Month: April 2021

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Now That My Crystal Ball Was Right For This Year’s Match, How Competitive Will Radiology Be Next Year?

crystal ball

For those of you that read my recent article during the interview season called From The Trenches! How Competitive Is Diagnostic Radiology For The 2021 Match?, you will know that my crystal ball was on target. Just take a look at the following NRMP match statistics to confirm my suspicions. If you look at the percent American MD and DO slots filled and add them up, that number is slightly higher than last year compared to the previous year. Then take a look at my prediction at the end of the blog; you will see the following statement: ” based on the secondary statistics, I see a similar to slightly increased match competitiveness for radiology.” Well, it just about matches!

Some people say that a broken clock is always right twice a day. But, I like to think that I do know a little something based on my pseudoscience. Now that I have established some street cred, the big question is, how does the crystal ball line up for next year? Well, my tarot cards project some changes over the next several years. And what will they be? So let me give you some of the reasons for my final opinion on next year’s match and then I will conclude after I sum it all up!

It Will Take A Few More Years For The Pandemic Effects To Settle Into The Medical Students Consciousness

News from the current radiology market tends to settle down into the medical school statistics several years after the fact. Why? Because medical students that have already decided to go for a particular subspecialty don’t like to change specialties right before the match. Therefore, whatever slight trends have occurred the year before, will tend to increase over the coming years. These trends include desirable radiology features like relatively more minor patient contact than other subspecialties (a positive in a pandemic) and a more remarkable ability to work from home than other medical specialties. Based on this theory, I expect more medical students to continue the upward trend of competitiveness for a radiology residency. We are in a positive feedback loop!

Zoom- The Crystal Ball Says The Trend Continues Allowing More Students Than Ever To Interview

We are in a period where the initial zoom interview is replacing the standard live interview. It’s just that much easier and cheaper to screen candidates. That fact also makes it much easier for candidates to take interviews that they may not have previously encountered before. It’s no big sweat to interview from your screen. But, it’s a major ordeal to travel two thousand miles by plane and car to arrive at your destination. So, we will continue to see a higher percentage of candidates interview at more institutions.

More Emphasis On Lifestyle/Flexibility

One of my colleagues recently polled graduating radiologists from want-ads. More than ever before, more new radiologists want the ability to do more work from home. Many new radiologists expect that they will not have to come into work to cover injections, perform procedures, or collect histories from patients. It has become a turn-off for some new radiologists to do anything at the hospital. I expect a similar trend to ensue over the next several years. And, radiology is one of those few specialties that can accommodate these sorts of candidates.

Artificial Intelligence Is Not The Sea-Changer It Was Expected To Be

It’s been 5-10 years since the artificial intelligence revolution had begun in earnest. And, what are the sharp changes that we have seen in the practice of radiology yet? Not as many as the pundits initially projected! Sure, we have some great triage tools, mammo CAD, lung nodule CAD, and improvements in software for reading CTs, PETs, and MRI. But has it changed the day-to-day work that much yet? Not at all. As usual, the folks in Silicon valley overmarketed their technologies to increase sales. But, it doesn’t necessarily amount to definite real-world changes in the practice of radiology. The replacement of radiologists is a far-off prophecy. It will remain that way for some time. And, medical students are beginning to understand the same!

So, What Does My Crystal Ball Say For The Next Year?

Well, if you can’t figure it out, re-read the previous four paragraphs! I am relatively bullish on the competitiveness of radiology in the NRMP match. My crystal ball sees continued increases in the quality and number of applications over the coming several years. What can stop this bullish trend? Lots of things! But, if I were an applicant now, I would have many more reasons to apply to radiology than several years before.

But remember this. Usually, periods that the match is more competitive are less valuable for the same applicants when they get out in the job market. The competitiveness and radiology market are highly cyclical. So, you may find yourself in a downdraft once you graduate or not! Regardless, as always, it is more important to apply to a subspecialty that you like. And even though I think radiology is the bomb, make sure that when you send your applications out, it is the specialty that you want!

 

 

 

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Can I Use Psychiatry As A Clinical Year Before Starting Radiology?

psychiatry

Question About Psychiatry Clinical Year

Hi Dr. Julius,

I initially matched into Psychiatry residency. However, I decided that Psychiatry was not for me and left after an intern year (which included two months of IM wards, one month of outpatient medicine, two months of Neuro, one month of ER, and six months of inpatient Psych) to serve as a GP for four years in the Air Force. I now plan to apply to Radiology. Will I be expected to repeat my intern year?

 

Answer

You posed an interesting dilemma about using psychiatry as a clinical year. If you look at the Radiology ACGME statement, which is as follows:

To be eligible for appointment to the program, residents must have successfully completed a prerequisite year of direct patient care in a program that satisfies the requirements in III.A.2. in emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, surgery or surgical specialties, the transitional year, or any combination of these.

This statement does consider psychiatry as an appropriate substitute for an internship year. However, it appears that you did spend a good chunk of the year on clinical care.

So, I would recommend the following: Give the ACGME a call and determine if you could count that year toward the program requirement (especially since you did have substantial non-psych months). On occasion, they do grant exceptions if you could prove that you spent the year performing direct clinical care. It’s worth a try.

