Author: Barry Julius

My name is Barry Julius, MD and I am the founder and chief editor of the website. I have been practicing as the associate radiology residency director at Saint Barnabas Medical Center since 2009. Through many years of on-the-job training, I have gained significant insight regarding all things radiology resident related. Over this time, I have noticed a significant lack of organized online resources for many common radiology residency issues unrelated to the typical medical education and scientific side of radiology. Therefore, I have created a credible, reliable, and informative site that is dedicated to radiology residents, students, program directors, and physicians interested in other radiology residency topics. The emphasis is on day-to-day residency information that is not covered on most educational sites. Topics will include surviving a radiology residency, radiology residency learning materials/books, financial tips, jobs, among other subjects that residents and other visitors may be afraid to ask or unable to find out.
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Radiology Residency Day One – How To Start On The Right Foot

residency day one

Last week, I wrote about what to do on the first day on the job as a radiology attending. For those of you about to begin radiology residency, I thought it would be unfair to leave you in the dust. So, today, we will talk about what to do on day one of the radiology residency. For this discussion, we will disregard all the formal introduction courses from the hospital. Mostly, that is a passive activity. Instead, I need you to know what you must do on your first day in the department. So, let’s start!

Get To Work Early

On that first day, I recommend arriving early. Get to know the parking, the bathrooms, and the building. You never know how long things will take until you arrive. And as a resident, impressions become exceedingly important. The last thing you want to do is to arrive late on that first fateful radiology residency day one!

Introductions And Thank You

OK. This one does not differ much from your attending’s first day. Your new colleagues and faculty want to make sure they made the right choice when they selected you. So, do this right. Make sure to thank all the folks who helped to get you into the program. This gratitude goes a long way to building solid relationships for the next four years!

Don’t Stand Out Too Much

When you begin your first rotation, be careful about what you say. You certainly don’t want your attendings tagging you as the class troublemaker. That can lead to undue negative attention later on. So, if you think you may say something that may upset your new employers, I would hold back until they get to know you later!

Ask About Special Programs (If Interested)

Some radiology programs have Early Specialization In Interventional Radiology (ESIR) slots. If you do not inform your program directors early on that you maintain interest in the program, the program may fill up, and the ESIR program may exclude you. So, ask to sign up, if interested, on that residency day one.

Ask About Expectations For The Rotation

Different from starting as an attending, most of you have no clue what you should begin to do on residency day one. On day one of our nuclear medicine program, the technologist showed the residents how myocardial perfusion scans work. But, in the following days, you would sit with an attending to learn the basics. You certainly would not want to miss either of those opportunities. On the other hand, if you start on fluoroscopy, perhaps you need to watch a few esophagrams on the first day. And then, a few days later, the attending may expect you to attempt one on your own. Without these clear expectations, perhaps not in the manual, you will start your rotation at a disadvantage. It is hard to meet expectations you don’t have!

Learn The PACS

Like a new attending, you must learn how to look at cases at your institution. Therefore, it behooves you to play around with the PACS system a bit. Also, make sure to ask for tips from your colleagues and attendings. Many times, if you don’t ask at the beginning, you will only learn much later after you have wasted many hours. Remember: these tips can save significant amounts of time and headaches!

Start Learning How To Dictate

Again and again, you will hear that learning to dictate has a steep learning curve. Therefore, there is no time like the present to learn. Begin with a few simple cases. But start now if you can. As a resident, this activity is one of the most active ways to learn radiology. It reinforces the buttonology of the PACS and the learning of the basics of radiology. In addition, it can help the attending out during the daytime. So, why not start on day one?

Let Your Attending Know The Plans

On that first day, you will often need to attend several activities that are integral to starting but maybe off-rotation. As a courtesy, let your attending for the day know when and what you need to do. This act of doing this establishes a rapport between you and your faculty!

Listen Carefully To The Program Director (Or Associate Program Director) Welcome

Most programs have an early morning or noon conference from the program director or associate program director. This conference is crucial! Most of the time, the program directors will give you their expectations and requirements. Usually, they will not repeat the tips and advice you will get from this session. So, take notes, and don’t miss a beat!

Borrow, Rent, Or Buy Books

By the end of the first day, you should know what you will need to complete your first rotation successfully. Most of the time, you will discover what to purchase, rent, or borrow books from your colleagues in digital or print form. So, make sure to get these necessary resources on day one!

Radiology Residency Day One- Final Thoughts

As with any first day of a new job, the first day of residency can become a nerve-racking experience. But don’t let it be. Instead, try to absorb all the unique experiences that you encounter. So, make sure to take in the new situation, the people, and your place of work. And most importantly, don’t be too hard on yourself. The staff and your colleagues have low expectations for the residents on your first fateful day. Later on, you will have many more days ahead of you to stress about giving that next tumor board or taking the core exam. For today, you can relax and enjoy!

