Year: 2021

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Rural Versus Urban Radiology- Who Wins?

urban radiology

Go to any radiology forum, and you will see an ongoing battle. Everyone wants to prove their point that where they work is the best. Some vouch for working in an urban radiology setting, and others espouse the benefits of working out in the middle of “nothing and nowhere.” Either way, I’m sure there are merits to both. But, let’s pick this topic apart and check out the overall best place to work for the average radiologist resident that is thinking about looking for their first attending job? To do so, we will enumerate and describe the main advantages and disadvantages of each of these choices. In the end, let’s look at the evidence and conclude as to which one is the most desirable outcome!

Rural Radiology

Advantages

More Benefits/Money

Indeed, this perk is the one everyone hears about the most. The farther away from civilization, the more money that most physicians make. And, why is that? Usually, hospitals need to supplement your salary to get you to work there! Nevertheless, it is a fact, and you can use it to your advantage in the outback!

Slower Pace

Everything work-related crawls at a slower pace in rural radiology. You are simply not going to see those crazy enthesioblastomas as often as you might like. On the other hand, because you are not a tertiary referral center, you can scroll the cases at twice the speed since they are much less fraught with complications.

Less Competition

Typically, you don’t need to vie for every patient and every dollar. The subsequent radiologist may be as far as 500 miles from you. So, you just don’t need to worry. You’ve just gained a few anti-stress points and lost a few pounds right there!

Nicer More Open Facilities

In the rural world, land and buildings are generally cheaper. So, you may notice larger and more modern reading rooms, better IR suites, and more well-designed hospitals in general. Lower costs for facilities usually mean more space for you.

Fresh Air

You probably know that smell when you walk outside into the natural world. Simply put, there is much less soot and grime in the air. So, all the flowers and pollen are hitting your sensory receptors as soon as you walk out the door. But, it is true. Your nose will know the difference when you work in a rural environment. And, you will gain a few extra years of life too!

Appreciative Patients

When medical resources are more scarce, patients tend to be more appreciative. You have a better shot at receiving a box of chocolates every year for your services. What you do is hypercritical in a place where fewer physicians work.

Mixed Results/Depends

You Do More Of Everything

Plus or minus. You may get to do more. Now, this may float your boat. Or it may be a cause for your concern. Either way, you will more likely be doing the arthrograms even though you are not an MSK-trained radiologist. Or you will read the mammo, even though you are not breast imaging trained. It’s part of the rural expectations!

Disadvantages

Less Collaboration

Fewer physicians mean less collaboration. That’s just how the math works. Also, it may be a little bit harder to get other expert opinions from your colleagues and your fellow specialists because they just don’t exist. Something to consider before you start a rural radiology career.

Loneliness,

For some folks, family is everything. And, when you live rurally, you have to consider that you may not have your usual family support structure. If you expect the in-laws to come by to help out with the baby, it is unlikely that will happen too often. Just something to think about when you decide to work rurally.

Different/Lack of Cultural Activities

You will not find as much theater and opera out in El Ranchero. But, you may have an excellent Strawberry festival! You just have to have expectations that you will have to travel to get some of the cultural activities you might expect in a large city.

 

Urban Radiology

Advantages of Urban Radiology

Culture

Some rads love the option to go out and watch the newest incarnation of West Side Story with the most famous actors and actresses. Others not as much. In any case, you will have more cultural options for all these activities.

Restaurants

If you like to eat out, the city is just a better environment. You have much more to choose from. And, you can have your Ethiopian fix (I like that cuisine!) and your Afghan meal for the next. It is just more readily available.

More Physicians/Collaboration

More people means more collaboration. You will have more subspecialists at your fingertips to contact and bounce ideas. It often helps when the cases are more complicated. Second opinions sometimes can be a lifesaver.

More Prestige

Larger cities and larger hospitals offer more powerful titles and sometimes more national/international respect. Working at Mass General does mean something to many other physicians and patients. Your name may carry more weight in the big city if you are into prestige.

Better High End/Tertiary Care

If you need treatment for rare diseases, most patients need to go to the big city. These places tend to be hotbeds of research and new therapies and diagnostic tools. The city is the place to be for this work.

Disadvantages Of Urban Radiology

Decreased Pay And Benefits

With all of these perks come the decreased pay because of the desirability of the location. This factor is more pronounced if you decide on a partnership track somewhere. These imaging businesses can afford to pay their radiologists less because they will come anyway!

