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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Inflation And Residency- Not A Winning Combination!

inflation

Many of you have probably noticed the headlines about high inflation rates. Over the past year, inflation has risen by over 7 percent. It may only seem like a number that the talking heads on TV and youtube espouse. And, maybe, you have noticed some increased dollar costs at the end of the trip at the supermarket. Or, perhaps take-out from the restaurants that you like the most are a bit more expensive. Then, of course, your gas tank is a lot more costly to fill. 

Taken individually, it may not seem like much. But it is probably more than you think when you add it all up. So, let’s discuss why folks with fixed, regular incomes like you tend to get battered the most. And then let’s talk about how you can potentially prevent the year from eating up your entire salary.

Why Inflation Significantly Impacts Residents

Annual Incomes Are Already Set For The Year

Often, hospitals create residency salaries before calculating the following year’s cost of living. Therefore, you may notice that your income does not meet the increase in the cost of living for this year. This relative decrease in salary can undoubtedly give you far less room to squeak by.

Most Residents Are Not Asset Owners

People who own assets such as houses don’t have to worry about rent increases because their mortgages don’t change. But unfortunately, most residents are not in that boat. Additionally, trainees do not have as many stocks, cryptocurrency, or other hard assets that rise with inflation. So, you are at a distinct disadvantage.

Increase In Prices Eat Into A Regular Salary Without Much Room For Discretionary Income

First of all, your salary is typical for the United States workforce. But, the ordinary person in the United States lives paycheck to paycheck. So, this increase in prices will take a significant bite out of your annual budget, especially when you have very little room for discretionary income, to begin with.

What To Do To Prevent More Pain!

Moonlighting

Not everyone has this opportunity available. But, if your residency has this option, you may want to think about participating. In-house moonlighting can help defray the additional costs of a high inflation rate, perhaps at the current inflation rate or even more. Plus, it will also allow you to sharpen your independent radiological skills. 

Sharing Apartments/House Hacks

Did you not want to share an apartment with colleagues when we had a more normal inflation rate of two percent? Well, maybe it may make more sense now. Overall, rentals will sharply increase in price this year for much of this year. And so, sharing the entire bill may make a lot of sense.

Or if you are fortunate to already own a property in the area. Maybe, you would want to rent part of it out this year to decrease your costs. This move can also significantly reduce the cost of inflation in your regular salary!

Strict Budgeting For Times Of Inflation

Lastly, if you are a prodigious spender, you may want to rethink this lifestyle, especially this year. Budgeting and tracking expenses closely can help decrease your annual costs and prevent the paycheck-to-paycheck lifestyle with high credit card debt. Use a spreadsheet or an application. Either way, this method may help to avoid overspending related to inflation!

Inflation And Residency

More than any other time in your career, inflation can eat away at a higher percentage of your annual income since your residency salary is relatively lower than what you will make eventually. Also, most residents don’t have the assets to decrease the influence of an inflationary world. Therefore, it can be tougher to make ends meet than a typical year.

Nevertheless, you can use some of these tools to prevent inflation from impacting too much. And hopefully, we will see some improvement in the following years and get back to a baseline lower inflation status!

 

 

 

 

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A Last-Minute Decision To Go Into Radiology Is OK!

last-minute decision

So, you’ve put all this time into beefing up your application for radiation oncology, urology, neurosurgery, or medicine. You have researched and toiled in these or other subspecialty electives for countless hours to make a good impression. And, it’s about time to make that ultimate decision to pursue your final goal. But, something doesn’t feel quite right. Your gut tells you that you will probably not want to spend the rest of your life in this field. What do you do? For those of you that have to make soon that heart-wrenching decision of which specialty to choose, it is OK to make a last-minute decision. Trust me. Don’t worry about disappointing others or not pursuing your original goal. Here are the reasons why.

A Subspecialty Career Lasts A Lifetime

We are not talking about just a few years. Whatever specialty you decide to choose can last the remainder of your career. So, don’t worry about disappointing your colleagues, research cohorts, and mentors. Don’t do it if you are sure that you are pursuing the wrong path!

Physicians Are Miserable When They Don’t Pick The Specialty Their Heart Desired

I know that too many physicians are miserable and burnt out in their career path. Many of them regret the day that they chose the wrong specialty. And, many decide upon the incorrect medical field because the one they want is time-consuming or “tough.” Most of us can live with a few challenging years, but not for difficult years for the remainder of our careers!

