Month: August 2020

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Do Board Review Companies Help With The USMLE?

board review

Not all students learn the same way. And, each method of studying has different pitfalls and benefits. For a distractible student, you need an isolated organized environment to study. And, a large group may not benefit this individual. As a kinetic learner, the action of performing a lab or dancing while reciting study material may allow you to absorb the material better. But, sitting in one place staring at a book may not work as well. My point is that board review is not a “one size fits all” activity. And I recognize that.

Moreover, in my experience, I have seen board review companies giving an unqualified boost to some test-takers in question. And, others who have not taken a board review course do just fine So, to answer the question posed on this post, do board review companies help medical students and residents with the USMLE, I will have to be a little wishy-washy and give you an unqualified maybe!

But if you are reading this post, what you are asking is will a board review company help me. And, perhaps, even more importantly, is the course a waste of money and time? So, another way to word the question would be, what types of medical professionals would and would not benefit from using a board review company? And, those are just the questions that I will answer!

Students That Benefit From Using Board Review

Residents Without Organizational Skills

What board review companies do best is to provide you with a routine and a defined way to study for the examination. They give you the material that you will need to make sure that you will pass the exam. For some students and residents, the course leaders’ material and the demands provide a bit more structure. Of course, a system and a routine can allow these test-takers to focus on studying for the exam.

Poor Test Takers

Some residents and ‘medical school students either develop anxiety or think too deeply about a question and perseverate for a half hour. Board review companies are good at making sure you understand the how’s and why’s of taking tests to improve your test-taking skills. What’s interesting about many poor test-takers is that they don’t necessarily translate into bad radiologists. In this situation, a board review company can provide a bit of a boost to your scores. It is most likely worth your time and money for that extra help if you consider how much more you will make in your lifetime.

Previous USMLE Low Board Scores Failures

They say that the definition of crazy is expecting a different outcome after doing the same thing again. Well, anyone that has not done well on a board exam beforehand should utilize the extra help to get you over the hump to increase your chances of acceptance into the radiology fold! Board review companies can help to change the way you study the next time around.

Students/Residents With Borderline Credentials For Acceptance

If you are a resident toward the middle or bottom of your medical school class, a higher score on Step I (Or now Step II USMLE with the new changes) can make all the difference between acceptance to residency/fellowship and rejection. Many residencies (and to a lesser extent fellowships) will use cutoffs in Radiology to ensure that the accepted class will pass the core exam. Why? Because there is a correlation between doing well on the USMLE exams and passing the core exam. And, a boost of only 5 points on your exam can make all the difference between capturing that interview and total rejection. It’s probably worth it to shell out that extra dough.

Foreign Applicants

Finally, if you are coming from another country, the programs will scrutinize your application more. Any advantage can help your case. If you have reached this far, you are better off taking a course even if it only increases your score by a few points. It may make all the difference!

Students That Don’t Need The Extra Help

Natural Born Test Takers

Yes. Some students and residents can take almost any test and pass it with flying colors. (Aren’t you jealous?) They have just mastered the art of examination to a tee. Based on the question itself, regardless of the information at hand, they can almost sniff the right answer. If that is you, then forget about board review. Save your money!

Honors in Every Course With Twenty Papers Already Completed

Check. Some folks have had an incredible academic record, and no matter what will get into the residency of their choice with or without excellent board scores. If this person is you, why bother to pay up for another exam?

You Get The Point!

I think you see what I am getting at here. Some folks don’t need to pay for that extra boost of a few points. It may not be worth the extra outlay of cash for those folks.

Board Review Companies Work Well For The Right Fit!

I know how painful it can be to shell out a bit more money when you already have umpteen gazillions of dollars of debt. But, sometimes, it is worth it to pay up for the additional help, especially if it may mean the difference between having a long career in the specialty you want. Having a guide that can get you through the pitfalls of studying for these tests is invaluable for the right sort of test-taker. So, consider where you stand and decide if it is right for you. Here are some of the more frequently used board review companies below that my residents have used to help you along with your decision. You can click on them if you are interested. I am an affiliate of both! (Princeton Review currently has a discount that expires on September 3!)

 

 

 

 

 

 

 

 

 

 

 

Academic Tutor LOL (24 hrs) – $180 Off!

