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.
Posted on by

Can Introverts And Extroverts Thrive In The Field Of Radiology?

introvert

Students and physicians compartmentalize the different medical subspecialties into different personality types. And from what I hear, stereotypical radiologists tend to be introverts (formal definition- shy, reticent people). But, do most of us radiologists prefer to be alone? And, can extroverts thrive in the radiology specialty? I will try to answer these questions and give you my thoughts about the personality of the folks in my field.

Are Most Radiologists Introverts?

Well, I believe that, on the whole, radiologists lean toward the introverted portion of the personality spectrum. I mean… Can many extroverts stand to sit in front of a computer for hours at a time culling through images and dictating reports? You need to spend a bit of time on your own in between interruptions. On the other hand, you probably know a few radiologists that are not wall-flowers. Most of the more extroverted radiologists gravitate toward the field of interventional radiology or mammography, fields with more frequent patient interactions. Additionally, many of these extroverts enjoy performing additional highly social responsibilities such as heads of medical staff, chairs of departments, or hospital administration. All these roles benefit from an extroverted, gregarious sort. But, these folks tend to be the minority.

Why Do Some Introverts Thrive In Radiology?

OK. So, the field lends itself to a more introverted personality. But why is it that introverts have the potential to thrive in radiology? Some of the noted qualities of introverts, such as paying sharp attention to detail and processing large amounts of data, are personality traits that allow an introvert to succeed. And, no matter what your colleagues say, introverts have the potential to enjoy fewer personal interactions in radiology than in other fields such as medicine or surgery. These features of radiology allow the introvert to thrive in his profession.

Nevertheless, the typical introvert needs to learn some extrovert skills. For example, with the many phone calls we make and the numerous technologists and nurses we must manage, it is next to impossible to bury one’s head in the sand. And to run a group as a stakeholder, the introverted radiologist needs to learn leadership skills. Completely isolating oneself from others does not work well in our profession.

Why Do Some Extroverts Thrive In Radiology?

In baseball, we find the lefty pitcher more likely to succeed because he throws differently from most pitchers. Likewise, the extrovert is likelier to shine in a group of individuals dominated by introverts. Every group needs folks that can shmooze with the right people, interact well with the administration, and lead a group toward success. These folks tend to shy away from some of the more analytical independent areas of radiology. And many opportunities exist that require the skills of the extrovert in our field. The introvert cannot go it alone!

Introverts/Extroverts- Does It Matter?

In our field, no one size fits all. We both need introverted and extroverted radiologists for our profession to thrive. A group without an extrovert is a recipe for disaster, with poor communication skills leading to anarchy. And, a group without the analytical skills of an introvert will not last long. So, let us try to appreciate one another for who we are. In the end, the best groups are a combination of both.

 

 

 

Posted on by

Private Equity Buyouts Of Radiology Practices – Who Gets Hurt?

privare equity

Why would anyone want to buy out a practice? Well, like all things economic, it’s simple: To make money. And that is what private equity companies do. They take over companies so the owners can collect a share of the profits. And who exactly are the private equity owners? These folks are private groups of investors that pool their money together to purchase companies. But, unlike publicly traded companies, the government does not regulate these companies as strictly.

So, why is this important for the typical radiologist to understand? Within the past few years, consolidation has hit the radiology industry. Some of this consolidation has resulted from private equity companies buying out radiology practices throughout the United States. And, who knows? Private equity companies may buy out your current or future practice. So, here is a summary of what you can expect, who wins, and who loses.

What Happens To The Radiologists After A Buyout?

The radiologist’s destiny is the million-dollar question. (Literally and figuratively!) Soon after a buyout, you may notice that the radiology employees lose some of their ability to advocate for patients (1). The private practice partner radiologists no longer hold the purse strings to enact change. So, all radiology employees of the new private equity entity must follow the rules of the new owner/leader.

Next, contract negotiations ensue. Initially, former partners and employees will tend to get good benefits, similar to the old practice. Over time, however, the stakes can change dramatically. In lean times, salary cuts and layoffs can begin rapidly. Since former partners no longer control the salaries, these folks may have just to take what they get. During more flush times, the former partners no longer reap the potential outsized rewards.

Further, in the future, you may notice that capital expenditures decrease to save profits for the private equity owners. That new CT scanner will be challenging to justify in the budget unless it has the potential to bring in new revenues. Private equity-owned practices can no longer buy equipment with the motivation of improving care alone.

The Winners

The most apparent winners are the older radiologists in the practice who will soon retire anyway. These owners can now collect on a payday that may be as high as 10-12 times their yearly salary. (2) This added benefit, in addition to their savings from years of practice, can allow an early retirement or a more leisurely lifestyle while working fewer days per week.

Depending on the terms of the agreement, the private equity firm can also gain much from buying a practice. The private equity can skim the additional profits previously from its former partners. However, this is all variable and depends on the partnership’s deal.

