Year: 2021

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What To Do When A Hospital Performs Procedures Without Radiologist Consent!

consent

Have you ever encountered this situation? A hospital acquires a new piece of equipment and starts doing studies on it. Yet, the hospital administration never inquires if the radiologists consent to read them. Or, the radiologists working there never vetted the reporting systems or the software to interpret them. The studies sit on the worklist for days until the radiology group can determine the next step. I’m sure some of you have experienced something similar to this. Some radiology residents may have noticed as well. So, what do you do with these errant studies? How do you discuss this topic with the administration? And, what are the following steps to ensure that these studies do not sit on the worklist forever?

Bring The Topic Up For Discussion With Administration And Appropriate Parties

At this point, there is no time to beat around the bush. It would be best if you communicated rapidly and directly with the folks who decided to start the program. Delays can only lead to the ire of the ordering referrer, the patient, and the administration allowing the new study. Even though you may not be directly responsible for the situation, your group can still be in a bind.

So, find the administrator who allowed the study and tell them you need to discuss the issue further. Also, it is crucial to let the referrer and the patient know that the interpretation of the study will be delayed. Communication is the essential element here.

Create A Radiology Committee to Determine If Radiologists Should Consent To The Study

Next, you need to ensure that you abide by the Hippocratic oath to “do no harm.” Some studies can only lead to other studies and procedures that may not be best for patient care. If that is the case, a committee should decide to nix the procedure from the imaging arsenal. The practice should recommend at a high level with objective data that the hospital or imaging center refrain from completing more of these procedures. 

On the other hand, if the study has clinical utility, it behooves the radiologists to ensure enough staff can read them. There needs to be more than an adequate number of radiologists to make the schedule work. A committee within the radiology practice should also decide to look into these issues before the hospital completes more studies.

Make Sure That The Radiologists Have The Appropriate Training

Assuming the study is clinically valuable, a committee must also determine how to ensure that the radiologist will have adequate training and experience to read the study. This preparation may include courses, webinars, direct patient encounters, or supervised learning. The practice should determine the necessary prerequisites.

Interpret The Studies And Build The Program

Once the program has begun, radiologists must start doing the readings as determined by the committee. Moreover, as part of practice building, it may be worthwhile for these radiologists to talk to community physicians, referrers, or other administrators to ensure the program grows.

Radiologist Consent And New Studies

Sometimes, hospitals and imaging centers can be overly eager to begin a new program to create new sources of revenue. However, a lack of communication with the interpreting physicians can lead to its downfall. Radiologists’ reputations and licenses can be on the line if the hospital and the radiology practice do not take the appropriate steps. So before you consent to start interpreting any new procedure, you need to discuss it with the correct parties, validate it to make sure it is appropriate, train the radiologists, and ensure a process to build a great program. Rome was not built in a day. Hospitals should not rush through new procedures, either!

 

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How To Overcome Imposter Syndrome As A Radiologist!

imposter syndrome

It’s the beginning of the new academic year. Many of you have just started your journey in the radiology world. Others are beginning their first foray into fellowship or as an attending. In each of these situations, you will likely start to doubt yourself. In the case of a first-year resident, other physicians will ask you questions that you believe they know more about than you do. As a fellow, you are probably unfamiliar with all the subtleties in your “expertise.” And, as a new attending, it will be hard to believe that your name will go at the bottom of the report, possibly alone. How can you handle all this responsibility? Are you even worthy? In each of these situations, you are undergoing imposter syndrome. You feel like you don’t have the knowledge and confidence to play your role in the healthcare system. So, what do you do?

Solutions To Imposter Syndrome

Act The Role

Now, I don’t want you to get in trouble. Of course, don’t say things that can negatively affect patient care, especially if you don’t know a topic that can affect a patient’s morbidity or mortality. However, if a resident or attending stops by to look at a film, don’t hesitate to say yes. Go through the case. Look at the priors and the report. When you look at cases with other staff, you develop more confidence in your consulting role.

