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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Evaluating The Pancreas On A Triple-Phase CT Scan Is A Minefield

triple-phase

I don’t know about you. But, for me, my least favorite CT scan has been the triple-phase CT scan to evaluate pancreatic masses. And, by most accounts in my group, many of our radiologists feel the same. For this reason, I would like to call the evaluation of the pancreas on a triple-phase CT scan a minefield. Many pitfalls in making the findings and interpretations abound. And no one, including the physicians and patients, is ever satisfied. But I thought this might be a good time to go through some of the issues you might encounter!

Subtle Lesions On A Triple-Phase

Pancreatic lesions tend to be some of the most subtle ones to detect. They can be hypovascular or hypervascular, infiltrative or circumscribed, versus cystic or solid. Sometimes, we see them in only one phase out of many in a triple-phase protocol. Even worse, you may only catch one of these lesions on a coronal or sagittal plane, which is not well confirmed by any other. You can miss one of these lesions in about a billion ways.

Severe Consequences For Missing A Lesion

Patient Tragedies

The lesions that you miss in the pancreas can be killers, literally. Both complex cystic and solid lesions can rapidly grow and kill the patient. I’ve seen significant changes over a few months or even less. Even worse, you can make the case that the patient would have significantly fewer complications if you had caught it earlier. These complications can include more extensive surgery, more potent chemotherapy with its consequences, or broader radiation treatment plans for palliative care. And the list goes on and on.

Legal Tragedies

Also, with the potential patient tragedies for missing lesions comes the potential for malpractice lawsuits in the “retrospectoscope.” Judges and juries can easily mistake “not-so-subtle” pancreatic lesions for prospectively discovered subtle ones. Along with the possibility of doing significant harm to patients for missing findings, this discrepancy can cause high-cost malpractice lawsuits/claims. If you read enough of these studies, it is only a matter of time before you receive one!

Numerous Additional Findings

In addition to the problem of finding the primary lesion, many different additional findings can change a patient’s management dramatically. These findings can also be very subtle. I’ve seen numerous permutations and combinations of various venous and arterial thromboses that folks always miss. Then, there is a debate about whether a lesion surrounds a vessel and to what extent. This issue necessarily affects whether or not one gets surgery. And I can’t tell you how often that outcome can differ depending on who is reading the study. Of course, you also have subtle lymph nodes with the porta adjacent to the head of the pancreas and within the celiac axis. All these different additional findings that you have to think about can make your head spin. And the consequences of missing them are dire!

Angry Surgeons

Finally, you must contend with the people who ultimately ordered the study. These tend to be the busiest of surgeons. And for that reason, the word “ornery” almost does not do justice. These folks are often on the edge of burnout from overworking and complex patients. They have their requirements for the reader they want and how they want their studies. You will notice at your institution that they might call a study for this surgeon a Dr. “John Doe” protocol because every surgeon wants the triple-phase protocol done slightly differently.

The Triple-Phase Protocol For The Pancreas Is A Minefield!

As you can see, when you find one of these studies coming through your department, batten down the hatches and do not let your attention stray. Making the findings can be challenging, and there are potentially “oh” so many of them. Remember to look at all the images and phases. And make sure to relay all the information neatly and logically. The triple-phase protocol for the pancreas is not for the faint of heart. It’s a veritable minefield of potential misses and problems!

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Is Radiology Training Like Learning A New Language?

language

Over the past few years, I have become more serious about learning Spanish and Hebrew. And after many years of stagnation, both have significantly improved. But what does this have to do with learning radiology as a resident? At first glance, it does not seem much. But as I took a deeper dive into the subject, it had everything to do with learning radiology. Radiology is a new language, different from almost every other aspect of medicine. You will learn a culture and terms you will hear almost nowhere else in medicine. To illustrate this point, when I went to my first noon conference as a medical student, the sound of residents describing and interpreting cases almost sounded like gobbledegook. Does that seem familiar to those who have attempted to learn a new language? It probably does!

