Month: September 2022

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Top Ten Signs You’re Not Ready For Call

ready for call

Last week we discussed the Top Nine Signs You Are Ready To Take Call. So, I figured I would not do justice to the topic of being ready for call without also creating a list of those signs that you might not be ready to take radiology overnights. Therefore, I have dedicated this list to those that think they are ready but are not. Maybe this is you? Check it out if any of these signs apply to you!

Never Double Checks Anything (Anything Goes!)

Our words matter, and anything that you say, the ER can use against you later on. If you recommend another test, guess what? You will probably get that test the same night! So, the resident who never checks their dictations to make sure everything makes sense and is corrected is in a world of hurt.

Anger Management Issues

If you constantly fight with your fellow residents or, even worse, your faculty, you probably need to settle down a bit before taking overnights. Ready residents can control their anger and not take it out on others because they know what they are doing. If you are in the former category, think about why that is!

You Repeat The Nighthawk Dictation Verbatim

If you rely on the nighthawk dictation as a crutch, it probably means you are not ready to strike it out on your own. You should go through every case as if it is new, even if another radiologist has already dictated it. You never know what they are going to miss. And, you certainly don’t want to miss the same things!

Never Looks Up History/Priors/Call For More Information

If you think you know it all and don’t ever need additional history or the need for priors, you are in for a rude awakening. The number of findings that you miss will be incalculable. And, you will miss the point of your imaging studies more often! It is one surefire way to mess up your cases at nighttime!

Assumes The History Is Correct And Relies On It Explicitly

Using history as a crutch is an elementary mistake that can lead to disaster. I can’t tell you how often the ER calls for hepatobiliary scans to rule out cholecystitis, even though the patient doesn’t even have a gallbladder! We need to check and recheck our work and compare it to priors to ensure we are doing a good service for the patient!

Disorganization And Routinely Forget Cases

If you forget to read films or complete your work during the daytime, do you think you will remember to finish everything at nighttime? Disorganization can lead to disaster. You can wind up dictating the wrong case on the wrong patient if you don’t watch what you are doing. So, get yourself into shape before starting!

Cannot Get Through The Daytime Cases on Time

It’s not just accuracy that matters at nighttime. Speed is critical as well. And, if you cannot get through work during the daytime, what makes you think you will get through everything at night? Cases will often come in batches, and everyone needs a timely report when this situation happens. Make sure that you are up to the task!

Only Knows The Aunt Minnie Diagnoses And Never Scrolls Through Cases

There is a big difference between knowing the diagnosis based on a solitary image and having to make your finding on an entire case that has hundreds of pictures. If you think you can get through your studies without the experience of scrolling through lots of cases, you will have lots of problems when you have to make all the findings at night.

Unintelligible Dictations

Do your attendings always tell you to edit your dictations because they can’t understand what you are trying to say? Well, listen to these folks very carefully. Dictations are the final product of what radiologists do. And, if you cannot say something intelligible, you have no business being on call!

Lack Of Rigorous Search Patterns

Every resident needs a rigorous search pattern when they are working at nighttime. Lacking a search pattern is a recipe for missing all the critical findings. If you never look for the spleen, you will never know it is absent. And so on. Hone in on your search pattern skills before starting to take call!

Are You Not Ready For Call Yet?

If one or more of these signs describes you, you may not be ready to take your first call. However, there is still a bit of time. So, go ahead and make adjustments before it’s too late!

 

 

 

 

 

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Top Nine Signs That You Are Ready To Take Call

take call

Are you wondering if you are at the level of a second-year resident, ready, able, and willing to handle overnight shifts independently so early in the year? Here are the top nine ways you know if you are prepared to take call!

Methodical Thinking/Search Patterns For Each Imaging Study

Do you have a search pattern for every case you attempt to tackle? When reading a CT scan, you should have the same search pattern for every study, including abdomens, necks, heads, legs, and more. Do you have a specific way you approach each of the sequences on an MRI? This approach is the minimum for starting as a resident on call!

Know When To Get Help

If you are not sure about a finding, what do you do? To answer this question, if you are ready for overnights, you will not blurt out the first idea that comes to your mind. Instead, maybe you will contact the ER physician to get more information or do a google search. Knowing when you don’t know something takes maturity and poise.

