Category: Resident Career

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Will Mini-Fellowships Replace Fellowships?

mini-fellowships

Question About Fellowships And Mini-Fellowships:

Hello,

Why is it that it is practically required to do a fellowship these days? Is there no value in being a general radiologist?

With many residency programs now moving towards offering “mini-fellowships” at the end of R4, could this trend change?

Sincerely,

Future Radiologist

Answer:

As you hinted, fellowships are not technically required, but they are very desirable. Why? Because most groups want someone that can help out with the studies that most others in groups cannot do. It could be interventional work, breast MRI biopsies, or high-end neuro cases. However, groups also want radiologists to be able to perform some general work. So, having the accompanying skill set of a general radiologist is very desirable. These are the most wanted radiologists, and you can call these sorts of radiologists generalists even though they have a specialty skill set. You will be sure to find an excellent job in this situation.

However, it is still possible to find work without a fellowship as a true general radiologist, especially in less popular places such as rural places in the USA. Herein lies the problem: If and when the job market changes, having no fellowship can put you in a bind if you decide you want to leave and find a job in more competitive parts of the country. So, my recommendation is always to do a fellowship just in case. It is for only one year.

Finally, mini-fellowships in a residency are excellent opportunities. But, they usually don’t provide the same in-depth dive into the subspecialty as a true fellowship. Usually, the mini-fellowship also lasts several months instead of a full year. So, I don’t see the trend of completing a full year fellowship changing so fast with the advent of these mini-fellowships. Furthermore, mini-fellowships have been around for five or more years. And, full fellowships remain much more desirable for practices than a few mini-fellowships during residency. Once again, if the job market changes and you only have mini-fellowships, you will be at a disadvantage. 

Great question,

Barry Julius, MD

 

 

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What Makes The Ultimate Radiology Job?

Recently, I received a question from one of my readers about the ultimate radiology job. What kind of job would it be? I was about to spit out the dull answer: there is no perfect job for everyone, which is true. However, I thought about this question more deeply. I figured I could get a little more down and dirty because there might be a perfect job for a specific person. So, I will do just that. 

Let’s talk about the ideal job for three different particular kinds of radiology personalities. The first would be the perfect job for the lifestyle radiologist. The second would be for the academic radiologist. Finally, the third would be the money-loving radiologist who wants to pay off all their debts as quickly as possible. At the end of each description, I will give you what I think would be a reasonable but high-end salary for the job I describe. You can’t have all the lifestyle features with all the money. And, you can’t be hardcore academic and always have the best lifestyle. But you can find a radiology job with at least one of these features!

Lifestyle Radiologist’s Ultimate Radiology Job

Optimal Working Time

Picture this. You get up late at 10 am without a furrow in your brow after taking a stroll with your dog down the street. Afterward, you return home and start working at 11 am at your own pace. You encounter nary an interruption. After a few hours of work, you have had enough for today. So, you take a shower and plan your next vacation to Thailand. Of course, you have 16 weeks of vacation per year, so finding time for this next adventure is not too difficult. You spend a leisurely dinner with the family, and the day ends smoothly.

The next day, you get up a bit earlier because you had gotten more than enough sleep the day before. Today is your day to come to work. Out of every three days of work per week, you stay at home one day, the other one you come in for, and the third is a miscellaneous day to catch up on the practice’s studies in no particular place and without hurry.

Friendly Practice Situation

As you arrive, all the techs and nurses greet you excitedly and are happy to see you. You are well-liked in the imaging center. Because of the complexity, you start reading through interesting films in your subspecialty that no one else can read. Of course, there is a smattering of normal cases every once in a while in between. Lunchtime finally arrives around noon. You meet with your colleagues for about an hour and go to a fancy restaurant to chat and enjoy the lunch break like you do when you go to work. You return to work unrushed and unfettered, in no rush to complete the rest of the day because you could always finish the rest some other time. 

The following day, the last one of the week, you help the practice catch up on occasional studies. You log on from home and leisurely read your cases. You make a few phone calls and complete your day’s work in a few hours. Of course, you may not get paid like other radiologists who do more. But the time off is worth it!

Radiologist Pay:350,000 dollars

Academic Radiologist’s Ultimate Radiology Job

Out of every five days of work, you have three full days to work on your academic research. Of course, that does not include the eight weeks out of every year that you receive paid speaking engagements or have time for continuing medical education (CME). Moreover, you have the support staff that most others can only dream about. These include two statisticians, a research coordinator, and your secretary. And you have the software and backup to quickly garner the resources to create well-sourced papers at the drop of a hat. Additionally, you have the administration’s help to obtain grants from private and public sources. This help includes multiple connections that overcome many hurdles other academics may encounter. 

