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Transparency And The ABR: Are The Leaders As Transparent As They Like To Think?

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At the recent Association of University Radiologists (AUR) meeting, the American Board of Radiology (ABR) adopted the theme of transparency in its lectures. However, as I sat and listened to the seminar on the ABR updates, the words did not jibe well with the theme.

How The ABR Supported Its New Found Transparency

Brent Wagner, MD, the President-Elect of the organization, attempted to show as a nonprofit entity, the books are wide open. And that, the money that they raise from testing fees and MOC mostly goes to the upkeep of the organization. In fact, they showed the public income tax form they filed with the IRS. In it, he stated that anyone could pretty much look up the finances of the organization and its members. So, I pulled up a copy of the nonprofit 990 IRS form for the 2016 tax year at the following link:  http://990s.foundationcenter.org/990_pdf_archive/410/410773787/410773787_201703_990O.pdf

Yes, much of the money does go to the running maintenance of certification, testing, and other appropriate uses. But, that is not all. If you look at the form, you will see listed the compensation for the executive board listed on page 7. According to the document, compensation for the president was 720,000 dollars for 50 hours of weekly work. In addition, the ABR paid the associate executive directors on the list who worked 20 hours over 260,00o dollars including all compensation. Of course, this compensation does not include any other outside remuneration that these individuals may receive from outside practices and institutions. So, if you take all the income into consideration, it is significantly more than the typical radiologist’s. But yes, it was available for all to see.

My Issues With ABR Executive Compensation

So, what is that did not sit well with me about the executive compensation? For one, you have an army of volunteers that the ABR does not pay for all their time and effort. Meanwhile, you have a small group at the top who collect significant rewards. Yes, this is a nonprofit organization and the folks that run it should get paid for its work. However, at the top, these folks earn a lot more than a typical radiologist. When I pay my annual dues, I don’t believe there is much value in paying a president of this organization over 700,000 dollars not including additional outside compensation that she may receive.

I mean, what exactly is the point of the organization? Simply, the ABR should dedicate itself to the high standards of the end product of residency, the radiologist. Additionally, the organization should make sure that it’s diplomates meet the minimum requirements to practice radiology safely while maintaining a relationship with the public and government. Should the leader at the top earn almost twice the average radiologist for this mission (not including other side income)? It’s certainly hard for me to justify.

And just because the organization exists as a nonprofit entity and must distribute all profits by the end of the year does not mean that the nonprofit model is fair. A nonprofit is only as good as its ability to distribute its funds appropriately for the betterment of a cause. Rewarding the executives with salaries above and beyond the typical radiologist does not qualify as a cause I want to support.

Moreover, finally, in order to justify the salaries it paid to its executives, the speaker compared itself to other nonprofit organizations. However, just because other nonprofit entities overpay its executives does not mean that the ABR should do so as well.

My Final Thoughts About ABR Transparency

Alright, I will give the ABR some points for coming clean with the whereabouts of its funding. And, I will give them some credit for talking about the remuneration of its members. As well, they gave us the means to access the information. On the other hand, the ABR is not forthcoming with providing the reasons for the exorbitant compensation of its leaders. We should advocate for more transparency and demand more from the ABR. Creating more equitable compensation to its employees and leaders should take a higher priority.

 

 

 

 

 

 

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AUR Meeting 2018- Themes And Undercurrents

Welcome to the second annual review of the Association Of University Radiologists meeting in 2018! So, why do I think we should review this meeting on an annual basis? Well, for one, many of the changes in residency you will experience stem from the academic realm.

Moreover, if you were to read the headlines and the summary of the lecture topics of the conference alone you would not get a good sense of what they will be changing. For example, this year, the heading of the meeting states “Health And Well-Being Of Profession And The Professional”. However, this theme is a small part of what actually happened at the meeting.

Yes, the lecturers did cover the topics of burnout and depression, relevant to the heading. But, if you dig a little bit deeper, compared to these themes, you would recognize that many other themes will impact future residents much more. So, what are the undercurrents that were most relevant? Basically, I am going to divide these topics as follows: continued improvement of the job market, increasing radiology residency match competition, the online longitudinal assessment, Radexam, and increasing time requirements for program directors.

The Hot Improving Radiology Job Market

Out of all the news, I think this is probably the most important. Based upon the hot topics lecture series at the AUR meeting, radiology has climbed out of its doldrums and now returns to a more normal job market. In the most recent year, over 1800 positions were available for new graduates. Very recently, the number of new hires amounted to the low 1100-1300. Furthermore, according to the conference, next year they predict that practices will need 2133 new hires. So, workforce demands are significantly increasing. My reasoning for the sudden increase in available jobs: a wave of retirements and willingness of practices to hire due to stable/good economic conditions. So, congratulations to all residents who chose radiology over the past 4-5 years! You can look forward to a great job market.

