions. Ultimately, this negative evaluation does not provide the resident with a learning opportunity. Nor can the resident correct the issue because the attending has not given actionable information.

What’s The Next Step?

OK. So, you’ve received the negative evaluation, but what are you supposed to do next? If you have received the first type of appropriate evaluation, it becomes straightforward. Try to correct the issue that your attending has outlined for you. An unfavorable review can sometimes be “kind.” Imagine that your attending never addressed the matter with you. If not managed, your error could stick with you throughout the remainder of your training, even your career. In a sense, you should thank your instructor for his insights. You may never have made amends on your own.

But then, there is the second sort of evaluation with no clear path to take. In this situation, initially, you would want to talk to this attending to clarify what the faculty intended in the evaluation. Most of the time, you can infer what your faculty evaluator originally meant. Oh, but if life was always so simple!

So this leads to the next step in the process. If you do not get a clear message from your attending, you must find someone who can give you the information. This step can mean you should attempt to find another attending who can figure out what this other faculty member intended. Or, perhaps, if that does not work, you can ask one of your co-residents. Sometimes, it can be a particular pattern of behavior that your other colleagues and faculty can identify but may be obscure to you.

The Good News About The Negative Evaluation

The typical negative evaluation doesn’t usually go anywhere. Most often, it stays in the cabinet of the program director or coordinator. Solitary negative evaluations are generally just that. They are one-offs. And, by immediately responding to the negative assessment, you have taken care of any potential harmful effects.

The Bad News

On the other hand, if there is a pattern of multiple negative evaluations or you allow the negative review to fester without an attempt to correct it, the negative assessments can pile up and become something more. Theoretically, it can become the beginning of a document trail for probation or even dismissal! Therefore, it behooves the resident to take whatever negative evaluations they receive very seriously. Action should ensue immediately.

My Take On The Negative Evaluation

You can look at the negative evaluation in two ways. First, you can see it as an insult to your whole persona. For those who take an evaluation this way, it is predestined to be negative. You will not learn from the message of the negative evaluation. And you will continue to make the same mistake. (Something you do not want to do when practicing radiology!) On the other hand, those that see a negative evaluation as not a vendetta but rather as an opportunity to correct their own mistakes will learn and improve their practice. What kind of radiologist do you want to be?

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The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

Wow, what a feeling! You did it! You’re officially a first-year Radiology resident! And, you just took your first step toward the rest of your life!! One full year has gone in the blink of an eye and you molded yourself into an unbeatable intern! Your mastery of surgical knots, writing extensive progress notes, rounding, and discharging patients have you feeling like you can tackle the world! In fact, you’re so eager to show off all your skills as a first-year radiology resident to your new Radiology Attendings on your first rotation that you jump right in and introduce yourself. You find a really comfy chair next to him, eagerly waiting to learn.

So, your attending opens the very first case and you already know the answer is pneumonia. Let’s face it on those long ICU rotations when was it not? To your surprise, it’s a head CT. He then gives it a quick scroll and asks those fateful words “Normal or abnormal?” … You sit there in silence… Chills run down your spine…sweat appears on your forehead…What just happened? Uttering the word ”I” a few times, you finally commit to the full sentence “I don’t know”. You have failed. You know nothing and feel like you are nothing… At least that’s how you feel for a short while. But hey, it’s your first day!

Get used to it… In the beginning months of the first year, the phrase “I don’t know” will become all too familiar because let’s face it, you don’t know! Not a thing! As an intern, you haven’t picked up a single book relating to radiology. And, you may have only looked at the impression to relay the information to your higher-ups when needed. You just did not have the time! So? What now? Where do you turn? Who can help you? You feel smaller than an insect. How can you possibly turn this around? Get ready to take all your years of what you learned and flush it down the toilet! You’re about to enter a whole new realm, the world of radiology.

The Mega Five

Enter the Mega Five. What is the Mega Five you say? Only the five most powerful resources at your fingertips for the first-year radiology resident! Sure, there are a ton more but these have been the most help in my experience. So, let’s start!

Case review series, Case review series, Case review series!!!

I cannot say it enough but these reviews are incredible. Most importantly, you don’t need a lot of background in order to learn as you go. And, the series takes excerpts of information from the Requisites (longer and wordier than the case review series!) and summarizes the material. Each case has questions and pictures. In addition, it literally contains every subject with increasingly difficult sections as you progress within each of the books.