Additionally, make yourself available for all procedures. Each time you perform the subsequent barium study, PICC line, or paracentesis, your hands and brain become slightly more familiar with the technique. This process allows you to feel more comfortable in your skin. Eventually, you will feel like you know what you are doing!

Becoming good at a role involves becoming a good actor at first. Eventually, the acting job will turn into your career, assuming you put in the work. And you will feel like you know what you are doing!

Read A Lot

As you probably know, radiology involves much more reading than most other specialties. This burden is due to our overlap with many specialties and the core examination. If you are not reading, you sure will feel like an imposter. At a conference, everything sounds like mumbo jumbo chicken gumbo. With the clinicians, you will be at a loss. But that all changes once you start reading intently. I promise. Whether reading films or other complicated radiology tasks, you can answer questions and feel comfortable in your skin.

Get Involved Actively In Your Specialty

Those who know many others in their career will rarely feel like an imposter. If you know all the “muckity mucks” locally, regionally, or nationally; you will feel much more grounded and connected to the world of radiology. So consider heading out there and meeting and networking at the RSNA, AUR, ARRS, and more. (especially when the pandemic eventually subsides!) Or, get involved in your hospital administration by participating in conferences, GME, or other resident administrative roles. Each time you do so, you will feel more invested in radiology and less likely to catch imposter syndrome.

Imposter Syndrome And Radiology: You Can Overcome It!

Only a few simple steps can move you down the road from imposter to maven. Acting the role, reading, and actively getting involved in your specialty are simple ways to move in that direction. Most of us feel like an imposter from the get-go. We have never done anything quite like radiology before starting our radiology track. But you can leave that position quickly. It’s a bit of work to end imposter syndrome. So, get cracking!

 

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Disrespect From A Surgical Attending- How To Deal?

disrespect

Question About Disrespect From A Surgical Attending

The Situation

Hello, I am a radiology resident berated by a surgeon with disrespect in the reading room in front of my colleagues and attendings. An outpatient had imaging findings of small bowel obstruction. I sent a secure electronic message via EMR to the aforementioned surgical attending who ordered the CT scan, an unexpected result that could potentially affect management. I did it out of courtesy even though the hospital policy does not include this as a critical diagnosis that radiologists need to convey immediately. My radiology attending signed the report a couple of hours after I had sent the message. 

However, the surgery attending did not see the message/report until later that afternoon and started to ask me via chat if I had contacted the patient or another surgeon. As per my hospital policy, I did not do that because this is not a clinical diagnosis requiring immediate notification to the clinical team, such as a stroke or pulmonary embolism. The surgery attending took the time to come to the reading room soon after. First, he asked me if I was a resident or an attending; when I answered that I was a resident, the surgery attending started to yell at me for not reporting a critical finding directly. He made it sound like the patient was going to the OR urgently (at the conversation time).

Surgical Attending Disrespect, Exaggeration, And Bluster

Furthermore, he was threatening me that the patient could have died due to the delay in communication. Later, I found out that the surgery attending had already spoken with the patient on the phone. The patient felt perfectly fine/refused to go to the ER and would wait until Monday to go to the clinic (documented in the EMR). Even though we caused no harm to the patient, the surgery attending was very contentious. He made a public scene and stated that I did not do enough to communicate this finding in the middle of the reading room. 

Also, if I had not messaged, the surgery attending may not have found out about the SBO until after the weekend, as the patient felt perfectly normal. The surgery attending cared more about displaying her power over a resident. Her display of power was not for resident education. Is a new SBO on an outpatient a critical enough finding to call the patient directly or attempt to reach the inpatient surgical consult within minutes? What do you think is the best course of action to combat what I perceive as bullying and disrespect? Thank you for listening to my long story.

Answer

There are two main issues in your question. First, let’s first start with the facts about small bowel obstruction. Second, I will discuss the reasons for this public display of power and disrespect and the right course of action.