So what are the features of successful linguists who can speak fluent second and third languages, which also appear when we learn radiology successfully? It includes everything from attitude to the amount of time you must put in. Let’s go through some of the most considerable similarities that I have found.

Steep Learning Curve

When you learn a new language, it is essential to remember those words that repeat time after time, like want, need, person, etc. So, in the beginning, you can say some simple sentences and string together simple ideas. During the first year of radiology residency, it’s the same. You learn all the basics quickly, including dictation and physics. But stringing together a more complex answer to a case is complicated. For that, it takes a very long time until you achieve mastery.

Don’t Be So Hard On Yourself

Language learning involves a lot of repetition. And, you may not be able to recall a word after seeing it ten, twenty times, or more. If you see learning after much repetition as a failure, you will no longer want to pursue language learning. It is part of the human learning process to forget and remember. Recognizing this natural part of language learning makes you realize you shouldn’t be so hard on yourself. 

Well, the same ideas work for radiology. You may not remember the findings of a particular disease entity or the energies of a radiopharmaceutical. It may be many times that you need to hear it before it sticks in your brain. That process is how human beings learn. We have to forgive our imperfections!

Continued Language Immersion Works

After a while in language learning, you will feel like you have hit a wall and nothing else sticks. But nothing can be farther from the truth. The more exposure you have, the better you get at speaking a language. Similarly, the more you spend time with other radiologists, the better you will become. Many things that we learn are almost subconscious. And, of course, the same applies to radiology learning. We need to constantly read, sit at the workstation, and perform procedures to get more and more exposure. Yes, you are learning, even when you don’t think you are actively doing so!

The More You Put Into A Language, The More You Get Out

The more time you put into a language every day, the quicker it will take you to achieve a significant level of fluency. If you take a thousand hours to learn a language, you will be much better off than studying it for 500 hours. The same applies to radiology residency. Whether you read 1 hour, 2 hours, or 3 hours per night affects how long it will take to become a superstar radiologist later in life. All the work you put in eventually pays off in spades.

Some Words/Accents Will Be Hard To Imitate

Sounding like a native speaker after learning a new language can almost seem impossible. The subtleties of language learning can take forever to achieve. Many language learners never even shed their old accents, but they sound slightly more and more native year after year. The same applies to the radiologist. We constantly strive to become like our favorite mentors and learn the radiology vocabulary. But, to do it right, we must work for years until we get to Shangri-La. Honing our dictation skills and coming up with the appropriate differentials and management on every case is what we all strive for, but never to perfection. We get asymptotically closer and closer to perfect fluency.

Read And Listen A Lot Before Speaking And Writing!

Before you hope to converse in a new language or become a proficient writer, you need to have an active vocabulary at your fingertips and know the sounds of the language. One cannot reasonably start to speak before one gets to this point. The same applies to radiology. Before taking cases and giving your opinions, you must read a ton and listen to your mentors dictating. It takes hours and hours before you have the power to do the same well. It’s a long process before you can dictate cases independently!

Radiology Is A New Language 

There are so many similarities between language learning and learning radiology because they are pretty much the same. We have to walk the walk to talk the talk. So, if you have ever had to learn a new language and have done it successfully, treat learning radiology almost identically. This experience is directly transferable to the process of learning the specialty. And if you have only had experience learning English, that’s okay too. Take some of these similarities between radiology and languages and heed some of the recommendations above. You will find the process of learning radiology a whole lot easier and more fun!

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Best Add-on Subspecialties As A Radiology Attending

add-on subspecialites

Have you ever thought about what would happen if you decided to specialize in an area different from your fellowship? Well, believe it or not, many radiologists commonly accomplish this feat after starting in practice. Maybe they want to try their hands on something new. Or, perhaps the group needs a sub-specialist that they don’t cover well. In any case, it happens all the time. So, what add-on subspecialties are the most conducive to on-the-job training and why? Here is a list of what I think attendings are most successful at tackling after fellowship.