Then, you have several days every week to resume clinical work. But, you have the help of your resident, fellow, and junior attending. They do most of the dictation; you get to edit and sign off on their reports. Your residents, fellows, and observers also do much of the work to help you create your following research paper. 

Also, you have easy access and collaboration with multiple specialties throughout the institution. No one is at each other throats. Everyone is willing and able to help each other to come up with great ideas for projects. It’s an environment that fosters learning and research.

Finally, you have already accumulated tenure at your institution. There is almost no way that you can be “canned.” You have put in the time, and the work has paid you back. 

Radiologist Pay: 550,000 dollars

Money Loving Radiologist Ultimate Radiology Job

This radiologist is willing to work as hard as it takes to repay all their student loans as quickly as possible and accumulate enough income to retire as soon as possible. That is the prime goal of this radiologist. And they have found the job they need to meet this goal. 

First, they found a job where the practice pays them precisely what she is worth for each case, plus a stipend from the hospital because she is in a somewhat underserved location. Her days are busy, but they go by fast. They read 200 cases daily, and the caseload is light on findings but large in number. Fortunately, she also works in an area where the case complexity is relatively low and the payer mix is quite high. Of course, they don’t take much of a break during the day, but they work hard all day and reap the rewards.

They also have the backup they need to increase speed regarding radiologist support. These include radiology assistants, a fabulous computer IT department, and an excellent dictation system. They work five days a week, and she gets paid a lot of extra money when they work on the weekends. But most critically, they can do that when they want. Finally, they get lots of vacation, but only take a few weeks out of the year to go away because they don’t want to do this job for the rest of their lives. She would rather have the cash instead. 

Radiologist Pay: 800,000 dollars

The Ultimate Radiology Job- What Do You Think?

You may or may not think that any of these jobs sound great. And that is OK. However, these scenarios are perfectly reasonable for these individuals and can present an ideal situation for these individualized career paths. Let me know if you have an idea for the perfect job, and I can devise another scenario for you!

 

 

 

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Counterpoint to Subspecialization As Radiology’s Future

subspecialization

I’m sick of it. It seems that almost every other week, I see an article that subspecialization is the future of radiology. If you listen to the average author who writes the average article on the internet about this topic, general radiology is dead. Just do a google search yourself, and you will come up with a gazillion search results on this subject.

But if that is the case, coming from the trenches, why is it that my practice needs generalist radiologists more than ever? And, it’s not just me. When I speak to radiologists in other private businesses, they are saying the same thing.

So, why this dichotomy? Of course, I have a few theories. First, there is a gap between what the academics believe to be accurate and what is happening in radiology practices. Second, by claiming that subspecialization is always better for patient care, the folks that write these articles are drumming up business for themselves. And, then finally, programs now gear their training to subspecialist training. So, there is a bias that more subspecialists are needed.

In any case, let me give you some reasons why creating more radiology subspecialists is not the cure for meeting radiology’s demands. Sure, we need our specialists. But we need our generalists as well. Here we go!

Do You Need An MSK Radiologist To Read A Knee X-Ray?

Not all of radiology needs sophisticated subspecialist read. Generally, emergency medicine physicians want a brief answer on whether there is a fracture or not with a short description. Most could care less about the finer points, such as the Kellgren and Lawrence system, to classify osteoarthritis. Do we need to train more specialist physicians to read these straight vanilla films? Is it worth the expense and time?

Maldistribution Of Subspecialists Relative To Studies Performed

If you think about the majority of subspecialist currently being trained, it is not a one to one relationship with the type and amount of work in radiology. For every neuroradiologist, there is a heck of a lot more non-neuro studies than neuroradiology work. We need to complete a lot more other sorts of work daily than the number of neuroradiologists available. Think about how many GI CT abdomen and pelvic cases we read in the ER and how many GI subspecialty radiologists there are throughout the country. The numbers don’t add up!

Too Much NonSubspecialty Work For Subspecialists

Similar to the previous notion, most practices can not provide enough reads for subspecialists to interpret films in their subspecialty every hour of every day they work. Most specialized radiologists read a percentage of their subspecialty work (usually less than 50%!). So, does it make sense for all radiologists to be sub-specialized all the time based on the amount of work performed? Not!