A Little Bit About Small Bowel Obstructions

Small bowel obstructions without other emergent ancillary findings such as portal venous gas, pneumatosis, free air, bowel wall thickening, SMA thrombus, free fluid, or focal fluid collections are typically managed clinically and are not “emergent.” As your hospital policy dictates, this reason is why radiologists do not usually have to make a phone call to the surgeon at your institution. And, you did more than required by sending the text message. 

Additionally, if you are talking about a plain film diagnosis, these findings are even less specific. I can’t tell you how often I have seen a plain film with dilated bowel loops and air-fluid levels. Then, we get a CT scan, only to see not much happening. A CT scan is a lot more specific for the diagnosis but is by no means perfect. 

Nevertheless, in a pure small bowel obstruction without complication, our role is less diagnostic than management-related. Usually, the surgeon wants to know if it is better, worse, or unchanged. This decision tree, along with the surgeon’s clinical assessment, should factor into the equation of whether they need to pursue the case/management further. The surgeon’s responsibility is to look at the plain film or CT scan with or without the radiologist and decide if further steps are necessary. This role is regardless of however the radiologist reads the study.

More About The Surgeon And What To Do

Based on your story, I suspect that the surgeon is at fault for negligence with the patient. And, I believe that the surgeon is transferring her inadequacies onto you. In my history of dealing with surgeons, the least confident ones unnecessarily tend to take their anger out on others. Unfortunately, you were a target because you are “lower” in the hospital hierarchy. This surgeon is trying to feel better about her faults by displaying her power over you.

If this bullying recurs or you feel that it was egregious, I would refer the case to your faculty in a situation like this. It is wholly unprofessional to berate and disrespect anyone in the middle of a public forum such as a reading room. I don’t care if it is a janitor, technologist, resident, or attending.

Also, it would help if you precisely documented what happened with any other witnesses. That way, it takes the situation to a faculty level with some objective facts. The attending staff can then can decide to talk to the surgeon based on the case. Unfortunately, as a resident, you are not in a position to reprimand or talk back to the surgeon.

On the other hand, your faculty can undoubtedly do so. This way, it should not happen again. And, maybe the institution can change this surgeon’s inappropriate behavior.

I would be very interested to know what you have decided to do,

Barry Julius, MD

 

 

 

 

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Why Artificial Intelligence (AI) Will Not Take Over Radiology!

AI

Artificial intelligence (AI) is still front and center for the layperson when discussing radiology. Family and friends always ask me why AI will not take over my day job. I had one of those “aha” moments in one of those discussions recently. We discussed how many factors will prevent AI from taking over our jobs anytime soon. These included legal, ethical/moral, and financial reasons. As I was droning on, I realized I could argue why AI could overcome these issues. However, one reason not related to these is why we won’t see a blank screen or a computer person from India, China, or any other country for that matter replacing our presence for a very long time. And that is that medicine is local, not universal. 

Medicine Is Local, Not Universal- AI Cannot Account For It!

“Standards”

Why would differing local “standards” be the most critical reason for keeping radiologists busy? Well, every country and every physician has their opinions about the best way to treat patients. Medicine is not universal. It is local. Yes, a few standards are omnipresent, like the Hippocratic Oath not to harm. But, other standards like lung nodule management vary widely among physicians, counties, states, and countries. The Fleishner criteria for managing pulmonary nodules are not standard. Some folks use that criterion; Others use LI-RADS.; And even others use ELCAP. 

I also know some clinicians that modify all these criteria to fit their patient populations. Therefore, it is only possible to standardize standards in an AI computer algorithm when your physician wants to use a different bar from the rest. One great way to lose the radiology business is to make recommendations that run counter to your referrers!

Management Differences Between Places

Different countries have different standards of care. For example, it would not be appropriate to recommend imaging a patient with an MRI of the shoulder in Canada due to lack of availability. Over there, physicians may be more apt to order a musculoskeletal ultrasound. Likewise, a radiologist in Canada may be more likely to recommend a musculoskeletal ultrasound for a possible rotator cuff tear. Yet, an MRI is part of a routine workup in the United States. Why? Because they have a much more significant backlog of patients waiting to get their studies done with fewer MRIs than we do in the United States.

