Category: Miscellaneous

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Perception Of The General Public Of Radiologists Versus Reality

general public

Ever wonder what the general public thinks about us and what we do daily? Here are some thoughts and fallacies about their perception of us versus our reality!

General Public Thinks Radiologists And Radiology Technologists Are The Same!

Almost every radiologist gets questions from their family or friends about whether you help position the patients to take the images they interpret. Or, you’ll get the question of whether you had to attend medical school. Well, the reason for that most likely stems from their perception that there are no differences between what a radiologist versus a radiology technologist does for patients. And, if you think I am crazy, ask your great aunt or an old acquaintance. There is a better-than-even chance they will say the same thing!

We Exist In Lonely, Dark Rooms Only

If someone understands some of the tasks we do for our jobs, they will also likely imagine us working in a dark room day and night. Sure, some tele-radiologists live that life. But, most of us still meet with colleagues, technologists, nurses, and patients. We also participate in tumor boards, teaching residents, and administration. Those interactions keep us engaged in our careers for most of us who chose radiology.

Radiologists Are Not Sociable

Here, nothing could be further from the truth. As many of you are interviewing, you will find that radiologists are mostly friendly. Sure, there are some lemons out there. But, we tend to be much more easygoing than the surgeon around the corner or the cardiologists down the hall. Many of us are interventionists or mammographers who see patients daily. Yes, some of us are a little more introverted than the typical physician and don’t do much of that patient-face work. Nevertheless, we tend to have more time to invest in ourselves than many other medical professions because we are not always on the job. So, we have hobbies and more that lead us to interact with many people!

All Radiologists Are Tech Savvy

We need to know how to work with PACS systems and spend much time on computers. But you probably know that many radiologists are not the most facile users of social media, virtual reality, programming, or other technological activities. Herein lies a surprise for many. You need to know your anatomy and a little bit of technology. But you certainly don’t have to be a techno-geek!

All Radiologists Are Rich

There is a significant variation in jobs, debt levels, cost of living, and more. Many radiologists make a good living. But, if you are hundreds of thousands of dollars in the hole from your medical school training, it would be difficult or not impossible to call these radiologists rich. Also, although academics can and do generally pay a respectable salary, it is not what many Americans consider crazy high. If you listen to Dave Ramsey, doctors, in general (and probably including many radiologists!), do not crack the top ten professions that are millionaires. It shouldn’t be that way, but it is!

General Public Perception Of Radiology Versus The Reality

Our daily reality as radiologists is starkly different from the expected existence of those not embedded in medicine. Like why we never quite get the job of an investment banker at the trading desk that trades foreign bonds, most folks will never know the sense of accomplishment and pride we take in our radiology careers. The average person may not know the difference between radiologists and technologists, our daily roles, and that we are not all Bill Gates. But it is good to know what the majority probably thinks of us!

 

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What Character Traits Make A Great Lead Radiology Technologist?

lead radiology technologist

I don’t know about you, but life can turn into hell in a handbasket when my lead technologist is absent. Noticeably, details are left undone. And, the technologists under them don’t function quite as efficiently as they used to. Of course, the responsibilities at these sites slightly differ if they work in an office versus a hospital But, I have noticed that what makes a lead tech successful at both remains mostly the same. So, what are the lead radiology technologist critical roles at your imaging center or hospital? And, what are those traits that make your department run as smoothly as silk?

Keep Of Track Of All The Issues- Organization

All the lead techs I know that are worth their weight in gold maintain records of everything without fail. They follow unread films like hawks, ensuring they have someone looking after them. And they always keep track of accreditation deadlines, both for the site and their fellow technologists and the radiologists. In addition, they might keep track of the stock, whether it be gauze, contrast dye, or tea for the employees. All this work adds up to be for someone that can maintain an organization like no other (even more than most radiologists!)

Can Rally The Troops

What good is a lead tech if the cavalry does not respect them? When a technologist is absent, who wants to pitch in to do extra if you don’t like who you work for? Well, that’s when a respected colleague enters the picture. Those techs that can command respect can also rally their colleagues to help the practice when times get tough, whether it is an absent tech or an inspection from JACHO. In times of need, you need a lead tech that will inspire hard work from their workers and colleagues.

