Year: 2020

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Colleague Recommendation: Can I Use It?

colleague's recommendations

Colleague Recommendation Question

 

Dear Dr. Julius,
Thank you for your tutelage via your blogs. Thank you for all that you do. It is truly inspiring and also hard work to maintain a (very current) blog despite your busy schedule!

I am a Canadian IMG (which counts as a foreign IMG), and I’d like to apply to Radiology in the States. I am currently M3 and doing my core rotations in the US. My step1 score was only 215, NOT stellar. My only redeeming quality is that I had worked in radiology for ten years before I entered medical school, and I was department head for three years. My question is: If I get a Letter of Rec. (LOR) from a Canadian radiologist with whom I’ve worked, would that be a faux-pas? Instead, I would much rather send out a LOR from a referee who has known me and seen me work for 4-5 years than a LOR from a 4-week elective rotation. Given ERAS takes up to 4 letters, do you recommend I include a Canadian letter from a Canadian radiologist who has known me well?

Oh, and if the score of 215 is too low, then forget all that I’ve asked above (haha), but I heard they are doing away with Step1 scores in 2022, and that is when I will be matching!
Thank you!

Answer:

I appreciate the kind words! But, in terms of your questions about which radiology recommendations to choose, I think that a colleague reference from someone who knows you well from work can be an effective letter of recommendation if she writes it well. Who better to see your work ethic than those with which you work?  There is no harm in doing so. You are in a much different situation than a medical student or resident who receives another reference from a colleague of the same level. In those instances, how could a fellow trainee honestly evaluate you? Usually, getting a recommendation like those would be a faux pas. (But that does not apply to you!)

Remember, all letters of recommendation have a bias. So, having one letter with a bias toward you from your former job makes sense. Also, as you mentioned, I would send this in addition to the letters that you would typically get for ERAS. It should not be your only stand-alone recommendation.

In terms of scores, make sure that you try to do well on Step II instead. They will be using this score for assessment of your test-taking skills instead of Step I when Step I board scores are no longer used in 2022.

Hope that helps,
Barry Julius, MD

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Considering An MBA: When Is The Right Time?

MBA

Recently, one of my residents asked an excellent question about both whether to pursue an MBA and the timing of getting one. And, I have a sneaking suspicion that many other radiology residents and radiologists have been taking an interest in starting MBAs with all that has been happening in healthcare lately. So, let’s talk about how and why an MBA can be useful. And, then we’ll talk a bit about the timing and the advantages/disadvantages of each.

Why Get An MBA?

First of all, how can an MBA help a radiologist’s career? Well, if you think about it, radiologists have so many years of training (counting college, we are talking typically 14 years of post-high school education)! But, in the entire 14 years of schooling, many radiologists have not had a lick of financial or management training whatsoever. Hell, I know of a few radiologists that can barely balance their budget! Additionally, many of these folks aspire to practice outside the typical clinical confines of radiology. Some may want to take up hospital or practice administration.

Then, when you look you check out the literature on those hospitals that are most successful, you will find that physicians typically run these health care enterprises. So, an MBA may be of great benefit to those of you who want to take this pathway. Take a look at these links supporting these claims here:

https://www.kevinmd.com/blog/2018/08/5-reasons-you-should-put-physicians-in-charge-of-hospitals.html 
https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors

So, if you want to run a tight ship and get into hospital administration, you, as a radiologist or radiologist-in-training, are well-positioned to be successful with the right financial/management education. And, for those of you in this boat, an MBA can make a lot of sense. Just make sure that you are doing it for the right reasons. At some point, the current pandemic will end, and we will return to a state of more normalcy. Don’t make your decision to choose an MBA only on the current poor radiologist job market!

MBA Before, During, Or After Fellowship?

So, all of this talk begs the question, when should you get an MBA? This part of the equation is a bit harder to answer, but I will give you my thoughts about the advantages/disadvantages of each.

Before Fellowship?

