Month: August 2022

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Top Ten Signs It’s Time For A Radiologist To Retire!

retire

I’m sure many of you have encountered radiologists who should have retired years ago but are still hanging around. Maybe they are burnt out. Or, perhaps, life has thrown them a few curveballs. Here are some of the top ten reasons why you know it’s time for your fellow radiologist to retire!

One Extra Case Sets Them Off

You probably know one or two radiologists like this. If anyone asks them to help with another case, they will lay it thick on you. Perhaps, they will yell and kick, or they will say they need to get home and can’t afford the time it takes to complete it!

They Can Only See Films From One Eye In A Certain Position

Some radiologists will do almost anything not to go to the doctor. They hang around longer than necessary in practice. I have known a few that would practice with ailments for which I am not sure they can compensate. For many of these radiologists, it may be time to pack your bags!

Spend More Time Napping During The Day Than Reading Cases

In the past, I used to know a radiologist or two who would spend a few hours in their office while everyone else was working hard. Some residents saw them getting shut-eye while everyone else struggled to keep up with the work. If you get to this point, maybe you should be getting up late every day at home without having to read films!

New Ailment Every Day

I’m sure you have heard of a radiologist who always seems to get sick. One day a heart condition, the next day, a limp, and the next day a raging cough. Some folks are too frail to make it to work. If that is you, it may be time for you to nurse yourself back to health and take some time off. It will do you some good.

Yells At The Medical Students Upon Arrival

Poor students. The wrath of some attendings manifests itself on the underlings that come in to visit. They are angry at the world and take it out on the learner. No, it isn’t right. But, it does happen. These folks need some time off to think about their behavior!

They Are Reading 400 Cases Per Day

Most practices have one radiologist that reads too much to be safe. If you are reading four hundred or more cases per day, I feel you are missing a lot of critical findings. Think again if that is what you want or if it’s simply time to slow down.

Flagged Cases So That A Particular Radiologist Will Not Read!

If you have your name tagged on one too many cases, it may be that another one of the radiologists is not allowed to read this referrer’s studies. Or, some physicians whisper about another radiologist and don’t want this person reading the cases. Either way, it’s not a good sign. It likely means that this radiologist is not doing his job well. This radiologist may want to give up and stay home.

Their Cases Always Seem To Make To Morbidity And Mortality Conference

Ever notice that the same radiologist’s cases make it to morbidity and mortality conferences? Well, perhaps, it is for a good reason. All their misses contribute to the holistic lousy patient care. Be on the lookout if this radiologist is in your department!

No One Can Speak To Them Anymore Or Ask Questions

Some radiologists stay away from this one colleague. Unlike most colleagues you can bounce ideas off of, they can’t ask any questions of this person for fear of yelling and negativity. You probably have someone like this in your practice. There is a good chance that it is time for this radiologist to retire!

Always Complaining That They Should Retire

Everyone knows of a radiologist that constantly talks about retiring. They say it in myriad ways, and it becomes a real bear to hear. “I can’t stand work it’s time to retire,” “I can’t take it any more and it is time to go” are the statements they make all the time. Well, do it already!

Reasons It’s Time For Radiologist To Retire

No one can work forever. But, I think that these reasons to retire soon do justice to those folks that should pack it in sooner rather than later!

 

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Should Teaching Programs Hire Non-Teaching Faculty?

non-teaching faculty

At almost any hospital residency program, you will have a mix of faculty with all different interests. Some like to teach and spend concerted time with the residents. In some more academic hospitals with residencies, other faculty want to pursue research areas. And then there is the final group that wants to put their energies into completing the day as quickly as possible and returning home to family without wasting time on other endeavors. So, today’s question is: should hospitals and practices with residency programs hire these non-teaching faculty if they have a residency program dedicated to teaching? To answer this question, let’s talk a little about the current hiring environment in radiology. And, then let’s discuss the advantages and disadvantages practices and hospitals face when hiring non-teaching radiologists in the current climate. And finally, we will come up with a feasible conclusion.

The Current Hiring Background For Radiologists

We are in the midst of one of the most acute shortages for radiologists in 2022 as it stands right now. Even residents that have not completed their training receive solicitations for work. It is not uncommon for practice owners to cover unwanted shifts to ensure their practices run smoothly due to a lack of personnel. And, starting offers for new radiologists are robust. A “warm body” that can read and catch up on all studies is a treat for many sites. So, many practices can prevent a practice crisis if they hire radiologists to do the work but do not want to teach, but at what price?