Able To Fill The Gaps

A great lead tech won’t make excuses. They will help themselves to fill in coverage when others are unavailable. Likewise, they don’t sit on a high pedestal expecting everyone else to do their bidding. In a pinch, they will do the job of others. And it all happens so seamlessly that you may not even notice!

An Approachable Lead Radiology Technologist

In the game of medicine, personality is key. And a lead tech should also be someone everyone can come to in a time of need. If a colleague needs a sick day, they should not fear approaching their lead technologist for the possibility of retribution. Instead, they need to be someone people can talk to and trust. Otherwise, big surprises happen, And they are not necessarily for the betterment of the radiology practice.

Takes Care Of Issues Become They Become An Issue

In addition to the trait of organization, lead technologists need to follow through with tasks, so they don’t become a bigger problem later on. This knowledge takes experience, know-how, and grit. Furthermore, they must know the art of triage to decide which issue to tackle next. Knowing whether to prioritize the next hospital business meeting or a technical problem with a piece of equipment can be challenging. Which needs to come first? Well, this is up to the judgment and actions of the qualified lead tech!

A Lead Radiology Technologist Knows How To Deal With Errant Technologists And Staff

Almost all practices have employees that don’t necessarily follow the rules. And they need to call these inappropriate behaviors out, lest they become a problem for the business. An excellent lead tech can take care of these issues with style and prevent the behavior from blossoming into patient losses or lawsuits! Who said the work of a lead tech was easy?

Scheduling

Scheduling can be a constant headache. And this role is typically critical for the lead tech. Knowing where and when to schedule colleagues can be very tricky and time-consuming. But, an excellent lead technologist can easily manage the schedule, ensuring everyone is where they are supposed to be at any given time!

The Great Lead Radiology Technologist!

Bet you might not have thought about all these critical roles a lead tech plays. It’s much more than you might think. But, if you want to hire the right lead technologist, these skills are critical to the smooth running of any radiology imaging department. It takes the right person for this job, and it’s not by any means an easy one! 

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Why Working From Hawaii Doesn’t Work For Most Of Us!

Hawaii

“The best laid plans of mice and men often go awry” is a famous quote that cannot be more true for us radiologists. I’m sure many of you have thought about what it would be like to work from a tropical island like Hawaii to read teleradiology cases several weeks out of the year in practice. Doesn’t sound too bad? How about reading evening studies and frolicking on the beaches with a Mai-Tai in hand in the daytime? Well, sorry to be the bearer of bad news; I will have to squash that thought for most of you. And here are some of the most likely reasons it won’t work.

It’s Still Relatively Easy To Hire Tele-radiologists

Although it is more expensive than a few years ago, if a practice has to choose between hiring overnight teleradiologists or a nighthawk and paying for a place in Hawaii for radiologists to read 6 hours every day, it is a lot less expensive to hire the overnight radiologist. Paying for a home for radiologists can be costly. And not everyone may want to go!

Not Everyone Can Get To Hawaii From Practice 

Believe it or not, if you create an outpost for radiologists to practice on a tropical island, not all of them can pack their bags and go. Some have families, and others have obligations that root these radiologists to the motherland. It is just not easy to get there for everyonee.

Additional IT Headaches

When creating a new outpost, you must ensure it runs well. The last thing a practice wants is a malfunctioning PACS system in a faraway outpost. That burden means the imaging business must pay for excellent IT support. And, with IT support comes additional expenses to maintain the site. Moreover, if the site goes down, other radiologists in the hometown will have to come to the hospital in the wee hours.

Billing Problems

Although not a complete game changer, with all the other issues, the location of dictations can create a headache for billing. Insurance companies do take into account the locale of the dictations. And this can make the process somewhat harder to get reimbursed. Let’s just add-on another issue to the whole!

Not Everyone Likes The Beach In Hawaii

Although going to Hawaii every once in a while to read some cases may sound great, not everyone loves the beach. Yet, your group will have to flip the bill for this privilege. Working from a beach location means you have to like crystal clear water and coconuts. What floats your boat may not be attractive to everyone!

Time Of Working May Not Be Optimal 

The time difference of 6 hours is not a reversed schedule. That means that when you go to bed at 10 PM EST, it is 4 PM in Hawaii. So, if you want coverage from 10 PM until 8 AM EST, you must go to work from 4 PM to 2 AM in Hawaii. Although better than working entirely overnight, it is not perfect for many radiologists. Some radiologists are early birds!

