Category: Ask The Residency Director

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I Want No Patient Contact And A High Salary- Which Fellowship Should I Choose?

high salary

Question About High Salary/Patient Contact

Dr. Julius, I read the article you wrote last year on how to choose a fellowship. Have you any new insights since then? Also, could you help me narrow down my specialty?

What I am looking for: a very high salary, independence, being able to work from home would be a luxury, minimal patient contact, be a specialist.

My background: I finished two years of general surgery and switched to radiology. R1.

Thanks for starting this website,

Unsure Resident

Answer:

Hi,

I’m glad you have developed specific criteria for what you require in a fellowship. Often, that can be the hardest part. Of course, I wouldn’t tell the folks interviewing you that you would want minimal patient contact unless you know the interviewers well. Radiology 3.0 has become part of the vocabulary of most academic departments. And that implies some patient care — just a word of warning. But, between you and me (and the wall), we both know that not all subspecialties carry the same amount of patient interaction! So, which specialties have less contact? Most of the pure imaging subspecialties are without procedures. MSK or Neuro would be specialties more likely to have less patient contact. 

High Salary Issue

Returning to the main question, which fellowship should you choose? Let’s start with the first criterion, a very high salary. Unfortunately, compensation is more tied to the number of reads and the location where you work than the type of fellowship you do. And, every year, the benefits of any given modality can change. For example, at one point, interventional radiology was the highest-paying specialty per procedure. Now, it generally pays less than most others. Currently, MRI probably reimburses better than most other studies. However, you would be chasing a moving target if I were to tell you that it would remain the same.

Independence Issue

Regarding independence, you ultimately rely on your referrers and patients, so you are never truly independent. But, if you want to become a group of 1, something like teleradiology would enable you to get your business paid with a 1099 form instead of a W-2. Also, teleradiology would allow you to interpret films as much or as little as you want. So, theoretically, you can “create” your desired high salary if you’re going to read like crazy! Additionally, teleradiology would naturally allow you to work from home. 

Summary

So, there you have it. Based on your criteria, a possibility would be a teleradiologist specializing in MRIs such as MSK, body MRI, or neuro MRI. However, the two things that you failed to tell me were whether you wanted to work late hours or what procedures you enjoyed the most. You should probably consider that in this “equation” as well. Let me know what you think!

Regards,

Barry Julius, MD

 

 

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Stuck In Pathology- Get Me Out!

pathology

Question About Changing From Pathology:

Hello,

I am a pathology intern halfway through the year. Now, I am confident that I have made a terrible mistake. Radiology was my dream residency throughout medical school. However, due to my spouse and I entering the couple’s match, I convinced myself that pathology was a better strategic option. I deeply regret not following my interests. And now, I feel that I may be trapped in this field forever, wishing I had stayed in my first course. I have no academic limitations that would have prevented me from being accepted into radiology had I applied. My question for you: Would switching from pathology to radiology be possible? And if so, how would you recommend I approach this difficult situation? Thank you very much for your time and advice.

Regards,

Stuck in Pathology

Answer:

It is still possible to switch to radiology. All is not lost. But, at least, it will involve an extra couple of years of residency. Unfortunately, the ACGME has changed the rules for what counts as a clinical year for radiology residency. At one time, you could apply pathology toward the “clinical year.” Per the ACGME, you must take another internship year in preliminary medicine, preliminary surgery, ob-gyn, emergency medicine, neurology, or a transitional clinical year. The biggest problem you may encounter, assuming that you have not applied this year already, is that you will have to wait until the following year to apply to prelim medicine and radiology. That will give you two years in pathology. When you take that third year of preliminary medicine, you will already have three years of residency before radiology residency. Due to Medicare funding issues, some programs may not have funding for your entire residency. Some programs will care about that more than others. But it shouldn’t prevent you from applying.

The Good News

However, you have a spot in a pathology program right now. So, if you applied for both a clinical year and a radiology slot simultaneously and didn’t get into a program, you would still have your current pathology residency position available as a backup. So, if you still desire radiology, it is worth a try regardless of the “funding issues.” It’s a bit of a longer path for you to get into a radiology residency, but certainly not impossible.

