Year: 2019

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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!

tomatoes

 

 

 

 

 

 

 

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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

 

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The Radiology Job Market Cycle: Don’t Enter At The Bottom!

market cycle

Last month, one of my favorite fellow radiology bloggers, Eric Postal at Diagnostic Imaging, wrote a piece entitled Where Did You Enter The Job Market? In it, he described some of the issues of entering the job market at different points of the radiology job market cycle. And, he painted a relatively even-handed picture of the situation.

Now, I don’t want to be Negative Nancy or David Downer, but, unfortunately, I have to give a less rosy assessment of the situation. Sometimes, you have to describe it like it is: The residency graduate at the bottom of the job cycle sometimes may never completely recover.

Fortunately, for anyone who is entering the job market at this current “high point” of the cycle, you will not have to experience any of these issues if you find the right job at the outset. But, for those of you who entered the job market cycle at less desirable times, you will understand precisely what I am saying. So, let me tell give you a summary of the reasons why job applicants in the nadir of the cycle may permanently feel the pain.

It Takes Years To Recover From The Personal Financial Losses

Once again, the magic of compound interest only works when you can maximize the earnings of your earliest working years. Unfortunately, working at 20 vs. 25 years at maximal salary makes an enormous difference. And, if you find a barely adequate job when you first start, you will have lost out on that opportunity. You may have delayed partnership by three, four, five, or more years. Or maybe, you chose a second fellowship instead of going out into the job market. Either way, those lost years can become more significant than you might initially think. In the end, a loss of this amount of time can lead to millions of dollars of decreased savings as a radiologist!

You May Have To Root Up Your Family From A Locale

So, you don’t like the circumstances of your first job due to its location or circumstances. Well, it may not work out so well for you and your family. Perhaps, you have children in elementary or middle school. In this situation, you may have to pack up your bags and take your whole family with you to another town. Imagine the trauma of moving for your children to a new school in a different city. It is happening right now to many of you that entered the job market toward the negative end of the cycle!

Forced To Practice In A Specialty Area That You Don’t Like

OK. You did that fellowship in mammography because you thought that it would help with obtaining a job in a medium sized city, even though you did not enjoy it that much. Now, your skills have atrophied in other areas in radiology. What do you do, now that you want to switch jobs? Another fellowship? Well, at your stage in your life, it’s not so easy to pick up and start another training subspecialty again, once you’ve been out and working for several years, is it? Your decision may stick with you, forever!

More Likely To Have Multiple Jobs

Anyone that starts a so-so job during a downturn will become more likely to leave their job when the market improves. Perhaps, you need to go because the practice has become so oppressive. But, who wants to pick up and start anew again? Moving can be such a drag. And, all those connections that you have made in the community, utterly lost!

Academic Career Rewards Delayed

Maybe, you have set your sights on an academic career, possibly becoming a chairman. But, wait. Since you entered at the bottom of the cycle, your department may not promote you as rapidly. Why? Because you have nowhere else to go. They can get away with it, of course!

Entering The Job Market At The Bottom Of The Cycle

No matter what other authors may say, there is no way around it. Nor, can I sugarcoat it. Entering the job market at the bottom of a cycle can become a permanent disadvantage to your career, finances, and future. But, I am glad to say these issues no longer apply for those starting after completing residency and fellowship now. Let’s continue to hope that for all of the future job applicants; the good times continue to roll!

 

 

 

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What It’s Really Like To Be Pregnant During Radiology Residency!

Dear Dr. Julius,


I am writing in response to the post that I recently saw on the Radsresident.com blog regarding pregnancy in radiology residency. While I commend you for your efforts to assist aspiring radiologists in their search to balance the stresses of training with life-altering decisions such as family planning, I must admit that the responses seem overly simplified and downplay the stresses that one faces while enduring this transition.

Having entered radiology residency with a child, who I had given birth to at the end of my third year of medical school, I certainly am not an expert on the stresses of having a first-time child during this portion of the training. I did, however, decide to have my second daughter during residency training. And, she was born towards the end of my R1 year.  If you were so kind as to indulge me, I would like to add some insight into the questions previously posed now that I am about the finish my R4 year keeping in mind the lessons I have learned along the way.

Is pregnancy in radiology residency doable?

Short and long answer: Yes. Starting or expanding a family in residency is ultimately a choice.  It is doable, but that doesn’t mean, you will not have to make sacrifices. Some days you will feel like a great mom and other days you will feel like a great resident. Every once in a while, you will feel both. Your time will be stretched; your attention will be split. You will have to work hard just like anyone else who has personal issues they are dealing with at home. If you commit though, you can make it work and not just survive residency but also thrive. I would also argue that my children have helped me keep perspective through this all, and I don’t believe I would be as good as I am if not for my desire to show them the rewards of working hard.

