Month: March 2021

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Presumptions About Our Radiology Colleagues Can Sow The Seeds Of Destruction!

presumptions

First and foremost, radiologists are people. And, people make presumptions about others, whether it is colleagues, leaders, or friends. It’s just human nature. However, it is also one of the biggest mistakes that one can make in business, particularly in private radiology practice. We all think that we know what kind of job our colleagues do. And, we base many of these stereotypes on miscommunication and pure conjecture. All this can lead to bad blood and, even worse, lousy practice outcomes. So, let’s go through the main reasons why presuming to know our fellow radiologist’s job is so dangerous to the practice and business of radiology?

Ways That Presumptions Damage A Practice

You Do Less Than Me!

If you like toxicity, this unfounded statement can spread the most venom to the rest of your colleagues. And, most of the time, it is not valid. Everyone does work a bit differently. So, work can be hard to quantify.

Moreover, this statement decreases everyone’s incentive to work. Who wants to work when everyone else does less? Of course, maybe there is one outlier in your practice that does a lot less. But, if you are always going to worry about everyone else, what is the incentive for you to work?

The Work They Do At The Other Practice Down The Street Isn’t Hard.

You can never tell for sure how hard work that some other practice is doing is difficult or not. Indeed, it is even worse to make that presumption. Has your practice ever tried starting a thriving vein center? It’s effortless to create one for yourself. Well, there is probably a lot more to the process than you think. Without doing the research, this assumption is a surefire way to lose a lot of money and time, not being prepared for the work you will need to succeed!

Presumptions That Administrative And Teaching Roles Are Not Real Work

This one is a real doozie. Almost every program director throughout the country has been the brunt of this presumption at one time or another. Yes, we are not constantly pumping out RVUs. But instead, we are teaching, fielding all the requests and complaints, and completing all the paperwork. A residency can fall apart without these services. It is not the same as reading films, but yes, it is real work!

MR, IR, Nuclear Medicine, Mammo, Etc. Are Easy

One way to get into trouble, presume that other radiologist’s area of expertise is simple. You don’t know until you work in the field. Think mammo is easy? Wait until your first lawsuit? And, MRI is not complex, right? Just wait until you miss your first subtle neural tumor. Every field has its challenges. And, each needs a lot of practice to become good at it!

It Doesn’t Matter That He Has The Ear Of The Referrer; I Work Harder

It’s not always just about the amount of work that you do. It is also about the perceived quality of your work. That radiologist that always gets phone calls to consult with referrers? There is probably a reason for that! Maybe he’s just friendly. But maybe, just maybe, he knows a lot. And perhaps he knows a lot more than you! You lose his expertise, and you start losing patients from your practice. It doesn’t matter how hard you work!

Presumptions About Our Radiology Colleagues: Sowing The Seeds Of Destruction!

Yes, presuming to know what your friends down the hall do on a day-to-day basis is fraught with danger. And, you probably know less than you think you do about your colleague’s issues. So, if you want to take this path, be very wary of the dangers above. It’s a surefire way to add to a toxic workplace!

 

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Can High Step III USMLE Scores Compensate For A Bad Step I And Step II?

step III

Question About Step III USMLE Scores:

Hello,

Would an excellent Step III score offset bad Step I and Step II scores? My Step I was 226, and my Step II was 219. Thank you!

 

Answer:

You have posted an interesting question. But, first, let’s talk about your scores. Your scores are not in the “bad” category. Typically, at our institution, a score of 226 on Step I can get you a foot in the door for an interview if everything else is OK. The step II score was a bit more marginal. But, the Step I score has shown that you have the potential to pass the core exam.

I agree that if diagnostic radiology becomes more competitive and institutions continue to use them for selection screening, they may slightly raise the bar. (although the score for Step I will be disappearing) That could make your scores not cross the threshold for acceptance for interviews. But, for now, I think many programs would accept those scores.

A Strange Situation Indeed

First of all, what is interesting, strangely enough, is that in the 12 years of working as an associate residency director, I have never seen the situation where both Step I and Step II are below 220 and step III is around 250 or so. And, I think I have a sneaking suspicion why.

First, very few people who score lower than the Step I and Step II thresholds will ever ace the exam in Step III. Additionally, we typically use cut-offs of 220 for either Step I or Step II. So, Step III is usually not on the radar because many residents typically don’t take this exam as “seriously and therefore we, as faculty, don’t either.” Why? Because the folks taking the exam are traditionally interns that don’t have as much time to study for it. So, the scores are not so critical. Instead, typically we care only that the resident has passed the Step III exam.

It’s Not About The Exam Itself

Again, to remind you, I am not a big fan of any of the USMLE exams. However, it is one of a few items that correlate with good core exam outcomes in radiology. And good core exam outcomes affect residency credentialing. So, unfortunately, all this talk about scores has nothing to do with being a good radiologist. Instead, it has only to do with the probability of becoming a board-certified radiologist. And, therefore, we are forced to use these scores as a screening tool for interviews.

