Year: 2022

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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!

 

 

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How To Keep Tabs On Incomplete Radiology Studies

incomplete radiology studies

At least once or twice a week, there are some incomplete radiology studies that you can’t read at the moment. Perhaps, the referring physician is not available to go over the results. Or, maybe the study has a technical issue before you dictate it. Other times, it’s a challenging study you want to share with your colleagues to get another opinion. 

You must complete these cases in any of these situations, but an issue or two prevents you from getting to them. Dropping the ball on any of these cases can lead to problems in the future. So, what is the best way to remind yourself to complete these tasks and finalize them? Should you use electronic or written materials for this task? Let’s go through some options some radiologists deal with some of these issues. Hopefully, this piece will help you to come up with a system as well.

Using Your Memory

For most of you, this technique would be the one I would avoid using alone. It’s a recipe for disaster unless you have a photographic memory you can turn to at any moment. You will most likely forget the critical information you need to look up the patient information and forget about the case itself.

Keeping Cases On Paper

Some real old timers I know kept a list of these critical cases in a tiny notebook they used to whip out at times. I know a few that would swear by this technique. They would typically write the name of the patient, the MR number, the date of birth, the phone number and name of the clinician, and the issue with the case itself. One of the most significant advantages of using a system like this is that you don’t have to worry about HIPAA violations if you keep the book safe. No one can access the patient data except for you. However, if you lose that book, you are SOL. And, it is easy to forget to come back to these patients.

Keeping Incomplete Radiology Studies On A Phone In Notes/Reminders

This method is the primary way I remember to take cases needing further involvement. I will put the patient information in a locked notes folder on my iPhone. And, I typically write down the information I will need to return to complete the case. By doing this, I know that I have all the information for the patient, safe and sound. Additionally, I check these data lists daily to ensure that I do not forget their further workup. If there is something that I need to take care of more urgently, I will typically serve myself a reminder as well to complete the task at a specified time/date.

Using The PACS System To Help You Out

Finally, some PACS systems have features that can help you with these errant cases. Some have instant messages for tech recall issues. And others have automatic messaging of critical findings. At our institution, I will typically tag my name to a study so that I will continue to see it on the worklist until I do the task. This method is another fail-proof way so that cases do not slip through the cracks. But, I recommend you look into some extra features on your PACS system that can help you a bit!

How To Keep Tabs On Incomplete Radiology Studies

We need practical tools to remember to complete delayed cases. Dropping the ball and forgetting about them is a recipe for disaster. So, find a way to recall these cases that work for you. Whether it is paper, notes/reminders on an iPhone, the PACs system, relying on your memory, or any combination of the above, make sure you have a plan in place. Some cases need the extra love!

 

 

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How To Learn Buttonology As A Radiologist

buttonology

When starting in radiology, the trickiest items to learn are often not the images, procedures, or concepts. Instead, figuring out what buttons to push to find what you want can be the most challenging. Electronic health records, PACs (picture and archiving systems), dictation software, and internet access and use can vary widely from institution to institution in quality and useability. And you may find that figuring it out can take a very long time, especially learning it efficiently. So, how do you set yourself up to learn the ropes when you need to figure this all out? Let me give you tips on how to go about learning all this technological buttonology.

Set Some Extra Time To Play Around With Buttonology

Time is your friend. Spending time practicing with the dictation or the PACs system is the best way to gain familiarity. Anyone can show you the buttons to press, but the chances of remembering how you did it can be close to zero. Only after manipulating the controls can you get used to how the software functions. And, it’s even better when looking at real-world cases. For me, software like Tera Recon has only become relatively easy to use after the tenth time I have processed a cardiac CTA. Also, I remember spending extra time trying to create templates on Powerscribe for dictation so that it was easy to do and could serve me well later on with numerous dictation templates. Time spent now will save oodles of time in the future.

Get To Know Your IT Specialists

Most institutions have dedicated staff to maintain and support PACs, RIS, and the internet. Suppose you want to get to know a function or filter better. Sometimes you have to ask them. I have found that I will sometimes spend three times the duration compared to an IT specialist to figure out how to overcome or improve an issue with the PACs station. So, be nice to these blokes!

Ask Your Fellow Residents And Faculty

When learning the buttonology of your systems, this point is not the time to be shy. I have always said that if we put the heads together of all the faculty, we would have the most comprehensive knowledge of how our electronics and software work. We all seem to know bits and pieces of these systems that can increase our efficiency. But, not everyone knows the same things. So, please, also ask your colleagues if you are unsure what to press or when. It can make all the difference.

Don’t Miss The Training Sessions.

Most of us don’t enjoy these training sessions. They usually interfere with our day (and even prevent us from eating lunch!) Nevertheless, take these sessions very seriously. They can enhance your daily efficiency in spades. I still remember when our hospital acquired the new PACs system; I spent a ton of the time making sure the hanging protocol for plain films and priors was suitable. Fast forward to today, and the couple of days I spent with a personal PACs trainer years ago have magnified my daily efficiency by a significant multiple compared to those who didn’t attend. It pays to stick around for the additional attention even though you may experience pain!

The Magic Of Buttonology!

