Month: May 2019

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No Procedures Please! I’m Sick Of Interruptions In My Workflow

no procedures

Question:

I’m happiest when I’m just plowing through cases at the workstation, as I find procedures are a considerable nuisance. Unfortunately, there seem to be in every subspecialty, but which ones give me the best opportunity to find a job with few/no procedures required?
Regards,
The Anti-Procedure Student

Answer:

Specialties Without Procedures

Fortunately for you, lots of areas within radiology require minimal to no procedures. Here is my list of the career paths I would be thinking about: Non-interventional neuroradiology, MSK outpatient radiology, heavily weighted academics, teleradiology, emergency radiology (depends on the hospital and their requirements), and informatics. Also, body imaging with an outpatient bent could be non-procedural weighted as well. (assuming that there is no fluoroscopy on site).

Non-Procedure Weighted Specialties

Moreover, let me give a pitch for thoracic and cardiovascular imaging. Many of those rads do not perform manual work. However, at some academic institutions, the thoracic imagers will perform the biopsies. And, at other places, you may get interrupted to supervise Cardiac MRIs and CTAs. That all depends on the workflow.
Nuclear medicine (my specialty) does involve iodine treatments and radiotherapies for other cancers. So, you will need to sit with patients and play doctor. And, you may need to perform lymphoscintigraphies. (Our residents do most of them!)  Also, at some institutions (not mine), you will need to stand and monitor the cardiac perfusion scans. However, you will find that we do not perform that many long involved procedures. Manual work is not our thing!

Procedure Heavy Specialties

Hopefully, you have figured out that breast imaging and interventional radiology does not work well for someone not interested in procedures with all the biopsies and/or vascular work. Also, women’s imaging, in general, is not a place for you with hysterosonograms and HSGs. And, finally, pediatric radiology is also chock full of procedures as well. You have intussusception reductions, VCUG, barium enemas, hands-on ultrasounds, and more. I would avoid that specialty!

My Final Summary

Now that I think about it a little bit more, about half of radiology does not emphasize procedures. You can easily find a path that will take you in that direction when you decide to pursue your career!
Good luck following your “procedureless” path!
Barry Julius, MD
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You Want To Become A Radiology Program Director! Are You Nuts?

radiology program director

Did you ever wonder how your radiology program director started to run a radiology residency? Did she desire this calling from day one or did the residency bestow this honor upon her? Well, let me tell you a little about the world of residency  directors (my world!)

Typically, let me give you a picture of the process. It usually happens like this. The Chairman of the radiology department comments at a meeting, “Who wants to take on the role of the new residency director?” You hear a wall of silence. Then, the Chairman asks, “Who doesn’t want the role of radiology program director?” And, then everyone raises their hand except the one guy who is sleeping in the corner. So, who do you think gets this vaunted position?

All kidding aside (not really!), it does take a unique (better phrased “atypically crazy”) individual to relish the opportunity to become a program director. Today, I am going to go into the type of person that can succeed and can find this role rewarding. Moreover, I will talk about the most significant challenges and rewards of this position.

Radiology Program Director Personality

Not all personalities can handle the position of the radiology program director. If you have anger management issues or react before thinking, you are in for a lot of trouble. Optimally, you want to install a person who has a lot of patience, enjoys teaching residents, and can handle long hours of paperwork. But, unfortunately, many times, that is not the case. Hence, the enormous turnover in residency directors. The turnover in residency directors occurs over six years on average, more rapidly than most other residency programs. (check out this article from 2013 by Dr. Ruchman on AJR)

Most importantly, however, this individual needs to understand the dynamics of working with other people. My theory about why the turnover is so high for radiology program directors: I believe that departments select program directors based on academic credentials and technical skills, not upon the personality that will be running these programs (A big mistake!) You cannot expect to run a program well without excellent communication skills. Believe me. Nothing angers residents more than working with a program director that does not listen and talk to the residents within their program!

Challenges

When I started writing this paragraph, I could not even think about where to begin since the trials and tribulations have been so numerous. But, I will take a stab at some of the more significant ones.

As much as any program director would like to say he picks the perfect residents and never had any issues during their tenure, this is rarely the case. (This is also true at the most “prestigious” programs- but they will not let that on!) To this point, most program directors have incredible stories of resident hardships, horrifying incidents, and more. All you have to do is ask, and they will tell you a bizarre story or two! But, here are some of the most difficult of the challenges.