Continued Increasing Competitiveness Of Diagnostic Radiology Residency

Similar to the previous year, the competitiveness of radiology residency in the match continues to increase. As in the previous year, the unfilled spots continues to decrease and the percentage of US grads entering radiology residency continues to increase. All of these signs point to a much more difficult time for the US and foreign grads to match in radiology.

Online Longitudinal Assessment Replacing 10 Year Exam

Yes, I know that many of you have not yet thought about the maintenance of certification requirements once you have completed your residency. However, this new program will impact all residents today once you graduate and become board certified. No longer will ABR diplomates need to take an exam every 10 years to maintain certification (unless you do not satisfy the requirements of the new program). Rather, everyone who takes the online assessment will be able to skip the test and simply answer weekly questions that you receive via email.

Each year you will receive 104 question opportunities and you can choose to answer as few as 52 per year. You need to pass the scoring performance criteria based on 200 questions every 4 years. Fortunately, this system will replace the time sink of having to attend a test in Chicago every 10 years with all its expenses. I am certainly looking forward to bagging my unnecessary trip to Chicago for the recertification examination!

Radexam Now Operational

For residency programs throughout the country, many have implemented the new Radexam, replacing the old in-service examination. From my experience, the old in-service examination served a futile role in evaluating residents over the 4 years of residency. I believe no correlation existed between the passage of the core examination and the in-service exam. Now, this fact may change. The new Radexam crowdsources questions from numerous question writers throughout the country. And, the questions are vetted and evaluated for validity. In addition, the exam tests residents according to individual residency level. They can be used at the end of a rotation. Eventually, the exams can be tailored toward the types of rotations the radiology residency has (modality or organ based). I look forward to evaluating the quality of this new exam. More importantly, I believe it has the potential to revolutionize evaluation of residents, especially at smaller programs.

Increased Mandated Program Director Time Requirements Officially Implemented Starting July 1, 2018

Especially at the smaller programs like ours, the new ACGME rules about program director minimum time requirements will create an enormous impact on the management of residency programs throughout the country. Check out this webpage from the ACGME and the associated chart below:

https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/420_DiagnosticRadiology_2018-07-01.pdf?ver=2017-08-10-081454-583

0.3 full-time equivalent (FTE) for programs approved for eight to 15 residents; (Core)
0.4 FTE for programs approved for 16 to 23 residents; (Core)
0.5 FTE for programs approved for 24 to 31 residents; (Core)
0.6 FTE for programs approved for 32 to 39 residents; (Core)
0.7 FTE for programs approved for 40 to 47 residents; (Core)
0.8 FTE for programs approved for 48 to 55 residents; (Core)
0.9 FTE for programs approved for 56 to 63 residents; (Core)
1.0 FTE for programs approved for 64 to 71 residents; (Core)
1.1 FTE for programs approved for 72 or more residents. (Core)

 

Basically, the minimum required time for program directors to administrate programs has in many cases doubled. At our program, we are going from a 0.2 Full-Time Equivalent (FTE) (one day of administration time per week) to a 0.4 FTE (two days of administration time per week). As many programs have suffered from lack of administration time for programs directors, this change should enhance the quality of many radiology residencies. Some manpower/administrative issues that remained unresolved in radiology residencies can now be tackled due to decreased time pressures.

Final Thoughts About The AUR Meeting

Unlike previous meetings over the past four or five years, most of the doom and gloom has passed. Ironically, although the headline lectures were about depression and burnout, the mood was much more upbeat for new and graduating residents. Between the rising job market and the stable economy, the new MOC, increased program director time requirements, and the new Radexam, things are looking up. Even the wave of concerns about artificial intelligence replacing radiologist has seemed to pass us by! (No one believes that it will replace radiologists any time soon).  So, for all radiology residents, you are entering the field at a great time. And, this meeting certainly confirmed my suspicions!

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Why Radiology Is Better Than Law!

law

For many of you training to become a radiologist (or any physician for that matter), by this point, you may be a bit cranky and tired. When this happens, I often hear residents question their original intentions and ask, “Should I have gone to law school instead?” Typically they follow this question with, “I would have finished my residency and would be rolling in the dough by now if I was an attorney…” But in the website’s style, I will immediately debunk those painful thoughts! So let’s start going through why law school is no replacement for becoming a radiologist!

Attorneys Have Loans, But Are Less Likely To Pay Them Back!

If you think you are alone in your debt, think again. Lawyers also have three years of law school loans that they must pay back. OK… It’s not four years. But, the prospects of having them paid back are more tenuous than yours. Did you know that the median attorney earns 118,160 dollars? (1) You may not be the median lawyer, you may say. Let’s say you are above average. An attorney at the 75th percentile makes 175,580 dollars. More rarely do attorneys bring the astronomical salaries that we hear about as partners in a firm on Wall Street for long periods.

