Year: 2022

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Don’t Let Significant Life Events Interrupt Residency!

significant life events

Many of you are guaranteed to have significant life events during your four years. Marriage, family crises, car accidents, and sickness are all part of life. And a four-year period of time is a large enough amount for something huge to change in your life. But, with the daily grind of residency, all these life events can become significantly more complicated. Who has time to be able to leave work at a moment while you are dealing with of myriad of possible life issues? So, what are some of the primary steps you can take to prevent your life from interfering with your work? How can you make sure to preserve your integrity within a radiology residency while these events happen during your radiology residency? Some of these obligations seem like common sense, but this is an excellent checklist for radiology residents. These steps can be easy to forget when life throws you a curveball.

Notify Relevant Faculty

You may be in an uproar because of a challenging event. However, most of your faculty will be understanding. If you are not going to be around because you need to go to court or a funeral, most faculty and attendings will understand. Additionally, you won’t be leaving them in the dust when you don’t show up for work at that time.

Get Coverage

By that same token as above, if you are not going to be around, try to find someone that can take your place if you need coverage for whatever rotation you are on. Now that you are a resident, you need to take responsibility for your actions, and getting coverage shows that you can handle the job.

Find Times That Don’t Interfere With Patient Care

OK. It is certainly not possible to change the time of a funeral. However, you can usually make many critical phone calls, heated conversations, and necessary appointments at times that don’t interfere with patient care. It is merely polite and appropriate to do so. Imagine you were the patient on the other end listening to a personal phone call from your doctor. That whole situation could be a bit embarrassing.

Try To Plan Events With Significant Notice

You can plan some significant life events with notice. Marriages, engagement parties, and meetings to discuss a will don’t have to occur in the middle of a typical workday. Try to plan these events well in advance, so they don’t have to interfere with your training and patient care.

Don’t Assume Everyone Knows Your Significant Life Events

When you are stressed out, not everyone may appreciate your situation. If you feel comfortable telling your colleagues and staff what is appropriate to divulge, let them know what is happening. Most folks will have some empathy for what you are going through at the time. It may even bring you closer to your residency. Most residencies are kind of like a family. Conflicts can arise when people in the family don’t know the issues.

Stay At Home If It Is Needed

Especially nowadays, since the beginning of the COVID pandemic, most faculty have become more sensitive to the issue of staying home if sick or can’t function appropriately at work. And, every once in a while, there is nothing wrong with taking a mental health day. If it makes you able to come back to work soon with renewed strength and attention, it may be worth the day or two that you need for yourself.

Dealing With Significant Life Events During Residency

Four years is a relatively long time to be anywhere, let alone a residency. And personal disasters and happy life occasions/milestones are destined to occur. Some of these events will distract you from the focus of your training. Nevertheless, try to mitigate the effects by following some of these guidelines. Simply telling folks the issues, getting coverage, and finding times to take care of business can make a difference. Following these guidelines allow you to look responsible. And they are ways to ensure that your residency will run more smoothly and without bogging you down with miscommunications and problems during radiology residency. Life interruptions don’t have to ruin your residency experience!

 

 

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The Art Of The Last Minute Radiology Deal

last minute

Ever notice how most big financial deals are settled, not years or months before the deadline, but only a few days, hours, or minutes until the final click of the clock? Whether it’s the federal government’s budget, car purchases, or buying a house/investment property, the definitive signature and finalized contract only takes place at the 59th second of the last minute, right before the deal has to be done. Settling for a new radiology position or a contract with the hospital as a radiologist is no different. Many radiologists expect they will not have to play this game because they are physicians and not subject to the vicissitudes of the business world. Nothing is further from the truth. This dance is merely how businesses, including imaging practices, complete large financial packages. And, as we are part of the business world in the imaging world’s eyes, you should expect the same.

So, what are some last-minute items you should negotiate when you sit down at the table to create your final package? When and how should you walk away from the table to whet the appetite of the other party and enhance your party’s circumstances? We will divide the conversation about negotiating into two separate parts, the individual and the hospital. Let’s talk about the art of the last-minute radiology deal!

Nailing The Best Last Minute Radiology Package

Generally, the contract is partially negotiable when you finally go through the interview process and receive your offer in the radiology world. At this point, there is a bit of give-and-take with your future employers. Typically, the first parts to settle are the salary structure, years to partner, vacation time, and some of the oversized line items within the contract. Some of these items may be immutable, but what can you leave to the end so that you can harness the best deal possible?

Moving Expenses

Most practices will flip the bill for this service for two reasons:

  1. It is a tax-deductible expense for the business.
  2. It ties the applicant to the imaging company because they will need a residence close to the job. In all my positions after fellowship, moving expenses were available as an option paid for by the practice.
  3. You can request it at the last moment.

Malpractice Tail Coverage

Typically, most malpractice insurance companies do claims-made coverage. And, if a plaintiff sues after you leave the practice, you will still need malpractice coverage. This detail is where malpractice tail coverage comes into play. If an imaging business wants you as an employee, they may very well tack this bonus onto your contract at the last moment.

Percent Working At Specific Roles

Nowadays, there are fewer and fewer generalist radiologists. So, you may not want to practice mammography if you had little experience of comfort in the modality during residency. So, practices will often accept additional clauses securing the percentage of time that you want to work in a specific modality, especially if they need this service anyway. You can often easily tack this stipulation onto the contract at the final moments.