In China, clinicians may regularly recommend “cupping” for different ailments. How can AI programs account for each cultural difference among countries, states, or counties based on availability, preferences, and cultural norms? These obstacles would be exceedingly difficult to overcome.

Differences Between Surgical And Medical Preferences

We work for other physicians. Our role is to make it easier for them to treat patients. And each clinician has specific needs for caring for their population. Oncologists look at assessment criteria differently from surgeons. Neurosurgeons have different interests than internal medicine doctors when they order a study. An AI program needs to consider all these factors when it summarizes findings and makes recommendations. AI is not ready to make different individualized reports for each subspecialist clinician. It would take massive programming power for which it’s not ready!

Differences Among Individual Patients

And finally, even among patients, culturally speaking, some patients want more aggressive workups, and others are more conservative. For instance, I may have a patient who can’t live with a small complex cyst in their breast and wants it drained. Meanwhile, another patient might be more willing to follow it. Some of these differences may be cultural or related to individual differences. How would an AI program account for that? AI is not ready to interpret every patient’s cultural and emotional status to make these decisions. Again, no supercomputer could make these individual recommendations for patients.

A Radiologists Job Is Still Way Too Complex For AI!

Whether it is differing standards, cultural differences, physician preferences, or individual patient preferences, radiology, in particular, is not a one-size-fits-all discipline. No program can consider all of these issues to replace a radiologist within the foreseeable future. The processing power required to figure this out for every clinician’s report would be enormous. Of course, 500 years later, a program may accomplish all these tasks and replace radiologists. But, by then, the same computer will replace every other job, and no trace of humans may exist as the singularity has come and gone! So, for those thinking about entering radiology, keep these issues from dissuading you. Over your career lifetime, you will still have a job!

 

 

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Hobbies For The Radiologist: Are They Just A Fling?

hobbies

Yes, I enjoy radiology. But, a whole world of other pursuits awaits me when I finish work. I may write for this website, learn two different languages (Spanish and Hebrew), play guitar, prepare for the next gig, read about finance, or cook. These are just some of the long-term projects and hobbies that I always seem to fall back on. Yet, I understand that not everyone has the time or inclination for my daily rituals. But, maintaining at least one toe outside the field of medicine is necessary nowadays. And, it is not just about making a paper trail for applications to medical school, residency slots, and radiology jobs.

So, what is it about hobbies and long-term projects that enhance my radiology career? Well, there are a whole host of benefits that come with other endeavors that I enjoy. These include looking at radiology with a fresh eye, reminding me that there is more to life than medicine, finding new friends with differing interests, keeping my brain active/enhancing my energy, and enabling me to transition to a post radiology world. And, these passions may also apply to you as well. Let’s explore some of these reasons to establish a hobby now!

Looking At Your Daily Work With A Different Perspective

Hobbies can allow you to look at the world from a different perspective. For example, instead of dreading waiting for a translator to help translate a Spanish-speaking patient, as a time sink, I look forward to interacting with patients who speak Spanish. It is a way for me to get to learn their culture and get more Spanish practice. Or, as if I am working at home, having a guitar on hand as I’m reading some film enables me to play a little bit while I take a short break. All these different hobbies allow me to look at work from a different perspective.

Hobbies Remind You There Is More To Life Than Medicine

As much as I enjoy radiology and medicine, most of us need time apart from the field so that we can go back to it with a fresh eye. Working on outside projects enables you to accomplish just that. It could be a musical ensemble or a trip to a third-world country. Whatever the case may be, you enhance your enthusiasm for your career when you return to work.

Enlarging Your Familiar Circle

Pursuing hobbies outside the field of medicine can allow the added benefit of meeting other people that think and operate differently from yourself. It is a way to expand your inner circle and make new friends. It’s effortless to stagnate and drift inward as a radiologist, especially for those radiologists that tend not to see as many patients. Hobbies can keep you socially active and engaged.

