Category: Resident Career

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Radiology Recruiters: The Good, The Bad, And The Ugly

radiology recruiters

Every once in a while, radiology residents and former radiology residents will ask if they should use radiology recruiters to search for jobs. And, if you glance at some forums (which will remain nameless!), radiology recruiters are labeled the epitome of evil. But, what is the real story behind radiology recruiters? Does it ever make sense to utilize their services? Or should you believe the hype online? Based on my own experience and the perceived experience of current and former radiology job seekers, I will give you the lowdown on the lowly radiology recruiter. By the time I finish, you will understand the good, the bad, and the ugly! (the Amazon affiliate link to the actual movie!)

The Good

Let’s start with the merits of a recruiter. For some with less job experience, recruiters can help improve the applicant’s overall package. What do I mean by that? They can provide services like interview practice, resume scrutinization, and general mentorship. For some, these services can be invaluable.

And then sometimes, these recruiters can provide insights to the applicant, such as contract negotiation tactics, legal help with contracts, and tips for the uninitiated. The recruiter can serve these individuals well if you don’t have the appropriate background to know some of the finer details of these job negotiation skills.

In some markets where the job seekers are scarce and applicants have lots of opportunities, some practices will utilize a recruiter to gain an edge. Rumor has it that those practices that use a recruiter are second-class. But, I don’t believe that is necessarily so. Sometimes, these practices may be smaller or do not have the connections with the local residency program as a feeder for positions. In these situations, recruiters can provide a valuable service to these lesser-known smaller practices, matching the appropriate applicant for the right job opportunity.

Finally, if the applicant is unfamiliar with an area or market, good recruiters can provide a good reference for the lay of the land. A good radiology recruiter will know a lot about the location and the market opportunities. Sometimes, searching for this information can be challenging to find on one’s own during the throes of residency or fellowship.

The Bad

The interests of the radiology recruiter and the applicant do not always align. What do I mean by that? A radiology recruiter can heavily advocate for an applicant to take a job that does not match his needs. If you think about who typically pays the recruiter (the practice), it almost always makes sense for the recruiter to push the job. Now, this can happen whether the job fits or not. To that end, an “honest” radiology recruiter may avoid this conflict of interest. But this is the real world, folks. And, not all recruiters follow the rules of nobility!

The Ugly

So, think about it. How are recruiters paid? Typically, most recruiters receive payment from a practice (a retainer) when they have placed a candidate successfully. And now, who do you think would be the preferred candidate, all things being equal, if you have two folks with precisely the same credentials, one using a recruiter and the other going it alone? Well, it’s pretty simple. The applicant without the recruiter will get the job. Why? It’s free for the practice to acquire the resident without the recruiter! This problem leads to the ultimate paradox of recruiting!

The Real Truth Behind Radiology Recruiters

Radiology recruiters can be a godsend for those applying to noncompetitive locations who are unaware of job opportunities or do not have honed business skills. On the other hand, recruiters can put you at a distinct disadvantage for those interested in more competitive locales with a bit more experience and those who know the opportunities and most of the practices in the neighborhood. So in these cases, I recommend you try to network or cold-call first.

As you can see, based on your situation, a recruiter may or may not be suitable for the applicant. Here’s the bottom line. Do your homework before looking for a recruiter. Radiology recruiters can be the reason for obtaining or losing your next job!

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Texting- A Minefield For The Radiologist

texting

Formerly as a student, you could get away with texting anything you wanted on your smartphone or computer. Unless you bullied your colleagues or significantly abused the technology, the consequences remained minimal. On the other hand, an “insignificant” text from a medical professional, including a medical student, radiology trainee, or radiologist, can lead to dire results. Between the potential for HIPAA violations, unforeseen job losses, and discoverability of texts for evidence in legal cases, poorly thought out texting can severely damage your career. So today, we will delve into the dark side of an important technology that we all use, the unencrypted electronic text/message. And, you will see why radiologists need to use this particular communication tool so carefully. We will go through five different situations in more detail.

Patient Information Texting Taboos

Sending patient information over an unencrypted text message can lead to a disaster. HIPAA has its tentacles everywhere. God forbid… If a third party discovers this message containing sensitive private patient information without authorization, the federal government can severely fine and even incarcerate you! And, we are not just talking about a few hundred dollars. Millions can be on the line! (1) Not only that, but the patient can sue you for breaching their confidentiality. It is a lose-lose-lose situation!