Also, I would recommend getting to know the radiology department faculty at your current institution by completing an elective rotation or stopping by to talk to the program directors. If they like you, that may also help to get you an interview and recommendations for a radiology residency. Knowing someone personally is always better than a blind bid for a residency slot.

Good luck,

Barry Julius, MD

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Does Artificial Intelligence Spell The End For Radiology?

artificial intelligence

Question About Artificial Intelligence:

Greetings, could you elaborate on these words ”(Artificial intelligence) will profoundly affect all of our careers, for better or FOR WORSE” and ”have more to gain and MORE TO LOSE”.

I am asking because, in the above text, you’ve written only about the good things about AI, while with these words, you’re also implying bad things about it, but I, as a reader, don’t know about them as you haven’t listed them.

I am a doctor from Europe whose first specialty choice is radiology, but this artificial intelligence surge is making me think twice about it. Everything I read, including your piece, is a 2-way street ala. ”AI is great, but you must adapt to it.”. The end. Could somebody please tell me HOW I will have to adapt and what the BAD things about AI in the radiology field are? It’s freaking me out! Radiology, as it is now, is a fantastic specialty, but I don’t want to be jobless and incompetent 10,15,20 years from now. It’s a life’s decision, and I have exactly ten days to decide!!

Thanks,

Worried Applicant

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Answer:

You are not alone in worrying about the future of radiology and AI. However, after attending the RSNA meeting and talking to colleagues, AI will not take over a radiologist’s job entirely for a long time (if ever). That aside, AI technology may allow fewer radiologists to do the same amount of work that we do right now. Improving triage, artifacts, and integration will make the radiologist’s job easier.

AI Will Not Take Over The World!

Why do I say this and not worry about AI taking over the world? First, the ability of an algorithm to detect something is only as good as the programmer, the number of data points, and the quality of the data. However, programmers have not optimized the algorithms. The data points are too few. And the quality of the data is not uniform. So, I don’t believe that will happen for many, many years from now.

Moreover, deep learning algorithms still have difficulty distinguishing simple solitary findings on a plain film, such as pneumothorax (often mistaken for chest tubes), let alone all the findings on a chest film. Therefore, I don’t believe the interpreting programs can independently function.

More importantly, companies will not want to accept the consequences of the liability of missing findings on films that go unchecked by a radiologist. So, I see AI as more of a team effort instead of a radical upheaval of all radiologist’s jobs. Let’s spread the liability risk!

What Is The Real Downside Of AI?

With the advent of any new technology, we will see our fair share of crashes, bugs, and technical problems. So, I believe that these would be the main downside. But I think the downside is reasonably limited overall. My advice- if you like radiology, you should go for it. If I were deciding on a profession today, I would not let my fears of AI dissuade me from choosing the radiological field.

My two cents,

Barry Julius, MD

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Can I Get Into Radiology With Poor COMLEX Scores?

Question:

 

Hello Dr. Barry Julius,

I am a 4th-year osteopathic medical student that is struggling to figure out how I can pull off getting into a radiology residency with disappointing COMLEX scores and a completely sub-par application.

Background:

I finally realized what I wanted to do in medicine and now I fear it’s too late. I come from a surgical background having been a Certified Surgical Technologist and First Assistant for ten years before getting to medical school. I realized during my 3rd year that I didn’t want to be a surgeon.

I fell in love with radiology during my ER rotation this year. I loved feeling like I was finally helping patients by reading films. So many times, I felt like I never got to the root of a patient’s problems in internal medicine and family medicine but with radiology, I felt like I was solving a problem. As soon as the radiology bug bit me, I immediately started researching requirements for getting into a diagnostic radiology residency. This task broke my heart into a million pieces. All I found was how competitive the programs were and how essential board scores were.

Main Problem

Passing COMLEX level 1 was the hardest thing I’ve had to do in medical school. I failed twice and finally barely passed on my 3rd attempt. I’m both ashamed and proud of how many times took the exam. I’m proud because I never considered quitting. Medicine has always been my passion, and nothing would ever make me give up on the dream of becoming a physician. I never felt like COMLEX was ultimately going to defeat me.

