Category: Lifestyle

Posted on by

Are All Radiologists Destined To Have Chronic Back Pain?

back pain

After walking my dog a while back and pulling a back muscle (thankfully, I recovered), I started to think about the risk of lower back pain and radiology. Am I more prone than others to having back issues? What are the chances that I can permanently have back pain from my day-to-day work? And, are the risks related to what kind of radiology you practice?

According to the literature, if you are a radiologist who sits and reads lots of films from a PACS workstation or an interventionist who always wears lead shielding and does procedures, your back may not thank you. Based on reality in the field, the human body was not meant to sit for many hours or stand in one place with heavy weights. So, let’s drift into the nitty-gritty data on radiologists and back pain. Then, we can discuss some standard solutions to remediate our woes.

The Hard Data About Radiologists And Back Pain

Here is some of the information to support these radiology-specific related back issues. In one study in the JVIR, the mean prevalence of the general population was around 31 percent for everyone. Then, when you look at the radiology community more specifically, you even get more stark statistics. Within the interventional radiologist population alone, 20.1 to 24 percent have back and neck pain limiting work. Additionally, the same study reported a prevalence of lower back pain in the general radiology population of 52 percent and back and neck pain in interventional radiologists at 60.7 percent. If you believe this study, the prevalence of back pain in radiology is nearly double the general population. This number is not small. It is the majority of us!

Another JVIR article states that the prevalence of back pain gets worse with age, especially among those who complete interventional procedures. (We all have something to look forward to!) That makes sense because of the extra weight that interventionists need to bear. The only saving grace is that radiologists have less back pain than nurses and techs. But that does not change the fact that we have a very high prevalence of back pain as radiologists.

The Only Solution: Prevention!

The last thing that radiologists want to do is get into a situation where you need back surgery. We all know that is the last resort. Heck, many of us read many spine X-rays and MRI horror shows. Some of the solutions espoused in the JVIR papers are reasonably simple. Taking a break is the best plan of action. If you notice that your back is beginning to hurt, you must take a break. Repetitive motions can exacerbate back pain. Exercises involving strengthening the back muscles may prevent significant injuries.

Others are more immediate and easy to do, including lifting slowly, sleeping on your side, and avoiding rapid bending movements. Stretching can also potentially prevent some forms of back injury (I’m a big proponent of this one!)

Finally, ergonomics helps with the situation. That means appropriately positioning equipment and monitors, back supporting seats, clearing the floors of obstructions, and custom-fitted garments for the interventionists among us.

Let’s Face It: Chronic Back Pain Is The Radiologist Bugaboo!

For surgeons, needle stick injuries are a big concern. For psychiatrists, their most significant issue is mental wear and tear. But we, as radiologists, face chronic back pain as our most prevalent job hazard. Furthermore, based on my recent back issue and this short survey of the literature, we need to take the prevention issues seriously. As the old Benjamin Franklin quote goes, an ounce of prevention is worth a pound of cure. Don’t let your imaging centers and hospitals convince you otherwise!

Posted on by

Is Radiology Still A Lifestyle Specialty?

lifestyle specialty

Many of you have probably heard about the classic acronym for choosing a lifestyle specialty called ROAD: Radiology, Ophthalmology, Anesthesiology, and Dermatology. But does radiology still belong in this acronym? Or should we entirely discard this as an ancient historical quirk? (Those days fifty years ago when we only used X-ray, nuclear medicine, and ultrasound!) So, let’s look at the criteria that should make up a lifestyle specialty, including the amount of time that you need to work, the amount of money that you can make, the amount of stress in your daily work life, and the flexibility of living and working where you want when you want. Then, let’s go through whether we, as radiology specialists, can still meet the criteria for a lifestyle specialty and compare it to others. And finally, let’s give the radiology specialty a final grade.

Grading Criterion For Radiology As A Lifestyle Specialty

Hours

This first criterion is a bit hard to pin down. Why? Because it all depends on how much time you want to put into your career. I know folks who want to care for their children, work three or four days a week, and never take a weekend call. (Of course, you pay for that!) Then, others want to spend lots of extra time to be the breadwinner for the family. But, if you take the average radiologist and the average week, most are on the job more than they would like to admit. We can have long days that can easily breach ten or eleven hours if the work becomes busy. Yet, not all days are like that. So, the average radiologist works a nine-hour shift five days a week.