MSK MRI

For many new attendings who already know other forms of MRI, taking up the requirements for MSK MRI is just a little more. There are great sources available. You can find loads of excellent MRI MSK outside courses. It’s relatively easy to find cases to overread at most institutions. Additionally, although present, the legal issues for MSK MRI are lower than for other areas, such as having misses in neuroradiology or a complication from an intervention. All these factors make MSK MRI an excellent modality to start to pick up after you finish your training.

Mammography

You may ask why it is reasonable to start practicing mammography after fellowship when it has the highest frequency of lawsuits from any other specialty. Although true, it also has some of the other lowest barriers to entry:

  1. Most radiologists have had some training in this specialty before working as an attending.
  2. The differential diagnosis is limited (though case management can be relatively complex but learnable on the job). And, it is relatively easy to overread your colleagues’ films. Many courses are available that can give you a refresher on the basics of tomography, MRI, and more.
  3. Most practices require additional coverage in this area.

Cardiac/Thoracic Imaging

Although some rads have completed fellowships, most folks who read cardiac studies such as Cardiac CTAs, calcium scorings, lung screenings, and Cardiac MRIs are not fellowship-trained. So, it is a doable add-on to your current skills. Courses are readily available, and the baseline knowledge needed for calcium scoring, lung screenings, and Cardiac CTAs is moderate. To become a cardiac MRI reader is a bit more time-consuming, but this area is wide open for folks that want to learn. Plus, most practices would love to have an additional reader or two.

Nuclear Medicine

I am not too proud as a nuclear radiologist to admit that nuclear medicine is one of those options conducive to an encore in your career. PET-CT is relatively easy to learn, aside from some artifacts and subtleties. After reviewing and over-reading some nuclear medicine studies, most general nuclear medicine is very doable. Cardiac perfusion imaging can be a challenge for some. But, I know of many radiologists who went to take a course and then came back to read additional cases with a radiologist. And they were excellent with their reads. If you are considering practicing nuclear medicine at any point, pay attention during residency!

Informatics

For this topic, all it takes is significant interest to become the go-to computer person in your group. Typically, by default, you, too, can become the guru. These folks like to play around with computers and are keenly interested in becoming part of the hospital information committees. Also, they are hobbyist programmers and closet geeks who love technology. All you need to do is read a lot and love all the nitty-gritty details of your PACs and information systems. With all this interest, you will have a leg up on the world of informatics and can become an expert in your practice. You don’t necessarily need a fellowship!

The Best Add-on Subspecialties To Practice

I firmly believe that no subspecialty in radiology is out of the realm of possibility once you become a full-fledged radiologist. However, some add-on subspecialties are more challenging when you are out in practice. Nevertheless, MSK MRI, mammography, cardiac/thoracic imaging, nuclear medicine, and informatics have lower entry barriers and are doable if you take an interest and there is a need. Something to consider if you want to try something new and you are out in practice!

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Making Silly Mistakes- Not The End Of The World!

silly mistakes

As I sit here writing late at night, my silly mistakes on radiology reports cross my mind. I can laugh about them now. But, when you first hear about them, they feel somewhat awkward. And I’m sure that you know what I mean. That prostate gland can become a uterus. Or, you pronounce a pregnancy on a patient with ascites. Maybe you say you saw a gallbladder in a patient with a prior cholecystectomy. It’s just a matter of time before it happens to you. If it doesn’t, you probably have not read enough scans! So, how can you make this experience a bit more comfortable? Here are some of my main words of advice to prevent you from being too hard on yourself.

Don’t Take Yourself Too Seriously

In the medical profession, many physicians tie their identities to perfection. Many of us encounter these physicians in medical school and our residency training. They tend to be miserable people. However, self-aware physicians will never make this mistake. We have to be able to admit that we will have our errors. And, if you do not make your identity perfect, you will look back and figure out how you made the silly errors you made. You might even laugh about them and enjoy the irony!

Realize Mistakes Will Happen

It’s not just a perfection issue. When you interpret enough films or perform more than your fair share of procedures, statistics say you will make a silly mistake. We can’t beat the numbers. And, the sooner we get through that notion, the happier we will be.