If they approve only part of a year, that could be a problem. Why? Because it leaves you with half a year that you still need to complete. It may be hard to find a residency slot to fill up half a year of requirements only. Nevertheless, you never know what they will say. I would be interested to know how it turns out!

Regards,

Barry Julius, MD

 

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Seven Ways Administration Can Destroy A Radiology Residency Program

administration

Like it or not, all radiology programs need the backing of their administrators to succeed. Unless faculty and residents want to pay for residency out of their own pockets and manage all the day-to-day issues themselves, it is the only way to survive. So, with all this power in the hands of the administrators, it is no wonder that they can direct a residency in ways they see fit. And they can use their power for the good of the program or to the detriment of everyone. So, if you are wondering how the administration can pull strings to destroy a radiology residency program, here are the top seven ways!

Lack Of Financial Support

Unfortunately, a residency cannot run itself without money. Whether it is the reading resources, Radexam, equipment, or teaching, all these line items cost money. If the administration takes all the money for themselves and is unwilling to cough it up for the residency program, a residency cannot continue functioning.

Lack Of Human Resources

It’s not all about equipment and stuff. It would help if you also had the workforce to make a residency function. These folks include program directors, residency coordinators, faculty, statisticians, and more. If you can’t hire or maintain these folks, you may as well pack it all in!

Unrealistic Expectations By The Administration

We all want the best for our residents. But, when administrators expect to create an academic powerhouse but are unwilling to hire the proper faculty, or if you want a class of incredible residents but are not willing to pay for the latest and greatest equipment and technology, do not expect to create a residency that will function!

Administration Culture Clash/Backseat Driving

Administrators and faculty often have different ideas about how to run a program. Just because you, as an administrator, provide the funds to operate a radiology residency doesn’t mean you can control everything. For instance, recruiting residents from only certain institutions because you get a kickback doesn’t work.

And, just because you, as a radiologist or program director, think you know everything about running a residency doesn’t mean you know enough about managing a program’s business. Spending money without controls can lead to poor hospital financial outcomes. Either side pulling all the strings can lead to a disaster!

No Backup For Program Directors/Department

To maintain respectability within an institution, program directors need support from their administration. They may encounter problems getting a statistician to help residents with studies to meet the requirements of the ACGME. Perhaps there are conflicts with another department overstepping its bounds and using radiology residents for non-educational purposes. In either case, the administration must back up the program directors and radiology department to maintain the department.

Unwilling To Update Old Equipment To Save A Buck

Yes, institutions do like to keep that ancient CT scanner or MRI. Why? Well, it becomes a cash cow when it is all paid off. No more hardware expenses mean higher profit margins. But there comes a time when you are just out-of-date and can’t keep up with the competition. And guess what? That also affects the residency. Residents don’t get the training they need, and fewer patients come to the institution because they don’t get the advanced imaging they need!

Loathe To Adopt New Technologies- Too Many Hoops

Sometimes, you need to adopt new technologies, but there is so much bureaucracy that you can never push the capital budget through. Perhaps the administration makes it so hard to obtain the correct paperwork. Or maybe they only meet in committee once every six months and are not quick to decide. In any event, if you snooze, you lose!

Yes, Administration Can Destroy A Radiology Residency Program!

Radiology residency programs are only as good as their weakest link. And if that link is the administration, the whole residency can fall apart. Whether the issues are financial, cultural, or bureaucratic, each factor can result in the program’s demise. So, when you choose a training program, make sure to look into who administers it!

 

 

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How To Pull Your Weight As A Radiologist!

pull your weight

You may not know it, but hiring a lazy radiologist is one of the biggest disasters a practice can encounter. Practices spend much time and money getting their new employees up to speed. The last thing you want to be is to have to pull your weight in addition to someone else. And you want to avoid being seen as one of these lackadaisical radiologists. Why? First of all, your job can be in jeopardy. Even worse, you will lead an unsatisfying work life fraught with the anger of your co-workers. And you will most likely miss out on the perks of becoming a senior practice member. So, how do you avoid this reputation and pull your weight? Here are some tips for holding your own!

Don’t Cherry Pick

If you want to anger your colleagues and establish a lazy reputation, this is the best way. It doesn’t take long for others to realize that you are taking all the easy-peasy cases and leaving all the tough ones out there for others to suffer.

Follow Through On Your Word

Imagine working with someone who says they will help with an overflow of cases and then decides to pack it in when the clock strikes 5 PM. Or, how would it feel to trade worksites with someone else only to have that person not show up as they said? These workers leave a bad taste in everyone’s mouth. Just follow through on your word!

Take That One Extra Case At The End Of The Day To Pull Your Weight

I’ve written about this before (click the link above!). But, it is true that if you help by taking that one extra case at the end of the day, it can make all the difference for the rest of your colleagues. As opposed to establishing a bad reputation, this kind-hearted technique will put you in everyone’s good graces!

Pull Your Weight By Dictating Leftovers

Most practices have a list of cases that can go untouched for what seems like eons. These may be cases with QA issues, incomplete imaging, or other miscellaneous issues. If you take charge of some of these cases that everyone else ignores, the practice will deem you a hero. Who wants to avoid working with a radiologist who takes charge of the worklist?