Occasionally, inefficient practices may also win in these arrangements. For instance, sometimes practices spend too much or cannot take advantage of economies of scale to increase efficiencies. So, it may take an outside entity to improve profitability. Of course, this assumes that the private equity entity knows how to run a practice better than the original employer and delivers some of the added profits to the radiologists. (Many times, that is not true!)

The Losers

Unfortunately, the biggest losers are the former non-partner stakeholders. These include full-time employees and employees on a partnership track. A buyout can derail the best-laid plans for the future. No longer can partnership track radiologists collect upon the sweat equity they have already committed to their years of practice. Likewise, former employees can no longer count on a similar job structure and contract.

The former younger partners may also lose a bit in the deal. No longer can they rely on many years of good salary ahead. The private equity firm will determine its future. On the other hand, at least these former partners will get a portion of a nest egg to add to their future retirement savings in the buyout.

Unlike those practices that stand to gain from a private equity arrangement, other private equity practices may liquidate the assets of an imaging business to the bare bone and improve profitability on paper so that the private equity firm can eventually resell the company to another entity. These sorts of practices can destroy a radiology imaging center. Good employees leave. Morale declines. And ultimately, the radiology practice can cease to exist. It can certainly happen.

How Much Can You Stand To Gain Or Lose?

So, if you are on the winning side of the equation and make 400,000 dollars per year, you may collect over 4-5 million dollars depending on who formerly owned the equipment and resources. That number, combined with continued employment, may satisfy those winners in the deal.

In the losing lane, non-partners no longer have the chance to build equity in practice. If you think about it, you have already committed three years to a partnership track, and the business has not already made you a partner; you have already lost those dollars of sweat equity. So, if your salary was 300,000 and the practice partners made 500,000, you have lost out on the difference of 200,000 dollars per year for three years or 600,000 dollars. You have also missed out on the ability to collect the 500,000 dollars in perpetuity once you have become a partner. Now, you are subject to the whims of the private equity firm.

The Basics Of Private Equity Buyouts

Describing a private equity buyout is relatively simple. It merely follows the laws of economics. You win if you are on the right side of the equation (the senior and private equity partners). On the other hand, if the equation does not favor you (most employees and some junior partners), you lose. So, if you are fortunate enough to choose among multiple deals, ensure you are doing what is best for your practice. A private equity deal can enhance or destroy your radiologists’ livelihoods!

I would love to hear your comments. What do you think about private equity buyouts in the field of radiology? Any experiences with private equity firms?

 

(1) http://www.physicianspractice.com/blog/understanding-hospital-buyouts-physician-practices

(2) https://www.aao.org/senior-ophthalmologists/scope/article/private-equity-buyouts-of-ophthalmology-practices

 

 

 

Posted on by

The Radiology Post-Interview Thank You Letter (Is It Worth The Time?)

thank you letter

As a former radiology medical student, resident, and fellow, I had always wondered whether the post-interview thank you letter makes a difference. Now that I am on the other side of the fence as a radiology attending, I can tell you that it can change your destiny. So, today I will talk about why a post-interview thank you letter is so important. In addition, we will also discuss whether you should physically write a letter or send an email.

Reinforcing The Connection

Picture this from the program director’s point of view. You converse with an applicant during an interview. And then, you find commonalities that connect both of you, the attending and the interviewee. How long does that connection last? Well, when you have 5-10 interviews with most of them having some sort of interesting conversation, not so long. So, how do you reinforce the excellent discussion you just had? Let me give you a hint… An excellent thank you letter!

Token Of Appreciation- It’s Polite

Not to say that Millenials are not appreciative. But, many express their appreciation in different ways. That said, an old-fashioned gen-Xer or baby boomer understands the significance of a thank you letter differently than a Millenial. It may not seem so important to you right now. I mean, how important can a thank you letter be? Well, perceptions differ widely depending on your generation. Some take insult to not receiving a thank you. Why play with fire? If the residency interests you, you can’t lose. Just send the thank you letter!

Networking- Helps With Finding Your Next Job

For those who do not know, program directors, fellowships directors, and chairpersons talk about their applicants. And sometimes, a great applicant may not rank highly enough in a program to match. Or perhaps, there are a whole bunch of applicants for one attending position. In this case, each applicant was great, but only one fits the bill. You never know. So sometimes, the thank you note receiver can give that push for the interviewer to mention your name to another bigwig because you wrote such a nice thank you letter. You never know… It can get you that next job.

Can Increase Your Ranking

Not to mention names of programs… But, at some programs, a thank you letter will bump you up a few notches in a rank list. Or, when there are many applicants for one job, and only one writes a thank you note, you significantly increase your chances of being selected for the post. So, just go ahead and do it!

Email Vs. Written- The Big Controversy

Based on the reasons above, I think I have easily supported the argument for writing the thank you note. Now, the even more pressing question (drum roll, please…): Do you write a handwritten thank you note? Or is shooting off a simple email enough?