Core Radiology

I love this book! It contains high-yield pictures and information, especially the Aunt Minnies. And, the book goes system-by-system, image-by-image. It even gives mini dictations of how you should describe the entity.  I can honestly say Core Radiology has helped bolster all my dictations positively. With all the knowledge you attain during 1st year, this book serves to solidify and maintain a steady foundation.

Radiopedia

I can’t believe I’m saying this but yes…Radiopedia is an incredible resource. First, you get fast information, pictures you can scroll through including CT and MRI studies, differential diagnoses, and links and videos. You can also sign up for these links and videos if you so choose (I did for emergency radiology before taking call). Finally, you can think of it as an underused gem like Wikipedia for radiology but even better!

RADPrimer

Oh, RADPrimer how I love you so… RADPrimer makes the list because let’s face it… What are facts without questions to test yourself? With over 4000 questions, you better just dive in and do 10 a day because it has a UWorld feel to it. And, if you’re like me, UWorld was the Holy Bible for USMLE Step 1, 2, and 3. So, why let this opportunity go to waste? Get cracking now…  Just start RADPrimer and crank out questions. You’ll see how much you really know from your studies.

Radiology Assistant

Last but not least, we have Radiology Assistant. To put it mildly, this website is incredible with detailed information, videos, pictures, and cartoons. You name it and they have it. In fact, I utilize this website as much as possible. There are even lectures to watch that break down hard topics, an amazing bonus.

But Wait There’s More…

In addition to my top five resources, of course, there are a ton more. Some of the other resources that I have used include Felsons Roentgenology,  E-Anatomy (application), headneckbrainspine.com, and Lieberman’s eRadiology. Although I poked fun at it above, I still need to mention the radiology requisites series in a better light. As wordy as they may be, you must read them. Why? Well, I’ve noticed that the question banks gather much of their information from the requisites. And finally, please do not be afraid to use free resources like Google, Google images, and even YouTube!

My Final Thoughts

The Mega Five worked well for me during my as a first-year radiology resident because these resources were readily available and came with a wealth of knowledge. If you take advantage of the Mega Five too,  your hard work, diligence, and dedication will pay off. You too will be saving lives “radiographically” one day at a time (A catchphrase for my dating app. I am a single resident, so don’t take it, it’s mine and copyrighted!) So, best of luck to you. Remember, being a first-year radiology resident is tough but there are lots of quality resources to help you out. So, never give up!

 

 

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When Do Radiologists Peak? (The Older The Better?)

peak

You can easily find all sorts of articles about when human intelligence in all of its forms peaks on the internet. For example, I particularly enjoyed one such article from science alert. As the piece states, different types of intelligence peak over different ages in one’s life. (1) We can always count on granny’s wisdom. Yet, we now know that many mathematicians write their seminal papers when they are young. But what about radiologists? Do we make the best radiologists when we first get out of fellowship and have just taken the boards? Or, do experienced radiologists make overall better radiologists? These are difficult questions to answer, but I shall attempt to come up with a logical conclusion.

Evidence For Increased Quality Of Younger Physicians

To start with, scientists have concluded that visual perception slows down with age. One article from the University of Arizona summarized that visual ambiguity increases with age because of brain inhibition defects. Over time, older people have a much harder time identifying unfamiliar shapes. Other studies have also shown losses in light sensitivity, motion, depth, and color perception. Although not specific to a radiologist’s work, presumably, these defects in processing could affect a radiologist’s reads over time. (2) Score one for youth!

Recently, another article based on an observational study in the BMJ stated that patients had lower mortality rates in hospitals when physicians under 40 cared for these patients. However, interestingly, there was a big caveat in this article. These outcomes only applied to doctors that did not see a large volume of patients. (3) So, I am not sure how well this data applies to radiologists since most of us see large volumes of studies. Furthermore, most of us do not directly care for our patients, as the physicians studied in this paper.

Evidence For Increased Quality Of Experienced Radiologists

On the other hand, a study in Radiology explored the quality of reads of mammographers over different ages. In this paper, they determined that experience counts. Notably, they found a significant increase in pickups and a decrease in false positives occurred during the first 1-3 years of community radiology experience. And even more importantly, the paper showed no significant drop off in quality as one aged. The false-positive rates had overall decreased over time. (4) Score one for experience!

Personal Experiences (Not Hard Evidence!)

Through my years as a radiologist from residency to the current day, I have certainly seen some fantastic radiologists over 70. Unfortunately, that statement does not apply to all the older radiologists that I have met. Some had passed their prime and likely had stayed in the field longer than they should have.