And what is the salary for a radiologist? Hmm… Well, it depends on the survey. But, if you look at the AuntMinnie website, they say that the median compensation is 503,225 dollars. (2) If you don’t like that survey, let’s try another showing a lower average salary. How about Medscape from 2017? (3) We are talking about an average of 396000 dollars. Either way, you split hairs. As a radiologist, you will more likely be making more! And more importantly, even though you may owe a bit more, you are more likely to pay those loans back!!!

Attorneys Have Long Hours Too!

If you think you work many more hours than an equivalent attorney, think again!!! Sure, attorneys spend more time at lunch to make that next deal or to increase connections. However, most hardworking attorneys work until late at night, especially if they want to become a partner in a practice. My former Wall Street attorney friends frequently worked until after 8 pm or even as late as 10 or 11 pm! So, I don’t want to hear that whining!

Attorneys’ Work Is Not As Interesting As Ours

OK… This statement is a bit opinionated. But, in my situation, it is very accurate. I certainly would much prefer to read films or perform procedures than splitting hairs over the definition of a word in court. The prospect of researching cases doesn’t do it for me. And, probably not for you if you have chosen to join the field of radiology!

Radiologists Have More Vacation, Ha!!!

Radiologists are blessed with more vacation time within the field of medicine than most other specialties. On the other hand, I can guarantee that few attorneys have eight or ten weeks off per year. I know we work hard when we are on. But it is sure nice to have those extra weeks of vacation, whether at home or away in Bora Bora!

Radiologist Contributions To Society

I’m not particularly eager to make overarching statements. However, I think this one is mostly true. Most radiologists make essential contributions to society by increasing overall health and well-being. Not to say that attorneys do not contribute to our communities, but I believe a more significant percentage of attorneys make less of a difference to humanity. I’m not sure how much ambulance chasers help the average human being! And many other attorneys serve even less noble purposes. On the other hand, hospitals would falter without the average radiologist working their shifts, and patients would have severe health issues!

Law School Vs. Radiology Training: A New Perspective

If those reasons are not enough to convince you about the benefits of radiology training over law school, maybe you should become an attorney! The grass is always greener on the other side in the throes of residency. But, I have news for you; take a look around. Training to become an attorney is not all that flashy. You are lucky right where you are!!!

 

(1) https://money.usnews.com/careers/best-jobs/lawyer/salary

(2) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=117841

(3) https://www.medscape.com/slideshow/compensation-2017-overview-6008547#4

 

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Artificial Intelligence And Radiology Voice Recognition Technology: What Can We Expect?

Do you get this irony? We hear so much lately about artificial intelligence and how it can potentially affect radiology. But, for all this talk about the application of artificial intelligence, I have heard barely a squeak on anything tangible about applying artificial intelligence to real-world voice recognition technology. Why do I find this so strange? Startup companies espouse artificial intelligence for so many applications, some with questionable benefit. Yet, sitting right in front of everyone’s face is the most obvious work efficiency improvement, the application of artificial intelligence to enhance voice recognition. It is an area that desperately needs attention!

To me, it makes no sense that companies do not pursue this avenue. Unlike other health applications, applying artificial intelligence to voice recognition technology will unlikely result in lawsuits or untoward health effects (unless the AI switches rights with lefts or unwittingly adds a lot of nos to our dictations!) And, voice recognition is exactly the type of technology that fits the paradigm of why developers construct artificial intelligence. Everyone’s voice is different and we all choose different words to express ourselves. So, a technology like artificial intelligence that learns the subtleties of each of our voices and vocabulary should really make a difference in daily work life. So, why don’t we hear about breakthroughs on the voice recognition front? Let’s take a look at what’s out there already…

My Internet Literature Search

Since so much potential exists for the intersection of AI and voice recognition, I started a simple internet search on this topic. And, guess what? This is the first article I found. Microsoft announced a milestone. The company’s most accurate artificial intelligence enhanced software reached an error rate for transcription of conversational speech measuring 5.1%. (1)

Next, I found another article from Inc. that talks about the world’s most accurate voice recognition technologies. The top three are as follows: Baidu, Hound, and Siri. For those of you that do not know these enterprises well, I will briefly discuss each of them.

First of all, Baidu… Baidu is a Chinese company similar to Google but made for China. Why is this needed the most? Well, think about typing in Mandarin and how long it takes to type. In Mandarin, it is much shorter to speak than to write. So, that makes sense. Second, Hound… Honestly, I had never heard of this enterprise prior to writing this article. Apparently, it was a first comer in the voice recognition personal assistant realm and is a fairly accurate digital assistant. And lastly, of course, is Siri by Apple… To say the least from my experience, if this technology is considered to the be one of the world’s most accurate, artificial intelligence voice recognition does not even come close to where it should be. I can’t tell you how many times Siri interprets my language incorrectly! (2)

What’s In Store For Radiology Voice Recognition?

Now, call me crazy… But, none of these technologies sound so great to me. If a speech recognition system gets approximately 1 out of every 20 words wrong as in each of these technologies, that could be a recipe for disaster in the world of radiology reporting. And, this is the best that artificial intelligence offers for voice recognition?

