Month: February 2021

Posted on by

Top Ten Reasons To Work As A Rural Radiologist (From A Suburbanite!)

rural radiologist

Go onto any radiology forum, and you will hear a perpetual argument about who has it better, an urban or rural radiologist. So, let’s nip this in the bud once and for all. Let’s give a top ten list as to why you should look for a career as a rural radiologist (coming from a suburban radiologist, of course!)

Top Ten Reasons To Practice As A Rural Radiologist!

Better Pay

This one is the most obvious, but it is true. Check out any of the want ads, and you will see sky-high salaries enticing you to drop on by. Typically, they may not say the name of the town. Why? because they know that you have never heard of it! How can this happen? Well, they need to incentivize you, the radiologist, to want to come there. So, why not take advantage of it? Make those big bucks!

Cheaper Cost Of Living

Not only do you have the advantage of extra pay, but your cost of living can be more than 50 percent or even 75 percent less than living in a city. Think about a three-bedroom apartment in New York or San Francisco for umpteen million dollars. What would that cost in a rural area? A few hundred thousand dollars at best. Think about all that cash you can save with that huge salary that you have.

Less Daily Pressure

More than the money, this one attracts me the most. The lifestyle of the inhabitants of the rural world tends to be less pressured. Less screaming and arguing. More space away from others to prevent kerfuffles. Why not work and live in such an environment?

Appreciative Patients

In rural communities, you tend to have patients that appreciate your work. Why? Well, they can’t simply go to the imaging center down the block. There isn’t any! Your word is valuable, and you are an integral part of the community. It’s just part of the package of rural America.

Cleaner Living – Nice Smell

You know that sweet smell of nature when you leave to go on a trip to the country. Well, if you work at a rural site, you can have that all the time. You don’t smell the exhaust pipes of tons of cars. Nor do you smell rotting garbage on the streets. You just have the crisp, clean air of nature.

Rural Radiologist: One With Nature

Like going for brisk walks with your dog? Or, you enjoy hiking on mountainous nature trails? Maybe, you want to go swimming in a lake? All you have to do is walk out your door, and it’s available. Not a bad gig for the nature-loving radiologist!

No Traffic

Imagine leaving your doorstep and driving to the hospital with no more than a few other cars driving on the road? That is a pipe dream for a city radiologist. But, it is the real world for the rural one. Get to work fast and without the hassle of not knowing exactly when you will arrive.

Larger Spaces/Newer Hospitals

Rural hospitals tend to be more open and modern. Why? Most were not built at the beginning of the 20th century. Therefore, you’ll find open floor plans for interventional suites and widely spaced modern reading rooms. These are features of most rural hospital centers.

Lower Decibel Levels-Better Health

When you step outside, you don’t hear the honks of cars or the screams of fighting neighbors. Instead, you hear the rustle of the leaves or the chirping of the birds outside. Furthermore, you don’t live in an area with as many pollutants in the air and water. It’s a setup for a healthier lifestyle.

A Rural Radiologist Can Do Everything

Finally, because you don’t have tons of competition in the neighborhood, you can do almost any type of procedure that interests you. You won’t be butting heads with the cardiologist who wants to take all the Cardiac MRIs or the vascular surgeon with all the peripheral vascular patients for angiography/peripheral vessel disease. The world is your oyster!

The Life Of A Rural Radiologist- Not So Bad!

So, there you have it. Here’s a top ten list for why to choose rural radiology from a local suburbanite. Take it or leave it. But, there are lots of advantages to rural life!

 

Posted on by

Considerations For An Internal Medicine Resident That Wants Radiology!

internal mediicine resident

Question From An Internal Medicine Resident:

 Hi,

I am an internal medicine resident and want to switch to radiology. I’m also a DO and didn’t take the USMLE. I realize most programs require the USMLE exams. I am thinking of taking the exams and applying to advanced or R positions or completing an internal medicine residency and applying to radiology as a 2nd residency. What are your thoughts regarding taking the USMLE while in residency and switching residencies? Any words of advice regarding how to get letters of recommendation from radiologists? Thank you

 

Answer:

First issue For An Internal Medicine Resident

I would consider applying to radiology as soon as possible. Why? Because the longer you spend in an internal medicine residency, the more likely medicare won’t fund your entire radiology residency. That can deter residency programs from choosing you when you apply for a radiology residency. So I would not delay. After two years of other residency/internships, you lose a good chunk of funding!