Silly Mistakes Are Learning Experiences

I found that each mistake is a learning experience, silly or not. When I think about how, when, and where I made a mistake, I understand the conditions that caused the problem. Did I go through a case too fast because it was the end of the day? Under what circumstances did I forget to look at the patient’s sex? Was I interrupted or too tired? Did I miss a finding because I neglected my search pattern, or was it a lack of knowledge in a particular area? Each of these questions allows us to delve deeper into the circumstances of an error and forces us to confront the truths so that it won’t happen again.

Silly Mistakes Can Be Teaching Tools!

Instead of covering up my silly mistakes, I use them as teaching points for others. These moments can be some of the most fun teaching tools. Moreover, they can make great stories. Who doesn’t like an excellent allegory to make that point stick? I would have been much less likely to do the same if I heard one of these ridiculous errors.

Yes, You Are Allowed To Talk About Your Silly Mistakes!

We are all human. When you dictate 10,000 reports containing 100 words, that’s a million. Just by sheer statistics alone, it’s only a matter of time before you say something ridiculous in one of those million words. So, get off your high horse and own your silly mistakes. At least make them into something useful!

 

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Making A Radiology Schedule Can Be Tough!

radiology schedule

In any stage of radiology, we all want the best schedule possible. Most of us hope for rotations where you can enjoy what you are doing, perhaps within your specialty. We desire vacation time that is fair and equal to others in a similar specialty/situation. And, you want a call that is equitable and reasonable compared to everyone else. Not all rotations fit that bill, though. Nor is it possible to accommodate everyone all the time. If you tweak one person’s schedule, you can make someone else life miserable. The balance is delicate. It’s kind of like when you give medication, and it comes with untoward side effects! So, if you are helping out with the schedule at your institution, how can you make the radiology schedule as palatable as possible for everyone? Here are some of the guidelines that work at our site.

Get The Appropriate Tools For The Radiology Schedule

Our main job is practicing as a radiologist, not as a scheduler. So, make sure that you get all the necessary tools to make your job as easy as possible. Whether it is radiology scheduling software, a business manager, or a secretary for the practice, you should have some assistance to help you along the way. Don’t try to make the schedule without these tools. It is below your pay grade!

Be Redundant

We all are human, and calamities befall all of us at one time or another. Whether it is sickness or taking care of loved ones, we have to expect that not all of us will be available on any given day. So, every practice needs a little bit of redundancy in the schedule. That way, your practice will have adequate coverage when these events happen. It is not feasible to allow just a skeleton crew to steer the ship. It can become a potential recipe for disaster if some calls out sick!

Communicate All Schedule Changes Well

In practice, this statement sounds entirely logical. But, often, lack of communication can represent the downfall of a radiology department. If you decide to change a location or rotation, you need an excellent system to communicate the change. And, preferably, you should make the change well in advance of the new schedule. Radiologists have plans too!

Make Sure There Is A Balance

If you want to stoke the anger of your colleagues, the best way to do that is to make sure that one radiologist gets the most cush rotation at the expense of everyone else. Therefore, it is critical to monitor the different calls and rotations and ensure that the numbers are as equitable as possible for each practice member. This step can be time-consuming. But, recording where each radiologist is working and how many calls they work should become a critical mission to improve the schedule.

Be Nice But Firm

You can’t always get what you want. (Just like the Rolling Stones song!) Sometimes, we need to cover rotations and calls that no one wants. And, everyone at some point will have to take one of these shifts regardless of how they feel about it. So, if you are in charge of the schedule, there are times you have to hold your ground for fairness’ sake, of course, in a friendly way. Scheduling can be a tough job!

Take Suggestions For The Radiology Schedule

Making a schedule for a practice can be complicated. And, you might not have the experience to know what makes sense in all of the subspecialty departments. Therefore, a scheduler must be willing to listen to the suggestions of those folks that may know the rotations and schedule in their area the best. Without the input of others, it is unlikely that you will be able to create a reasonable plan for everyone!