Don’t Argue Over Minutia: Who Should Do This Or That?

Yes. Every practice has rules of etiquette that dictate who should read what and when. But, in some cases, the boundaries are crossed. Don’t be that radiologist who refuses to help because the technologist completed the case after your shift time ends by thirty seconds. Just read the study!

Don’t Let Cases Bleed Over To The Next Shift- Pre-dictate!

In some cases, they need to wait for the subsequent radiologist on shift, but many don’t. Be cautious about not pre-dictating studies that you know will have to return for delays, such as questionable diverticulitis. You don’t want the work from your shift to bleed into the next. It shows respect to your colleagues that you are willing to do the work!

Pull Your Weight!

It’s sometimes easy to let things slide when you are tired and want to go home. But others have to complete any work that you still need to complete. So, as a young radiologist, don’t garner the reputation of laziness. Heed some of the recommendations above, and you will become a well-appreciated member of a radiology team!

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What Electives Are The Most Marketable?

marketable

Question About The Most Marketable Electives

Hello Dr. Julius,

I’m having difficulty deciding what electives to do during my last year of radiology residency. I will be doing a fellowship in body imaging, and I’m considering finding a job in a private practice (outpatient, ER, private hospital). I have a total of six electives. I thought of three neuro, two MSK, and one mammo versus three MSK, two Neuro, and one mammo. What would you recommend? What would make me more marketable?

I appreciate your help.

Thanks a lot for all the info you’ve provided us!

 

Answer

 

Your marketability will depend on multiple factors. But, the specific number of each of the rotations you provided is not so critical. More importantly, you should feel comfortable in whatever areas you want to practice when you finish your residency program outside of your fellowship.

For example, you may have done a lot of mammo before coming to fellowship. So, in that case, I would opt to do that elective less. Or, if you are weaker in MSK and are interested in practicing in that area as a radiologist, go for it. Each elective you choose should help you when you leave the academic world and start a real-world radiology job. And, if you want to be more creative, you can check out my previous blog on creating electives as a senior!

Let your experiences and desires to practice different subspecialties dictate which ones you should choose as an elective. At most job interviews, they are usually not going to delve into the details of how many rotations you have done. But they might ask you about mini-fellowships (since they are all the rage!). And they are surely going to ask you what you feel comfortable reading!

 

I hope this helps,

Barry Julius, MD

 

 

 

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New Radiologist? Don’t Go Over the Head of Your Boss!

your boss

For many of you, working as a radiologist will be your first full-time job. You are finally going to enter the real world. And, if you have not worked outside the world of training and education, you may be in for a few surprises. First of all, most practices’ mission is very different from your residencies, medical schools, and universities. Your boss will no longer be a teaching physician. Instead of educating students, your first position’s goal is most likely good patient care and earning a living.

Additionally, some of the rules and regulations you will need to follow along the way are also not the same. And many of these rules are unwritten. One of the biggest faux pas of new radiologists is going straight to the top without consulting your boss in the chain of command. Of course, sometimes, there are extenuating circumstances. But, for the most part, it does not serve your needs. Let’s go through some of the reasons why!

Hard Feelings

First and foremost, most bosses don’t like it when a senior manager tells them what to do when they could have managed the situation by themselves. Say, for instance, you decided to go directly to your chairman instead of the chief of nuclear medicine to tell her about an unruly technologist that yells at patients. And then the chairman decides to deal with the issue. Well, you are leaving the chief of nuclear medicine out of the equation. How do you think your boss would feel if the chairperson decides on the matter without consulting your boss. Or if she consults with your boss without you involved. Either way, you may cause a bit of bad blood in the department. That is poor communication!

People At The Top Often Don’t Have Time For All The Details

As y0u go higher up the chain of command, many leaders have much less time to deal with the day-to-day clinical work. Many chairpersons deal more with hiring and firing, salaries and negotiations, and budgetary issues rather than taking care of the daily needs in your ultrasound section. And, they have meetings and work that takes them away from your world. Why would you ask someone with less time to help you? The best person to ask if you are having an issue with an ultrasound machine is more likely to get an answer with the chief of ultrasound instead of a radiology chairman! Moreover, your direct boss usually has more time to deal with the situation.

Your Boss Knows More About Your Position

Your direct boss knows much more about what you do than the hospital president or the CEO of your private practice. Going directly to that person in charge will much more likely give you the answers you need than someone dealing with the business’s general issues. It’s always best to go to the source that knows what you do.

Builds A Better Relationship With Your Boss

Finally, you want to get to know your boss better? Well, the best way to do so is to communicate with him. Asking your senior questions when issues arise shows that you trust their opinions and feel like they are a valuable part of the team. What is a better way to build good relationships in your department?

Don’t Go Straight To The Top Unless Necessary!

There is a chain of command for a reason. Breaking it can cause undo hard feelings, give you the wrong answers, and prevent you from building better relationships within your department. So, think twice if you need a problem that you need to solve by going too far above the chain of command unless necessary. The outcomes may not be what you desire!