 

Second issue

It would help if you took the USMLE before applying to radiology. Most programs use this as a screening criterion. And you will be screened out of most programs. You should take the USMLE exams if you want to significantly increase your chance of getting into a radiology residency program. It would be best if you took this as soon as you can. The COMLEX just does not hold as much weight in radiology residency circles.

 

Third issue

Letters of recommendations from radiologists are not necessary if you have great letters. Although desirable to have at least one letter from a radiologist, most programs would understand if you do not have access to a radiology program at your institution. The quality of the recommendations counts the most, not the recommending physician (unless it is some famous name somewhere!) Of course, if you can rotate through a radiology department somewhere and get a LOR, that would be good too!

Regards,
Barry Julius, MD
Radsresident.com
Posted on by

Should Residencies Ever Rehire A Resident That Previously Left?

rehire

What is so special about the radiology resident when it comes to rehiring? Moreover, if a resident finds himself in a situation where he leaves and subsequently wants to go back, is it ever appropriate for a residency to rehire this individual? To answer these questions, let’s first discuss why residencies are so different from a regular job when rehiring.  

Why Rehiring Is So Different For Residencies?

Rehiring at a typical job and residency is not the same. For residencies, each post-graduate year has a distinct service role and responsibility that the program needs to fill, different from most jobs. Additionally, since residency is not just service (unlike a typical job), the resident also needs to meet educational qualifications in any given year. For some programs, that might mean passing specific procedural and cognitive activities. Finally, residents may need to fulfill designated milestones of differing responsibilities at each institution. So, residents are not easily interchangeable, and rehiring during residency can be challenging.

Additionally, when one leaves and wants to come back later, your program may not have the educational or financial resources to compensate the resident. For example, if you complete a different residency year and then return to radiology residency, Medicare may no longer fund your position. Or educationally speaking, a first-year most often cannot substitute for a third-year resident spot that might be open and vice versa. All these issues can also stand in the way of a rehire.

When Can A Residency Program Rehire A Former Resident?

Now that you can understand why rehiring might be so tricky, let’s discuss some of the situations that residencies might encounter that would enable the residency program to rehire a former resident. Three of these circumstances are a coincidental fortune, grants and opportunities, and institutional policies. We will go through each one of these in particular.

Coincidental Fortune

Sometimes all the stars align that allow a program to rehire a resident. Let’s take the example of a resident that was let go because of failing the Step III USMLE. At some institutions, residents need to pass the test before they reach their PGY-3 year. So, hospitals are not obligated to rehire individuals who do not pass their Step III boards after starting their PGY 3 year. 

But, let’s say the resident who failed initially was in good standing up until the boards and then passed their boards well into their PGY-3 year. Then, suppose the residency program has not filled that spot, and the former resident applied to it again after passing. In that case, the resident could be fortunate enough to retake their place (albeit possibly graduate later.) The story could have also ended without the resident able to retake their spot if it was no longer available. It was luck that enables the resident to get their job back again.

Grants And Opportunities

Other times, different programs have opportunities built into them to rehire residents after a specified amount of time. Perhaps, it is a year of international volunteering as a radiologist. Or, a resident may take off a year to complete a permissible research project in the institution. In these specific situations, programs can rehire their residents after they fulfill their time.

Institutional Policies

Finally, some institutions may have specific policies that forbid a resident from being fired. Perhaps, a residency suspends a resident but has done so without the appropriate documentation to do so. Other by-laws may force due process before termination (as long as it does not jeopardize patient care!) Specific policies in place at the hospital such as these can cause the rehiring of a resident.

To Rehire Former Residents: Not So Simple!

Residencies are much more than a typical job because of their education as well as service requirements. Therefore, rehiring former residents can present multiple obstacles due to the nuances of radiology residencies. Given these obstacles, don’t expect to regain your former position unless you do your due diligence to ensure that you still have a spot. Rehiring at a residency program is not the norm!

 

 

 

 

 

 

Posted on by

Service Exceeding Education At Your Program? Do Something About It!

service exceeding education

All radiology residencies have an Achilles heel. In the pursuit of creating an excellent education for all radiology residents, programs need to balance the “service obligations” with the “educational” environment. Now, there is a lot of debate about service exceeding education. But, we all know of rotations where the service obligations seem to outweigh what you may learn on rotation. You may have a mammography rotation where your attendings need you to complete all the needle localizations at the expense of learning diagnostic and screening mammograms. Or, perhaps, you have an interventional rotation where you can’t get into cases because the technologists need the residents to consent all the patients. Regardless, what do you do when you find yourself not receiving the education you think you should receive?

