Year: 2019

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The One Phrase You Should Ask For In All Your Letters Of Recommendation

letters of recommendation

ERAS season has recently begun. And, with applications to radiology residency and fellowships on the system now available, medical students and residents are scurrying about trying to find letters of recommendation from their faculty and mentors. On that note, if you are applying now, I would advise you to read one of my previous blogs (Cracking The Radiology Residency Application Code).  Previously, I have mentioned that references are one of the less significant discriminators in getting an interview for radiology. However, that statement only applies to decent letters of recommendation. It does not mean that you should find the wrong ones.  That can become a disaster. Remember. Program directors have so many excellent applications from which to choose. So, one lousy recommendation can lead yours into the DNR (Do Not Rank) pile. In the case of a horrible reference, it becomes a great discriminator!

In any event, as always, I want to distill the essentials of applying in the world of radiology into a few simplistic nuggets. Therefore, I am going to let you in on a little secret about what you should be looking for in a recommendation writer not only to avoid this situation but instead, I want to make your recommendation into the reason you may have success getting into your program of choice.

So, here it is, a simple phrase strategically placed within the recommendation, preferably at the end. And it is this, “Your name is the type of student that we want to take at our radiology residency program.” As an application reviewer, that phrase gives me more confidence about an applicant than any other.  If your mentor wants to take you into his program, especially another program director, then why wouldn’t I? So, how do you get that person to write that into your recommendation? I will give you some simple instructions on how to do so to achieve the results you want.

Perform Well On Rotations With Potential Reference Writers

OK. Performing well on rotation may seem obvious. But, on occasion, some residents will ask attendings to write a recommendation when their performance was marginal. Why does this happen? Well, usually, the resident feels more comfortable with obtaining this written reference due to the mentor’s easy-going personality. Don’t let that fool you! When a mentor has many other applicants to write for, your recommendation will not be of the same quality as his favorites!

Befriend Your Mentors

For many medical students, befriending your mentor is a tall order. Often, he may be twice or even three times your age. Or, your interests may significantly differ. However, make that attempt to get to know that person well before asking for a recommendation. Then, when you finally request one from this person, he will feel much more comfortable with writing one. I can’t tell you how many times a medical student or resident will come up to me and ask me for a recommendation when we have barely spoken. It reflects in the written letter!

Tell Them What To Write!

Lastly, this step can be the most critical. At this point, you know your mentor well, feel comfortable with her as a reference, and you know she feels the same about you. And, she is more than likely willing to help you out in any way she can. But, many reference writers do not know what program directors are looking for in a recommendation. So, it is your job to help them out. Ask them if they can slip the key phrase into their letter- “I want you in my program.” (Of course not that verbiage exactly but you get the point!)

Even better, some writers will ask you to make a version of the reference letter. Guess what, slip that phrase or something similar into the end. It has the potential to make your application stand out from the pile!

Capturing The Magic Phrase On Your Letters Of Recommendation

Now you know precisely how to proceed to get the best possible recommendation from your mentors to help you get into the spot you want. It does take a bit of work, forethought, and, most importantly, personal interaction. So, make sure to ask mentors on rotations where you have performed well. And, only request them from those that know you well enough to write you one. Only then will you be able to obtain a recommendation with the phrase that will significantly increase your chances of admission!

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Full-Time Practicing Primary Care Physician: How Do I Get A Radiology Residency Slot?

primary care

Question:

 

Hi.
I am a physician in a primary care specialty looking to go back to residency, specifically in radiology. I have been in practice for ten years and have realized that I do not want to practice primary care for the rest of my life. Have you had a resident in a similar situation? What factors do I need to consider? How does Medicare funding for residency come into play?

Thank you so much for your blog and the book. I realize this is a rather late stage to make a change, and I would appreciate your input.

 

Answer:

So, this is the deal: I would love to have physicians that have previously trained in other specialties. They make the best radiologists because they understand the clinical implications of diagnostic imaging. Some of my best radiologist mentors had completed another specialty first.