The quality and efficiency of every day depend on much more than just reading films. We need to be aware of how we can slog through the technical work of each day most efficiently by clicking the least amount of buttons and technological obstructions. But, it would help if you spent the time to learn the buttonology. So, give yourself some extra time to get to know each of the systems, ask your colleagues and staff if unsure, and do not miss any additional training sessions. Missing out on any of these extra steps will divert you from your ultimate target of maximizing your efficiency!

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Don’t Skimp On Sensitivity!

sensitivity

In radiology, almost anything can change our sensitivity to detecting disease. Problems with electronics and hardware such as PACS, the RIS, imaging software, or even dictation software can cause us to miss out on information. Phone calls and texts can interrupt our train of thought. Many of these problems can be beyond our control. But, there are also ways that we are directly responsible for our daily reads that can affect our sensitivity. So, what are some main ways radiologists can knowingly skimp on sensitivity to negatively affect patient care?

Not Getting Priors- A Template For Decreasing Sensitivity

Out of all the ways we can negatively affect patient care, this one likely has the most bang for the buck. Whether we need to search for changes that can affect chemotherapeutic regimens or determine if a pulmonary embolus is acute or chronic, we can severely decrease pathology detection and change patient management when we neglect priors. It is certainly worth the extra time to look at the prior studies!

Not Reading The Prior Reports

Just as critically, it is not just about searching the priors but also about reading the previous reports. I can’t tell you how often I have discovered items in the information that are the reason for performing the following study that may not be so obvious if you don’t read the prior dictation in addition to looking at it. It could be an incidental tiny pancreatic cyst or a subtle rib sclerotic rib lesion that you might not realize by just skimming the previous images . In either case, you must also make sure to peruse the prior reports to maximize sensitivity.

Using The Correct Software For Imaging

It is effortless to skimp on interpreting images when the programs are slow or unwieldy. However, we are obligated to look at studies in a way that will maximize sensitivity. That may involve looking at a PET scan on the appropriate interpretation platform or using the reconstruction software for coronary artery CTAs. If you skimp on this step, you are much more likely to miss disease that can negatively affect patient management.

Windowing/Protocols

It is much easier to go through a study if you don’t take the time to go through bone and liver windows on a CT scan or neglect the diffusion-weighted sequences on an MRI of the abdomen. However, by forgoing these steps, you are also sacrificing sensitivity. Sure, it’s nice to get home a bit earlier. But is it worth the outcome of missing a liver lesion or a hidden enlarged abdominal mesenteric lymph node?

Not Waiting For All The Images To Arrive

I get impatient when the computer sends the studies over slowly. That happens to almost everyone once in a while. And, it is very tempting to interpret the images based on the images that you have alone. But, for instance, axial CT scans images without the coronals, and sagittal can cause you to miss compression fractures, renal masses, and more. Don’t skimp on the waiting for these last images to cross over.

Skimping on Sensitivity!

We, radiologists, have taken a Hippocratic oath. This oath obliges us to do no harm. Although we are under pressure to complete all our cases, we must best answer the clinical question appropriately without sacrificing sensitivity. Or else the study can become worthless or, even worse, harmful to the patient. So, make sure to cross all your t’s and dot all your i’s by checking for priors, using the correct software, looking at all the windows/sequences, and not being impatient before interpretation. These are simple ways to increase our sensitivity and ultimately improve patient care!

 

 

 

 

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Great Expectations For The Radiology Resident

great expectations

The wait has finally arrived. After years of biding your time in medical school and residency, you are finally en route to what you want to do: begin training as a radiologist. And radiology residency begins. But, is it all that you had expected after all these years? Are you getting unadulterated teaching from your faculty as you had hoped? Is the learning at noon conferences with enthusiastic and engaging staff? Do the fellow residents live up to the great expectations that you had in the first place?

Well, there is a good chance that any residency program that you choose will not entirely live up to your great expectations. So, coming from an associate program director, what are reasonable expectations for your residency program when you start? And what are some unreasonable expectations for your newfound position? Let’s discuss these expectations by expounding on what is reasonable and limited. Then we will summarize the best way to treat these expectations overall.

Reasonable Anticipation

Reading Alongside Attendings

Any program worth its salt needs to have some time dedicated to having residents listening and reading along with attendings. At the beginning of the residency, the only way to know radiology is to listen to how your mentors interpret films and dictate. And this means some dedicated time to watch, listen, and learn the ropes in real-time with a radiology faculty member. A residency cannot survive for long without this factor.

Ability To Ask Questions

If your faculty shuts you down or insults you whenever you ask a question, you cannot thrive in residency. We learn by asking questions. And in the beginning, there is no such thing as a stupid question. Heck, you don’t even know what to ask! But, if your faculty scolds you for asking questions from your mentors, this would be an example of a malicious program to residents and learning!

Monitoring Your Dictations

Any residency should ensure that its residents are dictating and interpreting films appropriately. It is the currency of radiology. The only way to do that is to assess the outcome of the radiology process. And that is the final report or dictation. All residencies should have a system for attendings to review resident dictations. This process is an essential factor for learning.