Increased Competition In Urban Radiology

More physicians mean more competition for every dollar earned. You can’t just build a new imaging center and expect patients to come. Why can’t they get imaged at the business down the street instead?

Higher Living Expenses

Along with lower pay comes higher living expenses. Costs in cities like New York and San Francisco are out of control. And, even as a physician, the economy may force you to rent. Those Benjamins just don’t go anywhere near as far with those high housing and food costs.

Less “Outdoor” Activities

Cities are more conducive to the museums and theaters but less so to hiking up a beautiful green mountain somewhere. For you, that fact may be a game-changer.

So, Who Wins The War- Rural Or Urban Radiology?

Sorry. But, not every location will float everyone’s boats. However, I can say the following. Consider the rural job if you have significant debt because the cost of living can outweigh almost any other advantages of living in the city. The expenses alone will cause you to delay any such hope of financial freedom. Otherwise, find a place that will suit your needs for a long-term relationship. And that can be either rural or urban depending on your family and personality. Just remember. Weigh the pros and cons!

 

 

 

 

 

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How Competitive Is Radiology For The 2022 Match?

2022 match

We are well through a good chunk of our interview season. So, it’s about that time for me to start making predictions for the up-and-coming 2022 match as I have done for the previous years. Check out my blog for last year called From The Trenches! How Competitive Is Diagnostic Radiology For The 2021 Match? Based on last year’s predictions, it seems I was pretty close to the mark if you compare my thoughts to the NRMP stats. My goal is not to freak everybody about getting to residency. Instead, I want to paint as realistic of a picture as I can for those applying to give them some expectations of the process. Let’s see if I can also get it right for this year. (Hell, a broken clock is right twice a day!) Like last time, let’s use some of the objective and more subjective criteria to determine the application competitiveness.

Moreover, this year, we can make a fairer comparison between the interview candidates because we are directly comparing two zoom interview years. It’s more of an apples-to-apples comparison than last interview season when we didn’t have such a comparison. Hopefully, that will make my conclusions even more precise than the previous year.

“Objective Criteria” For The 2022 Match

Applicant Board Scores

Alright, let’s start with the obvious. The board scores are noticeably higher than last year when it comes to our applications. And, I would say a significant five to ten points higher. Although not the norm, scores above 260 are sometimes seen, more commonly than last year. Therefore, we have raised our cut-off slightly this year due to this increase. That certainly bodes well for the applicant pool, but not so much for the individual.

Interviewing Less Foreign Grads

At a smaller institution like ours, we tend to get more foreign grads than some of the bigger programs. That, of course, may change to some extent when we eventually merge. Nevertheless, the number of foreign grads invited to interview slots has decreased slightly. Why? It seems there are more local U.S. grads from which to choose. Now, I have traditionally loved our foreign medical school-trained residents, but our program obligates us to peruse the U.S. applications first. Be that as it may, I perceive a noticeable difference in the numbers of American medical school applicants to our program this year.

Fewer Zoom Cancellations

So, far I have also noticed fewer zoom canceled interviews at this point. Usually, folks get tired of interviewing by the midpoint of December, and the numbers begin to drop off a bit. This trend is not so much the case so far this year. Our interview days have been chock full of eager applicants. That also points to a more competitive year.

“Subjective Criteria” For The 2022 Match

More Interesting Applications

Every year has its fair share of interesting applicants. But, this year, the pool seems more varied. I see more “self-starters” like former business owners, high-performing talented musical folks, and folks with many other impressive side hobbies and unique talents. This increase seems to happen more often with a more competitive pool of applicants.

“The Covid Factor”

This year is the first year where applicants had a decent amount of time to mull over applying with the effects of Covid playing a role in their future specialty choice. For many applicants, this is where radiology begins to look even more attractive. First of all, many applicants have thought about and noticed the flexibility of specialty regarding patient care. Some folks have realized they may not have wanted to spend as much time with covid positive patients as, say, an internal medicine physician. Unlike other specialties, we can sometimes work from home and not have to worry about contracting and spreading Covid all the time.