I like to consider this pathway, the path of least resistance. By far, logistically speaking, it is the easiest route to take. You are already training in medical school, and many programs offer MD/MBA pathways during their stay. What’s another year of education when you are already paying for your training, right?

However, I have witnessed many residents having pursued this extra degree before entering our program. And, a good chunk of these folks has no interest in utilizing their education toward the goal of healthcare management and practice finance. Although some may take a few nuggets from their MBA training with them into practice, the return on investment can be small.  Why? Because they never created an action plan on how to use this degree.  An MBA is only worth the time and money if you know what to do with it. And, herein lies the most significant disadvantage of completing an MBA early on in your training.

Instead Of A Fellowship

Out of all the ways you can complete an MBA, this pathway is the rarest. And I don’t know any radiologists in my program who have completed an MBA instead of a fellowship. For most of you, it is a difficult time to complete an MBA. First of all, your accumulated debt upon graduating residency often feels like a gazillion dollars. Then, of course, most of you are ready to embark on your career as a radiologist after all the training that you have completed.

In terms of timing, if you did not have to worry about money or the time it takes to complete while having to pay loans, it may make some sense. By this point, you have a better idea of your career goals. And, you can better focus on the goals that you want to achieve when you complete your MBA. However, many of you, by this time, still have not had the working experience to utilize your MBA teachings fully.

After Fellowship

Finally, in terms of convenience, completing an MBA while working is probably the most disruptive. Now, many of you have families and lifestyles that are less conducive to completing another degree. But there are courses and university programs that are willing to work within the confines of your life. These programs are often called executive MBAs and allow you to finish the degree while working. I know of several radiologists that have taken this pathway. Of course, you can also opt for a more traditional 2-year degree.

For those of you that complete an MBA after your fellowship, you most likely have a laser-focused reason for completing an MBA. Maybe, you know that the leadership of your practice may need a new change and wants someone with business experience. Or, perhaps you want to begin working for hospital administration at an available position. At this point, an MBA is usually the most meaningful since you most likely have a targeted application for the degree.

Considering A Business Degree? Taking It All Into Consideration

Well, for those of you mulling the MBA route, all this information is a lot to think about. But think of the MBA as a tool. If you utilize your degree for the right reasons, it can pay off “big-time.” It will allow you to pursue your selected area and have the knowledge to do so. On the other hand, a poorly thought out mission to complete this degree can lead to becoming cash poor with little to show for it. So, be careful choosing this pathway and when you decide to pursue this degree. And, don’t let the Covid pandemic be your only guide!

 

 

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Not A Good Test Taker! Can I Make It Through Radiology Residency?

test taker

Question:

Current radiology resident, just finishing up the intern year, with concerns whether I’m cut out for this. I was a miracle match: Low MCAT scores. Pretty much barely passed all shelf exams. I’m not a good test taker.

Am I smart enough to be doing this, or am I kidding myself? If I fail this crazy 80% pass rate core exam, will they fire me? And then what will I do?

Any advice, uplifting stories, anything would be appreciated. Should I transfer out now? Or, should I stick it out and see if I can pull out another miracle? I don’t want to ruin my life here.

Help!

 

Answer:

First of all, you need to separate the following two issues, being a good radiologist and being a good test taker. I know of excellent radiologists who have had to take the core exam or the oral boards with multiple attempts to pass. So, don’t confuse taking tests with being “smart.” It is an entirely distinct skill from working as a radiologist. Moreover, don’t count yourself out. You may find that you are a better test taker than you think when you study material that is more relevant to your future career. You never know; maybe you’ll even pass on the first attempt.

 

Also, no program should fire you for failing a core examination if you are a good resident. Residencies should be looking at other characteristics other than the core exam and test-taking skills to assess their residents. If you do well in your residency, it should go noticed by your program directors and faculty regardless of your testing scores. No one test will ever be the judge of your abilities. And, if needed, you can retake the exam until you finally pass.