I’m also proud because I learned a lot about how to study and how I learn best. I’m ashamed because it made me feel like I wouldn’t make a great physician. Many mentors and patients have told me that I would make a fantastic physician. In my heart I know I would.

My Current Situation

I made friends with the radiologist at the hospital where I did my ER rotation, and I’m doing an elective rotation with him starting next week. I’m really excited about this opportunity but lingering in the back of my mind is maybe I have no chance of getting into a radiology residency. Tons of people have told me there is no way to salvage my situation, but I can’t accept that. I’m a fighter and always have been.

Even if you never reply to this message I honestly appreciate the chance to vent. The bottom line is, I will never give up trying to achieve what I want especially now that I’m so passionate about it. After reading some of your posts, I just wanted to know what you would do in my situation. What is your advice for someone like me, with a worthless application, but a strong drive to do whatever is necessary to achieve a goal?

 

Regards,

Worried Radiology Applicant

 

Answer:

Sorry, I have been unable to get back to you sooner. It has been a crazy week. However, I have had some time to mull the issues that you present in the letter and I have come up with a potential solution. But, it will take some soul searching, grit, and determination.

Why are the medical school exam board exams so critical for radiology residencies? Simply because the radiology boards is also a multiple choice question computer exam that is difficult to pass. And, most residencies would not want to commit resources to a resident that will not be able to pass the boards.

Get To The Bottom Of The Situation

So, this is what do you need to do. First, you need to figure out why you have such a hard time with the exam. This may be the most difficult part for you, to admit there may be a psychological problem with test taking to begin with. Many times this is a simple issue that can be easily solved. They have testing psychologists that can get to the root cause. It would be well worth your time to splurge a few thousand dollars now to get the answer that may save you hardship down the road.

For some, the issue can be solved with something as simple as anxiety exercises before the test. For others, it could be a learning disability that you were not aware of. Regardless, make the time and effort to complete this step. It will be well worth it.

USMLE: The Solution

Second, you need to take the USMLE. The good news for you: Most radiology residencies do not like to use the COMLEX as a screening tool. So, if you were to do well on the USMLE, they would never even care about your score on the COMLEX.

So, finally, I would dedicate a year to studying for the USMLE exams and doing well on them. How would I approach it? I would take a year of research in radiology to stay involved in the field. And, I would study at the same time so that you can get the scores you need.

Bottom Line

It will take a lot of from you to really tackle the issue of passing the USMLE and getting into radiology residency. But, if you really want it that bad, there is a way.

Regards,
Barry Julius, MD

 

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Do Average RVUs Matter For Private Practice And Academic Radiologists?

average RVUs

Question About Average RVUs:

 

Do you know the average RVUs per shift for radiologists and the differential between private practice and academic radiologists?

 

Thank you,

Wondering About RVUs

 

_____________________________________________________-

Answer:

I have not found a specific breakdown of work RVUs per radiologist regarding academic versus private practice. I can shout out to my audience and see if anyone has this information. Has anyone found any valuable data about this? If so, please write something in the comments section!) However, to figure out the average RVU per shift, you can take the average RVU of 10020 in 2023 (from Lifetrack Medical Systems) and divide that by approximately 200 days per year. (around the average number of days worked per radiologist) That would give you around 50 RVUs per day shift.

However, the question may not matter concerning practicality and potential job search. I know of private practices where they have a “lifestyle” practice and complete very low RVUs. Likewise, I know of academic centers where the radiologists work like dogs and meet ungodly RVUs. So, using this information to determine whether to go into private practice versus academia would be a mistake. You need to approach this issue individually, not on a global academic versus private practice basis. On the other hand, if you are using the information for research purposes, it may have an alternative use.

Assuming that you are using RVU data to look for jobs using this criterion, I would look at the specific RVUs of a group and, even more importantly, remember to also look at your particular role in the academic or private practice. Some “academic” centers do very little research and expect some radiologists to do almost entirely clinical work. Likewise, other private groups have a partial academic bent and are less heavily RVU-oriented.