Furthermore, many applicants see the critical role that we play in the diagnosis and management of Covid. To some, this is an attractive feature of radiology. Regardless of the motives, I see the “covid factor” making radiology a more attractive specialty than ever before

“Good Job Market”

The job market has been going strong in radiology for several years, except for the sudden blip/drop-off of the initial covid outbreak. When the job market has been relatively strong for some time (usually a few years), medical students begin to notice when salaries are relatively high, and the job market is healthy. Indeed, that situation has been active, and I believe it will remain this way for the foreseeable future (until the next market swing!)

My Final Assessment Of Our Radiology Competitiveness For The 2022 Match

Sorry to those that are worried about this year’s competitiveness. But, I see a significant uptick in the competitiveness in the application situation. I have found it noticeable compared to last year. But, the devil is in the details. Let’s see what the folks at the NRMP have to say in March!

 

 

 

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All The Hype About Artificial Intelligence Products Versus What Really Happened!

artificial intelligence products

Flashback to 2018 and 2019, and you can read some of my posts about the RSNA’s latest and greatest artificial intelligence products. So, what percentage of those products has your hospital or imaging center incorporated into their workflow? For us, I can tell you that number is exceedingly low. And, I am willing to bet that most of you have a similar story. So, I figured it would be fun to go through some of the promises that silicon valley has made over the past several years versus what has come to fruition in daily practice. Let’s go over their overpromises and underdelivering. It would be fun to do this every few years to check up on the progression of AI technology in Radiology!

Reading Mammo With Half The Amount of Readers

Ironically, if you have seen any decrease in the number of breast studies coming to your institution, it has far less to do with artificial intelligence. Instead, it is probably related to Covid! Nevertheless, most of the work has returned. And, I don’t know of any institutions that are using artificial intelligence to replace the initial screening reads for mammograms. (as enticing as that sounds!) Most places have the hebeejeebees for ethically, legally, and financially replacing a mammo reader with a computer!

Workflow Will Be Seamlessly Integrated

I was hoping this one would have taken place by now. But to no avail. Yes, we will be getting another EHR/RIS system to replace the one that we have right now. But rumor has it that, although better, it is nowhere near seamless. I am still waiting for the day that I pull up a case, and my computer instantly opens up a case, the appropriate priors, the relevant labs, a brief pertinent history, an internet blurb on the disease entity, and the patient’s most recent surgeries without having to click a button. I believe the day will come. But, I’m not sure it will be there during my working lifetime!

Radiologist Will Have No Role In Reading Bone Ages

This concept makes a lot of sense. AI should read cases with a low likelihood of lawsuits and unlikely dire outcomes. What better study for artificial intelligence to read than a bone age? It certainly meets those criteria. Furthermore, we analyze and match up features of hands with features similar to standard cases. This process should be easy peasy chicken squeezy. (Maybe in my dreams!) Well, I am still waiting for my institution to incorporate this incredible technology!

Dictation Will Be Entirely Automated Into Standard Reports

If I had a dime for every time a company would say, your reports would be so much easier without our technology; I would be a veritable gazillionaire. Of course, they will standardize everything. And, with one button click, the clinician will be able to localize your disease pathology on a film. Where is this technology? Certainly not at our institution. (And, probably not at yours either!)

CAD Artificial Intelligence Products For Mammography Will Work Well Much Better!

Maybe, CAD detection has improved. But, I do not notice it one bit at the institutions I work. For me, it seems like the same old random placement of circles and stars to match supposed masses and calcifications. Rarely (if ever) has it noticeably helped me. And it does not seem to have changed much. Heck, but what do I know?

Artificial Intelligence Products Will Help With Diagnosis On Chest X-Rays

I saw some tremendous potential technologies at the RSNA to help make multiple diagnoses on chest films. It would issue a probability here and there for different disease entities. Well, I have not heard a whisper of this program coming to our institution any time soon. And, I have a sneaking suspicion, you will not see at yours either.

Improved Triage

Finally, I have heard of computer programs that will pre-search for life-altering diagnoses such as intracranial bleeds so that it will draw your attention to these cases first. I would love a program like that, and the technology should not be too advanced. But, I am still waiting and waiting and waiting and waiting…

Still Waiting For These Great Artificial Intelligence Products!

So, where does all of this leave now? I would have to say right back where we started. We have not seen that much yet except for some behind-the-scenes CT and PET-CT image improvement. Let’s do another checkup every once in a while. I have a feeling, though, these products will take a lot longer than anyone initially expected!