Making A Fair Radiology Schedule

Scheduling is a critical part of any radiology practice. And it is not easy. Moreover, it may be impossible to satisfy everyone. But, if you have the tools you need and take into account the input of others while listening to some of my suggestions, you can make a schedule that will maximize equitability for everyone. It is possible to make a reasonable schedule for your residency or practice!

 

 

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You Will Have A Bad Radiology Day!

radiology bad day

Almost all of us start as wide-eyed, enthusiastic residents, ready to absorb nearly anything. I know I certainly did when I first started. But, eventually, at some point, all the planets will align the wrong way. Maybe you missed a finding and then dealt with an angry surgeon. Then, that same day, you had a heated argument with an OB/GYN resident who ordered an inappropriate study. Or, the chairman chews you out for not helping out one of the referring clinicians. Regardless of the number or sequence of events, you must expect some bumps in the road. As much as I like radiology, unforeseen problems will occur. So, how do you get your head back in the game after a bad radiology day like this? Here are some tips to help you proceed when you feel the radiology world is not in your favor.

Play The Long Game

I am sick of the cliche: “Residency is a marathon, not a sprint.” But, it is true. You have four years during your residency to learn and fulfill your goal of becoming a competent radiologist. A bad day here and there is not the end of the world (although it might feel like it!) For this reason, keeping your long-term goals in mind is essential to keep you on track. You can think of a bad day as a life lesson that will make you a stronger radiologist at the end of your residency.

Learn From Your Bad Radiology Day Mistakes

You may feel that miserable lump in your throat when you’ve made your mistakes. It’s never fun to miss appendicitis or have a team of surgeons berate you. But, good residents and learners will take this opportunity to self-correct and avoid making the same mistake twice. This principle is practice-based learning in a nutshell. Those who succeed at this will eventually become excellent radiologists, even if it doesn’t feel like it right now.

Maintain A Positive Attitude

Remaining positive can be a tough nut to crack in the face of stark adversity. But enthusiasm and positive attitudes do go a long way to getting you through that bad day. If you let the negative Nancy nay-sayers get to you because you are having a bad day, how can you treat the next patient well? We have to remember our goal as physicians is to help patients. A negative outlook will not allow you to fulfill your true potential.

Take A Mental Break

Sometimes, you need to give your mind and body a break. Listen to some music. Read that book that you always wanted to peruse. Every once in a while, getting your mind out of medicine is healthy. The perfect time to do so is after a bad day. Allow your mind and body to recalibrate. Human beings should not be on task 24 hours out of every day. It is healthy to take a break (contrary to the popular belief of some program directors!)

Learning From Your Bad Radiology Day

Not every day will inevitably be in your favor. The world does not work like that. But, if you play your cards right, you will come out of this day more enriched than when you started. It’s a matter of perseverance. So, remember why you are here, learn from your mistakes, maintain positivity, and give yourself a well-needed rest until you are ready to start anew. These techniques are some of the tried and true methods that will get you back into shape to practice radiology, prepared to work another day!

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Why A PACS Crash Can Be A Disaster!

pacs crash

Many of us have become numbed by the PACS crash. Yes, it can ruin our day and prevent us from completing our work. And, it can cause us to finish up work late. As well, we joke about it as just another technical glitch that we have come to expect. However, there are real-world ramifications to the PACs crash that we don’t discuss but should take a bit more seriously. For this reason, we should have vigorous backups and supports for the systems. Here are some of the potential tragic issues that patients, physicians, and radiologists can face.

Missing Findings

I don’t know about you. But, when I am in the zone, I use all my search patterns and am thorough, going through all the anatomy that I need. But, when the PACs crashes in the middle of a case, you lose track of where you were. Well, that’s when bad things happen. You lose your train of thought. Perhaps, you forget to look at the adrenal glands or the spleen. It is now that radiologists miss critical findings that can be detrimental to their patients.

Even worse, when the PACS crashes at nighttime, the ER can bombard you with loads of phone calls and prevent you from getting a wink of sleep. When you wake up the next day, you are barely awake. It’s a setup to missing even more findings!