Good luck with your search!

Director1

 

tomatoes

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How To Switch Gears From Orthopedic Surgery To Radiology As A Medical Student

orthopedic surgery

 

Question About Switching To Radiology From Orthopedic Surgery:

Hi Dr. Julius,

 

I’m a 3rd-yr med student with a growing interest in radiology. I’m in the middle of core clerkships and have come to appreciate how vital radiology is in all fields and how broadly it covers different parts of the body and aspects of medicine.

 My issue is that up till now, I have been pursuing orthopedic surgery, doing research, and making connections exclusively in that field. If I switch to seeking DR (maybe IR), what can I do to improve my ERAS application in the eyes of residency directors when I apply next year?

Background information (in case it helps): BS in engineering, currently at a top 25 med school, Step I – 233

 

 

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Answer:

 

Unfortunately, you can’t change what you’ve already done in orthopedic surgery. However, you still have time to get involved with research opportunities in radiology. Find a radiologist who needs some help with her research. At least, that shows some interest in the field. That is the low-hanging fruit that can help your application a little bit. It will also demonstrate some increased interest in the DR or DR/IR field. Even better, if you are interested in IR, I would find an interventionalist to work with and do research. That way, they could become your “mentor” and give your application even more relevance.

 

 

Suppose you have come from a good school with reasonable grades/Dean’s letter. In that case, you should have an excellent shot at a university program for DR. DR/IR is a little more of a crapshoot since it has become highly competitive. But you should still have a good chance as well. As I’ve mentioned, I highly recommend checking your Dean’s letter for any mistakes or “questionable” references. That is the most likely cause for a surprise for not matching where you want on match day. And it is also straightforward to correct if you can.

 

 

I hope that helps a bit,

 

Barry Julius, MD

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Radiology Acceptance And Increasing Time Since Medical School: A Negative Correlation?

acceptance

Dear Dr. Julius,

Thank you, Dr. Julius, for including me in your network. I understand how difficult it is for you to take time out of your busy schedule, and I do not mean to be a pain. Here’s my question… I applied for radiology and internal medicine. Subsequently, I matched in internal medicine this year (score 247,248, pass). I am keenly interested in radiology and will apply for the match after six years (3 years of residency, three years of J1 waiver, and ten years since graduation). Also, I am working on various research projects in radiology. Will the year of my graduation many years ago negatively affect the possibility of acceptance to radiology residency? I would be highly thankful if you could guide me and give me your insight.

Thank you for your time and consideration,

A Concerned Applicant

________________________________________________________

Dear Concerned Applicant,

Concerning your question, the number of years out does make a difference in the application process and changes the acceptance rate. Unfortunately, some programs have screening criteria that prevent graduates before a specific year from getting an interview. Why does this happen? I think many program directors don’t want to hassle with some issues that come with more experienced candidates. These may be unexplained gaps in time, foreign visa issues, changes in the USMLE tests, and more. That is not to say that all programs have this screening criterion.

More importantly, however, the more significant issue is not the number of years. Instead, it is the number of years you have completed your residency program already. Once you hit the three-year mark, the government may not fund your position. And the lack of funding translates into programs that will not grant you an acceptance due to the costs to the hospital. That is, some residency programs have less need for funding than others due to external sources. So, it is not impossible to find a radiology residency. But it isn’t easy.

In your situation, your best bet is to get to know the radiologists and program directors in the hospital at your residency. Also, as you are doing, participating in research at an institution with a radiology residency may give you more of an inside track. Again, you will still potentially find it difficult because radiology has become more competitive in the past couple of years, especially for foreign grads. Presently, programs can select applicants more discriminately from American medical schools without a J1 status than in previous years.

My recommendation to you is to continue to pursue the possibility of trying to get into a radiology residency if you have the means to do so. On the other hand, go through the application process with a sense of realism that you might not gain acceptance. The good news is that you obtained a residency slot in an internal medicine program! Congratulations! As a J1 visa holder, you have achieved something many others can only dream about. Luckily, now, you have a fallback position.