It Takes A Bit Of Extra Effort

Finally, creating another outpost outside your location takes some work and time. And most radiologists don’t want to have to deal with extra burdens. So, although it may be nice in theory, in practice, there are lots of other issues to worry about, first and foremost!

Nice Thought, But Hawaii Probably Will Not Happen In Your Practice!

Sorry to burst your bubble. I didn’t mean to put a kibosh on your hopes and dreams. Nevertheless, we need to be realistic. As you can see, all the headaches you need to work from Hawaii will probably not be worth the effort. Although a great idea, in theory, that’s another story in practice. If you like Hawaii, you may have to go there on vacation or work in Hawaii as your primary job!

 

 

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A Review Of Med School Insiders Insights Into Radiology

med school insiders

If you are like me, I am an avid youtube fan. Since it is in my wheelhouse, one of the topics I occasionally search for is radiology (in addition to astronomy, Ukraine, and guitar lessons!). And as I was surfing the YouTube world on these topics. I hit upon a series of videos with the hypnotic voice of Dr. Jubbal from Med School Insiders, a business that caters to students who want to enter the field of medicine. Many of these videos claimed to review Radiology as a field, including salaries, types of residents, the culture, and more. But does that mesmerizing voice have it all right? Or, is much of what Dr. Jubbal says about radiology a farce? Here is a review of the world of Dr. Jabal, and Med School Insiders impression of the field of radiology and whether he gets it all right.

Salaries- In The Middle Of The Pack?

The videos emphasizing radiology talk about salaries and consistently talk about radiology as somewhere in the middle of the pack. That phrase can be very misleading. As someone within the field, knowing where we stand in the salary ranking, I know that salary is highly dependent on where you work, whether you are in private practice or academics, and a slew of other factors. Based on my own experiences with these factors, radiology has been more consistently toward the top of the salary distribution on average than most other specialties. But, of course, it is possible to find a lower-paying radiology job.

Med School Insiders Talk About Artificial Intelligence

This factor is where Dr. Jubbal gets it wrong. He uses artificial intelligence as a risk for new students entering radiology. Artificial intelligence has consistently been underwhelming for most radiologists out there as a way to replace radiologists. The best CAD detectors for mammo and lung nodules have consistently underperformed expectations. The biggest problem with artificial intelligence is that there are always new data sets that the researchers have not inputted into their algorithms. And, any independent reads by a computer will not be able to take these myriad factors into account for a very long time. I don’t see any chance of it taking over a radiologist’s job for more than fifty years from now.

Even if artificial intelligence becomes more successful, radiologist numbers  are still way too low relative to the amount of work out there. Artificial intelligence may even boost efficiency to get more done in less time, enabling radiologists to do more with less and increase earnings. (That would be a good thing) Artificial intelligence, therefore, is not much of a risk at all to the profession. Sorry, Jabal!

ROAD/Flexibility

Dr. Jabal constantly adds radiology as part of the lifestyle specialties. Sure, we have one of the most flexible specialties regarding work location, shiftwork, and type of work. However, many of us have become insanely busy because we are replacing a lack of physician staffing elsewhere, i.e., emergency medicine, family medicine, etc. For this reason, patients will often get pan-scans without being seen by clinicians first. So, many of us have become very busy trying to keep up with the demand. So, I’m not sure we belong on the ROAD list anymore!

More Introverted Specialty

On this subject, I would have to agree on a bit. Although I know lots of radiologists who are very outgoing and personable, many radiologists would prefer to work alone as well. In other specialties, this introversion does not fly as well when you have to see tens of patients daily—seeing patients could become exhausting for an introvert. Radiology is a way to avoid the constant bombardment of patient contact. (Of course, it does not have to be that way!)

Competitiveness

Here is another area where I would have to agree with Dr. Jabal. Although the trends have become more competitive lately since COVID, we are certainly not as competitive as dermatology or orthopedics. We place somewhere in the middle of the pack, maybe a bit more toward the upper end of the mid-tier lately. Dr. Jabal seems to emphasize a similar level of competitiveness, somewhere toward the middle of the middle, That ranks close enough to the mark.