Are programs supportive of students who expand their family during residency?

The answer to this question depends but generally the answer is yes.  Most programs have some form of leave for residents. However, this does not mean that the program will pay for the entire time off. The Family Medical Leave Act (FMLA) should guarantee that you receive up to 12 weeks of time off if you need/want it, but this does not mean that you will be paid for the entire time. Additionally, the program may expect you to use your vacation time during your maternity/paternity leave. So, consider this when planning.

Some programs like mine have built in time for new parents (both male and female), which is up to 6 weeks PAID leave in addition to any vacation time you want to use up to the 12 total weeks off. However, standards may vary, and the best people to ask would be the residents themselves. As per the NRMP, programs cannot legally ask you about your family plans during an interview unless you ask questions that open the door to this subject. However, this doesn’t mean you cannot probe the current residents about their experiences (and honestly you should).

Are there radiation exposures that I would need to avoid in a diagnostic radiology residency?

As Dr. Julius said, the only potential for significant exposure you will face is during fluoroscopy or interventional radiology rotations. If you find out you are pregnant, you can alert your radiation safety officer and officially declare the pregnancy. Once a pregnancy is declared, you will receive an additional radiation badge that tracks the radiation you receive over your pelvis (the badge goes UNDER your lead). The badge measurement should represent an estimated amount of exposure to the growing fetus.  The most important time to avoid radiation exposure is during the first 12 weeks when organogenesis and rapid cell division is highest. However, you do not have to perform IR or fluoro duties later in the pregnancy if you don’t want to.

I had my IR rotation early on, so it wasn’t an issue. But, I ended up shifting my fluoro rotation to another academic year because I didn’t want any unnecessary exposure. Your program and the chiefs should be willing to work with you. If you feel comfortable talking to the chiefs ahead of time, you may even be able to coordinate those rotations earlier/later to avoid having to cause scheduling changes later on. Of note, some women choose not to declare their pregnancy and continue to work. I know of IR attendings who worked during their pregnancy the entire time. But the point is, it is your right to decide how much potential exposure you will receive. You need to feel comfortable.

Is there a typical year of residency easier to have a baby than others?

I think this sincerely depends on the program and how it distributes residents among services. I would agree that the R4 year may have more flexibility due to elective time. But, R1 year is also relatively light given the lack of call. In my hospital, R2 year is especially difficult and demanding, but the toughest year can vary depending on the program.

I tried to time my pregnancy on purpose towards the end of my R1 year. By doing this, I was able to take advantage of the six weeks of paid leave offered by my hospital. In combination, I was also able to take two weeks of vacation from R1 year and tack it on to 2 weeks of vacation from R2 year for a total of 10 weeks off. I will be finishing on time. And, I did not have to remediate any rotations except the few weeks of fluoroscopy I missed during an R4 elective.

Timing is not always doable, and you may experience stresses related to just trying to get pregnant during training – just something to keep in mind. I even met a girl last year who was eight months pregnant while taking her boards examination. She passed. Life goes on. Ultimately, there’s no perfect time to have a child, and the program should help you work through your needs as you encounter new challenges.

With radiology being a male-dominated specialty does this cause strife between residents during maternity leave? (Is there maternity leave?)

I can only speak from personal experience that I had very supportive co-residents. But, I believe this stems from the underlying culture of my program/hospital. I believe that resentment may be a little harsh to describe the sentiments of the other residents. Certainly, if additional/compacted call falls on your colleagues, they may be anxious for your return to mitigate the stress of call.  Not one of my co-residents ever questioned my dedication to the program during or upon my return from my leave. If anything, you may have some challenges with the attendings once you come back. And, you may find yourself having to prove your knowledge in light of a prolonged absence.

I would argue that as long as you are meeting milestones and keeping your major/minor change percentages on par with your colleagues, you should not have to worry. You need to understand, however, that your choice to take time off will require dedication and discipline. Upon your return, you will make up for the time you lost to “catch up.”

How do you decide if a program is family friendly and future-family friendly?