In addition to these “seminal” articles, I did find an interesting merger between the ACR and Nuance Communications to set up a collaborative effort to improve radiology reporting. (3) But, nothing tangible has yet been created to significantly improve voice recognition technology. It’s all in the initial phase. This leads me to believe there is a long way to go.

Final Thoughts

Sorry to break the news but… I don’t see any significant improvement in the quality of our radiology dictation software technology for a long time. So, until artificial intelligence software developers take voice recognition technology seriously and apply their talents to this area, change will not be around the corner. Therefore, continue to check your work many times over and dictate cautiously!

(1) https://techcrunch.com/2017/08/20/microsofts-speech-recognition-system-hits-a-new-accuracy-milestone/

(2) https://www.inc.com/kevin-j-ryan/internet-trends-7-most-accurate-word-recognition-platforms.html

(3) https://www.nuance.com/about-us/newsroom/press-releases/philips-and-nuance-bring-ai-into-radiology-reporting.html

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Top 10 Radiology Anachronisms Today From 1999

radiology anachronisms

Since I started my radiology residency in 1999 (only 23 years ago!), a whirlwind of changes has morphed the field of radiology into something very different from when I first started. It’s amazing how new modalities, technologies, and techniques creep up on us, gradually replacing the old ways. That got me thinking… Since everyone loves lists, what are the top 10 radiology anachronisms from 1999 that would be out of place today? Don’t worry… I’m not going back to the 1950s when pneumoencephalography reigned king because that was not my time. (And most of yours as well!) Instead, let’s start with some of the significant changes for general radiologists from the more recent past (Hopefully after you were born!). I think you might find this enlightening. Enjoy!

Analog Films/Film Panels

When I first started, I hit upon the end of the physical film era. Fortunately, I was one of the last classes to experience the dusk of its usage. Soon after, I graduated residency and never looked back in the world of film. Boy, did that change how we practice radiology!

Pulmonary Arteriograms and Trauma Aortograms

I will lump these two studies into one category because they are invasive diagnostic studies. For those of you that remember, the experts considered pulmonary angiograms for years to be the “gold standard.” Now, we only use chest CTAs. Wow, did that change in a huff with the newer CT technology! And, what about the trauma aortogram? Do you remember getting woken up at 3 AM to rule out aortic rupture? I certainly do!

Misplaced Imaging Studies

For those of you who experienced the film era, you will remember orthopedics taking a good percentage of studies down for surgery, never crossing the path of the radiologist’s eyes. How often does that happen now? Very rarely do films get lost on PACS!

Double Contrast Barium Enemas

In New Jersey, finding the equipment you need to complete a double contrast barium enema is almost impossible. And many residents have never even seen one performed. Incredible isn’t it?! Almost everyone seems to get a colonoscopy or virtual colonoscopy instead. It’s ironic because double-contrast barium enemas played an essential role in cancer screening. No longer!

Written Prelims

Most newer radiologists and residents can’t even picture writing a prelim, let alone writing anything down. That is just how we used to operate in 1999 as residents. We would hang the CT scan boards and then write our impressions on paper in a binder. How passé?

Clinicians in the Radiology Department

I remember when the radiology department bustled with activity from the surgeons and oncologists. Rarely does that happen anymore? Sure, you still get that occasional straggler that enters the room. But, that is more the exception rather than the rule. Too bad, huh?

PET Scanners Without CT

When I started, the debate about whether PET-CT would provide a significant added benefit over a standard PET scanner raged. Well, that debate ended rather quickly! I don’t think I’ve seen a traditional PET scanner around for a while!

Transcriptionists And Cassette Recorders

It’s next to impossible to forget about the changes in dictation technologies over the past 19 years. Granted, I don’t think that the technologies have gone far enough. However, a lot has still changed. I haven’t spoken to a transcriptionist or dictated into a cassette recorder for eons!

IVPs and Ionized Iodinated Contrast

Who can remember having to inject your patients for IVP with iodinated ionized contrast, no less? I do! The pain from an infiltrated dosage was immense. And, I can remember a lot more untoward allergic reactions. Well, fortunately, this is no more!

Absent Hospital CT Techs After Hours

Absent CT techs certainly would not fly at most hospitals anymore. Hospitals expect CT scanners to run at all hours, no matter the case’s urgency. I almost can’t imagine a hospital without 24-hour CT coverage. It makes me miss the old days!

Final Thoughts on Radiology Anachronisms Today From 1999

These radiology anachronisms are probably just the tip of the iceberg. And, I am sure you have your ideas about what would be an anachronism today from 1999. So much has changed! I would love to hear from you to find out what you think are some of the top radiology anachronisms. If you have a good one, please comment below!