I have less intense feelings about whether you should write or email. Let me give you an example. For someone like me, who has the worst handwriting since the dawn of language, I think a handwritten letter would counteract any positives of writing a thank you note. (I can picture the reader saying, “What the hell is that? This guy is disorganized and messy. Look at that handwriting. I’m not taking him here!”) On the other hand, for those of you that have great handwriting, a written thank you note can seem more personal and add to your application. I’ve seen some incredible thank you letters with a beautiful script that impress me.

So basically, the answer to this question, unfortunately, is: that it depends. On the other hand, a thank you note is almost always better than no thank you note. So, if you feel more comfortable writing an email instead of a written thank you letter: go for it!!!

The Thank You Letter Summarized

So, we now know how the thank you letter supports your application. And, it probably does not matter whether or not it is handwritten. Therefore, if you want to reinforce your connections, show that you are respectful, increase your chances of quality networking, and possibly increase your ranking or the possibility of getting that next job, bite the bullet and just write that thank you letter. There is no downside!!!

 

 

Posted on by

How Far Does A Radiologist Salary Go? (A Comparison Of Two Towns)

radiologist salary

Compared to a resident salary, any United States radiologist salary seems like much. And near us in the New York tri-state area, we sense that everything we buy is so expensive. But, how much more expensive is it? To tackle this question, we have to think of this differently. In the world of numbers and finance, the best way to understand finances is to compare one value to another. So, we will do just that.

Many of us here talk about how much more we would earn in take-home pay if we moved to the midwest. So, I decided to take a “nice” community out west that we could compare to ours. Specifically, I thought it would be interesting to think about what you would make if you lived in Omaha (if it’s good enough for Warren Buffet, it’s good enough for me!). And, then we could compare that amount with the Tristate area (my home turf of Northern New Jersey- Essex County).

Next, to standardize the calculations as best as possible, we will consider an average radiologist salary specific to both areas using a great radiologist salary map from Doximity from 2015. (an average is not perfect because it assumes you have been practicing for some time but is a reasonable estimate) Then, we will estimate expenses for a family of 4 in a similar type of home with four bedrooms (zillow.com helped us with the calculation) in a quality neighborhood with average student loans.

We will also assume that children attend public school and that your daily living expenses are average for the community. (numbeo.com helped us out with that) Subsequently, we will figure out how much you will be able to save over a year on a radiologist’s salary. And finally, we will compare what you can save and spend if you live in one place versus another.

Now, I know that we can’t account for everything. You may decide that you want to buy a more expensive house. Or, perhaps, you have a sweeter package at your practice than the averages I discuss. Additionally, I am not assuming that you will start lower on a partnership track and have a higher income when it is over. And I may not be accounting for other expenses. Nevertheless, these calculations are made to factor out the different locations, the goal of this article. So, let’s begin the comparison!

Northern New Jersey (Essex County)

So, in Essex County, the mean radiologist salary is 387,366 dollars. Let’s then assume you have the average-priced home in a nice neighborhood with a four-bedroom house. Based on a Zillow calculation, in Livingston, that would be $641,000. We will also assume that you have saved 64,100 dollars or about 10% for a down payment and that you have taken out a 4% mortgage for the rest over 30 years. (or, you will be paying yearly expenses of 36720 dollars with 25434 dollars of that interest). Then, we will calculate your annual payments based on the average student loan debt of $207,000. (You will try to pay it off over five years at 48948 dollars per year)

Property taxes in Livingston are somewhere around 2.3% per year. (14,473 dollars) Based on the cost of living, utilities for the four-bedroom house in Livingston would cost 4380 dollars per year (20 percent more in Omaha). Homeowner insurance would be another 1500 dollars per year. In Essex county, food expenses are 20% more (Let’s assume they are 1200 per month or 14,400 dollars per year).

Therefore, income after taxes and deductions is 387,366- 18,500 (retirement savings)- 83,867 (federal taxes)- 19,454 (state taxes) or 265,545 dollars. Let’s then subtract utilities (4,380 dollars) and food expenses (14,400 dollars). That takes us down to 257798 dollars. Then, let’s deduct the student loan annual expense of 48,948 dollars. That takes us to 208,850 dollars. After paying the mortgage and property taxes, and insurance, we are down to 156,157 dollars.

Now, we also need a car, don’t we? So, let’s assume that you are paying off a 30,000-dollar vehicle over three years. At a 2% interest rate, that is 859 dollars per month or 10,308 dollars per year. That takes us down to 145,849 dollars. You also need clothes. Let’s assume an annual expense of 12,000 dollars per year for the family. Now we are down to 137,849 dollars. Of course, we need to maintain the house at the cost of about 1 percent per year. That takes us down another 6410 dollars to 131,439—gas expenses per year- 10,000 miles per year or 1250 dollars per year. Car insurance costs another 2,000 dollars per year. Now we are down to 128,189 dollars.