 

Finally, I don’t think you need another miracle. You have already accomplished a challenging feat, getting into a radiology residency program. It will just take a bit of hard work, grit, and determination over the next four years to do a good job and get to the next phase of your career!
Regards,
Barry Julius, MD
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No Longer Practicing Radiology During The Covid Crisis? How To Keep Up!

practicing radiology

Many hospitals and imaging centers throughout the country have recruited radiology residents to help out with the Covid crisis. But that leaves many of these residents in a bind. Some residents may feel that they may be losing some of their hard-learned skills. And many have not had time practicing radiology, the main point of completing their residency. So, I am going to outline some steps to make the next several months more relevant to your training. I will do this by going through each residency year and what you should do to keep up your skills. And, I will divide what residents should into First Years, Second and Third Years, and Fourth Years as each of these groups are in different boats.

First Years

For many first years, you are probably not getting the same case experience as you did before. However, for those of you lucky to have some extra time outside of an ICU rotation, I would go through essential books in each subspecialty section. You will find some ideas for books that you may want to read through in my books and links section of this website. (as recommended by my residents) Make sure to read through some of the recommended reading materials at home, now that you may have more time (or even if you don’t!) The key to a successful first year is reading as a basis for the rest of your residency. Don’t squander this opportunity.

Also, if you are interested in interventional radiology, I would recommend participating in some of the procedures that a clinical rotation like the ICU may offer. Volunteer for lumbar punctures, central venous lines, and paracenteses, if possible. These are some procedures that overlap with radiology and will help to maintain what you have learned.

Second And Third Years

Second and third years are years to practice and learn the art of Radiology. So, in addition to reading like the first years.  I would make sure to emphasize radiology cases over only reading raw reading materials/textbooks. So, make sure to go through the case series. Also, when you have the chance, go to the PACS systems and review older cases from the year in different subspecialties, now that some of the regular imaging volumes have dried up. For instance, pick up some of the earlier MSK MRI and make your interpretations and match them up with the final dictations. This action will help to keep your skills and search patterns fresh in your mind since many elective sorts of cases have probably dried up a bit.

Also, even though the ABR has delayed the core examination, it is likely at the forefront of your mind. Make sure to continue to review test questions from sources like RadPrimer and others. (Check out a great post called Up To Date Book Reviews For The Radiology Core Examination from a former resident for some ideas) You certainly want to reinforce this information when you do take the test. Rinse and repeat as much as you can.

Fourth Years

Finally, we need to talk about the fourth year separately. Fourth-year is the best time to learn practical radiology. So, during this time, you should be reviewing areas of practice that you may feel less comfortable with. Especially now, more than ever, I would recommend doing this since the job market will most likely be changing. (Check out my recent post What’s In The Cards For The New Radiologist Job Market After Covid?). So, make sure to read cases in your weaker subspecialties to keep up or learn new imaging skills. (PACS is a godsend!) You may be using some of these skills at your next job!

Keep Practicing Radiology Skills: You Have Worked Too Hard To Lose Them!

Just because some of your radiology training has been canceled does not mean that you should stop practicing radiology. Now, more than ever, you should be making a concerted effort to hone your skills. Whether you are just starting as a first-year radiology resident and need the basics, or if you need more practical training in your final year, allowing your reading and procedural abilities to slip away would be a shame. Reading books and reviewing cases on PACS now is vital. Even though you may be busy outside of radiology with Covid patients, make a concerted effort to stay in the game. Don’t lose your hard-earned skills!

 

 

 

 

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Breast Imaging Versus MSK- What’s Better For Marketability And Lifestyle?

breast imaging versus MSK
Hi, Dr. Julius!
Been choosing between breast imaging versus MSK radiology fellowship, what do think is better in terms of marketability and lifestyle?
Yours truly,
Not quite sure
I find your choices of subspecialties of breast imaging versus MSK unusual because I almost consider them to be opposites in some senses. So, what are the particulars specifically about breast versus MSK radiology that you may find enticing or detract you from choosing them?

