Category: Miscellaneous

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Knowing Normal Variants: Experience Vs. Reading Books in Radiology (Doximity Article)

normal variants

A while back, I was looking at a stream of comments on one of the social media outlets. And, as the conversation flowed between residents and attendings, I noticed one significant distinction. The attendings tended to emphasize seeing thousands of cases to understand normal variants. While at the same time, the residents talked much more about books and case review series.

Within my residency program, I also notice a similar discrepancy between the resident and faculty opinions on learning normal variants. Therefore, since both parties vary widely on this topic, this would be the perfect forum to discuss the conflict. Here we go!

How Can You Best Learn Normal In Radiology?

To understand all of the normal variants in the world, you would have to practice radiology for hundreds of years. And as much as I love “thorough” books like Keats (linked to my Amazon affiliate!), they do not cover even half of the normal findings on plain film that you can easily confuse with pathology. Also, Keats does not include CT, ultrasound, MRI, mammography, or nuclear medicine. Since you cannot find all the variants in the literature, reading lots of books alone, in my opinion, does not enable you to learn enough to become proficient.

Additionally, the information inside rarely sticks if you are reading a book without context. If I were to go through the entire Keats book without any real-life images, I probably would not remember all that much.

This point brings me back to the essence of this article. How do you best learn normals? To maximize stickiness, I believe looking at lots of real-time cases within books, like Keats at your side, and having an attending sit next to you allows you to remember and understand normal variants the best. Context is key.

Reading Lots Of Films: Painful But Necessary?

In addition, it is not just about knowing the normals. You also need to read scores of films rapidly to identify the normal variants appropriately. There is no room to perseverate forever on every case you read. Rapid assessment of normals has become critical to thriving in a bustling private practice.

You cannot practice radiology without reading tons of cases with normal variants unless you find yourself shielded from many films within a large academic center or decide on an alternative career path. So, we recognize that you need to start reading early to produce insightful reports that differentiate normal as an attending. And, what better place than residency to learn these skills?

To that end, you may not believe it, but most program directors do not derive pleasure in causing undue pain to the residents by saying you need to spend “x” hours on a rotation. Instead, we seek to make sure that in addition to reading books, you also read enough studies to identify normal versus abnormal sufficiently. We want nothing more than to create an upstanding/quality radiologist.

What Is The Correct Balance To Develop A Feel For Normal Variants?

The perfect balance is difficult to figure out; we need to tweak it for the individual trainee and program. But, I would recommend spending more time at work with your faculty instead of dedicating too much time to study books.

Moreover, the government pays for you to perform clinical services. It’s hard to justify reading books when Medicare pays you to work. And just as importantly, nighttime after work tends to be the best time to reinforce your day’s learning.

The Bottom Line

Remember, you can always look at films by yourself later in your career or while on call. But, you will not always have the advantage of a readout with an experienced radiologist. So, I have to side with the faculty in this situation. Granted, I am biased, but they make the best point!

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Check out the original article at the following Doximity link!!!

https://opmed.doximity.com/articles/knowing-normal-experience-vs-reading-books-in-radiology

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Do Applicant Photographs Belong On The NRMP Residency Application?

Do you believe in the common cliché, “A picture is worth a thousand words?” And, are you interested in how to apply it to the interview process? Then, take a look at the recent paper in Academic Medicine entitled The Ethical and Legal Conundrum Posed by Requesting Residency Applicants to Submit Photographs of Themselves, and the Medscape article of an interview with the same author of this study in an article called Are Residency Application Photos Used for Discrimination?   Both pieces made lots of interesting points about the use of photographs for interviewing residents. However, I found the discussion in both of these articles to be a bit unsettling. And, let me show you why.

Well, take a look at the following quote as one of the final statements in the interview as a summary for the articles, “The photograph does not provide useful information that is necessary for selecting qualified candidates. Unless there’s a compelling argument for why you need a photograph, which so far no one has brought to me, I think it is unnecessary. Everyone I’ve shown the article to has agreed with our point of view. I am concerned that this is a possibly illegal practice, that it can cause people to be discriminated against, and that it is unfair.”

What The Articles Got Right

Let’s step back for a moment and think about this statement. At first glance, I initially agreed with the concept behind the article. Programs should never use a photograph to prescreen candidates. For instance, let’s say that one of the screeners in a program happened to hate nose rings. And, the image of an applicant showed her wearing a nose ring. Then, we might have excluded this applicant from the interview pool not based on credentials, but rather a nose ring on a photograph.  It could theoretically work that same way for race or ethnicity. That should never happen. I get it.

