Month: June 2022

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Do “Fancy” Residency Websites Mean Better Programs?

residency websites

Sure, some residency websites blow others out of the water. They have more fancy videos, smiling attendings, and satisfied residents. Their FAQs are thorough, and the mission statement is clear. But does this fluff and bluster mean you are in for a better ride during your residency? Or, does the word of your colleagues and faculty take precedence over anything you might see or hear on a residency application website? Let’s come to our conclusions. 

The History

Once upon a time, years ago, believe it not, there were no residency websites. And even after that, when I applied in 1997-1998, they were more of a mere afterthought. Anyone worth their salt would do their digging into the ins and outs of residency programs. Programs barely updated their information because the number of eyeballs hitting the web was far from what it is today. It simply was not the primary way to assess a program.

Fast forward to our time, and that is no longer the case. The currency of the world as we know it is the internet. And, if you don’t play that game, you lose.

Does A “Fancy Pants” Website Equal Better?

Let’s talk about some of the positives of well-curated residency websites. First, it shows that the residency program or hospital put some forethought into their online presence. So, it signifies hospital organization and a desire for the entity running the video to recruit residents. Remember. Creating a decent website is not required, so that is all well and good. Therefore, there is a tendency for residencies with high-quality websites to have more resources.

However, websites only show you the best of what the residency program and institution want to show. They will not let you know that they have not met their annual requirements to publish articles. Or, it will not tell you that they barely passed the last site visit due to a lack of faculty motivation. So, be very careful to believe everything the website wants you to see.

How Should You Evaluate Residency Websites In Your Calculus For Making A Decision?

Websites are helpful for a superficial survey of what the program may have to offer. Suppose the mission statement on the website declares that they aim to produce community radiologists. Then, it is probably true that you are looking at a program that deemphasizes research to make residents into good quality overall radiologists. So, if you are gung-ho about radiology research, it may be a way to exclude that residency program.

However, suppose you like the residency because the faces all looked happy, and the culture seemed benign. In that case, you will never know from watching a few videos from the institution and mulling the rhetoric on the website. It is a facade. I recommend checking the institution for yourself to know more about a program’s reputation.

Residency Websites: A Serious Business

Given the competition for the best residents among institutions, residency websites have become more of a significant business than years ago. But, it is a means of promotion. It may not demonstrate all the facts you need to hear before making your final decisions. So, regardless of whether a website is glorious or lousy, look under the cover and dig a little bit deeper if you are still interested in the program. Interview and check out the facilities if you still like them. And, of course, talk to the residents in the program if possible to get the real scoop. Don’t ever rely on a residency website and your primary/only source of information to make your final decisions!

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Are You Ready?

ready

The middle of June begins the annual season of change for radiology residencies. The first graduates start to move out as they have held their last few weeks of residency vacation to dedicate this time to move. And new residents prepare to find housing in the area and prepare for the new academic year. Even the first-year residents have an enormous transition from readers and observers to active participants in night shifts and calls. Since so much happens now, let’s discuss a checklist of some items you may not think about or forget before starting the new year. Don’t worry. I have you covered!

Bone Up A Bit On The Basics To Get Ready Before Starting

Whether you are about to start residency, call, or fellowship, why not take the time to read a bit before starting. Many fellow interns and residents say not to do anything before starting your new phase. But, many of them are not radiology trainees. We have more reading than most other specialties out there. So, get cracking. 

Suppose you are an intern. Read some anatomy atlases (if you haven’t done so already!). If you are about to take overnight call, consider some case review series, especially for ER radiology. And, if you are a fellow, start reading about some of the critical areas within your newfound subspecialty. Any bit of reading can give you a headstart.

Find Housing Close To Your Residency Program

You have limited time to get out there and find housing with all the pressures upon you. But, if I have to give one sagely piece of advice, you are usually best off living fairly close (optimally within a ten-minute radius)—the less time in the car or some form of transport, the better. You will have more time for studying and, perhaps just as importantly, more time for yourself. This advice comes from someone who has lived near and far from their line of work. It’s not worth the pain to live farther away!

Remember To Start Up Your Savings And Investments

Some of you will have the option of starting up 401ks with matches or making automatic contributions to Roth IRA. Regardless, before starting, don’t forget to automatize all these investments. As residents, you will not have as much time for a hands-on approach. So, start up those automated investments into those stock index funds before beginning. Trust me. Your future self will thank you many years from now!

