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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Are Less Paperwork And EHR Selling Features For The Radiology Specialty?

paperwork

As I was scrolling through some random Twitter feeds that came up in my email, I saw the following statement come up from a fellow physician: “Physicians should not use the amount of paperwork as means to decide on which specialty they should choose.” Well, as I stared at this statement, I became more and more incensed. Why? Because many burgeoning medical students were possibly looking at this Twitter feed. And, some may utilize this suggestion as they search for their specialty of choice. Meanwhile, this statement/question could not have been further from the truth. An excessive amount of paperwork could ruin the most glamorous and exciting medical specialty work.

High Paperwork Burden And Electronics Health Records (EHR) Use Is A Cause For Burnout

One of the main reasons for burnout and lack of interest in a specialty is the excessive paperwork and the inordinate number of clicks on an EHR system. This person suggested that medical students should ignore this factor and go into a subspecialty regardless. Now, I don’t know about you. But, for me, one of the best parts of radiology is having to deal with much less paperwork than our colleagues in other subspecialties. I delight in not having to constantly document interactions with patients and write tons of prescriptions, and mull through a myriad of HIPAA forms every day. These are tasks that would have made me miserable. And, we, as radiologists, do not have nearly as many of these issues as other subspecialties.

Of course, I also chose radiology based on the diversity, large information base, and my interest in technology. But, if I knew at that time that we had so much less paperwork than most other specialties, that would have indeed reinforced my decision. I certainly would use it as a way to choose between several subspecialties of interest!

Should We Use The Benefit Of Less Paperwork To Our Advantage In Recruitment?

Now, telling medical students that they should choose our specialty because we have less paperwork is like saying to become a secretary because you get to sit down all day. Sure, it is a perk of the job, but not the reason for joining our fold. But if presented in the right way and placed in the context of how other specialties have to deal with the work daily, it could become a game-changer. Have a student ask an internal medicine doctor how much time you spend on dictating reports and phone calls. And then have them sit with them while they are doing these tasks. The amount of time spent away from the more exciting patient care activities may shock them!

Then, have a student sit next to a radiologist on any given day. And let them see the amount of time we get to spend on patient care activities such as looking at films and performing procedures. They will see a significant difference between the amount of paperwork and EHR time. Then, they can use these factors as a valid means to deciding on which specialty is right for them.

Let The Student Decide On A Specialty Based On The Facts!

We all should choose a specialty in medicine based on the facts, not on emotion alone. One of those critical factors is the amount of paperwork and EHR. It is a pressing problem. And, pundits should not gloss over the unenticing aspects of a specialty. Practicing a medical specialty is not just about the glorified moments in the operating room or with a patient.

In reality, you can’t always do only the things you love. You also need to accept the facts of any specialty. And, if excessive paperwork is one of those realities, students need to know about it and make an informed decision. Negative information cannot just be swept under a rug when you make your specialty choice!

 

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My Experience With The Powerscribe Undo Button: A Call For Better Technical Radiologist Training!

undo button

I find one button on Powerscribe more satisfying than almost any other. No, it’s not the sign button, although signing off a study feels quite rewarding. Indeed, it’s not the auto text button. However, I press that one all the time to make my templates. And it does shorten my dictation time. Instead, it is that button typically buried in the edit menu of Powerscribe, the lowly undo button. I can’t tell you how many times I clicked the wrong button to lose half my dictation. And then I clicked on the Undo button to restore it to how it was.

Most of you are aware of this undo function. It returns anything you did before to its previous state as long as it was a line of spoken text, a cut, or a paste. But imagine not knowing about its existence. Well, that was my world as an attending physician for a good year or two. Now, it is embarrassing to release this information to the masses. But I have to let it out. It is true. I spent eons trying to recreate what I had dictated before without knowing there was a simple way to retrieve the information. I was not aware of the existence of the undo button for way too long. Imagine that.

The Undo Button: A Symptom Of A Bigger Problem With Radiology And Technology

This point about the undo button brings me to one of the most significant technical radiology issues. We, as radiologists, don’t know about so many computer and technology functions that can potentially make our lives easier and shorten our days. Now, maybe this issue is somewhat magnified because I have reached middle age, but I don’t think that is the case.