Friends, Colleagues, Mentors, Will Understand Your Last-Minute Decision

You may receive some disappointed looks at first. But, in the end, your true friends will understand that you need to make this decision for yourself, not for someone else, and certainly not for a superficial reason. Real friends will eventually understand the choice you made

Last-Minute Decisions Happen All The Time

I don’t know about you. But, I know many physicians, specifically radiologists, who decided to join the fold at the last minute on their fourth-year radiology rotation. No, they may not have all the credentials of someone preparing to do this pathway all along. But, they can make excellent radiologists (sometimes even better than ones that already knew their destiny!)

Hard to Back Out Once In A Pathway

The easiest time to make a decision is now. Once you have already started a new residency, it is much harder to reverse course. You need to get permission from program directors, colleagues, and the federal government! And you may not have the funds to change paths so easily. So, make this decision to go into radiology before you start another residency if you can!

You Don’t Need Tons Of Research To Get Into A Decent Radiology Program

Yes, completing research is excellent. But do you need tons of research to get into a radiology program? No! We have selected many candidates who did not have a laundry list of radiology-relevant projects. So, if you decide to avoid radiology because you don’t have the research to do so, don’t!

Better Off Getting Into A Mediocre Radiology Program Than None At All (It’s A Self Taught Discipline Anyway!)

Think again if you are interested in radiology and are not applying because you can only get into mediocre programs. Many great radiologists have not gone to man’s best institution. Fortunately for you, much of radiology is a self-taught discipline regardless. Any program in your desired field of choice is better than no program!

Look At Me! I Made A Last-Minute Decision

Lastly, and more importantly, please consider that I am one of those radiologists who made their decision after being on the internal medicine track all along. I only made my final decision at the beginning of the fourth year. And, it all worked out very well for me. You can make a last-minute decision to go into radiology as well!

The Last-Minute Decision!

Society puts too many negative connotations on the last-minute decision. In truth, though, last-minute choices are not always bad. What is terrible is refraining from pursuing what you want because you believe you have a fixed path. So, make that last-minute decision to join the radiology fold if that is what you want. Your last-minute decision can be the best one!

 

 

 

 

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What Hobbies Correlate With Becoming A Successful Radiologist?

successful radiologist

After reading a gazillion personal statements and participating in another bazillion interviews, I would be a kazillionaire if I had a dollar for every time I read that a medical student will make a successful radiologist because of one of their hobbies. And, if you gave me a small rock for every time a medical student claims that they are great at one of these hobbies and how that applies to radiology, I would be sitting on top of Mount Everest! So, do hobbies have any correlation whatsoever with becoming a high-quality radiologist? The answer to that question is yes. But, not the way you might think at first. And indeed, not in the way most folks add their hobbies to their personal statement.

So, let’s go through some of the more common hobbies applicants think will make them great radiologists. Next, I will disclose why applicants believe these hobbies make them higher-quality radiologists. But, of course, I will debunk this perceived correlation. Finally, I will reveal how hobbies help the average radiologist!

Photographers

One of the most popular themes in personal statements is the correlation between becoming an excellent radiologist and one’s love for photography. I often hear how they can see subtleties and make those same findings on a film. Well, I can think of several resident photographers, and their radiology abilities are all over the map. Some are excellent radiologists, and others are more average. So, I am not sure if this skill makes a significant difference in your findings skills. 

Video Gamers

Like photography, I have seen tons of applicants talking about video games as one of their hobbies. A more rarified few will claim that they are extraordinary competitive video gamers and have won prizes or cash for their endeavors. On this point, I have seen several articles talking about improved hand-eye coordination. But, it can also lead to distractions and decreased reading during residency. So, I feel that in terms of becoming a better radiologist, playing video games is kind of a wash.

Art Connoisseurs

Like the photographer, these folks talk about their love for paintings and museums. Others will even paint pictures themselves, some that have even made it to a gallery or two. And then folks tend to claim that they have a “good eye.” It is also a typical statement that I hear about in recommendations that usually tell me nothing. Why? Anyone can make this claim, and it is hard to back it up with facts as a medical student. Nevertheless, this hobby is a popular radiology applicant pursuit. In and of itself, I am not sure if it correlates that well with quality!