For comparison, many new radiologists fresh out of fellowship tend to overcall on imaging. The dictations of these radiologists often contain more unnecessary words and flowery language that clinicians do not want to read.

In the middle between these two extremes lies the middle age radiologist. Again, not all radiologists are created equal. And, some miss more than others. But overall, I have found these radiologists have the least problems with missing findings, irrelevant dictations, and overcalling diagnoses. They tend to know what to look for because they have been practicing radiology long enough. Yet, these radiologists do not suffer from significant perceptual issues.

My Take On The Peak Radiologist Based On All The Information

The article on mammography cements my suspicions that experience does count. Also, it says to me; individual radiologists may peak at a later date. On the other hand, even with “better perceptual abilities,” I have never met a newly graduated radiologist that I would have preferred to read my imaging studies over someone with more experience. Based on my encounters, I am biased toward favoring a quality peak multiple years after finishing residency and fellowship. Yet, based on scientific evidence, I believe that at some point, the decrease in perceptual abilities does affect the quality of work of senior radiologists. So, I would say that the final years of work most likely are somewhat past a radiologist’s peak.

My bottom line for the new radiologist: If you are finishing residency or fellowship, you should expect to continue to work hard and learn over your lifetime. Even though you have studied an extreme amount of information to pass the boards and get through your training, believe it or not, your best days are probably ahead of you!

(1) https://www.sciencealert.com/this-is-the-age-you-reach-peak-intelligence-according-to-science

(2) https://uanews.arizona.edu/story/research-shows-how-visual-perception-slows-age

(3) http://www.bmj.com/content/357/bmj.j1797

(4) http://pubs.rsna.org/doi/full/10.1148/radiol.2533090070

 

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How Important Is Level One Trauma To My Radiology Training?

level one trauma

Bullet wounds, stabbings, motorcycle accidents, falls, and blunt trauma from severe car accidents. These are some of the incidents that comprise most of the trauma at a level-one trauma center. But, let’s say you attend a program that does not have a level one trauma center, and you don’t see as many of these cases. Are you at a loss compared to your colleagues who do? And, what are the consequences for your future practice of radiology? Will you be a second-class radiologist? For many of you that have to decide on a residency with or without a significant trauma component, these questions cast doubts on some training programs. As I have trained at a level one trauma center and have been operating a residency without one, we will go through the training from a level one trauma you might “miss” during training.

Trauma Resident Checklists

Do you like to have multiple residents in other subspecialties waiting for you to check off the boxes? That situation is what you will experience at a level-one trauma center precisely. You will find that many exhausted nighttime residents are keenly interested in only finding out if you have read all those films yet, not worrying about the final diagnosis. Yes, it reminds you of all the images you need to see with each trauma. But ensuring the specialists have checked all the boxes does not add much to one’s training!

Limited Four Quadrant Ultrasounds

Are you interested in looking for free fluid at all night hours? Well, this is your opportunity. And unfortunately, the limited four-quadrant ultrasound is the tool of choice. Guess who wields the probe? You do!!! I can guarantee that you will be scanning everyone with a horrible accident that comes through the pearly gates of the emergency department. Is it worth all those additional sleepless nights so that you can find the free fluid? I’ll let you make that choice.

Repetitive Injury Patterns

Do you like variety? Trauma comes in so many fewer flavors than other interesting disease entities. Knife wounds exhibit most of the same findings over and over again. After your 15th splenic laceration, it gets old. And it’s not just the knife wounds. Blunt trauma, bullet wounds, and severe falls work the same way. I prefer a little more variety in my life!

Fewer Bread And Butter Cases

What does trauma experience usually replace? Typically, you will see many fewer bread-and-butter cases. And the time spent working up trauma cases has to substitute for something else. What do I mean by that? Level-one trauma centers may divert some diverticulitis, appendicitis, oncology, and renal stone patients down the street. I mean, who wants to go to an emergency department with all that bloody trauma when you can go to a much less hectic hospital. Unfortunately, for that reason, you get less experience with the diseases that most emergency departments always see. And these diseases are the ones that residents need to learn the most; the more common entities you will be working up the most in practice.

Level One Trauma- A Necessity For Training?

Yes, I will admit that level-one trauma centers provide a specialized experience. But for the most part, radiologists can learn what they need to know from the standard trauma they encounter at a hospital without completing a residency with a level-one trauma program. In addition, it is not hard for the resident to supplement their training with trauma reading. So, if you find a great program without a level one trauma center that otherwise matches what you want, by all means, still consider it. The absence of level-one trauma does not imply a significant gap in your radiology education!

