Category: Resident Career

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How To Decrease Radiologist Hospital Presence Without Jeopardizing Care

jeopardizing care

For years, the mantra of quality radiology groups was to provide excellent service. And that would involve establishing a presence at all times. But, like many other former tenets of radiology practices, Covid has been turning over many assumptions about our work. Now that we have a situation where physical presence in the hospital can jeopardize radiologist safety, radiology groups have been decreasing their in-hospital staffing. However, potentially reducing staffing can increase patient barriers to quality care. So this begs the question, how are radiologists replacing physical presence in the radiology department without jeopardizing care? I am going to talk about how many groups are going about this process. Then, let’s discuss the reasons why some radiologists will always still need to remain on-site. Finally, we will use a crystal ball and decide where this is all heading.

Ways Radiologists Are Decreasing Physical Presence Without Jeopardizing Care

Less Physical Patient Facetime And More Apple Facetime!

Interventionalists and mammographers, if they haven’t already, will followup patients without an on-site visit. We see even more utilization of online communications via Zoom, Google Meet, Facetime, and whatever other technology rears its head. It also enables radiologists to maintain efficiency and have office hours between reading films at home.

Increased Ordering Of Hands-off Testing

We are noticing an increase in those tests that do not involve a radiologist presence. For instance, if a mammographer cannot be on the site to see patients, instead of a hands-on ultrasound for a positive mammographic finding, he may recommend a breast MRI. Or, radiologists will be more apt to followup findings when they may have suggested a physical procedure such as a biopsy in the past. All these changes are presently occurring below the surface, but they are happening.

Replacing In-Person Interaction With Referring Clinicians

Since the advent of PACS, most radiologists have already noticed a steady decline in direct physical interactions with their clinicians. Surgeons and internal medicine physicians come down much less frequently to review films than ever. And, today’s pandemic is further catalyzing this change. We are seeing even fewer of our colleagues and having more phone interactions than ever before. Even extracurricular activities with our fellow physicians are decreasing. Hospital meetings are becoming online.

More Tech Issues Resolved Remotely

Many radiologists are increasing the physical barriers between the technologist and the radiologist. In the past, radiologists would often ask a question from their technologist, and she would stop by. No longer. Radiologists are tackling these same issues with a phone call or a text. It has become less feasible to have that direct physical technologist interaction.

More Remote Teaching For Residents

And, finally, training is not immune to the Covid world. Already, online seminars have replaced in-house lectures at most training programs throughout the country.  And, I would not expect that to go back to the traditional in-person norm entirely. It becomes more accessible than ever before to teach from a remote site.

So, What’s Left For The Radiologist To Do At The Hospital?

Alright, even with all these factors allowing radiologists to practice off-site, some radiologists must remain as a physical presence in the hospital. Of course, some procedures will always involve a human being. Administration of radioactive treatments, interventional procedures, and emergency coverage for contrast injections will continue to require a radiologist on-site. But, compared to all the roles a radiologist can perform off-site, it is indeed limited. Don’t expect to see as many radiologists sticking around the treatment facilities as they did before. Many practices have reduced their on-site staffing by as much as 30-70% during this crisis.

How Will Radiologist’s Presence At The Hospital Ultimately Evolve?

Many changes are currently in motion, making it even easier to perform more activities outside the confines of a typical hospital or imaging center without jeopardizing care. And, facetime, ordering preference changes, and other remote capabilities are some ways that radiologists have been decreasing physical presence at primary sites. In time, we may begin to see some return of radiologists back to the hospital as the risks to radiologists dwindle. Nevertheless, don’t expect radiologists to return to the same complement on-site after the dust settles as the tools for remote patient care have developed. When culture changes, even temporarily, some of it always sticks. Radiologists are by no means immune!

 

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Considering An MBA: When Is The Right Time?

MBA

Recently, one of my residents asked an excellent question about both whether to pursue an MBA and the timing of getting one. And, I have a sneaking suspicion that many other radiology residents and radiologists have been taking an interest in starting MBAs with all that has been happening in healthcare lately. So, let’s talk about how and why an MBA can be useful. And, then we’ll talk a bit about the timing and the advantages/disadvantages of each.

Why Get An MBA?

First of all, how can an MBA help a radiologist’s career? Well, if you think about it, radiologists have so many years of training (counting college, we are talking typically 14 years of post-high school education)! But, in the entire 14 years of schooling, many radiologists have not had a lick of financial or management training whatsoever. Hell, I know of a few radiologists that can barely balance their budget! Additionally, many of these folks aspire to practice outside the typical clinical confines of radiology. Some may want to take up hospital or practice administration.