Cooking

Here is a hobby that I also love. I prefer to eat my food than the food I purchase at restaurants. And, it does involve some hand-eye coordination, creativity, and knowledge. However, when I look at the applications of incoming medical students, I find nearly every other one has the same hobby. Because it is so prevalent in society, it doesn’t add much except for an excellent conversation between myself and the interviewee!

Music And The Successful Radiologist

We have all sorts of “radiologists-to-be” that either listen to, play, or dance to all kinds of music. For those that play different instruments (like myself), it undoubtedly is a great outlet to have fun and mix with other like-minded bandmates and friends. And, for the dancers and players among us, these folks may have slightly better hand-eye coordination. (plus or minus) Some may DJ on the weekends, and others may perform gigs. The extra time can detract from residency studying or improve hand-eye coordination. Nevertheless, I don’t see a strong correlation between the love for music and becoming a better radiologist in the way you might think!

So, How Do Hobbies Correlate With Becoming A Successful Radiologist?

Well, here is the kicker! None of these hobbies have much to do with the quality of radiologist that you will become. (as much as you might think!) However, having a hobby is more important than the hobby itself. You have something else to discuss and fall back upon when things may not go your way during residency. So, don’t worry about your hobby per se and how it will turn you into a great radiologist. It will not transform you into the “radiologist Excalibur.” In that respect, it is not so important. But add your hobbies to your application because it adds to your persona and character. We do like real people in our specialty of radiology!

 

 

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Find A Radiology Residency Or Job That Will Feel Like Well-Worn Sneakers!

sneakers

I don’t know about you folks, but when I buy new sneakers, I expect it will take a while before I can break them in. The material needs to stretch out to surround and cushion my foot gradually. Rarely do the sneakers fit perfectly on day one. The process can take months or even years until I get them the way I want. So, I buy them with the expectation of future comfort, not how they feel today.

If I try to buy the perfect sneakers, it never seems to work. I find myself returning lots of footwear (online nowadays!) And, I waste my time and incur multiple restocking fees or trips to the store for returns. So, what do I look for when I buy those sneakers? I look for reasonably comfortable pairs that fit snugly without too much discomfort. Also, I find pairs that will less likely cause me to trip over myself. So, what does this all have to do with radiology? It’s coming out of the left-field, right? Well, not really. Let me explain.

Like buying sneakers, residency programs, or first jobs rarely fit perfectly on that first day. It may be good enough and may have the potential to work well. But, you may notice the imperfections at first. These imperfections may trouble you because you may question if you made the right choice or not. But it would help if you had patience. Why? Because the outcomes can be costly, just like the returned footwear. And here are some of the reasons why.

What Doesn’t Work Perfectly Now Will Get Better In The Future

All the imperfections tend to loom larger when starting a new job or a new residency. You notice the worn call room or the resident that constantly complains. What else do you have to hang your hat on? But, I can assure those same issues that you see right now will most likely go away. Yes, you will face other problems and challenges as well. But, I have never seen anyone join a practice or begin a program that is perfect on the first day, week, or month. It just takes a bit of time for the sneaker to mold to your foot!

You Gain Familiarity With Your Colleagues- First Impressions Are Rarely Correct

How often have you noticed that your roommate or teacher was not as they first seemed in your academic career? In my case, I know that my first impression was often wrong. The teacher that seems bizarre often turns out to be the best. And, that roommate that you thought was off a bit may turn out to change your life. It’s all a matter of perspective. And, in the beginning, our views can be skewed. This sensation can feel just like the sneakers that may be a little bit tight at the top at the beginning!

The Costs To Changing Sneakers (Jobs) Are Immense

It is not so simple if you are leaving your residency program midstream or deciding to change to another faculty position elsewhere. Especially as a family, the costs of uprooting your accommodations, kid’s schools, or workplace are immense. Just like when you constantly have to pay those restocking fees, the price of changing jobs can add up over time and can become exceedingly difficult to recoup. It’s worthwhile to give your present job a second look to make sure that it is not what you wanted in the first place. 

Give The Well-Worn Sneakers (Residency/Job) A Chance To Support And Comfort You!

All outstanding accomplishments take time. So, give your residency or job a chance. Yes, there are times where a sneaker can break, or a rock gets stuck in the sole. In these unusual cases, the damages are irreparable, just like some rare residencies or career paths. But, those times are rare. In the end, you may find that you will live a much more comfortable and happier life if you stick it out a bit. Your feet will thank you!