I have seen younger physicians, like residents and early attendings, who need to learn how to link two studies together and compare them slice by slice. I have seen other attendings needing to be made aware of the simple functions of our software for calcium scoring, which would have saved them tons of time. And there are many other time-saving technology tools I am unaware of. If all the radiologists were to pool their technology know-how together, we would all shave off an extra hour of work every day. So, why do we not receive the technical training we need to make us more efficient at our job?

Radiologists Do Not Receive Formal Training Because We Are Expected To Learn On Our Own

Many radiologists jump headfirst into the world of dictation and PACS without receiving any formal training. Many of you who work for hospitals and imaging centers know what I am talking about. As a resident, I cannot remember any technology folks training the residents on using PACS. That same philosophy has continued throughout the years. Hospitals and imaging centers expect us to use our highly paid professional time to figure it all out independently.

Technology Trainers Don’t Know How To Train Radiologists

Several things happen when we get the “training” we need from the technology folks. First, they show you what you can do and allow you to play around with everything. And then they say you need to use it for a while to get accustomed to it. While that is undoubtedly true, we often miss out on multiple functions and knowledge that can increase our efficiency. The problem is that the technology experts training you are not radiologists. And they will never know the most important functions we need to use.

Lack Of Time/Money Dedicated Toward Training

Or, once in a while, you will get an excellent technology expert who will try to help you by creating hanging protocols, setting easy keys, and more. Some may become irritated when they realize they need to sit down with you for an extended period to make the technology precisely how you like. Or, the institution received a package deal that included limited training for the radiologists. The bottom line is that you may receive less education than you need.

Learning The Undo Button: A Simple Solution To Improve Workplace Efficiency

So, why do I bring up an entire blog about a simple undo button and the issues that go along with it? Well, it is a cry for good, down-to-earth technology instruction that every radiologist should have. We, as radiologists, hear about burnout and misery all the time. But, it is the little things that make radiologists happy. Radiologists are highly paid professionals who should become as efficient as possible to save time and money. Many excellent radiologists have left the field because of simple technology inefficiencies such as this one. Coming home 20 minutes earlier every day to be with our families should be a much bigger priority for radiology practices and hospitals. Improving radiologists’ technical and computer training is a simple and relatively inexpensive fix.

 

 

 

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The Doximity IPO: What To Do With A Small Windfall As A Radiology Resident?

windfall

Last week many residents throughout the country had the foresight and were lucky enough to get involved with the Doximity initial public offering for stock. It was a rarity because, unlike most IPOs, only doctors could get in on the initial public offering (IPO) action instead of the finance guys. Physicians were able to purchase up to 250 shares. In a few short hours, what was initially an investment of up to 26 dollars a share (6500 dollars), climbed to 55.98 dollars. On that one day alone, you could have made ((55.98-26)*250 or 7495 dollars. That would represent a 115% profit in one day. Not all bought the maximum number. Regardless, although not life-altering, for a resident, that means a significant sum of money compared to a typical resident salary. You could call it a sort of windfall.

Sure, there is lots of information out there about windfalls for physicians. Check out some of the articles on the white coat investor- My Experience With A Windfall. Or, you can read about What To Do With A Windfall.

But, most are not specific to your situation. Some may tell you might plunge that money back into the market. Others say take it and pay off your credit card debt. (Those folks should probably not have done the Doximity IPO in the first place!) And, others may decide to repay some more interest on your student loans. But what is the right place for you to plug that money in as a radiology resident? Are the considerations different for a radiology resident than other types of physicians?

Personal Finance Is Personal- What Is Right For You Might Not Be Right For Everyone (Except For Credit Card Debt!)

First of all, anyone with credit card debt should probably remove that debt immediately from your life. That is a no-brainer. Of course, that simple tenet is not just for the radiology resident. But, it is indeed a personal situation. Anyone paying interest over 10-15 percent is slowly getting their financial life sucked away like a Hoover.

But let’s assume that you are without credit card debt and have a decent amount of student loans. Currently, most of you have loans that are accruing very little interest because of the low-interest-rate environment and all the deferments from the pandemic. So, it is reasonable not to plug all the money back into the student loans. On the other hand, debt can be burdensome and a proverbial noose around the neck for others. What to do next depends on your tolerance for debt and your financial situation.

Where Should The Windfall Go If Not Student Loans (Think Roth!)