 

 

 

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When Do Radiologists Peak? (The Older The Better?)

peak

You can easily find all sorts of articles about when human intelligence in all of its forms peaks on the internet. For example, I particularly enjoyed one such article from science alert. As the piece states, different types of intelligence peak over different ages in one’s life. (1) We can always count on granny’s wisdom. Yet, we now know that many mathematicians write their seminal papers when they are young. But what about radiologists? Do we make the best radiologists when we first get out of fellowship and have just taken the boards? Or, do experienced radiologists make overall better radiologists? These are difficult questions to answer, but I shall attempt to come up with a logical conclusion.

Evidence For Increased Quality Of Younger Physicians

To start with, scientists have concluded that visual perception slows down with age. One article from the University of Arizona summarized that visual ambiguity increases with age because of brain inhibition defects. Over time, older people have a much harder time identifying unfamiliar shapes. Other studies have also shown losses in light sensitivity, motion, depth, and color perception. Although not specific to a radiologist’s work, presumably, these defects in processing could affect a radiologist’s reads over time. (2) Score one for youth!

Recently, another article based on an observational study in the BMJ stated that patients had lower mortality rates in hospitals when physicians under 40 cared for these patients. However, interestingly, there was a big caveat in this article. These outcomes only applied to doctors that did not see a large volume of patients. (3) So, I am not sure how well this data applies to radiologists since most of us see large volumes of studies. Furthermore, most of us do not directly care for our patients, as the physicians studied in this paper.

Evidence For Increased Quality Of Experienced Radiologists

On the other hand, a study in Radiology explored the quality of reads of mammographers over different ages. In this paper, they determined that experience counts. Notably, they found a significant increase in pickups and a decrease in false positives occurred during the first 1-3 years of community radiology experience. And even more importantly, the paper showed no significant drop off in quality as one aged. The false-positive rates had overall decreased over time. (4) Score one for experience!

Personal Experiences (Not Hard Evidence!)

Through my years as a radiologist from residency to the current day, I have certainly seen some fantastic radiologists over 70. Unfortunately, that statement does not apply to all the older radiologists that I have met. Some had passed their prime and likely had stayed in the field longer than they should have.

For comparison, many new radiologists fresh out of fellowship tend to overcall on imaging. The dictations of these radiologists often contain more unnecessary words and flowery language that clinicians do not want to read.

In the middle between these two extremes lies the middle age radiologist. Again, not all radiologists are created equal. And, some miss more than others. But overall, I have found these radiologists have the least problems with missing findings, irrelevant dictations, and overcalling diagnoses. They tend to know what to look for because they have been practicing radiology long enough. Yet, these radiologists do not suffer from significant perceptual issues.

My Take On The Peak Radiologist Based On All The Information

The article on mammography cements my suspicions that experience does count. Also, it says to me; individual radiologists may peak at a later date. On the other hand, even with “better perceptual abilities,” I have never met a newly graduated radiologist that I would have preferred to read my imaging studies over someone with more experience. Based on my encounters, I am biased toward favoring a quality peak multiple years after finishing residency and fellowship. Yet, based on scientific evidence, I believe that at some point, the decrease in perceptual abilities does affect the quality of work of senior radiologists. So, I would say that the final years of work most likely are somewhat past a radiologist’s peak.

My bottom line for the new radiologist: If you are finishing residency or fellowship, you should expect to continue to work hard and learn over your lifetime. Even though you have studied an extreme amount of information to pass the boards and get through your training, believe it or not, your best days are probably ahead of you!

(1) https://www.sciencealert.com/this-is-the-age-you-reach-peak-intelligence-according-to-science

(2) https://uanews.arizona.edu/story/research-shows-how-visual-perception-slows-age

(3) http://www.bmj.com/content/357/bmj.j1797

(4) http://pubs.rsna.org/doi/full/10.1148/radiol.2533090070

 

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How Important Is Level One Trauma To My Radiology Training?

level one trauma

Bullet wounds, stabbings, motorcycle accidents, falls, and blunt trauma from severe car accidents. These are some of the incidents that comprise most of the trauma at a level-one trauma center. But, let’s say you attend a program that does not have a level one trauma center, and you don’t see as many of these cases. Are you at a loss compared to your colleagues who do? And, what are the consequences for your future practice of radiology? Will you be a second-class radiologist? For many of you that have to decide on a residency with or without a significant trauma component, these questions cast doubts on some training programs. As I have trained at a level one trauma center and have been operating a residency without one, we will go through the training from a level one trauma you might “miss” during training.

Trauma Resident Checklists

Do you like to have multiple residents in other subspecialties waiting for you to check off the boxes? That situation is what you will experience at a level-one trauma center precisely. You will find that many exhausted nighttime residents are keenly interested in only finding out if you have read all those films yet, not worrying about the final diagnosis. Yes, it reminds you of all the images you need to see with each trauma. But ensuring the specialists have checked all the boxes does not add much to one’s training!

Limited Four Quadrant Ultrasounds

Are you interested in looking for free fluid at all night hours? Well, this is your opportunity. And unfortunately, the limited four-quadrant ultrasound is the tool of choice. Guess who wields the probe? You do!!! I can guarantee that you will be scanning everyone with a horrible accident that comes through the pearly gates of the emergency department. Is it worth all those additional sleepless nights so that you can find the free fluid? I’ll let you make that choice.