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Overcomplicating The Obvious For The Sake Of Academic Publication!

academic publication

Recently I came across an academic publication in the JACR, my favorite radiology journal, called Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. I had to look at it for a couple of reasons. First of all, I’ve written about the topic before in an article called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective!. My article espoused most of the JACR article’s ideas. And I wrote this article over 1.5 years before this new “academic” JACR article existed! (without even a citation of my publication!). Therefore, the topic was very relevant to my interests. 

Second, I was curious about if the conclusions would match up with my own. And, to answer the second question, they certainly did. As I summarized in my blog, this article also concluded that medical school prestige would gain outsized influences. Moreover, just like my article, they said that Step 2 scores would partly fill the gap left by the loss of Step I scores. (1)

Overcomplicating And “Academicizing” For The Sake Of Academic Publication

Nevertheless, having looked at the article for a few minutes, I found it more amusing how complicated they made this “study” to come up with simple logical, rational conclusions that any program director would make if you asked them. I mean, they got into “discrete choice experiments,” randomizing how faculty would answer when presented with different application situations. Simple surveys would have done the same trick. Now, I am a firm believer in evidence-based medicine to further science. But, this article is the perfect example of taking old information out there on the web (my own!) and overly complicating and “academicizing” what should be a simple logical thought process to create an “academic” paper out of it. If you will, this is another example of publishing for publishing’s sake merely to add to your credentials.

Is Your Article Genuinely Adding To Radiology Body of Literature?

Unfortunately, this type of intrigue happens all the time in academic radiology and medicine in general. So, if you genuinely want to add to the science and practice of radiology, think about the ideas and hypothesis that you are about to research. Are they original, or have other folks written about them? Will your paper serve a specific objective, or will it just add to the body of documents out there? And, finally, don’t try to complicate the issues when you can achieve the same goal in a much simpler way!

 

 

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Radiology Residency Makeover: What Can Make A Truly Excellent Program!

radiology residency makeover

Everyone has a different vision of what residency should be when they start. And some discover that residency is nothing as expected. Perhaps, you thought that you would get more lectures, but you are not receiving enough. Or, maybe you thought you would receive more thorough assessments by the faculty every week, but no one is checking up on you. Every residency has its sore points. But let’s say you could construct a radiology residency from scratch; what are some of the most critical elements you would like to fix? From an associate program director’s perspective, here are some essential items for a radiology residency makeover from the beginning!

Filling Out Evaluations- Seriously

In many residencies, evaluations get placed on the back-burner because attendings are busy and barely have time to do their work. But, what if faculty took these assessments seriously and took the time to give you real constructive criticism? I mean the type of analysis that would help fix your dictations or make you better at performing procedures. That takes a bit of time. But, receiving constructive criticism such as this would be well worth the price.

Formalized Guideposts For Applicants

Yes, most residencies claim to use milestones to ensure that residents are well on their way toward becoming independent radiologists. However, it’s more of a checkbox that most residencies place in residents’ portfolios to document progress. However, wouldn’t it be nice to have a radiology residency makeover so that you have specific achievable requirements to meet the goals and expectations of the program. I am talking about the type of thing such as the ability to read x numbers of chest films in a day by year two or having a formal standardized assessment for performing paracenteses that everyone needs to complete before allowing residents to do them independently. These guideposts are helpful and will enable you to know where you are at any given moment!

Lectures- Quality And Quantity

Some residencies promise lectures to all residents but do not deliver. Lecturers regularly cancel noon conferences due to other work obligations that they need to meet. Other residences give talks, but they are not of sufficient quality for residents to learn the material. Wouldn’t it be nice to have a residency that consistently provides the material you need to know with excellent lectures? And, lecturers that cancel permanently have a backup on deck—furthermore, all lessons are of homogeneously excellent quality.

A Radiology Residency Makeover So That All Faculty Care About Resident Welfare

Every program has some knowledgeable faculty. Nevertheless, it is another thing to care about resident well-being. Wouldn’t it be nice to have all faculty on board looking out for residents’ self-interest? It only takes a few caring attendings to help their residents along so that they can achieve great things. Whether it is helping pass the boards or having an interested soul to talk to, caring faculty can make all the difference in the residency experience.