There are also miscellaneous entertainment expenses and vacations. Say that would be 10,000 dollars per year. OK. Now we are at 118,189 dollars. Gardening and snow removal. Another 3000 dollars per year. or 115,189 dollars. Other expenses are out there that exist. But, we can’t go into too much detail. That sounds about right for a reasonable comparison.

Nebraska (Douglas County)

OK. In Omaha, Nebraska, the mean radiologist salary is similar to Northern New Jersey- 385,983 dollars. Based on the Zillow website, the average four-bedroom house is significantly lower at $254,000. Again, we will assume that you have 64,100 dollars already saved for a down payment and a 4% 30-year fixed mortgage (or a yearly payment of 10879 dollars with 7535 dollars in interest). Like before, based on an average student loan debt of $207,000 (Lendme) with an interest rate of 6.8% over five years, the amount paid per year will be 48948 dollars per year.

Property tax rates are slightly less in Omaha at approximately 2.1% of the assessed value or 5,334 dollars per year. Utilities are relatively similar in Omaha and Essex County at about 5976 dollars/year. Homeowner insurance is a lot less because of a significantly lower assessed house value at (254,000/641,000)* 1500 dollars or 594 dollars per year. And, food is somewhat cheaper at 14,400/1.2 or 12,000 dollars per year.

This time our income after taxes and deductions is 385983 dollars- 91,844 dollars (income tax) – 18,500 (retirement savings)- 23,437 dollars (state taxes) or 252,202 dollars per year. After taking away the annual student loan expense of 48948 dollars and the mortgage, property taxes, and insurance (10,879+5,334+594 or 16,807 dollars), we are down to a total of 186,447 dollars.

Cars in Omaha cost about 20% less overall, so let’s that that 30000 dollar car now costs 30,000/1.2 or 25,000. Assuming that you are going to pay it off over three years with an interest rate of 2% again, the total for the year would be 9,336 dollars. Now, we are at 177,111 dollars.

Clothing is about 10% less in Omaha, so your annual expense will be 12,000 dollars/1.1 or 10,909 dollars for the family. The total leftover now is 166,202 dollars. Maintenance on the house at 1% per year is 2,540 dollars per year, leaving over 163,662 dollars. Gasoline is similar in price at both locations at 1,250 dollars per year. Car insurance is lower, coming out to 1500 dollars per year. This expense takes us down to 160,912 dollars per year.

Entertainment expenses are about 30% less in Omaha, or 7,000 dollars, taking us down to 153,912 dollars per year. Gardening and snow removal are approximately 25% less at 2,250 dollars. Our final leftover take-home-pay after everything is 151,662 dollars.

Comparing A Radiologist Salary In Omaha And Northern New Jersey

The take-home pay difference between Nebraska and Northern New Jersey is at least 151,662- 115,189 or 36,473 dollars per year. That is significant dough! Theoretically, you can either put the additional money back into the mortgage or other investments, significantly increasing that sum over time. So, the question is- is living in Omaha worth at least 36,473 dollars of take-home worth it to you? Something to think about if you have lots of debt. It may make all the difference in the world!

 

 

 

 

Posted on by

Top Eight Advantages Of Living Close To Work As A Radiologist

close

Driving 50 miles to and from work or over 1.5 hours each way is undoubtedly a recipe for a problematic residency or career. (I did that for six years as an attending!) So, I recommend that you heed the following advice. Live close to the hospital and enjoy life! We will go through eight tangible benefits I have discovered now that I live close to work to support this argument. Try to do the same!

Traffic And Stress

Arriving at work after a school bus, a large white van, and a Toyota Prius cut you off during your 1.5-hour journey versus stopping at the one traffic light between my house and the hospital. Which one is more stressful? Hmmmmm… I can say that stress levels have declined by 95 percent at the beginning of the workday. Who cares if that guy in front of you cuts you off in the parking lot when you are five minutes from the hospital. You’ll still arrive on time!!!

Forgetting Things

The feeling of forgetting something important halfway through a 1.5-hour journey still sends shivers down my spine. I can still remember filling out the medical staff renewal forms due the same day, only to discover they were not in the car halfway through my trek to the hospital. If that happens now, no big deal. I just go home in the middle of the day and pick it up!

Healthier Lifestyle

All those hours on the road wreak havoc on your body. The body should not sit in a car for 3 hours a day. Fast food outlets become your friend. Fat accumulates in the wrong places. All that time that you lose, you can spend exercising or creating a healthier lifestyle for yourself.

Taking Care Of Things At Home

Occasionally, you need to drop off something at the house. Or, you may meet with a contractor to fix your ceiling leak. When you are 50 miles away, it is next to impossible. On the other hand, if you are right around the corner, you can usually stop by for a moment!

Community

Are you volunteering for the community? No problem. Want to coach a kid’s baseball team? You can manage it. Join a local symphony? It’s possible to find the time. Living close opens up many local opportunities you would never have otherwise!

