Miscellaneous Archives - Page 2 of 8

Posted on February 20, 2022 by Barry Julius

Calcium Scoring CT Scans- Are They Worth The Risk?

I am not a cardiovascular radiologist by any stretch of the imagination. However, I read lots of cardiac calcium scoring studies. And, a good chunk of the time, when I read these studies, I find all sorts of other issues. It may be a pulmonary nodule, a liver or renal lesion, or an adrenal nodule. Regardless, I see too many of these ancillary findings.

Why do all these incidental findings matter? Well, I have a sneaking suspicion that most of us don’t have a handle on the actual risks to this study. So, my question for today is, do these ancillary issues supersede the potential benefits of getting a cardiac calcium study. What are the complications of receiving this scan? And, what does the current literature say about how these “incidental” findings alter the actual risks of receiving this examination.

Calcium Scoring And Incidental Findings

If you want to read an excellent paper on the topic, look at the AJR article called Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact. To summarize, around 43 percent of patients receiving this study had some form of incidental findings. And in 52 percent of these patients, the author deemed these findings significant. So, if we do the math, 22% (0.42 x 0.52= 0.22) of the time we read these studies, we will find a significant incidental finding.

Now, in my experience, this number sounds about right. I find pulmonary nodules and hepatic cysts all the time with an occasional smattering of all other sorts of problems. And, I hate recommending the Fleishner criteria and ultrasounds to follow up these studies. Why? Because I know that they will lead to undue additional radiation, procedures, and other complications that we have not even thought about most of the time. And these issues don’t even include the untold psychological tax for each patient with an incidental finding.

Moreover, other patients may even have higher numbers of incidental findings. Check out this paper on diabetics and incidental findings, and you’ll see what I mean. How do we deal with these subsets of the population getting these studies?

And, then, of course, the number of incidental findings depends on the field of view. Some scans use a wider field of view than others which logically should pick up more incidental findings. I always think that if I had to have this test, I would want to receive one with a smaller field of view to decrease the possibility of the incidental finding!

What Is The Real Complication Rate Of Incidental Findings?

At this point, my research on this topic gets a little bit dicey. Unfortunately, I have not found quality information that reports on the actual complications of incidental findings of a relatively healthy person that receives a Cardiac Calcium Scoring CT scan.

Instead, I find myself having to turn to personal stories of relatively healthy patients that had issues with some of these incidental findings. I know one relatively young patient with a remote history of non-metastatic superficial melanoma who had multiple pulmonary nodules. The interpreting radiologist read them as significant enough to be suspicious for malignancy. The patient felt fine, but the surgeon wanted a VATS. Fortunately, the patient’s doctor canceled the surgery and allowed the patient to follow up with serial short-term chest CT scans. The nodules turned out benign!

Or, I think about a breast nodule that a radiologist found that turned out to be a small benign fibroadenoma. The patient had a significant workup with a slightly complicated course of bleeding. It may have gone unnoticed if not for the calcium scoring CT scan.

I am sure these individual cases are just the tip of the proverbial iceberg. Now, you may point out that we do find all sorts of lung cancers, metastatic disease, cirrhosis, and other diseases that may have some benefit of making findings early on a calcium-scoring CT scan. And, I can give you a few of those stories as well. However, these tend to be in a sicker population. Moreover, from my experience, these are a significant minority of cases compared to the world of the benign incidental findings on a Calcium scoring CT scan.

What Do You Say To Colleagues And Patients That Want To Get A Calcium Scoring Study?

Because the hardcore truth about complications and Calcium scoring is not out there yet, here is what I tend to tell relatively healthy patients. First, make sure that you have the risk factors to support receiving this test. As I described above, the complications are not benign. Second, if you think it is worthwhile and will change medical management, make sure to find an institution that uses a small field of view that encompasses less adjacent anatomy. There are many different protocols so that they can make a difference. And, then finally, if the radiologist discovers an incidental finding unless it is glaringly problematic, make sure to take a conservative approach if reasonably possible.

If you receive the test, we can’t undo the incidental finding. But, at least, you are aware of some of its risks and can mitigate some of the problems you may encounter!