Residents Running The Show

In the end, we need to be able to train residents to work competently and independently. On the other hand, some residencies don’t give the residents enough independence on all the rotations to truly get the experience they need to take charge of their service. Maybe they have needy patients that want attendings performing all the procedures. Or the faculty does all the work. Perhaps, an attending on-call overreads all your dictations. Wouldn’t it be nice if you could show that you could run the rotation at some point during your four years?

Residency Makeover: What Can Make A Truly Excellent Program!

As an associate program director, taking evaluations seriously, formalized guideposts, quality lectures, caring faculty, and allowing residents to take charge are some features that can transform a mediocre program into an excellent one. If you are lucky, your program follows these descriptions to a tee. But, life is not perfect, and neither are residency programs nor their faculty. Nevertheless, now you know, in an ideal world, this is probably your residency director’s dream!

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Evaluating The Pancreas On A Triple-Phase CT Scan Is A Minefield

triple-phase

I don’t know about you. But, for me, my least favorite CT scan has been the triple-phase CT scan to evaluate pancreatic masses. And, by most accounts in my group, many of our radiologists feel the same. For this reason, I would like to call the evaluation of the pancreas on a triple-phase CT scan a minefield. Many pitfalls in making the findings and interpretations abound. And no one, including the physicians and patients, is ever satisfied. But I thought this might be a good time to go through some of the issues you might encounter!

Subtle Lesions On A Triple-Phase

Pancreatic lesions tend to be some of the most subtle ones to detect. They can be hypovascular or hypervascular, infiltrative or circumscribed, versus cystic or solid. Sometimes, we see them in only one phase out of many in a triple-phase protocol. Even worse, you may only catch one of these lesions on a coronal or sagittal plane, which is not well confirmed by any other. You can miss one of these lesions in about a billion ways.

Severe Consequences For Missing A Lesion

Patient Tragedies

The lesions that you miss in the pancreas can be killers, literally. Both complex cystic and solid lesions can rapidly grow and kill the patient. I’ve seen significant changes over a few months or even less. Even worse, you can make the case that the patient would have significantly fewer complications if you had caught it earlier. These complications can include more extensive surgery, more potent chemotherapy with its consequences, or broader radiation treatment plans for palliative care. And the list goes on and on.

Legal Tragedies

Also, with the potential patient tragedies for missing lesions comes the potential for malpractice lawsuits in the “retrospectoscope.” Judges and juries can easily mistake “not-so-subtle” pancreatic lesions for prospectively discovered subtle ones. Along with the possibility of doing significant harm to patients for missing findings, this discrepancy can cause high-cost malpractice lawsuits/claims. If you read enough of these studies, it is only a matter of time before you receive one!

Numerous Additional Findings

In addition to the problem of finding the primary lesion, many different additional findings can change a patient’s management dramatically. These findings can also be very subtle. I’ve seen numerous permutations and combinations of various venous and arterial thromboses that folks always miss. Then, there is a debate about whether a lesion surrounds a vessel and to what extent. This issue necessarily affects whether or not one gets surgery. And I can’t tell you how often that outcome can differ depending on who is reading the study. Of course, you also have subtle lymph nodes with the porta adjacent to the head of the pancreas and within the celiac axis. All these different additional findings that you have to think about can make your head spin. And the consequences of missing them are dire!

Angry Surgeons

Finally, you must contend with the people who ultimately ordered the study. These tend to be the busiest of surgeons. And for that reason, the word “ornery” almost does not do justice. These folks are often on the edge of burnout from overworking and complex patients. They have their requirements for the reader they want and how they want their studies. You will notice at your institution that they might call a study for this surgeon a Dr. “John Doe” protocol because every surgeon wants the triple-phase protocol done slightly differently.

The Triple-Phase Protocol For The Pancreas Is A Minefield!

As you can see, when you find one of these studies coming through your department, batten down the hatches and do not let your attention stray. Making the findings can be challenging, and there are potentially “oh” so many of them. Remember to look at all the images and phases. And make sure to relay all the information neatly and logically. The triple-phase protocol for the pancreas is not for the faint of heart. It’s a veritable minefield of potential misses and problems!