Then, when you look you check out the literature on those hospitals that are most successful, you will find that physicians typically run these health care enterprises. So, an MBA may be of great benefit to those of you who want to take this pathway. Take a look at these links supporting these claims here:

https://www.kevinmd.com/blog/2018/08/5-reasons-you-should-put-physicians-in-charge-of-hospitals.html 
https://hbr.org/2016/12/why-the-best-hospitals-are-managed-by-doctors

So, if you want to run a tight ship and get into hospital administration, you, as a radiologist or radiologist-in-training, are well-positioned to be successful with the right financial/management education. And, for those of you in this boat, an MBA can make a lot of sense. Just make sure that you are doing it for the right reasons. At some point, the current pandemic will end, and we will return to a state of more normalcy. Don’t make your decision to choose an MBA only on the current poor radiologist job market!

MBA Before, During, Or After Fellowship?

So, all of this talk begs the question, when should you get an MBA? This part of the equation is a bit harder to answer, but I will give you my thoughts about the advantages/disadvantages of each.

Before Fellowship?

I like to consider this pathway, the path of least resistance. By far, logistically speaking, it is the easiest route to take. You are already training in medical school, and many programs offer MD/MBA pathways during their stay. What’s another year of education when you are already paying for your training, right?

However, I have witnessed many residents having pursued this extra degree before entering our program. And, a good chunk of these folks has no interest in utilizing their education toward the goal of healthcare management and practice finance. Although some may take a few nuggets from their MBA training with them into practice, the return on investment can be small.  Why? Because they never created an action plan on how to use this degree.  An MBA is only worth the time and money if you know what to do with it. And, herein lies the most significant disadvantage of completing an MBA early on in your training.

Instead Of A Fellowship

Out of all the ways you can complete an MBA, this pathway is the rarest. And I don’t know any radiologists in my program who have completed an MBA instead of a fellowship. For most of you, it is a difficult time to complete an MBA. First of all, your accumulated debt upon graduating residency often feels like a gazillion dollars. Then, of course, most of you are ready to embark on your career as a radiologist after all the training that you have completed.

In terms of timing, if you did not have to worry about money or the time it takes to complete while having to pay loans, it may make some sense. By this point, you have a better idea of your career goals. And, you can better focus on the goals that you want to achieve when you complete your MBA. However, many of you, by this time, still have not had the working experience to utilize your MBA teachings fully.

After Fellowship

Finally, in terms of convenience, completing an MBA while working is probably the most disruptive. Now, many of you have families and lifestyles that are less conducive to completing another degree. But there are courses and university programs that are willing to work within the confines of your life. These programs are often called executive MBAs and allow you to finish the degree while working. I know of several radiologists that have taken this pathway. Of course, you can also opt for a more traditional 2-year degree.

For those of you that complete an MBA after your fellowship, you most likely have a laser-focused reason for completing an MBA. Maybe, you know that the leadership of your practice may need a new change and wants someone with business experience. Or, perhaps you want to begin working for hospital administration at an available position. At this point, an MBA is usually the most meaningful since you most likely have a targeted application for the degree.

Considering A Business Degree? Taking It All Into Consideration

Well, for those of you mulling the MBA route, all this information is a lot to think about. But think of the MBA as a tool. If you utilize your degree for the right reasons, it can pay off “big-time.” It will allow you to pursue your selected area and have the knowledge to do so. On the other hand, a poorly thought out mission to complete this degree can lead to becoming cash poor with little to show for it. So, be careful choosing this pathway and when you decide to pursue this degree. And, don’t let the Covid pandemic be your only guide!

 

 

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What’s In The Cards For The New Radiologist Job Market After Covid?

radiology job market

In such a short time, a matter of weeks, the tenor of the radiologist job market has changed dramatically. Jobs in radiology were bountiful up until the beginning of March. Then, suddenly, elective procedures trickled down to almost nothing. And, practices began to fire their locum’s workers and furlough many part-time and full-time employees. But, this status will eventually end. And, the radiology job market will change and then establish a new baseline. But, what will that new baseline be? Can new graduates look forward to a booming job market once again? Well, let me give you a summary of what I think will happen as Covid-19 begins to wind down.

From Now To Three Months From Now

As we see a slight ramp up in elective studies, we will not yet see a brisk demand for radiologists. We will still have significantly fewer procedures, as many folks do not want to go to an imaging center for fear of contagion. However, many “elective” interventions, such as colon surgery for previously detected masses on colonoscopy, will need to begin again. But, don’t count on seeing many practices hiring just yet. Most practices will be more than adequately staffed during this time for the number of studies. Hiring freezes will remain.

Remember. You will continue to see advertisements for radiologists, but practices paid for these previous to the pandemic. These advertisements do not represent the current state of the job market!

Up To A Year From Now

Here, I will have to make a few more assumptions. But, I will postulate that a widely available vaccine is not yet available. And, I will conjecture that we have more widespread antibody testing (unlike now). Based on these premises, we will see more folks willing to come out to get their studies, especially those that tested positive for the antibody. However, fear will still prevent a lot of patients from getting the elective imaging that they want as not everyone will feel comfortable returning to hospitals and imaging centers. So, the patient load will not be back to the baseline. And, many practices will still be overstaffed based on the pre-Covid demand.  Therefore, new hires will have fewer job choices with lower salaries. Prospective new hires will face a tight job market.