Where The Articles Went Too Far

But, let’s take it to the next level. Once applicants have made it through the prescreening process and have arrived at our site for an interview, pictures can be beneficial to the applicant and the process. We’ve already seen the candidate. And, every time I look at a picture of the applicant, it jogs my memory about the person, the conversation, and the time. Often, the picture saves the day since so many interviews on a busy day can blur the lines between the candidates. Why would you want to get rid of such a tool?

Furthermore, we all have eyes and faces. You can’t ask all applicants to wear masks to an interview. Likewise, you cannot blindfold all the interviewers. And, if the picture is not biased enough, what about our voices? I mean everyone has a distinct accent. Uh oh, now applicants must wear sound mufflers to make sure that we cannot determine their identities.  And, what about our clothes? Our clothes can give away our culture and attitudes. Why don’t we have all applicants arrive at our interviews wearing the same required outfit? I think you get the point, but you can take anti-bias precautions to an extreme that no longer makes sense. And, that’s where both of these articles went.

My Final Opinion About Applicant Photographs

Applicant photographs do not belong in the prescreening process. We should choose who we interview based on merit alone. Perhaps, we should look at these pictures only after we have selected the candidate for an interview.

However, I believe these papers over-sanitize the interviewing process and residency program use of photographs. We are not perfect in making decisions about our candidates. And, we all have our innate biases. But, we should not erase the interview pictures from the applicant’s record just because it may affect our judgment. We need our judgment to decide who we should choose for our programs. Let’s not take this anti-bias point too far!

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Radexam- A Bridge To Getting Rid Of The Core Exam?

For years and years, programs throughout the country have been utilizing the ACR in-service exam as a way to find out if residents have been keeping up with the material. And, from my experience, the correlation of the test with the Dow Jones Industrial Average on any given day is higher than that measure. And, many program directors believe the same. Now, for the past year or so, programs throughout the country have been utilizing the new Radexam to drill down on radiology topics to check the same measures. But, is this exam all that it cracked up to be and what do we know about it? What would be the optimal exam if I had my druthers? Should we be using any monthly or annual review to test residents at all? Or, perhaps, we should eventually overhaul the current core exam process in favor of Radexam-like alternative?

What We Know About Radexam Currently

Unlike the previous in-service examination, the ACR created Radexam as a crowdsourced evaluation tool. Academic radiologists are constantly vetting the questions. Also, dissimilar to the in-service, the exam evaluates the resident based on her specific rotation. You will be able to tailor particular question banks to your individualized monthly requirements at your institution, whether modality or topic based. If you have a cardiovascular MR rotation, theoretically, you can create an exam that tests on that rotation. And finally, you can evaluate residents with this tool on a monthly basis.

After I have seen an exam from the batch, the test looks hopeful as a tool for making sure that residents are keeping up with the material. But, the only way to know for sure is to correlate the test with resident evaluations and the core examination. That should be coming to a theater near you soon!

The Optimal Exam

OK. Deciding upon the optimal exam is a tough one. But, let’s give it a whirl. Well, first and foremost, we have to remember the purpose of an examination for residency. And, no the target of an exam is not to correlate with board passage rates. Instead, we should be thinking farther down the road. Is the test evaluating residents on the skills that they will need to become a good radiologist? Test authors often get hung up on creating an exam for the exam’s sake and forget about this end purpose. If I were a test creator, I would have none of that.

What else? Well, I would create an examination such that if you were able to pass it, you could demonstrate to your government, colleagues, and patients that you have the necessary skills to practice radiology. Forget about curves and complicated statistical mumbo-jumbo. I would not care if the pass rate was 87 percent, 100 percent, or 2 percent. All I care about is that our residents have the abilities and skills that they need to practice. In the end, that is all the public should care about too.

Additionally, it would not happen at one sitting. No more travel to Chicago, Tuscon, etc. Instead, you would take it continually throughout your residency at your program as a way to show you have gradually mastered the competencies that you need to practice.

Finally, the exam should be relatively reasonably priced on resident budgets so that they can afford the fees to create it. Theoretically, this is a tough one, I know. But, with large amounts of student debt racked up over medical school and residency, it cannot be more critical.

How Does Radexam Match Up To The ABR Core Exam?

Well, this is the million dollar question that residency directors throughout the country are trying to answer. The success or failure of this exam hinges on this answer. Unfortunately, we don’t know the answer to this right now. But, I suspect that the correlation will be higher than the previous in-service exam. It does not take much. So, in that respect, you would be able to call it a success.