 

 

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Radiology Attending Day One: How To Get Started On The Right Foot

day one

Imagine: Your whole adult life consisted of schooling, including four years of college, four years of medical school, one year of internship, four years of residency, and perhaps one or two years of fellowship. And you will finish it all in a few days. This situation will be yours at some point. (If not at this moment!) Now, it’s day one, and you embark upon your new life as an attending.

For most, this transition is like moving from the confines of jail to the free world. No longer do you have someone to monitor you all the time. Now you become the arbiter of last resort. The buck stops with you. (All those hackneyed phrases are true!)

The transition to becoming an attending is enormous. And you want to make sure that you do it right. So, what are the most important tasks to accomplish on day one of your new job? What do you want to avoid? Assuming you have completed your administrative tasks before starting, we will go through some boxes you should check off on your first fateful work day.

Introduce Yourself To All The Staff

After the hospital orientations, ALS courses, and all that jazz has died down; you need to make a good impression on day one. The people you meet on that first may work with you for the next 30 years! So, make your introductions to all staff. That includes fellow attendings, technologists, nurses, secretaries, and janitors. By introducing yourself to everyone, you make yourself seem like a team player that is not “standoffish.” Who wants to work with someone who can’t talk to anyone in the department?

Dress The Part Of An Attending

You don’t want to stand out too much on that fateful day. So, make sure that your attire is appropriate to the department. I remember a few attendings at my prior residency that arrived at the department without a tie for the first time. The department chairman made these attendings return home and get a tie from their closet! You don’t want to start on the wrong foot in a department where you expect to work for many years.

Make Sure To Listen Carefully To Your New Colleagues

You will hear much on the first day of your new life. Sometimes, however, you will receive invaluable advice from your colleagues that you may never get again. So, pay attention. And, take notes if you don’t have a photographic memory. You are better off having the information you will need now than having to find someone to get the same information later on when you become really busy!

Stake Out The Joint

The first days are the time to explore your surroundings (Don’t break into the chairman’s office, though!) Discover the locations of the best bathrooms, cafeteria locations, local restaurants (if at an imaging center), physician and secretarial offices, reading rooms, interventional suites, and more. Become as familiar with the surroundings as you can. This is your new home!

Ask Lots Of Questions

OK. You don’t want to ask too many indiscriminate questions (It may seem like you don’t know anything!) But you do want to ask lots of important and relevant questions. Get to the practice’s expectations, pitfalls, and more. After the first day, your colleagues may become less attuned to answering these questions, as you will no longer be the new kid on the block. Get those questions in before it is too late!

Discover Your Boundaries

Especially on that first day, you do not want to step on anyone’s toes. Ask first if you want to help with a study that may not be in your daily expected routine. The last thing you want to do: is dictating a case only to find out that the clinical attending wanted a read from someone else. It does not look good for you or the practice. So, get to know and ask what you can and cannot do.

Get Dictation Standards

Different practices have specific requirements for all radiologists’ dictations. Some want structured reports, and others need the impression at the beginning. Make sure to ask your colleagues what exactly they expect before beginning your work. You certainly don’t want to rock the boat too much!

Learn The PACS and EHR

The PACS and Electronic Health Records systems have become crucial for relevant and quality reports. In addition, knowing these systems will significantly help your efficiency (You want to get out of work on time, don’t you?) Therefore, you need to spend your first day working to make sure that you get to know the PACS and EHR well. A little time now will save tons of time in the future. Think of it as an investment.

Work Slowly And Deliberately

As a fresh radiologist right out of fellowship, you don’t want to be known as the gal who does careless dictations. So, especially on that first day, slow down. Make sure everything you dictate is correct. You have years and years to pick up speed with your work. Now is not the time to rush, and newbies make more mistakes. Don’t add to the reputation!

Radiology Attending Day One- Final Thoughts

The first day as an attending is tough. You are transitioning to a new world, just like the many worlds you had transitioned to before. So, go forward and welcome the changes with open arms. Believe it or not, you will find your comfort zone one day. It just takes a bit of time!

 

 

 

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Is The Specialty of Radiology Better Off With Increased Competition?

increased competition

With the increasingly hot job market for new radiologists, medical student applications to residency programs have steadily increased over the past several years. But that got me thinking. Is the specialty of radiology better off with more hardcore medical students wanting to enter the profession? Or does radiology benefit more from residents who genuinely want to be here when times are tough? So, let’s go through the advantages and disadvantages of having both a competitive and a non-competitive application process. And then, we will come up with a conclusion to the final question: Is the specialty of radiology better off with increased competition?

 

What Happens With A Competitive Application Process

Advantages

From a program director’s perspective, let’s begin by saying that a program director’s job becomes much easier with increased competition. To find applicants, you do not have to interview as many candidates. And the applications tend to have fewer “blemishes.” That said, as much as it helps me, this factor impacts the specialty very little.