The New Baseline Post- Covid Era Radiologist Job Market

The further you go out, of course, my predictions will become less accurate. And, we will assume that Covid infections go away from vaccinations and herd immunity. But, having seen other cycles, I believe that we will see several changes from the pre-Covid world. First of all, many patients will likely still be reluctant to return to imaging. Why? Unemployment will be much higher than what it once was before the pandemic.

Additionally, we will see a cultural shift of less imaging than before the crisis. Patients will more likely demand higher standards for cleanliness and sterilization. And, therefore, we may see fewer radiology procedures than in the pre-Covid world.

Also, many practices will have augmented their home teleradiology capabilities. So, reading efficiency will have increased dramatically.

Then, to add insult to injury, private equity firms and corporate radiology have become more significant players in the radiology space. These firms, formerly offering enticing salaries to new graduates, will now significantly lower the wages of new hires. Furthermore, we will see a decline in the salary of the contracts of the old hires since these firms renew these contracts on an annual basis. Why will this happen? Because profits rule their bottom line, and corporate radiology can cut with impunity. Corporate radiology will work radiologists to maximal efficiency, skimming any gains that they can from their radiologists. They will have no incentive to hire.

Finally, if we assume that the stock market remains lower than it was before March 2020, many prospective retirees will not retire. Why pack it in when your portfolio remains much less than what you planned at the time of retirement?

Between all these significant factors, the radiologist job market will not return to the pre-Covid era baseline. Instead, the market will most likely be more similar to the world five to ten years ago when good jobs were harder to come by.

What Are The Chances That I Am Wrong?

Of course, I can be wrong. However, I see the winds of change ahead based on what has happened in previous cycles. So, for those folks that are graduating soon, don’t expect the same radiology job market as the recent past. You will most likely have to work much harder to get the same position at a lower wage.

So my recommendations for you, as for years prior, take your training and residency seriously.  Be competitive. Step out of your comfort zone. Aggressively take charge of your education to become well versed in all areas of radiology. And, finally, expect to practice in locations and subspecialties that are not your primary area of interest. Although not for forever, we will see a return to a world more similar to the previous down cycle of the radiology job market. For those of you soon to find jobs, prepare accordingly!

 

tomatoes

 

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Danger Of Using Case Studies To Dictate Imaging Policy: The Initial Covid-19 Study

case studies

Rumors abounded at the beginning of March 2020 about Covid-19. And, no one quite knew how Covid-19 would play out. All sorts of physicians were on edge to try to figure out what to do. But then a new case study about the role of CT scan arrived at the scene. And, clinicians began to read or hear about this “seminal paper” in Radiology that came out from China, called Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. This paper claimed a high sensitivity for the detection of the diagnosis coronavirus compared to PCR. Admitting physicians quoted it and demanded to get CT scans on their patients with presumed Covid-19. ER doctors were ordering Chest CT scans left and right.

What happened next? The throughput of patients slowed down to a crawl because the CT scanner needed special cleaning for potential Covid-19 contamination. Subsequently, this thorough cleaning delayed the treatment of patients. And, the CT scanner was out of commission for other patients that needed the CT scan for emergency workups.

Was it the right to use this paper to dictate the workup of patients? In hindsight, no. And, it brings up an all too common issue, the usage of case studies to dictate health care policy. So, what are the other factors that we need to evaluate before we decide to take a paper and apply it to patient care? Well, I will use this incident as a way to show you what you need to think about before using case studies to guide patient imaging. Let’s divide it into the following categories: practicality, throughput, exposure, and change in management.

Practicality- It’s Not All About Sensitivity Or Specificity

I don’t know about you. But, whenever I hear a test is highly sensitive or specific for a disease entity, I get excited. My first thought is usually, maybe we can use this exam to diagnosis patients? However, before arriving at that conclusion, we need to take a step back. Does the test make sense in the context of patients coming into the emergency department? Many clinicians did not think about these issues when they decided to utilize a CT scan to image presumptive Covid-19 patients. Just because you can make a diagnosis does not mean that you should complete a test.

Throughput is Important

A test is only useful when it can rapidly diagnose patients. In the case of CT scans for the diagnosis of Covid-19 patients, regardless of any other factor, our throughput for patient care significantly slowed down. And, this had a dramatic effect upon the patients that came into the Emergency Department for many other reasons. Always, physicians need to take this factor into account before jumping into ordering a test.

Exposure To Health Care Workers And Patients

We need to take care of all the folks that are providing services for the sick and infirm. If we do not perform this duty, we will have no health care workers to treat patients. In this situation, deep cleaning the CT scanner after each patient added undue risk to the technologists and nurses that completed these functions. Not to mention, you are also increasing the possibility of exposure to the next patient in the CT scanner. The upshot was a tremendous cost to the patients and employees.