However (and this is a big caveat), it does become more challenging to obtain a slot because of the Medicare funding situation. Once you have graduated from a U.S. residency and start to practice medicine, Medicare does not fund the additional years of training.
But all is not lost. If I were you, this is what I would do. Some residencies throughout the country have their spots funded by private sources in addition to Medicare. For instance, I know in New Jersey that University Radiology Group supports several residency slots privately for the Robert Wood Johnson program. These are the slots that you would need to find. You may want to try calling the departments up individually to find out if they would take a previously trained physician. Otherwise, you will potentially waste your time and money applying to places that would not enroll you regardless of how excellent your application.
And finally (and perhaps most critically), you need to be ready to go through the mental and financial hardships of repeating another residency. Depending on your family situation, you need to make sure that all members are “on board” with the change. It’s certainly not an easy four years. But, I can tell you that going into radiology was one of the best decisions I have ever made!
Good luck with the decision process,
Barry Julius, MD
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New Radiologist Wanting Locum Work? Think Twice!

locum

Have you ever thought about living in different places for a little a bit at a time? Maybe you have always wanted to do some traveling before starting to work? Of course, it sounds exciting to go from Honolulu for six months and then onto Dayton for the next six. Indeed, I thought about the locum lifestyle when I first started.

But, are you missing out on by taking this route instead of the established full-time job career path? Potentially. As much as the ability to travel for your job may entice you, think twice before embarking down this infrequently traveled road as a new radiologist. Let me give you some good reasons for turning this opportunity down.

Pigeon Holed/Loss of Skills

Do you want your new practice to call you that temporary plain film reader gal? Unfortunately, this sort of attitude prevails among many groups. And, imaging groups tend to place you in a particular role based on the desperate needs of the practice. So, if you sign up for XYZ, the group may utilize you in Y capacity. Over the years, this is a surefire way to lose your skills in other areas that you trained for in residency.

Will The Good Times Last?

What do you think happens when the bottom drops out of the radiology job market? Perhaps, imaging reimbursements drop precipitously. Or, suddenly, the stock market crashes and older radiologists stay in the field. And, yes, unfavorable radiology job markets like this have happened in two separate cycles since I started medical school.

In these situations, what happens first? Well, the excess fat gets cut. And, what exactly is the excess fat? It tends to be the locums’ jobs! When you start, you certainly don’t want to be in that first wave of job cuts. It becomes challenging to recover.

Locums Looked Upon Unfavorably

At many practices, the question that arises when they consider a new locum radiologist is: WHY ARE YOU A LOCUM RADIOLOGIST? From my experience, many radiologists believe (rightfully or wrongfully so) that locums radiologists have a defect. Perhaps, they read to slow and cannot hold a job. Or, maybe, the individual cannot get along with others and drifts from job to job. So, if you have a track record of only holding locum work, you have painted a particular picture of yourself that may not be attractive if you ever want to find a longer-term career!

Never Quite Maximize Efficiency

When you drift from place to place, you never get to learn all the systems in place to maximize your output. PACs machines, paperwork, clinician demands, and technology continually change. And, they differ from one practice to another. By definition, you remain less efficient and slower just because you do not have the long-term knowledge you need to keep up with your colleagues at a job using the same technology for the past ten odd years!

Difficult To Establish Long Term Relationships

What do I value most from my current job? I treasure the relationships that I have made with my colleagues, residents, and fellow clinicians. How do you create and maintain these relationships as a locum? Well, it can become very challenging at the very least. You are new the kid on the block and will remain that way until your short term tenure as a locum radiologist ends.

Locum Work: A Dangerous Road To Travel

Now, locums can be an excellent opportunity for specific individuals. If you have a family and want to fill in some time with some extra hours, it can make some sense. Or, maybe you want to retire soon and desire some additional inconsistent or occasional work. Finally, perhaps, you are independently wealthy, and a full-time career does not matter for you. But, for the typical fresh graduate with a lot of debt and wanting to begin a new locum path, you will encounter many obstacles that can affect your future career and growth. So, think twice if you choose to become a locum radiologist when you start. It may become one of your biggest regrets!