Repetitive Injury Patterns

Do you like variety? Trauma comes in so many fewer flavors than other interesting disease entities. Knife wounds exhibit most of the same findings over and over again. After your 15th splenic laceration, it gets old. And it’s not just the knife wounds. Blunt trauma, bullet wounds, and severe falls work the same way. I prefer a little more variety in my life!

Fewer Bread And Butter Cases

What does trauma experience usually replace? Typically, you will see many fewer bread-and-butter cases. And the time spent working up trauma cases has to substitute for something else. What do I mean by that? Level-one trauma centers may divert some diverticulitis, appendicitis, oncology, and renal stone patients down the street. I mean, who wants to go to an emergency department with all that bloody trauma when you can go to a much less hectic hospital. Unfortunately, for that reason, you get less experience with the diseases that most emergency departments always see. And these diseases are the ones that residents need to learn the most; the more common entities you will be working up the most in practice.

Level One Trauma- A Necessity For Training?

Yes, I will admit that level-one trauma centers provide a specialized experience. But for the most part, radiologists can learn what they need to know from the standard trauma they encounter at a hospital without completing a residency with a level-one trauma program. In addition, it is not hard for the resident to supplement their training with trauma reading. So, if you find a great program without a level one trauma center that otherwise matches what you want, by all means, still consider it. The absence of level-one trauma does not imply a significant gap in your radiology education!

 

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Should First Year Residents Give Interdisciplinary Conferences?

interdisciplinary conferences

Interdisciplinary meetings at many hospitals tend to be working clinical conferences. Ultimately, the primary clinical physician will decide on patient treatment based on the conclusions at one of these meetings. So, we better be careful in choosing which radiology team members prepare for interdisciplinary conferences to get the best possible patient care.

Therefore, this begs the question. Should a first-year resident claim responsibility for presenting at one of these interdisciplinary conferences? Or should the program delegate the senior resident or attending to give the conference? We will discuss why the more senior radiology resident or attending should take this critical responsibility.

Preparation Time

When a first-year prepares for one of his first few conferences, the time is very long. Why? First, the first-year resident needs to figure out what is essential. Then, they must ask a senior resident or attending which images are most relevant to the case. And finally, the resident must figure out the clinical significance of each finding.

On the other hand, a more senior resident or attending will experientially know what is most important. A more senior radiologist can perform almost all the legwork by himself. And, of course, he will understand the clinical ramifications of his findings and conclusions. The amount of time the preparer and the attending staff saves is enormous. It is the time that the junior resident or attending could have used for more critical activities.

Experience/Knowledge Level

A first-year radiology resident may find answering questions thrown at them during a conference difficult. A question can derail a junior resident’s presentation simply because he has not experienced that subject matter or modality. More importantly, it is also possible that the first-year resident may spout misleading information to the clinicians. This pitfall could theoretically influence patient management in the wrong direction.

For the more senior radiologist, she will be able to respond to clinical radiological inquiries with a backstop of years of experience to guide the clinician appropriately. In addition, the senior radiologist is more likely to nudge the clinician toward the appropriate treatment of his patients. Experience counts.

Conference Savvy

Years of conference experience “under one’s belt” also let the presenter know when to chime in, and when to stay silent. This skill only comes from years of practice. Although some junior residents may have this skill, you cannot expect all first-year residents to be adept at giving conferences. Eventually, all first-year residents will develop the art of presenting by observing and participating in many conferences. But, it is not appropriate to expect the first year to know the rules when they start.

Seniority

Even though there is a steeper learning curve for a first-year resident than a more senior resident, the experience of giving a conference is usually more valuable for the more senior resident. Why is that? For the most part, this resident will graduate from the program sooner and will need the experience of presenting for fellowship and beyond. The last year of residency should be a time to hone your presentation skills for the next career phase.

Interdisciplinary Conferences And The Presenter

Preparing and giving an interdisciplinary conference is crucial to the radiology residency experience. In deciding who should provide this conference, we must consider factors such as time, experience, skills, and seniority. Based on these factors, the more senior resident or attending is the right person to play this role.

 

 

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Halloween Tales From The Radiology Residency Crypt

crypt

 

In honor of the up and coming Halloween holiday, here is a collection of two of my own homemade nightmarish radiology residency stories. (written expressly for your amusement!!!) Beware of ghouls, ghosts, and program directors!

Story 1 – End Of Days

The noise of the resident’s footsteps battles the endless quiet of the hospital corridor but to no avail. A faint silent breeze blows through the hallway with a subtle smell of disinfectants, used to mask the horrid smells of sick patients that have rolled through the hallway. Doorways to physician offices and patient rooms are already locked and closed as the resident’s digital watch approaches 5 o’clock on Halloween, the hospital witching hour when everyone seems to leave. But, there is one door 30 feet down the hallway that is slightly ajar with light peeking through. It is his final destination.