Does It Change Management?

And, then finally, the most critical question that we need to ask ourselves is how does the test change management? In the case of Covid-19, a negative test did not preclude the possibility of the disease. So, regardless of the test outcome, the clinicians would need to use their clinical intuition to decide if they need to ventilate the patient or other invasive measures. Moreover, the treatment of the patient would remain the same, whether the CT was positive or negative. Why submit a patient to such a test?

Beware The Dangers of Using Small Case Studies To Dictate Policy!

We all need to take a step back when we hear the claims of physicians that we should be imaging a patient based on a paper. Instead, you should be answering the following questions: Is it practical? Will it prevent other patients from receiving appropriate testing? Will it endanger my staff and patients? And, does it change the management of the patient’s case? If the case studies can pass these tests, consider using it as a tool. If not, beware of imaging the patient based on a paper, the test may do more harm than good!

 

 

 

 

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Coronavirus: A Clarion Call For Universal Home Teleradiology

coronavirus

OK. By now, you are probably somewhat sick of hearing about the coronavirus. But, the illness certainly brings up specific issues in radiology that should rise to the forefront. As a microcosm, within my practice, we are intensely discussing preparations for the coronavirus storm that has begun. Will the next patient be a coronavirus victim, and will she expose our radiologists? What will happen if some of our radiologists become sick and cannot perform our duties? Can we provide the services that our customers and the hospital expect?

Without definitive guidance on what to do next, we are currently debating the appropriate responses. But one thing is clear. In this environment, we need to have the ability to read cases from home. Teleradiology from home is no longer a luxury but rather a necessity.

Hospitals, residencies, and practices that do not provide teleradiology are at risk of giving poor health care to their patients. Therefore it is the responsibility of hospitals and large imaging centers to supply the resources necessary expeditiously for remote reading. And, we have discovered that teleradiology in an emergency helps the most to decrease exposure, increase radiologist efficiency, and increase the flexibility of the radiologist workforce. So, let’s talk about these issues specifically.

Reducing Radiologist Exposure

Sure, we will need to have someone on the premises to perform specific responsibilities like interventional treatments, radioactive iodine administrations, etc. However, do we need all our radiologists to be present? Probably not. Why increase the risks to employees and physicians when you can mitigate exposure to the coronavirus? In the case of coronavirus, you want to protect the elderly radiologists and those families with babies or the infirm elderly at home. The ability to perform teleradiology decreases the number of staff members on the frontline, especially those at most risk. Thereby, you will have fewer radiologists and families affected by the virus. And, it is not necessarily just the coronavirus. The same goes for any pandemic. Do you really need to increase the number of infected hospital workers/radiologists?

Increases Radiologist Efficiency

One of the side effects of a pandemic is a potentially large amount of patients that need imaging. How do you provide these services with a fixed number of radiologists available? Well, for one, teleradiology enables a group to increase the capacity of imaging reads throughout a system. It becomes easier to read additional studies when the need arises. With a workstation at home, you can pick up a case at almost any time to help out when needed. And, one never knows when the flood of imaging for a disease will start. A hospital nightmare scenario would be to have a large number of patients storming the emergency department without the capability to increase the number of reads during an emergency!

Increases Flexibility of The Workforce

When an epidemic strikes, some of the healthcare workers will inevitably become ill. And, radiologists are not immune. Especially with a disease like a coronavirus, most infected workers will have very mild symptoms. Why would you want to take them out of the workforce when they can read from home and help with the overwhelming increased burden of patients in the system. For others, it allows those with babies or school-age children at home to contribute as well. The last thing that the hospital needs is a shortage of radiologists during a time of need. Hospitals should be encouraging all able bodies to participate in a fully staffed department. Home teleradiology enables efficiency.

Coronavirus: A Call To Teleradiology Action

Sometimes you need a wake-up call to get you going. And, the coronavirus is doing just that. For practices without home teleradiology services (like ours), we need to mitigate exposure, increase efficiency, and augment flexibility for the best patient care. And, this pandemic has demanded that the hospital should be focusing their resources, so that home teleradiology is available to their radiologists. It’s the right thing to do.

 

 

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Technologists Can Make Or Break You: Three Sample Cases

technologists

Here is the real world: Technologists sometimes forget to report on or miss findings. Other times, they may perform a new protocol without checking it with a radiologist. And, this is just the tip of the iceberg. All sorts of technologist mistakes and judgment errors can happen that can affect our interpretations. And since most of us rely on them so heavily, these errors can make our jobs just a bit more complicated.

Why do these errors happen? Well, technologists are human. In some cases, just like some physicians, a few technologists want to do the least amount of work possible. But, that is the minority. More commonly, they may be exhausted from a tough night. Or, perhaps, it’s just an erroneous judgment call. The bottom line is that their work can be very subjective. And any of these errant cases can ruin your day (and the patient’s too!) if you miss the opportunity to correct it. It’s why we need to check and double-check. Recently, I had some cases that reminded me of the fallibility of the technologist. So, I am discussing them to reinforce my point: don’t accept all the information provided by a technologist at face value!

