Month: October 2020

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One Additional Dictation Can Make All The Difference

additional dictation

For those of you thinking about working in a radiology practice, working as a team is the key to survival. And part of that team effort is work ethic. If some radiologists have different work ethic levels than others, it becomes a nidus for discontent. I believe that this varying culture of employees/owners is one of the biggest downfalls of individual practices. For example, an owner interested in maximizing income will not mix very well with an employee who took the job for lifestyle. And vice versa. However, when starting, you need to assume more responsibility, not less, regardless of the practice culture. So, what does it take to improve your practice environment?  It’s pretty simple. Be willing to take that extra case or dictate that study without a fuss at the end of the day. One additional dictation can make all the difference.

If you think this is a ridiculous statement with no relevance to you, take a look at your fellow residents or employees. Who are the folks that are the most successful at your level? It’s rarely the person that complains that he has too much work and cannot bear to read another study. And, it’s certainly not the person who always leaves over work for their colleagues. Instead, it’s that radiologist who completes that extra case at the end of the day to ensure that the next person is not swamped. So, what are the ways that dictating one additional study can make all the difference?

How Can One Additional Dictation Improve The Practice?

Builds Goodwill Among Fellow Physicians

If your colleagues notice that you are helping them out, they are much more likely to reciprocate for you. Therein begins the virtuous circle. And reading that one more case at the end of the day can start the whole process. It can have a snowball effect on the practice. You never know when you may have to leave in the middle of the day for an errand. Now, you have colleagues that are willing to cover and support you.

Builds Goodwill Among The Referrers

Sometimes that extra case can come at the end of the day. Most of you probably know of that 5 PM abdominal CT scan for abdominal pain. It may be the responsibility of the person on the next shift. But, by reading that case and calling the referrer, you have established a connection. That ordering physician will be much more likely to send future patients your way when they need a quick read.

Builds Goodwill Among Staff

Then, of course, most staff members hate to have extra cases lying around. Reading that additional case may allow them not to chase someone down to read the case later on that evening or the next day. Who wants the lead technologist to continually nag the radiologists to take care of that extra case? That employee will most likely put a positive word about you to your colleagues.

Increases Overall Revenue

The more cases that the practice reads promptly, the more revenue streams can come in quickly. It may sound silly that one dictation should make such a difference. But, rinse, wash, and repeat. Day after day, you can significantly prompt cash flow for the practice by reading that one extra case. That’s 365 cases per year if someone reads that case every day. Do the math and figure how much that is. That can only benefit you and your practice in the long run.

See, One Additional Dictation Can Make All The Difference!

I think you catch my drift. It’s not just about the one case itself. Instead, it is about the goodwill and economics that you bring to the practice over the long run by improving the work environment’s culture. Imagine if everyone does the same. That is called practice building, my friends. And it is the first step to creating an excellent environment to practice radiology!

 

 

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Thinking About Owning An Imaging Center? Tread Carefully!

owning an imaging center

Question About Owning An Imaging Center

 

Hi Barry, I received a call from a group of radiologists looking to sell an imaging center. We are a primary care group of 20 PCP’s. Can you direct me to resources to better understand the current pros and cons of owning an imaging center?

Thanks, 

Opportunity Knocks

 

 

Answer:

That is an excellent question!

Although I don’t own an imaging center myself, I can tell you some of the general pros and cons of owning one, having worked in many during my working lifetime.

Owning an imaging center is essentially like owning a second business. You will be responsible for a large team of employees. And, you will be critical to managing the property itself, whether it’s rented or owned. Moreover, you will collect the full payments from insurance companies, Medicare, Medicaid, and self-payers. Unfortunately, the reimbursements for current procedures continually drop over time, so you have to expect to provide some wiggle room when you purchase buildings and equipment. Be very careful not to overspend.

Furthermore, you need to run an efficient team or know how to find someone to run an efficient team. If not, your competitors down the street will run you out of business. It is not good enough to want to run an imaging center. Instead, you need to know the intricacies of how to run an imaging center. It is never has been and never will be a sure thing. (As many physicians think before owning one!)