 

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Why Radiologists Cannot Be Over-Confident!

over-confident

Some subspecialists make fun of radiologists because our favorite plant is the hedge. (An ancient lousy joke!) To the other extreme, I have found that those radiologists that are over-confident of their diagnoses tend to make the worst radiologists. Many residents don’t realize this, and some emulate these single-minded radiologists because they believe excess confidence helps patients and physicians. But, when they get out into practice, they recognize the error of their ways. And, quickly, they reverse course. So, let’s go through why that is the case before you may become one of those casualties. And then, I will provide a simple solution to get your point across without sticking to one foregone conclusion.

Why Radiologists Cannot Be Over-confident

Zebras Do Occur (Even For Over-Confident Radiologists!)

Of course, not all of our diagnoses have simple outcomes. For every 1000 peri-tonsillar abscesses, there are a small number of infected squamous cell carcinomas. And, there is also a smattering of even rarer birds that happen from time to time. I’ve been around a bit to see a lot (although not everything!) And, I know enough not just to hang my hat on my one beloved diagnosis.

All Of Us Sometimes Have Blinders On

Just like other clinicians, histories can sway us. If your ordering doctor constantly pushes toward one ineffable diagnosis, you, as a radiologist, are most likely to think the same. And that is the moment when you need your radiology cap on your head. Those intense pressures can easily lead you down the wrong road. At this point, we need to step back and reanalyze the situation and think about all the possibilities, not just the most likely.

The Legal System Is Not Forgiving

What do you think about when you see a bit of bowel wall thickening in a small bowel loop with no pneumatosis, free air, free fluid, focal fluid collections, or extraluminal contrast. Usually, it is infectious or inflammatory enteritis. But every once in a while, it turns out to be something much more malicious. Perhaps, the earliest sign of ischemia? I have seen multiple radiologists not mention the word ischemia somewhere in their dictation. And, the outcome for the physician (and sometimes the patient) has not necessarily turned out so well. The legal system does not allow for finite diagnoses, especially when one of those more unusual diagnoses can lead to a not-so-great result!

Potential Bad Patient Outcomes

And, most importantly, like in the ischemic small bowel example above, when we limit our differential diagnosis, we can also affect patient outcomes. Some clinicians will keep the alternative diagnoses in the back of their minds or will prophylactically treat for these entities even though it may not be your first suspicion. And, even though you may put these diagnoses third, fourth, or fifth on the list, it doesn’t mean it shouldn’t be in the dictation. We have to allow our clinicians to be aware of the unforeseen to prevent these bad outcomes.

How To Solve The Problem Without Being Too Hedgy

Given all the pitfalls of the over-confident radiologist, we usually should not come down too hard on one diagnosis. Instead, we have to give more than one option to clinicians because multiple possibilities exist. Yet, it is effortless for radiologists to get bogged down in a list, which also does not help the clinician. Suppose you come up with a list of differentials on a chest film of ARDS, pneumonia, or pulmonary edema; how does that help the clinician? How can you escape this hedge-like conundrum? 

Very simple. Ensure your reports talk about the diseases and a list of probabilities to go with the diagnosis. For instance, if you are leaning toward the diagnosis of pneumonia, you can say that the study is most consistent with pneumonia because of the fever and the multifocal pattern. But, make sure to say that other etiologies are less likely, how much less possible, and why. This technique allows us to guide the clinician toward the most likely diagnosis.

Instead Of Making The Mistake Of Becoming An Over-Confident Radiologist, Master Probability!

Radiologists have lots of diagnoses from which to choose. And, any one of these, albeit unlikely, can come true. So, we can’t afford to become overconfident and make the mistake of picking just one. Therefore, radiologists need to become circumspect and know the likelihood of outcomes. Our role is to guide our fellow physician colleagues. Thus, to become excellent radiologists, we should not adopt the tact of overconfidence. Instead, we need to become masters of managing probability!

 

 

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Rural Versus Urban Radiology- Who Wins?

urban radiology

Go to any radiology forum, and you will see an ongoing battle. Everyone wants to prove their point that where they work is the best. Some vouch for working in an urban radiology setting, and others espouse the benefits of working out in the middle of “nothing and nowhere.” Either way, I’m sure there are merits to both. But, let’s pick this topic apart and check out the overall best place to work for the average radiologist resident that is thinking about looking for their first attending job? To do so, we will enumerate and describe the main advantages and disadvantages of each of these choices. In the end, let’s look at the evidence and conclude as to which one is the most desirable outcome!

