Month: September 2020

Posted on by

The Frustrations Of Starting Residency With Nuclear Medicine

nuclear medicine

Order matters. And when you are starting in a radiology residency, it makes the most sense to learn subjects logically to get the most out of your first year. First, start with rotations that overlap most radiology topics. Then, afterward, get a bit more specific and esoteric. Right? However, as often is the case, many chief residents and program directors only have so many open slots to fill the rotation schedule. And all of them need to get filled. One of those residents has to begin with nuclear medicine. Maybe that person is you.

So, from the mouth of a nuclear radiologist to you, why can beginning with nuclear medicine be such a frustrating specialty rotation? Well, let me give you some reasons why starting with this subspecialty can be formidable. And, then I will provide you with the information you need to resolve the issue!

Reasons Why Starting With This Subspecialty Can Be So Frustrating 

Some Nuclear Medicine Attendings Are Not Radiologists

Sometimes, especially in highly academic facilities, nuclear medicine attendings are strictly nuclear medicine trained. These attendings live and breathe a different world than the nuclear radiologist. They can’t take an overnight call as a typical radiologist would do. And, their perspective is very different from a radiologist. Not to say that they are not good doctors. But instead, you may not learn on that first rotation what you need to know to succeed in a radiology residency. Starting off the block in this situation can make your transition to radiology residency that much more difficult.

Lots of Cases Are Off the Beaten Path

In many nuclear medicine departments, most studies have less to do with the rest of radiology. For instance, many facilities perform an overwhelming number of cardiac myocardial perfusion scans. Sure, there is critical information on these studies. But, on-call, you may be very unlikely to see a cardiac perfusion case at nighttime. Or, you will catch lots of other more esoteric sorts of studies like gastric emptying to salivagrams. Although essential, learning these studies do not help much when you are taking cases at noon conference.

Need To Study Information Only Relevant To Nuclear Medicine

Finally, in nuclear medicine, you will need to learn lots of information only applicable to nuclear medicine. Learning about the dosage of radiopharmaceuticals will probably not help you much elsewhere in radiology. And, understanding radiopharmaceutical biodistribution, although critical to grasp the pathophysiology of a disease, in reality, will not go a long way toward helping you read a CT scan. This information takes time to learn and may replace the time you could discover other radiology topics. 

How To Resolve The Issues That Come With Starting With Nuclear Medicine

When starting residency on a nuclear medicine rotation, regardless of whether your faculty is nuclear medicine only or a radiologist, make sure to look at nuclear medicine with the lens of how what you see on rotation does overlap with other subspecialties. Even the lowly salivagram has some features that you may find on other imaging modalities. In this case, look at the neck CT and MRI. Check out the anatomy of what you see on the salivagram, such as parotid atrophy, inflammation, or stones. Or, for the cardiac studies, make sure to learn about the angiograms, the cardiac MRI, and the CT scan findings as well. If you stay isolated in your learning and thinking, you will find nuclear medicine more frustrating.

Also, make sure to start learning those areas that you need to know for an independent call. Understanding the relevancy will make it seem like what you are learning has more real-world applications. Check out hepatobiliary scans, V/Q scans, and GI bleeding studies first to increase relevancy. Learning to interpret these studies will have easily observable influences upon patient management. It will make you feel all the more relevant when you are first starting.

Finally, seek mentors and fellow residents who have been in a similar boat to you when you are starting. You are not the one who has had this issue. Other residents have done very well even after starting with nuclear medicine as a first rotation.

Nuclear Medicine Doesn’t Have To Be So Frustrating On That First Rotation!

Well, there you have it. You may not be starting as central to all of radiology as you might have liked. But, you can create an experience that is worthy of a great month. Just follow some of the steps I listed and above, and you will learn a lot and have an excellent experience!

Posted on by

Benefits Of A Career At Your Home Residency Institution

home residency

If there were not enough reasons to take your home residency seriously, here is another big one: faculty members running residency programs usually look for great candidates to fill their practices. And that person that they are looking for might be you!

But why would programs want their residents to stick around? Doesn’t that decrease the diversity of experience of the faculty training? Well, yes and no. First, not everyone you recruit will be from the residency program. Newly hired residents mostly go to fellowship programs outside of the residency institution.

Yes, the resident does miss out on the nuances of working at different sites when you never leave your home residency program. However, let’s be honest. There are numerous benefits to holding on to your residents and not just recruiting outside the institution. Let’s go through the distinct advantages of the residency program and the residents becoming faculty at the same site as their residency.