And it isn’t straightforward. These skills include knowing how to negotiate with insurance companies, understanding how to get patients on and off the table quickly, when to provide new procedures/modalities, how to get your radiologists to work efficiently, and what furniture offers the best outcomes for patients. Therefore, your team needs to be extremely knowledgeable and experienced. Don’t just go into the process, thinking that you know what you need to do! Most importantly, why do you think you can run a better center than the radiologists that came before you?

That said, there is a reward if you can manage the most efficient/well-run practice in town. If not, I would stay out of the imaging centers’ business because it is very competitive, and the margins are tight.

If you want to find out more about running an imaging center, you can go to the ACR website, and they will provide you information and courses on how to run a practice. While you are there, check out the Radiology Leadership Institute, where they have entire classes on this subject. You might want to consider that as well.

 

Hope that helps,

Barry Julius, MD

 

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Counterpoint to Subspecialization As Radiology’s Future

subspecialization

I’m sick of it. It seems that almost every other week, I see an article that subspecialization is the future of radiology. If you listen to the average author who writes the average article on the internet about this topic, general radiology is dead. Just do a google search yourself, and you will come up with a gazillion search results on this subject.

But if that is the case, coming from the trenches, why is it that my practice needs generalist radiologists more than ever? And, it’s not just me. When I speak to radiologists in other private businesses, they are saying the same thing.

So, why this dichotomy? Of course, I have a few theories. First, there is a gap between what the academics believe to be accurate and what is happening in radiology practices. Second, by claiming that subspecialization is always better for patient care, the folks that write these articles are drumming up business for themselves. And, then finally, programs now gear their training to subspecialist training. So, there is a bias that more subspecialists are needed.

In any case, let me give you some reasons why creating more radiology subspecialists is not the cure for meeting radiology’s demands. Sure, we need our specialists. But we need our generalists as well. Here we go!

Do You Need An MSK Radiologist To Read A Knee X-Ray?

Not all of radiology needs sophisticated subspecialist read. Generally, emergency medicine physicians want a brief answer on whether there is a fracture or not with a short description. Most could care less about the finer points, such as the Kellgren and Lawrence system, to classify osteoarthritis. Do we need to train more specialist physicians to read these straight vanilla films? Is it worth the expense and time?

Maldistribution Of Subspecialists Relative To Studies Performed

If you think about the majority of subspecialist currently being trained, it is not a one to one relationship with the type and amount of work in radiology. For every neuroradiologist, there is a heck of a lot more non-neuro studies than neuroradiology work. We need to complete a lot more other sorts of work daily than the number of neuroradiologists available. Think about how many GI CT abdomen and pelvic cases we read in the ER and how many GI subspecialty radiologists there are throughout the country. The numbers don’t add up!

Too Much NonSubspecialty Work For Subspecialists

Similar to the previous notion, most practices can not provide enough reads for subspecialists to interpret films in their subspecialty every hour of every day they work. Most specialized radiologists read a percentage of their subspecialty work (usually less than 50%!). So, does it make sense for all radiologists to be sub-specialized all the time based on the amount of work performed? Not!

Who Will Take Care of Rural Radiology?

You can make the case that rural hospitals and imaging centers can farm out studies to large subspecialty teleradiology or academic reading centers. In essence, though, that will never work. Most “small hospitals” want a radiologist on the premises to take care of the population’s general needs. Someone has to do the biopsies, intussception reductions, and iodine treatments in the area without having to send patients to a big city or tertiary care center. And no, that cannot be a subspecialist that only reads one particular type of study. These radiologists would be twiddling their thumbs. There is not enough work to fill the day!

Subspecialization, Not The Cure-All For What Ails Radiology!

If I sat here all day, I’m sure I can think of myriad additional reasons why we also need our generalists in radiology. The point here is that subspecialization, although required, will not fulfill all the needs in the radiology universe. We should not overemphasize the subspecialist at the expense of creating fewer and fewer generalists. Instead, we need to meet the demands of the work that needs to get done. And, creating more super subspecialists is not the answer to all our problems!