Rural Radiology

Advantages

More Benefits/Money

Indeed, this perk is the one everyone hears about the most. The farther away from civilization, the more money that most physicians make. And, why is that? Usually, hospitals need to supplement your salary to get you to work there! Nevertheless, it is a fact, and you can use it to your advantage in the outback!

Slower Pace

Everything work-related crawls at a slower pace in rural radiology. You are simply not going to see those crazy enthesioblastomas as often as you might like. On the other hand, because you are not a tertiary referral center, you can scroll the cases at twice the speed since they are much less fraught with complications.

Less Competition

Typically, you don’t need to vie for every patient and every dollar. The subsequent radiologist may be as far as 500 miles from you. So, you just don’t need to worry. You’ve just gained a few anti-stress points and lost a few pounds right there!

Nicer More Open Facilities

In the rural world, land and buildings are generally cheaper. So, you may notice larger and more modern reading rooms, better IR suites, and more well-designed hospitals in general. Lower costs for facilities usually mean more space for you.

Fresh Air

You probably know that smell when you walk outside into the natural world. Simply put, there is much less soot and grime in the air. So, all the flowers and pollen are hitting your sensory receptors as soon as you walk out the door. But, it is true. Your nose will know the difference when you work in a rural environment. And, you will gain a few extra years of life too!

Appreciative Patients

When medical resources are more scarce, patients tend to be more appreciative. You have a better shot at receiving a box of chocolates every year for your services. What you do is hypercritical in a place where fewer physicians work.

Mixed Results/Depends

You Do More Of Everything

Plus or minus. You may get to do more. Now, this may float your boat. Or it may be a cause for your concern. Either way, you will more likely be doing the arthrograms even though you are not an MSK-trained radiologist. Or you will read the mammo, even though you are not breast imaging trained. It’s part of the rural expectations!

Disadvantages

Less Collaboration

Fewer physicians mean less collaboration. That’s just how the math works. Also, it may be a little bit harder to get other expert opinions from your colleagues and your fellow specialists because they just don’t exist. Something to consider before you start a rural radiology career.

Loneliness,

For some folks, family is everything. And, when you live rurally, you have to consider that you may not have your usual family support structure. If you expect the in-laws to come by to help out with the baby, it is unlikely that will happen too often. Just something to think about when you decide to work rurally.

Different/Lack of Cultural Activities

You will not find as much theater and opera out in El Ranchero. But, you may have an excellent Strawberry festival! You just have to have expectations that you will have to travel to get some of the cultural activities you might expect in a large city.

 

Urban Radiology

Advantages of Urban Radiology

Culture

Some rads love the option to go out and watch the newest incarnation of West Side Story with the most famous actors and actresses. Others not as much. In any case, you will have more cultural options for all these activities.

Restaurants

If you like to eat out, the city is just a better environment. You have much more to choose from. And, you can have your Ethiopian fix (I like that cuisine!) and your Afghan meal for the next. It is just more readily available.

More Physicians/Collaboration

More people means more collaboration. You will have more subspecialists at your fingertips to contact and bounce ideas. It often helps when the cases are more complicated. Second opinions sometimes can be a lifesaver.

More Prestige

Larger cities and larger hospitals offer more powerful titles and sometimes more national/international respect. Working at Mass General does mean something to many other physicians and patients. Your name may carry more weight in the big city if you are into prestige.

Better High End/Tertiary Care

If you need treatment for rare diseases, most patients need to go to the big city. These places tend to be hotbeds of research and new therapies and diagnostic tools. The city is the place to be for this work.

Disadvantages Of Urban Radiology

Decreased Pay And Benefits

With all of these perks come the decreased pay because of the desirability of the location. This factor is more pronounced if you decide on a partnership track somewhere. These imaging businesses can afford to pay their radiologists less because they will come anyway!

Increased Competition In Urban Radiology

More physicians mean more competition for every dollar earned. You can’t just build a new imaging center and expect patients to come. Why can’t they get imaged at the business down the street instead?

Higher Living Expenses

Along with lower pay comes higher living expenses. Costs in cities like New York and San Francisco are out of control. And, even as a physician, the economy may force you to rent. Those Benjamins just don’t go anywhere near as far with those high housing and food costs.