Emergencies

Sometimes disaster strikes. When you live far away, it is almost impossible to help out. On the other hand, if your child injures a leg playing soccer or falls off a horse and you live right near the office or hospital, you are no more than a few minutes away. You can even pick him up and drive him to your hospital yourself!

Family Time

Want to spend quality time with the kids in the evening? You will now have the time. Think it’s essential to go on date night with your spouse? It’s possible to make plans, even during the week. Need to plan family outings- like the school picnic or that hockey game in the evening. Not a problem!

Call Issues

Have to reduce an intussception at 3 AM? At least you are around the corner. You can get in and out in minutes. And, before you know it, you are done. Need to check a scan because the internet froze? All you need to do is drive-in for a moment or two, not 1.5 hours!

Live Close To Work!

As you can see, living close to the hospital makes a world of difference. And the advantages are almost endless. So, go ahead and try to live reasonably close to your work. You can live your life the way you want while not burdened by all the time wasted in the car!

 

Posted on by

The Isolated Specialist

isolated

No, this is not another article about physician burnout. Instead, today we will talk about why isolated specialists can lead to poor patient outcomes. So, why do I find this interesting? In my own experience, I have encountered multiple instances when I see isolated specialists as the cause of deficient patient care. Let me give you an example.

A radiologist will encounter a non-radiologist physician demanding that his patient receive unwarranted intravenous contrast for his CT scans every once in a while. What is the big deal about administering unwarranted intravenous contrast on CT scans? Well, say you perform a contrast-enhanced CT scan for a pulmonary nodule. Or perhaps, you decide to approve a contrast-enhanced CT scan of the abdomen to check for a retroperitoneal bleed with contrast while on Coumadin. The patient risks returning home with a “present”- acute renal failure in both situations.

Meanwhile, both CT scans would give you the same result regardless of whether we administer intravenous contrast. And both of these cases of acute renal failure are entirely preventable. If you perform the study as directed by the physician, you have complied with the order as the radiologist. Unfortunately, these cases can lead to a lawsuit that you have no hope of winning.

Poor Communication And The Isolated Specialist

So, what does this all have to do with the isolated specialist? The ordering physicians decided to order CT scans on their patients without consulting with the radiologist in both cases. Sometimes these orders can go through the system without the OK of the radiologist. And in both situations, communication with the radiologist could have prevented unnecessary contrast administration. Or in other words, lack of communication/isolation between the ordering specialist and the radiologist was the proximate cause of a bad patient outcome.

All this brings me to discuss the topic of today- the isolated specialist. I will divide it into two different sections: What are the effects of operating “in a bubble” isolated from our colleagues? And how can we prevent physicians from working in isolation from one another?

Effects Of Operating “In A Bubble”

Untoward Side Effects

Witnessed in the examples above, two patients that should have had a non-contrast scan instead had their scan “upgraded” to an intravenous contrast-enhanced CT scan. Instead, a simple phone call from the physician could have prevented the possibility of a bad outcome. And these examples are just the tip of the iceberg. Many other cases exist where the clinician could have communicated with the physician and prevented a bad outcome.

Increased Expense

Imagine how much expense inappropriate imaging costs both the insurance company and the out-of-pocket expenses to the patient. It’s not just the additional unnecessary contrast. Instead, it is the additional weeks spent in the hospital, blood draws, nurses, physicians, and on and on. The physician could have avoided all of that with a simple discussion with the radiologist.

Prolonging Workups And Hospital Stays

In our example above, it is not just the untoward patient side effects and unmanageable expenses incurred. Instead, it is also the increased time the patient may need to stay in the hospital to figure out the patient’s disease entity. Very few patients say, “I have renal failure.” Patients may experience fatigue and other nonspecific symptoms. And a physician has to work up the clinical situation. Imagine the loss of time from work or other productive activities incurred by the patient and doctor.

Also, this is just one example. Lack of communication between radiologists and specialist cause all sorts of problems. Ridiculous unnecessary workups often ensue, wasting everyone’s time.

Radiologist Lawsuits

Don’t forget about the potential for lawsuits. All the factors from the above situation meet the criteria to allow a legitimate case. These would be breach, causation, and damages:

  1. The radiologist administered intravenous contrast inappropriately, breaching the standard of care.
  2. Contrast administration is the proximate cause of the patient’s renal failure.
  3. The patient suffered damages, including renal injury and a hospital stay.

A simple discussion between the physicians could have prevented a lawsuit.

Remaining Ignorant About Alternative Diagnoses and Treatments

Frequently, I learn about many of the most up-to-date patient diagnostic tests and treatments when I pick up the phone and discuss a case with a clinical colleague. In the situation above, a simple question about contrast could have avoided causing harm to a patient. This example is one where the ordering doctor remained ignorant about alternative methods of diagnosis (a non-contrast CT scan) when no communication ensued. Isolating oneself from phone calls with the specialist often prevents the best possible patient outcomes.