However, we have a little more vacation than most other specialties. And part of that is a historical quirk. Back in the day, around the beginning of the twentieth century, many radiologists became sick from radiation sickness’s harmful effects. Therefore, they tended to have more vacation time to compensate. Flash forward to today, and you will still find radiologists with a bit more vacation than most (even though our jobs do not expose radiologists to as much radiation). 

Unfortunately, that time may not be during the holidays and summer weeks because hospitals need our services twenty-four hours a day, seven days a week. And some poor radiologist needs to cover! To average it all out, if I had to give a grade to this criteria, I would call it a B-. The extra vacation would boost our report card as opposed to other specialties. But, I am dinging us for the constant need for radiologists to work. If you had to compare our hours to other medical areas, others would work shorter and easier days with less vacation time. So, I certainly could not give us an A. But, yet we don’t have constant patient care like some internal medicine and surgical docs. B- minus seems reasonable to me!

Money

Money is a much easier criterion to define because we can base that number on a per-hour basis. And we can always harken back to our favorite medical specialty salary survey at Medscape. It’s a quick and dirty way to compare the average specialist’s salary for most medical specialties. The 2020 Medscape survey quoted the average radiology salary as the fifth most highly paid specialty out of twenty-nine at 427,000 dollars annually. So, that is in the top 20th percentile. For that reason, I can easily substantiate the grade of an A-. We are certainly not paid as much as the majority of Orthopedics and Neurosurgeons. But, indeed, we are nowhere near the salary of most pediatricians!

Stress

Ahh. This criterion is also highly variable, depending on your subspecialty. Some folks are purely outpatient and work in very cush environments or at home. And other folks are bombarded continuously with ER cases and stat procedures like neuro-interventionalists. However, as a whole, we typically don’t have to perseverate on phones with insurance companies like other subspecialties (I consider that one of the most significant stressors!) Yet, all of us are getting tons of phone calls. Moreover, we can enact actual harm to patients because what we say matters significantly to patient care, including life and death (a cause for aggravation and lawsuits!).

So, let’s compare it to other specialties. Dermatologists don’t have as many life-and-death decisions. Yet, ob/gynecologists, surgeons, and internal medicine docs have much more aggravations with insurance companies and uncompliant patients. So, I will give our specialty a B-, a standard average grade.

Flexibility

Now, if I had to pick one area where we excel, it is flexibility. We can live where we want, work when we want, be academic or private, and see patients or not see patients as we wish. I can’t think of any other specialties with our far-reaching flexibility for types of work as a radiologist. We can live and work in the country or the city. You can work on the weekends only or during the nights or days. Or, we can rarely see a patient again (especially as a teleradiologist!)

In this department, we beat out pretty much all the specialties. Not one even comes close to radiology when it comes to flexibility! I would have to give this criterion an A+.

Is Radiology A Lifestyle Specialty: The Final Conclusion

So, let’s give all our grades a weighted average and pretend we are still in college. Here is a post with the conversion info!

Hours: B- or 2.7

Money: A- or 3.7

Stress: B- or 2.7

Flexibility: A+ or 4.0

Drum roll, please. If you average out our grades based on these criteria, you get a final grade of 3.275, just a little shy of a B+. But let’s call it a B+, for argument’s sake. Do you think that still makes a lifestyle specialty? I think so. But, perhaps, not as much as you might have thought at first! It’s not an A!

Want to learn more about the specialty of radiology and the training involved? Check out my book on Amazon. And click on the link below. (I am an affiliate of Amazon as well!)

 

Posted on by

Will There Be A Mass Exodus Of Radiologists From The Cities?

mass exodus

Look through the newspapers, and you will most likely find articles espousing a mass exodus of urban residents moving to less crowded communities during the pandemic. And at first glance, it makes some sense. Local governments have banned bars, movies, exercise facilities, and more in the Covid era. Moreover, there are always close quarters, more prevalent in a city, which increase the risk of disease spread in the pandemic. So, why would anyone want to move to the city when finishing residency? It makes you think that new radiologists will permanently shun the cities.