Less “Outdoor” Activities

Cities are more conducive to the museums and theaters but less so to hiking up a beautiful green mountain somewhere. For you, that fact may be a game-changer.

So, Who Wins The War- Rural Or Urban Radiology?

Sorry. But, not every location will float everyone’s boats. However, I can say the following. Consider the rural job if you have significant debt because the cost of living can outweigh almost any other advantages of living in the city. The expenses alone will cause you to delay any such hope of financial freedom. Otherwise, find a place that will suit your needs for a long-term relationship. And that can be either rural or urban depending on your family and personality. Just remember. Weigh the pros and cons!

 

 

 

 

 

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How Competitive Is Radiology For The 2022 Match?

2022 match

We are well through a good chunk of our interview season. So, it’s about that time for me to start making predictions for the up-and-coming 2022 match as I have done for the previous years. Check out my blog for last year called From The Trenches! How Competitive Is Diagnostic Radiology For The 2021 Match? Based on last year’s predictions, it seems I was pretty close to the mark if you compare my thoughts to the NRMP stats. My goal is not to freak everybody about getting to residency. Instead, I want to paint as realistic of a picture as I can for those applying to give them some expectations of the process. Let’s see if I can also get it right for this year. (Hell, a broken clock is right twice a day!) Like last time, let’s use some of the objective and more subjective criteria to determine the application competitiveness.

Moreover, this year, we can make a fairer comparison between the interview candidates because we are directly comparing two zoom interview years. It’s more of an apples-to-apples comparison than last interview season when we didn’t have such a comparison. Hopefully, that will make my conclusions even more precise than the previous year.

“Objective Criteria” For The 2022 Match

Applicant Board Scores

Alright, let’s start with the obvious. The board scores are noticeably higher than last year when it comes to our applications. And, I would say a significant five to ten points higher. Although not the norm, scores above 260 are sometimes seen, more commonly than last year. Therefore, we have raised our cut-off slightly this year due to this increase. That certainly bodes well for the applicant pool, but not so much for the individual.

Interviewing Less Foreign Grads

At a smaller institution like ours, we tend to get more foreign grads than some of the bigger programs. That, of course, may change to some extent when we eventually merge. Nevertheless, the number of foreign grads invited to interview slots has decreased slightly. Why? It seems there are more local U.S. grads from which to choose. Now, I have traditionally loved our foreign medical school-trained residents, but our program obligates us to peruse the U.S. applications first. Be that as it may, I perceive a noticeable difference in the numbers of American medical school applicants to our program this year.

Fewer Zoom Cancellations

So, far I have also noticed fewer zoom canceled interviews at this point. Usually, folks get tired of interviewing by the midpoint of December, and the numbers begin to drop off a bit. This trend is not so much the case so far this year. Our interview days have been chock full of eager applicants. That also points to a more competitive year.

“Subjective Criteria” For The 2022 Match

More Interesting Applications

Every year has its fair share of interesting applicants. But, this year, the pool seems more varied. I see more “self-starters” like former business owners, high-performing talented musical folks, and folks with many other impressive side hobbies and unique talents. This increase seems to happen more often with a more competitive pool of applicants.

“The Covid Factor”

This year is the first year where applicants had a decent amount of time to mull over applying with the effects of Covid playing a role in their future specialty choice. For many applicants, this is where radiology begins to look even more attractive. First of all, many applicants have thought about and noticed the flexibility of specialty regarding patient care. Some folks have realized they may not have wanted to spend as much time with covid positive patients as, say, an internal medicine physician. Unlike other specialties, we can sometimes work from home and not have to worry about contracting and spreading Covid all the time.

Furthermore, many applicants see the critical role that we play in the diagnosis and management of Covid. To some, this is an attractive feature of radiology. Regardless of the motives, I see the “covid factor” making radiology a more attractive specialty than ever before

“Good Job Market”

The job market has been going strong in radiology for several years, except for the sudden blip/drop-off of the initial covid outbreak. When the job market has been relatively strong for some time (usually a few years), medical students begin to notice when salaries are relatively high, and the job market is healthy. Indeed, that situation has been active, and I believe it will remain this way for the foreseeable future (until the next market swing!)

My Final Assessment Of Our Radiology Competitiveness For The 2022 Match

Sorry to those that are worried about this year’s competitiveness. But, I see a significant uptick in the competitiveness in the application situation. I have found it noticeable compared to last year. But, the devil is in the details. Let’s see what the folks at the NRMP have to say in March!