Good luck with the pursuit of your goals,

Barry Julius, MD

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Should I Continue With My Fellowship After Years In Private Practice?

years in private practice

Question About Fellowship After Years In Private Practice:

I am an experienced radiologist and decided to join a fellowship after 12 years in private practice. Some people thought I was mad, and some thought I was going through a midlife crisis. I was sick of private practice work and wanted to do something new as I felt I was getting deskilled. So, I joined a fellowship in a tertiary hospital. Two weeks into the fellowship, I think I have become a bit slower and a little out of depth. I expected this change, and I thought it would take a few weeks for me to get up to speed. But now I feel I am very unwelcome because I am an outsider and there is a lot of politics.

I don’t know why I am writing to you, but I thought you might have seen a case like me and could provide some insight into my situation.

A Political Outsider

Response:

Dear Political Outsider,

I admire your tenacity to go back to fellowship. Sacrificing your current life for educating yourself after years in private practice to do something more speaks volumes about your determination and work ethic. Our most incredible residents are ones that have had prior experience. We have had one or two who completed former residencies in their own country before coming to our program.

Unfortunately, it sounds like you have entered a fellowship where education may sometimes take second priority to the whims of the folks who run the program. You have to decide if it is worth it to overlook the politics of your situation to receive the education that you wanted to get initially, Or do the politics of the place prevent you from accomplishing the goals that you had intended to get from the fellowship in the first place? It is often worthwhile to tough it out to get your education. A fellowship is for a relatively short period compared to years in private practice. So, if you can take the pain, it may be worth it. Especially if the tools you are learning will be essential to your future radiology practice.

Regards,

Barry Julius, MD

Question:

Hi Barry

Thank you so much for your feedback. Currently, I am doing the fellowship on my academic drive. It would have been nice if the department’s environment would have been additive.

I had joined the fellowship to gain more training. It appears all scans are done by consultants on weekends as they get paid extra by the department. So they have a vested interest in not letting us fellows report them.

The other day, I was in a meeting, and two radiology consultants mauled me in front of 30 doctors. They kept unsettling me while I was presenting and tried to humiliate me. I still have no clue what was their vested interest.

I want to thank you again for your encouragement.

Regards,

A Political Outsider

Response:

Dear Political Outsider,

Usually, those attendings/radiologists who exhibit bad behavior during a meeting do not reflect your competency. Instead, it measures the insecurity or mean-spiritedness of those who commit the inappropriate behavior. If these radiologists had an issue with you during the meeting, they should have taken you aside and spoken to you privately. Unfortunately, sometimes, in fellowship, you must keep a thick skin and try not to let these episodes derail your excellent work.

Good luck,

Barry Julius, MD

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I Am Caught In An Early Vicious Cycle: Help!

vicious cycle

Question:

Hello Dr. Julius,

I found your article about the struggling radiology resident and looked at your previous answer to a similar question. I am an R1. At the end of October, the program informed me that I was struggling and having problems with synthesizing information and communication issues. Since then, they told me I haven’t improved and am still behind my peers.

I know that you mentioned getting out of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD, they think my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and I accidentally got the GME involved in seeking information. I’ve been studying harder, but I have a shaken confidence. And I keep missing things and not improving. I am concerned that they will fire me. Where do I go from here? Do I start looking for another specialty or stick it out until they’ve had enough and will not renew my contract?

Name

Scared R1

————————

Answer:

Dear Scared R1,

Before anything else, you need to ask yourself if you have been putting in many hours of studying each day and have immersed yourself in radiology. If you are honest with yourself and have genuinely been putting everything you have into learning radiology, you shouldn’t be so hard on yourself. I am going to assume in your case that this is true.

So, what bothers me most about your situation is how you explain it. You said you just recently started as an R1. That would mean that you just began the second half of your first year. And yet, it seems that you assume that your PD and associate PD think that, inherently, you will not make it through your program.

It would be highly unusual for a PD to know that you can’t make it through your residency so early on. In my experience, I have had several residents who had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, they can know only by seeing how you do on call. (assuming you passed a precall assessment) So, it seems they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.