 

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Contract Negotiations: What Do You Ask From Your Future Employer?

contract negotiations

When you are in the process of completing a residency or fellowship, looking for a radiology job becomes a daunting task. Not only are you trying to find a career that will last for years, but you are also left alone swimming through the complexities of contract negotiations, an area you probably have not experienced before. It’s a brave new world.

 So, what do you do? As a typical resident, you find general information on the internet about the basics of contracts. And if you contact an attorney, he will probably give you generalities about how to approach contract negotiations. But, this post is different as it outlines what negotiation points a practice is more likely to give to the applicant.

To that end, today, you will get an insider’s view of what you are most likely to be able to negotiate and which benefits you may find difficult to change. You will also receive the perspective of someone who works as a private practice partner and advocates for his residents. Remember, I am not an attorney, so I am not providing legal advice. Instead, I am telling you what I think practices are more likely to leave on the table for negotiation and what items practices do not want to touch.

Depending on the desirability and location of the practice, however, you may be able to get a lot more, or you may have no wiggle room at all. That is something you will have to judge for yourself based on what you know about the practice. So, let’s go through some of the basics.

Benefits You Can Negotiate More Easily

Moving Expenses

Moving can cost a lot. Generally, you are talking about multiple thousands of dollars, especially if you move a substantial distance. However, many practices will usually be willing to include this benefit into the contract. Why? First, it is a tax-deductible expense for the business so that the practice will pay for it in pretax dollars. And then, it pays to create as many connections for you to the area as possible. What better way to accomplish this than to provide for moving expenses?

401k Plan Perks

Typically, practices tend to be more flexible with indirect expenses such as matching contributions to a 401k plan. Why? Again, it is a pretax benefit that the business can write off. Yet, it does not appear as an increase in income. Partners would prefer to negotiate a 401k plan than a salary because increasing a wage could lead to adding on additional income to other employees. It is much harder to calculate indirect perks!

Time Spent In Particular Departments

Maybe you hate mammography or can’t stand interventional procedures. In the beginning, discussing your expectations for where you want to work in the practice is entirely reasonable. For some applicants, this can make or break the quality of a job. And, for the imaging business, this can be a minor concession compared to other benefits!

Malpractice Tail Insurance

Malpractice tail insurance can cost an employee thousands of dollars when they leave a practice. So, this can potentially be a significant cost saving. And the practice can pay for coverage with pretax dollars. Like the 401k plan, it differs from the subheading of salary/income. For these reasons, the imaging business may be more willing to budge a little on a negotiated contract.

Restrictive Covenants

Nowadays, many practices place restrictive covenants within the contract to prevent the applicant from leaving and working for a local competitor. Each state enforces these covenants differently, and the time and distance restraints can vary widely. But, this can potentially lead to a problem if you want to continue living in the area and decide to quit your job. However, it is very unusual for a practice to enact the clause on a former employee legally. (although possible!) So, if you need to stay in the area, no matter how the job goes, this may be an item that you should consider entering into contract negotiations.

More Difficult Items For Contract Negotiations

Annual Income

Salaries are usually the most challenging item to negotiate. Why? Although typically not allowed, employees will often compare salaries, and tempers can flare if the employees perceive their salary as unfair. In addition, the partners usually compare the salaries of all their employees and themselves. It becomes hard to create a fair deal that does not impact others in practice. Some employees may have had more experience, and others bring particular skills to the practice. So, it can seem unfair among the partners as well. Unless you are in an enviable position of working at an undesirable location or you have a particular skill that the practice cannot find elsewhere, annual income is not as easily changed.

Years To Partnership

Years to partnership can also be a very touchy subject. Partners may have invested themselves in the business for years. And, you want to change the system to give you fewer years to partner? That typically does not fly as well as negotiating other benefits. In addition, large sums of money are at stake for each year removed from the track. So again, you will be hard-pressed to negotiate fewer years to partnership.

Buy-ins

Typically, a buy-in or sweat equity is an amount you pay to the practice for the privilege of becoming a partner. This number can vary from a nominal amount to millions of dollars. Again, emotions can flare when you decide to change the amount it costs to enter a partnership, as you may have to pay less than the other partners. In addition, some practices own equipment or real estate. It would be unfair for the practice to give away these assets. Depending on the business, this can be a challenging item to negotiate as well.