A New Fibroid In a 65-year Old

For those of you that have completed an ultrasound rotation, you probably have learned about the subjective nature of finding uterine fibroids. Some technologists need to see a very well-defined mass before calling them. And, others will measure almost anything with a slightly different echotexture.  Nevertheless, standards can vary widely. (One of the reasons it is better to have the same technologist to perform case after case)

So, in my situation, I had recently reported on a small intramural uterine mass that was not there in the prior study three years earlier.  And, I could not define a lesion in the previous study based on the images provided. So, I called it a “new” intramural uterine mass, most likely a fibroid. This time around, I received a phone call from an irate physician, saying that it is impossible to have a new fibroid crop up in a post-menopausal female. (Although not true) And for this reason, she said she was ready to take out the uterus.

Meanwhile, I had to calm her down by saying that the most common cause for a new lesion in the uterus is technical subjectivity. (Unless there was other clinical information that I was not aware of) Although, of course, weird lesions like leiomyosarcomas can occur. However, they are rare. And, it would be clinically appropriate to monitor the uterus for any significant changes closely. The clinician finally backed down. Who knew that an errant fibroid could cause such a problem? Just another example of how “minor” differences in the subjectivity of ultrasound technologists can have considerable ramifications!

A New Intussception- Get The Pediatric Surgeon Down Now!

A few weeks ago,  as I was packing my bags to leave at 10:01 pm as my shift had just ended, one of my residents runs into the reading room.  He yells, “Don’t leave! We have to reduce an intussception.”

So, I looked at the initial ultrasound images, and I saw bowel loops containing echogenic material. But, there was no significant bowel wall thickening or abnormal flow. It was almost a target sign, but it did not look quite right. Moreover, the technologist did not provide any real-time images to support her claim.

Therefore, like any half-way decent radiologist, I went back and looked at the priors. So, I checked a previous abdominal series performed right before the ultrasound. In it, you can see dense inspissated oral contrast through the colon, especially filling the entire cecum and a good majority of the large bowel. Well, there was my explanation for the appearance of hyperechoic material within the intestine on an ultrasound, not an intussception. Just because a technologist makes a diagnosis, doesn’t mean it is correct. Use all the information at hand!

New MRI Sequence Withdrawn

Finally, a while back, one day, we performed a brain MRI  to follow a patient with multiple sclerosis. And, the technologist called me after the patient had left, stating that they have a new protocol for multiple sclerosis patients, handed down from the administration. No one consulted me about this until this point. So, I look at the case, and I see that the typical most sensitive sequence for detecting plaques, the FLAIR sequence, is entirely missing. Additionally, I have no means to compare this study with his priors that had this same sequence. So, how can I say if the case is better, worse, or unchanged?

I consulted with my neuroradiologist colleague to confer about this situation because it didn’t make any sense. He agreed the patient needed to return and didn’t understand why the protocol was changed. Yet, the change in protocol forced a busy patient to return for additional imaging, wasting everyone’s time. A little bit of communication upfront could have resolved the situation. As you can see, protocol tweaks without communicating the change to the reading radiologist can have negative consequences!

Check And Double-Check- Technologists Can Make Or Break You!

Now, my primary goal is not to berate technologists. Instead, these examples show you that it is mission-critical to check and double-check their work, just like they should do the same for us. One wrong technical misstep can derail our ability to interpret images or provide quality patient care. Therefore, we need to catch them as best we can. We are all on the same team. So, remember that technologists, like radiologists, are fallible. Keep your eyes wide open and your head in the game!

 

 

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So, You Want To Become A Radiology Chair?

radiology chair

Maybe, you are ambitious and want to head a department. Or perhaps, your parents have high hopes for you and want you to become the boss. Although you think you may know, you probably have no idea about what goes into the radiology chair role. I know I didn’t until I started to practice. And, it can be challenging to find the truth about the job description (because they have too much bias!). So, what better venue than this blog to give you an accurate depiction of the position?

Of course, how much work you want to put into becoming a Radiology Chair is up to you. But, what does it entail to play the role of the Chair and do it well? And, is it worth the extra effort? First, I will discuss some of the personality traits that may be beneficial for the job. Then, let’s talk about the work, struggles, and benefits that you will need to think about before you start the process of working toward this goal. If you dare, go into this job pathway with your eyes wide open!

Personality Requirements For The Radiology Chair

Politically Savvy

Why is it critical to have a knack for politics? Well, invariably, there will be political factions that will push you towards different ends. And, you need to be strong enough to move the ship in a direction that is just and right for the practice. Therefore, you will need to deal with all sorts of personalities and points of view well.