The Covid Crisis And Breast Imaging Versus MSK

Let’s start with current conditions. Many breast imagers that only perform breast imaging are currently out of jobs. Why? Because elective procedures have dried up entirely. So, you are subjecting yourself to a less diversified specialty in terms of outpatient versus inpatient imaging, that’s one negative for breast imaging. Today, MSK is more desirable in the Covid world because these subspecialists usually perform general radiology and inpatient imaging. But, times are atypical right now, and both specialties will likely return to a baseline (perhaps lower than before the pandemic- check out What’s In The Cards For The New Radiologist Job Market After Covid?).

The Traditional Job Market And Both Specialties

More traditionally, there have been fewer folks that have wanted to go into mammography for several reasons, such as more patient contact, lawsuits, and less diagnostic diversity. For these reasons,  the mammography job market has otherwise remained better than most subspecialties through other recessions. On the other hand, MSK is more conducive to practicing general radiology since it overlaps with other areas in radiology a bit more. So, you will find more cross-coverage, And, for this reason, this subspecialty tends to be more subject to the whims of the radiology job market in general.
In terms of lifestyle, both subspecialties tend to be primarily outpatient. And, both subspecialties can be procedural and usually non-emergent. Mammo folks do biopsies, and MSK folks perform facet injections and bone marrow biopsies/arthrograms. But that’s about where the overlap ends. Mammography is a specialty for those people that like patient interaction. MSK, on the other hand, in general, tends to be a more solitary subspecialty where you can work without having to see patients if you want. I find this to be the most substantial difference between the two subspecialties. You have to figure out if you are a people person or not to make this determination.
So, there you have it. Those are some of my thoughts about the comparison between the two subspecialties in a nutshell.
Thanks for the great question!
Barry Julius, MD
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What’s In The Cards For The New Radiologist Job Market After Covid?

radiology job market

In such a short time, a matter of weeks, the tenor of the radiologist job market has changed dramatically. Jobs in radiology were bountiful up until the beginning of March. Then, suddenly, elective procedures trickled down to almost nothing. And, practices began to fire their locum’s workers and furlough many part-time and full-time employees. But, this status will eventually end. And, the radiology job market will change and then establish a new baseline. But, what will that new baseline be? Can new graduates look forward to a booming job market once again? Well, let me give you a summary of what I think will happen as Covid-19 begins to wind down.

From Now To Three Months From Now

As we see a slight ramp up in elective studies, we will not yet see a brisk demand for radiologists. We will still have significantly fewer procedures, as many folks do not want to go to an imaging center for fear of contagion. However, many “elective” interventions, such as colon surgery for previously detected masses on colonoscopy, will need to begin again. But, don’t count on seeing many practices hiring just yet. Most practices will be more than adequately staffed during this time for the number of studies. Hiring freezes will remain.

Remember. You will continue to see advertisements for radiologists, but practices paid for these previous to the pandemic. These advertisements do not represent the current state of the job market!

Up To A Year From Now

Here, I will have to make a few more assumptions. But, I will postulate that a widely available vaccine is not yet available. And, I will conjecture that we have more widespread antibody testing (unlike now). Based on these premises, we will see more folks willing to come out to get their studies, especially those that tested positive for the antibody. However, fear will still prevent a lot of patients from getting the elective imaging that they want as not everyone will feel comfortable returning to hospitals and imaging centers. So, the patient load will not be back to the baseline. And, many practices will still be overstaffed based on the pre-Covid demand.  Therefore, new hires will have fewer job choices with lower salaries. Prospective new hires will face a tight job market.

The New Baseline Post- Covid Era Radiologist Job Market

The further you go out, of course, my predictions will become less accurate. And, we will assume that Covid infections go away from vaccinations and herd immunity. But, having seen other cycles, I believe that we will see several changes from the pre-Covid world. First of all, many patients will likely still be reluctant to return to imaging. Why? Unemployment will be much higher than what it once was before the pandemic.

