Month: January 2022

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Inflation And Residency- Not A Winning Combination!

inflation

Many of you have probably noticed the headlines about high inflation rates. Over the past year, inflation has risen by over 7 percent. It may only seem like a number that the talking heads on TV and youtube espouse. And, maybe, you have noticed some increased dollar costs at the end of the trip at the supermarket. Or, perhaps take-out from the restaurants that you like the most are a bit more expensive. Then, of course, your gas tank is a lot more costly to fill. 

Taken individually, it may not seem like much. But it is probably more than you think when you add it all up. So, let’s discuss why folks with fixed, regular incomes like you tend to get battered the most. And then let’s talk about how you can potentially prevent the year from eating up your entire salary.

Why Inflation Significantly Impacts Residents

Annual Incomes Are Already Set For The Year

Often, hospitals create residency salaries before calculating the following year’s cost of living. Therefore, you may notice that your income does not meet the increase in the cost of living for this year. This relative decrease in salary can undoubtedly give you far less room to squeak by.

Most Residents Are Not Asset Owners

People who own assets such as houses don’t have to worry about rent increases because their mortgages don’t change. But unfortunately, most residents are not in that boat. Additionally, trainees do not have as many stocks, cryptocurrency, or other hard assets that rise with inflation. So, you are at a distinct disadvantage.

Increase In Prices Eat Into A Regular Salary Without Much Room For Discretionary Income

First of all, your salary is typical for the United States workforce. But, the ordinary person in the United States lives paycheck to paycheck. So, this increase in prices will take a significant bite out of your annual budget, especially when you have very little room for discretionary income, to begin with.

What To Do To Prevent More Pain!

Moonlighting

Not everyone has this opportunity available. But, if your residency has this option, you may want to think about participating. In-house moonlighting can help defray the additional costs of a high inflation rate, perhaps at the current inflation rate or even more. Plus, it will also allow you to sharpen your independent radiological skills. 

Sharing Apartments/House Hacks

Did you not want to share an apartment with colleagues when we had a more normal inflation rate of two percent? Well, maybe it may make more sense now. Overall, rentals will sharply increase in price this year for much of this year. And so, sharing the entire bill may make a lot of sense.

Or if you are fortunate to already own a property in the area. Maybe, you would want to rent part of it out this year to decrease your costs. This move can also significantly reduce the cost of inflation in your regular salary!

Strict Budgeting For Times Of Inflation

Lastly, if you are a prodigious spender, you may want to rethink this lifestyle, especially this year. Budgeting and tracking expenses closely can help decrease your annual costs and prevent the paycheck-to-paycheck lifestyle with high credit card debt. Use a spreadsheet or an application. Either way, this method may help to avoid overspending related to inflation!

Inflation And Residency

More than any other time in your career, inflation can eat away at a higher percentage of your annual income since your residency salary is relatively lower than what you will make eventually. Also, most residents don’t have the assets to decrease the influence of an inflationary world. Therefore, it can be tougher to make ends meet than a typical year.

Nevertheless, you can use some of these tools to prevent inflation from impacting too much. And hopefully, we will see some improvement in the following years and get back to a baseline lower inflation status!

 

 

 

 

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A Last-Minute Decision To Go Into Radiology Is OK!

last-minute decision

So, you’ve put all this time into beefing up your application for radiation oncology, urology, neurosurgery, or medicine. You have researched and toiled in these or other subspecialty electives for countless hours to make a good impression. And, it’s about time to make that ultimate decision to pursue your final goal. But, something doesn’t feel quite right. Your gut tells you that you will probably not want to spend the rest of your life in this field. What do you do? For those of you that have to make soon that heart-wrenching decision of which specialty to choose, it is OK to make a last-minute decision. Trust me. Don’t worry about disappointing others or not pursuing your original goal. Here are the reasons why.

A Subspecialty Career Lasts A Lifetime

We are not talking about just a few years. Whatever specialty you decide to choose can last the remainder of your career. So, don’t worry about disappointing your colleagues, research cohorts, and mentors. Don’t do it if you are sure that you are pursuing the wrong path!