Posted on February 6, 2022 by Barry Julius

Should Radiology Residents Have Workstations At Home?

One of the most significant changes in radiology in the post-Covid age is the ability for radiologists to “telecommute” to work. The pandemic has hastened the adoption of these technologies, not just for teleradiologists but for almost every practicing radiologist. Nevertheless, most radiology residents still cannot read from home workstations (although I have heard of a few).

So, is it a good idea for residents to have workstations at home? Well, I will go through some of the pros and cons of home workstations for residents. And, then I will give you my conclusion for which if any residents should have workstations from home.

Reasons For Residents To Not Have Workstations

Need Real-Time Consultations To Learn

My best teaching situations are routine phone calls and visits from our physician colleagues at the workstation. And when a resident takes these consults, they are most likely to learn how to practice and communicate in radiology. Working from home decreases these potential connections to the daily consultations that radiology residents will receive.

“No Real Time Teaching”

Especially for first-year residents, there is no substitute for sitting with an attending at a workstation for a bit to learn radiology. Yes, it is possible to make phone calls to your faculty to go over the images. But, usually, only after you have seen the case and without a faculty member by your side. So, you lose out on many teachable moments to learn about normal findings or ask miscellaneous questions on all the cases you see. These questions can be the most thought-provoking.

Reading In A Bubble

Yes. You need to make independent decisions and read by yourself eventually. But, when you are at the institution reading, you can more easily recruit the help of nurses, technologists, faculty, and more. It is much easier to talk to the ultrasound technologists about patients’ histories in person who just completed a case than to catch staff on the phone somewhere. Ancillary staff and fellow physicians add critical information to your findings and interpretations.

Expense

It is a significant additional expense for institutions to allow residents to read from home. Workstations can run in price from thousands to tens of thousands of dollars. And Medicare only indirectly reimburses for resident dictations, so it has low perceived value for the institutions. Therefore, resident workstations can theoretically increase the cost of healthcare.

Reasons To Have Workstations

Sick Residents

Residents get sick just like everyone else. And, sometimes, it’s a mild bug (or even Covid!). Most residents don’t want to infect everyone else. Yet, they still may have the ability and desire to work. Well, with a home workstation, that is still possible. Having a workstation from home opens the possibility of continuing to learn and read without having to take a day off!

Looking Up And Reading Cases Off-Hours

Sometimes, you just want to look at actual cases at any hour. Maybe, it was an interesting case from the day. Or, you just want to learn more about a particular subspecialty, say MR MSK. For that matter, residents (and faculty) are much more likely to learn about these cases and subjects on off hours if they can look them up quickly at home. That power can undoubtedly add to resident education.

Is It Worth It For Radiology Residents To Get Workstations?

I am certainly one of the biggest proponents for onsite learning as a faculty member. Based on the many reasons above, such as real-time teaching, I tend to learn more when sitting at the hospital surrounded by colleagues instead of reading cases from home. Something about being present with others enhances the learning process. And that is one of the main reasons residents do a radiology residency, to learn.

Nevertheless, there is no denying that the flexibility of home workstations can also help when a “traditional” learning environment is unavailable, whether due to sickness or after-hours work. So, I am not against residents having home workstations if the institution can afford to pay for it. But, home workstations should not replace the residency experience. Instead, workstations can supplement the learning environment for the resident. As an add-on tool, it’s not a bad idea!

Posted on December 5, 2021December 7, 2021 by Barry Julius

Overcomplicating The Obvious For The Sake Of Academic Publication!

Recently I came across an academic publication in the JACR, my favorite radiology journal, called Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. I had to look at it for a couple of reasons. First of all, I’ve written about the topic before in an article called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective!. My article espoused most of the JACR article’s ideas. And I wrote this article over 1.5 years before this new “academic” JACR article existed! (without even a citation of my publication!). Therefore, the topic was very relevant to my interests.