Doctor Jubbal, Med School Insiders, And Radiology

So, yes, Dr. Jubbal does toot his own horn as he had formerly trained as a plastic surgeon and subtly suggests that plastic surgery is the epitome of being a physician. If you can get past that, he does get some impressions of radiology right, especially the appeal to introverts and the general competitiveness of radiology. On the other hand, he misses the mark a bit for others, such as salaries, artificial intelligence, and the ROAD concept for radiology. But, overall, he does not do so badly. His youtube segments are enjoyable to listen to and can help residency applicants in general. My advice, though, is never to use one source for anything. And try to find mentors in the residency space within your specialty of interest. The best advice will come from physicians within the area of training where you want to apply!

 

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What Was Radiology Life Like Without PACS?

without pacs

I may be dating myself, but I am the last generation that did a radiology residency without PACS. Yes. I lived and breathed the pre PACs era. Some of it was pretty good. And, other parts of it, not so much.

Nevertheless, radiology was very different before hospitals started to add these systems to their networks. So, what are some of the most significant changes I have seen throughout my career when I compare the two eras? What was life like before the advent of PACS? Let’s go through some of the most critical differences in radiology.

Many More Films Got Lost Without PACS

On any given night, you would expect a good percentage of cases to remain in absentia without a dictation. Unsurprisingly, the orthopedic surgery residents would stealthily slip into the reading room when the radiology resident stepped out. And this person would steal the films so that the surgeons could use them for orthopedic surgeries at nighttime. Or, the alternators (the old defunct machines that you might see in the back of a reading room somewhere nowadays) would suck up several films, and they would get lost in the device or even shredded to pieces. Many cases would simply no longer be available for dication either for a delayed period or never. Film loss was just a fact of life. Nowadays, it is only the rare irretrievable case that you will need some help with from the IT folks.

Saw A Lot More Clinicians

Today, our reading rooms fill up with primarily residents and a smattering/skeleton crew of a couple of attendings. Back in the day, the reading room was hustling and bustling. Surgeons, Ob-Gyns, and more would regularly show up to look at their cases with you because they couldn’t look at them themselves on a PACS system. You got to know each clinician by name and personality. It was more than just a tryst in the reading room. Of course, that came with the upside of meeting great physicians and the downside of discovering a few jerks here and there. Nevertheless, the reading was much less of a lonely place. And, you would learn about the final disposition of cases more often because we kept in close contact with our physician brethren.

Had To Produce Your Films For Case Conferences

Have any of you ever encountered a dark room? Back in the day, it was a regular event for radiologists. We would have to develop our copies to present for case conferences. It was a big deal and somewhat time-consuming. But, we all got to know this haven of darkness every so often. It was much more intricate than just downloading a case on PACS or snapping a picture on an iPhone for a presentation on a Powerpoint. These technologies were available but still uncommonly used at the end of the pre-PACS era. It was a pain in the-you-know-what!

Priors Were Less Common

Getting priors was a real pain in the neck back then. We would somehow have to go down to the file room and retrieve them. Therefore, we would dictate many more cases without them because they could be hard to come by. So, you could imagine we lost some specificity and sensitivity in these dictations. And, then, when you did retrieve the priors, you would receive these enormous folders where you had to find suitable films. You would be lucky if you didn’t get a paper cut in the process. (They were much more prevalent back then and hurt like hell!)

Less Windows Available Without PACS

Nowadays, we click a button and re-window a case. Back then, you couldn’t look at the bones if you didn’t have the bone windows on film. So, the techs would print fewer windows to save on film. Often, if the reason for the study had nothing to do with the window, you would not have them available to read. I’m sure we missed tons of osseous lesions!

Keep Lists Of Results On Overnight Cases

Instead of having a PACS system to look cases up, we would have to keep a running tab of the patient studies we read, especially on CT rotation. Clinicians would come down and check out the results on the list and chat with the resident. Every room would have a list of cases from the previous night. Eventually, they would make their way onto the Radiology Information System. But until then, the responsibility was ours to keep tabs on everything in the reading room.

Working From Home, Ha!

And finally, working from home was a figment of one’s imagination. We needed to perform all reads and procedures in-house. Imagine being unable to take off to let the Verizon folks fix something in the house. That was our world. We lived and breathed the hospital in those days!

Radiology Life Without PACS

We lived in a different world back then. Radiology lifestyle and culture have changed dramatically over the years since hospitals have installed PACS. Yes, we had more contact with other physicians, but it came at the expense of many problems. Nevertheless, although mostly better today, some good did happen before hospitals introduced PACS to our world. Would I want to go back to those times? Probably not. But they were a great experience that new radiologists cannot imagine today!