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Malpractice Tail Insurance? Pop The Question Before Your Next Job!

malpractice tail insurance

Since most training programs cover their trainees for malpractice insurance, it is probably the last item on your mind. And you already have enough residency and fellowship issues to worry about right now. Nevertheless, as soon as you apply for your first job, all that will change—malpractice insurance costs tens of thousands of dollars. Tail insurance can cost even more than the malpractice insurance itself. And, if you are not aware of this insurance, you can lose a bundle when/if you decide to change jobs. So, what exactly is malpractice insurance tail coverage, and why is it so critical to know how it works before taking that next job?

What Are The Different Types Of Malpractice Insurance?

First, we need to discuss some of the basics of malpractice insurance and the types of insurance policies. The two types of insurance policies you will often hear about are occurrence and claims-made policies. The least common type of malpractice insurance is called an occurrence policy. It covers all claims made before and after you leave a practice. Why is an occurrence policy less common? Simply because it is more expensive than claims-made plans.

On the other hand, a claims-made policy terminates right after you leave your job. So, if you stop working and are sued for a claim after you leave your employment, you will have no coverage. An attorney’s fees can be costly!

Malpractice Tail Insurance- A Gap Filler!

So, what does malpractice tail insurance do? Naturally, it covers any lawsuit claims from your old job after you change positions. The old claims-made policy does not cover these potential suits. This way, you will continue to have malpractice insurance if you leave. 

How Can Practices Weaponize This In A Negotiation?

Knowledge is power when it comes to negotiating a contract. And, frequently, many residents don’t know to ask about malpractice tail insurance. So, when changing jobs, they are stuck dealing with the following practice for malpractice tail insurance coverage as a benefit. This negotiation can potentially decrease the overall compensation package at the new job. In a worst-case scenario, you may have to flip the entire bill out of your pocket. 

And this sum of money is not insignificant. One article quoted the malpractice tail insurance costing 2.5 times the cost of malpractice insurance per year. In radiology malpractice insurance, this can translate into a 40-50 thousand-dollar bill. That money could have gone to paying down debt, buying a new house, or your kid’s college savings. And you could have potentially avoided all this loss by negotiating a tail in your first contract!

The Key To Knowing About Malpractice Tail Insurance!

I want to know what you are getting into before you take your next job. Other parts of the compensation package may be too good to overlook, and a claims-made policy without tail coverage may be relatively insignificant. Or, it can be a deal-breaker. Regardless, don’t let a new practice tell you they have excellent malpractice insurance coverage, only to find that you have an enormous bill to pay when you leave. Pop the question before you take your next radiology job!

 

 

 

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How Can I Prevent Low Imaging Volumes From Causing Me To Lose My First Job?

low imaging volumes

Question About Low Imaging Volumes:

Hi. I am an R2. I’ll most likely do a fellowship in body imaging (mostly because I haven’t felt a click with any particular specialty). I keep reading about practices firing radiologists because of low imaging volumes due to COVID. I’m concerned that this will affect me when I apply for jobs because I am only interested in private practice. I want to position myself with some advantages, and I need your advice on how to do this. I particularly enjoy the IT aspects of radiology (troubleshooting PACS, EMR, making software more efficient, automation, computer hardware). In my residency, there is a faculty member who is the “Director of IT.” And, I might be interested in a role like this.

My question is, do you think this is something that is even an advantage if you are seeking private practice? If so, how can I enter this space? Is there a course? Do I do research? If this is a bad idea, are there other things I can do during residency to give myself an advantage when it comes time to apply for a job in private practice? 

What should I do?

 

Answer:

Armaments To Prevent Job Loss

These are excellent questions, and I have a few answers! Let’s start with the first one about practices firing employees because of low imaging volumes. First of all, this Covid situation will most likely all but disappear by the time you graduate residency. Nevertheless, one of the best protection against getting canned is to become invaluable in whatever area that you practice. That niche can be informatics/IT. However, it all depends on the type of practice where you work.

If you aim to work at a small private practice somewhere, it will probably not help all that much. If you work for a larger institution or an academic center, it can help a lot, depending on what you do. In an educational sort of setting, if you are pumping out tons of papers and creating lots of programs/IT solutions for your colleagues, no one will want to let you go. Alternatively, if you are in charge of a massive corporate IT program, and the business cannot function well without your knowledge, they will not fire you. On the other hand, if the IT services you provide are just a little help, and the clinical work that you provide to the practice is not so much. Well, then you will not have the same job security.

At this stage of your career, work hard, and perform well in residency regardless of your fellowship. Learn about all aspects of radiology as much as you can so that you can establish a niche for yourself when you leave your residency. To repeat, most folks that are good at what they do will be the last to be fired.