Second, I was curious about if the conclusions would match up with my own. And, to answer the second question, they certainly did. As I summarized in my blog, this article also concluded that medical school prestige would gain outsized influences. Moreover, just like my article, they said that Step 2 scores would partly fill the gap left by the loss of Step I scores. (1)

Overcomplicating And “Academicizing” For The Sake Of Academic Publication

Nevertheless, having looked at the article for a few minutes, I found it more amusing how complicated they made this “study” to come up with simple logical, rational conclusions that any program director would make if you asked them. I mean, they got into “discrete choice experiments,” randomizing how faculty would answer when presented with different application situations. Simple surveys would have done the same trick. Now, I am a firm believer in evidence-based medicine to further science. But, this article is the perfect example of taking old information out there on the web (my own!) and overly complicating and “academicizing” what should be a simple logical thought process to create an “academic” paper out of it. If you will, this is another example of publishing for publishing’s sake merely to add to your credentials.

Is Your Article Genuinely Adding To Radiology Body of Literature?

Unfortunately, this type of intrigue happens all the time in academic radiology and medicine in general. So, if you genuinely want to add to the science and practice of radiology, think about the ideas and hypothesis that you are about to research. Are they original, or have other folks written about them? Will your paper serve a specific objective, or will it just add to the body of documents out there? And, finally, don’t try to complicate the issues when you can achieve the same goal in a much simpler way!

Posted on October 14, 2021October 14, 2021 by Barry Julius

Five Radiology Residency Tips- Special Podcast Interview!

Here is a special post with a recent youtube podcast interview with me about tips for radiology applicants/residents. Enjoy!

Posted on October 10, 2021 by Barry Julius

Why A PACS Crash Can Be A Disaster!

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

Missing Findings

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

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

Incomplete Information Leading To Bad Treatments

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

Significant Loss Of Revenue For The System

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

Angry Physicians And Patients

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

Inability To Make Emergency Diagnoses

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

Potential Legal Ramifications

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

Loss Of Confidence In The System

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

A PACS Crash Can Be Devastating!

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

Posted on July 11, 2021April 28, 2024 by Barry Julius

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

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

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

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

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

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

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

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

Technology Trainers Don’t Know How To Train Radiologists

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

Lack Of Time/Money Dedicated Toward Training

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

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

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

Posted on April 18, 2021March 24, 2024 by Barry Julius

Seven Ways Administration Can Destroy A Radiology Residency Program

Like it or not, all radiology programs need the backing of their administrators to succeed. Unless faculty and residents want to pay for residency out of their own pockets and manage all the day-to-day issues themselves, it is the only way to survive. So, with all this power in the hands of the administrators, it is no wonder that they can direct a residency in ways they see fit. And they can use their power for the good of the program or to the detriment of everyone. So, if you are wondering how the administration can pull strings to destroy a radiology residency program, here are the top seven ways!

Lack Of Financial Support

Unfortunately, a residency cannot run itself without money. Whether it is the reading resources, Radexam, equipment, or teaching, all these line items cost money. If the administration takes all the money for themselves and is unwilling to cough it up for the residency program, a residency cannot continue functioning.

Lack Of Human Resources

It’s not all about equipment and stuff. It would help if you also had the workforce to make a residency function. These folks include program directors, residency coordinators, faculty, statisticians, and more. If you can’t hire or maintain these folks, you may as well pack it all in!

Unrealistic Expectations By The Administration

We all want the best for our residents. But, when administrators expect to create an academic powerhouse but are unwilling to hire the proper faculty, or if you want a class of incredible residents but are not willing to pay for the latest and greatest equipment and technology, do not expect to create a residency that will function!

Administration Culture Clash/Backseat Driving

Administrators and faculty often have different ideas about how to run a program. Just because you, as an administrator, provide the funds to operate a radiology residency doesn’t mean you can control everything. For instance, recruiting residents from only certain institutions because you get a kickback doesn’t work.

And, just because you, as a radiologist or program director, think you know everything about running a residency doesn’t mean you know enough about managing a program’s business. Spending money without controls can lead to poor hospital financial outcomes. Either side pulling all the strings can lead to a disaster!

No Backup For Program Directors/Department

To maintain respectability within an institution, program directors need support from their administration. They may encounter problems getting a statistician to help residents with studies to meet the requirements of the ACGME. Perhaps there are conflicts with another department overstepping its bounds and using radiology residents for non-educational purposes. In either case, the administration must back up the program directors and radiology department to maintain the department.