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Is Radiology Training Like Learning A New Language?

language

Over the past few years, I have become more serious about learning Spanish and Hebrew. And after many years of stagnation, both have significantly improved. But what does this have to do with learning radiology as a resident? At first glance, it does not seem much. But as I took a deeper dive into the subject, it had everything to do with learning radiology. Radiology is a new language, different from almost every other aspect of medicine. You will learn a culture and terms you will hear almost nowhere else in medicine. To illustrate this point, when I went to my first noon conference as a medical student, the sound of residents describing and interpreting cases almost sounded like gobbledegook. Does that seem familiar to those who have attempted to learn a new language? It probably does!

So what are the features of successful linguists who can speak fluent second and third languages, which also appear when we learn radiology successfully? It includes everything from attitude to the amount of time you must put in. Let’s go through some of the most considerable similarities that I have found.

Steep Learning Curve

When you learn a new language, it is essential to remember those words that repeat time after time, like want, need, person, etc. So, in the beginning, you can say some simple sentences and string together simple ideas. During the first year of radiology residency, it’s the same. You learn all the basics quickly, including dictation and physics. But stringing together a more complex answer to a case is complicated. For that, it takes a very long time until you achieve mastery.

Don’t Be So Hard On Yourself

Language learning involves a lot of repetition. And, you may not be able to recall a word after seeing it ten, twenty times, or more. If you see learning after much repetition as a failure, you will no longer want to pursue language learning. It is part of the human learning process to forget and remember. Recognizing this natural part of language learning makes you realize you shouldn’t be so hard on yourself. 

Well, the same ideas work for radiology. You may not remember the findings of a particular disease entity or the energies of a radiopharmaceutical. It may be many times that you need to hear it before it sticks in your brain. That process is how human beings learn. We have to forgive our imperfections!

Continued Language Immersion Works

After a while in language learning, you will feel like you have hit a wall and nothing else sticks. But nothing can be farther from the truth. The more exposure you have, the better you get at speaking a language. Similarly, the more you spend time with other radiologists, the better you will become. Many things that we learn are almost subconscious. And, of course, the same applies to radiology learning. We need to constantly read, sit at the workstation, and perform procedures to get more and more exposure. Yes, you are learning, even when you don’t think you are actively doing so!

The More You Put Into A Language, The More You Get Out

The more time you put into a language every day, the quicker it will take you to achieve a significant level of fluency. If you take a thousand hours to learn a language, you will be much better off than studying it for 500 hours. The same applies to radiology residency. Whether you read 1 hour, 2 hours, or 3 hours per night affects how long it will take to become a superstar radiologist later in life. All the work you put in eventually pays off in spades.

Some Words/Accents Will Be Hard To Imitate

Sounding like a native speaker after learning a new language can almost seem impossible. The subtleties of language learning can take forever to achieve. Many language learners never even shed their old accents, but they sound slightly more and more native year after year. The same applies to the radiologist. We constantly strive to become like our favorite mentors and learn the radiology vocabulary. But, to do it right, we must work for years until we get to Shangri-La. Honing our dictation skills and coming up with the appropriate differentials and management on every case is what we all strive for, but never to perfection. We get asymptotically closer and closer to perfect fluency.

Read And Listen A Lot Before Speaking And Writing!

Before you hope to converse in a new language or become a proficient writer, you need to have an active vocabulary at your fingertips and know the sounds of the language. One cannot reasonably start to speak before one gets to this point. The same applies to radiology. Before taking cases and giving your opinions, you must read a ton and listen to your mentors dictating. It takes hours and hours before you have the power to do the same well. It’s a long process before you can dictate cases independently!

Radiology Is A New Language 

There are so many similarities between language learning and learning radiology because they are pretty much the same. We have to walk the walk to talk the talk. So, if you have ever had to learn a new language and have done it successfully, treat learning radiology almost identically. This experience is directly transferable to the process of learning the specialty. And if you have only had experience learning English, that’s okay too. Take some of these similarities between radiology and languages and heed some of the recommendations above. You will find the process of learning radiology a whole lot easier and more fun!

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Best Add-on Subspecialties As A Radiology Attending

add-on subspecialites

Have you ever thought about what would happen if you decided to specialize in an area different from your fellowship? Well, believe it or not, many radiologists commonly accomplish this feat after starting in practice. Maybe they want to try their hands on something new. Or, perhaps the group needs a sub-specialist that they don’t cover well. In any case, it happens all the time. So, what add-on subspecialties are the most conducive to on-the-job training and why? Here is a list of what I think attendings are most successful at tackling after fellowship.