Getting The Most Out Of Your Hospital Deal Last Minute

Similar to negotiating as an individual for a position, often, you may play the role of negotiating a contract with a hospital. The extensive line items usually come first, like contracts, the functions that the practice will need to fulfill, etc. But what are some other critical parameters you can negotiate at the end?

Separation Clauses

Sometimes the deal does not work out the way that both parties expect. Therefore, you may want to find a way for the hospital and practice to part without too much hardship. This separation clause is a stipulation that may not seem important at the time of the deal signing. But, it is critical to have an out when things go south. So, it may not be the priority, but it is something that you can negotiate later on.

Support For Other Services (Chairman, etc.)

Some radiology services can be very costly but not considered at first glance. Here is where you can negotiate for extra support. Line items such as residency management, chairmanship, or other ancillary roles are some examples of fees that the institution should pay because they don’t come for free. These are great add-ons at the end of the deal.

The Art Of The Last Minute Radiology Deal!

Consider these line items to add to the contracts you might negotiate. Of course, they may not be the first items you would consider when starting a negotiation. But, they can be critical add-ons once at the end of the talks that can make a significant difference in your final contract. Every little bit counts when you are about to strike a deal in your favor!

 

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What Was Radiology Life Like Without PACS?

without pacs

I may be dating myself, but I am the last generation that did a radiology residency without PACS. Yes. I lived and breathed the pre PACs era. Some of it was pretty good. And, other parts of it, not so much.

Nevertheless, radiology was very different before hospitals started to add these systems to their networks. So, what are some of the most significant changes I have seen throughout my career when I compare the two eras? What was life like before the advent of PACS? Let’s go through some of the most critical differences in radiology.

Many More Films Got Lost Without PACS

On any given night, you would expect a good percentage of cases to remain in absentia without a dictation. Unsurprisingly, the orthopedic surgery residents would stealthily slip into the reading room when the radiology resident stepped out. And this person would steal the films so that the surgeons could use them for orthopedic surgeries at nighttime. Or, the alternators (the old defunct machines that you might see in the back of a reading room somewhere nowadays) would suck up several films, and they would get lost in the device or even shredded to pieces. Many cases would simply no longer be available for dication either for a delayed period or never. Film loss was just a fact of life. Nowadays, it is only the rare irretrievable case that you will need some help with from the IT folks.

Saw A Lot More Clinicians

Today, our reading rooms fill up with primarily residents and a smattering/skeleton crew of a couple of attendings. Back in the day, the reading room was hustling and bustling. Surgeons, Ob-Gyns, and more would regularly show up to look at their cases with you because they couldn’t look at them themselves on a PACS system. You got to know each clinician by name and personality. It was more than just a tryst in the reading room. Of course, that came with the upside of meeting great physicians and the downside of discovering a few jerks here and there. Nevertheless, the reading was much less of a lonely place. And, you would learn about the final disposition of cases more often because we kept in close contact with our physician brethren.

Had To Produce Your Films For Case Conferences

Have any of you ever encountered a dark room? Back in the day, it was a regular event for radiologists. We would have to develop our copies to present for case conferences. It was a big deal and somewhat time-consuming. But, we all got to know this haven of darkness every so often. It was much more intricate than just downloading a case on PACS or snapping a picture on an iPhone for a presentation on a Powerpoint. These technologies were available but still uncommonly used at the end of the pre-PACS era. It was a pain in the-you-know-what!

Priors Were Less Common

Getting priors was a real pain in the neck back then. We would somehow have to go down to the file room and retrieve them. Therefore, we would dictate many more cases without them because they could be hard to come by. So, you could imagine we lost some specificity and sensitivity in these dictations. And, then, when you did retrieve the priors, you would receive these enormous folders where you had to find suitable films. You would be lucky if you didn’t get a paper cut in the process. (They were much more prevalent back then and hurt like hell!)

Less Windows Available Without PACS

Nowadays, we click a button and re-window a case. Back then, you couldn’t look at the bones if you didn’t have the bone windows on film. So, the techs would print fewer windows to save on film. Often, if the reason for the study had nothing to do with the window, you would not have them available to read. I’m sure we missed tons of osseous lesions!

Keep Lists Of Results On Overnight Cases

Instead of having a PACS system to look cases up, we would have to keep a running tab of the patient studies we read, especially on CT rotation. Clinicians would come down and check out the results on the list and chat with the resident. Every room would have a list of cases from the previous night. Eventually, they would make their way onto the Radiology Information System. But until then, the responsibility was ours to keep tabs on everything in the reading room.

Working From Home, Ha!

And finally, working from home was a figment of one’s imagination. We needed to perform all reads and procedures in-house. Imagine being unable to take off to let the Verizon folks fix something in the house. That was our world. We lived and breathed the hospital in those days!

Radiology Life Without PACS

We lived in a different world back then. Radiology lifestyle and culture have changed dramatically over the years since hospitals have installed PACS. Yes, we had more contact with other physicians, but it came at the expense of many problems. Nevertheless, although mostly better today, some good did happen before hospitals introduced PACS to our world. Would I want to go back to those times? Probably not. But they were a great experience that new radiologists cannot imagine today!

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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!

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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!