Advantages Of A Monthly Exam Versus Annual Exam

The more often that we evaluate a resident during residency, the more likely that we can closely follow the learning process. On the downside, however, no one likes to be placed underneath a microscope at all times. Additionally, testing creates an artificial environment that differs from the day-to-day practice of radiology and medicine in general. But overall, the more often you test, the better you can check to see if the resident is completing the learning tasks necessary to become a radiologist. And, that brings me to my next and final thought.

Should We Consider Overhauling The Core Exam And Replacing It With Radexam?

If the core exam, as we know it, does not satisfy many of the criteria for an optimal examination, should we consider looking for alternatives? I believe that the curt answer is yes. And, Radexam may fit the bill if we drill down on it a bit.

First of all, it tests residents more often than a core exam, so that it allows a more accurate evaluation of the resident’s medical knowledge and skills throughout residency. Second, you can have residents take it on a home computer in a more realistic setting instead of some impersonal test center of some sort, leading to test-taking anxieties. Third, Radexam is crowdsourced and overhauled continuously throughout the year. Instead, the core exam questions are vetted, but only at a few intervals. And, finally, you can attune the Radexam to your program. Not all programs teach the same material throughout the country. Moreover, not all the content on the core exam will be relevant to your future practice of radiology. Radexam may resolve that issue.

Final Thoughts About The Radexam

We are still not quite there yet when it comes to knowing about exactly how Radexam will play out. In any case, I am hopeful that the outcomes will match up with the medical knowledge and skills that residents need to learn. And, as a bonus, I also would like to see a better correlation of Radexam with the core exam outcomes. (which I think we will) If these correlations are high, perhaps, we should consider Radexam as an alternative to entirely replace the in-service that we use right now and maybe sometime down the road, the core exam. Although no test is perfect, many of its features are significantly closer to my optimal examination than the current ones. Let’s start the debate to consider our best options.

 

 

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Halloween Special: Ten Scariest Radiology Resident Situations

In honor of today’s holiday, here is the second radsresident annual Halloween special: a top ten list of the scariest situations for radiology residents! See if you agree…

 

halloween

1. Taking your first night of call

2. Failing the core exam

3. Getting called into the program director’s office

4. Making your first significant miss on a film

5. Taking your first case at noon conference

6. Being unable to obtain a recommendation for fellowship.

7. Receiving a subpoena from an attorney

8. Getting chewed out by your faculty in front of your colleagues.

9. Falling asleep at nighttime while working and not getting up before morning readout.

10. Picking up the phone from the ER to find out you are not reading fast enough.

 

 

 

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Blogs And Social Media: Worthwhile For Resident Education?

Today is a unique opportunity to see me live and in action on video. Recently, to help out with faculty development, I created a short video on the hospital website. So, I thought it might be of interest to the radsresident.com audience. In it, you will get see to see me justify this website’s existence! Enjoy my video called Blogs And Social Media: Worthwhile For Resident Education?

 

 

 

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Radsresident.com- Happy 2nd Year Birthday!!!

It’s now been two years of radsresident.com weekly articles, posts, and ask the residency director questions. In total, we have almost 200 posts (194 to be exact!) on all sorts of topics dedicated to radiology residency. And, it seems that my readers want more! Moreover, the site continues to grow significantly from its humble beginnings, and its viewership had almost quadrupled from the months when it first started.

So, let’s talk about a bit about what has been going on for the past year or so. To do that, I will discuss the three segments of viewers that take an interest in this website. Overall, they are evenly divided. To categorize them, I would separate the viewers of radsresident.com into those interested in radiology residency application advice, general residency advice, and finally, post-residency advice. Within each group, the readers gravitate to some of the more popular resources on radsresident.com. And, I will show you some of the articles on each of these topics as I list the most popular posts on this website. Additionally, we will talk about some of the plans for the up and coming year and where we are heading.

Let’s start by showing you what articles have been the most popular over the course of the past year and for all-time. Here are the pieces that the most people find helpful (and entertaining I hope!) After the title, you will see that I categorize each into one of the three segments above.