Additionally, we will see a cultural shift of less imaging than before the crisis. Patients will more likely demand higher standards for cleanliness and sterilization. And, therefore, we may see fewer radiology procedures than in the pre-Covid world.

Also, many practices will have augmented their home teleradiology capabilities. So, reading efficiency will have increased dramatically.

Then, to add insult to injury, private equity firms and corporate radiology have become more significant players in the radiology space. These firms, formerly offering enticing salaries to new graduates, will now significantly lower the wages of new hires. Furthermore, we will see a decline in the salary of the contracts of the old hires since these firms renew these contracts on an annual basis. Why will this happen? Because profits rule their bottom line, and corporate radiology can cut with impunity. Corporate radiology will work radiologists to maximal efficiency, skimming any gains that they can from their radiologists. They will have no incentive to hire.

Finally, if we assume that the stock market remains lower than it was before March 2020, many prospective retirees will not retire. Why pack it in when your portfolio remains much less than what you planned at the time of retirement?

Between all these significant factors, the radiologist job market will not return to the pre-Covid era baseline. Instead, the market will most likely be more similar to the world five to ten years ago when good jobs were harder to come by.

What Are The Chances That I Am Wrong?

Of course, I can be wrong. However, I see the winds of change ahead based on what has happened in previous cycles. So, for those folks that are graduating soon, don’t expect the same radiology job market as the recent past. You will most likely have to work much harder to get the same position at a lower wage.

So my recommendations for you, as for years prior, take your training and residency seriously.  Be competitive. Step out of your comfort zone. Aggressively take charge of your education to become well versed in all areas of radiology. And, finally, expect to practice in locations and subspecialties that are not your primary area of interest. Although not for forever, we will see a return to a world more similar to the previous down cycle of the radiology job market. For those of you soon to find jobs, prepare accordingly!

 

tomatoes

 

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How To Mitigate The Next Pandemic: Encourage New Physicians To Get Business Training!

pandemic

Crises have a habit of magnifying gaps that we could not have imagined beforehand. And, this Covid pandemic reveals these large cracks in our healthcare system by the dozens. We have seen hospitals and imaging centers functioning without physicians receiving the appropriate personal protective equipment (PPE). We are witnessing a lack of ventilators for our sickest Covid patients. Moreover, we are beholding our healthcare system, reliant on lucrative elective procedures, go sour. Practices, hospitals, and imaging centers temporarily are almost empty (other than Covid patients) and dependent on our government to stay afloat. And, these issues are just the tip of the iceberg.

Did these misfires have to happen? Could leadership have prevented the dramatic shortfalls that we are experiencing now? How can we have known our future? Well, it’s a matter of ill-preparation.  And, this pandemic was not on the radar. But why? For years, many intelligent folks have been warning about preparations for pandemics. (check out this TED talk by Bill Gates) And, it is not just him. Other brilliant scientists and doctors have warned us about preparing for the next pandemic. No one listened.

Reason For Health Care’s Poor Preparation For The Current Pandemic

Why did hospitals and our healthcare system ignore prescient information sitting right in front of their noses? Well, it has to do with the model of healthcare that we follow in this country.  We have been treating healthcare as just a business for years.  And if you think about it only in these terms, the situation that we are in makes sense. Why would you prepare for calamity if it’s going to decrease your short-term and intermediate-term profits? Preparations reduce your bottom line.

But herein lies the crux of the problem. We can’t just think of healthcare as a business, but also as a way to protect and serve people. To accomplish this task, we have charged the wrong leaders with the responsibilities of running our healthcare system. Having only a JD or MBA, although helpful for understanding the business of medicine in the short term, is not enough. We need leaders in charge who have also been in the trenches and understand what our physicians and patients need in the long run. They need to understand the science and art of medicine. For these reasons, I would argue that we need more MDs and MD/MBA types in administrative leadership positions. With physicians in charge, hospitals could have prevented many of these issues.