Keeping Your Brain Active

Radiology can indeed be an intellectual pursuit. But, focusing on anything too much can cause a lack of stimulation. When you branch outside of radiology and medicine, it can keep you more excited about learning and reading. And, this is not just about your hobby, but rather anything else that you pursue, including radiology!

Allows You To Eventually Transition To A Semi-Retirement Or Retirement That You Enjoy

This concept may seem a long way off. But, hobbies you establish today will allow you to do other things the day you decide to partially or entirely retire. Few radiologists can work forever (although I do know a few!) Nevertheless, starting some hobby that you love today is more than a fling. It can become a lifelong mission that you can look forward to in your later days.

Hobbies- More Than Just A Fling!

You may think that hobbies should be the last item on your mind when your days are so busy as a trainee. But, starting a hobby now or continuing with projects from your past should become mission-critical. The best radiologists are happy outside the field the medicine as well. So, don’t forget to pursue other hobbies and projects that you enjoy. It will enhance your career and make you more excited about the day-to-day work!

 

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Are Less Paperwork And EHR Selling Features For The Radiology Specialty?

paperwork

As I was scrolling through some random Twitter feeds that came up in my email, I saw the following statement come up from a fellow physician: “Physicians should not use the amount of paperwork as means to decide on which specialty they should choose.” Well, as I stared at this statement, I became more and more incensed. Why? Because many burgeoning medical students were possibly looking at this Twitter feed. And, some may utilize this suggestion as they search for their specialty of choice. Meanwhile, this statement/question could not have been further from the truth. An excessive amount of paperwork could ruin the most glamorous and exciting medical specialty work.

High Paperwork Burden And Electronics Health Records (EHR) Use Is A Cause For Burnout

One of the main reasons for burnout and lack of interest in a specialty is the excessive paperwork and the inordinate number of clicks on an EHR system. This person suggested that medical students should ignore this factor and go into a subspecialty regardless. Now, I don’t know about you. But, for me, one of the best parts of radiology is having to deal with much less paperwork than our colleagues in other subspecialties. I delight in not having to constantly document interactions with patients and write tons of prescriptions, and mull through a myriad of HIPAA forms every day. These are tasks that would have made me miserable. And, we, as radiologists, do not have nearly as many of these issues as other subspecialties.

Of course, I also chose radiology based on the diversity, large information base, and my interest in technology. But, if I knew at that time that we had so much less paperwork than most other specialties, that would have indeed reinforced my decision. I certainly would use it as a way to choose between several subspecialties of interest!

Should We Use The Benefit Of Less Paperwork To Our Advantage In Recruitment?

Now, telling medical students that they should choose our specialty because we have less paperwork is like saying to become a secretary because you get to sit down all day. Sure, it is a perk of the job, but not the reason for joining our fold. But if presented in the right way and placed in the context of how other specialties have to deal with the work daily, it could become a game-changer. Have a student ask an internal medicine doctor how much time you spend on dictating reports and phone calls. And then have them sit with them while they are doing these tasks. The amount of time spent away from the more exciting patient care activities may shock them!

Then, have a student sit next to a radiologist on any given day. And let them see the amount of time we get to spend on patient care activities such as looking at films and performing procedures. They will see a significant difference between the amount of paperwork and EHR time. Then, they can use these factors as a valid means to deciding on which specialty is right for them.

Let The Student Decide On A Specialty Based On The Facts!

We all should choose a specialty in medicine based on the facts, not on emotion alone. One of those critical factors is the amount of paperwork and EHR. It is a pressing problem. And, pundits should not gloss over the unenticing aspects of a specialty. Practicing a medical specialty is not just about the glorified moments in the operating room or with a patient.

In reality, you can’t always do only the things you love. You also need to accept the facts of any specialty. And, if excessive paperwork is one of those realities, students need to know about it and make an informed decision. Negative information cannot just be swept under a rug when you make your specialty choice!