But, are there other factors that may influence radiologists to choose a location to work over the coming years? Are they increasingly going to opt for a more simple life in rural America over the years to come? Let’s go through the motivations for young radiologists to stay or leave the urban landscape. Then, we will decide how it will all play out in the end.

Reasons For A Mass Exodus Of Radiologists From The Cities

Increased Fear of Close Interactions

Knowing that a highly infectious and potentially lethal disease can spread by respiratory droplets, definitely changes how you think about taking the subway, walking the streets, and assembling with groups of friends. But will it stick over the long run? We will see a slight shift in how we feel about living in the cities for years to come.

More Difficulties Raising A Family

All the challenges of living multiply in a large urban center when you have children as well. Imagine the issues that urban families face when they have to find day-care, nannies, and school with the added problems of a pandemic at hand. Of course, this factor will most certainly lessen the charms of living in a large city.

Culture Shifts

We learn many of our habits, wants, and “needs” from our colleagues and friends. The mere suggestion of your friends hinting that they no longer wish to live in a city to work can influence your choices of where you will want to settle down. So, new residents will more apt to move where their colleagues also want to go. This attitude can also persist over a long time.

Reasons For Radiologists To Stay

Pay

Typically, when you are on the side of an employer, the harder it becomes to find employees, the more you need to pay to get excellent workers. Theoretically, for this reason, you may begin to see better jobs and higher incomes in the city than before. Of course, with the massive student debt burdens, this can somewhat counteract the perceived threats of urban living in the Covid era.

Housing Costs

With a shift of young adults moving to the suburbs and the more rural areas, you will decrease rental and, eventually, housing prices. If you reduce one of the most significant expenses that young families have when they start, you make it more attractive to the new employees, such as radiologists. Cities may become more attractive in this sense.

The Wild Card

Historically speaking, people have a short term memory when it comes to disasters. Look at the population of Manhattan after the twin towers fell. It didn’t take long for the citizens of New York to want to return to urban living. Or, look at the population of Nagasaki in Japan. At the time of the nuclear bomb, the number of residents was 263,000. Yet, today it has almost doubled at over 513,000. Finally, take the populations of most cities before and after the 1918 pandemic. Most recovered. So, the temporary cultural shifts that have occurred with previous disasters do not necessarily cause long term population shifts.

So, Will There Be A Mass Exodus From The Cities?

Well, it is true. Young radiologists will present with unique challenges if they choose to stick around in the cities for the next year or two. Additionally, pay, and housing costs will take some time to catch up to the new marketplace. So, some new radiologists will opt to live in more rural areas than would have previously.

But, this attitude will not last forever. The economics will eventually catch up. And, the culture will shift, once a vaccine becomes widely available. Based on these factors and history, radiologists will soon forget about the hazards of city life. So, don’t expect to see the competition for rural jobs to increase that much. The long term trends do not favor a seismic shift in deciding where to work and live. Logic dictates that you need to take reactive newspaper articles exclaiming a permanent mass exodus from the cities with a grain of salt!

 

 

Posted on by

Loss Of A Pet- A Lesson All Residents Can Learn About Quality Of Life

Today’s post is not for everyone. For those of you that have never owned a pet or do not understand why anyone would decide to keep a pet, especially during residency, you can stop reading here. But for those of you that take a keen interest in living with a pet of some sort, I think you will find this post very enlightening.

Most posts I write are not personal. Today’s post is very different. It serves several purposes. First, I aim to show my readers how we dealt with a sick beloved pet during the past few weeks in order to give examples of tough decisions that need to be made. Next, I am going to translate this episode into a life lesson about maintaining a good quality of life, translating it to residency. And finally, more importantly for me, I am going to be a bit selfish and eulogize the recent loss of my best friend and dog, Otis. The past few days have been some of the most difficult days of my life. I already miss him dearly.