 

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What Are The Best Resources For Learning Ultrasound?

learning ultrasound

Question:

Hi! I was wondering what source you would recommend as the best to teach ultrasound to radiology residents?
Thank you!!

Answer About Learning Ultrasound:

So, I did a little bit of “market research” for you. And, I asked a few of my best radiology residents what they preferred to read to learn ultrasound. I did this because the best ways to learn regularly change. So, this is what they told me.
When they first started, they used the Ultrasound Requisites to get a solid background on the topic. Afterward, they would use what they would like to call the big blue book- “Rumack”  (Diagnostic Ultrasound) to look up additional information about any specific case. Most importantly, however, each of the residents said it was most critical to go inside the room to scan at the beginning to experience how they get the pictures and to understand the basic ultrasound anatomy. And, I have to agree with this method for learning ultrasound. I utilized a similar approach and it worked for me.
One of my great radiology mentors always said the following: “Ultrasound is not a spectator sport.” That was one of my favorite phrases. And, I continue to tell the same to my residents. You need to go into the rooms at the beginning and learn how it all works to get to know the world of ultrasound. Otherwise, all you will see are a bunch of disconnected grainy pictures!
Let me know if you have any other questions!
Barry Julius, MD
(All links are to books are at Amazon where I am an affiliate)
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Can You Pass The 2019 Precall Quiz?

precall quiz

Once again this year, I am presenting 10 cases from our precall quiz. These cases will help to determine if you are ready for taking call at your institution. Each of these is the sort of the case you will likely encounter on call at some point. Sixty-five percent is passing. Partial credit is possible. Make sure to write down the answers on a sheet of paper and cross-reference them with the answers provided on the bottom of the page. See if you will be competent to take overnights or if you need to study a bit more before you are ready!

By the way, if you think you can score better the next time or if you want some more practice, check out the previous years’ precall quizzes. The links to the 2018 and 2017 quizzes are right below. Good luck with the exam!

2018 precall quiz

2017 precall quiz

 

Case 1:

 

 

Case 2:

 

Case 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 3:

What is the possible diagnosis?

How would you manage this case at nighttime?

 

Case 4:


Case 5:

Case 6:

 

 

Case 7:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 8:

 

Case 9:

What is the diagnosis?

What else would be of help to increase the specificity of the study?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 10:

 

 

Answers to Cases:

  1. Right-sided ileocolic intussusception
  2. Right perihilar mass with pneumothorax
  3. Possible diagnosis: fetal demise with conflicting images in M-mode, How to manage: scan yourself in real time with M-mode or cine
  4. portal venous gas, bowel pneumatosis, SMA thrombosis- call surgeons
  5. Proximal transverse colonic apple core lesion, suspicious for primary colonic neoplasm
  6. Normal CT brain
  7. Hill-Sachs deformity with a loose body (greater tuberosity overlying the glenohumeral joint)
  8. Mets with multiple levels of cord compression. Abnormal signal within the cord, suggesting ischemia.
  9. Findings suspicious for PE (High probability study- old verbiage), What would increase specificity? A prior V/Q SPECT
  10. Left distal ureteral stone with left-sided hydronephrosis and hydroureter and adjacent inflammatory change, porcelain gallbladder (increased risk for carcinoma)
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Why Do Radiologists Overall Have A High Net Worth?

high net worth

As some of you know, income is merely a snapshot of the overall financial health of the profession. On any given year, that can change on a dime. Procedure reimbursement can change. Codes can vary. And, professional or technical fees rarely stay the same.

However, most financial surveys report on physician income, ostensibly the real marker of physician economic well-being. But, what is the one long term indicator of a medical specialty’s financial health? Well, it’s going to be a long term indicator of physician savings, their net worth!

More to the point, each year, Medscape publishes the physician debt and wealth report. And, this information is more telling about the long-term state of our profession than any other survey out there. Therefore, I look at these statistics very carefully to see how we compare to everyone else out there in the medical world.