 

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My Experience With The Powerscribe Undo Button: A Call For Better Technical Radiologist Training!

undo button

I find one button on Powerscribe more satisfying than almost any other. No, it’s not the sign button, although signing off a study feels quite rewarding. Indeed, it’s not the auto text button. However, I press that one all the time to make my templates. And it does shorten my dictation time. Instead, it is that button typically buried in the edit menu of Powerscribe, the lowly undo button. I can’t tell you how many times I clicked the wrong button to lose half my dictation. And then I clicked on the Undo button to restore it to how it was.

Most of you are aware of this undo function. It returns anything you did before to its previous state as long as it was a line of spoken text, a cut, or a paste. But imagine not knowing about its existence. Well, that was my world as an attending physician for a good year or two. Now, it is embarrassing to release this information to the masses. But I have to let it out. It is true. I spent eons trying to recreate what I had dictated before without knowing there was a simple way to retrieve the information. I was not aware of the existence of the undo button for way too long. Imagine that.

The Undo Button: A Symptom Of A Bigger Problem With Radiology And Technology

This point about the undo button brings me to one of the most significant technical radiology issues. We, as radiologists, don’t know about so many computer and technology functions that can potentially make our lives easier and shorten our days. Now, maybe this issue is somewhat magnified because I have reached middle age, but I don’t think that is the case.

I have seen younger physicians, like residents and early attendings, who need to learn how to link two studies together and compare them slice by slice. I have seen other attendings needing to be made aware of the simple functions of our software for calcium scoring, which would have saved them tons of time. And there are many other time-saving technology tools I am unaware of. If all the radiologists were to pool their technology know-how together, we would all shave off an extra hour of work every day. So, why do we not receive the technical training we need to make us more efficient at our job?

Radiologists Do Not Receive Formal Training Because We Are Expected To Learn On Our Own

Many radiologists jump headfirst into the world of dictation and PACS without receiving any formal training. Many of you who work for hospitals and imaging centers know what I am talking about. As a resident, I cannot remember any technology folks training the residents on using PACS. That same philosophy has continued throughout the years. Hospitals and imaging centers expect us to use our highly paid professional time to figure it all out independently.

Technology Trainers Don’t Know How To Train Radiologists

Several things happen when we get the “training” we need from the technology folks. First, they show you what you can do and allow you to play around with everything. And then they say you need to use it for a while to get accustomed to it. While that is undoubtedly true, we often miss out on multiple functions and knowledge that can increase our efficiency. The problem is that the technology experts training you are not radiologists. And they will never know the most important functions we need to use.

Lack Of Time/Money Dedicated Toward Training

Or, once in a while, you will get an excellent technology expert who will try to help you by creating hanging protocols, setting easy keys, and more. Some may become irritated when they realize they need to sit down with you for an extended period to make the technology precisely how you like. Or, the institution received a package deal that included limited training for the radiologists. The bottom line is that you may receive less education than you need.

Learning The Undo Button: A Simple Solution To Improve Workplace Efficiency

So, why do I bring up an entire blog about a simple undo button and the issues that go along with it? Well, it is a cry for good, down-to-earth technology instruction that every radiologist should have. We, as radiologists, hear about burnout and misery all the time. But, it is the little things that make radiologists happy. Radiologists are highly paid professionals who should become as efficient as possible to save time and money. Many excellent radiologists have left the field because of simple technology inefficiencies such as this one. Coming home 20 minutes earlier every day to be with our families should be a much bigger priority for radiology practices and hospitals. Improving radiologists’ technical and computer training is a simple and relatively inexpensive fix.

 

 

 

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The Doximity IPO: What To Do With A Small Windfall As A Radiology Resident?

windfall

Last week many residents throughout the country had the foresight and were lucky enough to get involved with the Doximity initial public offering for stock. It was a rarity because, unlike most IPOs, only doctors could get in on the initial public offering (IPO) action instead of the finance guys. Physicians were able to purchase up to 250 shares. In a few short hours, what was initially an investment of up to 26 dollars a share (6500 dollars), climbed to 55.98 dollars. On that one day alone, you could have made ((55.98-26)*250 or 7495 dollars. That would represent a 115% profit in one day. Not all bought the maximum number. Regardless, although not life-altering, for a resident, that means a significant sum of money compared to a typical resident salary. You could call it a sort of windfall.