Most Popular Posts Over The Past Year

  1. How Much Work Is Too Much For A Radiologist? (Think RVUs!) – Post-residency advice
  2. Up To Date Book Reviews For The Radiology Core Exam – Residency advice
  3. How To Create A Killer Radiology Personal Statement – Application advice
  4. Top Traits Of Great Radiologists (They Might Not Be What You Expect!) – Residency advice
  5. A Common Radiology Applicant USMLE Misconception – Application advice
  6. How To Choose A Radiology Fellowship – Post-residency advice
  7. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”? – Post-residency advice
  8. What To Look For In A Radiology Residency? – Application advice
  9. Five Reasons Why The First Year Of Radiology Residency Can Be The Most Difficult – Residency advice
  10. How To Make A Good Impression As First Year Radiology Resident – Residency advice

Most Popular Articles Of All Time

  1. How Much Work Is Too Much For A Radiologist? (Think RVUs!) – Post-residency advice
  2. Up To Date Book Reviews For The Radiology Core Exam – Residency advice
  3. Top Traits Of Great Radiologists (They Might Not Be What You Expect!) – Residency advice
  4. How To Choose A Radiology Fellowship – Post-residency advice
  5. A Common Radiology Applicant USMLE Misconception – Application advice
  6. Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”? – Post-residency advice
  7. Radiology Residency And The SOAP Match – Application advice
  8. How To Make A Good Impression As First Year Radiology Resident – Residency advice
  9. The Struggling Radiology Resident– Residency advice
  10. What To Look For In A Radiology Residency? – Application advice

So, you may notice that the viewership is pretty much evenly divided among the segments and is broad regarding radiology residency related interests. Therefore, I will continue to write articles with these factors in mind.

Population Using Radsresident.com

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

  1. Organic search (Google, etc.) – 69%  of readers
  2. Direct (typing in radsresident.com) – 17% of readers
  3. Social (Facebook, Twitter, etc.) – 14% of readers
  4. Referral (Links and websites)-  2% of readers

From where are my readers?

  1. The United States – 65%
  2. India – 8%
  3. Canada- 2.5%
  4. United Kingdom – 1.9%
  5. Malaysia- 1.25%
  6. Australia – 1.24%
  7. Philippines – 1.18%
  8. Pakistan – 1.05%
  9. Saudi Arabia – 1.01%
  10. Brazil – 0.86%

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

59,348 individual users (22,084 the previous year)

129,902 page views (around 55,000 the previous year)

What Else Has Happened Over The Past Year?

In addition to the useful articles and posts, we have continued to give you the case of the week. I hope you are enjoying these cases. Moreover, you may have noticed updates and edits on many of my older articles to make them easier to read and access.

More recently, I have become a Doximity Author. Over the next several months, you may notice many of these and new articles featured on the website.

Finally, I am still in the process of editing my new ebook called The New Attending Physician Guidebook as you can see in the cover below. This ebook should be out for release in several weeks to a month on Amazon.com. I will update you all on the official release date when I know.

 

 

 

 

 

 

 

 

 

What Else To Expect Over The Course Of The Next Year On Radsresident.com?

To continually improve and make this website as helpful as I can to you, the readers, you may notice a few changes here and there. First of all, over the next several months you may begin to see fewer Wednesday posts and newsletter emails.  Instead of a weekly feature on all Wednesday evenings, we will dedicate Wednesdays evenings to sponsored posts, guest posts, ask the residency director questions, Doximity authored posts, and special event posts only. I am doing this to devote more time to maintenance of the website since it has grown substantially over the past two years (it has become a big job having close to 200 posts!)

However, I will continue to post regularly scheduled articles every Sunday as well as the weekly e-newsletter on this day. Additionally, I will still post the case of the week on Sundays on the e-newsletter, Instagram, Facebook, and Twitter. Like before, I will continue to publish the case of the week answers to the website each Wednesday evening.

Lastly, I want to express my appreciation to all of you for utilizing this website as you have been doing over the past year. To continue to do that, you can continue to support this website by buying books through amazon.com, signing up for grammarly.com, and clicking on my reputable sponsors/partners including Contract Diagnostics, The Disability Doc, Residency Swap.org, and Splash Financial. By continuing to click on these links, and signing up for these services, you help to fund this website and provide the opportunity for me to keep giving you the great content you have come to expect. Once again, thank you to all my readers for a fantastic year!

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Is Radiology Still A Career Or Just A Job? And What Does It Mean?

job

What exactly is a career? If you listen to the internet authority, Wikipedia, it is “an individual’s metaphorical “journey” through learning, work and other aspects of life.” And, what is the definition of a job? Again, if you listen to “all-knowing” Wikipedia, a job is an activity, often regular and often performed in exchange for payment (“for a living.”)

So, which definition does radiology meet today, a career or a mere job, a transaction made to make a simple living? Many long-standing radiologists and outsiders would say that radiology is a career. You spend countless years learning and practicing the art and science of radiology. Moreover, when you finish, you live and breathe the profession. You strive for professional excellence. More importantly, it becomes ingrained as part of your persona.

These everyday thoughts are an oversimplified answer to whether radiology is a career or a job. As such, the response has transformed itself over the past ten to 20 years.