Not Take All Criticisms To Heart

As a Chair, you will hear and field mostly complaints from colleagues, staff, and hospital administration. Very rarely, do folks get a compliment on a job well done. (Even if you are doing so!) So, you will need to let the upsetting criticisms slide off your back. Do not take it to heart. Or else, you will become a depressed and bitter radiologist!

Good Communicator

You need to let all parties know what you are doing with an open hand. One ingredient that gets employees more upset than anything else: finding out changes after the Chair has implemented them. Or, not letting anyone know about your intentions. Poor communication is a recipe for disaster in practice.

Strong Decision Maker

And, finally, this position entails making some hard choices that you will have to live with for the rest of your life. You will need to hire, fire, budget, and strategize. I would recommend that you have a strong stomach to make these decisions. Rarely, can you make everyone happy with all the decisions you make.

Job Requirements

Hiring and Firing

First of all, you will have the honor and privilege of hiring new employees. Not so bad, huh? But, that also comes with the painful task of firing ones that are not working out. If you have never experienced such a job, let me tell you, from my experience as a partner, that is certainly not fun. And, the Chair tends to be the leading player in this activity.

Fielding All Complaints- Radiologists And Other

Any practice of substantial size will receive complaints. And, if you are not getting them, you are probably not reading enough films to sustain a business. But with the territory of Radiology Chair comes fielding those complaints. And these can be from your practice, staff, hospital administration, or other clinicians. You will soon discover that many folks are not happy. And you have to deal with it all!

Attending Tons Of Meetings

If you like meetings, the chairman position is the job for you. Between partnership meetings, hospital staff meetings, galas, and more, you will soon become all too familiar with gatherings. You better have some tolerance for this activity!

Paperwork and Budgetary

As the head of a department, your signature needs to go onto lots of documents. It’s not official unless your name is on it. Moreover, you need to read those papers. Indeed, you don’t want your name going out on something you or your practice does not want.

Future Planning/Strategic Management- Mergers, Acquisitions, Contracts, Etc.

OK. I think that this part of the job is not so bad. Who doesn’t like planning the direction of your business? I believe it is the responsibility of all partners. But, the Chair should take a particular interest in these activities. They need to lead the business to better places!

Political Representation For Department- Parties, Etc.

The Radiology Chair is the figurehead of the practice. Think of the position as the President of the United States. If you don’t go to the hospital gala, who else will? And if you don’t show up on time for your work, everyone else will arrive late as well. Whatever you do makes a statement for better or worse.

Negotiations- Insurance and Other

Every hospital and private practice has times when you need to arbitrate to accomplish the goals of your department. Perhaps, you need to negotiate a salary or an insurance rate. Or, you need to get that great new CT scanner for the department. Regardless, you will be in charge of this process. Learn how to bargain with your peers!

Legal

Finally, your name will appear on lawsuits that strike the partners and employees. Since you are representative of the practice, there is a better chance that you will have to show up in court to defend the group’s position. Be prepared for this eventuality.

Advantages To The Role Of Radiology Chair

More Admin Time

Well, now you finally have what you want. You’ve got some more administrative time. Unfortunately, you will dedicate that time for all of those new responsibilities listed above (and probably a few more!). But, you may have a little bit more flexibility with your schedule. (If you are lucky!)

? Increased Pay

In some departments, the Chair makes a substantial amount more than her colleagues (especially in academics or massive private practices). For others, it does not move the needle that much. Regardless, there is usually some monetary bonus to being a chairman

? Respect

If you do an excellent job as a Radiology Chair, your colleagues and work alliances will respect you more. You will become a highly trusted member of the hospital and physician community. On the other hand, beware of becoming a poorly performing chair. You will have the active hostility of all!

Disadvantages

Time Away From Family

All these additional roles do not come without a price. You will most likely need to spend more time with your colleagues than with your family. It’s just the nature of the job.

Meeting After Meeting

The chairman’s role necessitates numerous meetings. To maintain communication with all parts of the practice, it becomes a necessary evil. The worst of the meetings are about when to decide the next meeting!

Less Clinical Time

The more you spend on administration, the less you spend on clinical work, That is just the nature of the beast. For some folks, this may seem enticing. And for others, not so much. In either case, know what you are getting into before you take this path!

Radiology Chair- Is It A Job Or A Lifestyle?

So there you have it. As you can see, becoming a chairman is not a road to a passive job with passive income. Instead, you most likely will work harder than you ever did before (unless you don’t care and want to do a bad job!) But, at the same time, it can come with a few rewards and prestige if approached in the right way. Just think about all the possibilities if you take this path. And, as I said at the beginning, go into this role with your eyes wide open!

 

 

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Radiology Sign On Bonuses: A Marker Of An Imploding Practice Or A Booming Market?

sign on bonuses

Nowadays, checking out any of the job websites or even the ACR career center, it’s like window shopping at a candy store. So many great opportunities. High salaries, suitable locations, and even sign-on bonuses. But, are these jobs with sign-on bonuses all that they are cracked up to be? I mean, how bad can it be, begin with an extra twenty grand before you have even started to work! Well, of course, there is more to the sign-on bonus than what you would realize at first glance. So, let’s go through some of the conditions and circumstances for that first sign-on bonus. And, let me even disappoint you some more when you find out the strings that may be attached!