So, what other advantages does a competitive process offer? First, the candidates will often have more experience in research. But does this create better radiologists? Depending on whether the resident wants an academic career, that is up for debate. However, I can say that it again makes the program director’s job a little bit easier because the faculty do not need to teach some of the primary research mechanics to get them started. Additionally, this resident will also likely produce more research during residency.

With increased competition, residents tend to be slightly more attentive to keeping up with reading. Moreover, these residents tend to be more motivated by passing tests. In other words, they may be a bit more “obsessive-compulsive.” Now, this would theoretically work in favor of passing the boards. However, according to the infinite wisdom of the test makers (the ABR), this doesn’t change the pass rates since they opt to create tests based on curves, not content.

Disadvantages:

Over the years, I have noticed that competition also motivates applicants who want radiology because of the competition, not necessarily for the love of radiology. In the long run, this can lead to increased burnout. Furthermore, it can change the culture of radiology residency and radiologists into a less forgiving and highly pressured environment. Again, this is more of a tendency rather than a truism.

Increased competition also brings out fewer nontraditional applicants to radiology. These include folks who have completed other residencies and different careers. In the setting of increased competition, they have a much harder time receiving interviews because programs often screen them out of the system due to their increased time in or before residency. However, nontraditional applicants bring a different perspective to residencies. Moreover, they have been through more, are more mature, and often make better leaders.

What Happens With A Non-competitive Application Process

Advantages

Residents who apply during a less competitive time are a different group of candidates. I like to call them type B personalities. These folks create a less pressured environment and a calmer culture for the residency program. This decreased stress can make the four-year residency process more tolerable for everyone.

Likewise, during tough times, the limited selection of candidates forces residency programs to accept nontraditional candidates. As stated, these candidates lend a mature perspective to a residency program. In addition, these residents want to be involved in radiology for the love of the specialty rather than the competition and the “great” job market.

And then, programs will often downgrade their expectations of these non-competitive residents. Decreased expectations lower the pressures on the residents during their program and can create a less harried culture with reduced burnout.

Disadvantages

I don’t have the statistics to back this up. But, from my experience, tough times lead to residents with a higher dropout rate. Sometimes, these residents cannot meet the rigorous academic challenges of residency. When this occurs, residencies can lose their precious spots to other specialties like primary care.

Also, these residents have overall less experience with research. So, most residencies with non-competitive applicants will create less output during these challenging times. (This is a disadvantage for the more academic residency!)

And then, finally, residencies have more work cut out for them. They must put more time into teaching and spoon-feeding the residents to ensure they complete the program.

Weighing The Balance- Is Increased Competition Better For The Specialty?

So, where do I stand in this controversy? Well, residency directors and their programs must put more work into the residents during the “tough” years to get them “up to snuff.” But, you know, I’ve seen great residents during the lean times and times of abundance. So, I think we put more emphasis on competition to get better residents than we should. In the end, good residencies mold their residents into great radiologists regardless of the zeitgeist of the times. And that’s the way it should be!

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Transparency And The ABR: Are The Leaders As Transparent As They Like To Think?

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At the recent Association of University Radiologists (AUR) meeting, the American Board of Radiology (ABR) adopted the theme of transparency in its lectures. However, as I sat and listened to the seminar on the ABR updates, the words did not jibe well with the theme.

How The ABR Supported Its New Found Transparency

Brent Wagner, MD, the President-Elect of the organization, attempted to show as a nonprofit entity, the books are wide open. And that, the money that they raise from testing fees and MOC mostly goes to the upkeep of the organization. In fact, they showed the public income tax form they filed with the IRS. In it, he stated that anyone could pretty much look up the finances of the organization and its members. So, I pulled up a copy of the nonprofit 990 IRS form for the 2016 tax year at the following link:  http://990s.foundationcenter.org/990_pdf_archive/410/410773787/410773787_201703_990O.pdf

Yes, much of the money does go to the running maintenance of certification, testing, and other appropriate uses. But, that is not all. If you look at the form, you will see listed the compensation for the executive board listed on page 7. According to the document, compensation for the president was 720,000 dollars for 50 hours of weekly work. In addition, the ABR paid the associate executive directors on the list who worked 20 hours over 260,00o dollars including all compensation. Of course, this compensation does not include any other outside remuneration that these individuals may receive from outside practices and institutions. So, if you take all the income into consideration, it is significantly more than the typical radiologist’s. But yes, it was available for all to see.

My Issues With ABR Executive Compensation

So, what is that did not sit well with me about the executive compensation? For one, you have an army of volunteers that the ABR does not pay for all their time and effort. Meanwhile, you have a small group at the top who collect significant rewards. Yes, this is a nonprofit organization and the folks that run it should get paid for its work. However, at the top, these folks earn a lot more than a typical radiologist. When I pay my annual dues, I don’t believe there is much value in paying a president of this organization over 700,000 dollars not including additional outside compensation that she may receive.