Disadvantages To Hiring Non-Teaching Faculty At A Teaching Site

If They Don’t Have To Teach, Why Should I?

The biggest fear for a practice of mixed radiologists is the impression of inequity. When radiologists see that they can get away with less responsibility, you may hear the phrase “it’s not fair” bandied about. This unfairness leads to decreasing morale and radiologists thinking about leaving practice for greener fields elsewhere. This environment can be toxic even if you compensate faculty members for teaching.

Does Not Foster A Culture Of Inquiry

To create an excellent residency program, I like to say you need a culture of “why.” I love when my residents ask why about the reports, procedures, or protocols they see. It forces me to rethink my training and beliefs to analyze what we do “by rote’. And, it’s a great way to reinforce and learn new knowledge for attendings and residents. Disinterested attendings who do not participate can spoil this excellent learning environment.

 Advantages To Hiring Non-Teaching Faculty At A Teaching Site

Free Up Teaching Faculty Who Want To Teach

If you can isolate the non-teaching faculty to rotations that do not involve teaching, you can allow the teaching radiologists to teach without the hindrance of backed-up work. Freeing faculty members who want to teach can theoretically improve the teaching faculty’s morale. However, the practice would need to decide on a protocol for which it will not degrade residency training.

Can Get More Work Done

You may have heard the adage, “a resident will slow you down.” Yes. There is some truth to that. It takes time to explain and go over dictations and give lectures. If you do not have these responsibilities, it is possible to plow through extra work throughout the day (perhaps with a headache!). Practices with some attendings that work without residents can theoretically accomplish more RVUs during the day.

Should Your Teaching Practice/Residency Program Hire Non-Teaching Faculty?

There is always more to a decision that might be easy at face value in a typical environment. New radiologists that do not teach can cause inequities and do not foster a teaching culture. Nevertheless, freeing up teaching faculty and getting the practice work completed is critical. So, if you see a new grumpy radiology hire that does not want to teach residents and is plowing through the cases, there is a good reason for that. Many practices are under duress to hire a body to fulfill the work of the business, not just to teach residents. However, programs that employ these radiologists must ensure they are not on teaching rotations to minimize conflicts. Instead, programs should make a concerted effort to plug in those attendings that want to teach to the divisions with the most exposure to residents. It may take a bit of adjustment on the part of the resident and the faculty until the radiology shortage resolves!

 

 

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The Last Case Bolus Phenomenon!

bolus phenomenon

Ever notice that the end of a shift tends to have a bolus of cases? Just as you are allowed to leave the building, you find yourself with multiple studies that you need to read emergently. Usually, they are more complicated, and you don’t leave your station near when you are “supposed to be” finished. Well, this bolus phenomenon is not by any means random. Based on logic and my experiences, there is much more to this phenomenon. So, let’s go through some of the causes why you suddenly experience more cases that can often be the most difficult ones right at the end of your shift. You may be surprised at the reasons!

Transitions Are Not Smooth

Down in the emergency department, just like in radiology, no one wants to leave over work for the next ER attending shift. So, they will often order a bolus of cases so that the next physician does not have to write for them. This process causes a sudden cluster of studies in the radiology department. And, at this point, toward the end of your shift, you also feel the heat.

The ER Doctor Likes Your Work

Here is some good news/bad news for you. Guess what. Sure it’s great that the ER physician downstairs likes your dictations and diagnostic acumen. You have made a friend for life! However, that same phenomenon can lead to a bit of pain; right before your shift ends, they will try to get in as many patients as possible so that the physician downstairs will get all your dictations before the subsequent radiologist arrives. Sometimes, it does not pay to be the best!

ER Shifts End The Same Time As The Radiologist

Unfortunately, we like to begin and end shifts at typical times. Ten o’clock can be a standard time for physicians to leave. So, as the radiologist, you are not alone at that time. Therefore, you will receive the bolus of cases that need a disposition at the same time that you will leave. In this case, you can resolve this issue by changing the timing of shift changes so that they don’t coincide.