The Clawback

First and foremost, when you sign on to that job with the bonus, take a look at the fine print. Often, the money will come with the assumption that you will be working there for a certain amount of time. It could be one, two, three years, or more. And, the firm will have the right to take a portion or all of it back if you have not met all the specified conditions.

Look At The Specifics

Sometimes, this signing bonus can be not exactly what you think you are signing up for. Take a look at all the stipulations. It could depend on the number of films that you have read. Or, the practice may only release the money on the condition that you have read mammograms or another specialty that does not interest you. Again, the devil is in the details!

Issues With The Practice Itself

Then, you need to ask yourself, why is the practice offering this extra money? Can’t this imaging center find great people because they are a known entity in town where all the radiologists want to work? Take a second look if they are offering you a bonus. Sometimes these entities provide these excellent bonuses because they can’t retain their employees currently. Is this “gift” just an act of desperation to find a warm body to read the films? Well, maybe yes or maybe no!

Market-Related Factors

And then finally, the most likely reason for sign-on bonuses, the market itself. Is the demand for radiologists at the moment so competitive that it forces them to compete with additional incentives? Is the location not that desirable? Is there truly a severe shortage of radiologists that they would have to make such an offer? Any or all these reasons may be at play. A practice can be an excellent place to work. But, market forces can sometimes create a situation for you to gain from their loss. And, for the end of 2019, these situations are all too common.

My Final Two Cents (A Bit Less Than Some Sign-On Bonuses!)

Really, the case for a sign-on bonus depends on many circumstances, some practice-related and others that rely wholly on the market. In any case, make sure to look at the fine print before you “sign-on” to a job with a sign-on bonus. It may not be what you had initially thought!

 

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Can Trauma Radiology Help You In Your Career?

trauma radiology

I have to admit. When I was a radiology resident, I used to dread the “traumaramas” that would arrive at our level one trauma center in Rhode Island. Because of our unique location, we would receive tons of vehicle accidents. And motorcycle accidents were the worst. Limbs would hang on by a thread. Road burns, covering more than half the body, shearing off half of the patient’s skin. And, horrible head injuries would be part of the norm (especially in those riders without a helmet!). Subsequently, we would image almost every body part imaginable! Squadrons of surgeons and surgical residents would stop by to check the films. Trauma radiology was an enormous time drain.

In the past, I did talk about trauma radiology a bit (check out How Important Is Level One Trauma To My Radiology Training?).  But, recently, with our residency merger marching onward and new potential opportunities for our residents to rotate through trauma at other sites, I began thinking again about the highlights and pitfalls of a trauma rotation again from a new perspective. Did all this extreme level I trauma help me to become a better radiologist? What about it do I still utilize today? And, most importantly, the question that you would be afraid to ask… what about the experience may not add anything at all to your radiology training experiences? These are some of the issues that I will tackle (like a 400-pound linebacker!)

The Good

Organizational Skills

First and foremost, since you have these trauma patients that come in with a gazillion injuries and bazillion imaging studies, you have to keep your wits about you. You cannot afford to forget about any of the search patterns you have learned and miss any of the studies that the ED performs. Of course, if you do, Murphy’s law says that it will be the one with the critical findings!

Having a trauma rotation forces you to keep your priorities straight and organize your work. And, it’s critical for getting through the night. But, these same skills will aid you immensely when you start your first radiology job.

Working Under Pressure

Pressure creates diamonds. Sometimes we all new need a bit of pressure to be at our best. Unfortunately, our work is not all beds of roses and teddy bears. We need to think on our feet and give appropriate advice. And, that also applies to the real world. Doctors expect their reports on time without mistakes. And patients want excellent patient care. Working in an active trauma rotation allows you to build these critical skills that will find you in good stead later on.

Trauma Findings

And then, of course, you will not look at studies the same way after completing a trauma rotation. Instead, you will read every image with an eye toward trauma. Liver lacerations, bowel injury, renal pedicle avulsions, and more will become part of your search pattern for all-time. In the real world, sometimes, but not often, we still see the same trauma that you will learn about during your residency.

Just as critically, it can help to prepare you for the boards. If you have seen a bit of trauma, it that much less you need to study. You have lived it!

The Not So Good

Trauma- Can Be Overly Repetitive

I’ve mentioned it before in my other blog on the topic, but I will re-emphasize again. Trauma radiology is a bit more repetitive than other areas in radiology. The patterns remain the same with a more limited repertoire of findings. There is only so much that we need to enhance our skills.

Learning Checklist Radiology- Not So Great!