Physicians Are Miserable When They Don’t Pick The Specialty Their Heart Desired

I know that too many physicians are miserable and burnt out in their career path. Many of them regret the day that they chose the wrong specialty. And, many decide upon the incorrect medical field because the one they want is time-consuming or “tough.” Most of us can live with a few challenging years, but not for difficult years for the remainder of our careers!

Friends, Colleagues, Mentors, Will Understand Your Last-Minute Decision

You may receive some disappointed looks at first. But, in the end, your true friends will understand that you need to make this decision for yourself, not for someone else, and certainly not for a superficial reason. Real friends will eventually understand the choice you made

Last-Minute Decisions Happen All The Time

I don’t know about you. But, I know many physicians, specifically radiologists, who decided to join the fold at the last minute on their fourth-year radiology rotation. No, they may not have all the credentials of someone preparing to do this pathway all along. But, they can make excellent radiologists (sometimes even better than ones that already knew their destiny!)

Hard to Back Out Once In A Pathway

The easiest time to make a decision is now. Once you have already started a new residency, it is much harder to reverse course. You need to get permission from program directors, colleagues, and the federal government! And you may not have the funds to change paths so easily. So, make this decision to go into radiology before you start another residency if you can!

You Don’t Need Tons Of Research To Get Into A Decent Radiology Program

Yes, completing research is excellent. But do you need tons of research to get into a radiology program? No! We have selected many candidates who did not have a laundry list of radiology-relevant projects. So, if you decide to avoid radiology because you don’t have the research to do so, don’t!

Better Off Getting Into A Mediocre Radiology Program Than None At All (It’s A Self Taught Discipline Anyway!)

Think again if you are interested in radiology and are not applying because you can only get into mediocre programs. Many great radiologists have not gone to man’s best institution. Fortunately for you, much of radiology is a self-taught discipline regardless. Any program in your desired field of choice is better than no program!

Look At Me! I Made A Last-Minute Decision

Lastly, and more importantly, please consider that I am one of those radiologists who made their decision after being on the internal medicine track all along. I only made my final decision at the beginning of the fourth year. And, it all worked out very well for me. You can make a last-minute decision to go into radiology as well!

The Last-Minute Decision!

Society puts too many negative connotations on the last-minute decision. In truth, though, last-minute choices are not always bad. What is terrible is refraining from pursuing what you want because you believe you have a fixed path. So, make that last-minute decision to join the radiology fold if that is what you want. Your last-minute decision can be the best one!

 

 

 

 

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What Hobbies Correlate With Becoming A Successful Radiologist?

successful radiologist

After reading a gazillion personal statements and participating in another bazillion interviews, I would be a kazillionaire if I had a dollar for every time I read that a medical student will make a successful radiologist because of one of their hobbies. And, if you gave me a small rock for every time a medical student claims that they are great at one of these hobbies and how that applies to radiology, I would be sitting on top of Mount Everest! So, do hobbies have any correlation whatsoever with becoming a high-quality radiologist? The answer to that question is yes. But, not the way you might think at first. And indeed, not in the way most folks add their hobbies to their personal statement.

So, let’s go through some of the more common hobbies applicants think will make them great radiologists. Next, I will disclose why applicants believe these hobbies make them higher-quality radiologists. But, of course, I will debunk this perceived correlation. Finally, I will reveal how hobbies help the average radiologist!

Photographers

One of the most popular themes in personal statements is the correlation between becoming an excellent radiologist and one’s love for photography. I often hear how they can see subtleties and make those same findings on a film. Well, I can think of several resident photographers, and their radiology abilities are all over the map. Some are excellent radiologists, and others are more average. So, I am not sure if this skill makes a significant difference in your findings skills. 

Video Gamers

Like photography, I have seen tons of applicants talking about video games as one of their hobbies. A more rarified few will claim that they are extraordinary competitive video gamers and have won prizes or cash for their endeavors. On this point, I have seen several articles talking about improved hand-eye coordination. But, it can also lead to distractions and decreased reading during residency. So, I feel that in terms of becoming a better radiologist, playing video games is kind of a wash.

Art Connoisseurs

Like the photographer, these folks talk about their love for paintings and museums. Others will even paint pictures themselves, some that have even made it to a gallery or two. And then folks tend to claim that they have a “good eye.” It is also a typical statement that I hear about in recommendations that usually tell me nothing. Why? Anyone can make this claim, and it is hard to back it up with facts as a medical student. Nevertheless, this hobby is a popular radiology applicant pursuit. In and of itself, I am not sure if it correlates that well with quality!