Who Will Take Care of Rural Radiology?

You can make the case that rural hospitals and imaging centers can farm out studies to large subspecialty teleradiology or academic reading centers. In essence, though, that will never work. Most “small hospitals” want a radiologist on the premises to take care of the population’s general needs. Someone has to do the biopsies, intussception reductions, and iodine treatments in the area without having to send patients to a big city or tertiary care center. And no, that cannot be a subspecialist that only reads one particular type of study. These radiologists would be twiddling their thumbs. There is not enough work to fill the day!

Subspecialization, Not The Cure-All For What Ails Radiology!

If I sat here all day, I’m sure I can think of myriad additional reasons why we also need our generalists in radiology. The point here is that subspecialization, although required, will not fulfill all the needs in the radiology universe. We should not overemphasize the subspecialist at the expense of creating fewer and fewer generalists. Instead, we need to meet the demands of the work that needs to get done. And, creating more super subspecialists is not the answer to all our problems!

 

 

 

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Benefits Of A Career At Your Home Residency Institution

home residency

If there were not enough reasons to take your home residency seriously, here is another big one: faculty members running residency programs usually look for great candidates to fill their practices. And that person that they are looking for might be you!

But why would programs want their residents to stick around? Doesn’t that decrease the diversity of experience of the faculty training? Well, yes and no. First, not everyone you recruit will be from the residency program. Newly hired residents mostly go to fellowship programs outside of the residency institution.

Yes, the resident does miss out on the nuances of working at different sites when you never leave your home residency program. However, let’s be honest. There are numerous benefits to holding on to your residents and not just recruiting outside the institution. Let’s go through the distinct advantages of the residency program and the residents becoming faculty at the same site as their residency.

The Resident’s Perspective

You Know What You Are Getting Into

Familiarity is the number one reason to stick around at your home base. You are much less likely to be surprised by the business if you know them beforehand. I can’t tell you how often I have heard of practices withdrawing partnership positions at the last second, a month or two before the scheduled start time. Or, some imaging businesses may be less savory than you think. These disasters are much less likely to occur when you learn about your future job as you train during residency.

It Feels Like Home

It is comforting to work for a practice you know. You wake up and go to work with colleagues that you already respect. And, by now, you probably have many connections and friends in the same place you went to your residency program. You can’t find that as quickly if you move to a new radiology practice in a new locale!

You Know Your Location Beforehand

Sometimes, folks move to a new job to find out they want to live in a different environment. Perhaps you thought you might like to live in a rural community and then discovered that you enjoyed the suburbs better. Or, you decide to live farther away from your family, only to realize that you should have been living closer. You answered all these questions while living near your home residency program beforehand. Your surroundings are already familiar.

The Program’s Perspective

You Know What You Are Getting Into

Just like for the resident, I believe this one is the biggie. One of my favorite phrases is, “Better off with the devil you do know than the devil you don’t!” And that phrase doubly applies when recruiting from inside the system. If you are hiring from within, you already know all the quirks of the applying candidates. On the other hand, an unknown outside entity can throw your practice into disarray if you find out that the person you are hiring is not as it seems. I can’t tell you how many radiology businesses hire an “unknown” candidate only to find out once they start that they do not do mammography after saying that it might interest them during an interview. And other new candidates are not as good as they seem. These sorts of issues occur much less often when you recruit your own!

You Can Recruit For The Specialty You Need

Say that your practice is short of MSK radiologists. If you run a residency program and you like a candidate, you can tell them you will have a job if you complete an MSK fellowship. By targeting great candidates for your practice, you can also guide these individuals into areas your business may need. Of course, residents may not want to do what your imaging practice requires. But, if you choose between several fellowships that you might like the same, it would not hurt to complete the one that helps your future practice.

You Can Choose Those Resident Features That Will Grow Your Practice

If you are looking to hire, your practice probably needs certain types of faculty. Perhaps, many of the faculty members in your hospital are introverted, and you need a future extroverted leader to run the business. Or, your desired resident is a techie, and you require someone who knows their way around a RIS system and PACS. Recruiting residents who will help build the practice in these respects can fulfill all the niches you might need in the future.

Working At Your Home Residency Base

Don’t dismiss the possibility of working for the institution where you have trained. Even though the grass may seem greener on the other side, staying put has distinct advantages. Take into account all the opportunities that arise as you make your choices for your career. But your original experiences working at the same site as where you trained may be the best!