 

 

 

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Is Radiology Still A Lifestyle Specialty?

lifestyle specialty

Many of you have probably heard about the classic acronym for choosing a lifestyle specialty called ROAD: Radiology, Ophthalmology, Anesthesiology, and Dermatology. But does radiology still belong in this acronym? Or should we entirely discard this as an ancient historical quirk? (Those days fifty years ago when we only used X-ray, nuclear medicine, and ultrasound!) So, let’s look at the criteria that should make up a lifestyle specialty, including the amount of time that you need to work, the amount of money that you can make, the amount of stress in your daily work life, and the flexibility of living and working where you want when you want. Then, let’s go through whether we, as radiology specialists, can still meet the criteria for a lifestyle specialty and compare it to others. And finally, let’s give the radiology specialty a final grade.

Grading Criterion For Radiology As A Lifestyle Specialty

Hours

This first criterion is a bit hard to pin down. Why? Because it all depends on how much time you want to put into your career. I know folks who want to care for their children, work three or four days a week, and never take a weekend call. (Of course, you pay for that!) Then, others want to spend lots of extra time to be the breadwinner for the family. But, if you take the average radiologist and the average week, most are on the job more than they would like to admit. We can have long days that can easily breach ten or eleven hours if the work becomes busy. Yet, not all days are like that. So, the average radiologist works a nine-hour shift five days a week.

However, we have a little more vacation than most other specialties. And part of that is a historical quirk. Back in the day, around the beginning of the twentieth century, many radiologists became sick from radiation sickness’s harmful effects. Therefore, they tended to have more vacation time to compensate. Flash forward to today, and you will still find radiologists with a bit more vacation than most (even though our jobs do not expose radiologists to as much radiation). 

Unfortunately, that time may not be during the holidays and summer weeks because hospitals need our services twenty-four hours a day, seven days a week. And some poor radiologist needs to cover! To average it all out, if I had to give a grade to this criteria, I would call it a B-. The extra vacation would boost our report card as opposed to other specialties. But, I am dinging us for the constant need for radiologists to work. If you had to compare our hours to other medical areas, others would work shorter and easier days with less vacation time. So, I certainly could not give us an A. But, yet we don’t have constant patient care like some internal medicine and surgical docs. B- minus seems reasonable to me!

Money

Money is a much easier criterion to define because we can base that number on a per-hour basis. And we can always harken back to our favorite medical specialty salary survey at Medscape. It’s a quick and dirty way to compare the average specialist’s salary for most medical specialties. The 2020 Medscape survey quoted the average radiology salary as the fifth most highly paid specialty out of twenty-nine at 427,000 dollars annually. So, that is in the top 20th percentile. For that reason, I can easily substantiate the grade of an A-. We are certainly not paid as much as the majority of Orthopedics and Neurosurgeons. But, indeed, we are nowhere near the salary of most pediatricians!

Stress

Ahh. This criterion is also highly variable, depending on your subspecialty. Some folks are purely outpatient and work in very cush environments or at home. And other folks are bombarded continuously with ER cases and stat procedures like neuro-interventionalists. However, as a whole, we typically don’t have to perseverate on phones with insurance companies like other subspecialties (I consider that one of the most significant stressors!) Yet, all of us are getting tons of phone calls. Moreover, we can enact actual harm to patients because what we say matters significantly to patient care, including life and death (a cause for aggravation and lawsuits!).

So, let’s compare it to other specialties. Dermatologists don’t have as many life-and-death decisions. Yet, ob/gynecologists, surgeons, and internal medicine docs have much more aggravations with insurance companies and uncompliant patients. So, I will give our specialty a B-, a standard average grade.

Flexibility

Now, if I had to pick one area where we excel, it is flexibility. We can live where we want, work when we want, be academic or private, and see patients or not see patients as we wish. I can’t think of any other specialties with our far-reaching flexibility for types of work as a radiologist. We can live and work in the country or the city. You can work on the weekends only or during the nights or days. Or, we can rarely see a patient again (especially as a teleradiologist!)

In this department, we beat out pretty much all the specialties. Not one even comes close to radiology when it comes to flexibility! I would have to give this criterion an A+.

Is Radiology A Lifestyle Specialty: The Final Conclusion

So, let’s give all our grades a weighted average and pretend we are still in college. Here is a post with the conversion info!