Sending The Wrong Information To The Wrong Person

Have you ever texted a friend only to realize that two seconds after clicking send, it went to the wrong person or group? I suspect a majority of you, at one point or another, have encountered this problem. Usually, it is something benign. But occasionally, it can damage your reputation. Imagine sending a text to a friend saying, “I find Harry annoying.” And instead, it travels to the head of the department, and Harry is her fiance. These damaging texts happen all the time. But no longer may you lose just a friend. Instead, you may also lose your job or damage your reputation.

Poorly Communicated Intentions

Did you notice that most texts come off abruptly without context or emotion? We often misinterpret information that we intend to communicate by text as an offensive slight to colleagues or ourselves. A simple, seemingly insignificant text message to a technologist such as why didn’t you complete the study? can be interpreted in many different ways. Think about it. The technologist recipient may think that you blame him for never finishing his studies. Or perhaps, he can interpret this message as the radiologist believes that the technologist has a personal vendetta, which is why he thinks the technologist does not want to complete studies. On the other hand, it may just mean what it says: you need to complete the study and nothing more. Simple oral communication would have translated the initial intention more accurately with the appropriate accompanying facial expression and emotion.

Helping Out The Dark Side

Did you know that any text you send is potentially discoverable evidence for a lawsuit? You text your colleague, “I missed the pulmonary nodule on patient MR#123456”. Now that the text is in cyberspace and on your friend’s phone. The lawyers can recover that text from the cloud or your friend’s phone if the patient decides to sue you. All bets are off whether that text will incriminate you in a court of law!

Unintended Slip-Ups

And then, there is the essential unintended slip-up. Perhaps, the word correction software on your iPhone changed a word to something more sinister. Think about it. We see it happening all the time. I’ve seen the shift in expression from “see to sex” or “person to pee.” And unknowingly, you send the message out to the program director. (He may not be as forgiving as me!) In the wrong context, especially with the recent spout of sexual harassment charges, that message containing these words can be devastating!

Beware The Simple Text

In the modern era, avoiding texting our friends, colleagues, and loved ones is next to impossible. And, I am not saying that we should never text each other. However, based on these hazards, we should proceed cautiously and read over every text we create many times. An ounce of caution today can prevent a lifetime of work trying to recover from a poorly thought-out text!

(1) https://www.truevault.com/blog/what-is-the-penalty-for-a-hipaa-violation.html

 

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Phone Etiquette For The Radiologist

phone etiquette

Back in the day, I remember my former program director/chairman at Rhode Island Hospital, Dr. John Cronan, lecturing on the basics of the business of radiology. (if you’re reading this, I bet you’re impressed that I remember!) He mentioned the three A’s of maintaining a good radiology practice: affability, availability, and acumen. And, after all these years, I still take this to heart. Good phone etiquette also fits into the equation of the three A’s. It is one of the keys to maintaining a quality practice to entice repeat customers, fellow referring physicians, and patients.

And the rules apply not just for standing phones at your practice but also for cell phones too (We are not living in the 1980s, folks!) With the tens of thousands of phone calls, you will receive over your lifetime, the concepts behind good phone etiquette remain the same. So, let’s go through each of these threads to guide you on how to approach the phone.

Availability

Let’s address the most controversial area first. How can we be available by phone most of the time when I create a post such as Should Radiologists Ignore the Phone? Well, it creates a conflict of interest. We do need to make sure that we concentrate on our films first and avoid errors. On the other hand, it does not mean that we should ignore the phone. So, how do we solve this dichotomy? If you are not actively reading films, always pick up the phone. And, if you cannot pick up the phone now, at least you can promptly return messages that you may receive from the secretary or your voicemails.

If a clinician can never get through to you, you know where their business will go- down the street to the other guy! So, allowing your clinician to contact you is of the utmost importance.

Affability

Affability implies more than picking up the phone and being friendly. It also means an air of professionalism. What do I mean by that? If you are picking up a phone in a particular location, let your caller know they have reached that specific destination. So, if you are in CT scan, you may say Your Hospital, CT scan, Dr. X speaking.

Like us, clinicians run short on time, and we must respect their demands. They may arrive on your line through an operator, unsure of their destination. Taking the time to announce exactly where and who you will go a long way to establishing a rapport between you and the referrer.