If some of the windfall is not going back into student loan debt, where should it go?. To answer this question, if you haven’t done so already, it is time to get a head-start on investing. You are already behind the eight-ball as a physician. So, filling a Roth IRA with an index fund would probably not be a bad start for most of you. One of the best financial decisions I made many years ago was to start a Roth IRA when I was in residency. A small amount has significantly increased in value over time. So, with this small windfall, consider taking some of the money and adding it to a Roth IRA.

Reasons For Radiology Residents In Particular To Choose The Roth IRA

How does being a radiology resident change the equation about where to put the money? Well, because you are more likely to make a higher salary than your pediatrician and internal medicine colleagues, you may want to consider putting more into investments than loans.

In particular, for two reasons, the Roth IRA even makes more sense for the radiology resident. First of all, your salary will be higher as a radiologist, so you will have to pay more taxes on the amount of post-tax money you put in than your lower-salaried colleagues. So, now is even a better time to take advantage of your low tax situation.

Second, you can afford to be a little bit more aggressive than other specialties. More future dollars allow you to put more into stocks because you can afford more risk. So, putting more away into investments can make more sense.

A Small Windfall And Investing For The Radiology Resident

Opportunities arise from time to time, and you may find new money, such as the Doximity IPO. As a radiology resident, your situation may differ slightly from other physicians. So, based on your risk profile, consider taking a bit more of your windfall and investing in a Roth IRA. That’s what I would do if I had a few extra dollars and were still a radiology resident!

 

 

 

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The Radiology Residency Exit Interview- Why Should You Care?

exit interview

You’re finally about to hang in the towel. You’ve taken and passed your core exam, completed all your overnights, given your last tumor board, and finished your final residency dictation. Suddenly, you receive a call from the program coordinator. He says the residency program director wants you to come to her office for your last exit interview. Why even bother? What’s the point of a final discussion when heading out of Dodge anyway? Well, let me give you some reasons why this interview is the most important of your residency from a program director’s perspective.

Want A Recommendation?

Believe it or not, even after you leave your residency, faculty still receive phone calls from your employers if you are looking for a job or decide to change to a new one. And the last thing that you want your residency program director to say is, “That darn resident, he didn’t even care to give an exit interview.”

These folks that call for you from your subsequent practices are serious. And any bit of bad news about you can derail your next great job. Especially when the job market may or may not be the same as it is now!

No Holds Barred Summary Of Residency Issues

After residency, you feel you have no more obligations to the program. Anything you say now is not encumbered by your desire to impress or achieve. You can now have a heart-to-heart with your program director without any of the “BS.” It’s a great time to give the real lowdown on the residency, both good and bad. This interview is the best time to get a reality check on your program from the program director’s perspective.

The Exit Interview– A Last Chance For Great Residency Advice

For the resident, now is the time to ask any burning questions about how the world works, what you need to do to become great, or other residency-based training tidbits you can use for the rest of your career. So, residents will usually ask excellent questions at this time, right before they leave. Residency is usually a once-in-a-lifetime experience. And becoming an attending is so different. Subsequently, residents will often ask inspired questions to learn what they need to succeed in their next radiology life!

Maintaining Contact Information

Not everyone will remain in the same institution forever, and the same goes for your residency faculty. This interview is an excellent last opportunity to cull the contacts from your residency. Get those phone numbers, linked-in addresses, and social media connections finalized. You never know when you will need to contact your faculty again. It may be to consult on an interesting case, recommend a new job, or just to say hi. In any case, keeping this information safe and sound is critical!

Making Sure Everything Is In Order For Future Jobs- They Do Check!

Procedure logs, iodine treatments, and the number of cases completed are critical statistics that your next employer may need. So, ensure you have all the information you will require before you leave. To get hired, you need to back up your previous experiences. Also, make sure that your learning portfolio is all squared away and that you have records of all the academic research, presentations, and posters safe and sound. Often, you will continue to need all this information well into the future. This interview is your last shot at getting all of this straight!

The Radiology Exit Interview- A Critical Component

Between all these factors, including recommendations, giving the real low down on residency, getting some quality advice, garnering contacts, and ensuring everything is in order for your future career, the radiology exit interview is an integral but final component of the residency process. So, it has many more uses than you may have thought. You are not just paying homage to your residency program. Instead, you are providing a genuine service to your future career and helping out your program director. Therefore, you should take the interview seriously. During residency, it is your last chance to help out your program and ensure a great future for yourself in your radiology career!