Unwilling To Update Old Equipment To Save A Buck

Yes, institutions do like to keep that ancient CT scanner or MRI. Why? Well, it becomes a cash cow when it is all paid off. No more hardware expenses mean higher profit margins. But there comes a time when you are just out-of-date and can’t keep up with the competition. And guess what? That also affects the residency. Residents don’t get the training they need, and fewer patients come to the institution because they don’t get the advanced imaging they need!

Loathe To Adopt New Technologies- Too Many Hoops

Sometimes, you need to adopt new technologies, but there is so much bureaucracy that you can never push the capital budget through. Perhaps the administration makes it so hard to obtain the correct paperwork. Or maybe they only meet in committee once every six months and are not quick to decide. In any event, if you snooze, you lose!

Yes, Administration Can Destroy A Radiology Residency Program!

Radiology residency programs are only as good as their weakest link. And if that link is the administration, the whole residency can fall apart. Whether the issues are financial, cultural, or bureaucratic, each factor can result in the program’s demise. So, when you choose a training program, make sure to look into who administers it!

Posted on October 1, 2020October 1, 2020 by Barry Julius

Happy Birthday Radsresident- Four Years Old!

Happy Birthday To Radsresident.com!!!

Another year has gone. Indeed, it’s been a strange one. Usually, sea changes such as these occur at a snail’s pace. But, this year, they have been fast and furious. And, here at radsresident, we’ve been capturing it all! Covid, getting rid of scores on Step I, the sudden change in the job market, and the increase in teleradiology capabilities are some of the significant rapid changes we have covered in one year.

So, how has radsresident fared among all these rapid changes? Well, once again, I will break down the growth of the website, the most popular posts, some of the new changes, and what you can expect over the up and coming year!

Radsresident Growth!

This year alone, from September 24, 2019, to September 23, 2020, we have continued our rapid growth. We have had over 140,000 individual visits, up from 121,000 the year before, and 35000 from when we first started. That is 400% growth over four years. Not bad for a niche website!

Additionally, as of now, we have 360 individual posts to choose from on all sorts of radiology residency related topics and lots of new pages with cases and more. Just like last year, you can download a helpful free ebook called The New Attending Physician Guidebook: How To Search For The Right Job And What To Do Once You Start if you sign up for the weekly newsletter. You can also purchase our signature book on Amazon called Radsresident: A Guidebook For Radiology Applicant And Radiology Resident. And that does not include the precall quizzes you can take to see if you are ready to take an overnight call.

Let’s go through the most popular posts over the past year and of all time!

Population Using Radsresident.com

How are you folks arriving at the posts and articles on this website?

Organic search (Google, etc.) – 69% of readers
Direct (typing in radsresident.com) – 12% of readers
Social (Facebook, Twitter, etc.) – 17% of readers
Referral (Links and websites)- 2% of readers

From where are my readers?

The United States – 70%
India – 7%
Canada- 2.3%
United Kingdom – 1.8%
Australia – 1.2%
Saudi Arabia 0.9%
Pakistan 0,8%
Brazil 0.7%
Philippines – 0.7%
Germany – 0.6%

How many individual users have frequented the website over the entire past year? (based on Google Analytics)

102,794 individual users (84,848 the previous year)

201,850 page views (177,288 the last year)

What Else Has Changed Recently?

You may have noticed that I have added The Residency Store to the website. It is a place where you can find radsresident products, quality affiliate companies, and affiliate merchandise relevant to the residency experience. I have been toying with the idea of making it into more of an “educational store” and highlighting educational products for residents. The store is a work in progress, and you will most likely see some more changes in this part of the website over the next year.

Plans For The Up and Coming Year!

Making plans is the fun part about running a website. You get to come up with ideas and then experiment with what works and what doesn’t. It’s the ultimate rush to try to find posts, pages, and useful products and services for my loyal readers.

