Year: 2018

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Should I Be An Independent Gun For Hire?

independent gun

Nowadays, new radiologists may face a new choice, not as prevalent years ago. As such, you may work for one or more than one firm that allows the option of independent contracts or employed work. Most commonly, this decision exists for those who choose teleradiology. But other arrangements are also possible. So, what do you do? Do you operate as an independent contractor getting yearly 1099 forms? Or do you take employment wages and receive a W-2 at the end of the year? Although this decision may seem innocuous, significant consequences await those who don’t think about how to proceed. So, today we will discuss the advantages and disadvantages of contracted work. In addition, we will talk about a significant pitfall you must avoid when you begin your first independent contractor job. Let’s start!

Reasons To Become A Gun For Hire

Independence allows radiologists to contract out with multiple groups. Many employed positions muzzle the worker by outlining in the contract that they may not work with other groups or outside work. On the other hand, theoretically, as an independent contractor, you can work with five or more different groups and facilities. Similarly, the more the independent contractor works, the more you can get paid. This workflow differs dramatically from an employed worker that often has a fixed salary with, perhaps, a small production bonus.

In addition to the ability to work with multiple facilities, the independent contractor can also deduct expenses from their income taxes. As a typically employed radiologist, you cannot write off items like fax machines, paper, health insurance, 401k plans, and more. When you work for yourself, all these deductions can significantly reduce your taxable income. Therefore, making more take-home income with the same salary is possible.

Then, of course, depending on how you structure your business, you may be able to take advantage of the new tax laws that favor corporations. For instance, you may depreciate capital equipment more rapidly over time. And, if your income dives below a lower threshold, you can deduct additional earnings as a pass-through corporation. Additionally, you may be able to put more retirement account funds away in a SEP-IRA versus an employed 401k plan. Whatever the case, I highly recommend discussing the consequences of different corporate structures and tax ramifications with your accountant.

Becoming A Gun Is Not All Peaches And Cream!

What issues do independent contractors need to contend with? Maintaining contracts with different entities becomes your responsibility if you independently contract with multiple facilities. And the loss of one or more contracts can devastate your finances if you rely on this income to sustain your household. No longer can you rely on your employer for your paycheck.

Working for yourself as an independent contractor can also become a lonely business. Instead of working in an extensive practice with many other radiologists, some independent work can isolate you from your colleagues. For some, this can be a potential deal breaker.

Other issues arise, such as traveling from facility to facility to work. (if you work at multiple locales) If you have a more capital-intensive business and, for instance, you run remote computer software, you may need to fix the equipment if it goes down. Or, if you work from home and have a power outage, how do you run your business? These questions do not have to cross the mind of the employed radiologist.

Finally, if you employ other workers/services, you also rely on their work. If they don’t show up, you don’t get paid!

A Major Independent Contractor Pitfall

For those of you who go down the road of an independent contractor, you must remember what you take home; you do not entirely keep. Naturally, you always have to save additional money for the taxman. More than that, you will also likely need to pay quarterly estimated taxes to prevent IRS penalties. Again, I would talk to your accountant about the details of your situation.

To Be Or Not To Be An Independent Contractor

Becoming an independent contractor as a radiologist certainly can have significant benefits. But, no job comes without its pitfalls as well. Suppose you like the independence of working for multiple groups, getting paid as much as you work and being able to deduct certain work expenses. In that case, independent contracting has a certain allure. At the same time, it also involves different risks you must take. Additional rewards never come without some sacrifice!

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Want To Improve During Radiology Residency? Think Small!

improve during radiology residency

A few days ago, I had an “aha!” moment that caused me to stay and listen to the radio in the car for an extra 10 minutes in the garage. In the “on-air” discussion, the presenter of the radio show claimed that to create tangible improvements in any skill, we need to learn from our mistakes and set smaller, more reachable defined goals for ourselves. We can’t look at our most impressive role models and realistically say I will be just like them without a plan of action. Instead, we need to create a specific goal with small attainable means to get there. And I believe the same holds for improvement in the field of radiology. I would subscribe to a similar philosophy for all radiology trainees- to improve during radiology residency, you need to “think small.”