Don’t Get Too Shaken By The Mob

It’s always tough when you have a team of tired surgeons hanging on your every word. And they want a STAT read yesterday. Nevertheless, you have the confidence to plow through any case with a stream of eyes and ears watching your every move. They will have to wait until you are ready to give them your impression!

You Know All The More Common Disease Entities And Findings That Will Kill Patients Or Cause Severe Morbidity

If you can make the findings of a patient with diverticulitis, aortic ruptures, bleeds, pneumothoraces, and more, you are more than halfway to your goal of taking call. When taking cases independently, these entities should be on top of your mind. And, you should be actively looking for them when you take any study. Those that do will be unlikely to make any significant misses!

Can Tell Normal Versus Abnormal Fairly Quick

When you have seen enough cases, your brain can tell if an image is normal or abnormal before you can verbalize what the problem might be. You have already trained your brain to know what the general findings of a normal case should be. Therefore, you can look at almost any study and know that you should pursue it further if you assess it as abnormal!

You Make The Findings Before Your CT Attending Does

This one is not a requirement. Nevertheless, it is a good sign. If you can make the findings before your faculty member does, you have already been preparing for the time you would start to take calls. Kudos to you!

Notice A Sigh Of Relief When Your Attending Knows You Are On

Knowing when you are wanted can take a bit of emotional EQ. But, if you notice that your attending’s blood pressure drops by a bit and calms down when you arrive in the morning to work on the day’s rotation, this is generally a good sign. You have your faculty trained to know that you do good work.

You Get Phone Calls From ER Physicians To Ask Your Opinion

You are probably doing a fabulous job if you are getting phone calls asking for you by name because they like your reads. Most ER physicians will not actively seek out a junior radiologist instead of faculty to see what you think. You should be honored that they respect your judgment!

Seasoned Technologists Actively Look For You During The Day

Yes, technologists do know a lot. They most likely have been in the same job for years and have seen many cases. If these folks actively seek you during the day to get your opinion over others, you probably know a thing or two. That’s the ultimate compliment!

Are You Ready To Take Call?

Don’t worry if none of these statements pertain to you early in the year. You still have a bit of time. However, try to make some of these signs your goal before the start of your first call. At that point, you will get the hint that you are ready!

 

 

 

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Should You Join A Practice With Skeleton Coverage?

skeleton coverage

We are in a brave new world. A great job market for starting radiologists is associated with a tough time with radiologist recruitment. And it’s a nationwide problem—tons of work but few radiologists to complete it. So, like many new radiologists, what do you do if you consider joining a practice with skeleton coverage? Should you join these practices or move on to the next “fully staffed” large conglomerate? What are the main risks that you will encounter when starting? Is it at all worth thinking about these practices with skeleton coverage? Let’s figure out if you are the type of person who should consider such a practice!

Advantages Of Skeleton Coverage

Lots Of Opportunities For Moonlighting

When I started, I was hungry for additional shifts to help pay down my student loans. And those spots were not always available. But, in an environment like this, with thinly covered practices, you will have many opportunities. Nights, weekends, and teleradiology coverage will all most likely be available to you, ripe for the picking. You can pay down your debts and save a bit for a new house in no time!

Opportunities For Leadership Positions

A thin bench will create many opportunities for you to become part of almost any organization role right from the bat. If you are interested in hospital administration, you can begin on this path to fulfill your ambitions from the beginning. Are you interested in teaching? Start on your merry way toward becoming a program director, no competition! Or want to become the practice’s CEO eventually? Take on financial roles immediately. You will have very little competition to get started at these positions!

Potentially A Quicker Path To Partnership/Owner

The more needed you are, the more leverage you have. And, if you have enough radiologists barely to fill the rosters, guess what? You may be able to use that leverage to up your time until you can become an owner. Think about it. You have the potential to increase your earnings significantly, more than you may have thought when you first started looking.

Disadvantages/Risks Of Skeleton Coverage

Ripe For Buyout

A thin bench can mean that radiologists can no longer take on the extra workload. It’s just not sustainable. And the casualty can be the sale of the practice to a private equity firm. Caveat emptor- may the buyer beware!