Sure, there is lots of information out there about windfalls for physicians. Check out some of the articles on the white coat investor- My Experience With A Windfall. Or, you can read about What To Do With A Windfall.

But, most are not specific to your situation. Some may tell you might plunge that money back into the market. Others say take it and pay off your credit card debt. (Those folks should probably not have done the Doximity IPO in the first place!) And, others may decide to repay some more interest on your student loans. But what is the right place for you to plug that money in as a radiology resident? Are the considerations different for a radiology resident than other types of physicians?

Personal Finance Is Personal- What Is Right For You Might Not Be Right For Everyone (Except For Credit Card Debt!)

First of all, anyone with credit card debt should probably remove that debt immediately from your life. That is a no-brainer. Of course, that simple tenet is not just for the radiology resident. But, it is indeed a personal situation. Anyone paying interest over 10-15 percent is slowly getting their financial life sucked away like a Hoover.

But let’s assume that you are without credit card debt and have a decent amount of student loans. Currently, most of you have loans that are accruing very little interest because of the low-interest-rate environment and all the deferments from the pandemic. So, it is reasonable not to plug all the money back into the student loans. On the other hand, debt can be burdensome and a proverbial noose around the neck for others. What to do next depends on your tolerance for debt and your financial situation.

Where Should The Windfall Go If Not Student Loans (Think Roth!)

If some of the windfall is not going back into student loan debt, where should it go?. To answer this question, if you haven’t done so already, it is time to get a head-start on investing. You are already behind the eight-ball as a physician. So, filling a Roth IRA with an index fund would probably not be a bad start for most of you. One of the best financial decisions I made many years ago was to start a Roth IRA when I was in residency. A small amount has significantly increased in value over time. So, with this small windfall, consider taking some of the money and adding it to a Roth IRA.

Reasons For Radiology Residents In Particular To Choose The Roth IRA

How does being a radiology resident change the equation about where to put the money? Well, because you are more likely to make a higher salary than your pediatrician and internal medicine colleagues, you may want to consider putting more into investments than loans.

In particular, for two reasons, the Roth IRA even makes more sense for the radiology resident. First of all, your salary will be higher as a radiologist, so you will have to pay more taxes on the amount of post-tax money you put in than your lower-salaried colleagues. So, now is even a better time to take advantage of your low tax situation.

Second, you can afford to be a little bit more aggressive than other specialties. More future dollars allow you to put more into stocks because you can afford more risk. So, putting more away into investments can make more sense.

A Small Windfall And Investing For The Radiology Resident

Opportunities arise from time to time, and you may find new money, such as the Doximity IPO. As a radiology resident, your situation may differ slightly from other physicians. So, based on your risk profile, consider taking a bit more of your windfall and investing in a Roth IRA. That’s what I would do if I had a few extra dollars and were still a radiology resident!

 

 

 

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The Radiology Residency Exit Interview- Why Should You Care?

exit interview

You’re finally about to hang in the towel. You’ve taken and passed your core exam, completed all your overnights, given your last tumor board, and finished your final residency dictation. Suddenly, you receive a call from the program coordinator. He says the residency program director wants you to come to her office for your last exit interview. Why even bother? What’s the point of a final discussion when heading out of Dodge anyway? Well, let me give you some reasons why this interview is the most important of your residency from a program director’s perspective.

Want A Recommendation?

Believe it or not, even after you leave your residency, faculty still receive phone calls from your employers if you are looking for a job or decide to change to a new one. And the last thing that you want your residency program director to say is, “That darn resident, he didn’t even care to give an exit interview.”

These folks that call for you from your subsequent practices are serious. And any bit of bad news about you can derail your next great job. Especially when the job market may or may not be the same as it is now!