Changes To The Equation of Job Versus Career For Radiologists

So, what has changed over the past decade or two that has morphed the answer to this question? First, the landscape of medicine has dramatically shifted. Students that formerly completed school with reasonable amounts of student loans are now graduating with hordes of debt. Additionally, external pressures from governmental bureaucracies have dramatically increased. The number of films radiologists need to read, and procedures they must perform have exponentially climbed. Some may say that the numbers have far surpassed what is safe for patients.

Finally, different demographics have joined the profession. Today, many radiologists want to practice part-time to raise a family or pursue other interests. Years ago, this type of radiologist was much less common.

Individually, each of these factors plays a role in the change. In the following few paragraphs, we will go into more detail about the reason for each.

Reasons Radiology Has Become A Job For Many

Student Debt

Let’s start by talking about the noose of enormous student debt hanging around the shoulder of new radiologists. In the past, radiology residency graduates could afford to pick and choose where and what to practice based on the merits of the post-residency job alone. No longer is that the case. Now, it becomes more important to make sure you can afford the debt service payments and the day-to-day living expenses of the region of practice. For many, finding work is about desperately needing to make ends meet. So, radiology merely becomes a means to this end.

Increased Bureaucracy

We all feel the weight of increased paperwork and regulations we must follow. To that end, maintenance of certification has become more stringent (although, more recently, it has been slightly letting up). Requirements for accreditation have been increasing exponentially. Also, the maze of insurance requirements to complete a study keeps rising. Moreover, these factors are the tip of the iceberg. For many radiologists, many bureaucratic factors lead them to resign themselves to practice radiology as a job.

The Work Treadmill

Nowadays, many radiologists are hostage to the ever-increasing number of studies they need to read. Public expectations for the delivery of results promptly and efficiently have climbed. Also, time to transcription has become the holy grail of the hospital administration. In these conditions, how can some radiologists perceive their work as more than just a cog in the wheel to make ends meet?

Changing Demographics

Finally, we need to also talk about why different radiologists pursue radiology. No longer do all radiologists fit the same mold. For some, their role in raising a family has become more crucial than the position that they may play in running a radiology practice. So, these radiologists merely want to fund their lifestyle and not get involved in the professional aspects of radiology.

What Does This All Mean?

Well, to start with, we know that the most consummate professionals invest heavily in their careers and see their profession as a calling. These are the incredible clinicians, the movers, and the “shakers.” Moreover, they perform groundbreaking research, make improbable diagnoses, teach their residents, and create radiology systems and businesses to promote the profession.

However, based on the new pressures on individual radiologists, we cannot expect all radiologists to see their original “calling” as a “career.” Instead, many other factors play into the equation. Student debt burdens some radiologists. Alternatively, the chains of bureaucracy and increasing workloads prevent the pursuit of their interests and infringe upon the professional lifestyle of a radiologist.

Regardless, we should not talk badly about radiologists who need to work in the profession merely as a job. Many radiologists have excellent reasons for that. Instead, we should work to fix those factors that have changed to make radiology into a job so that we can improve the quality of our profession and return it to a career for all.

 

 

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How Much Does It Take To Start A Radiology Imaging Center?

imaging center

Ever get a question that goes something like this, “Why don’t you start up an imaging center?” Well, in the land of pixie dust and chocolate-covered mountains, that may work. However, in an expensive world with loads of student debt, only the rare physician can gather enough cash to begin a new radiology practice. Additionally, who is to say that you will have enough patients in your location to survive? In any case, that got me wondering how much does it take to create an imaging center startup? So guess what? That is my insane plan for today. We will calculate the annual capital expenses to start/run your practice. So, at least, you will have a response that you can give to those naive friends and relatives of yours!

First, let’s sort out what kind of imaging center about which we are talking. Well, I am thinking about the average Joe diagnostic center with one of each piece of equipment. And let’s skip interventional and nuclear medicine for the sake of simplicity. Perhaps, this center will have an MRI, a CT scanner, an ultrasound unit, a mammogram tomography unit, and an x-ray apparatus. We will also assume that you locate your practice in an average part of the country with mediocre building costs. Let us say that we will amortize the sizeable capital-intensive equipment for over ten years. Finally, we will amortize the building for thirty years.

Most importantly, these calculations are made on “the back of the hand,” meaning that I would not rely on them to create your imaging center. Numbers can vary widely. Nevertheless, I am doing this so that you can get a sense of the costs involved.

What are the fixed capital costs for an imaging center?