In addition, treat your referring physicians on the phone as if they were a friend, not just another burden of the day. Even if it is 4:55 PM and you are about to leave the department, don’t be curt on the phone. Our referrers are the lifeblood of a radiology practice, so creating a relationship between the radiologist and the clinician is crucial. In the end, we need to develop friendships, or else why should the clinician refer patients to you instead of his friendly radiologist down the street? (We live in competitive times!)

Acumen

Finally, just as you treat any consult, on-phone or in-person, we need to ensure that we do our best to solve our referrers’ questions. Be direct. Make sure to answer any questions that you can answer correctly off-the-cuff. And, if you don’t know the answer at the moment, you can always look up the information and get back to the clinician. It is our responsibility to help our fellow doctors. That is just part of our job.

It is also awe-inspiring when you can give a source or a paper to your referring physician documenting why you think your recommendation is correct. It goes a long way to show that you keep up with all the literature. Additionally, it makes it more likely your referrer will return the next time.

Final Thoughts About Phone Etiquette

Many radiologists may dismiss phone etiquette as an extraneous part of our practice that is not worth their time. But, I beg to differ. Instead, it is an essential part of an excellent radiology practice. It is how we connect with our referrers, make friends with our fellow physicians, and direct our clinicians to the next step, whether ordering the appropriate test or solving a diagnostic dilemma. So, make sure to follow the rules of the phone!

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Can Introverts And Extroverts Thrive In The Field Of Radiology?

introvert

Students and physicians compartmentalize the different medical subspecialties into different personality types. And from what I hear, stereotypical radiologists tend to be introverts (formal definition- shy, reticent people). But, do most of us radiologists prefer to be alone? And, can extroverts thrive in the radiology specialty? I will try to answer these questions and give you my thoughts about the personality of the folks in my field.

Are Most Radiologists Introverts?

Well, I believe that, on the whole, radiologists lean toward the introverted portion of the personality spectrum. I mean… Can many extroverts stand to sit in front of a computer for hours at a time culling through images and dictating reports? You need to spend a bit of time on your own in between interruptions. On the other hand, you probably know a few radiologists that are not wall-flowers. Most of the more extroverted radiologists gravitate toward the field of interventional radiology or mammography, fields with more frequent patient interactions. Additionally, many of these extroverts enjoy performing additional highly social responsibilities such as heads of medical staff, chairs of departments, or hospital administration. All these roles benefit from an extroverted, gregarious sort. But, these folks tend to be the minority.

Why Do Some Introverts Thrive In Radiology?

OK. So, the field lends itself to a more introverted personality. But why is it that introverts have the potential to thrive in radiology? Some of the noted qualities of introverts, such as paying sharp attention to detail and processing large amounts of data, are personality traits that allow an introvert to succeed. And, no matter what your colleagues say, introverts have the potential to enjoy fewer personal interactions in radiology than in other fields such as medicine or surgery. These features of radiology allow the introvert to thrive in his profession.

Nevertheless, the typical introvert needs to learn some extrovert skills. For example, with the many phone calls we make and the numerous technologists and nurses we must manage, it is next to impossible to bury one’s head in the sand. And to run a group as a stakeholder, the introverted radiologist needs to learn leadership skills. Completely isolating oneself from others does not work well in our profession.

Why Do Some Extroverts Thrive In Radiology?

In baseball, we find the lefty pitcher more likely to succeed because he throws differently from most pitchers. Likewise, the extrovert is likelier to shine in a group of individuals dominated by introverts. Every group needs folks that can shmooze with the right people, interact well with the administration, and lead a group toward success. These folks tend to shy away from some of the more analytical independent areas of radiology. And many opportunities exist that require the skills of the extrovert in our field. The introvert cannot go it alone!

Introverts/Extroverts- Does It Matter?

In our field, no one size fits all. We both need introverted and extroverted radiologists for our profession to thrive. A group without an extrovert is a recipe for disaster, with poor communication skills leading to anarchy. And, a group without the analytical skills of an introvert will not last long. So, let us try to appreciate one another for who we are. In the end, the best groups are a combination of both.