Loan Repayment

Unfortunately, residents bemoan student loans more than anything else. And the high debt burdens residents must face paying for the privilege of going to college and medical school can be overwhelming. To make things even worse, however, most practices will not make this an employee perk because the practice cannot deduct the money pretax. Perhaps even more important than that, the business has to trust that the employee will not skip town and leave the practice prematurely. As you can see, imaging businesses take a lot of risk by adding this benefit to sweeten the deal for the applicant. Therefore, a new employee getting loan repayment as a benefit is unusual unless the practice is in desperate need of the applicant.

Contract Negotiations: A Battle Or The Beginning Of A Great Friendship?

Finally, I have not mentioned the most critical point of contract negotiations. A contract is only as good as both of the parties’ word. A contract can be ironclad for the employer or employee. Regardless, the specifics outlined by a contract are rarely used if the employee likes the job, and the employer likes the employee’s work. Only when things don’t go as planned the contract becomes truly important. So, here’s the bottom line and the irony of it all. As crucial as contract negotiations can be, invest more time and effort in figuring out whether the job is right for you rather than worrying about the nitty-gritty details of the contract. Good luck!

Comments

Have any strong opinions about other items that should be negotiated in a contract? We would love to hear your thoughts by commenting below!

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Best And Worst Days To Be A Radiologist On Call

worst days

Some may wonder why you always may have a “black cloud.” And others seem to work only on quiet evenings. Well, maybe the black cloud or halo you wear is more than chance. Perhaps, you sign up for the easy or difficult calls without realizing the consequences of your choices. So, to advise which days you need to consider working and others you should avoid, I am listing some of the best and worst days to be on call. Here we go!

Best Days

Snow Days

If you ever work on a day with a heavy snowstorm, consider yourself lucky. If it is a state of emergency, it’s even better. Almost no one arrives at the doors of the emergency department. Why? Because they are not allowed on the roads!!! And, if they can’t drive, getting into a bad accident becomes much more challenging. Hence, you are in for a beautiful night!

Your Favorite ED Attending’s Shift

It turns out that not all ED attendings are alike! You have found gold if you find one that rarely seems to order imaging studies. Follow this attending to the ends of the earth. And, make sure to work those calls that match this chap’s shifts!

Christmas

Although not always palatable for some, you cannot find another holiday when patients sparsely frequent the emergency room like this day. No one wants to be in-house. And indeed, no one wants to receive an imaging study. Plus, to add another perk, many hospitals give free meals to those who work this holiday. If you can tolerate working on Christmas and want an easy day, seriously consider working!

Super Bowl Sunday

For those who don’t enjoy football, this holiday will treat you to a great evening. Imagine barely hearing a pin drop in the reading room. That is usually the theme when working on Super Bowl Sunday during the game. The television tempts almost every patient and physician to watch the screen. Therefore, you can pretty much expect a quiet evening.

Worst Days

Independence Day

This holiday does not lend itself to quiet while the weather is lovely. And explosives abound. What more needs to be said???

The Hours After The Super Bowl

Call it the rebound effect—all those hours of watching delay the inevitable. Injuries and phone calls miraculously appear again out of the blue. And all that food and alcohol consumed by the celebrants… Well, let’s put it this way. Every cause has an effect. Unfortunately, if you work this time, do not expect to rest!

First Day After Large Snowstorm Is Over

Everyone returns to work after that significant snowstorm is over. Well, guess what? They have to dig out their driveways or drive on slippery roads. These activities do not come without consequence. Heart attacks, falls, and car accidents are everywhere. It’s just not a pleasant day to work!

Your Least Favorite ED Attending’s Shift

Some attendings just like to order studies. And usually, the younger and more inexperienced the attending physician working in the ED, the more studies ordered. So, beware of a shift with this sort of physician. The emergency department will inundate you until you are teeming with work. Try to postpone your call to another day!!!

Great Weather

Blue skies? Perfect temperature? You are in for a rough day! Everyone wants to be outside. And guess what? That means sports and injuries. And, you are on the front line… So? They are coming to the hospital for imaging!!!!

Summary Of The Best And Worst Days

You can’t always control when you are going to work on call. However, if you have a choice, now you know the best days to work and those to avoid. Hey… There’s nothing better than a nice quiet night when you can enjoy working at a leisurely pace and take the time to learn from each of your cases. So, plan to take call on these days and avoid the other frantic shifts if you can!!!