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Malpractice Tail Insurance? Pop The Question Before Your Next Job!

malpractice tail insurance

Since most training programs cover their trainees for malpractice insurance, it is probably the last item on your mind. And you already have enough residency and fellowship issues to worry about right now. Nevertheless, as soon as you apply for your first job, all that will change—malpractice insurance costs tens of thousands of dollars. Tail insurance can cost even more than the malpractice insurance itself. And, if you are not aware of this insurance, you can lose a bundle when/if you decide to change jobs. So, what exactly is malpractice insurance tail coverage, and why is it so critical to know how it works before taking that next job?

What Are The Different Types Of Malpractice Insurance?

First, we need to discuss some of the basics of malpractice insurance and the types of insurance policies. The two types of insurance policies you will often hear about are occurrence and claims-made policies. The least common type of malpractice insurance is called an occurrence policy. It covers all claims made before and after you leave a practice. Why is an occurrence policy less common? Simply because it is more expensive than claims-made plans.

On the other hand, a claims-made policy terminates right after you leave your job. So, if you stop working and are sued for a claim after you leave your employment, you will have no coverage. An attorney’s fees can be costly!

Malpractice Tail Insurance- A Gap Filler!

So, what does malpractice tail insurance do? Naturally, it covers any lawsuit claims from your old job after you change positions. The old claims-made policy does not cover these potential suits. This way, you will continue to have malpractice insurance if you leave. 

How Can Practices Weaponize This In A Negotiation?

Knowledge is power when it comes to negotiating a contract. And, frequently, many residents don’t know to ask about malpractice tail insurance. So, when changing jobs, they are stuck dealing with the following practice for malpractice tail insurance coverage as a benefit. This negotiation can potentially decrease the overall compensation package at the new job. In a worst-case scenario, you may have to flip the entire bill out of your pocket. 

And this sum of money is not insignificant. One article quoted the malpractice tail insurance costing 2.5 times the cost of malpractice insurance per year. In radiology malpractice insurance, this can translate into a 40-50 thousand-dollar bill. That money could have gone to paying down debt, buying a new house, or your kid’s college savings. And you could have potentially avoided all this loss by negotiating a tail in your first contract!

The Key To Knowing About Malpractice Tail Insurance!

I want to know what you are getting into before you take your next job. Other parts of the compensation package may be too good to overlook, and a claims-made policy without tail coverage may be relatively insignificant. Or, it can be a deal-breaker. Regardless, don’t let a new practice tell you they have excellent malpractice insurance coverage, only to find that you have an enormous bill to pay when you leave. Pop the question before you take your next radiology job!

 

 

 

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How Can I Prevent Low Imaging Volumes From Causing Me To Lose My First Job?

low imaging volumes

Question About Low Imaging Volumes:

Hi. I am an R2. I’ll most likely do a fellowship in body imaging (mostly because I haven’t felt a click with any particular specialty). I keep reading about practices firing radiologists because of low imaging volumes due to COVID. I’m concerned that this will affect me when I apply for jobs because I am only interested in private practice. I want to position myself with some advantages, and I need your advice on how to do this. I particularly enjoy the IT aspects of radiology (troubleshooting PACS, EMR, making software more efficient, automation, computer hardware). In my residency, there is a faculty member who is the “Director of IT.” And, I might be interested in a role like this.

My question is, do you think this is something that is even an advantage if you are seeking private practice? If so, how can I enter this space? Is there a course? Do I do research? If this is a bad idea, are there other things I can do during residency to give myself an advantage when it comes time to apply for a job in private practice? 

What should I do?

 

Answer:

Armaments To Prevent Job Loss

These are excellent questions, and I have a few answers! Let’s start with the first one about practices firing employees because of low imaging volumes. First of all, this Covid situation will most likely all but disappear by the time you graduate residency. Nevertheless, one of the best protection against getting canned is to become invaluable in whatever area that you practice. That niche can be informatics/IT. However, it all depends on the type of practice where you work.

If you aim to work at a small private practice somewhere, it will probably not help all that much. If you work for a larger institution or an academic center, it can help a lot, depending on what you do. In an educational sort of setting, if you are pumping out tons of papers and creating lots of programs/IT solutions for your colleagues, no one will want to let you go. Alternatively, if you are in charge of a massive corporate IT program, and the business cannot function well without your knowledge, they will not fire you. On the other hand, if the IT services you provide are just a little help, and the clinical work that you provide to the practice is not so much. Well, then you will not have the same job security.