How To Get Into Information Technology

Next, how can you enter this IT space? Well, some of it depends on how much experience you have in IT already. If you don’t have the knowledge that you would need to take over the IT at a practice, you would probably want to look into the Informatics fellowship. This fellowship will give you the basics of what you will need to know about IT for radiology practices. There, you can establish connections that you would need to find a career. Additionally, research in your area of specialty is never a bad idea during residency or fellowship, especially if you want to follow the more academic path.

Final Advice

So, there you have it. Work hard, learn as much as you can about radiology, consider an informatics fellowship (if that is what you want), and perform a niche in a practice that others have a hard time filling. These are the ingredients that will keep you in practice regardless of the Covid or any other unfortunate situation that may arise to lower imaging volumes for radiologists.

Good luck,

Barry Julius, MD

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Going Through A Covid Surge? It May Help Your Career!

surge

Yes. Covid-19 has been an epic disaster. But, in any emergency, opportunities arise. And a new Covid surge is no exception. Sure, the hospital may curtail or delay some of your training in radiology. However, this pandemic affords you other chances to establish a reputation for yourself in your hospital and community. And, you will learn other clinical skills that are just as critical as radiology. Demonstrating your prowess in these dark times can lead to unforeseen possibilities in the future. These opportunities can prove themselves more valuable for your future than you might think at first glance.

So, what are these potentialities that I am referring to? Your experiences and performance during the Covid era can lead to job openings, better recommendations, networking, improved clinical skills, better awareness of the community, and more if you play your cards right. Let’s talk about how.

Increased Contact With Hospital Administration

In a typical environment, most residents have very little to do with the hospital administration. At the beginning of the first year, they may hear a few words from the executives to introduce them to the hospital. And at the end of the last year, they help to hand out the diplomas. That’s about it. But, in many departments, this paradigm has shifted.

Now that you are providing a service for the hospital under extenuating circumstances, you are more likely to have the ear of the administration. If you ever want to start looking for a job in the hospital and perform well, they will more likely remember you when the time comes to search. Even better, if you ever want to look for a career in hospital administration, there is no better time to prove your worth and team-building skills than now.

Better Recommendations

Tough times call for more teamwork. And, what better way to get to know your attendings than a stressful situation such as this? In actuality, faculty are more likely to get to know their residents when you are in close contact. You are no longer just another resident! And, this will show in the recommendations that you receive.

Increased Intra-Departmental Networking/Learning

Since you will most likely work with different teams of subspecialty physicians throughout the hospital during a covid surge, you will get to know your colleagues better. Believe it or not, cross-currents of learning and insights into other specialties also help with becoming a better radiologist. It could be pulmonary, cardiology, or pathology. All subspecialties overlap with ours!

Just as critical, establishing relationships with other physicians that you would never have seen as a radiology resident, will make you more valuable. Who would other physicians instead refer patients, a radiologist that they know well, or someone else?

More Awareness Of Clinical Medicine

Sometimes in radiology, we can grow farther away from the real reason why we went into medicine in the first place, to help patients. Having more direct interaction with patients, even in an unforeseen emergency such as this one, can lead us back to our clinical roots and remind us why we are radiologists in the first place. It allows us to rehone our clinical skills that will come in handy later on as an attending.

Getting To Know The Community

Some residents go to residencies based on the quality of the program alone, ignoring the community. However, you also serve a community, and sometimes getting into the clinical nitty-gritty can allow you to understand the patient populations for which you work. If you doubt the importance of your role in helping out the community, look at the media presentation of healthcare workers. Typically, they present all of us (even radiologist residents) serving the hospital as heroes. Heck, in our community, the leaders hosted a parade for the folks at the hospital to demonstrate their appreciation. So, if you think that you do not influence the community, you are dead wrong. Getting back to these roots will allow you to appreciate once again where you work!

Time To Prove Your Mettle During A Covid Surge!

I know. You may not have bargained for these circumstances. However, there are always a few golden nuggets that we can take away in almost any bad situation. So, even though you think there is no value to having work other roles in a surge, it may be more helpful to your career growth than you think!