He thinks about how it was only just an hour ago when the hospital was active and buzzing. The program director took him aside to tell him to meet at 5 o’clock, speaking curtly. Yet, it almost felt like an eternity. No sign of anything he could have wanted. But the time has now almost arrived. He is almost here.

Turning his attention back to the slightly ajar door, his stomach begins to knot up. Heart paces more quickly. Thump, thump, thump… he can hear and feel his chest almost explode. Barely can he muster the energy to knock on the door. But, he does. And, he hears the faint serious tone of the program director’s deep voice, “Come in…”

As he peers into the office, ancient films line the edges of the walls with glowing light panels underneath them. Diseased skull images, x-rays of horribly broken bones, and bizarre abdominal series with a variety of different foreign bodies all sit tucked into their appropriate places on these walls. Perhaps, the program director found them amusing. Nonetheless, they are entirely inappropriate and bone-chilling. And there, behind a large messy wooden desk sits the program director watching and waiting for him to sit down…

Resident: Gulp… “Uh, sir, why I am here?”

Program Director: “Well… I spoke to the technologists and they said great things about you. I wanted to relay the information that you had done a great job with your patients in interventional radiology.”

Resident: “That’s good news, right? Well then, I will get out of your hair”

Rapidly, the resident gets up out of the hard seat and makes a beeline for the cold door. But, he stops short just before arriving there.

Program Director: “Well, there is one more thing I need to tell you.” He clears his throat with a loud, “Ahem…”

Turning back toward the director, he notices his eyes become a bit glossy and sees a lump form at the back of his throat. He endlessly waits for another word to leave from his mouth, but it doesn’t seem to come.

Resident: “OK… What is it?”

His eyes point to a box across from his door that he must have missed when he entered the room, so nervous for this encounter. The resident looks closely at the side of the box and notices his own name. Pictures line the edges of the box. They look familiar. He notices they are pictures of him and his family. Wait a second… They were just on his desk in the resident room yesterday. At the base of his box lies a thick binder. His learning portfolio.

Resident: “Uh sir. What does this mean? Why is all my stuff from my desk in this box?”

Progam Director: “Well, I guess I didn’t tell you. I thought you knew. The hospital ran out of money for your residency spot. You were chosen out of a hat. We have to let you go. You have to find a residency slot somewhere else.”

Resident: “Noooooo!!!!”

Moohaahaahaa!!!!

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Story 2: The Halloween Reading Room Of Hell

It’s 5:00 PM on Halloween evening and the resident begins his shift. He remembers hearing how the other residents say they were “killed” by the number of cases on call on Halloween night. Even so, like many other nights, he enters the reading room.

Although the room only contains a few PACS monitors, a cramped desk, and a hard wooden chair, his reading room is so small that there is barely any space to move about and there is no wired phone. The walls and door are thick and lead lined. All these factors together, make physicians that enter the room feel like the walls are about to cave in. The walls rapidly muffle the voices from within. Noise from outside the door does not penetrate through the heavy doors and walls to allow the radiologist to dictate cases uninterrupted.

The room begins to bustle with activity as clinical attendings and residents walk in and out viewing CT scans of a group of Halloween pranksters caught by the police with altered mental status after their pursuers beat them silly. And, others were interested to see the scans of some kids with stomach aches from eating too much treats/candy, of course, to rule out appendicitis.

The workload is nonstop. His cell phone rings off the hook. And, clinicians stop into the cramped room by the dozens. Hours go by.

It’s now about 10 pm during the heart of Halloween eve. Clinicians continue to bombard the poor resident throughout the evening. A final large bolus of clinicians stops by to see another imaging study. They finally leave. After all this activity, the resident didn’t have a moment to himself to dictate any of the cases on the PACS system.

Now that everyone left the room, he thinks he has the time he needs to get all the dictations out for the morning’s attending. He can’t take another interruption. Suddenly, with frustration peaking, he slams the door and yells, “I can’t take it anymore!” There are a loud bang and a click. The room falls silent.

Rushing through the next ten CT scans in the cramped room, he notices something unusual. No one comes in or out the door. He dismisses the issue and continues to run through the next ten CT scans. Still not a peep. It’s just his voice and the computer dictaphone.

Exhausted from dictating so many CT scans, he rises from his chair to stretch his legs. He realizes that he wants a breath of fresh air. Slowly, he attempts to turn the doorknob and pull the door. Nothing happens. He tries again. No movement.

No big deal. He decides to get out his cell phone to call security to get him out of the reading room. As he attempts to turn the iPhone on with his fingerprint, nothing happens. The battery must have run out after being in his pocket for all these hours in a lead-lined room and all the phone calls he had to make.

Now he begins to furiously bang on the door. No response. Nothing. How can anyone hear him in this lead-lined tiny room?