The Resident’s Perspective

You Know What You Are Getting Into

Familiarity is the number one reason to stick around at your home base. You are much less likely to be surprised by the business if you know them beforehand. I can’t tell you how often I have heard of practices withdrawing partnership positions at the last second, a month or two before the scheduled start time. Or, some imaging businesses may be less savory than you think. These disasters are much less likely to occur when you learn about your future job as you train during residency.

It Feels Like Home

It is comforting to work for a practice you know. You wake up and go to work with colleagues that you already respect. And, by now, you probably have many connections and friends in the same place you went to your residency program. You can’t find that as quickly if you move to a new radiology practice in a new locale!

You Know Your Location Beforehand

Sometimes, folks move to a new job to find out they want to live in a different environment. Perhaps you thought you might like to live in a rural community and then discovered that you enjoyed the suburbs better. Or, you decide to live farther away from your family, only to realize that you should have been living closer. You answered all these questions while living near your home residency program beforehand. Your surroundings are already familiar.

The Program’s Perspective

You Know What You Are Getting Into

Just like for the resident, I believe this one is the biggie. One of my favorite phrases is, “Better off with the devil you do know than the devil you don’t!” And that phrase doubly applies when recruiting from inside the system. If you are hiring from within, you already know all the quirks of the applying candidates. On the other hand, an unknown outside entity can throw your practice into disarray if you find out that the person you are hiring is not as it seems. I can’t tell you how many radiology businesses hire an “unknown” candidate only to find out once they start that they do not do mammography after saying that it might interest them during an interview. And other new candidates are not as good as they seem. These sorts of issues occur much less often when you recruit your own!

You Can Recruit For The Specialty You Need

Say that your practice is short of MSK radiologists. If you run a residency program and you like a candidate, you can tell them you will have a job if you complete an MSK fellowship. By targeting great candidates for your practice, you can also guide these individuals into areas your business may need. Of course, residents may not want to do what your imaging practice requires. But, if you choose between several fellowships that you might like the same, it would not hurt to complete the one that helps your future practice.

You Can Choose Those Resident Features That Will Grow Your Practice

If you are looking to hire, your practice probably needs certain types of faculty. Perhaps, many of the faculty members in your hospital are introverted, and you need a future extroverted leader to run the business. Or, your desired resident is a techie, and you require someone who knows their way around a RIS system and PACS. Recruiting residents who will help build the practice in these respects can fulfill all the niches you might need in the future.

Working At Your Home Residency Base

Don’t dismiss the possibility of working for the institution where you have trained. Even though the grass may seem greener on the other side, staying put has distinct advantages. Take into account all the opportunities that arise as you make your choices for your career. But your original experiences working at the same site as where you trained may be the best!

Posted on by

How Do I Find Hybrid Model Radiology Practices?

hybrid model radiology practices

Question About Hybrid Model Radiology Practices

 

Hi,

I just read the “Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money“?“. I am interested in the hybrid model for the same reason you mentioned and I love money :-). Also, I love teaching the residents. But I am not big on research, publishing, etc.

But I do not have any idea, and I do not seem to find any information about the hybrid model. Is it a rare breed? I am a PGY4 resident and working in one of the hybrid model radiology group led residency training on the East coast.

Any ideas about some of the hybrid radiology groups along the east coast or anywhere in the US?

Answer

 

Great question!

 

There are probably more hybrid model radiology type jobs than you might think at first glance. However, not enough such that it can potentially limit you when it comes to living circumstances/location. You may need to be flexible on where you eventually want to settle down if this is the type of practice you want. It worked out well for me at Saint Barnabas in New Jersey (Imaging Consultants of Essex), and it happened to be in a place that I wanted to live.

If I were to start looking for places with a hybrid business model, I would start by looking at community residencies throughout the country. Or, you can look at “minor” affiliate hospitals that have residents rotating through the department. These sorts of programs are more likely to house hybrid model radiology practices as well. Not all of these are private practices; however, Some will be hospital run practices, and others will be purely academic.

You can certainly give these folks a call and find out what kind of business model they follow. I believe that this sorting method will provide you with the most excellent chance of finding hybrid type practices. Like your residency, my old stomping grounds at Brown University/Rhode Island Hospital used to be a hybrid model practice. But, I think it has changed to more of a hospital-based imaging practice if I am not mistaken. Unfortunately, some of these hybrid practices have become hospital-owned for a myriad of reasons.

 Regardless, try this method out. I think it will help you find some of these sorts of practices.