 

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Partnership Track Behavior: A Primer

partnership track

Congratulations! You’ve nabbed the job you have always wanted. And your employer has placed you on a partnership track. But, you know that not all who started on the partnership track made it to the Promised Land. To prevent yourself from becoming the next casualty, you’ll do almost anything to ensure that one day you will become a partner with all its benefits. So, how can you entice your employers over the next two, three, or four or more years to take you into their fold? Having experienced the process and worked for many years as a partner in private practice, let me give you some basic tenets you need to follow.

Make Small Pleasant Waves, Not Large Ones

Let me tell you a little obvious secret. As much as the practice owners say they will treat you the same as other partners, please don’t believe a word they say. Until the day that you become a partner, any current partner can use any irritation or error against you. Worst case scenario, the upset partner can delay your partnership indefinitely!

So, my advice to you is: don’t rock the boat. Do what you must, but don’t push your views on others. Sure, consider changing a knee MRI protocol with the blessing of all the other MR readers in the department. But, don’t overhaul all the protocols on the magnet without their consent. Talk to the CT scan representative but don’t volunteer to become the promoter of the CT scan manufacturer without notifying the chairman. And so on. I think you get the picture.

Complete All Your Assigned Work And Some

Want to impress your fellow practice partners? Of course, you need to complete all of your work. But even more importantly, when you finish everything, help out your fellow radiologists. Over time your extra effort will get noticed. It certainly can’t hurt to have rave reviews from your cohorts when the time comes for them to vote you in as an equal shareholder. Who doesn’t want a fellow partner that always wants to take on additional responsibilities?

Pace Yourself

Many former employees never made it to partner: What do they have in common? Either they made too many mistakes because they read films too fast. Or, they become so worried that they will miss essential findings that they take forever to read and dictate the studies. Especially at the beginning, you don’t want the partners to categorize you as either of those sorts of radiologists. So, take your time. But remember, you don’t have all the time in the world!

Avoid Saying Anything Bad About A Partner

This advice seems obvious but is a common reason for ending a partnership track or, even worse, your employment! Never. Never utter a bad word about your superiors to anyone else. Trust me. Trash talking about your colleagues is a cardinal error that will bite you when you least expect it. Indeed, that partner you were talking about will not want to hear that he is lazy when the time arrives to decide on your future!

Don’t Complain Unless It’s Unavoidable

OK. Maybe, that PACS system keeps malfunctioning. Or that technologist always to forgets to put the measurement of the spleen on the worksheet. Try to deal with these minor situations yourself before running them by the partners. No one likes a constant complainer. And, who wants to make that person your fellow partner? Indeed, not your employers!

Volunteer For Practice Building

You are taking on a partnership track for a reason. Of course, you expect to play a role in not just the daily reading of films and performing procedures. Instead, you desire to involve yourself in the other facets of the business. In that vein, nothing looks better than taking on Grand Rounds talk that no one else can or wants to do. Or volunteer for the hospital credentialing committee. Perhaps, you should become the point man for the CT lung screenings in your community.

Practices usually do notice these additional activities. But most importantly, the partners appreciate the extra effort when the time comes to vote on your final disposition.

The Psychology Of The Partnership Track

Like any other path that you have undertaken in your career, you have to first start at the bottom. Beginning a partnership track is no different. So, put your tools to the grindstone and prepare to work hard for the time you are on a partnership track (and hopefully beyond!). Only then can you increase your chances of reaching your final goal of reaping a partner’s added rewards, prestige, and respect!

 

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Should First Year Residents Give Interdisciplinary Conferences?

interdisciplinary conferences

Interdisciplinary meetings at many hospitals tend to be working clinical conferences. Ultimately, the primary clinical physician will decide on patient treatment based on the conclusions at one of these meetings. So, we better be careful in choosing which radiology team members prepare for interdisciplinary conferences to get the best possible patient care.

Therefore, this begs the question. Should a first-year resident claim responsibility for presenting at one of these interdisciplinary conferences? Or should the program delegate the senior resident or attending to give the conference? We will discuss why the more senior radiology resident or attending should take this critical responsibility.

Preparation Time

When a first-year prepares for one of his first few conferences, the time is very long. Why? First, the first-year resident needs to figure out what is essential. Then, they must ask a senior resident or attending which images are most relevant to the case. And finally, the resident must figure out the clinical significance of each finding.

On the other hand, a more senior resident or attending will experientially know what is most important. A more senior radiologist can perform almost all the legwork by himself. And, of course, he will understand the clinical ramifications of his findings and conclusions. The amount of time the preparer and the attending staff saves is enormous. It is the time that the junior resident or attending could have used for more critical activities.