And, this year I found something interesting. On one of the last Medscape survey slides (#23 to be exact), our specialty has the highest percentage of physicians with a net worth over 2 million, tied with a few other specialties (plastic surgery and orthopedics). At the same time, we have the lowest percentage of physicians with a net worth under 500,000 dollars (slide #22). However, we are not quite at the top for the proportion of physicians over 5 million dollars (slide #4). And, on another presentation on physician income on the 2019 Medscape Physician Compensation Report, we are only tied for 5th highest mean income.

So why is it that we do not have the highest income but yet we have a higher percentage of physicians with a net worth of over 2 million dollars? Moreover, why do we have a lower portion of radiologists with a net worth of greater than 5 million dollars than many other specialties?  Let’s dig further into the weeds.

Radiologists Are Not Show-Offs

You probably know a few radiologists that drive their 100,000 dollar Tesla and live in a castle. However, overall, radiologists are not ones to take all the credit. And, from my experience, most are more humble, similar to how we need to work within our profession.  And, this personality trait more typically describes their more simple spending patterns.

What do you do if you don’t spend much on things to display to the world? You save or at least get rid of debt!

Many Years Of Good Fortune

For years, radiologists have been blessed with more and more new procedures and technology. And, each year, private insurers and the government continues to reimburse reasonably well. This pattern has become long standing for years and years. Regular salaries mean more saved wealth!

Additionally, even in the leaner times, newer radiologists could command a higher salary than most other professions out there. So, even recent grads will tend to have lower debt loads and higher net worth than other specialists.

Skewed Age Of The Measured Population

Elsewhere in the survey, you will note that the older the physician, the more net worth saved. And, the population of radiologists slightly skews to older age compared to some of the other professions. We can still work into our 70s, 8os, and even 90s (if we are lucky!) All we need is a set of glasses and some insurance credentialing, and we are good to go! Therefore, savings can take the same overall weighting as well.

We Do Not Have As Many Income Extremes

What exactly explains why radiologists less commonly have a net worth over 5,000,000 dollars compared to some of our other subspecialty brethren? At least, this is my explanation. We can’t sell eyeglasses in our offices (as some ophthalmologists do) and engage in businesses that involve patient purchases. And, we need to take all sorts of insurance to make ends meet. (Many physicians in other specialties have concierge practices that don’t!) So, as a whole, we tend not to have some of the upper extremes of income that other medical specialties can provide. Therefore, most of us do not accumulate the more substantial assets (over 5 million dollars) that other specialties more often do.

Radiologists And High Net Worth

So, these are my explanations for the overall state of financial affairs for the average radiologist in the community. Remember. Not all of us adhere to these rules. You will undoubtedly find impoverished debt-ridden radiologists as well as radiologists who live more similarly to Jeff Bezos than the typical physician. But, based on being in the trenches, these overall patterns seem to explain the survey results. Shoot me an email or message if you think differently!

 

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Breast Versus IR- The Ultimate Choice

breast versus ir

Question About Breast Versus IR:

 

Hi Dr. Julius,

I am a PGY4 resident and currently ranking my fellowship programs. Right now, I am still debating between an IR and Breast imaging fellowship. I am an active person who likes to deal with patients (within limits) and do procedures. Also, I am a family guy who likes to spend time with family and travel together besides social activities. I love IR, and I see myself in IR, but everyone is warning me of the stressful lifestyle and crazy calls. I know it depends on the practice that I will join. But, sometimes I think about it differently. I mean why I would spend two years in IR fellowship (Non-ESIR) to perform mostly central lines and biopsies. Plus, people tell me that IR will become routine, and I will lose the exciting part and left with the scraps.

On the opposite side, breast imaging is a good lifestyle. I will see patients (I enjoy seeing patients) and perform procedures. Also, I am willing to do 50% breast and 50% general radiology after fellowship if I complete a breast fellowship. I don’t want to regret not going to IR. Should I risk it better than regretting it? I have to submit my ROL by the end of this month; I appreciate your help.