 

Regards,

Barry Julius, MD

 

Posted on by

Why Radiology?

why radiology

Interestingly enough, at this point, we at radsresident.com have published around 500 posts on all sorts of topics. Yet, I have never addressed why radiology might be the right fit for you. Strange. Well, better late than never!

Let me also direct you to my previous post on how I decided to go into radiology (which certainly was not a straight path!). As a supplement to this article, hopefully, it will allow you to understand that you can enjoy a specialty even though you may not know what you want to accomplish in your career yet!

Now, with all that background, we are ready to go through some radiology features that present unique reasons for new students to consider entering the field.

Intellectual Stimulation

If you like intellectual challenges, radiology offers more than most specialties. To this day, I remember presenting the topic of histiocytosis X (eosinophilic granuloma) as an internal medicine resident and hearing jeers from my general medicine colleagues because the disease was “too rare” for a presentation. Well, in radiology, we are all about the rare and unusual. That is what makes our specialty tick. We love our cases of eosinophilic granuloma, Henoch-Schoelin purpura, and more. For us, seeing all these zebras is not a burden but a reward. And, with the number of films that radiologists read in the tens of thousands per year, we are much more likely to see many of these rare birds than our fellow medical colleagues and specialists. Welcome to our world!

Flexibility- Business, Hours, Location, Etc.

Radiology has some of the most flexible working environments. If you want to work from home, you can. Want to read films from California yet live in New York? No problem. We can more easily work remotely than most other specialties. If you like late-night shifts, go for it. Or, if you want to own your practice, it is still possible. The world is your oyster and the flexibility and ways we can practice dwarf most other medical specialties out there.

As Much Patient Contact As You Want (Or As Little!)

We’ve got specialties like mammography, interventional radiology, radiopharmaceutical treating nuclear medicine physicians, and more for those who love to see patients. Yet, for every track with significant patient contact, several do not. And, when Covid-19 came around, some radiologists were as happy as a clam to sit on the sidelines. Others had the opportunity to become a central part of treating Covid patients. Regardless, all these possibilities can allow you to practice how you want without being drained by constant patient care or insufficient patient contact.

Lots Of Contact With Fellow Physicians

There is no doubt about it. We speak and consult with more of a smattering of all physicians than almost all other medical specialties. I talk to physicians in every subspecialty for cases I have read (even the occasional dermatologist and psychiatrist!). Most other specialties cannot boast about the wide range of medicine that we cover as we can.

You Don’t Have To Be All In (Like A Surgeon)

Radiology is one specialty that allows you to practice medicine without living and breathing daily. Unlike a surgeon who must be on all the time because of the hours and pressure, many radiologists can practice as little or as much as possible. I know many senior radiologists who read films a few days a week. Likewise, if you want, you can also work a ton. The opportunities abound!

Relatively Decent Compensation

OK. We may not make as much as some orthopods or neurosurgeons. But, we certainly make a respectable income compared to most other specialties. (Check out the Medscape compensation survey from 2020) Of course, that can change on a dime. But, as it stands now, we are in relatively good shape. If you compare the highest and the lowest-paid specialties, it has never been near the bottom!

Can Be Academic Or Non-Academic

Some medical specialties are conducive to either academic or non-academic medical practice. In ours, we have a choice. Want to become the “supersubspecialist” who writes tons of papers? Practice as a neuro-interventionalist or an academic pain medicine MSK radiologist, and you’ll have many opportunities to publish. Or, if you want to work as a generalist and never see a student again, go for it! In almost any radiological subspecialty, there are many opportunities to practice in either setting!

First Clinician Users Of High Tech

Finally, we often adopt new complex technologies before almost all the other medical specialties. Whether it’s artificial intelligence, new MRI contrast agents, better PET-MR equipment, and more, we usually get the privilege of operating these bad boys before anyone else gets a hold of them. And for the tech-savvy among us, it can be a dream come true!

Why Radiology?

Well, I think these reasons say enough about why radiology can be an excellent choice for you. Our specialty may be an ideal match if you like flexibility, intellectual stimulation, reasonable compensation, high tech, and many options. Think about it. And don’t let the primary care-biased medical school Deans sway you from pursuing this specialty if these are the career options that you want. As far as I know, you only live once!