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Top Ten Signs It’s Time For A Radiologist To Retire!

retire

I’m sure many of you have encountered radiologists who should have retired years ago but are still hanging around. Maybe they are burnt out. Or, perhaps, life has thrown them a few curveballs. Here are some of the top ten reasons why you know it’s time for your fellow radiologist to retire!

One Extra Case Sets Them Off

You probably know one or two radiologists like this. If anyone asks them to help with another case, they will lay it thick on you. Perhaps, they will yell and kick, or they will say they need to get home and can’t afford the time it takes to complete it!

They Can Only See Films From One Eye In A Certain Position

Some radiologists will do almost anything not to go to the doctor. They hang around longer than necessary in practice. I have known a few that would practice with ailments for which I am not sure they can compensate. For many of these radiologists, it may be time to pack your bags!

Spend More Time Napping During The Day Than Reading Cases

In the past, I used to know a radiologist or two who would spend a few hours in their office while everyone else was working hard. Some residents saw them getting shut-eye while everyone else struggled to keep up with the work. If you get to this point, maybe you should be getting up late every day at home without having to read films!

New Ailment Every Day

I’m sure you have heard of a radiologist who always seems to get sick. One day a heart condition, the next day, a limp, and the next day a raging cough. Some folks are too frail to make it to work. If that is you, it may be time for you to nurse yourself back to health and take some time off. It will do you some good.

Yells At The Medical Students Upon Arrival

Poor students. The wrath of some attendings manifests itself on the underlings that come in to visit. They are angry at the world and take it out on the learner. No, it isn’t right. But, it does happen. These folks need some time off to think about their behavior!

They Are Reading 400 Cases Per Day

Most practices have one radiologist that reads too much to be safe. If you are reading four hundred or more cases per day, I feel you are missing a lot of critical findings. Think again if that is what you want or if it’s simply time to slow down.

Flagged Cases So That A Particular Radiologist Will Not Read!

If you have your name tagged on one too many cases, it may be that another one of the radiologists is not allowed to read this referrer’s studies. Or, some physicians whisper about another radiologist and don’t want this person reading the cases. Either way, it’s not a good sign. It likely means that this radiologist is not doing his job well. This radiologist may want to give up and stay home.

Their Cases Always Seem To Make To Morbidity And Mortality Conference

Ever notice that the same radiologist’s cases make it to morbidity and mortality conferences? Well, perhaps, it is for a good reason. All their misses contribute to the holistic lousy patient care. Be on the lookout if this radiologist is in your department!

No One Can Speak To Them Anymore Or Ask Questions

Some radiologists stay away from this one colleague. Unlike most colleagues you can bounce ideas off of, they can’t ask any questions of this person for fear of yelling and negativity. You probably have someone like this in your practice. There is a good chance that it is time for this radiologist to retire!

Always Complaining That They Should Retire

Everyone knows of a radiologist that constantly talks about retiring. They say it in myriad ways, and it becomes a real bear to hear. “I can’t stand work it’s time to retire,” “I can’t take it any more and it is time to go” are the statements they make all the time. Well, do it already!

Reasons It’s Time For Radiologist To Retire

No one can work forever. But, I think that these reasons to retire soon do justice to those folks that should pack it in sooner rather than later!

 

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Should Teaching Programs Hire Non-Teaching Faculty?

non-teaching faculty

At almost any hospital residency program, you will have a mix of faculty with all different interests. Some like to teach and spend concerted time with the residents. In some more academic hospitals with residencies, other faculty want to pursue research areas. And then there is the final group that wants to put their energies into completing the day as quickly as possible and returning home to family without wasting time on other endeavors. So, today’s question is: should hospitals and practices with residency programs hire these non-teaching faculty if they have a residency program dedicated to teaching? To answer this question, let’s talk a little about the current hiring environment in radiology. And, then let’s discuss the advantages and disadvantages practices and hospitals face when hiring non-teaching radiologists in the current climate. And finally, we will come up with a feasible conclusion.

The Current Hiring Background For Radiologists

We are in the midst of one of the most acute shortages for radiologists in 2022 as it stands right now. Even residents that have not completed their training receive solicitations for work. It is not uncommon for practice owners to cover unwanted shifts to ensure their practices run smoothly due to a lack of personnel. And, starting offers for new radiologists are robust. A “warm body” that can read and catch up on all studies is a treat for many sites. So, many practices can prevent a practice crisis if they hire radiologists to do the work but do not want to teach, but at what price?