How Do We Prevent The Specialist Isolation?

Make It Easier To Contact Physicians

I think we have to blame both the ordering physician and the radiologist in these situations. Many physicians make it next to impossible to contact them by phone. Likewise, I know many radiologists who shun the phone under all circumstances. We have to make a conscious effort to make ourselves more available. Perhaps, it is a simple answering service that can solve the problem. Or, a radiology assistant may do the trick to improve communication.

Remember We Don’t Know Everything

Sometimes, we need to remind ourselves that each of our own experiences by ourselves is extremely limited. Only our interaction with others can allow us to understand patient issues best and give our patients the best care possible. We need to remain humble and ask for help from the radiologist and the ordering physician.

Computer Guidance

I hate to say it. But, clinical decision support systems have the potential to increase communications between clinicians and radiologists. When the computer detects the potential for a wrong imaging study order, it will force the clinician to interact with the radiologist. Potentially, this can relieve some of the issues of specialist isolation.

Attend Physician Friendly Events (Staff Meetings, Golf Outings)

Finally, many say that interdepartmental physician functions are unnecessary. But, I cannot disagree more. Making ourselves feel more comfortable with our colleagues allows physicians to be more likely to pick up the phone with a colleague who can become a friend. What better way to decrease isolation than sharing fun events with our colleagues?

Final Thoughts About The Isolated Specialist

Radiologists and specialists need to treat specialist isolation as a severe barrier to good patient care. And unfortunately, isolation is all too common. So, we need to make inroads to break down these barriers. Reducing specialist isolation will prevent patient side effects, reduce hospital stays, lessen patient expenses, decrease lawsuits, and increase diagnostic and treatment options. As specialist physicians, let’s all make a concerted effort to solve this critical problem together.

 

Posted on by

Addressing Referrer Psychology In The Radiology Report

psychology

What are the most important differences between most resident and attending reports? Residents’ dictations tend to be one size fits all. On the other hand, the attending will usually look at the referrer’s name and specialty before starting with a dictation. Then, he integrates referrer psychology into the report. And finally, seasoned attendings will approach a dictation as a solution to the specific clinician’s problem.

Why is it important to address these differences? The primary reason for radiology’s existence is to provide solutions for our fellow physicians to come back for more. So, we must satisfy our referrers’ needs in our reports before anything else. And therefore, we need to individualize these solutions in every dictation we complete. For today, I aim to teach how residents and even junior radiologists can change their “one size fits all” reports into a report with a laser-like focus that answers the referrers’ questions. Let’s do just that!

Addressing Pertinent Positives And Negatives

Take a look at a great radiologist’s dictation. If the patient has a history of an abdominal aortic aneurysm, you will see statements about dissection, rupture, mural thickening, or ulceration. Or, if the patient has prostate cancer, the dictation will detail the sclerotic osseous lesions, iliac and inguinal nodes, liver lesions, the prostatic bed, and pulmonary nodules. You are much less likely to observe these relevant findings in the resident’s dictation. It is more likely to be a bland checklist. Addressing the pertinent information goes a long way to addressing the psychology of the ordering clinician.

Keep In Mind What The Referrer Wants To Know

Typically, the first paragraph of the findings should answer the clinician’s question. Logically, this makes sense. The clinician most likely analyzes only the first part of the findings and impression, if any. In addition, make sure to start with those items that contain the most critical information—then run down the findings in order of importance. For the clinician reading the report, the priority order clarifies what is most important. Dissimilar to the typical resident dictation, its goal remains clear, to answer the clinician’s question appropriately.

Give Some Leeway To The Referring Clinician

A clinician does not like to be hemmed in by the requirements of the report. So, make sure to give the clinician that leeway. Do not lock in on one diagnosis, forcing her to pursue that avenue. What do I mean by that? I will give you two examples.

First, give all the relevant likely diagnoses. If you start talking about something in-depth that is unlikely to be the cause of the patient’s illness, in essence, you may force the hand of the clinician to pursue the wrong diagnosis to the cost of poor patient care and expense to the system.

Second, you can legally bind the clinician to perform an unneeded procedure if you recommend a biopsy without an alternative. If for some reason, something goes awry and the doctor does not pursue that avenue, legal consequences can follow. So, be careful what you say!

Don’t Leave The Referrer Hanging

I like to call this waffling. Instead of giving many differentials, make sure to come down on those most likely to be the diagnosis. Always attempt to attach probabilities to the different possibilities. This process makes it much easier for the physician to provide appropriate testing and quality care.

Ask For More History

You may think the clinician will get annoyed if you ask him for more information. But, it is usually the opposite psychology. It shows you are taking the initiative. And, you are more likely to create a relevant report that will be helpful to the patient and the clinician. Rarely does a good history ruin a report!