 

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Check With Your Faculty Before Letting A Barium Patient Go!

barium patient

Barium slinging is harmless, right? I mean, what’s the big deal about letting a patient go after you complete a standard esophagram or barium enema? How often have you, as a resident, completed one of these studies without checking the results with your attending, only to let the patient go home right afterward? I bet most of you have done so at one point or another. If there is any complexity in the case whatsoever, I would think twice before letting the barium patient leave before checking it. Why? Well, for lots of reasons. And I will divide them into the following broad categories, legal, lack of experience, extra scrutiny, patient-related issues, and lack of insight into history. Let’s go through them one by one.

Legal Issues

Residents are not the final interpreters of any study, whether it be a plain film, CT scan, or ultrasound. Additionally, distinct from most other imaging modalities (except for ultrasound), the resident is responsible for showing and carefully examining the findings. If she does not technically demonstrate the findings based on history, the study becomes useless to the ordering physician. Consider the resident not spotting the terminal ileum in a small bowel series for inflammatory bowel disease. Or, maybe he doesn’t complete a cine of the upper esophagus in a patient with dysphagia. Who is responsible for the lack of information targeted to patient history? The attending, of course! Just read this AJR article about barium enemas and malpractice, and you will think again. Radiologists are liable for the missed interpretation based on resident imaging!

Relative Lack Of Training

When barium slinging was more common years ago, it used to be one of the more litigious radiology areas. Just like mammography, you could easily miss all sorts of colon cancers, ulcers, and more. Typically, it would take years of experience to develop the trained eye to find these abnormalities. Don’t think that barium work is easy, so much so that you can blow it off as a low tech waste of time. On the contrary, one inexperienced resident may not be enough to catch the pathology that you will need to find. There is hubris in thinking you know more than you do! Moreover, think of this opportunity to go over the case as an additional learning opportunity to become better.

Second Set Of Eyes

On that same notion, having a second set of eyes can be a critical adjunct to making the finding. It’s like breast imaging. Often, the ultrasound technologist cannot find a blessed thing corresponding to the patient’s lump. But, as soon as you, the physician, walk into the room, WHAM! It’s right in front of your face as clear as day. Sometimes, you need that second set of eyes to get you out a particular mindset. It’s worth it.

It’s A Big Deal To Bring The Patient Back

Finally, if you miss looking for a finding on the study, the patient may not return so quickly, especially as an outpatient. For instance, in the patient population with dysphagia, many of these patients may come from rehabilitation facilities or nursing homes. Did you ever think about how hard it was to get the patient to the study in the first place? Or, maybe the person has a hectic job and made special arrangements to complete the procedure. Now, you need to bring the patient back. You may not think so, but it can become a huge issue!

Check With Your Faculty Before Letting The Barium Patient Go!

Don’t take these studies for granted. Allowing for these studies to go unchecked can cause all sorts of trouble, including legal dilemmas, missing findings, and having to bring unavailable patients back for more imaging. So, please, if you are on the fence, think twice before sending that patient home without having your attending check it. It could be lousy patient care!

 

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DO Friendly Programs- Should I Bother To Apply?

do friendly

Question About DO Friendly Programs!

 

Hello! Thank you so much for this website; it has helped me out immensely. What is your take on small community programs with lots of DO residents? They seem to have a pretty good fellowship match (IR in some top programs, a pretty good mix of fellowships overall).

 

Thanks a bunch,

Low Tier

 

Answer:

 

I am somewhat biased as our program has welcomed both DO and Caribbean medical school graduates for years. And, yes, folks consider us a “community” program. (although that will change with our impeding merger)

 

My philosophy on radiology education is that a residency is only as good as what you put into it. Regardless of the name, if you work hard and read a lot, you will come out of your residency as a great radiologist. The big difference some of the more popular programs afford is additional subspecialty work that you might not get elsewhere and hardcore research that you may or may not want. However, all is not lost if your residency does not fit this category. Indeed, you can get some of these experiences during your fellowship. And, most residents complete a fellowship after residency.

 

In terms of being a DO friendly program, I have no problem with that. As long as education is of high quality and the program’s resources are adequate, it should not matter if the residents are Caribbean, foreign, or DO. In our residency, some of our best residents tend to be Caribbean grads, for one reason or another. That should not dissuade you from applying to a program if you know that the program’s quality is high, and you will receive the training you want. We have had excellent residents from American, Caribbean, and DO residencies alike.

 

Hope that helps,

Barry Julius, MD

 

 

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Do CAQ Fellowships Add Any Additional Benefits?

caq

Have you ever wondered why some subspecialties have a separate certificate of added qualification (CAQ) while others don’t? Are there any advantages to getting these added certificates? Or is it just another degree? If you hate taking additional tests, why would you even bother with another examination to get one? I know that these are some of the questions that I have thought about a bit. And this is a great forum to answer them!