Cooking

Here is a hobby that I also love. I prefer to eat my food than the food I purchase at restaurants. And, it does involve some hand-eye coordination, creativity, and knowledge. However, when I look at the applications of incoming medical students, I find nearly every other one has the same hobby. Because it is so prevalent in society, it doesn’t add much except for an excellent conversation between myself and the interviewee!

Music And The Successful Radiologist

We have all sorts of “radiologists-to-be” that either listen to, play, or dance to all kinds of music. For those that play different instruments (like myself), it undoubtedly is a great outlet to have fun and mix with other like-minded bandmates and friends. And, for the dancers and players among us, these folks may have slightly better hand-eye coordination. (plus or minus) Some may DJ on the weekends, and others may perform gigs. The extra time can detract from residency studying or improve hand-eye coordination. Nevertheless, I don’t see a strong correlation between the love for music and becoming a better radiologist in the way you might think!

So, How Do Hobbies Correlate With Becoming A Successful Radiologist?

Well, here is the kicker! None of these hobbies have much to do with the quality of radiologist that you will become. (as much as you might think!) However, having a hobby is more important than the hobby itself. You have something else to discuss and fall back upon when things may not go your way during residency. So, don’t worry about your hobby per se and how it will turn you into a great radiologist. It will not transform you into the “radiologist Excalibur.” In that respect, it is not so important. But add your hobbies to your application because it adds to your persona and character. We do like real people in our specialty of radiology!

 

 

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Find A Radiology Residency Or Job That Will Feel Like Well-Worn Sneakers!

sneakers

I don’t know about you folks, but when I buy new sneakers, I expect it will take a while before I can break them in. The material needs to stretch out to surround and cushion my foot gradually. Rarely do the sneakers fit perfectly on day one. The process can take months or even years until I get them the way I want. So, I buy them with the expectation of future comfort, not how they feel today.

If I try to buy the perfect sneakers, it never seems to work. I find myself returning lots of footwear (online nowadays!) And, I waste my time and incur multiple restocking fees or trips to the store for returns. So, what do I look for when I buy those sneakers? I look for reasonably comfortable pairs that fit snugly without too much discomfort. Also, I find pairs that will less likely cause me to trip over myself. So, what does this all have to do with radiology? It’s coming out of the left-field, right? Well, not really. Let me explain.

Like buying sneakers, residency programs, or first jobs rarely fit perfectly on that first day. It may be good enough and may have the potential to work well. But, you may notice the imperfections at first. These imperfections may trouble you because you may question if you made the right choice or not. But it would help if you had patience. Why? Because the outcomes can be costly, just like the returned footwear. And here are some of the reasons why.

What Doesn’t Work Perfectly Now Will Get Better In The Future

All the imperfections tend to loom larger when starting a new job or a new residency. You notice the worn call room or the resident that constantly complains. What else do you have to hang your hat on? But, I can assure those same issues that you see right now will most likely go away. Yes, you will face other problems and challenges as well. But, I have never seen anyone join a practice or begin a program that is perfect on the first day, week, or month. It just takes a bit of time for the sneaker to mold to your foot!

You Gain Familiarity With Your Colleagues- First Impressions Are Rarely Correct

How often have you noticed that your roommate or teacher was not as they first seemed in your academic career? In my case, I know that my first impression was often wrong. The teacher that seems bizarre often turns out to be the best. And, that roommate that you thought was off a bit may turn out to change your life. It’s all a matter of perspective. And, in the beginning, our views can be skewed. This sensation can feel just like the sneakers that may be a little bit tight at the top at the beginning!

The Costs To Changing Sneakers (Jobs) Are Immense

It is not so simple if you are leaving your residency program midstream or deciding to change to another faculty position elsewhere. Especially as a family, the costs of uprooting your accommodations, kid’s schools, or workplace are immense. Just like when you constantly have to pay those restocking fees, the price of changing jobs can add up over time and can become exceedingly difficult to recoup. It’s worthwhile to give your present job a second look to make sure that it is not what you wanted in the first place. 

Give The Well-Worn Sneakers (Residency/Job) A Chance To Support And Comfort You!