Just like we cannot expect to become like George Harrison at the guitar in just a few lessons, we cannot assume that we will practice the highest-quality radiology after a few months of residency or even one year of practice. Improvement and learning occur at a snail’s pace. In radiology, like most complex fields, becoming a consummate professional is a slow incremental process. And, we shouldn’t be so hard on ourselves and our residents for not being perfect. Each one of us started without the complete set of knowledge and skills that we have today.

Allow For Small Imperfections

Residents often beat themselves up for missing an individual finding or misinterpreting a case. And, as polished attendings, some of us lose sympathy for the trials and tribulations of the resident. We emphasize the occasional miss, not the learning experience. Attendings may harp on the small mistake and cajole the resident about reading a film in the wrong way. But are these the appropriate courses of action for residents and attendings? Probably not. Being hard on ourselves because of a miss helps no one. And instead of hounding the resident who missed a finding, radiologists should be helping him realize he should be thankful to make the solitary error in a comfortable learning environment rather than as a final decision-maker.

We all need to understand, residents and attendings alike, that to become a consummate professional, we must make a few mistakes along the way. Radiology trainees are no exception.

Remember, only after correcting many minor mistakes throughout residency can the radiology trainee become an incredible radiologist. Radiology mentors should encourage residents to take those leaps of faith rather than hold back and merely rely on the Nighthawks or in-house attendings. Attendings should not throttle the innate drive of radiology trainees to think and do more. We do that by punishing rather than celebrating the small mistake as a tool for learning.

Setting Achievable Specific Goals

In addition to allowing for imperfection, residents must create learning plans focused on learning “small” individual skills to improve, not generalized goals. What do I mean by that? Outline the specific topic areas you want to learn and the resources you will need to cover the material. Don’t just say I will learn all about nuclear medicine this month. Be specific about the how and what. You will never reach the end goal if you don’t set a plan that emphasizes the small stuff. The ability to build upon small goals block by block eventually creates incredible professionals in any field.

Want To Improve During Radiology Residency: Think Small!

The overall completion of generalized tasks does not make a radiologist great. Instead, it is the sum of learning from our mistakes and completing “small” goals over time. So, let us all celebrate the “small.” Ultimately, the sum of “the small”corrections of imperfection and achieving specific milestones builds great radiologists.

 

 

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Ten Reasons Why Service Jobs Are Important Preparation For Your Radiology Career!

service jobs

For those out there who worked at Taco Bell during high school or the local Target (1) for a year while in college, these kinds of service jobs may seem irrelevant to your radiology resume. But for program directors and residency selection committees, we find these “real-world” experiences invaluable in creating a picture of a well-rounded person. Here is a list of ten reasons service jobs are crucial to your career!

People Skills

Ever had to get someone to make a final decision because they were unsure if they wanted the Dell or Acer Computer at Best Buy? Or perhaps, you had to take someone’s order at the local Denny’s. These skills are immediately translatable to situations we encounter with people daily in our field. Perhaps, you need to convince a patient to get an interventional procedure completed. Or maybe, you must soothe a patient before getting their barium enema? These people skills will come in handy!

Managerial Skills

Need the technologist to work with you when you are doing fluoroscopy? Well, those years managing the local Subway shop will serve you well. If you can get your employees to clean the restaurant floor, it is not a giant leap to having the technologist prepare everything before your next fluoroscopy the way you like!

Ability To Deal With The Real-World

Is your head in the clouds because you’ve been only thinking about abstractions your entire life? Or do you have some fundamental translatable practical skills? A few months working at your local supermarket will certainly cure you of living in a dream world! We, as radiologists, constantly have to manage real-world situations, not just the anecdotes we read in books!