 

 

 

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All The Hype About Artificial Intelligence Products Versus What Really Happened!

artificial intelligence products

Flashback to 2018 and 2019, and you can read some of my posts about the RSNA’s latest and greatest artificial intelligence products. So, what percentage of those products has your hospital or imaging center incorporated into their workflow? For us, I can tell you that number is exceedingly low. And, I am willing to bet that most of you have a similar story. So, I figured it would be fun to go through some of the promises that silicon valley has made over the past several years versus what has come to fruition in daily practice. Let’s go over their overpromises and underdelivering. It would be fun to do this every few years to check up on the progression of AI technology in Radiology!

Reading Mammo With Half The Amount of Readers

Ironically, if you have seen any decrease in the number of breast studies coming to your institution, it has far less to do with artificial intelligence. Instead, it is probably related to Covid! Nevertheless, most of the work has returned. And, I don’t know of any institutions that are using artificial intelligence to replace the initial screening reads for mammograms. (as enticing as that sounds!) Most places have the hebeejeebees for ethically, legally, and financially replacing a mammo reader with a computer!

Workflow Will Be Seamlessly Integrated

I was hoping this one would have taken place by now. But to no avail. Yes, we will be getting another EHR/RIS system to replace the one that we have right now. But rumor has it that, although better, it is nowhere near seamless. I am still waiting for the day that I pull up a case, and my computer instantly opens up a case, the appropriate priors, the relevant labs, a brief pertinent history, an internet blurb on the disease entity, and the patient’s most recent surgeries without having to click a button. I believe the day will come. But, I’m not sure it will be there during my working lifetime!

Radiologist Will Have No Role In Reading Bone Ages

This concept makes a lot of sense. AI should read cases with a low likelihood of lawsuits and unlikely dire outcomes. What better study for artificial intelligence to read than a bone age? It certainly meets those criteria. Furthermore, we analyze and match up features of hands with features similar to standard cases. This process should be easy peasy chicken squeezy. (Maybe in my dreams!) Well, I am still waiting for my institution to incorporate this incredible technology!

Dictation Will Be Entirely Automated Into Standard Reports

If I had a dime for every time a company would say, your reports would be so much easier without our technology; I would be a veritable gazillionaire. Of course, they will standardize everything. And, with one button click, the clinician will be able to localize your disease pathology on a film. Where is this technology? Certainly not at our institution. (And, probably not at yours either!)

CAD Artificial Intelligence Products For Mammography Will Work Well Much Better!

Maybe, CAD detection has improved. But, I do not notice it one bit at the institutions I work. For me, it seems like the same old random placement of circles and stars to match supposed masses and calcifications. Rarely (if ever) has it noticeably helped me. And it does not seem to have changed much. Heck, but what do I know?

Artificial Intelligence Products Will Help With Diagnosis On Chest X-Rays

I saw some tremendous potential technologies at the RSNA to help make multiple diagnoses on chest films. It would issue a probability here and there for different disease entities. Well, I have not heard a whisper of this program coming to our institution any time soon. And, I have a sneaking suspicion, you will not see at yours either.

Improved Triage

Finally, I have heard of computer programs that will pre-search for life-altering diagnoses such as intracranial bleeds so that it will draw your attention to these cases first. I would love a program like that, and the technology should not be too advanced. But, I am still waiting and waiting and waiting and waiting…

Still Waiting For These Great Artificial Intelligence Products!

So, where does all of this leave now? I would have to say right back where we started. We have not seen that much yet except for some behind-the-scenes CT and PET-CT image improvement. Let’s do another checkup every once in a while. I have a feeling, though, these products will take a lot longer than anyone initially expected!

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Overcomplicating The Obvious For The Sake Of Academic Publication!

academic publication

Recently I came across an academic publication in the JACR, my favorite radiology journal, called Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. I had to look at it for a couple of reasons. First of all, I’ve written about the topic before in an article called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective!. My article espoused most of the JACR article’s ideas. And I wrote this article over 1.5 years before this new “academic” JACR article existed! (without even a citation of my publication!). Therefore, the topic was very relevant to my interests. 