I hate cookbook medicine. And, unfortunately, trauma radiology can be the epitome of the proverbial cookbook. Emergency doctors and surgeons expect particular views and types of studies for every given trauma patient and situation. And, we need to oblige as their radiologist. They will assume that we do things their way, whether required or not. It is just part of the trauma formula. I like a bit more flexibility!

The Hours

For multiple reasons, traumas tend to roll in late at night when you are at your peak of exhaustion. Additionally, they tend to occur all at once. It’s just a fact. So, you will have to power through the tough nights when you will not get an ounce of shuteye (Not that you were getting any on other call rotations anyway!)

Trauma Radiology- The Final Verdict

Learning trauma radiology is critical for the boards. And though it may or may not be central to your practice of radiology, and can drain you at times, it can reinforce some good habits that you need to become an excellent radiologist. Whether it is organizational skills, working in tough situations, or knowing the critical elements of trauma, these are some of the skills that you will need later on in your career. So, take it all in stride!

 

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How To Be Happy In Your Radiology Career: Internalize Rewards!

internalize rewards

If you were to ask me about the most critical part of my radiology residency and practice experience, my answer would not be what you might think. Yes, the medical knowledge that I learned was important. And, the communication skills I obtained were invaluable as well. But, those experiences are not to which I am referring. Even perhaps more significant than anything else, I learned the ability to internalize rewards from the practice of radiology.

What do I mean by this? For me, the most significant rewards of practice don’t come from the administration or my colleagues’ lathering praise onto my work. And, it does not come from a massive monetary bonus. (although it can’t hurt!) Instead, I do what I do because I take an interest in the science, art, and practice of radiology. And I derive joy from giving patients quality care.

For new folks coming out, this may not make much sense. Programs have given them evaluations and recommendations, giving them tons of external feedback. And, they continue to thrive on words from others. Additionally, they hear about more significant attending radiology salaries and look forward to getting their own. But that is all fluff. Only when you can internalize the rewards of practice, you will find happiness in your career.

Why Do I Mention All This?

Many new graduates (but not all) expect the applause of others to continue in their job, whether it be your bosses, colleagues, or patients. And then, one day, a clinician criticizes your work, or your colleagues say you are missing findings. Or, maybe at the beginning, you didn’t quite receive the salary you may have initially expected. Then, at the drop of a hat, you want to pack it all in and then quit. Why is that? Well, I believe part of it has to do with the inability to internalize rewards, expecting all the rewards to come from others. And, I have a few theories for this issue! Let’s call them the Millenial Mentality, too much feedback, and lack of experience/grit. I will go into each of them individually.

Causes For Inability To Internalize Rewards

Millennial Mentality

I am sure I will get blowback from this one. But, I think there are unique parenting differences between the millennial generation and the ones before. Of course, these differences don’t apply to all of the parents of the Millenials.

One of the most significant differences is the overemphasis on the reward rather than the process. You can see that represented by all the trophies that children receive for just participating in an activity. Nowadays everybody gets a prize. It never used to be like that. Only the best or the winner would receive the reward. So, if you came in fourth place, you wouldn’t get a badge of honor. And, you had to learn to deal with losing. Learning sometimes to lose enables kids to learn to love to emphasize the competition (or the process) and not the reward (the trophy).

Let’s now fast forward years ahead to your first job. No longer are you receiving the reward, the adulation of your faculty colleagues or the feedback you were expecting? It’s not what you are accustomed to. And, it becomes much harder to appreciate the work that you do.

Too Much External Feedback

Residencies nowadays are on feedback overload. Between milestones and monthly evaluations from attendings and colleagues, semi-annual assessments by the program director, and daily feedback from your faculty, it doesn’t end. And, this was just the tip of the iceberg. Formerly you would receive tons of forced feedback in medical school and college as well in the form of tests and evaluations. And, this is what graduates continue to expect.

However, this is not the way most practices and businesses work. You cannot expect to receive constant attention from your bosses. They may be very busy and have to attend to lots of other issues. Now, this is not to say that you can’t expect some feedback. However, it can make a new radiologist very uncomfortable when all this feedback suddenly stops at her first job.

Lack Of Experience/Grit

And, then finally, many new radiologists have never held a regular job before going to medical school. In truth, being a radiologist may be their first leap into the real world.  Yet, many times, it is only by experiencing the realities of an average job that many folks learn to appreciate the ups and downs of your career and let some of it roll off your back.

It’s those times that a customer yells at you for not getting their drinks on time. Or, the occasion that you had to deal with a fight between you and your manager. You learn to deal with these untidy situations. And, you apply them to your career. It allows you to brush off the criticism you may take and move on. You learn not to take everything to heart.

Internalizing Rewards: A Key To Success?

With all this baggage upon many new radiologists, it is possible to shed the luggage one by one. Be mindful of some of these learned behaviors and the historical context through which you have lived. And, don’t expect your colleagues, superiors, and employees to kowtow to your greatness. Learn to love what you do and not just the external trappings of success. You will be much more happy in your career!