 

 

 

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Private Equity Buyouts Of Radiology Practices – Who Gets Hurt?

privare equity

Why would anyone want to buy out a practice? Well, like all things economic, it’s simple: To make money. And that is what private equity companies do. They take over companies so the owners can collect a share of the profits. And who exactly are the private equity owners? These folks are private groups of investors that pool their money together to purchase companies. But, unlike publicly traded companies, the government does not regulate these companies as strictly.

So, why is this important for the typical radiologist to understand? Within the past few years, consolidation has hit the radiology industry. Some of this consolidation has resulted from private equity companies buying out radiology practices throughout the United States. And, who knows? Private equity companies may buy out your current or future practice. So, here is a summary of what you can expect, who wins, and who loses.

What Happens To The Radiologists After A Buyout?

The radiologist’s destiny is the million-dollar question. (Literally and figuratively!) Soon after a buyout, you may notice that the radiology employees lose some of their ability to advocate for patients (1). The private practice partner radiologists no longer hold the purse strings to enact change. So, all radiology employees of the new private equity entity must follow the rules of the new owner/leader.

Next, contract negotiations ensue. Initially, former partners and employees will tend to get good benefits, similar to the old practice. Over time, however, the stakes can change dramatically. In lean times, salary cuts and layoffs can begin rapidly. Since former partners no longer control the salaries, these folks may have just to take what they get. During more flush times, the former partners no longer reap the potential outsized rewards.

Further, in the future, you may notice that capital expenditures decrease to save profits for the private equity owners. That new CT scanner will be challenging to justify in the budget unless it has the potential to bring in new revenues. Private equity-owned practices can no longer buy equipment with the motivation of improving care alone.

The Winners

The most apparent winners are the older radiologists in the practice who will soon retire anyway. These owners can now collect on a payday that may be as high as 10-12 times their yearly salary. (2) This added benefit, in addition to their savings from years of practice, can allow an early retirement or a more leisurely lifestyle while working fewer days per week.

Depending on the terms of the agreement, the private equity firm can also gain much from buying a practice. The private equity can skim the additional profits previously from its former partners. However, this is all variable and depends on the partnership’s deal.

Occasionally, inefficient practices may also win in these arrangements. For instance, sometimes practices spend too much or cannot take advantage of economies of scale to increase efficiencies. So, it may take an outside entity to improve profitability. Of course, this assumes that the private equity entity knows how to run a practice better than the original employer and delivers some of the added profits to the radiologists. (Many times, that is not true!)

The Losers

Unfortunately, the biggest losers are the former non-partner stakeholders. These include full-time employees and employees on a partnership track. A buyout can derail the best-laid plans for the future. No longer can partnership track radiologists collect upon the sweat equity they have already committed to their years of practice. Likewise, former employees can no longer count on a similar job structure and contract.

The former younger partners may also lose a bit in the deal. No longer can they rely on many years of good salary ahead. The private equity firm will determine its future. On the other hand, at least these former partners will get a portion of a nest egg to add to their future retirement savings in the buyout.

Unlike those practices that stand to gain from a private equity arrangement, other private equity practices may liquidate the assets of an imaging business to the bare bone and improve profitability on paper so that the private equity firm can eventually resell the company to another entity. These sorts of practices can destroy a radiology imaging center. Good employees leave. Morale declines. And ultimately, the radiology practice can cease to exist. It can certainly happen.

How Much Can You Stand To Gain Or Lose?

So, if you are on the winning side of the equation and make 400,000 dollars per year, you may collect over 4-5 million dollars depending on who formerly owned the equipment and resources. That number, combined with continued employment, may satisfy those winners in the deal.

In the losing lane, non-partners no longer have the chance to build equity in practice. If you think about it, you have already committed three years to a partnership track, and the business has not already made you a partner; you have already lost those dollars of sweat equity. So, if your salary was 300,000 and the practice partners made 500,000, you have lost out on the difference of 200,000 dollars per year for three years or 600,000 dollars. You have also missed out on the ability to collect the 500,000 dollars in perpetuity once you have become a partner. Now, you are subject to the whims of the private equity firm.

The Basics Of Private Equity Buyouts

Describing a private equity buyout is relatively simple. It merely follows the laws of economics. You win if you are on the right side of the equation (the senior and private equity partners). On the other hand, if the equation does not favor you (most employees and some junior partners), you lose. So, if you are fortunate enough to choose among multiple deals, ensure you are doing what is best for your practice. A private equity deal can enhance or destroy your radiologists’ livelihoods!