Second, I was curious about if the conclusions would match up with my own. And, to answer the second question, they certainly did. As I summarized in my blog, this article also concluded that medical school prestige would gain outsized influences. Moreover, just like my article, they said that Step 2 scores would partly fill the gap left by the loss of Step I scores. (1)

Overcomplicating And “Academicizing” For The Sake Of Academic Publication

Nevertheless, having looked at the article for a few minutes, I found it more amusing how complicated they made this “study” to come up with simple logical, rational conclusions that any program director would make if you asked them. I mean, they got into “discrete choice experiments,” randomizing how faculty would answer when presented with different application situations. Simple surveys would have done the same trick. Now, I am a firm believer in evidence-based medicine to further science. But, this article is the perfect example of taking old information out there on the web (my own!) and overly complicating and “academicizing” what should be a simple logical thought process to create an “academic” paper out of it. If you will, this is another example of publishing for publishing’s sake merely to add to your credentials.

Is Your Article Genuinely Adding To Radiology Body of Literature?

Unfortunately, this type of intrigue happens all the time in academic radiology and medicine in general. So, if you genuinely want to add to the science and practice of radiology, think about the ideas and hypothesis that you are about to research. Are they original, or have other folks written about them? Will your paper serve a specific objective, or will it just add to the body of documents out there? And, finally, don’t try to complicate the issues when you can achieve the same goal in a much simpler way!

 

 

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Radiology Residency Makeover: What Can Make A Truly Excellent Program!

radiology residency makeover

Everyone has a different vision of what residency should be when they start. And some discover that residency is nothing as expected. Perhaps, you thought that you would get more lectures, but you are not receiving enough. Or, maybe you thought you would receive more thorough assessments by the faculty every week, but no one is checking up on you. Every residency has its sore points. But let’s say you could construct a radiology residency from scratch; what are some of the most critical elements you would like to fix? From an associate program director’s perspective, here are some essential items for a radiology residency makeover from the beginning!

Filling Out Evaluations- Seriously

In many residencies, evaluations get placed on the back-burner because attendings are busy and barely have time to do their work. But, what if faculty took these assessments seriously and took the time to give you real constructive criticism? I mean the type of analysis that would help fix your dictations or make you better at performing procedures. That takes a bit of time. But, receiving constructive criticism such as this would be well worth the price.

Formalized Guideposts For Applicants

Yes, most residencies claim to use milestones to ensure that residents are well on their way toward becoming independent radiologists. However, it’s more of a checkbox that most residencies place in residents’ portfolios to document progress. However, wouldn’t it be nice to have a radiology residency makeover so that you have specific achievable requirements to meet the goals and expectations of the program. I am talking about the type of thing such as the ability to read x numbers of chest films in a day by year two or having a formal standardized assessment for performing paracenteses that everyone needs to complete before allowing residents to do them independently. These guideposts are helpful and will enable you to know where you are at any given moment!

Lectures- Quality And Quantity

Some residencies promise lectures to all residents but do not deliver. Lecturers regularly cancel noon conferences due to other work obligations that they need to meet. Other residences give talks, but they are not of sufficient quality for residents to learn the material. Wouldn’t it be nice to have a residency that consistently provides the material you need to know with excellent lectures? And, lecturers that cancel permanently have a backup on deck—furthermore, all lessons are of homogeneously excellent quality.

A Radiology Residency Makeover So That All Faculty Care About Resident Welfare

Every program has some knowledgeable faculty. Nevertheless, it is another thing to care about resident well-being. Wouldn’t it be nice to have all faculty on board looking out for residents’ self-interest? It only takes a few caring attendings to help their residents along so that they can achieve great things. Whether it is helping pass the boards or having an interested soul to talk to, caring faculty can make all the difference in the residency experience.

Residents Running The Show

In the end, we need to be able to train residents to work competently and independently. On the other hand, some residencies don’t give the residents enough independence on all the rotations to truly get the experience they need to take charge of their service. Maybe they have needy patients that want attendings performing all the procedures. Or the faculty does all the work. Perhaps, an attending on-call overreads all your dictations. Wouldn’t it be nice if you could show that you could run the rotation at some point during your four years?

Residency Makeover: What Can Make A Truly Excellent Program!

As an associate program director, taking evaluations seriously, formalized guideposts, quality lectures, caring faculty, and allowing residents to take charge are some features that can transform a mediocre program into an excellent one. If you are lucky, your program follows these descriptions to a tee. But, life is not perfect, and neither are residency programs nor their faculty. Nevertheless, now you know, in an ideal world, this is probably your residency director’s dream!