Start-Up Car And Renters Insurance

Many of you are moving. So, don’t forget to change up all your insurances. Sure it can be a pain in the neck, especially if you are moving to a new state. But, it is a necessary evil. The last event you need is to start residency after a theft that you can’t recover or have issues with your car once you have already started. Make sure all these insurances are in place before you start.

Make Sure You Have Your Medical Licenses And Credentialing Ready To Go

Some of you will need your state medical license before beginning residency. Others will be able to use the hospital license. Either way, you will still have much to do to ensure that you get it processed and ready to go. Credentialing in all forms can be more arduous than you might think. And, it pays not to worry much about it after you start. So, get everything in as soon as possible, so you will not worry about the details during your residency!

J1 Visas, Etc…

Finally, for foreign graduates, don’t forget to ensure that all the paperwork you need to stick around is complete and ready to go. We have seen a few folks that had a problem getting back into the United States because they did not finish their paperwork. It happens!

Are You Ready? Get Psyched For The Change!

So many errands to do before starting and so little time to do them. Here is a bit of a nudge to get you going so you can start the year with a bang. Before starting, take a gander at this list and ask yourself, what did I forget? This list can help you recall what you need. But, most importantly look forward to the next academic year. Change is exciting and will be here before you know it!

 

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Why Radiologists Need To Protocol Cases

protocol

Like many institutions, we perform cardiac CTA studies at the behest of our emergency medicine, internal medicine, and cardiology colleagues. They say do the study, with or without a protocol, and the technologists jump without a reflexive thought. For example, one patient had a chest CT scan a few days earlier for shortness of breath. It turned out that the patient had enough calcium in their coronary arteries to make their vessels look like lead pipes. For those who know anything about cardiac imaging and CTAs, tons of calcium within the coronary arteries make it nearly impossible to interpret them for stenosis because of significant beam hardening artifact, limiting evaluation of the lumen.

Nevertheless, without batting an eyelash, the technologists completed the coronary CTA, which was uninterpretable for detecting coronary stenosis. It had a calcium score of over 4400! Now, if only someone had looked at the CT chest, we could have avoided the CTA chest at the cost of unnecessary contrast, additional radiation, and of course, the financial cost to the patient.

This case is a microcosm of what is happening to radiology. Scans come through fast and furious, making it difficult to vet the protocol and the priors on everyone. But, by letting cases get through the system without forethought and protocols, we expose our patients to subpar medicine. In light of these facts, here are some of the critical reasons why radiologists need to protocol cases.

Avoid Unnecessary Studies

How often do we get the wrong orders for the indication? Very frequently! Daily we get orders for CT scans that ask for contrast when none is needed and vice-versa. Of course, a patient with flank pain should not generally get contrast on the first scan if they are looking for stones. But, wrong orders for studies with contrast happen all the time, causing unnecessary exposure to radiation and contrast that is not needed. Protocoling can prevent most of that.!

A Protocol Can Make Sure Studies Are Done For The Right Reason

When technologists and nurses come up to me and ask if they are performing the correct study, the first question I always ask is, “why are we doing the study?” There is a reason for that. We get orders that are not necessarily for the indication that clinicians want. It could be a white blood cell scan for when a simple gallium scan is warranted. Nevertheless, we can correct most of these potential errors before they get to the table!

Protocols Can Add Information To The Case

Protocoling can add critical information to the case. It may help find a relevant prior like the cardiac CTA above. Or you might find a valid reason for a study that might not be evident initially. Perhaps, the doctor is looking for a fistula and needs rectal contrast. Sometimes, you can only figure that out by digging deeper. You know what they say… Garbage in. Garbage out!

Prevent Patient Discomfort

Many radiology studies are uncomfortable and difficult. A CT scan on a patient with severe back pain can be a nightmare. Imagine going through a CT scan in this situation when you could have avoided the test if the radiologist had protocoled it beforehand. Well, this issue happens all the time. We owe it to the patients to prevent additional harm!

Prevent Angry Clinicians

When we do not protocol cases before imaging, we do not get the answers that the doctors are looking for. This cycle leads to unhappy referrers that do not receive the intended study. And, we get these irate phone calls afterward. Do you want your clinician to send patients back to your department again? Well, if you consistently deliver the wrong studies for the patients, that will not happen!