I mean, what exactly is the point of the organization? Simply, the ABR should dedicate itself to the high standards of the end product of residency, the radiologist. Additionally, the organization should make sure that it’s diplomates meet the minimum requirements to practice radiology safely while maintaining a relationship with the public and government. Should the leader at the top earn almost twice the average radiologist for this mission (not including other side income)? It’s certainly hard for me to justify.

And just because the organization exists as a nonprofit entity and must distribute all profits by the end of the year does not mean that the nonprofit model is fair. A nonprofit is only as good as its ability to distribute its funds appropriately for the betterment of a cause. Rewarding the executives with salaries above and beyond the typical radiologist does not qualify as a cause I want to support.

Moreover, finally, in order to justify the salaries it paid to its executives, the speaker compared itself to other nonprofit organizations. However, just because other nonprofit entities overpay its executives does not mean that the ABR should do so as well.

My Final Thoughts About ABR Transparency

Alright, I will give the ABR some points for coming clean with the whereabouts of its funding. And, I will give them some credit for talking about the remuneration of its members. As well, they gave us the means to access the information. On the other hand, the ABR is not forthcoming with providing the reasons for the exorbitant compensation of its leaders. We should advocate for more transparency and demand more from the ABR. Creating more equitable compensation to its employees and leaders should take a higher priority.

 

 

 

 

 

 

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Clinician Interruptions In The Reading Room: A Necessary Evil Or An Avoidable Interaction?

clinician interruptions

For those of you that practice radiology, how often do clinicians interrupt you on a busy rotation? And, what percentage of the time does the clinician provide helpful information without interrupting your train of thought? I know I can only speak for myself, but many clinical interactions prevent me from completing my work, increase my inattention, and should probably occur at another time. How often does a clinician stop by to ask you when you will finish his patient’s report only to lengthen the time to complete the dictation? Assuming my experience is similar to others, I believe those clinician interruptions can overwhelm many positive daily interactions.

 Plus, based on the evidence (check out Should Radiologists Ignore The Phone?), we know that interruptions cause an increase in error rate with our reads. So, therefore, clinician interruptions become much more than an issue of mere convenience. Instead, we need to take clinician interruptions very seriously. To cover this longstanding theme, we will discuss whether clinicians and providers should be allowed to enter the radiology reading room. Then, we will talk about potential solutions to these problems. So, let’s begin!

Reasons To Allow Clinicians To Enter The Reading Room

Knowing that interruptions prevent us from reading cases to the best of our ability, one could make a case that we should nail our reading room doors shut. But fortunately (or unfortunately!), this cannot happen in reality. Moreover, it probably is not such a good idea.

So, what are some legitimate situations when a clinician in the room may enhance the reading of our cases? Well, first of all, we must welcome all good histories that help us to make a diagnosis. A clinician coming into the room with this message can become a lifesaver, literally. The clinician can change the diagnosis and management.

Second, a clinician in the room can help when we need to relay an urgent message. For instance, perhaps you find an impending aortic rupture and need to get in touch with the vascular surgeon. Wouldn’t it be nice if the physician just happened to be standing next to you instead of calling all over the hospital to find him?

And then, sometimes, a clinician can enhance our reads when we are unsure of the best way to manage the patient. For instance, maybe, you recommend an MRI, but unknowingly the patient already has a pacemaker. Yet, if a knowledgeable clinician stood next to you, you would ensure that the patient had received some other test, such as a gallium scan.

Clinician Interactions That You Should Prevent

As I discussed above, clinicians should not ask the radiologist when he will complete the study. An assistant or secretary should handle these requests. Furthermore, the technologist or clinician should mark a study as STAT, priority, or routine. And the radiologists should dictate these cases in an appropriate order from most emergent to least. For this reason, a clinician stopping by the reading room interrupts the workflow and is redundant.

In addition, as much as I like medicine rounds from an educational point of view, having a team of medical physicians interrupting the radiology workflow on initial patient reads does not contribute to good patient care. Educational rounds during live readouts can disrupt search patterns and often warrant inefficient rereads of the same films. Furthermore, these types of interactions can cause other errors. On the other hand, educational rounds at a specified time after the radiologist made the reading would not detract from patient care.

Finally, as much as I like a suitable, quality, friendly conversation, clinicians should not use the reading room as a place for small talk. These sorts of conversations can also act as a nidus for errors!

What Are Some Potential Solutions To Allow Useful Clinical Interactions While Mitigating Interruptions?

Unfortunately, the task is not easy. But here are some logical recommendations:

First of all, having a “1st line triage” can help the process of selecting who can enter the reading room. Like other professionals with secretaries and assistants, radiologists should also have clinical assistants who can manage interactions with our colleagues. Radiology assistants can serve this function. (a more expensive option) Alternatively, junior residents may also help to prevent unwarranted interaction. Rather than interrupting the clinician workflow, the junior resident can field the questions and may interact appropriately with the physician. The junior resident can also learn about clinical medicine from the interaction.