All outstanding accomplishments take time. So, give your residency or job a chance. Yes, there are times where a sneaker can break, or a rock gets stuck in the sole. In these unusual cases, the damages are irreparable, just like some rare residencies or career paths. But, those times are rare. In the end, you may find that you will live a much more comfortable and happier life if you stick it out a bit. Your feet will thank you!

 

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Why Radiologists Cannot Be Over-Confident!

over-confident

Some subspecialists make fun of radiologists because our favorite plant is the hedge. (An ancient lousy joke!) To the other extreme, I have found that those radiologists that are over-confident of their diagnoses tend to make the worst radiologists. Many residents don’t realize this, and some emulate these single-minded radiologists because they believe excess confidence helps patients and physicians. But, when they get out into practice, they recognize the error of their ways. And, quickly, they reverse course. So, let’s go through why that is the case before you may become one of those casualties. And then, I will provide a simple solution to get your point across without sticking to one foregone conclusion.

Why Radiologists Cannot Be Over-confident

Zebras Do Occur (Even For Over-Confident Radiologists!)

Of course, not all of our diagnoses have simple outcomes. For every 1000 peri-tonsillar abscesses, there are a small number of infected squamous cell carcinomas. And, there is also a smattering of even rarer birds that happen from time to time. I’ve been around a bit to see a lot (although not everything!) And, I know enough not just to hang my hat on my one beloved diagnosis.

All Of Us Sometimes Have Blinders On

Just like other clinicians, histories can sway us. If your ordering doctor constantly pushes toward one ineffable diagnosis, you, as a radiologist, are most likely to think the same. And that is the moment when you need your radiology cap on your head. Those intense pressures can easily lead you down the wrong road. At this point, we need to step back and reanalyze the situation and think about all the possibilities, not just the most likely.

The Legal System Is Not Forgiving

What do you think about when you see a bit of bowel wall thickening in a small bowel loop with no pneumatosis, free air, free fluid, focal fluid collections, or extraluminal contrast. Usually, it is infectious or inflammatory enteritis. But every once in a while, it turns out to be something much more malicious. Perhaps, the earliest sign of ischemia? I have seen multiple radiologists not mention the word ischemia somewhere in their dictation. And, the outcome for the physician (and sometimes the patient) has not necessarily turned out so well. The legal system does not allow for finite diagnoses, especially when one of those more unusual diagnoses can lead to a not-so-great result!

Potential Bad Patient Outcomes

And, most importantly, like in the ischemic small bowel example above, when we limit our differential diagnosis, we can also affect patient outcomes. Some clinicians will keep the alternative diagnoses in the back of their minds or will prophylactically treat for these entities even though it may not be your first suspicion. And, even though you may put these diagnoses third, fourth, or fifth on the list, it doesn’t mean it shouldn’t be in the dictation. We have to allow our clinicians to be aware of the unforeseen to prevent these bad outcomes.

How To Solve The Problem Without Being Too Hedgy

Given all the pitfalls of the over-confident radiologist, we usually should not come down too hard on one diagnosis. Instead, we have to give more than one option to clinicians because multiple possibilities exist. Yet, it is effortless for radiologists to get bogged down in a list, which also does not help the clinician. Suppose you come up with a list of differentials on a chest film of ARDS, pneumonia, or pulmonary edema; how does that help the clinician? How can you escape this hedge-like conundrum? 

Very simple. Ensure your reports talk about the diseases and a list of probabilities to go with the diagnosis. For instance, if you are leaning toward the diagnosis of pneumonia, you can say that the study is most consistent with pneumonia because of the fever and the multifocal pattern. But, make sure to say that other etiologies are less likely, how much less possible, and why. This technique allows us to guide the clinician toward the most likely diagnosis.

Instead Of Making The Mistake Of Becoming An Over-Confident Radiologist, Master Probability!

Radiologists have lots of diagnoses from which to choose. And, any one of these, albeit unlikely, can come true. So, we can’t afford to become overconfident and make the mistake of picking just one. Therefore, radiologists need to become circumspect and know the likelihood of outcomes. Our role is to guide our fellow physician colleagues. Thus, to become excellent radiologists, we should not adopt the tact of overconfidence. Instead, we need to become masters of managing probability!