The Struggling Resident

The biggest challenge to the average program director is the struggling resident that cannot make it through the program. And, this may be for any number of reasons, but most commonly related to mental health, learning disability, or social/professionalism issues. Fortunately, these encounters are rare. And, most of the time, the residency team can solve them. But, every once in a while, they do crop up, and residency programs will have to let a resident go.

Trust me. It is heart-wrenching and terrible. However, in the end, each residency director has to attest to the following when they sign the graduation certificate, “This resident is competent to practice in the field of radiology.” And, if you cannot do that, then you cannot graduate the resident. We have a responsibility to the community to make sure that dangerous radiologists do not practice medicine. If you are working as a director long enough, it will happen in your program.

The Weird “One-Off” Incidents

Also, of course, there are the “one-off” incidents that most directors will encounter that can present real challenges as well. What do I mean by that? You have a resident that gets into trouble with the law for a DUI or a fist fight between a radiology resident and a surgeon in the middle of the night. I can tell you that each situation is unique and presents its own set of challenges on how to deal with them. We are always flying by the seat of our pants!

Mind-Numbing Paperwork

Lastly, we need to accept the responsibility of mind-numbing paperwork at times. In the past, with the old site visit system, we needed to create a gazillion essays about why our residency program should exist with terminology and mumbo-jumbo that you would not believe based on the musings of a few Ph.D. education types. But even today, with the newer site visit system, we still have enormous quantities of documentation to prepare.

Additionally, between the milestones, surveys, resident/faculty evaluations, meeting minutes, and more, you need an army of coordinators and personnel who are computer savvy to make sure your residency program can continue to survive. (That’s why small residency programs find it challenging to survive) However, many of these responsibilities often fall into the lap of the program director. And, these items are just the proverbial tip of the iceberg!

Rewards

Yes, with great responsibility comes great rewards. And, this time-honored cliche applies no differently to those running a radiology residency program. I can think of almost no better feeling than to see your residents succeed, becoming chairmen of other departments, writing inciteful academic papers, and becoming incredible clinicians once they graduate.

Also, getting your residents past the hardships they may encounter during their residency program can take an incredible amount of work, but there is no better reward than getting them over these obstacles and watching them take off in their careers. In the end, we are coaches and mentors. And, if you like these roles, you may enjoy becoming a program director (As long as you can accept all the other flaws that go with it!)

Becoming A Radiology Program Director- Are We Nuts?

Well, after all this discussion, the short answer is yes, we are nuts. We need to have unique nutty characteristics that enable us to succeed in our job. And, we take joy in the experience of teaching over all the other issues that come with the position. But, if that is nuts, so be it!

 

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Is Radiology Falling Apart Or Will It Continue To Thrive? I Need To Know!

radiology falling apart

Question Theme: Is Radiology Falling Apart?

Hi, thanks for doing this blog, it’s been an excellent resource for me as a medical student interested in radiology.

As a medical student, there is a lot about radiology as a field that appeals to me; the short “patients”, the diagnostic nature (you give your interpretation, and you finish w/ the patient), the fact that work doesn’t come home, the essence of medicine being radiology, the flexibility of the field in having non-medical interests, etc. However, as someone who wouldn’t be practicing for the next 7-8 years at least, and as someone who wants ideally to have a substantial long career, there are a couple of things that give me pause that I hope you can clear up.

1) I’ve heard a lot of conflicting thoughts about the radiology job market and the increasing “race to the bottom” for salaries along with w/ increases on workload. Can you comment at all on this and how you see the trends for several years out?

2) I have always leaned toward being a private practice physician. And, I know the direction across all specialties is increased consolidation (practices being bought out by hospitals, venture capitalists, etc.), but it seems like radiology is more prone to this than other fields. Do you see this trend holding for the near future?

3) Re: increasing workload; how flexible are practice options still? Is going to Hawaii or New Zealand for weeks at a time to do remote reads even feasible? What are the main practice options viable for a starting radiologist outside of being an academic/private radiologist?

4) In a similar vein, do you see radiology going down a comparable path to EM, where you have many shifts at odd times and holidays? With the push towards 24/7 coverage, I’ve heard rumors this could be the future of the field, and I do not like the schedules EM physicians have at all.