Final Determination About Step III

In brief, to answer your question, Step III is the least influential of all the USMLE exams for receiving interviews. An excellent step III score will most likely not compensate for feeble Step I and II scores (which yours are not!)

I hope that answered your question,

Barry Julius, MD

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Reasons To Check In With Faculty Early In The Morning!

check in

Radiology residency programs differ widely in the independence that they allow their residents. Some let their residents do most procedures almost entirely by themselves. And others are more stingy with giving permission. Regardless of your situation, however, it is critical to check in with your scheduled cases before the day begins with your attending as a young learning physician. These include rotations, especially fluoroscopy and interventional radiology. And it’s not just to say hi! It is excellent for education and patient care. Let me give you multiple reasons why.

Getting A Good History- Filling In The Gaps

Sometimes residents either do not know the right questions to ask. Or other times, radiologists may have discussed the case with the ordering physician already. Each of these different circumstances provides information that the resident does not already have. These critical facts can change the direction of the case. For instance, if you already know that a patient is here for dysphagia, you would perform an esophagram that would critically analyze the upper esophagus instead of mainly the stomach or duodenum. Why not check in with your attending to confirm what is going on?

Increase Learning

By going over the schedule with your faculty in the morning, attendings will most likely discuss the disease entity that you will need to know. All this discussion is the best way to reinforce what you have already learned. Even better, it is a great way to introduce you to new topics and issues you may face when performing the case. And, it’s an easier way to learn what you may need to know for the boards.

Check-In For The Collaboration

Working with your attendings allows you to get to know them better. A team-based approach is usually better than going at it alone. Teamwork usually leads to a better relationship over the year. Who knows? Maybe, you will eventually ask this faculty member for a recommendation!

Attending May Not Realize Case Is On The Worklist

Sometimes cases can get lost, even on PACS systems nowadays. Accession numbers and MRI numbers can be incorrect. Or, the tech can batch a case on the wrong worklist accidentally. By going over the morning case, your attending now knows what she can expect on the wordlist during the day. And, if it is not there (for whatever reason), either you or your faculty can look into it. It is one surefire way to make sure that the case does not slip through the cracks!

Performing Studies The Way The Faculty Likes It

Every faculty member likes cases done in different ways. Some may want a few extra views of the stomach on an upper GI series. Others expect a thorough workup of the esophagus. Regardless, you will now precisely know precisely what you should do before even starting the case. All this diligence prevents the attending from bringing the case back and ensuring that you perform it appropriately. In the end, it is your attending’s name on the report and takes full responsibility for everything you do!

Check-In With Your Faculty First Thing In The Morning

It is more than just lip service to check in with your attending in the morning. Checking in serves many practical purposes, including getting better and more valid information, learning about diseases, preventing cases from falling through the cracks, and ensuring you complete the procedure correctly. So, pick up the phone or stop by your attending’s office. And let your faculty know what is on the schedule before starting. It is an excellent way to augment learning and improve patient care!

 

 

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Should You Take A Phone Call From A Physician Outside Your Residency System?

phone call

Picture this scenario. It is 2 a.m., and you get a phone call from a doctor at an outside hospital not associated with your residency. The doctor asks about a patient previously admitted under one of the radiology faculty at your institution. This faculty member also has privileges at another site, but your residency program is not affiliated with this other imaging center. He prompts you to try to contact the faculty member to do the procedure at the other hospital. If you comply with the phone call demands, it will take time away from reading cases while you take call. What do you do?

Many of you may have encountered a situation such as this one. And, you might think there is a simple answer. Of course, you should help out a fellow clinician in need, right? But, in fact, many issues should come into play before making this final decision. So, let’s go through these factors and come up with a balanced answer to this question. Let’s tackle this problem from three different angles: patient care, the hospital/residency perspective, and the financial/legal perspective. Then, we will come up with a final conclusion on how to deal with this scenario.

The Patient Care Perspective

From a patient care perspective, as long as you can verify that the physician calling is truly a physician, helping out a fellow clinician could potentially benefit the patient the clinician is calling about. However, while trying to get in touch with your radiologist, you are distracted from the work you have at hand. You may be delaying all the CT scans, ultrasounds, and more that need to get read at nighttime. So, in terms of patient care, answering the phone call may at best be a wash in terms of fulfilling your duties.

The Hospital/Residency Perspective

On the other hand, you are also providing a service to an outside doctor, not in your job description. You are supposed to be taking care of patients at your institution, not other sites. Moreover, the hospital and the federal government pays you to take care of patients at this site. Answering the phone call for the convenience of an outside attending is outside your job purview.