 

Posted on by

Independent Call: Which Radiology Residency Year Should Take The Most?

independent call

Call burdens can vary widely in residency programs throughout the country. You have those programs with the dreaded 2nd-year crush. Others distribute calls more equally. Some have the third and fourth years taking the majority of overnights. Whatever the case, each program weighs its independent call schedule slightly differently by residency year. Any program can choose to structure the burdens however appropriate. (as long as 1st years are not taking independent calls as per the ACGME guidelines.) However, educationally speaking, who should bear the brunt of coverage and why? Let’s go through some of the more common call structures and the advantages and disadvantages of the call’s different weightings.

Front Loaded Independent Call For R2 Residents

Although not the most desired distribution of calls by emergency room physicians, residents get the most experience early on in their residency with this structure. It allows the R2 resident to build the radiologist’s confidence early on to practice as a radiologist. This resident can take this experience and apply the rules to the remainder of their residency. As I always have said, you are not an actual radiologist until you have had a call, a venue where you can make independent decisions. Until then, you will always be a student.

Moreover, it allows the current 2nd years to have a cushier future R4 year filled with electives and mini-fellowships (assuming they have passed the core exam). It also gives the resident extra time to study for the core exam at the end of the R3 year. And it allows for time at the AIRP during the R3 year.

Back Weighting For R3 and R4 Residents

Theoretically, weighing the call to the R3 and R4 years gives residency programs the advantage of having their more experienced residents take the most overnights. But, there is a catch-22 to this philosophy. If you want more experienced residents, you must give them independence earlier! Just because you put more senior residents on call does not mean you are getting more experienced reads. Call itself is the most critical experience for building practical knowledge, not studying from a book or reading a faculty radiologist’s final reads.

Whatever the case may be regarding back weighting and experience, the experience of having more calls toward the end of the residency sets the resident up better for independent work and moonlighting in their fellowship or as a full-fledged radiologist. The recency of critical training prepares residents better for the practice of radiology. When you finish the fellowship, it is possible to complete all your calls during your R2 year and not work independently as a radiologist three or four years later. That situation might put you in dire straits for making independent decisions at your first job. By backweighting the call, this issue is no longer a threat.

Even Distributions of R2, R3, R4 Calls (As Much As Possible)

Of course, an even distribution is the least burdensome of call distributions. It allows the resident to experience calls without the burdens of doing them all at once. Moreover, an even distribution gives the resident some experience early on. And it allows the resident to maintain skills throughout the residency. Finally, it even gives the resident the confidence to know that she has the experience to function as faculty when done.

Although it is impossible to make any call exactly, even given the constraints of studying for the core exam and the AIRP, this distribution can benefit from early experience and late reinforcement.

A Program Director’s Perspective of Independent Call Weighting In Today’s Environment

As program directors, we have political and educational concerns when a chief resident gives us a sample schedule for overnight coverage. The program directors and the chief resident often do not have complete control over distributing calls throughout the residency. Sometimes, the emergency department requires more senior residents. Other times, individual rotations such as interventional radiology prohibit residents from taking calls. So, giving the resident the perfect “educational” call weighting during residency is not always possible.

Nevertheless, some call throughout residency seems to give the most balanced education. As much as the ABR leaders say the core exam shouldn’t interfere with this training, the core exam does. A poorly thought-out core exam strikes again! Until we develop a better system than the core examination to test residents, it will always prevent programs from having the optimal mix!

 

 

Posted on by

Non-Traditional Student: A Disadvantage For Radiology Residency Application?

non-traditional

Non-Traditional Student Question:

 Hello, Dr. Julius!

My question is regarding the perception of non-traditional medical students during the radiology residency match process. I am a current MD student who is ten years older than the average admission statistic for my school with class rank and scores well within the published ranges for a successful match. Should I expect my non-traditional status to be an extra hurdle during residency interviews? If so, what advice can you offer to help ease residency directors’ concerns? Also, would you recommend addressing it in my personal statement?

Your thoughts on the subject would be much appreciated!

Regards,

Non-Traditional Student

 

Answer:

From my experience and I believe from most program directors’ experiences, your older age will be a plus at application time. I have found that non-traditional applicants tend to be more mature, precisely know what they want, and are more conscientious than their younger peers. Additionally, they tend to become less distracted by the minutia of a residency and are more goal-driven. You should never apologize for your additional years of wisdom. Instead, embrace it.

When you write your personal statement, you should expound on your vast experiences that a younger resident does not have. Remember, also, to check out my blog called How To Create A Killer Radiology Personal Statement. Honestly, though, I would not worry about your age either when you write your personal statement or at the interview time. If this was an average job on the street, age could be a detriment. But, in the world of radiology,  it is a plus, not a minus!

 

Respectfully,

Barry Julius, MD