Disadvantages To Hiring Non-Teaching Faculty At A Teaching Site

If They Don’t Have To Teach, Why Should I?

The biggest fear for a practice of mixed radiologists is the impression of inequity. When radiologists see that they can get away with less responsibility, you may hear the phrase “it’s not fair” bandied about. This unfairness leads to decreasing morale and radiologists thinking about leaving practice for greener fields elsewhere. This environment can be toxic even if you compensate faculty members for teaching.

Does Not Foster A Culture Of Inquiry

To create an excellent residency program, I like to say you need a culture of “why.” I love when my residents ask why about the reports, procedures, or protocols they see. It forces me to rethink my training and beliefs to analyze what we do “by rote’. And, it’s a great way to reinforce and learn new knowledge for attendings and residents. Disinterested attendings who do not participate can spoil this excellent learning environment.

 Advantages To Hiring Non-Teaching Faculty At A Teaching Site

Free Up Teaching Faculty Who Want To Teach

If you can isolate the non-teaching faculty to rotations that do not involve teaching, you can allow the teaching radiologists to teach without the hindrance of backed-up work. Freeing faculty members who want to teach can theoretically improve the teaching faculty’s morale. However, the practice would need to decide on a protocol for which it will not degrade residency training.

Can Get More Work Done

You may have heard the adage, “a resident will slow you down.” Yes. There is some truth to that. It takes time to explain and go over dictations and give lectures. If you do not have these responsibilities, it is possible to plow through extra work throughout the day (perhaps with a headache!). Practices with some attendings that work without residents can theoretically accomplish more RVUs during the day.

Should Your Teaching Practice/Residency Program Hire Non-Teaching Faculty?

There is always more to a decision that might be easy at face value in a typical environment. New radiologists that do not teach can cause inequities and do not foster a teaching culture. Nevertheless, freeing up teaching faculty and getting the practice work completed is critical. So, if you see a new grumpy radiology hire that does not want to teach residents and is plowing through the cases, there is a good reason for that. Many practices are under duress to hire a body to fulfill the work of the business, not just to teach residents. However, programs that employ these radiologists must ensure they are not on teaching rotations to minimize conflicts. Instead, programs should make a concerted effort to plug in those attendings that want to teach to the divisions with the most exposure to residents. It may take a bit of adjustment on the part of the resident and the faculty until the radiology shortage resolves!

 

 

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The Last Case Bolus Phenomenon!

bolus phenomenon

Ever notice that the end of a shift tends to have a bolus of cases? Just as you are allowed to leave the building, you find yourself with multiple studies that you need to read emergently. Usually, they are more complicated, and you don’t leave your station near when you are “supposed to be” finished. Well, this bolus phenomenon is not by any means random. Based on logic and my experiences, there is much more to this phenomenon. So, let’s go through some of the causes why you suddenly experience more cases that can often be the most difficult ones right at the end of your shift. You may be surprised at the reasons!

Transitions Are Not Smooth

Down in the emergency department, just like in radiology, no one wants to leave over work for the next ER attending shift. So, they will often order a bolus of cases so that the next physician does not have to write for them. This process causes a sudden cluster of studies in the radiology department. And, at this point, toward the end of your shift, you also feel the heat.

The ER Doctor Likes Your Work

Here is some good news/bad news for you. Guess what. Sure it’s great that the ER physician downstairs likes your dictations and diagnostic acumen. You have made a friend for life! However, that same phenomenon can lead to a bit of pain; right before your shift ends, they will try to get in as many patients as possible so that the physician downstairs will get all your dictations before the subsequent radiologist arrives. Sometimes, it does not pay to be the best!

ER Shifts End The Same Time As The Radiologist

Unfortunately, we like to begin and end shifts at typical times. Ten o’clock can be a standard time for physicians to leave. So, as the radiologist, you are not alone at that time. Therefore, you will receive the bolus of cases that need a disposition at the same time that you will leave. In this case, you can resolve this issue by changing the timing of shift changes so that they don’t coincide.