Building

So, we will begin with fixed expenses. What are the most considerable fixed costs of an imaging center? Of course, these include the building that houses the equipment and staff and the imaging machines that make up the imaging center. Concerning the structure, we will assume that it is around 5000 square feet. So, how much is it annually to pay for an average space measuring 5000 square feet? It turns out I was able to find the average cost per square foot of retail and industrial space throughout the country. Based on the realtors website chart, the average industrial area would measure 6.92 per square foot, and the average retail space would be 17.12 per square foot. The building we would need could be in an industrial space but would need to be accessible to customers, so let’s make our cost 10 dollars per square foot or 50,000 dollars per year.

Not only do we need to pay for the building, but we also need to renovate the building before beginning our center. Designing the construction would involve spending on an architect to create the renovations—figure on another 20% of the building’s cost or 100,000 dollars. Let’s amortize over ten years and say that it will cost around an additional 12,000 dollars per year.

Then, of course, we need to pay property taxes. Let’s figure that the number is around 2% of the price per year or 10,000 dollars. Also, we need to insure the building and business. Let’s tack on another 10,000 for good measure.

Moreover, finally, the structure and practice need to be certified and inspected. So, let’s add another 10,000 dollars.

Total= 82,000 dollars per year

Machines/Service Contracts

How much is an MRI? Well, the answer to that is that it varies widely. However, we are talking about the average MRI, maybe even used. So, based upon this MRI price guide, let’s say that it costs around 200,000 dollars. That would amount to a monthly payment of about 2,000 dollars or 24,000 dollars per year. You will also need a service contract to maintain the system. That would run another 100,000 dollars.

Next, let’s take the price of an average CT scanner. Based on information on the lbnmedical website, it would cost around 100,000 euros or 116,000 dollars for a typical CT scanner. Again, amortized over ten years, we are talking approximately 1,200 dollars per month or 14,000 dollars per year. However, that is not the only significant expense for the MRI and CT scanner. You need a service contract. That service contract goes for around another 100,000 dollars per year per machine based on the blockimaging website.

Next, let’s look into the price of an average mammography unit. That would cost somewhere in the realm of 250,000 dollars (or 30,000 dollars per year) if we use the data from tractmanager with a service contract costing around 50,000 dollars per year.

Also, we need an x-ray unit. That would be around 100,000 for a digital machine, according to the blockimaging website(or 12,000 dollars per year). Finally, let’s say service would cost another 50,000 dollars per year.

Total= 380,000 dollars per year

PACs system/RIS

Naturally, our center will need an information system capable of handling all the studies that we are performing. That does not come for free! So, how much does that cost? For an average “smallish” imaging center like ours, the website purview.net states it costs around 1500 dollars a month or 18,000 dollars per year for a cloud-based solution, including IT. Not so bad, right? Well, you also need an information system management package to schedule, manage dictations, and more. That would run you another 450 dollars per month per user, according to this website. We will assume a couple of users. It would cost around 900 dollars per month for 12 months or 11,000 dollars per year.

Total= 29,000 dollars per year

Furniture/Room Items

Furnishings can be a hard one to estimate. Moreover, it can be more costly than you might think for desks and chairs, as well as patient tables, and more. Unfortunately, I cannot perform an exact calculation. However, I will estimate for the facility that it would cost around a few hundred thousand dollars. If we were to amortize that over ten years, we would say that it would cost about 24,000 dollars per year.

Total= 24,000 dollars per year

Sum Total For Capital Expenditures= 515,000 dollars per year

What are the annual recurrent costs for an imaging center?

Workforce

The annual recurrent costs include all the people and things you need to run a practice. Let’s start with the workforce. Most importantly, we will begin with the behemoth expense in the room, the radiologist. What is the average annual package for a radiologist? According to salary.com, that would be around 400,000 dollars, of course not including extras such as malpractice and more benefits. Let’s say for argument sake that would end up at approximately 500,000 dollars.

You also need technologists to run the show. So, we will assume that you have a moderately busy practice. Therefore, you will need an ultrasound tech, an MRI tech, a mammogram tech, and a CT/x-ray tech. According to salary.com, this would run around 60,000 dollars per year per technologist. For this imaging center, that would total about 240,000 dollars.

We would also need a medical physicist to make sure our practice is compliant with all regulations. The mean medical physicist salary is around 183,000 dollars per year. However, we don’t need a full-time physicist. Let’s say we were able to share a physicist among several other practices. So, let’s say that it would cost 183,000/4 or around 45,000 dollars per year.

Importantly, you need to hire secretaries to run the front desk. Let’s take a couple of secretaries for our practice at the cost of 40,000 each per year, according to salary.com. That would total to 80,000 dollars per year.