5) Finally, as more of a fun question, what are some of the most exciting things on the horizon for radiology as a field? I know we hear a lot about AI, but I’m assuming there’s more in the pipeline besides that. Perhaps any new modalities altogether? Or whatever else is exciting to you personally.

Thank you so much for helping out a “jaded” and burnt out M3! Continue being great!

 

Answers:

Great question(s). Each of these queries can be an entire blog! But, I will try to answer each of these in short order.

Will radiology be involved in the “race to the bottom” for income? Well, I do agree that over time, the workload has been ramping up due to increasing efficiencies created by technology. And, I see that trend continuing. However, the pattern will take a slightly different path. But, let me start with a little radiology history.

Initially, the first expansion of work for radiologists was multiple new modalities  (ultrasound, CT, and MRI.) Then, the next revolution was the PACs system and the digitization of images.  Now, we are about to experience a new generation of efficiency, that would be the software and AI revolution to assist you with your work. So, yes, you will be continuing to read more studies quicker. And, the government will not be adding new money into the system. Therefore, we will be much busier over time, and the money reimbursed per procedure will decline. However, with AI, it may not be “harder” to read these studies because AI will help you with things like triage, dictation, and detection. So, if you like technology and anatomy, radiology will still be the best field in medicine!

What about consolidation? Unfortunately, I believe that this trend will continue for a while. Economies of scale will continue to make larger better. What does that mean for you? You will more likely need to work for either a large private practice group, a corporate entity (i.e., large teleradiology company), or a large academic center. The days of 2-10 person private practices are slowly drifting away! (I was thinking about writing on this topic in an up and coming blog as well!)

How flexible are the options to practice? Well, here is where radiology takes the cake. Again, it depends on your debt load and your desire to work. But, all the options that you mentioned are still available. Hawaii and New Zealand are more than possible. And, you can work any number of days per week. Just like any other field, however, the less you work, the less you will make. So, you need a financial backstop if you want these options! If you desire a more atypical area to practice in radiology, that is available too. Try informatics if that suits you! Or, consultation work is possible. The sky is the limit in terms of flexibility!

Will radiology work turn into ER shift work? I believe you will have several choices and that it depends on how you choose to practice radiology. As I mentioned in the last paragraph, I think we will continue to see lots of options to decide how to practice. But, for many young graduates, you are right, some may be forced to do shift work depending on their debt level and where they want to live. But, by no means, will you have to do shift work. Clinicians wish for the presence of a physical radiologist in their hospitals. And, day time work will still be available.

What do I find exciting about radiology? That can also be an expansive answer. However, I am a nuclear radiologist, and I am fascinated by the new varieties of diagnostic radiopharmaceuticals coming down the pike for all sorts of diseases. Additionally, I see loads of new cancer treatments with new radiopharmaceuticals as well. Moreover, PET-CT and SPECT-CT  technologies are markedly improving, making visualization, and diagnosis more straightforward and quicker. In terms of other areas, MRI is a continually developing field with new sequences and contrast agents in numerous different fields (MSK, Breast, etc.) And, these technologies are expanding on top of an AI platform. So, is the future of radiologist exciting and bright? Certainly, yes!!! And, once again I can’t emphasize enough the answer to the theme of this letter, “Is Radiology Falling Apart?”, a firm no!

I hope this (briefly) answers and alleviates some of your questions and concerns,

Barry Julius, MD

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Radiology Game of Thrones: University Vs. Corporate Vs. Private Practice- Who Will Win?

radiology game of thrones

Each of the three most prevalent practice models is vying for complete domination of the realm of radiology.  And, each of them wants to leave no survivors. They want to capture all the money, glory, and radiologists for themselves! Well, in honor of the up and coming last episode of the Game of Thrones, I figured I would narrate an all-out battle within the radiology Game of Thrones, which is happening right now as we speak.

So, first, who are the players and what are their armaments and defenses against the  “battle-hardened troops” of each group? And then, who will be the winners and losers in the battle to obtain the “Radiology Iron Throne”? We will discuss the conflict in detail!