The Ultimate Responsibility of Pet Ownership- Our Story

When we decided to commit to getting a dog, we committed ourselves to its entire life. We are ultimately not only responsible for feeding, comforting, bathing, and taking our pets outside but also the decisions we need to make when facing an inevitable loss. The difficulty is only compounded when you are training during the incredibly busy time of residency.

In our case, our incredible dog, Otis, had an episode of spontaneous agonal breathing. Like a madman, I rushed him off to our car and drove him to the animal hospital nearly 70 miles per hour through side streets. I passed him off to the technologist like a football so that the emergency veterinarians could instantly treat him. And, they treated him rapidly and professionally with a pericardiocentesis to drain off fluid during an episode of pericardial tamponade. While performing the ultrasound, the sonographer discovered a right atrial mass. Then, in the morning, the veterinarian radiologist scanned his abdomen, only to diagnose him with splenic nodules as well. They declared that he had untreatable metastatic hemangiosarcoma, a terminal cancer of dogs. It would consume him possibly in days or weeks, and if we were lucky, months.

We faced the ultimate decision after the veterinarians stabilized him. What do we do next? Do we bring him home now? Should he be euthanized? I couldn’t bear to say goodbye at this point because he seemed like he returned to his normal self for the time being. We decided to bring him home, hoping he would have a few more good weeks, maybe months.

The next week was one of the best weeks I ever had with my dog. We walked, let him roll in the grass (his favorite activity!), and allowed him to sniff just about everything. It was great. But, the day of reckoning finally arrived too soon. This time, the whole family came with him to the hospital after we noticed some subtle discomfort and worried that he was to become unstable.

The Big Decision- Quality of Life Issues

We knew at this point we had the big decision to make. Do we treat him with serial pericardiocenteses aware that the fluid accumulation and new episodes of pericardial tamponade would become more and more rapid? Or, was it time to say goodbye? We based our final decision on his quality of life. We had to say goodbye.

It was one of the most gut-wrenching decisions, I ever had to make. He was my best friend on earth.  We slept on the same bed, traveled together, and ate meals with each other. He was always there for me over the past 10.5 years. It was his helplessness and innocence that pulled at my heartstrings. And now, I had to put him down. It was for the best. But, it made the decision no easier.

Life Lesson

What is more important than the quality of life? Whether it is a person or a pet, it does not matter. We need to do for our loved ones what is right for them and not for ourselves in the moment.

Translated into the residency experience, we should always think about the quality of not just our own lives but also the quality of life for our spouses, relatives, friends, family, and beloved pets. It’s not always about reading the most cases, staying late every day, only to miss out on our loved ones as time passes by. Bottom line. We need to sniff and smell the roses, just like Otis always did.

Ode to the Memories of Otis

You were the size of a toy truck when I picked you up in Charlotte, North Carolina over 10 years ago. You lovingly sniffed me and graciously accepted me into your life. I thank you for that.

Driving home from the airport, you slowly pushed open the Sherpa bag with your nose as I drove you to our house to see what was happening. Your curiosity was always without boundaries. I thank you for that.

Rolling in the grass was your heaven. You could always spontaneously enjoy the moment. I thank you for that.

When other puppies would bite the hands of their owner to get a treat, you would make sure to take the treat carefully always making sure that we were OK. You were always like that in your life. I thank you for that.

Sitting crosswise, you were always there to protect the kids. I thank you for that.

Good-natured and non-aggressive, you were beloved by all the people and canines you have ever met. I thank you for that.

For all the wonderful memories we had together over the past ten years, I wish we had more. Your life was too short. And, we will miss you dearly. The great memories of you will last our lifetime and beyond. I thank you for that…

From Your Beloved Family- we give thanks for every moment we shared together. Rest in peace…

 

 

 

Posted on by

I’m a sick radiologist- Should I come to work?

I am confident that most of you, whether a radiology resident or an attending, have felt sick at one time or another. And, most likely, you were unsure about coming to work. Moreover, this decision can become incredibly complex.

Here are some of the issues you probably thought about. Is there adequate coverage? How sick are you? Are you going to be seeing patients for that day? Are you going to be sitting down in isolation for most of the day? Are your reads or your procedures going to be compromised by your illness? What is the group’s culture about taking a sick day? How will it affect your colleagues if you do not show up? Will it prevent you from being promoted? Unfortunately, these difficult questions compound when you cannot think clearly due to illness.