Practical Problem Solving

Perhaps you worked as a waiter at a restaurant and spilled tomato sauce on your client. Or maybe the deli slicer stopped working? How do you deal with these situations on the fly? As we practice medicine, we need to have the same ability to think on our feet and “outside the box.” Working in service jobs is excellent practice!

Workplace Diversity

When you work at the local McDonald’s, you encounter all races, socioeconomic classes, and cultures. What do we do as radiologists? Well, we also need to take into account these factors for our patients and staff. If you have never had the experience of working with a diverse population, you will not understand the nuances of daily radiology work!

Teamwork

Have you only experienced the artificial environment of working with others at school? Or, have you needed to work as a team to make those sales at the Gap? Working in service jobs is a fantastic way to get this experience!

Understanding of Business Bottom Line

Ever had to run a business to pay your employees and make ends meet? You don’t get that experience by reading books! Instead, it would help if you involved yourself firsthand. And you know what? Radiology is a service business like any other. We need to meet the bottom line too. Now, we know you can empathize with our work!

Conflict Resolution

For those of you that never held a real service job, it is difficult to comprehend how to solve conflicts among your staff. A little practice at your local drug store routinely calming your clientele as they wait to fill their prescription goes a long way toward solving conflicts with your patients and staff as a radiologist!

Ability To Handle New Technology

Maybe, you had to learn an entirely new register at the local hardware store. Or, perhaps, the engraving tools changed. You need to know these new tools very quickly. Guess what? Changes happen in radiology all the time. See, these service jobs are an introduction to our world!

Service Jobs And The Bottom Line

Working in the service industry before beginning a radiology residency is no joke. We, as program directors, truly value the efforts that you have made to work a real job. Whether it is conflict resolution, problem-solving, or learning how to be part of a team, your experience in the service industry will help prepare you for our line of work. So, go forth, don’t be embarrassed, and add that job to your resume. It can only help your cause!

(1) Target is an affiliate of this website

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I Am Caught In An Early Vicious Cycle: Help!

vicious cycle

Question:

Hello Dr. Julius,

I found your article about the struggling radiology resident and looked at your previous answer to a similar question. I am an R1. At the end of October, the program informed me that I was struggling and having problems with synthesizing information and communication issues. Since then, they told me I haven’t improved and am still behind my peers.

I know that you mentioned getting out of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD, they think my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and I accidentally got the GME involved in seeking information. I’ve been studying harder, but I have a shaken confidence. And I keep missing things and not improving. I am concerned that they will fire me. Where do I go from here? Do I start looking for another specialty or stick it out until they’ve had enough and will not renew my contract?

Name

Scared R1

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Answer:

Dear Scared R1,

Before anything else, you need to ask yourself if you have been putting in many hours of studying each day and have immersed yourself in radiology. If you are honest with yourself and have genuinely been putting everything you have into learning radiology, you shouldn’t be so hard on yourself. I am going to assume in your case that this is true.

So, what bothers me most about your situation is how you explain it. You said you just recently started as an R1. That would mean that you just began the second half of your first year. And yet, it seems that you assume that your PD and associate PD think that, inherently, you will not make it through your program.

It would be highly unusual for a PD to know that you can’t make it through your residency so early on. In my experience, I have had several residents who had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, they can know only by seeing how you do on call. (assuming you passed a precall assessment) So, it seems they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.

Remediation of the Vicious Cycle

Second, the ACGME requires the program director to allow you to remediate your situation. They can’t just indiscriminately fire a resident without due process. And, since you have barely started radiology, there is no way you could have had an adequate opportunity to remediate the situation. Again, this assumes that you have not done anything to endanger your patients or fellow staff that would require them to prevent you from working.

So, where does this leave you? Well, improvement is an incremental process with occasional setbacks along the way. You may feel like you are not improving, but you are. The key is to learn from your mistakes and not repeat them repeatedly so that the vicious cycle continues. It’s ok to have missed at this point. You certainly can’t expect a first-year not to make any mistakes.