Incomplete Information Leading To Bad Treatments

Unable to pull up priors or histories? Well, you know what they say: Garbage In. Garbage Out! That PACS crash can cause incomplete reports that won’t even answer the question that the clinician asked. This lack of information can lead to patient disasters and poor outcomes. How is the poor radiologist to know the diagnosis of the patient when there is no history anywhere?

Significant Loss Of Revenue For The System

If you can’t dictate, you can’t get paid. PACS crashes can lead to problems with demographics and matching patients to studies. And that’s only the beginning. Depending on the severity, it’s possible to lose tens of thousands of dollars with a long-term PACS crash. A PACS crash can cut the imaging center or hospital’s bottom line!

Angry Physicians And Patients

And then there is the ill will you build with the patients and clinicians. Who wants to return to an institution with delays and constant technical malfunctions. What’s the point when they can go to the institution down the street? It is tough to build back goodwill once it is lost.

Inability To Make Emergency Diagnoses

Hemorrhagic strokes, appendicitis, and more significant disease entities can cause morbidity and mortality. We, as radiologists, find these entities all the time. And every second counts. When you lose your PACS system, you lose those valuable seconds to save a life potentially.

Potential Legal Ramifications

Even when the system comes back up, everyone is on the hook. All the misses, delays, and anger can cause lawsuits and the potential for long hours with an attorney. Not to mention all the legal fees your practice can rack up when dealing with the misdiagnoses and angry patients you could not help because of a PACS crash.

Loss Of Confidence In The System

Finally, PACS crashes can cause lost confidence in the system. These systems can be a hospital, imaging center, or clinic. Anytime you lose information, you lose trust. These patients may never come back to your department again if the PACS system does not work. It can be a permanent loss!

A PACS Crash Can Be Devastating! 

Most tend to make fun of the ineptitudes of information technology and the folks staffing them. However, there is a real-world consequence when the PACS goes down. Patients can get hurt, and we have the potential to be at fault legally. Physicians and referrers struggle. And, the radiologists can look like fools. So, the next time your hospital looks for a PACS system, make sure to get involved and find a reliable and redundant system. The last problem we need is another PACS crash!

 

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What To Do If You Have A Blemish On Your Radiology Application!

blemish

Some of you are applying for radiology this year with a blemish. Maybe, it’s a course or two in medical school that you initially failed but later retook it and did fine. Or maybe, you had a tough time in one of your clinical rotations because of an errant resident or attending. Regardless, now is the time you need to deal with these issues. Why? Because radiology has become more competitive, many program directors toss aside many applications with a blemish since there are many without them. This problem can also be the case, even though you would be an excellent candidate for radiology. So, what can you do?

Own The Blemish

First of all, don’t disregard the facts. Own your blemish. Yes, you may get fewer interviews than others. But, if you play your cards right, you can increase your chances of acceptance at sites where you interview.

By owning the blemish, you need to have insight into what caused it in the first place and use it to make you stronger. Yes, it will affect you. But, you need to address the issue. The program director will ask you about it. So, explain in your personal statement. Show what you learned from your blemish and why it can be a strength rather than a weakness. No radiologist is perfect,  Don’t go hiding it or sweeping it under the rug. Most programs will know or find out!

Complete Radiology Research

Radiology research is the grand equalizer. It shows that you are interested in radiology even while busy with an internship or senior-level courses. And, it allows you to succeed even though other parts of your application are subpar. It is not a cure-all, but it can compensate for some faults elsewhere. Heck, a paper of yours that gets into the New England Journal of Medicine will undoubtedly elevate your application to a much higher level!

Ace Your Internship/ Senior Level Courses

This statement goes without saying. However, many applicants concentrate so much on the blemish that they don’t get the grades in their most recent courses or internship that will give them that needed boost. Don’t forget that your current courses can count just as much as the blemish. If you don’t perform well on your current rotations, all may be lost!

Do Well On Your Remaining USMLE Exams

All is not lost if you did not ace Step I or even II. Yes, it will make it a bit harder since many programs screen those exams. But, whether it is step II or III USMLE that you need to take, they can still matter a lot if you do very well, especially while you are busy with other endeavors. It shows you can handle stress well and have the potential to pass the radiology core exam.