Second, make sure to make it understood that the reading room should exist as a place for reading films and not unwarranted conversations. The placement of signs and a general culture of using the reading room as a workplace can prevent some of these disruptions.

Finally, we should proactively inform and train our clinical colleagues regarding the appropriate questions and times to enter a reading room. Continuing education via interdisciplinary conferences and general interactions can undoubtedly help.

Final Thoughts About Clinician Interruptions In The Reading Room

Clinical interruptions are more than just a nuisance. Instead, they directly impact workflow and increase the error rates of the interpreting radiologist. Therefore, hospitals and imaging centers should create appropriate reading environments for beneficial clinical interactions with radiologists. At the same time, they should create an environment that avoids significant clinician interruptions. Hiring more staff, using residents appropriately to triage, and creating quiet reading rooms can allow uninterrupted workflow. So, next time you are interrupted, be proactive and do not allow these interactions to continue. Politely ask the offending clinician to wait until you complete the reading. And then consider discussing the issue with your residency or hospital. Working to improve the efficiency and quality of clinical interactions can save lives!

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What Really Goes On At A Radiology Practice Partners’ Meeting?

partners' meeting

I can remember back during my radiology residency many years ago. Every so often, the radiologists at my hospital would meet secretly outside the hospital for their partners’ meetings. As the radiology attendings rapidly left to abandon their shifts to get to this meeting, I thought perhaps the partnership was just like the secret societies such as the Freemasons or the Illuminati. Maybe, they had a secret handshake? Or could they be plotting the overthrow of the hospital or government? What was going on at the partners’ meeting?

Most likely, you also wonder what happens during the partners’ meeting since you have never experienced anything like it. Moreover, you are an outsider, not privy to private practice business. Yet, one day many of you will also become a partner in a radiology practice. So, today I will reveal the secrets behind what partners discuss at their business meetings. Therefore, pull up a chair, read this post, sit back, drink, relax, and enjoy. Now, you will learn the truth behind what the partners discuss at a partners’ meeting!

Finances

As you might expect, at most meetings, a business manager often discusses the current state of a practice’s finances. Are reimbursements declining? Do new potential sources of revenue exist? What imaging modalities are trending higher? Should the business renegotiate insurance contracts? For some of you, your eyes may glaze over when you hear about a practice’s finances. However, these discussions are essential for continuing business as usual. And, yes, radiology is not just about health care. It also needs to run positive income to pay the employees, the fixed costs, the partners’ salaries, that end-of-the-year Christmas party, and more. Most meetings involve financial discussions.

Long-Term Strategies- Mergers, Acquisitions, And Partnerships

Nowadays, practice size has trended upward. Many practices must evolve to create larger entities so that they can use economies of scale to reduce costs and maximize profits. What do I mean by that? Essentially, practices can distribute fixed costs among a larger group of employees, thus saving money for the business. Therefore, you probably hear a lot about practices merging or private equity firms buying out imaging companies to save on costs. Well, partner meetings are common private forums for discussing these issues. In addition, you can expect practices to talk about ways to maintain good relationships with the hospitals and clinical colleagues as a long-term strategy. This long-term strategizing all happens at some partners’ meetings.

Manpower Issues/ Human Resources

Almost every practice has its fair share of issues with employees. Perhaps, some physicians do not meet the requirements of the hospital. Or maybe, clinicians have been complaining about certain practice members. Partners meetings are the appropriate forums to discuss these practice problems. In addition, partners discuss hiring new employees to meet the demands of the practice. Partners will discuss these problems and attempt to devise solutions to match the workforce to the practice’s needs.

Scheduling

One thing that is constant in any practice is change! Whether it be new imaging modalities, increasing requirements of films to be read, or losing business to other clinicians, the scheduling demands must meet the appropriate workloads. Partnerships will broach better ways to schedule partners and employees to maintain maximal efficiency. In this same vein, practices will also debate vacation policy schedules and the appropriate workloads for daily and weekly rotations whose needs may differ over time. These items commonly enter into the typical partners’ meeting.

Beauracracy and Compliance Issues

Every year, governments develop new rules and regulations for practices to follow. A few years ago, it was ICD-10 codes. Now we have new quality improvement mandates set by Medicare. Whether for certification maintenance or hospital credentialing bylaws, these items constantly change and can be crucial for maintaining the practice and complying with the law. All partners need to keep aware of the newest compliance issues to run an imaging business successfully. What better forum than a partner’s meeting to discuss this?