All this being said, occasionally, some residents can’t cut it. But these residents are rare, and I certainly would not be ready to pack it in just yet.

At this point, you should view each mistake as a learning opportunity, not as something to get discouraged about. You need to stick it out with some grit and determination to get through this difficult time. Radiology residency can be very tough for first-year residents. Staff can be unforgiving.

Improvement is a gradual, almost imperceptible process in any small time frame. You may notice the changes from reading and studying in a more extended period. Continue to soldier on, and let me know how things go!

Sincerely,

Barry Julius, MD

 

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Question About Improving The Vicious Cycle:

Hello Dr. Julius,

Thank you for the encouraging reply. In your experience, what is the usual time frame for struggling residents to see improvement? I’ve finished four weeks on a must-cover, and my faculty state that I am not improving. I have another four weeks to go, but I am concerned that if I haven’t improved much in the first four weeks, what are my chances of improving in another?

Sincerely,

Scared R1

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Answer:

Scared R1,

Four weeks is a concise amount of time to assess for global changes/improvement. If we are talking about more specific goals you have set, that would be more appropriate. Based on what you are saying, it is hard to determine what improvements they are trying to assess. Global assessments don’t work too well. I am writing an article talking about that.

On the other hand, programs and residents can assess and create incremental specific goals. Hopefully, they are creating these for you, and you have made some for yourself. You can undoubtedly reach specific smaller goals within a 4-week block if these goals are appropriate.

Barry Julius, MD

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Nighthawk: A Viable Career Option For Radiologists?

nighthawk

When you think about the field of radiology, do you picture yourself working from dusk to dawn for years at a time? I suspect that most of you have not. More likely, you’ve probably dreamed of a 9-5 job with an occasional call on weekends and evenings. So, what do you lose out on by beginning a career as a nighthawk? And, are there any permanent advantages to working as a Nighthawk for years? Let’s delve into the main issues of working as a radiology Nighthawk.

Why Nighthawk Can Be So Difficult

Imagine yourself on the computer at night beginning at 10 pm and working until the wee hours of the morning at 7 am, reading films night after night. For most people, social and business activities occur during the daylight hours. So, when you create a schedule for yourself such as this, you essentially live the life of a loner. Sure, you may receive phone calls from attendings and medical professionals who need your assistance from time to time. But are those interactions you looked for when you decided to go into radiology? Probably not.

Furthermore, say you need to take care of some business at a bank or make returns to a store. These mundane activities turn into a real hassle. Instead of conveniently stopping by these places to take care of business, now you must reverse your entire schedule to get there. It can be hard enough sometimes to get out of work, even for me during the daytime! I can only imagine the difficulties for a nighthawk.

And then, of course, there are the health issues. Study after study has espoused the dangers of reversing one’s sleep schedule to counter normal nighttime sleep. Take a look at this article from the sleep foundation (1). They list many physical, mental, performance, and safety issues the night worker encounters. Believe it or not, it includes increased cancer risks, depression, and more. Do you want to take on these increased risks?

The Allure Of Nighthawk

Yet, wouldn’t it be nice to set up shop any place you want? Do you want to live on the west side of Manhattan? Or, maybe rent a home in Malibu on the beach? Well, it doesn’t matter if local jobs are unavailable when you are a Nighthawk. You can work from anywhere. But is it worth the sacrifice?

For some folks, Nighthawk positions allow radiologists to get their proverbial foot in the door. In some locations, getting into a practice can be exceedingly tricky. (although not as much in the current job market!) And sometimes, Nighthawk can be a solution. Because the hours are less desirable, radiologists are less likely to compete for these entry jobs. Now, you have a way in. But don’t think you can quickly work your way into a daytime position. Other radiologists in practice certainly will not chomp at the bit to take your place!

Then, working at an office or hospital with others may not sit well. Some people would instead go it alone, literally. Of course, Nighthawk from home can be a very solitary assignment. Maybe, this is what you want from life.