Hours: B- or 2.7

Money: A- or 3.7

Stress: B- or 2.7

Flexibility: A+ or 4.0

Drum roll, please. If you average out our grades based on these criteria, you get a final grade of 3.275, just a little shy of a B+. But let’s call it a B+, for argument’s sake. Do you think that still makes a lifestyle specialty? I think so. But, perhaps, not as much as you might have thought at first! It’s not an A!

Want to learn more about the specialty of radiology and the training involved? Check out my book on Amazon. And click on the link below. (I am an affiliate of Amazon as well!)

 

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Is Nuclear Medicine A Dying Field?

dying field

Question About Nuclear Medicine As A Dying Field:

Hi Dr. Julius!

What is the future of nuclear radiology? I have seen some programs that offer dual certification pathways within their DR residencies. Is that worth it? I’ve also heard it’s a bit of a dying field, thoughts?

Also, is therapeutic nuclear radiology becoming a feasible pathway for radiology grads? On paper, it sounds fantastic to use radionucleotides to not only diagnose but also treat patients.

Thank you!

Answer:

Once again, an excellent question from one of my readers!

Well, I have a lot of opinions on this topic since I am first and foremost a nuclear radiologist. And I am happy to share them with you!

Nuclear Medicine History/Background

You first have to start by understanding the history of the specialty. Nuclear medicine is one of the oldest subspecialties in radiology. It came about before ultrasound and was once the only other high tech modality for radiologists other than x-rays. So, back in the old days, probably around 50 years ago or so, a lot of really smart radiologist went into the field. And, at that time, the area was distinct from the rest of the radiology field. So, they formed a separate board society and training programs “unattached” to radiology residency in addition to a fellowship after residency. Fast forward to our time, and you have a bit of a mess. Most applicants to nuclear medicine would prefer to get into radiology because you can do so much more. You have much better job prospects because the radiology training is so much more diverse.

The Split

But, this current organization of two separate radiology and nuclear medicine creates a problem. Generally, the folks that are only nuclear medicine need more to do than just reading nuclear medicine studies during the daytime. Most practices do not have enough work to support a nuclear radiologist. So, enter the new dichotomy. There are those nuclear medicine physicians who train primarily in radiology that, in general, prefer to do the diagnostic radiology work along with diagnostic nuclear medicine. And then, some are only nuclear medicine trained that need to create a new livelihood for themselves. And one of those areas is the realm of nuclear medicine treatment. In general, right now, these procedures do not pay well and are very time-consuming. However, these nuclear medicine physicians provide an essential service by administering the radioactive pharmaceuticals and following up the patients over time.

I believe in the future; the specialty will split into these two entities- diagnostics and treatment- because of the current mechanics of reimbursement and what procedures that nuclear medicine docs and nuclear radiologists can perform.

Is Nuclear Medicine A Dying Field?

Finally, to complete the answer to your question, diagnostic and therapeutic nuclear medicine are very active in research and new radiopharmaceuticals coming in for clinical use. So, nuclear medicine is certainly not a dying field. But, who performs what is changing. Of course, there is some overlap. For instance, I perform radioactive iodine treatments and do pretty much all diagnostics. But, I don’t do any of the Lutithera or Xofigo treatments or others available to the public. And, there are all variations in between. Nevertheless, nuclear medicine is an excellent specialty for someone who wants an exciting radiology subspecialty and likes to practice general radiology (Which is what I do!)

That is my long-winded answer to your question (I could have even gone on for longer but had to stop somewhere!)

Dr. Barry Julius

By the way, for those of you interested in a book for nuclear medicine, I would highly recommend the Mettler book. I used it to study for my recertification examination! (I am an Amazon affiliate and receive a commission)

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Why Residents Should Start Returning To On Site Lectures!

on site lectures

Since Covid-19 began, most radiology residencies throughout the country have moved to a model of all remote lectures. At first, it was a knee-jerk reaction, which was entirely logical at the time. Now that we have a better idea of the disease and how it spreads, programs can return to a system with some live lectures. Programs can safely organize conferences with smaller groups in larger spaces to reduce transmission chances. Like public schools, many radiology residencies are returning to some form of a hybrid system with remote and on site lectures.