Transport Logjam

Ever take a gander outside the reading room, only to see ten patients in beds in line in the waiting area, waiting for their study. A lack of transporters can often cause this logjam. And, the same lineup often happens in reverse when they need to leave. These logistical issues often occur when your hospital does not pay enough to get these transporters to do their jobs. A hospital is only as good as its weakest link!

Pressure For Disposition, a Definite Cause For The Bolus Phenomenon

Finally, some emergency medicine physicians can become fickle. These emergency medicine physicians delay and protract until they finally decide what to do. And they must make this final decision before the end of their shift. To do so, they will probably need that definitive imaging study to confirm or refute their suspicions. So, these examinations culminate their thought processes right before they leave. You are there reading CT scans for them to reap the benefits!

The Last Case Bolus Phenomenon Is Not Random!

It feels painful to experience a large cluster of cases at the very end of your day, right before the end of your evening. However, contrary to what you might think, it is not a random process. Poor transitions, ER physician fans, problematic timing, transporters, and pressure for disposition, are all factors that often cause this bolus phenomenon. Some of these factors you can change and others not so much. It’s one of those hazards we experience when a shift is about to end. It’s just part of the job!

 

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What Milestones Will You Achieve At The Age Of 50?

milestones

Now that I am on the cusp of hitting the big 50 and I have been practicing radiology for nearly twenty years post-residency let me give you some thoughts about where I have gone in my radiology career after residency and fellowship. Life does not end after residency. By showing you my career path and milestones, I hope to give you a bit of perspective on the twists and turns you can expect in your career. Also, you might find it enlightening to see the critical junctures I had and apply them to what you may want to do as you go along in your practice. I will start when I just finished my fellowship in 2004, summarize what happened in approximately five-year intervals from 2009 to 2019, and finish with the present. 

2004- My First Job

As I had just started my first practice, my first goal was to get as much experience as possible to become the best radiologist I could be. Also, paying off my student debts and saving for the eventual purchase of a house was first and foremost on my mind. At this point, I would work extra shifts and read as many cases as possible; it was a considerable adjustment after six years of postgraduate training and medical school. I made sure to attend loads of courses to keep up with radiology. And I was excited to start on a path to a partnership tract. (Turns out that happened during my second job!)

2009 – Partnership Begins

After this point, we had paid down our student loans (one of the significant milestones) and lived in our house for a bit. After years of medical school, residency, fellowship, and partnership track, I felt what it was like to settle down in a stable career; I became ensconced in the radiology residency and began to take on new roles once I started as a partner in a partnership. And, I began to learn a bit more about the intricacies of the business of radiology, not just the day-to-day practice. Work and routines became more familiar and seemed like a family.

2015-2016- Expansion And New Roles- Many New Milestones

Our practice began to grow incrementally with the acquisition of new hospital contracts and outpatient sites. Learning about how mergers and acquisitions work was fascinating as part of this expansion. And I became the medical director of one of our outpatient sites. To this day, I continue to run this private office. During this period, I learned about all the organizations and issues with new sites, ensured appropriate staffing, and began covering all the different areas at this site. The outpatient office has become a second home within the practice for me.

Then, in 2016, I decided to start up radsresident.com on a whim due to my interest in teaching and the internet. Still, it has been an incredible experience that merges all the aspects of radiology, technology, and writing that I enjoy. And it’s been going strong ever since!

2022- The Fun Continues

To this day, I still enjoy the complex cases and people that I have met in radiology since I started. Although I am no longer gung-ho about working extra shifts like at the beginning of 2004, the residency program, this website, and my day-to-day work continue to challenge me. And I look forward to going in to work every week. Moreover, extra-curricular activities play a more significant role in my life. Yes, they have changed over the past twenty years, but they are critical for having a fulfilling life and career.

What Are The Milestones You Expect Over Your Career?

Indeed, I could not have exactly predicted what would happen to my radiology career since my fellowship ended. If you had told me after finishing my training in 2004 that I would be running a blog, a residency program, and an outpatient office while being a partner in practice at 50 years old, I am not sure if I would have believed you. Changes along my career path have made the past twenty years enjoyable. So, I advise you to embrace the milestones you will experience in your career. It will make for a much more rich and exciting path. For me, I expect the next twenty years to be no different!