And finally, practices will often jack up the income stream to entice the new radiologist to take a Nighthawk position. The savings can be enormous for those of you with extreme debt (I mean greater than 500,000 dollars). Of course, it is not without sacrifice, however.

To Make The Ultimate Sacrifice- A Nighthawk Position

In the end, it is your decision. A Nighthawk position does have significant advantages, but not without substantial sacrifices. If you are willing to forego convenience, tempt fate, and live a loner’s life but live where you want and pay your debts off sooner, then maybe, just maybe, a Nighthawk position is for you!

 

(1) https://sleepfoundation.org/shift-work/content/living-coping-shift-work-disorder 

 

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Radiology Recruiters: The Good, The Bad, And The Ugly

radiology recruiters

Every once in a while, radiology residents and former radiology residents will ask if they should use radiology recruiters to search for jobs. And, if you glance at some forums (which will remain nameless!), radiology recruiters are labeled the epitome of evil. But, what is the real story behind radiology recruiters? Does it ever make sense to utilize their services? Or should you believe the hype online? Based on my own experience and the perceived experience of current and former radiology job seekers, I will give you the lowdown on the lowly radiology recruiter. By the time I finish, you will understand the good, the bad, and the ugly! (the Amazon affiliate link to the actual movie!)

The Good

Let’s start with the merits of a recruiter. For some with less job experience, recruiters can help improve the applicant’s overall package. What do I mean by that? They can provide services like interview practice, resume scrutinization, and general mentorship. For some, these services can be invaluable.

And then sometimes, these recruiters can provide insights to the applicant, such as contract negotiation tactics, legal help with contracts, and tips for the uninitiated. The recruiter can serve these individuals well if you don’t have the appropriate background to know some of the finer details of these job negotiation skills.

In some markets where the job seekers are scarce and applicants have lots of opportunities, some practices will utilize a recruiter to gain an edge. Rumor has it that those practices that use a recruiter are second-class. But, I don’t believe that is necessarily so. Sometimes, these practices may be smaller or do not have the connections with the local residency program as a feeder for positions. In these situations, recruiters can provide a valuable service to these lesser-known smaller practices, matching the appropriate applicant for the right job opportunity.

Finally, if the applicant is unfamiliar with an area or market, good recruiters can provide a good reference for the lay of the land. A good radiology recruiter will know a lot about the location and the market opportunities. Sometimes, searching for this information can be challenging to find on one’s own during the throes of residency or fellowship.

The Bad

The interests of the radiology recruiter and the applicant do not always align. What do I mean by that? A radiology recruiter can heavily advocate for an applicant to take a job that does not match his needs. If you think about who typically pays the recruiter (the practice), it almost always makes sense for the recruiter to push the job. Now, this can happen whether the job fits or not. To that end, an “honest” radiology recruiter may avoid this conflict of interest. But this is the real world, folks. And, not all recruiters follow the rules of nobility!

The Ugly

So, think about it. How are recruiters paid? Typically, most recruiters receive payment from a practice (a retainer) when they have placed a candidate successfully. And now, who do you think would be the preferred candidate, all things being equal, if you have two folks with precisely the same credentials, one using a recruiter and the other going it alone? Well, it’s pretty simple. The applicant without the recruiter will get the job. Why? It’s free for the practice to acquire the resident without the recruiter! This problem leads to the ultimate paradox of recruiting!

The Real Truth Behind Radiology Recruiters

Radiology recruiters can be a godsend for those applying to noncompetitive locations who are unaware of job opportunities or do not have honed business skills. On the other hand, recruiters can put you at a distinct disadvantage for those interested in more competitive locales with a bit more experience and those who know the opportunities and most of the practices in the neighborhood. So in these cases, I recommend you try to network or cold-call first.

As you can see, based on your situation, a recruiter may or may not be suitable for the applicant. Here’s the bottom line. Do your homework before looking for a recruiter. Radiology recruiters can be the reason for obtaining or losing your next job!