Examples Of Why Physician-Hospital Administrators Would Make Better Health Care Administrators/Leaders

Let’s take some of the examples I provided above. PPE and ventilators are examples of two expenses that make no sense for a hospital to buy if you are thinking only about the business of medicine. First of all, buying such equipment would attract patients with infectious diseases to your institution because you have the equipment to manage only the sickest of patients. These patients cost more to the hospital. Additionally, why buy ventilators or PPE if you don’t need them now?. For-profit and non-profit institutions lose money off of their balance sheets, thereby decreasing bonuses given to their leaders. We can no longer think in these terms.

Or, let’s think about elective procedures as a way for hospitals to make money. Does it make sense? No. In a pandemic, the profit centers of a hospital shut down, causing the government to have to bail them out. Instead, healthcare profits should be made based on treating patients for sickness and making them well. Who better than a physician with some business sense to change this system so that we begin to treat patients and not just increase short term hospital cash flow?

The Answer: Encourage More Physicians/Radiologists To Receive Business Training

I want to underscore that we do need folks with business minds in charge of our healthcare institutions. However, these folks should be the doctors as leaders who can understand both business and medicine. To know how to run a healthcare system, you need experience in the trenches, both in the corporate world and medicine.

So, we, as program directors, mentors, and faculty, should encourage our residents to learn more about hospital administration. Instead of dismissing those residents that are not following our clinical footsteps, we should guide these new physicians on how they can begin this new pathway. Business courses should not be just an afterthought or tack-on to the radiology curriculum.

We need to start thinking differently about what and how we teach about the business of medicine. Let’s start taking more seriously some of the excellent curricula that the ACR or other physician societies offer and create mandatory externships to learn more about healthcare administration. Or maybe, just like informatics or MSK, all specialties should have fellowships dedicated to hospital administration. Now is the time to create easy-to-follow health care administrative pathways for our residents. It’s more than just creating another silly specialty pathway; it’s the future and viability of the entire healthcare system at stake!

 

 

 

 

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Should Hospitals Force Radiology Residents To Work In The ICU During The Covid Crisis?

ICU

Radiology residents are working in the ICU or the wards to meet the increasing demands of an influx of Covid-19 patients, sometimes having little to do with their training. And, most residents have graciously accepted their new duties, in the name of helping a higher cause. But why must residents comply with these demands? Are hospitals treating these physicians fairly? Is it ethical for h0spitals to require residents to participate and forego training in their desired subspecialty? And, what must the hospital ethically provide in return? Let’s answer some of these burning questions as it reveals some underlying issues about residents and residencies themselves.

The Government Indirectly Hires Residents

Once you sign your residency contract on the dotted line (or solid line!), you are receiving a salary from not just the healthcare system that employs you, but also indirectly from a pool of money provided to the hospitals by Medicare. And, most residents receive these government funds in one way or another. Therefore, you are indirectly working as the Government’s servant. In this setting, residents must comply with the Government and the hospital to receive a salary. So, hospitals do have the right to set aside educational objectives for the moment (even though it may not be what you bargained for!)

Residency Has Service And Educational Obligations

It’s not all about take, take, take! There are two components to any residency, educational and service obligations. Not too long ago, in an attempt to get back Social Security taxes from the Federal Government, residents sued the IRS because they claimed that medical residents were students and not employees. (Check out this article) In the end, the Government returned taxes to residents because the Government never clarified the definition of a resident. However, nowadays, the definition of residency changed. Today, the Government/IRS considers residents to be employees, not just students. And, for that reason, all current residents pay Social Security taxes as well as need to comply with government/hospital demands for service. (That includes time in the ICU!)

What Do Hospitals/Government Need To Provide In Return?

Hospitals have a moral and ethical obligation to provide a safe environment for resident trainees. Any institution that does not offer such a setting violates the spirit of a resident’s contract with the institution. What does that mean? Well, hospitals should treat residents like any other employee. In the case of this epidemic, hospitals should provide residents with the protective equipment they need to stay safe. No resident should risk life and limb without the appropriate accommodations of the institution in return.