University Radiology

Armaments

Out all of the weapons that the Universities can use to maintain control over radiology, they can manipulate the credentialing boards and legislative bodies such as the American Board Of Radiology (ABR), American College Of Radiology (ACR), and the Accreditation Council For Graduate Education (ACGME). In other words, they can stack these organizations with their members to get the radiologists they want. Want to make it harder to become a mammographer? Just make a new exam! Decide you need to work at a university hospital to provide services for a specific need. Well, let’s make the rules for that. They hold the majority of the political cards and are willing to use it pronto!

Also, who trains the radiologists? The academics, of course! These organizations can manipulate the minds and careers of new radiologists coming out to meet their own needs! Want to lengthen the time to credentialing? (Which they’ve done already by creating the credentialing exam!) Go ahead and have fellows for a few additional years to meet the requirements of these practices!

Defenses

These organizations tend to be large and have lots of money and politics backing them. It is challenging to uproot the Massachusetts Generals and the Columbia Presbyterians of the world. Plus, they have reputations that precede them. If you are planning to root them from the face of the earth, good luck!

Corporate Radiology

Armaments

These large entities can slice and dice the cash flow coming in so that they can create efficiencies that did not exist before. How do they do it? Of course, economies of scale. And they find willing radiologists to join their ranks. How? By offering younger radiologists higher salaries but never giving them a complete slice of the pie when they become more senior.

Plus, they have the backing of large private equity companies who have large amounts of money to throw at the situation to make their cause more viable. Need more equipment or bodies? They can raise more funds and gather up their needs. They have economies of scale in their favor.

Defenses

Many radiologists want to have a quality lifestyle and are willing to pay for it in any way they can. So, they can always recruit teleradiologists, part-timers, and early retirees to fill their ranks. What better defense than having the ability to maintain a constant supply of low paid troops to protect the organizations!

Private Practice Radiology

Armaments

Which organizations tend to be the most efficient and provide the highest long term cost effectiveness for imaging centers and hospitals alike? The private practices, of course. When you have incentives to work, you create these opportunities to save money for the system with good quality healthcare. So, this is their strong point and mantra.

Defenses

Although they do not have large swaths of capital at their back like the other entities, they can recruit new radiologists who want to form long-lasting relationships and are committed to entrepreneurship while taking control of a slice of the pie for themselves. Also, it is very challenging to find new general radiologists to replace the old guard since training programs emphasize subspecialization over private practice. Good luck finding academic subspecialists to read general work in rural areas to replace the current radiologists, especially when the job market now is so tight!

The Battle For The Radiology Game of Thrones: Who Will Win?

The Current State Of Affairs

Well, the fight for the radiology Game Of Thrones is raging on right now. And, the swords are swinging. So, what’s happening in the current market wars?

Private practices have been losing some ground. Why? New radiologists that come out are no longer as committed to the lifestyle of an individual practitioner. Many do not want to perform the sacrifices that need to be made to work for these organizations. Working on weekends and call, indeed, do not entice these new radiologists. Also, programs no longer emphasize training of general radiologists over subspecialization, causing some private practices to wither and die. So, private practice overall has been at the losing end.

On the other hand, the large corporate entities have been enticing new applicants with the promise of a quality lifestyle. They have been the big winners of late. And, these numbers bear out at each of the AUR meetings that I attend. Teleradiology and corporate radiology have been increasing their numbers.

And then, of course, academics have continued along their merry way. They are a steady presence since they control the politics, research, and numbers of residents they produce.

The Future: My Predictions

But, what about the next several years? I mean there are fewer radiologists per job. So, where will they go? Well, corporate radiology can always jack up the salaries of its members when times are good. Therefore, they will continue to recruit well. And, when the cycle reverses, they will continue to squeeze radiologists for every penny they have! But, lifestyle alternatives in corporate structures will continue to trump private practice organizations for most new radiologists.

And, what about the academic radiology world? Well, as long as they continue to maintain control of the politics and entry into radiology, they will be around for a long, long time. They can also promise a better lifestyle for new radiologists as they enter the field as well as have the financial backing to do so. And, for those residents I interested in research and teaching, they will always be an option.

Where will the private practice radiologists fit into the equation? Well, I see continued mergers and acquisitions until the smallest groups can finally compete with the other entities. Only by protecting themselves with increasing size can these private practices compete in the real world. Until then, the overall numbers of private practice radiologists will continue to shrink a bit.