How To Improve A Rotation With Service Exceeding Education? A Playbook!

Step 1- Be Specific About The Problem Of Service Exceeding Education

The first thing you need to do is to be specific and write down the particular problems in the rotation. In other words, what are the educational circumstances that your program is not meeting? If you believe that the residents don’t have enough paracenteses, write that down. If you find that the nuclear medicine attending is never in the reading in the room or is not giving enough lectures, make sure to add that onto the list. Make sure you enumerate each of those problems. Eventually, you will want to address the issues with the educational committee.

Step 2- Cross-Reference with The ACGME Program Requirements

Next, check the ACGME program requirements. See if the problem is one that directly contradicts the philosophy and regulations of the program requirements. If so, write down how the issue interferes with the program’s goals. This step is critical because programs must fulfill their educational objectives to their residents. If they do not, programs can meet repercussions from the ACGME. At worst, the ACGME may not reaccredit your program until they comply. Some corrections can be costly. You can expedite change if you document how the issues may prevent the program from meeting the ACGME bylaws.

Step 3- Document The Issues And Provide Data

Now that you have the specific issues and why they may interfere with the program’s goals, create a data trail. For example, if you are not receiving the right number of conferences every week, document all the faculty’s conferences. Or, figure out what number per week you have been receiving or the rate of cancellation of lectures every week. You will need to have some hard data when the time comes to present the issues. Objective data helps because you can eventually factually show that the fix can improve the problem.

Step 4 – Create A Plan To Fix The Problem

Come up with a financial or educational plan to solve the problem. Say your program lacks a statistician and you need one to satisfy the research requirement, come up with the potential costs of hiring one for the hospital or the program. Of course, it is a good idea to meet with your faculty to figure out satisfactory solutions. As a resident, you may lack the experience to know some of the costs and problems that the institution may encounter when they attempt to fix the problem. So, gather a team of folks that do know more about the area you wish to improve.

Step 5- Formally Meet With The Program Director, GME Committee, Etc.

Since you have already enumerated the problems, figured out how they interfere with the program education/requirements, provided accurate, objective data, and created a plan to fix the problem, now is the time to meet with the appropriate committee. You should submit the initial run through to the education committee or the program directors at the program level. Here the committee can discuss the issues and enact a plan. If the solution is not amenable to being fixed at this level, the education committee can submit the plan to the GME level, hospital level, etc. Nevertheless, you need to formally present a plan so that the program or hospital can make a solution.

Step 6- Implement The Plan

Now that the institution or residency is backing the solution, you should be part of the team that seeks to implement the solution. Make sure that the plan is working as stated and followup to check for a positive outcome. Most of the time, you will find a reasonable solution for the previous issues. (But not always!)

Step 7- Document Outcomes

Now that your institution has “repaired” the problem, you still have more work to do. Make sure that the fix is not worse than the problem itself. It is therefore vital to objectively document how the changes to the program have affected the outcomes. If the hospital institutes a policy that faculty members that miss lectures will receive a pay cut and the lecturers continue to miss giving noon conferences, the fix was not an adequate solution. So, this step is crucial to show that you have a viable solution to your original problems.

Why Bother With All This Extra Work To Remedy Service Exceeding Education?

Well, the answer to this question relatively simple. Your radiology residency program is the foundation for your future career. And, if your education is not adequate, it will reflect in your future employment.

Furthermore, this learning experience is not only good for learning how to fix your residency. It is also a great way to learn the principles to enact change in any career stage. You can adapt the same steps to almost any situation where you want to enact helpful change. So, figure out those areas in your program where service requirements overburden learning and think about ways to enhance your residency rotations using this seven-step guide. It is an exercise worth the effort!

Posted on by

Will Translational Research Help My Radiology Application?

translational research

Question About Translational Research And Residency

 

Hi Dr. Julius,

I’m a first-year MD student and wondered, for research-heavy residencies, whether the type of research I’ve done is essential. For example, do PD’s like to see more translational research rather than clinical?