And, hospitals should continue to pay their residents at their negotiated salary. Understandably, hospitals are struggling with the lack of revenue from canceled elective procedures. However, the amount that they receive for maintaining residency programs remains fixed by the Government. Therefore, it is only fair that residencies should continue to receive their salaries without furlough or pay cut. They are not the same as general employees whose wages can be subject to market forces.

A New World Order For Radiology Residents: Time In The ICU

No. ICU work is not what most residents signed up for when they began their radiology residencies. However, radiology trainees are still, first and foremost, physicians with service obligations. Part of these requirements is a duty to do no harm and help patients. Moreover, hospitals also have ethical and moral responsibilities toward their residents. Therefore, when both the resident and hospital meet these conditions, radiology residents can and should play a role in meeting the new needs of the healthcare system. Hey, when did you ever sign up for something that was as you exactly expected?

 

 

 

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Danger Of Using Case Studies To Dictate Imaging Policy: The Initial Covid-19 Study

case studies

Rumors abounded at the beginning of March 2020 about Covid-19. And, no one quite knew how Covid-19 would play out. All sorts of physicians were on edge to try to figure out what to do. But then a new case study about the role of CT scan arrived at the scene. And, clinicians began to read or hear about this “seminal paper” in Radiology that came out from China, called Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. This paper claimed a high sensitivity for the detection of the diagnosis coronavirus compared to PCR. Admitting physicians quoted it and demanded to get CT scans on their patients with presumed Covid-19. ER doctors were ordering Chest CT scans left and right.

What happened next? The throughput of patients slowed down to a crawl because the CT scanner needed special cleaning for potential Covid-19 contamination. Subsequently, this thorough cleaning delayed the treatment of patients. And, the CT scanner was out of commission for other patients that needed the CT scan for emergency workups.

Was it the right to use this paper to dictate the workup of patients? In hindsight, no. And, it brings up an all too common issue, the usage of case studies to dictate health care policy. So, what are the other factors that we need to evaluate before we decide to take a paper and apply it to patient care? Well, I will use this incident as a way to show you what you need to think about before using case studies to guide patient imaging. Let’s divide it into the following categories: practicality, throughput, exposure, and change in management.

Practicality- It’s Not All About Sensitivity Or Specificity

I don’t know about you. But, whenever I hear a test is highly sensitive or specific for a disease entity, I get excited. My first thought is usually, maybe we can use this exam to diagnosis patients? However, before arriving at that conclusion, we need to take a step back. Does the test make sense in the context of patients coming into the emergency department? Many clinicians did not think about these issues when they decided to utilize a CT scan to image presumptive Covid-19 patients. Just because you can make a diagnosis does not mean that you should complete a test.

Throughput is Important

A test is only useful when it can rapidly diagnose patients. In the case of CT scans for the diagnosis of Covid-19 patients, regardless of any other factor, our throughput for patient care significantly slowed down. And, this had a dramatic effect upon the patients that came into the Emergency Department for many other reasons. Always, physicians need to take this factor into account before jumping into ordering a test.

Exposure To Health Care Workers And Patients

We need to take care of all the folks that are providing services for the sick and infirm. If we do not perform this duty, we will have no health care workers to treat patients. In this situation, deep cleaning the CT scanner after each patient added undue risk to the technologists and nurses that completed these functions. Not to mention, you are also increasing the possibility of exposure to the next patient in the CT scanner. The upshot was a tremendous cost to the patients and employees.

Does It Change Management?

And, then finally, the most critical question that we need to ask ourselves is how does the test change management? In the case of Covid-19, a negative test did not preclude the possibility of the disease. So, regardless of the test outcome, the clinicians would need to use their clinical intuition to decide if they need to ventilate the patient or other invasive measures. Moreover, the treatment of the patient would remain the same, whether the CT was positive or negative. Why submit a patient to such a test?

Beware The Dangers of Using Small Case Studies To Dictate Policy!