Feeling Safe

If you feel like faculty members threaten you or fear for your sanity (or life!), you have a real problem. No person can go through such a stressful learning situation in addition to the stresses of radiology residency (and yes, radiology training is considered stressful!). Nor should any resident have to encounter a problem such as this.

Unreasonable Expectations

Unadulterated Attention From Attendings At All Times

Whether you are in a research institution, University program, University-affiliated program, or community/private practice residency, you will not be the priority of most faculty. Most have research to publish, work to complete, and families to come home to. So, if you are too idealistic that you will receive the attention of all the faculty all the time, you will never feel satisfied.

Expectations That Everything Will Be Taught

Yes. For some concepts, it does help to have a teacher. But, no matter what anyone says, most radiology is self-taught. We need to see 100 cases of appendicitis, thousands of routine chest x-rays, and perform hundreds of paracenteses before we get it all right. No one but yourself can do that for you. And, that does not include all the concepts you need to reinforce and remember by reading in every area that radiology covers.

All Teachers And Colleagues WIll Be Your Friend

Just because we are all radiologists does not mean everyone will be your buddy. Similar to the “real” world, we all have different personalities and desires. And, not all people mesh well together, no matter how much we want that to happen. On the other hand, we all can learn from one another. If you apply every person in your program to this concept, regardless of how they feel about you, you will begin to appreciate them for who they are.

Great Expectations

We all come into new situations with great expectations. But, check for yourself. Are these expectations realistic or not? Any program should fulfill the basic requirements, such as working directly with attendings in a safe environment. But, you can’t expect any program to pull all the challenging weights for you. There is just some work you need to do for yourself. It’s the only way to become an excellent radiologist!

 

 

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Why Mission Statements Are Mission Critical

mission statements

Ever thought about what kind of radiologist you wanted to be? Many of you, you were probably thinking about private practice. Others have thought about writing papers and becoming the academic type. Maybe you are a hands-on radiologist and like to have your fingers on everything. And, a distinct minority of you may have opted for the business route. But have you ever noticed the website of the residency you attended or are interested in joining? Many of you have not thought twice about it. But, at the beginning of your residency website, mission statements describe what the residency program strives to be. Does that match what you have ultimately wanted to become? You may not realize it, but it is probably a pretty good match in most cases. And that is for a good reason. It is what the program that you attended trained you to become.

For those applying to residencies, this message about your residency should play a significant role in your decision to interview and rank the programs you attend. But, it usually is barely a thought within the application process. Getting into a residency program itself can be daunting enough. Nevertheless, I wouldn’t blow this message aside. It could make the difference between a career you desire and one you will regret. And here are the critical reasons why.

Mentorship

If you attend a program with a mission statement that contradicts what you strive to achieve, it can make it a bit more challenging to obtain the desired outcome. For instance, if you are going to a program without a research emphasis and want to learn to write papers, you will have a more challenging time finding a mentor who can teach you the ropes. It’s not impossible. But, you will not find it as easy to learn the tricks of the trade. To get high-quality papers published, you need certain ingredients. And, you are more likely to find the know-how in a program that does say research in its mission statement.

Or, if you are interested in global radiology and the program does not state anything about it, you are less likely to find a radiologist that works outside the country to emulate. You will have a harder time finding the connections you need to make a similar jump in your career.

Location/Reputation

Some programs mention that they are well known regionally, nationally, or internationally. Depending on where you want to stake your reputation, this factor can influence the location of your practice when you finally set up shop. A regionally known residency is excellent if you want to stay in the area. Likewise, if you wish to have connections throughout the country, consider a program with a national reputation. And, if you want international referrals and work, a residency with this reputation may be the right one for you. These choices can impact where you decide to work in the end.

Procedural

You will notice the words hands-on in some residency mission statements. This verbiage symbolizes that the staff has the procedural know-how to train its residents to feel comfortable with many radiology procedures. Not all programs emphasize these skills. So, it is critical to figure out if you want a residency with a procedure-heavy emphasis. It’s not necessarily for everyone!

Cultural Factors

Other mission statements will claim to have to maintain a diverse class. These residencies may utilize culture/race/sex in addition to interests and competencies to decide which residents to rank in their program. So, expect a more racially/ethnically diverse mix in these programs than another one that does not mention this factor. 

Connections and Mission Statements

If you cull through mission statements with a fine-tooth comb, you will notice that they may talk about connections within the community, global resources, businesses/industry, or other departments. Take these connections seriously because they may influence your residency and where you ultimately decide to practice. They may allow you to branch out to other areas that may jibe with your interests. It’s something else to mull.

Mission Statements Are More Critical Than What You Might Initially Think!

When you decide on a residency, that little phrase at the beginning of the residency website holds much power over your future career. Generally, it is a theme that the residency program follows seriously and can impact where you want to practice and what you will eventually do. So, before deciding where you want to go, take a second look at this clause. And determine if the values and ideals derived from these mission statements mesh with yours!

 

 

 

 

 

 

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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!

 

This website is an affiliate of Amazon. A percentage of the items purchased through Amazon through the links on this site are paid to the radsresident.com website.

 

 

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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!