Communicate The Results More Effectively

After you complete the report, check it over multiple times. Few things bother the referrer more than reports with incomplete, unintelligible sentences. Perhaps unwillingly, you leave out the word “no” somewhere in your dictation. Believe it or not, this can be crucial to the clinician’s treatment plan. Most of the time, the unnecessary phone calls I receive are for the occasional grammatical or incidental mistake in the dictation. It happens to everyone. But, try to minimize this effect by checking your work!

Summary On Addressing Referrer Psychology

To create a sound report that helps the clinician, you need to get into the mind of the ordering doctor. So, think like a clinician. Put all the relevant information into the dictation without the fluff, always keep in mind the goal of the ordering doctor, make sure to give some leeway to the physician, get an appropriate history, and make sure you look over your report so that it makes sense. Not only will the referrer appreciate your dictations more, but your patients will receive better care too!

 

 

 

 

Posted on by

The Program Director Interview Welcome Presentation: More Than Meets The Eye?

welcome presentation

 

 

As part of the radiology residency interview trail, most interviews begin with a welcome presentation delivered by the program directors. I know. Your eyes may start to glaze over as you think about these presentations. All of them blur together by the time you have reached your second or third interview.

But wait… Maybe there is more to these conferences than meets the eye. Although sometimes painful, these presentations are chock full of information that will become very important once you begin the radiology residency. And, believe it or not, the initial program director lecture content usually does summarize the residency programs well. So, try your best to maintain awareness instead of falling asleep in that comfy chair in a warm room with the program director droning on about the program. Listen very carefully and take notes. Your future career is on the line. Ignore it at your peril!

To summarize for today, my goal is to cue you on what you should tune into when you hear these lectures. Most quality presentations contain wide-ranging information, from residency rotations to information about ancillary staff and even imaging equipment. But what do you need to get out of the production? I’ve divided some of the most important themes you may not find elsewhere with the following subheadings: program theme, staff availability, teaching methods, program stability, and fellowship connections. We will go into all of these in more detail.

Program Theme

Every program has a general theme. Some programs are academic. Others produce community radiologists. And even others gear themselves to the interventional radiologist. Usually, the presentation develops one or more of these general themes. Most of the time, you will not find this information on the website or paper. For instance, I can tell you that when I gave the welcome presentation, I emphasized how our program runs as a private practice in an academic community setting. It doesn’t say that anywhere on the website or in the packets we give the applicants. You will be hard-pressed to find this information elsewhere. So, you need to take notes and write down the kind of program you are interviewing.

Staff Availability

Often, the welcome lecture summarizes how open the program is to input from the residents. Can you ask the attending a question on the fly? Or do you have to make an appointment month in advance to get the program director’s ear? You can derive a sense of the general communication between the residents and the attendings from the interaction with the program director and residents during the welcome session. Again, you won’t receive this information quickly from other sources.

Teaching Methods

Most presentations mention the styles that attendings utilize to teach the residents. Does the program emphasize multiple-choice questions at conferences? Do they like to use the Socratic method of teaching how to read films? Or maybe, the residents are taught chiefly by total immersion in the rotation. For some residents, this may be a crucial determiner of the effectiveness of their learning over four years. I’m unsure how you begin to find this information unless you know the other residents or the program director well.

Program Stability

If you listen carefully, the program director may talk about the attending staff at the institution. Are they all young? (Usually, that means there has been a recent collapse of the residency program) Or, as I like to say, do all the staff members stay around until they are in a “proverbial box.” The average age of the staff is 70. (If you see a residency program like this, maybe they churn their young attendings) This information can also be hard to come by using other means.

Fellowship Connections

Usually, you can find out where the former residents went to their fellowships after residency online. However, the program director may drop hints about getting their residents into these fellowships. That is just as important. Do the attendings have deep seeded connections at other institutions? Or rather, the program director may not talk about staff connections at all (A red flag!). Typically, the welcome presentation will divulge some additional information about these connections.

The Welcome Presentation- More Than Meets The Eye

As you can see, a welcome presentation is more than just a summary of all the information everyone already knows about the program. Typically, it summarizes facts about a residency program that you may not be able to find easily elsewhere. So, I recommend listening (as dull as some of them may be!). You may learn a thing or two that will help you decide where you want to match!

 

 

Posted on by

Should I Attend The Radiology Department Holiday Party?

holiday party

 

It’s almost that time of the year. And if you have not received an invitation yet, it will probably arrive in your email or mailbox soon. Yep… It’s time for the annual radiology department holiday party.

Our department has hosted a party every year since I started as an attending in my practice. (over 17 years ago!) Faculty expect most of our residents to attend the festivities since it is such a deep-seated tradition at our organization. And most do.

But what if you are on the fence? Maybe you have other obligations or are not the party-goer type. Whatever the case may be, you need to decide whether to attend or not. Well, I am here to help you with that decision! Let’s go through six reasons you should try to make that holiday party if possible.

Esprit De Corps

You are not just a radiologist but also a team member. Showing up displays your pride in the organization and lets everyone else know you care about the department. Now, all the others will understand that you are a team player, too!