Transport Logjam

Ever take a gander outside the reading room, only to see ten patients in beds in line in the waiting area, waiting for their study. A lack of transporters can often cause this logjam. And, the same lineup often happens in reverse when they need to leave. These logistical issues often occur when your hospital does not pay enough to get these transporters to do their jobs. A hospital is only as good as its weakest link!

Pressure For Disposition, a Definite Cause For The Bolus Phenomenon

Finally, some emergency medicine physicians can become fickle. These emergency medicine physicians delay and protract until they finally decide what to do. And they must make this final decision before the end of their shift. To do so, they will probably need that definitive imaging study to confirm or refute their suspicions. So, these examinations culminate their thought processes right before they leave. You are there reading CT scans for them to reap the benefits!

The Last Case Bolus Phenomenon Is Not Random!

It feels painful to experience a large cluster of cases at the very end of your day, right before the end of your evening. However, contrary to what you might think, it is not a random process. Poor transitions, ER physician fans, problematic timing, transporters, and pressure for disposition, are all factors that often cause this bolus phenomenon. Some of these factors you can change and others not so much. It’s one of those hazards we experience when a shift is about to end. It’s just part of the job!

 

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Hospitals Need to Invest More In Radiology IT Support!

radiology IT support

In an environment where hospitals’ profit margins are becoming tighter, what is the most likely area where they can cut costs? Well, it’s undoubtedly not surgery or nursing. That would look not very good for the hospital and drive competitors elsewhere. Could it be hospital beds? No, because that would lead to direct patient complaints and less capacity. Is it the high-tech equipment and hardware? Not usually, because that is a great marketing tool to get doctors to refer patients your way. Instead, unfortunately, the places where a hospital can cut costs are usually the behind-the-scenes. And one of these areas on the chopping block is radiology IT support.

Who cares if the radiologists if a radiologist’s job is more demanding? It doesn’t affect the hospital’s bottom line, right? Does it matter if the radiologists must stay an hour later to deal with PACS crashes, firewall issues, and incompatibility with outside studies? The radiologists need to get their job done anyway for patient care. Well, that philosophy has become commonplace in the world of hospital savings.

In reality, the costs of not supporting a hospital’s information technology are enormous. It decreases efficiency for doctors, patient outcomes, and staff morale. And hospitals certainly do get complaints, albeit on the back end. So, what are the tangible results of having poor IT support, and why should hospitals treat this issue as mission-critical for the system. Let’s delve into the reasons why.

Radiology IT Support Allows For Quicker Turn Around Time

Turnaround time is one of those statistics that hospitals hang their hats on to show that they are efficient. And what is one of the most significant factors in a delayed turnaround time? Well, it’s the radiology study. The time it takes for the patient to have dictated images is widely dependent on having a constantly functioning PACS and dictation system. Patients will have to stick around longer without a functioning IT support system, a money-losing proposition.

Better Patient Treatment

Not having IT support may mean malfunctioning networks and servers for many reasons (decreased bandwidth, storage capacity, etc.). Often, this process results in loss of access to priors. And guess what? As I said in my previous rant on priors, this leads to poorer patient care because of decreased specificity and sensitivity. Or, it can even lead to disastrous outcomes if you can’t process studies like CTAs of the brain. And these are just some horrible outcomes of many!

Increases Morale (Waiting on The Phone)

Want to keep your doctors within the hospital system in a competitive market. Then be sure to support IT. Radiologists, physicians, and nurses are more apt to leave when they notice a constant breakdown of the electronic health records and PACS systems. These nagging factors are a continuous source of reported physician burnout (among others). We should be trying to maintain our physicians, not creating a revolving door!

Increasing Patient Satisfaction Scores

One of those other factors that hospitals love to tout is their patient satisfaction surveys. Hospitals regularly feature positive survey outcomes on billboards and commercials to show that they are competent institutions. Well, guess what? Those scores will not cut the mustard if patients have to stay in-house because no one can access the electronic records!

Saves Hospital Costs

The costs of malfunctioning electronic support systems are substantial. Imagine having to keep your patient for extra days in the department because a lack of support prevents patient discharge. Based on this issue alone, costs skyrocket to thousands of dollars per day for a hospital stay. And this doesn’t account for all the other expenses that a poorly served electronic health records and PACs system entail!

Radiology IT Support Is Not An Option That Hospitals Can Skip!