MSK MRI

For many new attendings who already know other forms of MRI, taking up the requirements for MSK MRI is just a little more. There are great sources available. You can find loads of excellent MRI MSK outside courses. It’s relatively easy to find cases to overread at most institutions. Additionally, although present, the legal issues for MSK MRI are lower than for other areas, such as having misses in neuroradiology or a complication from an intervention. All these factors make MSK MRI an excellent modality to start to pick up after you finish your training.

Mammography

You may ask why it is reasonable to start practicing mammography after fellowship when it has the highest frequency of lawsuits from any other specialty. Although true, it also has some of the other lowest barriers to entry:

  1. Most radiologists have had some training in this specialty before working as an attending.
  2. The differential diagnosis is limited (though case management can be relatively complex but learnable on the job). And, it is relatively easy to overread your colleagues’ films. Many courses are available that can give you a refresher on the basics of tomography, MRI, and more.
  3. Most practices require additional coverage in this area.

Cardiac/Thoracic Imaging

Although some rads have completed fellowships, most folks who read cardiac studies such as Cardiac CTAs, calcium scorings, lung screenings, and Cardiac MRIs are not fellowship-trained. So, it is a doable add-on to your current skills. Courses are readily available, and the baseline knowledge needed for calcium scoring, lung screenings, and Cardiac CTAs is moderate. To become a cardiac MRI reader is a bit more time-consuming, but this area is wide open for folks that want to learn. Plus, most practices would love to have an additional reader or two.

Nuclear Medicine

I am not too proud as a nuclear radiologist to admit that nuclear medicine is one of those options conducive to an encore in your career. PET-CT is relatively easy to learn, aside from some artifacts and subtleties. After reviewing and over-reading some nuclear medicine studies, most general nuclear medicine is very doable. Cardiac perfusion imaging can be a challenge for some. But, I know of many radiologists who went to take a course and then came back to read additional cases with a radiologist. And they were excellent with their reads. If you are considering practicing nuclear medicine at any point, pay attention during residency!

Informatics

For this topic, all it takes is significant interest to become the go-to computer person in your group. Typically, by default, you, too, can become the guru. These folks like to play around with computers and are keenly interested in becoming part of the hospital information committees. Also, they are hobbyist programmers and closet geeks who love technology. All you need to do is read a lot and love all the nitty-gritty details of your PACs and information systems. With all this interest, you will have a leg up on the world of informatics and can become an expert in your practice. You don’t necessarily need a fellowship!

The Best Add-on Subspecialties To Practice

I firmly believe that no subspecialty in radiology is out of the realm of possibility once you become a full-fledged radiologist. However, some add-on subspecialties are more challenging when you are out in practice. Nevertheless, MSK MRI, mammography, cardiac/thoracic imaging, nuclear medicine, and informatics have lower entry barriers and are doable if you take an interest and there is a need. Something to consider if you want to try something new and you are out in practice!

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Making Silly Mistakes- Not The End Of The World!

silly mistakes

As I sit here writing late at night, my silly mistakes on radiology reports cross my mind. I can laugh about them now. But, when you first hear about them, they feel somewhat awkward. And I’m sure that you know what I mean. That prostate gland can become a uterus. Or, you pronounce a pregnancy on a patient with ascites. Maybe you say you saw a gallbladder in a patient with a prior cholecystectomy. It’s just a matter of time before it happens to you. If it doesn’t, you probably have not read enough scans! So, how can you make this experience a bit more comfortable? Here are some of my main words of advice to prevent you from being too hard on yourself.

Don’t Take Yourself Too Seriously

In the medical profession, many physicians tie their identities to perfection. Many of us encounter these physicians in medical school and our residency training. They tend to be miserable people. However, self-aware physicians will never make this mistake. We have to be able to admit that we will have our errors. And, if you do not make your identity perfect, you will look back and figure out how you made the silly errors you made. You might even laugh about them and enjoy the irony!

Realize Mistakes Will Happen

It’s not just a perfection issue. When you interpret enough films or perform more than your fair share of procedures, statistics say you will make a silly mistake. We can’t beat the numbers. And, the sooner we get through that notion, the happier we will be.