A Protocol Can Decreases Costs

The costs to image patients are immense. And simply one incorrect study can cost the patient and the institution thousands of dollars. Protocoling is a tremendous backstop to ensure that health care costs are more reasonable. Sure, we may not have much time in our busy schedules. But, protocoling can certainly decrease costs to the system!

Protocol: An Easy Way To Prevent Bad Medicine

If your attending asks you to take a stack of patients and ensure the protocols are correct, it is not a waste of time. With all the benefits of eliminating waste and practicing good medicine, it is something that we should all do regularly. So, look at those orders before the hospital performs the studies. Protocoling can make a huge difference in patient care!

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Know Your Marketplace Value!

value

As you meander through your training, it is rare to hear from your hospital or training program about your actual value. Sure, you can look on the internet and figure out what the average radiologist in a particular place and situation makes. Of course, you will find salary surveys like Doximity and Medscape. But, they are often off base for your specific situation. These surveys are an odd mixture/overall average of all sorts of practitioners- part-timers, owners, full-time employees, and other employment situations.

So, why is the most accurate information so difficult to find? First of all, hospitals, corporate practices, partnerships, and teleradiology firms (and even your residency program!) are vested in either obfuscating or undercutting the value of radiologists and their practices. It is in their vested interest to hire you at the lowest possible rate to save the most money. Furthermore, you are less likely to change jobs if you don’t know your worth. And, you know what that means. Whether you are a new graduate from residency or an owner/partner of a practice, every radiology trainee and radiologist needs to know their value in the workplace. So, today I will talk about how you can figure out a closer approximation of your value in the marketplace. Knowing your worth is essential for negotiating your next offer to get your best and most comparable value in the market.

Look On Job Sites- Can Give You A Ballpark Value!

Nowadays, many job sites (comp health, radworking, etc.) can give you a vague idea about what radiologists are getting in your market. Sometimes these numbers are inflated for bad situations such as too many RVUs or inappropriate working environments. Nevertheless, it can give a general gestalt of the numbers in that particular radiologist market.

Read ACR Magazine And JACR

The ACR tends to have some good information about the state of the marketplace. It tends to tell you which trends are taking place right now. These trends can give you an idea about the hiring environment. For instance, every once in a while, they will have surveys on working environments or market demand. I find it an interesting ancillary source to figure out the general trends about how radiologists are valued.

Check Out The Big Surveys, But With A Grain Of Salt!

I mentioned some more prominent surveys before, like Medscape, Doximity, and the Aunt Minnie Salary Survey. However, you can’t entirely rely on these for your specifics. Some even include the average with residents who mistakenly add their numbers to the mix. But, if you are looking into the practice of radiology in general, they are not horrible. Then, there is the paid-for evaluation of physician salaries, which has biases. Some have a hospital bent. Others lean toward a private practice or even partnership. You need to be very careful when interpreting this information. It may not apply to your particular situation!

What Are The Needs At Your Hospital And Network?

Sometimes a microcosm of the radiologists at your local residency can be applied to other practices in radiology. For example, is your practice having a tough time findings mammographers. Most of you will hear murmurs of these issues during your residency. This gossip can help determine the value of particular specialties and know how valuable you may become to your future radiology practice when the time comes.

What Is The Mood Of The Forums?

Here is another criterion that is not entirely objective. But, it does give you a flavor of the needs of radiologists in the general community. I like the Aunt Minnie Forum because it has a general radiology bent. And, you see here all sorts of opinions on there. Of course, you will find a few trolls. But, it does give the overall mood of the specialty at a given time when it comes to radiologists and radiology practice valuation. It works as a starting point.

Knowing Your Marketplace Value Is Essential!

When the time comes to look for a job, knowing your worth is essential. Some offers will not be close to the actual value of the work that you will do. And others will be more realistic. To negotiate appropriately, knowing this number is essential. So, consider surveys, but remember they are not entirely correct. Also, consider using other ancillary methods such as the ACR magazine, online job sites, your own hospital needs, and even the overall gestalt when you scroll through the forums. All these are tools that can help to give you a better idea of your magic number. If you don’t learn this information, there is a good chance you will not receive what you are worth!