Thanks

Breast Versus IR

 

Answer:

What you do in IR depends upon where you decide to practice. If you choose the option of working in a highly academic large center that is on the cutting edge, you can be performing many other procedures other than central lines and biopsies. But, of course, you might sacrifice salary if you have a lot of debt. (not all the time but most).
And for the most part, if you are doing IR, you will have more weekends and nights. It is true that you will not be able to leave the department as smoothly during the daytime to take care of issues at home. Albeit, you may get more vacation overall to compensate for the extra time on call. When you are working in IR, you will generally work on your feet a lot for long hours.
On the other hand, breast radiology does allow you to work fewer weekends and nights as well as being able to occasionally escape to do other things during the day if you are reading screeners. And, you can perform procedures (even cutting edge procedures depending on the institution) But, in general, as breast radiologist, the procedures that you complete will be less involved. In both career paths, however, you will get to work directly with patients (and be a real doctor!)
So that is my little summary for you. There is a sort of lifestyle/procedure decision that you will need to make. What I’ve discovered over the years: no field is going to meet every one of your criteria. Those folks that are the happiest can decide which track to choose based on their life priorities.
Hope that helps,
Barry Julius, MD
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Why Standards Of Care Are Important To Fight For!

standards of care

I don’t know if you have noticed, but you have probably heard the term standard of care bandied about a bit during your residency program at some point.  But, first of all, what does the standard of care mean? Well, according to MedicineNet, it is “A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.”

However, not all standards are the same. Some measures are national standards, and others are merely within one’s department or practice. But, why is it so important to all physicians, and more importantly, specifically for radiologists? And, what happens if we all don’t meet the “standard of care”? Well, the result may not be so beneficial for you or your practice. Consequently, standards of care are of critical relevance to our world. And, that’s the topic for today!

Legal Reasons To Follow National And State Standards Of Care

OK. Let’s first start with the bugaboo. If a practice or its members are not following the best national/state standards of care, they are prime candidates for a lawsuit. To that end, one of the three pillars of a successful malpractice lawsuit is not meeting the standard of care, So, that alone should make you quake in your pants if you do not abide by these norms.

Importance of Individual Practice Standards

Well, it’s not only about the legal issues when you do not follow national and state standards. Additional trouble can ensue if you do not apply standards within your group. What do I mean by that? Well, not all practices follow the same rules because norms throughout the country and state can differ widely. Let me give an example.

If you decided to look up the requirements for how to determine which patients are appropriate candidates for a hysterosalpingogram (a test to check the anatomy of the uterus and fallopian tubes), the information is all over the map. At best, the data about how you should decide which patients should get the test is scattered and based on differing experiences. Some groups advise that you should perform the procedure between 6-10 days after a menstrual period without additional testing. Others recommend that patients should also have a urine B-HCG level before considering the patient for the test.

In either case, each practice standard is theoretically acceptable. However, if each member of radiology practice uses different criteria for deciding upon when to perform the procedure, what happens? The secretaries become confused about how and when to schedule the examination. And, the technologist or nurses can easily forget what each radiologist requires before the exam. It becomes a mess of confusion. So, practices need standards to prevent these inefficiencies.

Moreover, god forbid if somehow, a patient discovered that they were pregnant before the test, and one radiologist did not test the patient with a B-HCG level (unlike all the others in the practice), then that radiologist did not meet the standard of care for the practice. Theoretically, that could also open up the radiologist to additional legal actions.

Standards Of Care From The Patient Side

Finally, from the patient point of view, nowadays patients can look up information about best practices and procedures online before deciding to get a test. If your group does not meet these standards, and the patient becomes aware of a subsequent complication related to not meeting these norms, at best, the patient may never return. And, at worst, your practice becomes at increased risk of receiving legal action.

Fight For Group Standards Of Care!

As you can see, we all need to be on the same page in any radiology group. Changing practice standards to vary from national and state norms can lead to disaster for the group and the individual radiologist. Moreover, creating specific practice standards within a group can be critical to maintaining efficiency and reducing confusion among the staff. So, think twice if you decide to be OK with not meeting standards in your practice, it may be your future career at stake!

 

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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!