Also, you may need a business/marketing manager for the site to run the show. That does not come cheap as well. The cost would run around 100,000 dollars per year, according to salary.com.

And finally, you need someone to clean the facility. Perhaps, a janitor? Let’s say another 25,000 dollars per year.

Total= 990,000 dollars

Billing And Benefits Management

Nowadays, you also need an expert that helps with billing since it is complicated and takes much time to learn. Besides, it is critical for maximizing revenue for the practice as well as for avoiding Medicare fraud. Often, these same “experts” also help out with payroll, insurance, and more. Most work on a percentage of the gross revenue for the practice. We will say for the sake of argument around 5 percent. For an average facility, we will say total revenues are around 3,000,000 dollars. So, a billing/benefits management for this site would run approximately 150,000 dollars per year.

Total= 150,000 dollars

Other Costs

Of course, you also have to pay for heat, hot water, and electricity. These expenses do not come cheap, especially when you are running all this equipment. I will estimate a lump sum of around a couple of thousand per month or 24,000 dollars per year.

Moreover, it would help if you had miscellaneous recurrent expenses like toilet paper, contrast media, intravenous supplies, and more. Let’s figure on another 35,000.

Total=59,000 dollars

Sum Total For Recurrent Costs= 1,199,000 dollars/year

Let’s Add It All Up For The Imaging Center- Don’t Shoot The Messenger!

So, there we have it. I have created an approximation of most of the expenses that you might have if you were to start your imaging center. Of course, if you decide to plop the imaging center in the middle of Manhattan or San Francisco, my estimated costs would be a lot smaller than the real total costs. (You know what they say- location, location, location!) Alternatively, if you stationed the imaging center in the middle of nowhere or an undesirable area, the costs would likely be less. However, this may be somewhat closer to the actual expenses for an average place in the United States. So, drum roll, please… Here is the final summary total of our costs-

Building- 82,000 dollars per year

Machines/Service Contracts- 380,000 dollars per year

PACs System/RIS- 29,000 dollars per year

Furniture/Room Items- 24,000 dollars per year

Workforce- 990,000 dollars per year

Billing and Benefits Management- 150,000 dollars per year

Other Costs- 59,000 dollars per year

Final Total= 1,714,000 dollars/year

Think you can afford that, starting as a new radiologist? I bet for most of you out there, probably not. Of course, you may be able to obtain financing. However, for the majority of us without the experience, it is a tough nut to crack.

So, there you have it. You now have an answer for your naive family members when you get popped the question, “Why don’t you start an imaging center?” Until next time, signing off…

 

For those of you interested in how imaging centers market themselves online, especially during the time of Covid-19, take a look at some of these tips from tomatoes.digital below

7_marketing_tips-medical-imaging

Check out the following link if you are interested in more information: https://bit.ly/389WnlF

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Radiology As A Backup Specialty: Should Radiologists Be Offended?

backup

During the AUR meeting a few years ago, one of the speakers announced that more medical students than ever used radiology as a backup specialty. Well, how can that be? I mean, radiology is a fantastic specialty, right? Yet, our medical students have chewed us up and spit us out. At that point, you could just about hear the moans and groans in the background of the lecture hall. But then, I thought about it and felt a bit differently. Why? Well, that is what I would like to delve into today.

Most Applicants Don’t Know What They Want

Over the years, I have found that most radiology applicants, like other specialties, think they know what they want. However, when you dig a bit deeper, you find out they are not sure. Hell, I had no clue when I entered the specialty. When you ask applicants why they want to join specialty X, many have difficulty verbalizing their true motivations. Often you hear, “I like using my hands” or” I like coming up with differential diagnoses.”

Truthfully, however, these reasons are, at best nonspecific. And, if you dissect what these residents are saying, you would recognize that the reasons why an applicant claims to have applied to a specialty have no bearing upon what he wants. You can apply to surgery, interventional radiology, urology, and other specialties because you want to use your hands. Or, you can come up with differential diagnoses in almost any specialty in the medical field.

Often, applicants bury the real reason for applying to a specific specialty deep within their psyche. Perhaps, they want to say it’s the lifestyle, the culture, or the money. So, how can we become offended by medical students that don’t know what they want?

Our Specialty Is Getting Noticed!

For applicants to apply to our specialty, even as a backup, it means that they must have some foreknowledge about us, to begin with. That means we are doing something right. Maybe, we are training more medical students about imaging in medical school. Or, perhaps, they hear about an improving job market. In either case, residents have found reasons to apply to us, even though it may not be their first choice!