However, not all programs are going in that direction. So, what have residents lost over the past half-year by having remote lectures only? And, do they stand to gain anything by returning to some form of in-house live classes? Let’s go through why most programs should, in-part, try to get back to some on site lectures.

Keep Residents Awake And Focused

I’ve been in this situation many times. Zoom starts up, and instead of having the camera focused on your face, you decide to put a picture up with a likeness of you and start completing other work. Or, you tend to another conversation at the same time. The bottom line is that it is much easier to lose focus when you are in a remote environment because there is less buy-in. Many other options are available to capture your attention than the lecture itself.

More Invested In Studying For The On Site Lectures

If you know that you will attend a lecture in person, you are much more likely to read up on a topic. Why? Because you don’t want to look like a total dullard. That motivation is vital for some residents to stay on top of their reading. Going remote without that feeling of obligation decreases the resident’s responsibility to learn some of that material beforehand. Anonymity breeds less involvement in the subject matter.

The Personal Touch

Once you go online to listen to your conferences, you lose some of the nuances of the conversation. The lecturer may not see those beads of sweat welling onto your forehead when you are unsure of an answer. Likewise, the listener may lose the tone of the lecturer, perhaps frustration or satisfaction. By missing these cues, you also lose the opportunity to figure out what you might be missing in the conversation and help that student or redirect the speaker.

Training on Software

I don’t know about your program. We have lots of different programs in our nuclear medicine department to help us interpret images. We have one system for DATscan quantification, another method for Neuroquant, a general PACS, GE software for processing cardiac studies, TeraRecon for looking at PET-CT scans, and Intellispace for remote nuclear medicine access. I’m probably even missing a few more. However, my point is that it is challenging to train residents on software without that hands-on touch in person. In my experience, Zoom like encounters for this sort of training does not do the trick. It can be harder to point out how to use different kinds of programs and software.

Esprit-De-Corps

Finally, joint meetings lead to shared experiences both from students/residents and lecturers as well. When you are all in the same environment, you build trust, social interactions, and the feeling of a team environment. It’s just not the same taking your conferences online where you can’t discuss issues after the lecture or crack a few jokes together. It tends to be all business, not the sort of environment that helps to form bonds.

Returning To On Site Lectures Once Again!

As much as it may be more convenient to give and receive lectures by Zoom, there is a role for returning to some form of on-site classes. Of course, remaining healthy is a top priority in almost any residency program. But, it is possible to keep your lecturers and residents at reasonably low risk if you take the proper precautions. So, based on the net positives of keeping residents focused, improving resident studying, personalizing the learning experiences, better technical training, and maintaining a team environment, hopefully, your program is considering on site training in some form once again. It’s not just for show. These are tangible benefits to the on site experience!

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Happy Birthday Radsresident- Four Years Old!

happy birthday

Happy Birthday To Radsresident.com!!!

Another year has gone. Indeed, it’s been a strange one. Usually, sea changes such as these occur at a snail’s pace. But, this year, they have been fast and furious. And, here at radsresident, we’ve been capturing it all! Covid, getting rid of scores on Step I, the sudden change in the job market, and the increase in teleradiology capabilities are some of the significant rapid changes we have covered in one year.

So, how has radsresident fared among all these rapid changes? Well, once again, I will break down the growth of the website, the most popular posts, some of the new changes, and what you can expect over the up and coming year!

Radsresident Growth!

This year alone, from September 24, 2019, to September 23, 2020, we have continued our rapid growth. We have had over 140,000 individual visits, up from 121,000 the year before, and 35000 from when we first started. That is 400% growth over four years. Not bad for a niche website!

Additionally, as of now, we have 360 individual posts to choose from on all sorts of radiology residency related topics and lots of new pages with cases and more. Just like last year, you can download a helpful free ebook called The New Attending Physician Guidebook: How To Search For The Right Job And What To Do Once You Start if you sign up for the weekly newsletter. You can also purchase our signature book on Amazon called Radsresident: A Guidebook For Radiology Applicant And Radiology Resident. And that does not include the precall quizzes you can take to see if you are ready to take an overnight call.