He begins to feel hot as the air is stagnant. There is no temperature control. Now sweating like a banshee, beads drip onto the floor from his forehead. Claustrophobia sets in. Feels like a coffin. He can’t breathe. Eyes roll to the back of his head as he slumps down in the seat. Everything appears blurry. The room is moving back and forth. He finally settles down, now unconscious.

Floating upward, he is looking at his body slumped in his seat not breathing. The rest of the night’s CT scans not dictated. Clock on the wall says 8 AM. The door is finally jiggling. A security guard opens the door, not even taken aback by the ghastly sight of the dead resident. He begins to wrap up the body in a plastic bag and thinks  Another resident killed by Halloween call. No one will know the difference. Just like the other residents always say- residents are “killed” on call. It happens every year!

Moohaahaahaa!!!

 

 

 

 

 

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Radiology Swap- University Radiologist Goes To Private Practice (Part 2)

radiology swap

Today we return to Part 2 of our Radiology Swap blog. Click on Radiology Swap- Radiology Private Practitioner Goes To University (Part 1) to catch up if you missed the first part of Radiology Swap!

University Radiologist Goes To Private Practice

Day 1 Radiology Swap:

Unaccustomed to working in a private office, the University radiologist is surprised by the relatively small size of the office. The parking lot is not too full, and he can walk rapidly from his car to the office, very different from usually having to walk from the back of the parking lot—a nice perk.

Finally, entering the building, he locates his workstation and seat. As soon as he sits down at the desk with the PACS monitor, a technologist dumps a stack of papers with today’s work next to the monitors. It must be about 150 cases. Where are my resident and fellow? I need them to help me with the dictations! Oh, my God!!!! I just realized that I forgot how to use a dictaphone.

After struggling with dictations and having read maybe 10 of them, 11 AM rolls by as he teaches the technologists about the ultrasounds they show him. But, the technologists roll their eyes as they just want to get through the cases so they can go home. They sense him droning on and on! He looks at the stack of papers given in the morning. It still looks the same!

Noon: He begins to receive phone calls, not happy ones. Clinicians are asking him about the results of chest x-rays, ultrasounds, and MRIs. Unsuccessfully, he tries to soothe them and let them know he has not looked at them yet, but he will get to them! No lunch for me.

Eyes reddened, head bleary, and voice cracking, the University radiologist now realizes it is almost 5 PM. He has only finished maybe half of the stack of orders. Lots more to go. No one to talk to. I can’t leave yet to get to the family.

10 PM arrives, and he is finally finishing his last dictation of the “day.” How does the private practice radiologist do it?

Day 15 Radiology Swap:

He arrives wearily into the office, looking haggard and worn with a 15 lbs weight loss since he started the job (1 pound per day!). His temper flares every once in a while, taking out his frustrations on the constant bombardment by the technologists by making snide remarks and yelling at the staff’s mistakes. For the past 15 days, he has left the office in the dark, no earlier than 8 PM. No direct contact with interested learners or other clinical physicians. All interactions on the phone. So, this is physician burnout!

Day 30 Radiology Swap:

Assessment day for Radiology Swap!!!

Practice President: So, you have worked in our practice for the past 30 days? Let’s start with the good part: I’m glad to see that you have made it through the encounter.

Academic Radiologist: Yeah, barely. How do you guys do it?

President: We do it efficiently to make money. The more we read, the more we earn. It keeps us going. In any case, let’s continue with your review. We received many complaints from our staff that you were curt and inappropriate at times. It was like pulling teeth to get you to do fluoro cases on our patients. You kept on grumbling- “Where’s my resident?”

Academic Radiologist: I thought you would at least provide me with a physician assistant to help with daily work. I don’t usually touch patients. My residents do it for me.

President: We also received numerous complaints from our referrers that they did not receive their reports in a timely fashion. We lost some serious business this week.

Academic Radiologist: When you get 150 new studies per day, everyone has to wait!!!

President: I don’t think we would be able to keep you here because we need radiologists to keep up with the work. We don’t get paid if we don’t read the minimum volumes!

Academic Radiologist: The best part of this job was the 15 lbs weight loss! I can finally get some sleep again. His eyes begin to close, dreaming about returning to his academic position.

 

The Radiology Swap Meetup

So, the academic and private practice radiologists now seat themselves in the same room to share their experiences after having returned to their respective jobs.

Private Radiologist: How do you do your job on a daily basis without getting totally bored?

Academic Radiologist: How do you do your job without getting totally burnt out?

Private Radiologist: Let’s agree that we are not right for each other’s jobs. It would never work out for us.

Academic Radiologist: At least I can understand what you go through on a daily basis. We used to make fun of private practice radiologists. Don’t think that I will do that anymore.

Private Radiologist: Doesn’t mean that we can’t be friends. Let’s go out for drinks! I think we both earned it…

Academic: True. We both earned some stiff ones.

The radiologists leave the room and head down the street, never to look back on their former residency swap experiences again and happy to go out for some drinks…

THE END

(until next time!)