The Main Subspecialty Certificates Of Added Qualification

What are the officially recognized CAQ specialties by the American Board of Radiology (ABR) certificate of added qualification? As listed in the link above, the three most common that radiologists typically complete (from most popular to least popular) are neuroradiology, pediatric radiology, and nuclear medicine. The ABR also lists Vascular and Interventional radiology as a CAQ specialty. But, in reality, it is now a distinct full-blown specialty with a separate board and residency program. And then finally, it also lists hospice and palliative medicine as well as pain medicine as two more options. I don’t know of any radiology residents who have completed these subspecialties CAQ after a radiology residency. But, I am sure there are a few out there somewhere.

How Did Some Subspecialties Become CAQ Subspecialties And Others Did Not?

For the CAQ subspecialties, an academic cohort of individuals decided to make specific qualifications for their subspecialties. Sometimes, it was to limit encroachment from other specialties upon their turf. Or, it was to protect the subspecialty’s interest and maintain minimum standards.

Other subspecialties that do not have a CAQ, never had enough members to put in the effort to create a CAQ. It takes a bit of work and money to create an entirely new CAQ exam and all the bureaucracy that accompanies it!

What Are The Privileges/Disadvantages That CAQs Provide?

Financial/Job Advantages?

Sometimes, practices and hospitals ask to have certain subspecialists on their staff. And, in particular, they often want CAQ subspecialists. Why? Well, because frequently, other physicians or hospital administrators demand them. This demand may give you a slight advantage when you eventually go out into the job market. You may find that these subspecialties can add a few dollars to your starting salary when you begin to look. For instance, interventional radiologists and mammographers have commanded a higher salary in the recent past out of the starting gate.

Moreover, some hospitals require credentialing in specific subspecialties for their staff members. You can often see these in job board descriptions if you look at any online radiology job site. If you don’t have these credentials, you will be unlikely to get that job!

Legal Advantages (Or Disadvantage)

As a CAQ holder, you have the privilege (or disadvantage!) of the legal world considering you an expert in these fields. What does that mean? First of all, the courts hold your reads to a higher standard than other Joe Shmo general radiologists out there. In a positive sense, your subspecialty read will carry more weight in the court of law. On the downside, it also means that there will be a lower threshold for misdiagnosis than a typical diagnostician.

Additionally, the CAQ will allow you to have some “street cred” if you decide at some point to go ahead and perform expert legal work. Lawyers love having subspecialists on their payroll to convince jurors one way or another in malpractice lawsuits.

Pigeon Holing

If you are neuroradiologist and hold a CAQ, you are more likely to work at the facility, and complete neuro reads. Of course, this work can be great if it is the lot that you have chosen in life and you are happy doing it. However, it may pigeon hole you into becoming a neuroradiologist even if you are not so fond of the subspecialty work. So, beware of the subspecialties that you choose!

Surveys

If you like making some extra dough on the side, becoming a CAQ subspecialist opens up a few doors to get these subspecialty surveys. Typically, these surveys pay a little bit better than more general ones because of the laws of supply and demand. You are now less one of a fewer number, so you are needed more!

Bragging Rights

And, then, of course, you have the added benefit of bragging rights. If you happen to work at an academic facility, these bragging rights become more important to maintain your status in the field. And these institutions base promotions on their credentials. And, yes, the CAQ counts as another hoop in this game!

Testing

Finally, you will need to pass a qualifying exam in whatever CAQ subspecialty that you choose. For those of you who have had enough testing over the years, this added test may be more than you can bear.

Do Non-CAQ Specialties Have Any Meaning?

With all these inherent characteristics of CAQ specialties, do fellowship specialties without any CAQ have any meaning? Of course, they do! The point of any added subspecialty training, regardless of subtype, is to get additional training in areas of interest. And if you are telling me that a fellowship in Cardiac MRI holds no value because there is no ABR CAQ, you are suffering from CAQ delusions of grandeur. Fellowship training with CAQ or not is only as useful as what you learn during your fellowship. And, there are lots of imaging procedures to learn with or without an official CAQ!

My Whirlwind Tour Of The CAQ World

So, there you have it. Now you know what you need to know about the basics of the CAQ subspecialties. Being CAQed certainly has its privileges and its downsides as well. Make sure to enter this data into your choices when/if you decide upon a fellowship!