So, there you have it, folks. As we wait for the last episode of the Game of Thrones, we will finally learn who the clear winners and losers are. Similarly, for us, only time will tell if my predictions for the radiology Game of Thrones will come true. For those of us that are fans of the show, enjoy tomorrow’s episode. You will never think of radiology and its different career pathways the same!

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What Are The Best Radiology Blogs Out There?

radiology blogs

Question About Radiology Blogs:

Dear Dr. Julius,

Here I am again, this question may not fall under ‘ask the residency director‘ category, but it can fall under ‘ask the radiology director who aims to spread knowledge about everything related to radiology.’

So my question is, what would be the best radiology blogs you can recommend? In your blog, I saw your posts about social media, and from time to time you mention other good bloggers such as Eric Postal, etc. but I believe we can highly benefit from a list of recommendations processed by you and your years of experience in this field. Addition to that apart from blogs, what other websites/MOOCs can you recommend for learning Radiology?

Thanks in advance.

Answer:

Favorite Large Radiology Blog Websites:

Once again, an excellent question. I had to think about this one for a while because I don’t see that many regular radiology bloggers that write a lot. (Most radiologists don’t have the time or inclination!) But, if you are talking about websites with musings about radiology in general and the social media/blogging angle, my favorites are auntminnie.com, Medscape, and Doximity. (In full disclosure, I am a Doximity author as well!)
Occasionally, I used to log on to sermo.com for additional articles and community interest. However, I have not recently been to that website.

Favorite Individual Radiology Blog Website:

I also happen to like a blog called Benwhite.com. He is one of a few individual radiologists that I know of with a blog and an individualized website that writes many quality articles geared to residents. However, he has a mix of non-radiology and radiology relevant articles. Also, if you happen to have student loan debt, he has written a book on that too. (Medical School Loans:  A Comprehensive Guide) The White Coat Investor reviewed his text and gave it a thumbs up. Off the beaten radiology path, Ben also created a nano-poetry forum, definitely unique.

Favorite Online Radiology Blog Magazine

In terms of online bloggish magazines, I get Diagnostic Imaging sent directly to my email. That is how I got to know of Eric Postal and his writings. He stuck out in my mind because of his stories and distinct quirky style. (He reminds me a little bit of Andy Rooney from 60 minutes without the hard sarcasm!) However, there are very few regular radiology bloggers that I know of who write on topics similar to the general interests that I write about with a resident bent. Hence, my blog niche!

Hardcore Radiology And Educational Websites

On a more hardcore radiology note, I have the ACR and AMA updates sent directly to my email. Occasionally, they have some articles and information about the business side of medicine and radiology that interests me a bit. Or, they have state-of-the-art scientific updates and news.
Toward the pure educational side of things, I tend to go to radsource.com and radiopedia to look up information in a pinch. And, of course, I often use the standard Google search for images, articles, and additional information when needed. If I want to go in depth or can’t find the information on these sites, I find specific publications on PubMed!
Let me know if I can help you with anything else,
Barry Julius, MD
(In full disclosure, I am an affiliate of amazon.com!)

 

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Hard Proof That The Radiology Core Examination Does Not Work! Need We Say More?

radiology core examination

I can still remember these words, “All you need to do is to study and attend your rotations. If so, you will pass the core radiology examination.” And also, “Residents should not need additional time off to study for the test. They get all the time they need.” Lawrence Davis, MD, the former head of the Radiology Review Committee (RRC), stated these comments with confidence at an Association of University Radiologists (AUR) meeting a few years back. According to the recent article in Aunt Minnie, ARRS: Residents who passed Core Exam valued test prep; nothing could be farther from the truth.

Here is a direct quote from the article, “survey respondents who passed the Core Exam and got a higher overall score used a greater number of test-prep resources, had more time off to study, and had higher U.S. Medical Licensing Exam (USMLE) Step 1 scores (240 versus 221) compared with residents who scored lower or failed.”

Based on this new information, this group entirely invalidated the former RRC head thoughts in one fell swoop. Furthermore, the data stands directly against the ABR mission to create an exam to test basic competency. Now, the evidence to support my theory in a previous article about the new test is live and “in the flesh.”