Silly Mistakes Are Learning Experiences

I found that each mistake is a learning experience, silly or not. When I think about how, when, and where I made a mistake, I understand the conditions that caused the problem. Did I go through a case too fast because it was the end of the day? Under what circumstances did I forget to look at the patient’s sex? Was I interrupted or too tired? Did I miss a finding because I neglected my search pattern, or was it a lack of knowledge in a particular area? Each of these questions allows us to delve deeper into the circumstances of an error and forces us to confront the truths so that it won’t happen again.

Silly Mistakes Can Be Teaching Tools!

Instead of covering up my silly mistakes, I use them as teaching points for others. These moments can be some of the most fun teaching tools. Moreover, they can make great stories. Who doesn’t like an excellent allegory to make that point stick? I would have been much less likely to do the same if I heard one of these ridiculous errors.

Yes, You Are Allowed To Talk About Your Silly Mistakes!

We are all human. When you dictate 10,000 reports containing 100 words, that’s a million. Just by sheer statistics alone, it’s only a matter of time before you say something ridiculous in one of those million words. So, get off your high horse and own your silly mistakes. At least make them into something useful!

 

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Making A Radiology Schedule Can Be Tough!

radiology schedule

In any stage of radiology, we all want the best schedule possible. Most of us hope for rotations where you can enjoy what you are doing, perhaps within your specialty. We desire vacation time that is fair and equal to others in a similar specialty/situation. And, you want a call that is equitable and reasonable compared to everyone else. Not all rotations fit that bill, though. Nor is it possible to accommodate everyone all the time. If you tweak one person’s schedule, you can make someone else life miserable. The balance is delicate. It’s kind of like when you give medication, and it comes with untoward side effects! So, if you are helping out with the schedule at your institution, how can you make the radiology schedule as palatable as possible for everyone? Here are some of the guidelines that work at our site.

Get The Appropriate Tools For The Radiology Schedule

Our main job is practicing as a radiologist, not as a scheduler. So, make sure that you get all the necessary tools to make your job as easy as possible. Whether it is radiology scheduling software, a business manager, or a secretary for the practice, you should have some assistance to help you along the way. Don’t try to make the schedule without these tools. It is below your pay grade!

Be Redundant

We all are human, and calamities befall all of us at one time or another. Whether it is sickness or taking care of loved ones, we have to expect that not all of us will be available on any given day. So, every practice needs a little bit of redundancy in the schedule. That way, your practice will have adequate coverage when these events happen. It is not feasible to allow just a skeleton crew to steer the ship. It can become a potential recipe for disaster if some calls out sick!

Communicate All Schedule Changes Well

In practice, this statement sounds entirely logical. But, often, lack of communication can represent the downfall of a radiology department. If you decide to change a location or rotation, you need an excellent system to communicate the change. And, preferably, you should make the change well in advance of the new schedule. Radiologists have plans too!

Make Sure There Is A Balance

If you want to stoke the anger of your colleagues, the best way to do that is to make sure that one radiologist gets the most cush rotation at the expense of everyone else. Therefore, it is critical to monitor the different calls and rotations and ensure that the numbers are as equitable as possible for each practice member. This step can be time-consuming. But, recording where each radiologist is working and how many calls they work should become a critical mission to improve the schedule.

Be Nice But Firm

You can’t always get what you want. (Just like the Rolling Stones song!) Sometimes, we need to cover rotations and calls that no one wants. And, everyone at some point will have to take one of these shifts regardless of how they feel about it. So, if you are in charge of the schedule, there are times you have to hold your ground for fairness’ sake, of course, in a friendly way. Scheduling can be a tough job!

Take Suggestions For The Radiology Schedule

Making a schedule for a practice can be complicated. And, you might not have the experience to know what makes sense in all of the subspecialty departments. Therefore, a scheduler must be willing to listen to the suggestions of those folks that may know the rotations and schedule in their area the best. Without the input of others, it is unlikely that you will be able to create a reasonable plan for everyone!

Making A Fair Radiology Schedule

Scheduling is a critical part of any radiology practice. And it is not easy. Moreover, it may be impossible to satisfy everyone. But, if you have the tools you need and take into account the input of others while listening to some of my suggestions, you can make a schedule that will maximize equitability for everyone. It is possible to make a reasonable schedule for your residency or practice!