Experience/Knowledge Level

A first-year radiology resident may find answering questions thrown at them during a conference difficult. A question can derail a junior resident’s presentation simply because he has not experienced that subject matter or modality. More importantly, it is also possible that the first-year resident may spout misleading information to the clinicians. This pitfall could theoretically influence patient management in the wrong direction.

For the more senior radiologist, she will be able to respond to clinical radiological inquiries with a backstop of years of experience to guide the clinician appropriately. In addition, the senior radiologist is more likely to nudge the clinician toward the appropriate treatment of his patients. Experience counts.

Conference Savvy

Years of conference experience “under one’s belt” also let the presenter know when to chime in, and when to stay silent. This skill only comes from years of practice. Although some junior residents may have this skill, you cannot expect all first-year residents to be adept at giving conferences. Eventually, all first-year residents will develop the art of presenting by observing and participating in many conferences. But, it is not appropriate to expect the first year to know the rules when they start.

Seniority

Even though there is a steeper learning curve for a first-year resident than a more senior resident, the experience of giving a conference is usually more valuable for the more senior resident. Why is that? For the most part, this resident will graduate from the program sooner and will need the experience of presenting for fellowship and beyond. The last year of residency should be a time to hone your presentation skills for the next career phase.

Interdisciplinary Conferences And The Presenter

Preparing and giving an interdisciplinary conference is crucial to the radiology residency experience. In deciding who should provide this conference, we must consider factors such as time, experience, skills, and seniority. Based on these factors, the more senior resident or attending is the right person to play this role.

 

 

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An Insider’s View Into The Radiology Residency Rank List

rank list

The ranking process and rank list seem like a black box from a medical student’s perspective. But today, we will shed some light on how the process works (at least in our radiology residency!) Of course, I cannot speak for all radiology residency programs. But, many programs do have a similar process.

So, how does this all work? You will be the proverbial fly on the wall in today’s post. More importantly, hopefully, you will gain insight into what we look for when we meet and what the rank list process entails.

The Basics Of The Rank List Process

It all begins a few days before the interviews take place. Each interviewer takes home a pile of applications to review before the interview day. Of course, we consider the usual suspects- the Dean’s Letter, research, experiences, recommendations, and all the other components of the process (See Cracking The Radiology Residency Application Code!) And all of these factors are weighted accordingly, with the Deans Letter weighted the most in the equation.

Then, we add on our impressions of the candidate from the interview. Based on these factors, typically, the interviewers give each candidate an overall grade on the day of the interview. Why? Because the applicants stick freshly in our minds on the interview day.

Most importantly, however, after we give the candidates this initial grade, we confirm our impressions with the residents. We call this meeting the coffee clutch. (Other programs, I’m sure, have other names for this sort of meeting!) Depending on the gestalt of the residents, we may change that final grade to higher, lower, or to do not rank.

Only then, once we have the residents’ input, does each interviewer finalize the overall grade that the applicants receive. And we place the interview candidates into three primary piles. The first batch is the application pile that satisfies our credential and personality requirements. We like to call these applications the “rankables.” Most candidates fall into this grouping.

For the next category, we call this the question pile. Sometimes, we will revisit these candidates at a later juncture after we have obtained additional information. Other times, we must mull over the quality of the rest of the candidates before we decide to rank them finally.

And lastly, the final group of applications is those that do not pass muster. We place these into the Do Not Rank list (informally called DNR/DNI!) To summarize, these applications are from candidates with inadequate credentials, personality flaws, or other issues that we think would not fit our program’s culture and philosophy.

How Do We Create Our Rank List?

If you remember before, I mentioned that each interviewer gives a candidate an overall grade. And, for any given day, we always have two interviewers. Each interviewer provides a score from 1 to 11, with 1, the lowest possible score (except for DNR/DNI!) and 11, the highest possible score. Subsequently, we sum the score of the two interviewers, representing the candidate’s primary grade. (scores range from 2-24) Most applicants assemble somewhere in the middle of the pack (scoring between 10-14)—of which those exceptional scores higher and those weaker trends lower.

However, we did not entirely complete our work yet! Next, we take into account a couple of other factors. First, folks that submit a thank you letter will receive an additional half point. And then, those that come for second looks will also garner a half point. (We only add points if we did not DNR the candidate!) What is our motivation behind this? We like to add a little bit to these folks that take the time to show interest in our program. If you think about it, it makes sense. Candidates who succeed in our program want to be here. And, thank you letters and second looks show additional interest. So, it makes sense to reward these folks.