Befriending Your Colleagues

What better opportunity to get to know your colleagues? Not just your fellow residents but the technologist who works down the hall and the nurse who cares for your patients. You can finally see these people not just as hospital employees but also as living human beings. You can even dance the Macarena on the dance floor with them, too!

Get To Know Your Attendings

It can be hard to get to know your bosses when they are involved in patient care and running a residency, telling you what to do. You may feel uncomfortable with the party because you now must sit down with them and chat. Now, you can spend time with your “difficult attendings” in an environment unrelated to your primary occupations. Who knows? Maybe it will lead to an excellent recommendation!

To Be Polite

You know… Someone had to shell out the money for the party. And the radiology department invited you to enjoy a party with them. Is it nice to skip out on an event created just for the benefit of all to enjoy? Not really!

Getting Involved

You can’t always study. Sometimes, you have to get out there and get involved. Getting involved can be as simple as showing up early to work up your patients. But it can also mean attending a party. You’ve signed up for this residency. So, show up for the events!

Find Out What Really Happens In The Department

Few better opportunities arise that allow the resident to see what happens in the radiology department. When the attendings “let their hair loose” and have a few drinks, you know who plays with whom. And, you get the real low down about what goes on. You can’t learn everything from a book!

Is It That Important to Attend The Holiday Party?

Yes!!! We struggle all year to work hard to learn and improve patient care. It’s now time to take some time aside to get to know our department. Let us enjoy the fruits of our labor together!

 

 

 

Posted on by

Paid Surveys For Radiologists Revisited

Completing paid surveys is probably one of the easiest methods of earning some extra cash on the side. And as we know, when you have hundreds of thousands of dollars in debt, every little bit helps. In addition to the extra cash, surveys have enabled me to learn more about some of the newest radiology technology and products that I may not have learned about otherwise.

In the past, I have briefly addressed opportunities for completing paid surveys in my prior post called Alternative Careers And Supplemental Income For The Radiologist. But today, I thought I would go into some more detail about surveys since I regularly participate. So, let’s start by talking about the general rules for deciding when it makes sense to complete a survey, go through the different types of surveys, and then finally delve into some of the opportunities that are available out there based on my own experiences.

My General Rules For Deciding If A Survey Is Worth The Effort

You will find that surveys vary widely in the amount of time and effort for a given amount of cash. Unless you really enjoying completing surveys for free, survey companies should compensate you well for your knowledge and time. Remember, even medical students usually have more education than the folks giving out the surveys. And, education comes at a price. So, I would recommend to not allow the survey companies to take advantage of your goodwill.

In fact, let me give you my rule of thumb. A survey company should compensate you at a rate similar to or greater than what you would earn by moonlighting. What do I mean by that? If you are a resident and you can make 100 dollars per hours by working an extra shift, then you should work at a rate no less than 100 dollars per hour. That means if you work on a survey for 15 minutes, you should get paid no less than 0.25×100 dollars or 25 dollars for your time.

Also, make sure not fall for the sweepstakes entry reward for completing a survey. Usually, there is no guarantee you will win. And, you are essentially providing a free consultation.  You are worth much more than that!

Finally, if you need to travel to complete the survey, make sure you calculate the amount it costs to get to the survey. Deduct that amount from the survey fees to come up with a final total to decide if the survey is worth your time. Or even better, have the survey company reimburse you for the travel expenses.

The One Exception To My Rules

But, of course, I have one exception to the rules. (Just like there always is!) If you have nothing else to do at the time, then I permit you to consider completing a survey for less. Why do I think that is a reasonable exception? Well, getting paid for doing something is always better than doing nothing, even if you are not getting paid what you are worth. Hell, you have lots of bills to pay for your medical school training!

What Are The Different Types Of Surveys?

Surveys opportunities vary widely. These include the standard online questionnaire, participation in a phone interview, a direct interview with a survey manager, and sitting on an expert panel. Out of the different varieties, I find the online questionnaire to be the least thought-provoking and energy draining. Other forms of surveys require more active participation. You need to be awake to answer the questions!

In addition, survey companies attend national conferences and offer opportunities for radiologists. Take advantage of these opportunities when they avail themselves. Often times, these opportunities can be the most lucrative.

Overall Best Survey Companies For Radiologists

Over the years, I have found that at any given time, the best survey companies change. Depending upon your specialty, the best radiology survey company may vary. Presently, the following companies still give me the most opportunity to complete paid radiology related surveys at the highest rates: GLG Group and M3 Research. In fact, I remain an affiliate of both of these companies since I complete these companies’ surveys regularly. Of course, other survey companies every once in a while ask for my opinions. On the whole, GLG Group and M3 Research still give me the most opportunities.

Final Thoughts

Although no magic bullet exists for getting rid of student debt, survey opportunities can give a significant boost to your bottom line. Try to avail yourselves of the opportunities when they arise. Who knows? You may even learn or thing or two!