Even more confusing, most of the articles that I have read regarding physicians and sickness are not written directly for the radiologist. Radiologists are a bit different than other hospital or outpatient physicians. Depending upon the day, the rotation, or job description we may or may not have direct patient contact. So, we have to have to think about the question of missing a day of work differently from other physicians.

What about the literature regarding sickness for the general physician? Many articles say not to come to work if you are a sick physician. (1,2) And others are more indeterminate. (3,4) However, the body of research is sparse about whether the ill physician, let alone a radiologist, should come to work. In this post,  I will try to address the most common issues that may sway your decision one way or the other.

Continue reading I’m a sick radiologist- Should I come to work?

Posted on by — 2 Comments

Radiology Resident- Get Up and Move It!!!

Sitting can be hazardous to your health. Just take a look at some of the article headlines and links from major news organizations- CNN, CBS, Huffington Post. And, the list goes on…

What do we picture radiologists doing all day? Unfortunately, the stereotype is that radiologists are sitters; we are on a comfy chair near a diagnostic workstation, powering through loads of studies. There’s some truth to that. In fact, I can almost guarantee that you will gain that freshman fifteen pounds during your first year of residency if you follow the typical work schedule without modifying your behavior. That’s the bad news.  The good news is that there are ways to circumvent the habit of sitting down for long periods of time, even as a radiologist.

And, since residents are early in their career, it is easier to start forming habits that will potentially last a lifetime. So, here are some suggestions to conquer the ills of long-term sitting, whether you are a radiology resident at work or at home.

1. Stand Up

Many desks these days allow you to complete your work while standing. In fact, we have several workstations dedicated to the standing radiologist in our own department, although unfortunately not enough.

But, let’s say that this option is not available. What can you do to remind yourself to get up? I recommend either a watch timer or an Apple Watch. Regularly, I get messages on my watch to tell me to stand up. It can be occasionally annoying, but it usually does the trick even though there are times I am unable to get out of my seat.

Additionally, little things help. Instead of texting your colleagues, consider getting up and having a conversation with someone. Instead of calling the technologist to complete a study, get up and tell them. These are ways you establish connections with people and lessen the amount of time you are sitting during the day.

2. Get the most calorie burn out of your workspace

Whenever I am at work, I always think about ways to maximize my body’s workload. Think about calorie-burning activities like banning the word elevator from your vocabulary. In fact, the only time I take the elevator is when there is a “wet paint” sign on the stairs. Using the stairs is a great way to burn those extra calories

Take a long way around to get to your next meeting or conference, whether it means going outside or visiting your colleagues. Just remember to leave your workstation a little bit earlier!

3. Get that heart rate up- find a new activity you can stick with!

Any activity that doesn’t interest or excite me, I find difficult to stick with. And, I think it is easy to extrapolate the same to others. So, find something that increases your heart rate, but most importantly find an exercise routine that you enjoy. And, it is crucial to do so. Remember, radiologists sit down more than most other professions and you certainly don’t want to add home sitting time to your total.

For instance, I started running several years ago and have continued diligently only because I look forward to the run. Why? It’s very simple. I have my iPad set up to watch Netflix and HBOGO shows that I find hard to watch without interruptions by just sitting down. Some of the series that I have gone through include Game of Thrones, The Sopranos, House of Cards, and Mad Men, among many others. So, I really look forward to my time on the treadmill.

Also, you may want to find activities that intrinsically interest you because you are learning something new, whether it be physical, mental, or practical. I have recently taken up Tae Kwon Do and have found it to be a great way to build up my stamina, flexibility, and coordination. Each lesson I take, I find that I am learning new things and want to come back for the next time. Some of that enjoyment certainly stems from the great instruction I receive locally from Ko’s Tae Kwon Do with Grand Master Ko.

Get Up And Move It!

Getting out there and moving is especially important as a radiologist because of the increased sedentary lifestyle and the years that you can potentially lose due it’s health consequences. So, make a concerted effort to get up and move!!!