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How Do I Gain Confidence To Read Complex Cases Outside Subspecialty?

confidence

Question About Confidence About Reading Outside Subspecialty

I will be completing a neuro fellowship in one year. Still, my potential job opportunities require that I read everything, including MSK and Body MRI, which I don’t have the confidence about for one reason or the other. I need to learn to read these studies; how do I do this? Would I have to do a second fellowship?

Not quite sure how to proceed!

Answer

Yes, many of the great radiology opportunities indeed involve generalist work with the ability to do your subspecialty (in your case, neuro). And, from my experience, most general radiology practices expect that their neuroradiologists cross over to all sorts of other subspecialties within MRI in addition to the sophisticated neuro cases. So, the big question here is how you get the confidence to read other complex subspecialty cases outside your wheelhouse. And, I believe in your situation, a second fellowship is most likely not the answer. How do I know that? Well, I have already been there.

So, what did I do to ensure that I would feel confident enough to read MSK MRI on the job even though my primary specialty was nucs? During my residency training, I made sure to read extra cases in the modality when I was on site. I accomplished some of this just before my fellowship in nuclear medicine. And, this was in the days just before PACs started. So, it was much harder to do back then.

Nowadays, it’s much more manageable. Start picking up cases from the PACS, read them, and then look at the dictations afterward. This method is a simple way to gain confidence and familiarity with other specialty areas you usually don’t read. You can even do this at your up-and-coming neuro fellowship since most are affiliated with a hospital or outpatient center that does MSK MRI. So, I would try this first. How do I know this will work? Well, it certainly worked for me. I feel reasonably comfortable with reading MRI MSK to this date.

Of course, your confidence will continue to build even after you start working. However, at least you will give yourself a head start if you begin the process. I hate to say it (because I’m not too fond of the ABR jargon), but this skill is what the ABR calls practice-based improvement in a nutshell!

That’s some advice that has worked for me!

Barry Julius, MD

 

 

 

 

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How To Prevent Home PACS Systems From Causing Chaos

chaos

We all have different ways in which we like to work. Some folks find that clutter and chaos foster creativity. And others can’t stand the slightest mess in front of them (or behind them!) I am in the first camp. I find clutter a bit cozy, allowing me to feel comfortable sitting down and starting to write. It is almost like a stimulant. But, this layout does not work for everyone. So, figuring out where to put a bulky PACS system in your office is no small task. Your well-being depends on it.

Integrating our newfound large multi-monitor computers into the overall theme of our office caused chaos. For those of us with other family members in the same workspace, these systems can interfere with the room, taking over large swaths of workspace real estate and increasing the appearance of clutter even more. So, how do you ensure the PACS does not dominate the room? And how can finding a space for it allow the rest of the family to coexist peacefully? Based on my experience, here are some tips to avoid family disputes over losing working real estate to a PACS.

Get A New Connection For A Better Workspace

Sometimes, the internet connection can limit the options for arranging a workspace. I prefer a direct hookup of the PACS system to the ethernet rather than a wireless connection. The information just gets sent to the computer that much quicker. If you don’t have the correct arrangement of hookups in the office, you may be unable to place the PACS in the right spot. Well, there is a quick fix for that. Just get a new connection and put it wherever you want!

Put The System In An Unused Space Within The Office

Only some offices have a ton of space. But, occasionally, a room may have an underutilized unique niche where that PACS system can go. It could cover up a blemish in the room or, even better, make it look more like an office. Go ahead and fill that spot with the computer system. See how it fits. It may make the office space feel like a great workspace.

Build A New Enclosure Within The Room For The PACS System

You may have the room for the PACS at other times, but you may need the appropriate spot to place it. To ensure that you can have the space you desire, you need a bit of creativity to reshape the room, add a desk, or build some cabinets around it. Either hire the carpenter to create what you want or do the woodwork yourself. Either way, a new enclosure may be all you need to make the workspace of your dreams.

Divide The Room

You may have no other option but to divide the room into two. One person wants their workspace without interruption, and the other can’t stand that eyesore called a PACS system. If you have the space to divide the room into two, go for it!

Find Another Room Altogether To Prevent Chaos

OK. Only some people have space in the house to create another office dedicated to a PACS system. But, sometimes, finding that extra room is the only solution. You can’t put an entire PACS system on top of another family member’s workspace. It’s a great way to create a battle royale!