 

Answer

 

That is an excellent question. I would look at an application with research dramatically different from how a program director at some of the other research-heavy institutions like Mass General, University of Pennsylvania, or Washington University would look at the same application. Since I am in more of a clinical residency, my eyes begin to gloss over when I see too many bench-type research projects on an application. This soporific circumstance happens, mostly, when I see lots of enzymatic reactions with words that I have not heard of before without much explanation. It just does not capture my attention. On the other hand, at one of those bench research institutions, that same application with enzymatic reactions may excite them.

In my world, I am always trying to figure out the relevance to radiology residency. Nevertheless, even if not directly related to radiology residency, any exposure to research for you makes our lives a lot easier when you need to complete research requirements as a resident. You will know some of the basics and can “hit the ground running.”

More importantly, most of the more clinical-based residencies (like ours) are looking to see if you have had some research exposure. In the setting of my residency, clinical-based research would trump the translational variety. That being said, having done some research in any area does add a little to the application. It shows a commitment to learning and studying a topic in depth.

Bottom line. You may want to emphasize research a little differently at the various institutions when you apply. Think about the residencies you are applying to and gear your experiences and your applications to those residencies. It will augment your ERAS application to make it more relevant!

 

Regards,

Barry Julius, MD

 

Posted on by

From The Trenches! How Competitive Is Diagnostic Radiology For The 2021 Match?

2021 match

From a program director’s standpoint, the competition for residents this year has been one of the most difficult to ascertain. First, we have a pandemic preventing applicants from traveling to the institutions they have been applying to. Second, applicants can now apply to as many programs as they like without having to travel. And, finally, most programs are relying on the internet entirely for the interview experience. All these experiences are new and unique for radiology residencies. So, how can you compare the competitiveness of this year to others for the 2021 match? Is the increasing number of applicants and interviewees related to the match’s new dynamics, or is it a real increase in numbers?

Even the quality of applicants this year does not entirely help answer how competitive is diagnostic radiology. Increasing applicant quality may relate to the growing ease of interviewing with Zoom and a decreasing number of excellent canceling their interviews. Why cancel when it is so easy to complete your interview online? Nevertheless, let’s take on some of the secondary criteria and try to tackle the answer to how competitive is radiology this year using our crystal ball.

What Are Some Of The Secondary Criteria To Help Us To Determine Radiology Competitiveness For The 2021 Match?

Applicant Board Scores

No. I am a firm believer that board scores cannot measure the quality of a future radiologist. However, it is associated with future pass rate on the core exam test (another marginal exam!) And, “higher quality” applicants do tend to have higher Step I board scores. (Soon to disappear!)

So what is my first-hand experience with board scores? Of course, I am working in a microcosm. Therefore, I can’t vouch for other institutions. Nevertheless, board scores overall seem to be grossly the same as in other recent years. I have not seen a noticeable uptick in the numbers. These statistics lead me to believe; perhaps, applicant competitiveness may have marginally changed, if at all.

Residents Applying From Other Specialties

I have noticed a significant uptick in applicants applying from other subspecialties this year, especially surgery. This phenomenon only tends to happen when applicants perceive radiology as a hot field. Why sacrifice another residency and go into radiology if the prospects of finding a suitable job are not there? This secondary statistic does bode well for the increasing competitiveness of applicants.

Foreign Versus American Graduates

In more competitive years at our institution, we have tended to see a lot more students from American medical schools, fewer students from the Caribbean and foreign schools, and fewer students from D.O programs. This year’s numbers are grossly very similar to other recent years regarding the mix of students applying to our institution. So, I don’t see this as a vote for increasing competitiveness.

Amount of Research Published

More students do more research when the match is very competitive because applicants know they need it to ensure a spot. What about this year? Well, it seems to be very similar or marginally increased compared to other years. This statistic does not significantly change the outlook.

So, What Is My Final Assessment Of Radiology Competitiveness For The 2021 Match?

You would think that the pandemic would increase radiology’s desirability due to the ability to work from home and the increasing utility of imaging in the health care system. However, based on the secondary statistics, I see a similar to slightly increased match competitiveness for radiology. Like other institutions, we are interviewing more candidates. But, otherwise, the changes seem to be less significant than one might think, with little difference in board scores, similar numbers of foreign grad applicants, and overall unchanged research quantity of applicants. Of course, the one factor that can bode more increased competition from my small world is an increasing number of applicants are applying from other specialties. But, it is only one of many. All these factors add up to a similar year as the last few when it comes to radiology competitiveness. We will see what the future holds on 2021 match day!

 

What do you think? If your opinion differs throw me a comment or email!