But, I am going to take it one step further. The results of this new study signals that the ABR needs to revamp the entire radiology core examination once and for all. And, let me tell you why.

The Core Radiology Examination Is Not Based On Practical Knowledge

One of the stated goals of the ABR is to demonstrate competency of recent radiology graduates. But, how can the ABR test those stated goals if the core exam performance depends on residents needing more study time? All the knowledge that they need should come from day-to-day studying and working alone, not from taking additional time off to study.

Additionally, a medical career examination should test for baseline competency, not test-taking skills or superfluous facts. If you need to buy all these supportive test-prep resources, then you are testing for more than baseline competency. In reality, you are checking for skills outside of the purview of radiology, the ability to take a test. Who do you want to hire a good quality worker/radiologist or a great test-taker?

We Are Supporting The Test Taking Support Companies At The Residents Expense

Once again, the resident is an afterthought when it comes to all the fees that we make them pay. The typical resident has to shell out thousands of dollars to the ABR. And then, the ABR forces upon them the indignity of paying for additional test prep resources on top of everything else. Whether it is books, courses, online question banks, or index cards, each dollar spent on these resources adds to the enormous debt of the typical radiology resident. When are they going to start thinking about the needs of radiology residents?

Now, there are traditional resources such as subspecialty books that residents can and probably should buy. But, are we helping residents by having them pay for the additional resources to pass a test that does not measure what the ABR intends. Who finally wins out in the end? Well, the test taking companies, of course. They earn hundreds of thousands of dollars on the backs of indebted radiology residents.

Let’s Stop Playing Games Once And For All!

The ABR needs to stop deluding themselves that the core exam serves the purpose that the organization had expected. The evidence against the utility of the test is now officially on the table. Let’s now start the process of creating a new examination that works as intended. Back to the drawing board, folks!

 

 

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Brains Versus Breast: Which One To Choose?

brains versus breast

 

Question About Brains Versus Breast:

Dear Barry,

I hope you are doing well. I am PGY4/R3 radiology resident, hesitant between breast imaging and Neuroimaging. And, I have a concern about lifestyle and job market in the next couple of years. Which one do you think, will have a better job opportunity?

Answer To The Brains Versus Breast Question:

Both areas can make for an excellent career, but it all depends on what kind of environment, pressures, and lifestyle you want. To help you out I can give you a little summary of the critical factors about I would be thinking.
First of all, let’s start with the general pressure of work. In Neuroradiology, if you miss something in a film, it can be the difference between immediate life and death. On the other hand, if you miss cancer, the results are not as immediately devastating. However, the patient is more likely to sue you for your mistakes. So, I think that your choice in this department depends on what you feel you can handle. Moreover, you will be more procedure and patient-oriented if you pursue the mammography angle since you will be performing biopsies and seeing patients. As a non-interventional neuroradiologist, most see very few live patients and do fewer procedures.
Next, the lifestyles for both specialties can overlap. However, the mammographer can find more jobs that tend to be five days a week or part-time gigs without call. For the neuroradiologist, most do some inpatient hospital work, so it leads you to find a career with more weekends and nights. Indeed, this lifestyle does not apply to all neuroradiologists, however.
And finally, the job market for both specialties is relatively hot. Both neuroradiology and breast are the most needed radiologists out there. There is no lack of jobs at present. And, if I use my crystal ball, I don’t see any significant change coming through the market shortly. Of course, radiology job markets do change with the economy and macro-factors that I can’t predict. However, as long as the economy remains vigorous and radiologists continue to retire, you can expect a continued hot job market. If we look out to the more distant future, when that changes, so does radiologist job availability.
That’s my little summary for you!
Barry Julius, MD

 

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Canceling A Procedure? Call The Clinician!

Not all ordered procedures make sense. Perhaps, the clinician decided on you performing a biopsy based on an incorrect typographical error in a report from the radiology department. Or, even though the clinician thinks that a carotid stent would be helpful, you conclude that the risks of a procedure outweigh the benefits. In the end, these decisions to perform or cancel a study are ours to make, not the referrers. And, sometimes, canceling a procedure for a good medical reason is the best we can do for the patient, end of story. You can feel good about yourself, doing right for the patient. Plus, you have one less procedure for the day!