Removing The Chaos Of A New PACS!

For many folks, a bulky PACS system is a necessary evil. It is an eyesore. Yet, it is what allows us to improve our radiology work-life balance. Before plunking it down somewhere random in a room, consider making it more appetizing for everyone. Whether it takes making a new connection, finding a new niche, building a spot for the PACS, dividing the room entirely, or moving somewhere out of the space completely, making space work for everyone is critical. Placing the PACS in the right spot should be more than an afterthought! 

 

 

 

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Don’t Hesitate To Call Your Colleagues!

call your colleagues

One of the most challenging parts of becoming a radiologist is developing an awareness of when you don’t know something. Of course, when you discover what you are missing, you can look for information on the web to fill in some gaps. But, just as important, it is also critical to know when you need more than your research. Many times, experience alone can teach you the correct diagnosis or management. As a radiologist, I don’t hesitate to pick up the phone if I doubt that I can get the information myself. I call the expert in the subspecialty. So, what are some benefits when you reach out to your colleagues? Well, here are some of the advantages that I have encountered.

Experience Trumps Books Sometimes

Most books only give you some information on how to make a diagnosis. Sometimes, only a vast breadth of experience can help solve some cases. And, if you don’t know, what are the chances you can make that diagnosis? Much less, of course. So, finding someone who can confidently read that temporal bone study can make all the difference in diagnosing a rare congenital disorder. Doing the research yourself is different.

Subtle Management Issues Are Not Easy To Find Online

Many times, you can figure out the patient’s diagnosis, but you can’t find any resources to tell you what to do next. Again, managing a patient’s condition can sometimes only be appropriately triaged when you have made the diagnosis before. So, why not pick up the phone and find the expert who has managed this patient many times? Get it right the first time!

Call Your Colleagues To Increase Confidence In Your Dictations

Other times, you have all the necessary information to make the appropriate recommendations. But what you need is confidence in your report. And it reflects in your dictation. When you speak to an expert colleague, you can confidently diagnose and confirm the next steps. Why not be sure of what you should do next?

Better For Your Learning

When I hear information from someone else, I retain the knowledge more than by looking up a fact in a book or online. Your colleagues will often relay the information on the phone more excitingly so that you can remember the case for a long time. They may give you other examples of similar patients or situations. Or, they lace the information with a good joke! Regardless, sometimes, hearing input from others is the best way to learn.

More Time Efficient To Call Your Colleagues

You can sit around researching information forever or ask someone who has trained for years in the subspecialty and knows a lot. Which one will save you more time? That phone call to your colleague can save valuable minutes of your time and energy. We only have so many hours in a day!

You Will Begin To Get Consults From Others As Well

One of the most exciting parts of becoming a radiologist is getting interesting consults from others. When you ask questions of others, you are also more likely to get consults from your colleagues. They will feel comfortable enough to reach out to you when you have a patient in your subspecialty when they don’t know how to proceed. It’s good to feel needed in your practice!

Don’t Hesitate To Call Your Colleagues!

When you call your colleagues about something you don’t know, you gain experience that you don’t have, learn esoteric management skills, increase confidence, educate yourself, improve time management, and gain the trust of others. So, why not pick up the phone and call your colleague? It is an essential ingredient for excellent patient care!

 

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MOC And Practice Based Improvement: Easiest Ways To Satisfy The Requirement!

practice based improvement

As a steward to my private practice to keep everyone up to date for ABR maintenance of certification, one area more than any other has caused more confusion. And that is practice-based improvement. In the beginning when the ABR created this requirement, it was not clearly defined. And, it has undergone a more significant change than any of the other requirements that the ABR demands. Now, to this day, I still get radiologists in practice asking me – “How can I satisfy this requirement?” No doubt it isn’t all that apparent.

So, let me refer you to the ways to meet these ABR requirements (just click this link). It will describe what you need to satisfy the requirements of the ABR. But, for those of you that hate reading meaningless dry lists, let me give you my interpretation of six of the easiest ways that you can meet this obscure requirement!

Easiest Ways To Satisfy The Practice-Based Improvement Requirement!