Remediation of the Vicious Cycle

Second, the ACGME requires the program director to allow you to remediate your situation. They can’t just indiscriminately fire a resident without due process. And, since you have barely started radiology, there is no way you could have had an adequate opportunity to remediate the situation. Again, this assumes that you have not done anything to endanger your patients or fellow staff that would require them to prevent you from working.

So, where does this leave you? Well, improvement is an incremental process with occasional setbacks along the way. You may feel like you are not improving, but you are. The key is to learn from your mistakes and not repeat them repeatedly so that the vicious cycle continues. It’s ok to have missed at this point. You certainly can’t expect a first-year not to make any mistakes.

All this being said, occasionally, some residents can’t cut it. But these residents are rare, and I certainly would not be ready to pack it in just yet.

At this point, you should view each mistake as a learning opportunity, not as something to get discouraged about. You need to stick it out with some grit and determination to get through this difficult time. Radiology residency can be very tough for first-year residents. Staff can be unforgiving.

Improvement is a gradual, almost imperceptible process in any small time frame. You may notice the changes from reading and studying in a more extended period. Continue to soldier on, and let me know how things go!

Sincerely,

Barry Julius, MD

 

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Question About Improving The Vicious Cycle:

Hello Dr. Julius,

Thank you for the encouraging reply. In your experience, what is the usual time frame for struggling residents to see improvement? I’ve finished four weeks on a must-cover, and my faculty state that I am not improving. I have another four weeks to go, but I am concerned that if I haven’t improved much in the first four weeks, what are my chances of improving in another?

Sincerely,

Scared R1

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Answer:

Scared R1,

Four weeks is a concise amount of time to assess for global changes/improvement. If we are talking about more specific goals you have set, that would be more appropriate. Based on what you are saying, it is hard to determine what improvements they are trying to assess. Global assessments don’t work too well. I am writing an article talking about that.

On the other hand, programs and residents can assess and create incremental specific goals. Hopefully, they are creating these for you, and you have made some for yourself. You can undoubtedly reach specific smaller goals within a 4-week block if these goals are appropriate.

Barry Julius, MD

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Worried About Dismissal Due To Bad Evaluations: My Dilemma: How Do I Keep My Radiology Residency Position?

dilemma

Hi Dr. Julius,

Big fan of your blog. I often come here for tips on being a better radiology resident. So I wanted your advice on a dilemma I’ve had.

The Dilemma!

The Evaluations

I am currently a third-year resident. Certain attendings have raised concerns about me since the beginning of the first year, specifically regarding my medical knowledge and procedural competency. The overwhelming majority of my evaluations have been primarily positive. However, the CCC has mainly picked on the negative assessments. I had some struggles with Fluoroscopy in my first year. At the end of that year, I was placed in a remediation program and assigned some radprimer modules, which I completed. I repeated the fluoro rotation in my second year and had positive reviews, with everyone saying I was at the level and receiving positive evaluations. One of my ER faculty felt that I had trouble synthesizing information. However, the others thought while I was not a superstar, I was appropriate for my level. 

At the end of last year, the CCC committee thought that in addition to GI/GU, I also needed help in Neuro. Still, given that I had scored over 30% in the in-training examination, I did not officially qualify for the program. However, I met with the assigned Neuro attending a couple of times. Due to the third year being busy with overnight calls, AIRP, and outside pediatric rotations, I haven’t had a chance to meet with her after the first month.

My Attempts To Remediate

Still, I have independently been working on the radprimer modules and doing them alone. Most recently, I completed an IR rotation (IR is something I am interested in, and I did receive two recommendation letters from 2 different IR attendings). At this rotation, the techs complained about my professional behavior (I have never had any issues with any other tech from any other modality). I was frustrated about being scutted out of procedures to get H&Ps and consents. In a rage, I had given extremely poor evaluations of the rotation techs and attendings. So, this time, the attendings have rated me poorly, with evaluations questioning my medical decision-making and procedure skills. I want to say that I busted my ass this time, kept my mouth shut, and did what the program told me, but that did not help me.