Unhappy Radiologists

More than any other factor, working with fellow radiologists with low morale can be a real downer. And, no factors more than a thin shell of coverage can cause your fellow radiologists to be stressed and miserable. Especially when you are raring to start at your first new practice, this is not the toxic environment you had signed up for when you first applied for the job.

Forced Coverage

Sure, you have all these extra opportunities. But, at what cost? Now that you are missing out on a nucs guy, you have to cover the PET-CTs. Or, maybe you have to cover all these extra available shifts you were not planning to work. If you’ve recently had a baby or have lots of other hobbies that you want to pursue, additional opportunities can be a curse instead of a blessing.

Should You Join A Practice With Skeleton Coverage?

It can be a tough call. But, it depends on your needs and wants. For the new radiologist with lots of ambition, it can be the right decision with lots of opportunities and time to make extra money. But be careful. It can be at the expense of a sell-out by your fellow radiologists or just a plain old miserable environment. So, consider all these factors when joining a practice with a thin bench!

 

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What Is The Optimal Call Situation For Radiology Residents?

opitmal call situation

Almost every program has its method of giving radiology residents the “call” experience. But, by no means is it standardized. Some programs have in-house attendings to back up the residents. Others use nighthawk, some all the time, and others sparsely. Some don’t have much in-house backup at all. And others weigh CT scans more highly than other modalities. And the list of possibilities for any given program can vary on and on. So, what critical elements of the optimal call situation should you look for when you are thumbing through the different radiology programs out there to find the one that best fits you? Of course, I will give you my two cents!

Independence Of Decision Making For The Optimal Call Situation

First and foremost, unless you want to do research permanently and cannot give a lick about making independent decisions, you should consider this priority one when searching for a call experience. At some point during your residency, you must make your own decisions, which need to count. Without this factor, you will never truly leave your first year of residency. The ability to make sound decisions is the difference between a student and a radiologist. So, make sure you have the power to make some decisions in each of the different modalities. Each modality that you cannot make an independent decision for is one less modality your residency will prepare you for when you finish!

Meaningful Decisions To Have Some Affect On Patient Management

To be clear, making a decision is not enough. The decisions that you make need to have some impact on your workup. The pressure of worrying about patients will keep you up at night, both as a resident and as an attending. Making calls that go nowhere will not be enough to satisfy the requirement of independent call. Every radiologist needs to know the consequences of what we do. Otherwise, you will become powerless to make these same decisions in practice.

A Reasonable Quantity Of Cases

It is easily possible to veer on either side of this equation. Some residencies are so overburdened with cases that the resident has no time to think and make decisions. So, too many of the decisions are bad ones. Likewise, if you are working call at a podunk hospital that is about to close from a lack of patient visits each year, this is not such an optimal call situation for learning either. At nighttime, your residency should have enough work to teach you how to become a radiologist. It’s hard to give you an exact number, but it’s usually a little more than you might think!

A Good Mix Of Cases

Some institutions are in counties where everyone comes from the same culture/background. This mix of cases is not such a great recipe for learning about the diversity of radiology. Also, if the program relegates you to read CT only and gives you no opportunities to look at MRI and plain film cases, this situation will not serve you so well. Find a residency where you can get sufficient studies in all modalities and patients.

Nighthawk Vs. Q Night

Finally, I have always been a proponent of the nighthawk system. I believe it will make your residency life a whole lot better for most of you. I find it very hard to adjust my sleep schedule to the every 4th-day rhythm. On the other hand, your body will get used to the nighthawk sequence reasonably quickly so that you no longer have the 4:30 am blues when you cannot see straight. This factor may not matter much for some with different circadian rhythms. But for me, it makes a humongous difference!

The Optimal Call Situation For Radiology Residents

No call situation is perfect. However, to optimize your overnight learning during your radiology residency, find programs where you have independence and meaning in your decisions, a decent number and mix of cases, and a nighthawk rotation. You will discover that these features will enhance your learning once you practice more independently, which will eventually spill over to your work as an attending. At that point, you will feel comfortable in your skin, knowing that you had excellent training!