We all need to take a step back when we hear the claims of physicians that we should be imaging a patient based on a paper. Instead, you should be answering the following questions: Is it practical? Will it prevent other patients from receiving appropriate testing? Will it endanger my staff and patients? And, does it change the management of the patient’s case? If the case studies can pass these tests, consider using it as a tool. If not, beware of imaging the patient based on a paper, the test may do more harm than good!

 

 

 

 

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Radiology In The Post Covid-19 Era: How Will The Specialty Change?

covid-19

For almost all of us, the COVID-19 pandemic has affected our daily lives in some form or another. Some folks have been temporarily furloughed or lost their jobs. Other radiologists are infected and sickened by the virus. And, we all feel a level of heightened anxiety. But, one day, this situation shall end, hopefully, sooner rather than later. Moreover, with the end of the pandemic, the field of radiology will never be the same. It will be a post-COVID-19 era, a new world for radiology.

So, what will change in our field after the dust settles, and we approach a more “normal” life once again? This question is what I will attempt to answer to give us an idea. So, let’s divide my predictions into the following categories: demand for radiology residency, remote learning, teleradiology, and finally, numbers of onsite radiologists. No, I am not the oracle of Delphi, and I cannot foretell the future with certainty. However, my sixteen-year experience in the field of radiology and work with radiology residents allows me to make some educated guesses about what we can expect to change in radiology at the end of this pandemic.  Let’s give this a whirl!

Increased Demand For Radiology Post Covid-19

Medical students throughout the country are in the thick of the action. And, they can now see the role that different physician specialists play in a pandemic. I am sure that many medical students will notice that radiologists play a vital role in the diagnosis and management of COVID-19. Yet, they tend not to be on the front lines like the Emergency Physicians, internists, and surgeons. Not to say we don’t come in contact with these patients. But, for many medical students, I believe this critical role we play, and our overall relative decreased exposure to contagious disease will become an attractive feature that draws more applicants into the fold. I would imagine seeing more applications to radiology residency for the next several match cycles.

Remote Learning For Radiology Residents

Due to the restrictions on group meetings, most programs, by now, have shored up their capabilities to give teleconferences and administer online learning materials. Before, for many residencies,  it was only an adjunct to learning. Now, just like for public education, it has become a necessity and will become ingrained into the fabric of all residencies throughout the country. I believe this will stick.

Universal Teleradiology

For practices that didn’t have much of an online presence outside the hospital, they now will. If you read my previous article, Coronavirus: A Clarion Call For Universal Home Teleradiology, you will understand that it is incumbent on practices to develop an online presence to decrease exposure to disease, and increase efficiency and workforce flexibility. Hospitals and practices are waking up to these issues. And, these changes are taking place right now forever transforming radiology.

Fewer Onsite Radiologists

Of course, hospitals and practices need onsite radiologists to fulfill their obligations. We need to do the biopsies, treatments, direct patient care, interventions, and more.  However, we do not need to do much of the work onsite. And, all radiologists will, therefore, have more flexibility to read from home, outside the normal confines of an office or hospital. Teleradiology will no longer be only for teleradiologists, but rather a tool for all radiologists. And, thus, you will see fewer radiologists sitting at hospital workstations. Instead, clinicians will call many more radiologists at their home offices with their questions.

Radiology In A Post Covid-19 Era

Yes. The field of radiology will never be quite the same. We are moving toward different practices and norms. And, increase demand/applications for our specialty, ubiquitous remote learning, universal teleradiology, and a leaner number of radiologists stationed at hospitals and practices are some of the features that you will most likely notice in a post-Covid era. Although some of you may disagree, it makes logical sense as we are developing the infrastructure for these changes as the pandemic continues to smolder. So, look around your departments over the next several months and years. Just like the addition of PACs, or when CT became part of bread and butter radiology, you will be taking part in the next sea change of our field!

If you think of other changes or disagree with my predictions, shoot me some comments or an email about what you think.  I would be interested to hear your opinions!