I would advise asking the residents during your time with them on interview day or during pre-interview dinners. Don’t single yourself out, but ask general questions like, “How many residents have families?”; “What’s the program’s family leave policy? Is it paid? Do you have to use your vacation?” As Dr. Julius mentioned, having support nearby or having a supportive partner is probably the most important thing. Radiology residency may be less demanding in terms of physical time in the hospital. However, you will need to read and study during your off time to excel. You will be preparing case conferences during off hours if your program doesn’t give you dedicated time. You will need to carve out time for yourself and your well-being. All this work requires the support of others.

Feel free to allow your readers to contact me directly with questions on Twitter @KVincentiRad.

Thank you for your time.
Kerri Vincenti, MD
Chief Radiology Resident
Pennsylvania Hospital of the University of Pennsylvania
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AUR Update 2019: What’s In Store For Your Radiology Residency?

For those of you that don’t know, the Association of University Radiologists (AUR) annual meeting is the main forum for all radiology residency programs throughout the country to discuss the most critical issues affecting radiology residency programs, GME education, and radiology medical student education. These include anything from the radiology residency match to the job market as well as the hardcore academic issues.  So, once again, I would like to keep you up to date with the AUR update 2019 on what is new in radiology education and the main factors that may impact your training.

Radiology Match/Competitiveness

As I had previously promised in a previous blog on the match, I will provide with a summary of the numbers compared to past years. Slightly different from my experience in the match, the numbers pointed to an overall similar year for radiology residency competition. Compared the previous year, 18 spots were left open (previously ten places). And, the percentage of foreign graduates were also similar (32% vs. 29%). However, the number of applications per resident had increased significantly, perhaps driving somewhat more competitive applicants into the interview spots.

Given the numbers, however, the facts show no significant change in competitiveness from year to year. Interestingly enough, in my experience, the overall quality of the applications was higher. (my experience can differ from the overall statistics!) So, I believe that some increased self-selection has been happening, not measured by the statistics. In terms of competitiveness, one of the hot topics lectures stated that radiology this year was similar in competitiveness to emergency medicine.

The Job Market

Like the previous year, the future has become rosy for new radiology residency graduates. Droves of retiring radiologists and a good economy are leading to the robust job markets for new radiology resident graduates. Also, similar to the last year, there are nearly two jobs available for each diagnostic radiology residency graduate. I would say that is not too shabby!

Furthermore, the needs of practices remain similar to the past. Body imaging, neuroradiology, and interventional are the most common available first jobs. And, the greatest need for radiology practices remains breast imaging, body imaging, and neuroradiology. Most jobs posted are again available in the South and the least in New England.

What I found particularly interesting: 8% of all graduates were able to find a job with no fellowship training. I’m not sure what the statistics were for the previous years (probably a lower percentage in past years), but I have a feeling these folks would still have a hard time finding a position on the populated coasts. However, these statistics bode well overall for all graduates trying to find a job.

Change In Board Pass Rate Minimums

From an associate residency director of a “smallish” program, ACGME board passing changes have the potential to make some issues for smaller radiology residency programs. No longer is the minimum requirement an 80% pass rate for residencies by the end of the residency.  Instead, each program needs either an 80% first-time core examination pass rate or be over the 5th percentile for all residencies (that makes up about seven programs) with a look-back of five years. If you happen to have a “freak” year or two of a lower pass rate as a smaller program, the ACGME can target your residency for a new site visit. And, that can wreak all sorts of havoc!!!

Radexam

Now that the monthly evaluation exam has matured a bit, we have more details on this evaluation system. You can expect the availability of a more sophisticated assessment of individual scores and more customizable examinations to different institutions. You will see new exams in fluoroscopy, GI, and GU. Even the AIRP plans to have a distinct test to confirm that residents have attended the conference!
Also, they have instituted a new overall R3 level assessment test for these residents before going into the core exam. The examination will be available until June 20 and may be a great way to assess the progress of the resident for the core. We will see!

Unconscious bias

The quality of the speakers at the meeting varies widely. But, this year the AUR meeting provided us with a treat. Straight from the NPR news station, Shankar Vedantam gave an excellent lecture on unconscious bias and how that can affect radiologists when it comes to issues like the selection of diverse radiology residency applicants. No, it did not provide us with a formula for maintaining diversity in our residencies. But, it did give a new perspective on how we make the decisions that we do. If not this year or next year, I would expect some future changes in the rules for the overall process of residency selection and evaluation to incorporate some of the principles from this talk.

AUR Update 2019 and Change

The one constant in all radiology residencies is “change.” And, this year with the AUR update 2019 is no exception. Between the match, the improving job market, changing pass rate standards, an evolving Radexam, and new perspectives on unconscious biases, I foresee that our program, as well as all programs across North America, will have to roll with the punches and continue to adjust!