At this stage of your career, work hard, and perform well in residency regardless of your fellowship. Learn about all aspects of radiology as much as you can so that you can establish a niche for yourself when you leave your residency. To repeat, most folks that are good at what they do will be the last to be fired.

How To Get Into Information Technology

Next, how can you enter this IT space? Well, some of it depends on how much experience you have in IT already. If you don’t have the knowledge that you would need to take over the IT at a practice, you would probably want to look into the Informatics fellowship. This fellowship will give you the basics of what you will need to know about IT for radiology practices. There, you can establish connections that you would need to find a career. Additionally, research in your area of specialty is never a bad idea during residency or fellowship, especially if you want to follow the more academic path.

Final Advice

So, there you have it. Work hard, learn as much as you can about radiology, consider an informatics fellowship (if that is what you want), and perform a niche in a practice that others have a hard time filling. These are the ingredients that will keep you in practice regardless of the Covid or any other unfortunate situation that may arise to lower imaging volumes for radiologists.

Good luck,

Barry Julius, MD

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Do CAQ Fellowships Add Any Additional Benefits?

caq

Have you ever wondered why some subspecialties have a separate certificate of added qualification (CAQ) while others don’t? Are there any advantages to getting these added certificates? Or is it just another degree? If you hate taking additional tests, why would you even bother with another examination to get one? I know that these are some of the questions that I have thought about a bit. And this is a great forum to answer them!

The Main Subspecialty Certificates Of Added Qualification

What are the officially recognized CAQ specialties by the American Board of Radiology (ABR) certificate of added qualification? As listed in the link above, the three most common that radiologists typically complete (from most popular to least popular) are neuroradiology, pediatric radiology, and nuclear medicine. The ABR also lists Vascular and Interventional radiology as a CAQ specialty. But, in reality, it is now a distinct full-blown specialty with a separate board and residency program. And then finally, it also lists hospice and palliative medicine as well as pain medicine as two more options. I don’t know of any radiology residents who have completed these subspecialties CAQ after a radiology residency. But, I am sure there are a few out there somewhere.

How Did Some Subspecialties Become CAQ Subspecialties And Others Did Not?

For the CAQ subspecialties, an academic cohort of individuals decided to make specific qualifications for their subspecialties. Sometimes, it was to limit encroachment from other specialties upon their turf. Or, it was to protect the subspecialty’s interest and maintain minimum standards.

Other subspecialties that do not have a CAQ, never had enough members to put in the effort to create a CAQ. It takes a bit of work and money to create an entirely new CAQ exam and all the bureaucracy that accompanies it!

What Are The Privileges/Disadvantages That CAQs Provide?

Financial/Job Advantages?

Sometimes, practices and hospitals ask to have certain subspecialists on their staff. And, in particular, they often want CAQ subspecialists. Why? Well, because frequently, other physicians or hospital administrators demand them. This demand may give you a slight advantage when you eventually go out into the job market. You may find that these subspecialties can add a few dollars to your starting salary when you begin to look. For instance, interventional radiologists and mammographers have commanded a higher salary in the recent past out of the starting gate.

Moreover, some hospitals require credentialing in specific subspecialties for their staff members. You can often see these in job board descriptions if you look at any online radiology job site. If you don’t have these credentials, you will be unlikely to get that job!

Legal Advantages (Or Disadvantage)

As a CAQ holder, you have the privilege (or disadvantage!) of the legal world considering you an expert in these fields. What does that mean? First of all, the courts hold your reads to a higher standard than other Joe Shmo general radiologists out there. In a positive sense, your subspecialty read will carry more weight in the court of law. On the downside, it also means that there will be a lower threshold for misdiagnosis than a typical diagnostician.

Additionally, the CAQ will allow you to have some “street cred” if you decide at some point to go ahead and perform expert legal work. Lawyers love having subspecialists on their payroll to convince jurors one way or another in malpractice lawsuits.

Pigeon Holing

If you are neuroradiologist and hold a CAQ, you are more likely to work at the facility, and complete neuro reads. Of course, this work can be great if it is the lot that you have chosen in life and you are happy doing it. However, it may pigeon hole you into becoming a neuroradiologist even if you are not so fond of the subspecialty work. So, beware of the subspecialties that you choose!

Surveys

If you like making some extra dough on the side, becoming a CAQ subspecialist opens up a few doors to get these subspecialty surveys. Typically, these surveys pay a little bit better than more general ones because of the laws of supply and demand. You are now less one of a fewer number, so you are needed more!