Although many hospitals would like to skip this “expensive” service to save money, you need the full-time support of a dedicated IT team for better patient care, decreasing hospital costs, and increasing the system’s efficiency. Although not evident on the front end, the downstream effects can be enormous. By not supporting IT, hospitals are merely shooting themselves in the foot. It’s not an option that hospitals can skip!

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Inheriting Other Program’s Problems – The Lateral Residency Transfer

lateral residency transfer

Every once in a while, a program will lose a resident for various reasons. It could be to move closer to family, poor performance, or a gazillion other reasons. When this unfortunate event occurs, a program is stuck trying to fill a spot. And, you would think at first glance that it would be pretty straightforward. I mean, radiology is pretty competitive nowadays. Instead, only a fixed small number of residents can transfer from one PGY3, PGY4, or PGY5 spot to another. And, programs need to be very careful when they recruit these positions. A lateral residency transfer from another residency program can become more problematic than having one less resident in the program.

So, what are the issues that residency programs face when recruiting residents from other programs? And, what kind of transfers are programs looking for? Here are some of my thoughts on these situations.

Lateral Residency Transfer: A Minefield Of Problems

Professionalism Issues

Many applicants from other institutions leave because their former residency program does not want to renew their contracts. Out of those reasons, one of the most common is the professionalism violation. It could be any one of thousands of professionalism infractions, including ethical, moral, and legal issues. Moreover, programs suffer from a lack of information about the resident’s former residency. Frequently, the former site of the applicant doesn’t release “all the information.” So, poor professionalism behaviors can quickly arise again when the resident enters your program.

Academic Issues

In addition to the professionalism issue, many lateral transfer residents cannot academically make it through their current program. Perhaps, it is related to test-taking skills, dictations, or inability to make the findings. If you hire them without knowing the real issues, these same issues will eventually surface when they transfer to your program.

Medical/Mental Health Issues That Can Interfere With Training

We also have to worry about medical and mental health problems interfering with resident training. Notably, this information can be complicated to retrieve because it is a HIPAA violation for a program to give this information out to another freely. And although programs make every attempt to overcome these issues, it can lead to all sorts of problems for both the incoming resident and their colleagues who need to cover them.

The Fickle Resident

Finally, some residents leave because they spontaneously want to abandon their former program for various unstable reasons. These include dating scenes, being in a warmer climate, or myriad other miscellaneous reasons. This sort of resident can decide to do the same when entering your program. Not a great situation!

What Programs Want From A Lateral Residency Transfer

Residents That Need To Leave To Be Closer To Family

Sometimes residents will have a sick relative, and they need to care for them. Or, they have a wife and children who live in a different country than their current residency program. These reasons are legitimate. And, they make for a happier resident that will be more likely to complete the radiology residency.

Particular Interests That The Former Residency Cannot Satisfy

Other times residents discover they have different interests that one residency cannot meet. Perhaps, they are interested in participating in bench research not available to them at their current site. Or, maybe the new site has a PET-MRI, which is the resident’s area of interest. Regardless, these reasons can be valid as to why the resident may want to come to your program.

Legitimate Medical Issues That Will Not Interfere With Training

Some residents need to be closer to certain cities/hospitals to get their treatment. And, perhaps, it is not available at the current institution/town. Or they need the care of family members to help them with health issues. These residents can potentially become a great asset to a new program if they meet its demands.

A Real Change Of Heart For The Lateral Residency Transfer

In medicine, it is effortless to make a mistake. We don’t necessarily know what we want to do when we get out of medical school. Medical schools do not give the best sampling of what life is like post-medical school in all specialties. And, many residents realize they made a mistake early on. Sometimes nuclear medicine residents or emergency medicine residents who have completed imaging rotations can qualify for these more advanced positions. Well, these sorts of residents can become the best trainees because of their dedication to doing something they want to do instead.

The Lateral Residency Transfer Can Be A Tough Situation!

Due to all the pitfalls and possibilities that a lateral transfer can offer, it can be challenging to cull residents that will fit the new program’s culture and meet the demands and rigorous tests of residency. Selecting residents with professional/academic violations, medical issues, or the fickle resident can throw a wrench in the new residency program when similar problems arise in the new program. And this situation can be worse than not recruiting any radiology resident. But, many residents have valid reasons for changing programs as well. So, residency programs, just like the residents, need to do their due diligence. The consequences of picking the wrong resident can be dire!