In the situation of those candidates squarely in the middle of the pack, these minor half points can potentially make a humongous difference. Since most candidates congregate around the mean, it simply puts you above everyone else in your category.

Submission Time

Once we finish our last day of interviews, we check for and add on any extra thank you letters and second look points to all members of the rank pile. In addition, we revisit the question pile, making sure to call who we need to call, get additional information, and decide whether we will rank these applications.

We add the numbers to create a final ranking for each candidate’s application. But, we are still not done. We recheck the applicant rank list several times to ensure that the rank order makes sense and we have not made any other errors. And then finally, we input the numbers directly into the computer on the NRMP website.

Final Thoughts

Well, that’s about it. Nothing earth-shattering! No system is perfect. But in my biased view, the process seems logical and fair. I like to think that we do a decent job with our information.

Most importantly, the proof is in the pudding. When I realize the great residents we have accepted over my tenure as Associate Residency Director using our ranking process, it has paid dividends over time. Our residents have been fantastic!

 

 

 

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HSA Plans: A Cheatsheet For The Radiology Resident

HSA

Over the past several years, how health insurance covers residents has drastically changed. And residents have been caught unwittingly in the crossfire. Many hospital health insurance plans have recently moved to a high deductible version from plans that cover most day-to-day expenses to save money. Since these changes have taken effect, many of you must contribute more pocket money to pay for these medical expenses. The government has created a new savings vehicle called the health savings account (HSA) to meet these healthcare expenses. (1) Many of you can participate in such a plan. But is it worth your while? How much should you contribute, if anything? These are some of the questions that I shall attempt to answer today.

The Mechanics Of The HSA

In summary, this savings plan can serve several purposes. First, you can use the HSA plan to cover those expenses that do not meet the deductible amount. So, how does this work? Typically, the institution you work for will take out a certain amount of money from each paycheck on a pretax basis, biweekly or monthly. And they will add these dollars to your HSA account. Depending on the resident’s needs, you may decide how much to add to this account for the year up to a maximum of $3850 for a single resident and $7750 for a resident family in 2023. So essentially, you can use this pretax money for your health benefits.

Most importantly, however, you can roll this money over from any given year. What you leave in your HSA account stays inside the account in perpetuity and can be added to the HSA at your next job. It’s all yours!

Best Way To Use The HSA Account

Even though you are saving tax dollars to pay for your day-to-day expenses, think twice about using these extra savings for your present healthcare needs. Why would I say something like that? Well, since you get the money pretax and then you can take the money and invest it without paying a dime on the interest earned if you use it for health care, it is the ultimate account to not pay taxes both on the front end and also on the back end when you take it out. Think of it as a way to avoid taxes altogether. So, it has become the best investment vehicle for most of us. No other accounts give such a significant tax benefit like this.

Let me give you some comparisons. We all must pay income taxes on Traditional IRAs and 401k plans when we take the money out. And we all must pay the income taxes on the funds in a Roth IRA before putting them into that account. Unlike these other accounts, the HSA account is the only one that allows you never to ever pay a dime of taxes on the money! Therefore, if you can afford to put away some of this money without using it yearly, you can invest it tax-free and get the most benefit possible.

In addition, typically, most retirees use over 300,000 dollars to pay for medical expenses. (2) That’s a lot of dough! And through the magic of compounding, since residents have a long career ahead of them, this account can potentially cover those expenses. So ultimately, this can be your medical care retirement account!

How Much Should You Contribute To The HSA?

This question is probably the toughest of them all. It depends on what you can afford. You probably shouldn’t fill the account to the maximum for those with very high debt loads. Instead, pay down at least some of the interest on your loans up to the $2,500 maximum deductible amount. But it certainly pays to put at least a little into this account since the tax benefits are so high. For those with a lighter debt load, maximize what you can put into this account. You may want to substitute some of the money for savings in other vehicles to pay for the investments in this account.

Final Thoughts About Resident HSA Plans

There is no such thing as a free lunch. However, the HSA comes as close as I have seen to one. So, make sure to consider the benefits of an HSA seriously. And think hard about contributing as much as you can. It can make the difference between a harried and a worry-free retirement!

(1) https://20somethingfinance.com/maximum-hsa-contribution/

(2) https://www.fool.com/retirement/2017/12/31/96-of-people-with-a-health-savings-account-are-mak.aspx