“Participation as a member of an institutional/departmental clinical quality and/or safety review committee”

Most radiologists who work with or for a hospital have to be a part of a safety committee. For me, I am part of the nuclear medicine QA and MRI quality committees. So that fits the bill as meeting this requirement. But almost any committee that has anything to do with safety would satisfy this ABR requirement if, god forbid, you had an audit!

“Publication of a peer-reviewed journal article related to quality improvement or improved safety of the diplomate’s practice content area”

This requirement is also pretty benign for those who work for or with a radiology residency program. Nowadays, most academic and pseudo-academic world departments need to work on a quality improvement project with residents. It is pretty easy to get your name on one of these articles if you have a residency program. Most residents would be happy to have you on their project to help them out a bit!

“Participation as a member of a root cause analysis team evaluating a sentinel or other quality- or safety-related event”

Left up to interpretation, this can mean being a compliance officer or part of a team responsible for morbidity and mortality conferences. Many practices have baked this conference into their partners’ meetings already. So, you may be satisfying this requirement and may not even know it!

“Regular participation (at least 10/year) in departmental or group conferences focused on patient safety.”

Again, you may be doing this already. Many radiologists have to participate in tumor boards, surgery conferences, or other morbidity and mortality conferences. All these conferences count toward the requirement. You may already have more than ten. Just make sure to record them!

“Creation or active management of, or participation in, one of the elements of a quality or safety program”

If you are desperate and have a residency program, this can mean giving a lecture on a safety topic to residents. You can provide a pre-test and a post-test. Then, all you need to do is to show improvement. Oualaa… A quick way to satisfy the requirement if you can’t meet the others.

“Active participation in applying for or maintaining accreditation by specialty accreditation programs such as those offered by ACR, ACRO, or ASTRO”

For many, this is another easy one. Yearly, I am bombarded with questions for continuing accreditation for the ACR from my technologists, physicists, and more. And, there is a good chance that your practice requires ACR accreditation too. All you have to do is document your participation!

Meeting The MOC Practice-Based Improvement Requirement

So, there you have it, six relatively painless ways to satisfy the MOC requirements. Many of these you may be doing already and not even realize it. It seems silly to have these as a requirement to maintain accreditation in radiology because many of them are on the fringes of what we do as radiologists. But whatever works and makes our lives easier so that we can continue our ABR accreditation!

 

 

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Don’t Forget To Learn How To Make The Findings!

make the findings

In a few more weeks, most first-year residents will begin to take call and metamorphose from a student into a valuable member of the radiology team. Nightime independent call is what separates the radiology child from the adult. But, as always, most residents have a few hurdles to overcome before they begin. They need to be able to make the findings.

One of the hurdles is the precall quiz—a test before the start of the new year. And, not all first-year residents are ready for the task. Why is that? And what can residents and programs do to equip radiology residents for their newfound role?

Knowledge Versus Search: Two Separate Skills.

Most radiology residents concentrate on the information side of the equation. It’s a much more familiar task. From time and memoriam, including medical school and internship, residents have been studying from books. So, reading books is what they know how to do best. They can remember the names of the disease entities and perhaps some descriptions associated with them. But, radiology is a lot more than recall and picking out a few disease entities from your memory. Instead, it is also the process of making the finding while scrolling through many images on a PACs system. This skill is entirely different. If you don’t believe me, have your average fairly knowledgeable internal medicine physician attempt to read a CT scan and make the findings. It doesn’t tend to work out too well! (There are exceptions to every rule, however!)

How Not To Be Just A Bastion Of Knowledge And Also Make The Findings

Practice

Just like another task in life, you need to put the time in to become proficient—the same works in radiology. You need to spend hours at the workstations scrolling through images in addition to reading the books (as you have been doing for years). If you don’t spend the time with the mouse and the computer on the PACs, your brain will not be ready to pick out the findings when the time comes.

Study Checklists

Whether they admit it or not, every radiologist uses some form of checklist to make sure they have looked at all the parts of the study. And every resident needs to create the same. If you don’t create a checklist, you will never know what is missing. Why? Because residents and non-radiology physicians tend to make positive findings. But, the negative findings can be just as important to figure out history and disposition. Splenectomies, adrenalectomies, and appendectomies are some of the discoveries you will miss on a CT scan if you do not have a checklist for every organ system. And if you miss these, some of your impressions will sound silly or meaningless.,

Look At Pictures

Finally, residents also need to read. And reading differs from the standard physician resident. Internal medicine residents, surgical residents, and ob/GYN residents can get away with reading only the text or reading the text first. But, we radiologists have to do things a bit backward. We need to look at the pictures first, then the captions, and then the text. Why? Because we are an imaging-based specialty, and if we don’t see the findings on an image, we will never know what to find!