Insurance And Benefits

In this category, I will include malpractice, health, life, and disability insurance, pension plans, and yearly bonuses. Partners must approve the renewal and disbandment of these annual benefits. These changes depend on the costs and overall contribution to the practice and partners. You wonder how they come up with these policies. Well, usually, this occurs at the partnership meeting!

Residency Issues

Lastly, although residency issues crop up, that can affect the practice. If you have an imaging company with a residency, the partners may or may not discuss it in a partnership meeting. But, they occasionally make it to the partners’ meeting agenda. The discussion could be about new residency requirements, a site visit from the ACGME that all partners need to plan for, a specific resident issue, a problem resident, and more.

The Secret Partners’ Meeting- Final Thoughts

A partners’ meeting is a necessary evil to maintain a practice. And, as you can see, a partners’ meeting agenda can fill up quickly. Depending on the time of year and the number of issues, meetings can take hours and hours. Yet, the partners’ meeting is an essential aspect of a quality partnership and business. So, the next time you see the partners disappearing to attend the partners’ meeting, you now have some faint idea of what happens. Although you may never learn the secret handshake (or the nitty-gritty financial details), you now know what to expect from that occult partners’ meeting. And no, it’s most likely not just about discussing you!

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Top 10 Resident Issues That Radiology Faculty Wants You To Know But Can’t Say

Top 10 Resident Issues

Most radiology attendings want their residents to succeed. However, etiquette rules cause many to withhold their feedback about some of the resident issues that they encounter on a daily, weekly, or monthly basis. Unfortunately, for that reason, they keep many of you in the dark. However, please learn from their mistakes and enlighten you all. So, to prevent you from continuing with these resident issues, I thought I would create a top 10 list that the faculty wants you to know but may not say… Here we go!!!

You’re Too Aggressive

Are you overcalling everything or coming down hard on a final diagnosis without any other differential? Are you accustomed to the surgical mentality? No longer can you just nod in agreement, but you push, push, push? Everything is an argument. And, your attending does not have the time to talk back. Gosh darn it, perhaps you are more aggressive than you should be at this stage of the game!

He Misses Everything

When your attending sees that you are missing all the findings during the night, he may not feel so great telling you about all these errors. How will that help anything? And I mean, he doesn’t want you to feel bad about it when he tells you, does he? Unfortunately, you may miss out on some of these learning experiences. But, your attending may not let you know!

She Has Poor Hygiene

Poor hygiene can be just plain embarrassing. But, sometimes, your faculty may become very uncomfortable dealing with malodors or unkempt appearance. It often needs to be said to the resident but doesn’t. And, all the other faculty and residents suffer from this resident’s poor hygiene!

You Just Don’t Listen

The attending keeps on telling the same resident the same old thing. But, time after time, nothing changes. No longer can the attending tell you what to do anymore because it does not seem to work? So, your attending does not bother you anymore. What’s the point of hurting your feelings?

He’s Way Too Enthusiastic

Don’t get me wrong, but it is great to be enthusiastic. And, your attending certainly does want you to become excited about radiology. But, too much of anything is no good. And sometimes too much enthusiasm can be a bit too much. It can wear on your techs, nurses, and attendings. So, temper that enthusiasm just a bit!

You’re Just Plain Dumb

Often, your attending will ask you questions to see if you have been reading enough. And it is OK to get some things wrong. However, on occasion, a resident does not know anything that he should. Is your attending going to tell you that, maybe or maybe not? Who wants to say to the resident that she is just plain dumb?

She’s Getting A Bit Too Chummy For My Liking

On occasion, our residents can become a little too familiar with us if you catch my drift. It can all be a little too “touchy-feely.” So, think about how you communicate with your attending. Is it appropriate? Or are you trying too hard to become his best friend?

He Wants Always To Be Spoon Fed

Most residents want to learn from their attendings. Some residents expect all the learning to come from their attendings with no work on their part. If you desire to breed ill-will, you can do just that. Don’t help out your attending. Instead, just expect them to teach. It can be very irritating!

You’re Always Abandoning Ship When The Work Is Not Done

Excuses, excuses, excuses… You have to get to a wedding. Or, maybe you need to go on a date with that new beau. Well, your attending does not want to be the one to break it to you. He does not want to be the unfeeling guy that ruins the resident’s time. But, is it right that you are always missing all that work?

He’s Preventing Me From Getting Anything Done

Some residents like to talk a lot. And, most attendings like a good conversation as well. But, sometimes, it can interfere with the daily work that needs to get completed. How can your attending break it to you when she likes you a lot. Well, it can be challenging at times!

Final Thoughts About Resident Issues That Faculty Want You To Know But Can’t Say

Rightfully or wrongfully so, many taboos exist that prevent faculty from telling you, the radiology resident, what is going on. And even though attendings are supposed to evaluate and give direct constructive criticism and feedback, that is not the reality of the situation. So, if you think that you may have one of these ten resident issues listed above, try to change it on your own because you may never get the real story!