 And remember, for those of you who have not yet graduated, USMLE step I is no longer going to be scored in the future. So, the Step I exam will become less of an issue (unless you fail, of course!)

Get To A Know A Radiology Residency Program

Finally, try to get to know the faculty in a radiology residency near you. Maybe, you are in medical school and have access to the folks in a residency program. Or you are amid an internship. In any case, attempt to get to know the staff in the local residency program. Ask to meet with the faculty or participate in projects. These connections can help get them to know you as a person and not just as an application with a blemish!

Applications With A Blemish: All Is Not Lost!

I cannot give you a money-back guarantee that you will find a spot in a residency with an application blemish, especially as radiology has become a bit more competitive. However, in most cases, all is not lost. If you own the blemish, complete research projects, do well at your current level, ace the following USMLE exams, and get familiar with a radiology residency faculty, you can surely up your chances of getting accepted!

 

 

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New Tax Laws Cancelling The Backdoor Roth IRA- A Major Loss For Radiology Residents!

backdoor roth IRA

Debt, burnout, declining reimbursements are some of the issues new radiologists need to face. But, yes, the hits keep on coming. Now, new radiologists also have to contend with a potential loss of the Backdoor Roth IRA. Again your future has just become murkier.

Right now, in Congress, Senators and representatives are duking it out over taxes and how to raise money for a multi-trillion-dollar spending bill. One of the line items on the agenda is the cancellation of the Backdoor Roth IRA, as the public perceives it as a tool for the rich to save on taxes. So, what exactly is a Backdoor Roth IRA, and how will this affect you? And, most importantly, what you can do to help to stop it.

What Is A Backdoor Roth IRA?

Let’s first start with what a Roth IRA is. A Roth IRA, which many of you know, is a post-tax account that accumulates tax-free for the rest of your life. Most residents should put as much into this account right now while they have a low salary and are underneath the income limits. The Roth account allows any future earning on this money to grow tax-free in perpetuity, even when your income climbs as an attending.

A Backdoor Roth IRA is also a Roth IRA. But most radiologists cannot put money into a Roth IRA directly because there are income limitations (you need to make below 140,000 as a single filer and 208,000 as a married filer in 2021). 

However, there has been a loophole. Any high-income earner can first put money into a Traditional nondeductible IRA and immediately convert it to a Roth IRA. Now, you essentially have the same Roth IRA as any earner below the limits has. 

Why Is/Was It Such A Great Option For Radiologists?

I have been using this savings vehicle since we were allowed to start in 2010. It has allowed for outsized tax-free earnings on money that I have put in the account. Not having this account would have significantly negatively impacted my savings. It is truly one of the last tax breaks for high-earning professionals like radiologists.

Because of the power of compounding, the younger you are, the more beneficial the account is. So, any resident should be concerned about Congress eliminating this Backdoor Roth IRA because it impacts you more than someone like me who has already been depositing into this account for years.

Moreover, you never had to pay another dime of taxes on the money you put inside the account. Granted, at present, it is only 6000 dollars per individual or 12,000 dollars for a couple. But, that number rapidly increases over time with the tax-free earnings and rising yearly contributions pegged to inflation. Over the long run, it was an excellent tool for avoiding tax drag on your accounts.

Finally, some radiologists may be in a high tax bracket when they retire because they may have most of their savings in 401k type accounts. It allowed for some money not to be taxed and hedged your bet about future taxes and earnings on your withdrawals.

What Can You Do Prevent Congress From Cancelling The Backdoor Roth IRA?

Every radiology resident should be writing to their congressman and asking them to refrain from canceling the bill. You have so much debt. You don’t start earning real money until late in life. And, you have been taking on the burden of Covid. I see this as a stab in the back for all future high-earning physicians. Of course, radiology residents are not a large bloc of citizens. But, every person counts. So, consider writing to your congressman to add to the lobbying in your congressional districts!