Make The Findings!

Remember. Radiologists read a ton because we cross over so many different specialties. But, in the end, we are primarily an imaging specialty. So, we have to learn how to make the findings, not just be an information bank for consultation with our colleagues. Don’t forget to practice a lot by reading lots of films on PACs, utilizing checklists to avoid missing critical findings, and reading the pictures first when reading textbooks. Practicing these skills will enable you to become an excellent radiology resident and a great radiologist. It’s not all about just reading books!

 

 

 

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External Moonlighting In Private Practice: Tread Carefully!

external moonlighting

It’s exciting to collect that first paycheck which can be an order of magnitude higher than your residency salary when you first start as a fully trained radiologist. But, many of you may want to make even more at the beginning. It’s not uncommon to have debt loads that would make regular folks cringe. Nevertheless, some private practices discourage external moonlighting to make that extra money when starting. Why do some businesses work this way? And, what do you do if you want to continue working at your first practice but are not happy about this policy? Let us muddle through some of the issues that you may face when you want to make some extra dough when starting.

Why Do Some Practices Discourage External Moonlighting?

External Allegiances

Moonlighting outside the realm of your main job could create loyalties external to the practice. Let’s say you sign a contract to work during a vacation at an external site, but the primary imaging business also could use your help. This dichotomy of purpose can create a conflict of interest since you will support another practice instead of your primary allegiance. Furthermore, perhaps that other job can be more enticing than the one that does not allow moonlighting. Radiology practices fear having employees change jobs. It is very costly and causes the other practice members to have to take up the slack.

Practices Want To Encourage Their Own Internal Moonlighting

Sometimes the work can get busy. Maybe, it’s a new MRI that opened up. Or, perhaps a senior partner recently retired. In either case, there are many times that practices need all hands on deck to cover the rotations with the extra work. Why would a business allow external moonlighting when it may have many opportunities of its own? The practice needs to cover this extra work!

Exhaustion/Burnout/Vacation

Some practices are more lifestyle-oriented and encourage their radiologists to take their vacations. Burnout is an actual entity. And, we all need a break once in a while. Working all the time on your vacation time can be a recipe for burnout. The exhaustion of the partners and employees is a very costly situation. Why not go to the extra lengths to discourage burnout by forbidding doing external work outside the practice?

I Like The Practice But How Can I Deal With Strong Policies Discouraging External Moonlighting?

Ask For Internal Moonlighting Gigs

Some practices don’t advertise moonlighting opportunities that they have available. So, instead of assuming that your primary radiology practice has nothing available, just ask around. Sometimes senior partners would rather have time off rather than the extra money. Other times, work needs to get done that is making the days longer and more stressful. Both situations often occur. And although not advertised many times, they are potential extra ways to earn some extra dough. Sometimes all you need to do is ask!

Have Them Make An Exception

Sometimes rules are made to be broken. Practice by-laws are in place for the average situation for the average employee or partner. But, who is to say that you are average? If you provide a compelling reason for the business to make an exception to the external moonlighting policy, sometimes they will. Some practices may be more liberal for non-partners or partners. If need be, check with the chair and find out if it is possible.

Work Only During Vacations Or Out Of State

Suppose the practice is concerned that you won’t be dedicating your full attention to your primary job as an external moonlighter. Or, your main radiology job is worried that you will be competing locally with your primary radiology practice. Then let the radiology practice know that your external work will not interfere with either. Guaranteeing that you will only work out-of-state or on vacations may convince the partnership to allow a bit of extra work to make some more cash.

External Moonlighting: The Unwritten Rules

When you look at external moonlighting policies from a birds-eye view, it can make a lot of sense for a practice. It can protect the business from losing their employees and partners, ensuring that work does not go uncovered, and preventing burnout and exhaustion. But there are ways to deal with these issues and get the extra work that you want. So, instead of folding your hand, ask around and make sure to let your practice know that you are interested in moonlighting from the get-go. You may get the extra work you want without destroying your primary job!