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AUR Meeting 2018- Themes And Undercurrents

Welcome to the second annual review of the Association Of University Radiologists meeting in 2018! So, why do I think we should review this meeting on an annual basis? Well, for one, many of the changes in residency you will experience stem from the academic realm.

Moreover, if you were to read the headlines and the summary of the lecture topics of the conference alone you would not get a good sense of what they will be changing. For example, this year, the heading of the meeting states “Health And Well-Being Of Profession And The Professional”. However, this theme is a small part of what actually happened at the meeting.

Yes, the lecturers did cover the topics of burnout and depression, relevant to the heading. But, if you dig a little bit deeper, compared to these themes, you would recognize that many other themes will impact future residents much more. So, what are the undercurrents that were most relevant? Basically, I am going to divide these topics as follows: continued improvement of the job market, increasing radiology residency match competition, the online longitudinal assessment, Radexam, and increasing time requirements for program directors.

The Hot Improving Radiology Job Market

Out of all the news, I think this is probably the most important. Based upon the hot topics lecture series at the AUR meeting, radiology has climbed out of its doldrums and now returns to a more normal job market. In the most recent year, over 1800 positions were available for new graduates. Very recently, the number of new hires amounted to the low 1100-1300. Furthermore, according to the conference, next year they predict that practices will need 2133 new hires. So, workforce demands are significantly increasing. My reasoning for the sudden increase in available jobs: a wave of retirements and willingness of practices to hire due to stable/good economic conditions. So, congratulations to all residents who chose radiology over the past 4-5 years! You can look forward to a great job market.

Continued Increasing Competitiveness Of Diagnostic Radiology Residency

Similar to the previous year, the competitiveness of radiology residency in the match continues to increase. As in the previous year, the unfilled spots continues to decrease and the percentage of US grads entering radiology residency continues to increase. All of these signs point to a much more difficult time for the US and foreign grads to match in radiology.

Online Longitudinal Assessment Replacing 10 Year Exam

Yes, I know that many of you have not yet thought about the maintenance of certification requirements once you have completed your residency. However, this new program will impact all residents today once you graduate and become board certified. No longer will ABR diplomates need to take an exam every 10 years to maintain certification (unless you do not satisfy the requirements of the new program). Rather, everyone who takes the online assessment will be able to skip the test and simply answer weekly questions that you receive via email.

Each year you will receive 104 question opportunities and you can choose to answer as few as 52 per year. You need to pass the scoring performance criteria based on 200 questions every 4 years. Fortunately, this system will replace the time sink of having to attend a test in Chicago every 10 years with all its expenses. I am certainly looking forward to bagging my unnecessary trip to Chicago for the recertification examination!

Radexam Now Operational

For residency programs throughout the country, many have implemented the new Radexam, replacing the old in-service examination. From my experience, the old in-service examination served a futile role in evaluating residents over the 4 years of residency. I believe no correlation existed between the passage of the core examination and the in-service exam. Now, this fact may change. The new Radexam crowdsources questions from numerous question writers throughout the country. And, the questions are vetted and evaluated for validity. In addition, the exam tests residents according to individual residency level. They can be used at the end of a rotation. Eventually, the exams can be tailored toward the types of rotations the radiology residency has (modality or organ based). I look forward to evaluating the quality of this new exam. More importantly, I believe it has the potential to revolutionize evaluation of residents, especially at smaller programs.

Increased Mandated Program Director Time Requirements Officially Implemented Starting July 1, 2018

Especially at the smaller programs like ours, the new ACGME rules about program director minimum time requirements will create an enormous impact on the management of residency programs throughout the country. Check out this webpage from the ACGME and the associated chart below:

https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/420_DiagnosticRadiology_2018-07-01.pdf?ver=2017-08-10-081454-583

0.3 full-time equivalent (FTE) for programs approved for eight to 15 residents; (Core)
0.4 FTE for programs approved for 16 to 23 residents; (Core)
0.5 FTE for programs approved for 24 to 31 residents; (Core)
0.6 FTE for programs approved for 32 to 39 residents; (Core)
0.7 FTE for programs approved for 40 to 47 residents; (Core)
0.8 FTE for programs approved for 48 to 55 residents; (Core)
0.9 FTE for programs approved for 56 to 63 residents; (Core)
1.0 FTE for programs approved for 64 to 71 residents; (Core)
1.1 FTE for programs approved for 72 or more residents. (Core)

 

Basically, the minimum required time for program directors to administrate programs has in many cases doubled. At our program, we are going from a 0.2 Full-Time Equivalent (FTE) (one day of administration time per week) to a 0.4 FTE (two days of administration time per week). As many programs have suffered from lack of administration time for programs directors, this change should enhance the quality of many radiology residencies. Some manpower/administrative issues that remained unresolved in radiology residencies can now be tackled due to decreased time pressures.