The CCC Meeting And Possible Dismissal

So, I am highly concerned about the CCC’s decision regarding my future. The CCC meets at the end of this month. I’ve been meeting my program director weekly to review things like him helping me remediate, etc. I am not officially on probation. At the last meeting, I heard through the grapevine that two vocal attendings were pushing for my dismissal/probation. Also, I wanted to mention that before the IR rotation, the GI/GU rotation attendings had given me positive evaluations, which made me appropriate for my skill.

So, I am sorry for the long-winded post; I am apprehensive about being dismissed by the CCC. What kinds of steps should I take to solve this dilemma? Should I meet with the GME committee or write the CCC a letter explaining my side of the events? My misses have been at par with other residents at my level. However, the perception is that I have missed a lot. Should I try to get the faculty who have written me positive evaluations to send to the PD?

I would very much appreciate your help!

I also should point out that two residents in my program failed last year, including the current chief. The education is not excellent, so they have even more reason to fire me as they think I will fail.

Sorry for using a pseudonym.

Name

Helpless Rad

Dear Helpless Rad With A Dilemma,

I’m sorry to hear about your dilemma over the past few years. Think of it this way. All these events have the potential to make you a much stronger radiologist.

Based on your story, it seems like you have hit something called the vicious circle (the opposite of the virtuous circle) detailed in my previous blog called The Struggling Radiology Resident. Once a few attendings think that your performance is not up to par with your colleagues, these vocal attendings often spread the same sentiment to the other attendings. And poor evaluation and expectations from many attendings subsequently ensue. Usually, this happens regardless of your “true performance.” Unfortunately, the new evaluation milestone evaluation system (meant to prevent this dilemma with the global assessment) does not stop below-average recommendations from these staff members, even though you may exhibit improvement.

How To Repair The Dilemma

In any case, let’s get to how you can stop the vicious circle dilemma. (It’s not an easy or short process!) First thing, you need to take immediate action. Figure out why your attendings think that you have problems synthesizing information. Is it related to former errors you made during a call that you have already corrected since you are more senior? Was it a personality issue? Or is there a deeper-seated learning issue? 

Over the years, I have had a few residents with learning disability issues that only came to light when they started radiology since the learning skills are so different from other specialties and medical school. You need to figure out what the base issues are. If you are unsure, you may want to talk to your attendings to find out exactly what they think. Talk to both the attendings that favor you and those you believe do not. Then, set up your remediation plan based on your and your attending’s assessments. Afterward, give the plan to meet with the clinical competency committee so that they can see that you are trying to take action to improve. Finally, check to see that it matches their plans and expectations. That will go a long way toward showing you are proactive.

Keep It In The Department

By the way, I would try to avoid going through the GME. You want to ensure the issues stay within the department if possible. To that end, it sounds like you are not at the level of a GME issue such as probation. Going above the clinical competency committee status means this becomes a hospital-wide rather than a departmental dilemma. That can lead to further hard feelings between you and the department. Of course, in certain abusive situations, that may be necessary. But from what I think you are saying so far, it sounds like you can probably contain the damage to your department.

Basic Concepts To Live By

Also, it sounds like you committed one of the cardinal errors of someone with little workforce experience (unfortunately, many medical residents are in that category since their first job is in medicine!). You tried to avenge those who gave you inadequate evaluations by giving them bad ones. As you can see, that typically gets you into hot water. As a resident, you are at the bottom of the totem pole, which will continually worsen your situation. It just does not work! Always be careful what you put into writing, no matter what someone else says about you. It sounds like you will not make that mistake again!

Finally, you must understand that repairing the vicious circle will take a long time. Do not expect your faculty to change their thoughts about you for a while. You can sway them to your side only after many months or even a few years of hard work. It’s a long road to solve this dilemma, but your job is to ignore what they may think of you now. Just keep on plugging away and improving bit by bit. Eventually, you may get some of these attendings to understand that their former opinions of you were entirely unfounded.

I hope that helps. And let me know if there is anything else I can help you with,

Barry Julius, MD