Let’s go through the most popular posts over the past year and of all time!

Most Popular Posts

Past Year (Top Ten In Order)

1. How Much Does It Take To Start A Radiology Imaging Center? 

2. How To Create A Killer Radiology Personal Statement

3. How to Choose a Radiology Fellowship

4. What Clinicians Don’t Want From A Radiologist- The 8 Deadly Sins

5. How Much Work Is Too Much For A Radiologist? (Think RVUs!)

6. The Fellowship Personal Statement- What’s The Deal?

7. Top Traits Of Great Radiologists (They Might Not Be What You Expect!)

8. The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

9. The Post Interview Second Look – Is It Worth My Time?

10. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”?

 

All Time Most Popular (Top Ten In Order)

1.How Much Work Is Too Much For A Radiologist? (Think RVUs!)

2.How Much Does It Take To Start A Radiology Imaging Center?

3. How To Create A Killer Radiology Personal Statement

4. How to Choose a Radiology Fellowship

5. Top Traits Of Great Radiologists (They Might Not Be What You Expect!)

6. Up To Date Book Reviews For The Radiology Core Examination

7. The Post Interview Second Look – Is It Worth My Time?

8. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”?

9. A Common Radiology Applicant USMLE Step I Misconception

10. What Clinicians Don’t Want From A Radiologist- The 8 Deadly Sins

 

Population Using Radsresident.com

How are you folks arriving at the posts and articles on this website?

  1. Organic search (Google, etc.) – 69% of readers
  2. Direct (typing in radsresident.com) – 12% of readers
  3. Social (Facebook, Twitter, etc.) – 17% of readers
  4. Referral (Links and websites)- 2% of readers

From where are my readers?

  1. The United States – 70%
  2. India – 7%
  3. Canada- 2.3%
  4. United Kingdom – 1.8%
  5. Australia – 1.2%
  6. Saudi Arabia 0.9%
  7. Pakistan 0,8%
  8. Brazil 0.7%
  9. Philippines – 0.7%
  10. Germany – 0.6%

How many individual users have frequented the website over the entire past year? (based on Google Analytics)

102,794 individual users (84,848 the previous year)

201,850 page views (177,288 the last year)

What Else Has Changed Recently?

You may have noticed that I have added The Residency Store to the website. It is a place where you can find radsresident products, quality affiliate companies, and affiliate merchandise relevant to the residency experience. I have been toying with the idea of making it into more of an “educational store” and highlighting educational products for residents. The store is a work in progress, and you will most likely see some more changes in this part of the website over the next year.

Plans For The Up and Coming Year!

Making plans is the fun part about running a website. You get to come up with ideas and then experiment with what works and what doesn’t. It’s the ultimate rush to try to find posts, pages, and useful products and services for my loyal readers.

So, what is in store for the website? Well, last year, I tabled creating a video series for lack of time. (Life sometimes gets in the way!) But, this year, I plan on completing some videos in a new video series called Reading More Quickly, Accurately, And Getting More Sleep. The goal is to create exclusive videos to go through how to search on each of the imaging modalities and specific anatomic regions. It will likely include CT scan, and MRI segmented into different body parts, ultrasound, nuclear medicine, fluoroscopy, mammography, and more. It’s a lot of work to make the quality sufficient for my audience. But, I hope to get the first video out before the completion of the next academic year. Folks on my newsletter will be first to know when I officially complete the first one.

With all the additional new posts and information over the past several years, I am planning to begin to compile and publish some new books specifically for the radiology applicant, the radiology resident, and the radiology fellow. These books will hone in more specifically on my core readers and those that would benefit from this website (but don’t know it yet!) That is also a work in progress.

And then, of course, you will continue to get the varied posts on all the essential information that you need to succeed in radiology applications, residency, and beyond!

As Always, It’s Great To Hear From My Audience

Once again, I am proud to be writing for this incredibly intelligent and exciting audience. One of the best parts of managing this website is to be able to have the privilege of helping you out with your radiology issues. I love to hear your opinions and thoughts with the great questions you submit on Ask The Residency Director. Please, keep the great questions coming to radsresident.com. Until next year!