A Badge Of Honor

Only a few years ago, the radiology applications had dropped precipitously. In addition, the quality of applications had significantly decreased as well. Instead, today, we have become respectable enough to apply to! We are returning to the old norm. So, we should feel excited that qualified applicants are again considering our specialty.

So, We Are A Backup Specialty. Should We Be Offended?

Back to the original question again… Let’s look at radiology for what it is. It’s one of few specialties that allow physicians the flexibility to pursue so many avenues and satisfy the academic and clinical wants of most. And now, if we dissect why residents perceive us as a backup, I think we should not become offended. Instead, we should give the new applicants some credit. They are beginning once again to recognize the specialty of radiology for what it is: an excellent choice for a great career!

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Is The Specialty of Radiology Better Off With Increased Competition?

increased competition

With the increasingly hot job market for new radiologists, medical student applications to residency programs have steadily increased over the past several years. But that got me thinking. Is the specialty of radiology better off with more hardcore medical students wanting to enter the profession? Or does radiology benefit more from residents who genuinely want to be here when times are tough? So, let’s go through the advantages and disadvantages of having both a competitive and a non-competitive application process. And then, we will come up with a conclusion to the final question: Is the specialty of radiology better off with increased competition?

 

What Happens With A Competitive Application Process

Advantages

From a program director’s perspective, let’s begin by saying that a program director’s job becomes much easier with increased competition. To find applicants, you do not have to interview as many candidates. And the applications tend to have fewer “blemishes.” That said, as much as it helps me, this factor impacts the specialty very little.

So, what other advantages does a competitive process offer? First, the candidates will often have more experience in research. But does this create better radiologists? Depending on whether the resident wants an academic career, that is up for debate. However, I can say that it again makes the program director’s job a little bit easier because the faculty do not need to teach some of the primary research mechanics to get them started. Additionally, this resident will also likely produce more research during residency.

With increased competition, residents tend to be slightly more attentive to keeping up with reading. Moreover, these residents tend to be more motivated by passing tests. In other words, they may be a bit more “obsessive-compulsive.” Now, this would theoretically work in favor of passing the boards. However, according to the infinite wisdom of the test makers (the ABR), this doesn’t change the pass rates since they opt to create tests based on curves, not content.

Disadvantages:

Over the years, I have noticed that competition also motivates applicants who want radiology because of the competition, not necessarily for the love of radiology. In the long run, this can lead to increased burnout. Furthermore, it can change the culture of radiology residency and radiologists into a less forgiving and highly pressured environment. Again, this is more of a tendency rather than a truism.

Increased competition also brings out fewer nontraditional applicants to radiology. These include folks who have completed other residencies and different careers. In the setting of increased competition, they have a much harder time receiving interviews because programs often screen them out of the system due to their increased time in or before residency. However, nontraditional applicants bring a different perspective to residencies. Moreover, they have been through more, are more mature, and often make better leaders.

What Happens With A Non-competitive Application Process

Advantages

Residents who apply during a less competitive time are a different group of candidates. I like to call them type B personalities. These folks create a less pressured environment and a calmer culture for the residency program. This decreased stress can make the four-year residency process more tolerable for everyone.

Likewise, during tough times, the limited selection of candidates forces residency programs to accept nontraditional candidates. As stated, these candidates lend a mature perspective to a residency program. In addition, these residents want to be involved in radiology for the love of the specialty rather than the competition and the “great” job market.

And then, programs will often downgrade their expectations of these non-competitive residents. Decreased expectations lower the pressures on the residents during their program and can create a less harried culture with reduced burnout.

Disadvantages

I don’t have the statistics to back this up. But, from my experience, tough times lead to residents with a higher dropout rate. Sometimes, these residents cannot meet the rigorous academic challenges of residency. When this occurs, residencies can lose their precious spots to other specialties like primary care.

Also, these residents have overall less experience with research. So, most residencies with non-competitive applicants will create less output during these challenging times. (This is a disadvantage for the more academic residency!)

And then, finally, residencies have more work cut out for them. They must put more time into teaching and spoon-feeding the residents to ensure they complete the program.

Weighing The Balance- Is Increased Competition Better For The Specialty?

So, where do I stand in this controversy? Well, residency directors and their programs must put more work into the residents during the “tough” years to get them “up to snuff.” But, you know, I’ve seen great residents during the lean times and times of abundance. So, I think we put more emphasis on competition to get better residents than we should. In the end, good residencies mold their residents into great radiologists regardless of the zeitgeist of the times. And that’s the way it should be!