So, what is in store for the website? Well, last year, I tabled creating a video series for lack of time. (Life sometimes gets in the way!) But, this year, I plan on completing some videos in a new video series called Reading More Quickly, Accurately, And Getting More Sleep. The goal is to create exclusive videos to go through how to search on each of the imaging modalities and specific anatomic regions. It will likely include CT scan, and MRI segmented into different body parts, ultrasound, nuclear medicine, fluoroscopy, mammography, and more. It’s a lot of work to make the quality sufficient for my audience. But, I hope to get the first video out before the completion of the next academic year. Folks on my newsletter will be first to know when I officially complete the first one.

With all the additional new posts and information over the past several years, I am planning to begin to compile and publish some new books specifically for the radiology applicant, the radiology resident, and the radiology fellow. These books will hone in more specifically on my core readers and those that would benefit from this website (but don’t know it yet!) That is also a work in progress.

And then, of course, you will continue to get the varied posts on all the essential information that you need to succeed in radiology applications, residency, and beyond!

As Always, It’s Great To Hear From My Audience

Once again, I am proud to be writing for this incredibly intelligent and exciting audience. One of the best parts of managing this website is to be able to have the privilege of helping you out with your radiology issues. I love to hear your opinions and thoughts with the great questions you submit on Ask The Residency Director. Please, keep the great questions coming to radsresident.com. Until next year!

Posted on July 26, 2020December 9, 2020 by Barry Julius

Which Radiologists Will Have The Hardest Financial Impact From The Pandemic?

Based on the individual circumstance, the pandemic has affected radiologists very differently. Financially speaking, some radiologists have barely felt any impact whatsoever from the epidemic. Maybe they practice farther from the pandemic epicenters. Or perhaps, they work directly for hospitals that have longer-term contracts and can weather the financial storm. Others are residents or V.A. employees that receive a fixed salary from the government. But that leaves out a good-sized chunk of the total radiologist population.

So, which subgroups has the Covid pandemic affected the most financially and will most likely have a lasting impact on their financial well-being? Let’s go through two clusters that I believe will have the most economic impact from the pandemic. Logically, these would be those newly-minted radiologists from their fellowships in hard-hit areas, just recently hired (or possibly furloughed!). Also, of course, those recent retirees that unluckily retired just as the pandemic hit. How significant will these losses be? How can they recover? And what are the critical lessons that we need to learn from this episode in our history?

New Radiologists Just Finishing Fellowship

New radiologists are getting hit by a double whammy. First, they are potentially losing out on initial income due to less than expected initial revenue. For some, this may come in the form of a leave or salary cut. For others, it may be a loss of a job. In many of these cases, this initial loss of income comes when loans are typically first due, and even worse, when debt loads from medical school are at their highest. For some, inevitably, this can cause a bit more financial suffering as these radiologists need to make ends meet.

Furthermore, the first few years of retirement savings are the most critical due to the geometric rate of return of invested savings. Think about it. If pensions and retirement contributions are delayed or canceled, these are the dollars that have the most power.

Suppose you are fortunate to have a 10 percent annual interest rate and work for thirty-five years. These initial dollars can be worth as much as 28 times what you put into it when you retire at 67 years old. If you delay merely one year, the same dollar only is worth 25.5 times what you put into it. Compare that to the same savings of a 50-year-old radiologist who has to delay savings by a year. If there are 15 years left in his career at 10 percent interest, each dollar will be worth 4.2 times the initial value. If this same radiologist delays their pension by a year, that same dollar will be worth 3.8 times what they put in. Those additional dollars have much less significance.

Newly Retired Radiologists

When you first begin retirement, you often need a wad of cash to pay for daily expenses. And, many of these radiologists may have cashed out their stash from the stock market. If you were unfortunate to cash out a large amount of your savings at the time of the crash and had not slowly converted your holding to less risky assets, you may have cashed out at the time of the twenty to thirty percent loss in the stock market in March. This loss could have severely decreased your overall net worth and the ability to have a comfortable retirement. Additionally, for those retiring radiologists who were planning to go part-time, many practices were unwilling to hire back some of these radiologists as the volumes had precipitously declined. Again, this could have made for the perfect financial storm!

How To Bounce Back From A Covid Economic Disaster

Keep Those Expenses Down

For many of us, this episode may have been the first time we have had to dip into an emergency fund. It goes to show you that radiologists are not immune from financial hardships (as lucky as we have been in the past!). So, make sure not to spend your savings quickly. Avoid old spending habits, and make sure to tighten your belts. Simple acts such as going through your credit card statements and reducing unneeded expenses can help enormously. And canceling luxury and unnecessary purchases can also assist. None of us can be sure when we will return to a more “normal” baseline.