No Holds Barred Summary Of Residency Issues

After residency, you feel you have no more obligations to the program. Anything you say now is not encumbered by your desire to impress or achieve. You can now have a heart-to-heart with your program director without any of the “BS.” It’s a great time to give the real lowdown on the residency, both good and bad. This interview is the best time to get a reality check on your program from the program director’s perspective.

The Exit Interview– A Last Chance For Great Residency Advice

For the resident, now is the time to ask any burning questions about how the world works, what you need to do to become great, or other residency-based training tidbits you can use for the rest of your career. So, residents will usually ask excellent questions at this time, right before they leave. Residency is usually a once-in-a-lifetime experience. And becoming an attending is so different. Subsequently, residents will often ask inspired questions to learn what they need to succeed in their next radiology life!

Maintaining Contact Information

Not everyone will remain in the same institution forever, and the same goes for your residency faculty. This interview is an excellent last opportunity to cull the contacts from your residency. Get those phone numbers, linked-in addresses, and social media connections finalized. You never know when you will need to contact your faculty again. It may be to consult on an interesting case, recommend a new job, or just to say hi. In any case, keeping this information safe and sound is critical!

Making Sure Everything Is In Order For Future Jobs- They Do Check!

Procedure logs, iodine treatments, and the number of cases completed are critical statistics that your next employer may need. So, ensure you have all the information you will require before you leave. To get hired, you need to back up your previous experiences. Also, make sure that your learning portfolio is all squared away and that you have records of all the academic research, presentations, and posters safe and sound. Often, you will continue to need all this information well into the future. This interview is your last shot at getting all of this straight!

The Radiology Exit Interview- A Critical Component

Between all these factors, including recommendations, giving the real low down on residency, getting some quality advice, garnering contacts, and ensuring everything is in order for your future career, the radiology exit interview is an integral but final component of the residency process. So, it has many more uses than you may have thought. You are not just paying homage to your residency program. Instead, you are providing a genuine service to your future career and helping out your program director. Therefore, you should take the interview seriously. During residency, it is your last chance to help out your program and ensure a great future for yourself in your radiology career!

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How Do I Gain Confidence To Read Complex Cases Outside Subspecialty?

confidence

Question About Confidence About Reading Outside Subspecialty

I will be completing a neuro fellowship in one year. Still, my potential job opportunities require that I read everything, including MSK and Body MRI, which I don’t have the confidence about for one reason or the other. I need to learn to read these studies; how do I do this? Would I have to do a second fellowship?

Not quite sure how to proceed!

Answer

Yes, many of the great radiology opportunities indeed involve generalist work with the ability to do your subspecialty (in your case, neuro). And, from my experience, most general radiology practices expect that their neuroradiologists cross over to all sorts of other subspecialties within MRI in addition to the sophisticated neuro cases. So, the big question here is how you get the confidence to read other complex subspecialty cases outside your wheelhouse. And, I believe in your situation, a second fellowship is most likely not the answer. How do I know that? Well, I have already been there.

So, what did I do to ensure that I would feel confident enough to read MSK MRI on the job even though my primary specialty was nucs? During my residency training, I made sure to read extra cases in the modality when I was on site. I accomplished some of this just before my fellowship in nuclear medicine. And, this was in the days just before PACs started. So, it was much harder to do back then.

Nowadays, it’s much more manageable. Start picking up cases from the PACS, read them, and then look at the dictations afterward. This method is a simple way to gain confidence and familiarity with other specialty areas you usually don’t read. You can even do this at your up-and-coming neuro fellowship since most are affiliated with a hospital or outpatient center that does MSK MRI. So, I would try this first. How do I know this will work? Well, it certainly worked for me. I feel reasonably comfortable with reading MRI MSK to this date.

Of course, your confidence will continue to build even after you start working. However, at least you will give yourself a head start if you begin the process. I hate to say it (because I’m not too fond of the ABR jargon), but this skill is what the ABR calls practice-based improvement in a nutshell!

That’s some advice that has worked for me!

Barry Julius, MD