But wait. Is that all? Well, you have not completed your work yet. What is the one way that you can get yourself into loads of trouble even though you canceled a procedure for a good reason? Hint! You can look at the title above, or instead, check out what I am about to tell you in capital letters: CALL THE CLINICIAN! And, let me tell you why.

It May Delay Clinical Treatment

Even though you serviced the patient well by canceling a procedure, it may not have benefited the patient as you thought if you do not notify the ordering physician.  Let me give you an example. You were planning on performing an angiogram to determine the location of a GI bleed. And now, you have canceled the examination because the GI bleeding stopped. And let’s assume you did not contact the ordering physician. Well, perhaps, the treating physician had delayed treatment for hyperthyroidism based on the assumption of your administration of intravenous contrast material. Look what you did! Now, the patient had her treatment hindered for many weeks by your lack of communication.

Potential Increasing Risks To The Patient

Sometimes patients temporarily stop necessary medications before a procedure. For instance, many patients take Coumadin as preventive medicine for stroke if they have a prosthetic valve because they are at increased risk for blood clots. Therefore, typically, you need to withdraw the patient from anti-coagulants to prevent bleeding during or after a procedure.

And, when you cancel a procedure, many times, the patient will not return to their regular scheduled regimen until the doctor reorders it. Moreover, the patient’s risk for stroke can increase each day he does not receive the medication. Therefore, it behooves you to let the ordering physician know. Why would you want to enhance a patient’s risk for further morbidity?

It’s Offensive Not To Notify The Ordering Physician

One of our prime roles as physicians is to communicate results (or lack of results) to our colleagues and patients. By withholding critical information from the ordering physician, you disrupt the link. And, yes, canceling a procedure counts as “critical information.” If you want to make sure not to get repeat customers in your department, be sure not to pick up the phone and call!

You Can Ruin Your Reputation

Technically, you may be the best neuro angiographer in the world. But, if you cannot let your colleagues know that you decided to cancel that stent placement procedure, then, who cares about how good you are? You are not giving patients the best medical care. And, you certainly do not want to establish that reputation.

There’s More To Do After Canceling A Procedure!

Practicing quality radiology involves more than just making quality clinical decisions and performing appropriate procedures well. Just as importantly, we also need to maintain the links of communication with our clinical colleagues so that we can give the best possible care to our patients. And, if sometimes, the best decision for the patient is to cancel a test, make sure to contact your fellow physician. Don’t spoil your excellent patient care with a lack of communication!

 

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What Do Interventional Physician Assistants Do?

Interventional physician assistants

Question About Interventional Physician Assistants:

Hello!
I am a physician assistant student at a large American University. Presently, I’m in the middle of my clinical year, and I’ve just completed my 4th rotation. I have spent the last four months in and out of hospitals. Recently, I have been exposed to interventional radiology. Moreover,  I was very impressed with the role that physician assistants play in this field of medicine.

Until recently, I had never even considered interventional radiology. However, I want to work in a field that is procedure driven. To that end, I am good with my hands and spent 13 years as a firefighter/paramedic which is very procedure driven. So naturally, I found myself very intrigued about interventional radiology as a possible career for a PA. Is there any way you could put me in contact with someone to answer some questions about a PA’s role within IR?  Thank you for this website. It has been incredibly helpful, and I hope to hear from you soon!

Regards,

Future Possible Interventional Assistant

Radsresident Answer For A Future Interventional Physician Assistant:

I agree that the best resource would be to talk to a PA that does interventional radiology. We do not have an interventional PA in our program to which to refer you. However, I have worked with a few interventional physician assistants during my residency and at a previous job a while back and I could shed some insight into what they do.

Both of the PAs that I had worked with functioned as an assistant in complex cases. Also, they were the primary operators in procedures such as PICC lines and ports. Moreover, they would see patients in “tube rounds.” If you haven’t heard of this term, it means they would talk to the patient and provide updates on the status of their catheters and interventions after the procedure. And, they would write the formal notes in the chart to document the condition of the patients. Also, they involved themselves in morning rounds before seeing the patients for the day. And finally, they performed the consents for procedures to reduce the workload for both attendings and residents during the day. Both PAs that I worked with served an invaluable role in the practices and became a critical part of the team.

Hope that gives you a little bit better insight into what they do,
Barry Julius, MD