Final Thoughts About The AUR Meeting

Unlike previous meetings over the past four or five years, most of the doom and gloom has passed. Ironically, although the headline lectures were about depression and burnout, the mood was much more upbeat for new and graduating residents. Between the rising job market and the stable economy, the new MOC, increased program director time requirements, and the new Radexam, things are looking up. Even the wave of concerns about artificial intelligence replacing radiologist has seemed to pass us by! (No one believes that it will replace radiologists any time soon).  So, for all radiology residents, you are entering the field at a great time. And, this meeting certainly confirmed my suspicions!

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A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

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Residency Travel For Presentations: What Are The Steps Involved?

travel

Congratulations!!! The Radiology Society of North America (RSNA) has accepted your poster for presentation at the convention. Or perhaps, the Association of University Radiologists (AUR) has chosen you to make a presentation at the next meeting. When and how do you prepare for the trip? What are the best travel arrangements? How and when do you make your plane flight? I plan to answer these questions and more to make your next trip that much easier!

Notify The Program Coordinator First

Most importantly, before booking the event, ensure that your program coordinator knows first. Why? If you forget to do this, you may find the hospital will reimburse you less than you think. Or, perhaps, the program will not cover certain parts of the trip. The program coordinator also has precious information on how to submit expenses for your trip. You must submit your receipts at many programs first and then get your money back later. In other programs, they may cover your expenses upfront. This information is critical, and your coordinator usually has the answers!

Book The Hotel Next

Booking a hotel is usually the rate-limiting step for residency travel for presentations. Why do I say that? Hotels tend to book up first before the plane, the meeting, etc. Over the past few years, I have known several residents who could not reserve a spot in their first-choice hotel because it was already entirely booked. So, you should check your meeting website before booking. Often, you will find group discounts for hotel stays.

Some other tidbits for booking your hotel: First, stay as close to the conference as possible. You don’t want to worry about damaging your poster or arriving late to the event on the day of your presentation. And you certainly don’t want to get stuck in a downpour! Also, make sure to review the hotel for your needs before booking. So, if you are taking your family, ensure they have the correct size room, etc. Finally, before booking a hotel, also join the hotel club so that you can receive points for rewards for the next time you travel.

Make The Flight Arrangements

Over the years, I have found that it is best to book a direct flight if possible. Worrying about connecting flights can be extremely unsettling. Sometimes, the plane arrives at its destination too late, and then you miss the next connecting flight. The last thing you want to do is arrive late for your conference! It is generally safer and less time-consuming to fly one direct flight instead of many legs. It is not worth the minimal savings.

If you are interested in flying as economically as possible, I recommend several possibilities. You can sign up for multiple price alerts from different airlines. Also, some websites let you know when the airlines have the best deal. These include sites like Hopper and Hipmunk. One article also advised following #airfare #flights on Twitter to get you the best deals. Check out the following article that I thought was extremely helpful: http://www.chicago tribune.com/lifestyples/travel/ct-best-time-to-book-airfare-20170614-story,amp.html

Finally, if you have not done so already, it makes sense to sign up for frequent flier miles at the airline you choose. Most likely, you will fly again and again. So, you may as well try to benefit as much as possible! Also, some credit cards accumulate frequent flier miles and give extra benefits such as free baggage check-in.

Sign Up For The Meeting

Regarding signing up for the event, most meetings for radiology do not fill to the maximum. So, you do have a bit of time. But be careful. Some conferences have early bird specials and discount early bookings. Therefore, don’t perseverate too much. Also, make sure you book the event under the heading of a resident. At some meetings, residents get a discounted rate!

Think About Local Transportation To the Gig

Now, this part gets a little complicated. For most of you, taking a shuttle to the hotel is the most cost-effective and straightforward. However, others may arrive with family members and plan to travel to other sites at the meeting destination. Or, maybe you want to travel a bit near the meeting after your presentation. In that case, consider renting a car. (It’s usually a bit more expensive!) Otherwise, if you want to get in and out of the meeting quickly, stick to using shuttles or sharing a taxi with friends to save a few bucks.

Keep Your Poster/Presentation Safe

Treat your presentation like gold! Make sure it is safely ensconced in a cardboard roll if it is a poster. Or make sure you protect your flash drive well if you need to present. I would recommend having a backup if possible. The last thing you want to do- is to notice you have a broken flash drive when you are about to present your topic!

Don’t Freak Out!

All that hard work has amounted to getting to this point. So, you will do great. Practice your presentation a few times in your room if you think you may be a bit rusty. These few days, you should be enjoying the fruits of your labor, not worrying about your presentation.

Enjoy Your Travel Destination!

OK. You have traveled to such a great destination. Why not try to take advantage of the site? Plan some activities. Try some great restaurants. Tour the area if you can. Have some fun! Who knows if you will get a chance to return soon? Congratulations!