Additionally, from the residency perspective, taking extraneous phone calls is not helping you in your training. Nor does this phone call count as service duty. Therefore, taking this phone and performing this service runs counter to what you should be doing at nighttime.

The Financial/Legal Perspective

Your malpractice insurance does not cover you if you are taking care of patients outside the institution. Let’s say you can’t get in touch with the faculty member to take care of this patient. But, you have promised to get in touch with him. Now, in a sense, you are taking responsibility for a case outside your institution. You have some obligation toward the doctor that called, the patient that needs care, and the faculty member that you need to call. If something goes wrong with these entities’ connections, the law can hold you partially liable theoretically. And, the residency does not insure you for that!

What To Do With The Outside Phone Call?

You have one reason to respond to this outside physician’s request (“to be helpful”), and you have multiple additional patient care, residency, and financial/legal reasons not to get involved. So, what is the best course of action? Based on these reasons, you need to make it the hospital’s responsibility to get the doctor’s information. Refer the doctor to the operator or the help desk!

In a perfect world, we can help out everyone. But, there are costs and benefits to everything we do. Sometimes, initially, the seemingly most logical and straightforward answers are not the best!

 

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Top Ten Reasons To Be An Urban Radiologist! (From A Suburbanite!)

urban radiologist

Last week I gave you all a top ten list for becoming a rural radiologist. But, I have received a few complaints from my urban colleagues that believe they have been shortchanged. Despite all the advantages of rural radiology, there are still some significant advantages for urban radiologists. Today, to be evenhanded and in honor of the city life, here are the top ten reasons to migrate to the city as an urban radiologist!

Concentration Of Specialized Radiologists In One Place

Where else can you find a subspecialist that specializes in neuro intervention of vascular malformations as well as a Xofigo center of excellence? Unlikely that you will find this in the middle of rural Nebraska. But, in a big city, you can find a subspecialist in almost anything. And, you can become that specialist because of the high concentration of patients in one place!

High Quality Of The Urban Radiologist

That is not to say that rural radiologists are bad, but it does take a lot to survive in the city. And finding that job usually requires some high falootin’ credentials. It would help if you had the right hybrid of certificates and connections. So, you do find a large proportion of overachieving physicians in the city. It even goes the same for radiologists!

More Cross-Pollination With The Urban Radiologist

What happens when you gather a bevy of doctors in one place? Well, you get to hear the war stories in other departments. And you are more likely to discuss other physician areas of interest. Of course, this discussion will often lead to distinct outcomes, whether creating research or treating patients differently. For instance, you have an all-star thyroid pathologist on the premises, so you are more likely going to do lots of thyroid biopsies, more so than other institutions. Cross-pollenation changes the dynamic.

Convenience

Where else can you walk a few hundred feet away from your site of work or residence and go to a supermarket, drug store, and dog training facility? I certainly can’t think of any. There’s no need to maintain a car or means of transportation. It’s all at your fingertips by walking or public transit.

Easier For The Urban Radiologist To Get A Date

Maybe you are single and looking? When you out in the middle of rural Idaho, you might have a more challenging time finding a significant other. And many young radiologists are still single. So, think about that urban job. You are more likely to find like-minded folks and, of course, get hitched!

Larger Diversity Of Patients

Are you looking to become more culturally aware? Well, look no further than the city. You will see all types of folks and have the opportunity to communicate and learn from them. It just doesn’t happen to the same extent out in the hinterlands. It’s only one of those advantages of city life.

Greater Swath Of Pathology

Along with the more significant cultural diversity comes an increased variety of pathology unique to every culture and country worldwide. You will find all sorts of weird and bizarre diseases in the middle of a city you won’t find elsewhere. These can include all kinds of genetic and environmental pathology. Want to swing for fences with differential diagnoses with zebras? Go practice in the city!

Cultural Opportunities

Do you like the opera or want to see a heavy metal rock concert? Maybe you want to check out the local happenings at the new dinosaur exhibit? There is no better place for this than a large city. You will never get the same opportunities out in the country.

Lots Of Shopping

Folks come all over the world to shop at select stores in large cities. And, you can find goods and services that you would seldom find anywhere else. It may be a market for ancient lamps or a store for hand-hewn mannequins. You can find it all, and it may only be a few footsteps from your urban job!

Restaurants/Food

For the eclectic culinary lover of a radiologist, there is no better place to try out the flavors of the world. Olive Gardens and Chili’s (as much as I like them) don’t always do the trick. Sometimes you want to eat out or pick up food from a culinary king. And, even better, when you step out of your imaging center to go to pick it up next door!

Being An Urban Radiologist- Not So Bad!

Yes, rural radiology does have its advantage when it comes to the cost of living and pay. But life is not all about money. You miss out on a whole world of opportunities when you live outside the city in rural America. So, if you like culture, entertainment, and convenience, consider a life in the city as an urban radiologist. You won’t regret it!