Return To Work As Soon As Possible

For those younger radiologists that have been furloughed or let go, don’t stop searching for full-time employment as soon as possible. Time is of the essence as a dollar earned today is much more powerful.

And, for those radiologists that were about to retire, you may reconsider complete retirement. Part-time work allows you to make a reasonable salary, when available, and can help defray some of the financial hardship losses.

What Are The Take-Home Lessons About Radiologist Financial Well-Being?

Like any other profession, we are not immune to the whims of the economy and “black swan” events. All of us need emergency funds, regardless of our perceived safety nets at our jobs. And, all of us should continue to save and invest throughout our careers to prevent us from the potential losses of a sudden downfall. As the old boy scout motto reminds us, be prepared!

Posted on July 19, 2020 by Barry Julius

Is The Radiology Home Workstation Becoming Too Good?

At the home of most radiologists nowadays, you will find a computer remotely hooked up to a Picture Archiving And Communication System (PACS) where they can look at films and dictate cases. As I sit typing this blog, I am staring at a home workstation across the room myself. It enables me to read studies from home with all the comforts thereof. Additionally, I find that the chair here is comfier, the mouse works a bit better, and there are fewer glitches on it than the ones at work. But this presents an issue that even I have felt a few times. Why go into the hospital when I can do some of the same things with one home’s amenities and work even more efficiently? Is there any role for reading from an on-site computer?

Well, if you do read in the reading room at your facility, gone are the days when most specialists would come down often to the department to read over a film in your reading room. Instead, you are lucky to get a few stragglers-by, usually, a resident who wants to learn a bit, or maybe a physician with a family member that needs a read on a film. Yes, the din of conversation of colleagues has continued to melt away slowly. But, with decreasing clinical interactions, even on-site, do our comfy home workstations represent the final nail in the coffin for working at the hospital? And what do we lose by being able to do our work at home more efficiently than from the workplace? Let’s summarize some of the most significant losses and problems in this new world as we work at our home workstations instead of on-site.

Future Colleagues And Friends (Outside of Radiology)

Some of the most excellent docs that I have encountered; I have only met because they stopped by the reading room to look at a film with me. And, slowly, over time, I got to know them better. Eventually, we might have lunch together on occasion or see each other at some staff meetings. It’s just not the same when you get a ring from a doctor to look at a film. And even with fewer interactions at work, these new potential connections are lost.

Meaningful Interactions And Learning Opportunities

When a fellow specialist walks into the reading room to look at a study, they will typically talk about their work. And, usually, I will learn something new about their specialty. Maybe, it’s a new technique that the surgeon uses or a new technology that the gastroenterologist operates. Regardless, fewer interactions at home without our colleagues means fewer opportunities to learn about other areas in medicine.

Teaching Opportunities

Likewise, sometimes I want to bring home an essential point to a clinician that came down to check out a study. Perhaps, it’s when to use contrast on a CT scan. Or, maybe it’s when they should order a V/Q scan. These were teachable moments to make sure that clinicians used imaging appropriately. Now, some of these focused teaching opportunities to improve care are lost.

Increasing Burn-Out (For Some)

Then, of course, with the complete loss of foot traffic at home instead of work, we lose some sense of connection to others. This disconnect can lead to a loss of meaning in our work. On-site, you are more likely to hear about what happened in the operating room or the patient on the floor. Working from home can distort your sense of reality. And, us results-oriented radiologists can lose a sense of meaning in our work, causing burnout.

So, Is The Home Workstation Too Good?

I have to admit. Sometimes, it is pleasant to be able to read studies from the comfort of home. And, there are certainly moments to take advantage of that. But, I believe that there is still a time and a place to spend some time at the hospital workstation. The home workstation will never be too good to replace the imaging center environment entirely. Although we may not realize it at any given moment as we work from the hospital, most of us still receive fringe benefits. I don’t think the home workstations will ever entirely replace on-site work!