Bragging Rights

And, then, of course, you have the added benefit of bragging rights. If you happen to work at an academic facility, these bragging rights become more important to maintain your status in the field. And these institutions base promotions on their credentials. And, yes, the CAQ counts as another hoop in this game!

Testing

Finally, you will need to pass a qualifying exam in whatever CAQ subspecialty that you choose. For those of you who have had enough testing over the years, this added test may be more than you can bear.

Do Non-CAQ Specialties Have Any Meaning?

With all these inherent characteristics of CAQ specialties, do fellowship specialties without any CAQ have any meaning? Of course, they do! The point of any added subspecialty training, regardless of subtype, is to get additional training in areas of interest. And if you are telling me that a fellowship in Cardiac MRI holds no value because there is no ABR CAQ, you are suffering from CAQ delusions of grandeur. Fellowship training with CAQ or not is only as useful as what you learn during your fellowship. And, there are lots of imaging procedures to learn with or without an official CAQ!

My Whirlwind Tour Of The CAQ World

So, there you have it. Now you know what you need to know about the basics of the CAQ subspecialties. Being CAQed certainly has its privileges and its downsides as well. Make sure to enter this data into your choices when/if you decide upon a fellowship!

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

financial

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

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

New Radiologists Just Finishing Fellowship

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

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

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

Newly Retired Radiologists

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

How To Bounce Back From A Covid Economic Disaster

Keep Those Expenses Down

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

Return To Work As Soon As Possible

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

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

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

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

 

 

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

mass exodus

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

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

Reasons For A Mass Exodus Of Radiologists From The Cities

Increased Fear of Close Interactions

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

More Difficulties Raising A Family

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

Culture Shifts

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

Reasons For Radiologists To Stay

Pay

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

Housing Costs

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

The Wild Card

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

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

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

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

 

 

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The Best Radiology Subspecialties To Retire Early!

retire early

For some residents and radiologists, radiology is a calling. And, for those folks, retirement is the last thought on your mind. But, for others, it is just a job. And I get both points of view. But, regardless of which camp you are in, many of us have other hobbies and second careers that we would like to accomplish before it is too late. And, radiology has been an excellent medical specialty so that you can retire early.

So, let’s try to figure out from two different perspectives, early partial retirement or full retirement, which subspecialties within radiology are the best. Why? Although it is possible to partially or fully retire from any radiology subspecialty, certain ones lend themselves to early partial or full retirement more than others. And, many of you are trying to figure out which specialty to choose for your future career. So, after hours of deliberation, let me give you my clear winners in both departments. If you are on the fence, maybe, I can sway you in one direction or the other!

Best Radiology Subspecialty For Early Partial Retirement

So, you are considering coming into work two to three days a week later on in your career. And, you still like practicing radiology. It might not be so bad to have four or five day weekends every week, right? Here is the specialty I chose that is most conducive to this path and why.

General Radiology/Body Imaging

I believe there is one clear winner for this category. If you had to pick one subspecialty that would most likely keep you in the game, even at an older age, it would have to be general radiology/body imaging. And, this choice may be in contrast to what others may tell you. But, radiologists that are general imagers tend to have the most extensive array of experiences and training. So, this training allows them to continue practicing radiology at a high level, even at a ripe old age. And, you are less likely to become an anachronism when you have many skills. If one imaging modality goes out of style(i.e., pnemocephalography!), you have many others to bank on.

Best Radiology Subspecialty for Early Full Retirement

In this pathway, the goal is to make as much money as quickly as possible. Then, you can pack it away so that you can do whatever else you want at a spry young age! Here is the subspecialty I believe is most favorable to this track.

Neurointerventional Radiology

Sure, this field can be a pressure cooker. And, it is not for the faint of heart. Clinicians will wake you up late at night to perform critical procedures on their patients. However, you are more likely to command top dollar for your services when you are actively practicing. And, while in practice, you will become difficult to replace. Of course, this will allow you to take that money and funnel it into retirement as soon as possible!

To Retire Early Isn’t Everything!

Now, most of you are going into radiology, not to retire early, but to have an exciting and fruitful career. However, it is nice to know that if you tire from the day-to-day work, and want something else out of life, you can. So, go into a particular subspecialty not to retire, but for what interests you the most. And, if you are not sure which subspecialty to pick, maybe these ideas will persuade you!