I would love to hear your comments. What do you think about private equity buyouts in the field of radiology? Any experiences with private equity firms?

 

(1) http://www.physicianspractice.com/blog/understanding-hospital-buyouts-physician-practices

(2) https://www.aao.org/senior-ophthalmologists/scope/article/private-equity-buyouts-of-ophthalmology-practices

 

 

 

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How Far Does A Radiologist Salary Go? (A Comparison Of Two Towns)

radiologist salary

Compared to a resident salary, any United States radiologist salary seems like much. And near us in the New York tri-state area, we sense that everything we buy is so expensive. But, how much more expensive is it? To tackle this question, we have to think of this differently. In the world of numbers and finance, the best way to understand finances is to compare one value to another. So, we will do just that.

Many of us here talk about how much more we would earn in take-home pay if we moved to the midwest. So, I decided to take a “nice” community out west that we could compare to ours. Specifically, I thought it would be interesting to think about what you would make if you lived in Omaha (if it’s good enough for Warren Buffet, it’s good enough for me!). And, then we could compare that amount with the Tristate area (my home turf of Northern New Jersey- Essex County).

Next, to standardize the calculations as best as possible, we will consider an average radiologist salary specific to both areas using a great radiologist salary map from Doximity from 2015. (an average is not perfect because it assumes you have been practicing for some time but is a reasonable estimate) Then, we will estimate expenses for a family of 4 in a similar type of home with four bedrooms (zillow.com helped us with the calculation) in a quality neighborhood with average student loans.

We will also assume that children attend public school and that your daily living expenses are average for the community. (numbeo.com helped us out with that) Subsequently, we will figure out how much you will be able to save over a year on a radiologist’s salary. And finally, we will compare what you can save and spend if you live in one place versus another.

Now, I know that we can’t account for everything. You may decide that you want to buy a more expensive house. Or, perhaps, you have a sweeter package at your practice than the averages I discuss. Additionally, I am not assuming that you will start lower on a partnership track and have a higher income when it is over. And I may not be accounting for other expenses. Nevertheless, these calculations are made to factor out the different locations, the goal of this article. So, let’s begin the comparison!

Northern New Jersey (Essex County)

So, in Essex County, the mean radiologist salary is 387,366 dollars. Let’s then assume you have the average-priced home in a nice neighborhood with a four-bedroom house. Based on a Zillow calculation, in Livingston, that would be $641,000. We will also assume that you have saved 64,100 dollars or about 10% for a down payment and that you have taken out a 4% mortgage for the rest over 30 years. (or, you will be paying yearly expenses of 36720 dollars with 25434 dollars of that interest). Then, we will calculate your annual payments based on the average student loan debt of $207,000. (You will try to pay it off over five years at 48948 dollars per year)

Property taxes in Livingston are somewhere around 2.3% per year. (14,473 dollars) Based on the cost of living, utilities for the four-bedroom house in Livingston would cost 4380 dollars per year (20 percent more in Omaha). Homeowner insurance would be another 1500 dollars per year. In Essex county, food expenses are 20% more (Let’s assume they are 1200 per month or 14,400 dollars per year).

Therefore, income after taxes and deductions is 387,366- 18,500 (retirement savings)- 83,867 (federal taxes)- 19,454 (state taxes) or 265,545 dollars. Let’s then subtract utilities (4,380 dollars) and food expenses (14,400 dollars). That takes us down to 257798 dollars. Then, let’s deduct the student loan annual expense of 48,948 dollars. That takes us to 208,850 dollars. After paying the mortgage and property taxes, and insurance, we are down to 156,157 dollars.

Now, we also need a car, don’t we? So, let’s assume that you are paying off a 30,000-dollar vehicle over three years. At a 2% interest rate, that is 859 dollars per month or 10,308 dollars per year. That takes us down to 145,849 dollars. You also need clothes. Let’s assume an annual expense of 12,000 dollars per year for the family. Now we are down to 137,849 dollars. Of course, we need to maintain the house at the cost of about 1 percent per year. That takes us down another 6410 dollars to 131,439—gas expenses per year- 10,000 miles per year or 1250 dollars per year. Car insurance costs another 2,000 dollars per year. Now we are down to 128,189 dollars.

There are also miscellaneous entertainment expenses and vacations. Say that would be 10,000 dollars per year. OK. Now we are at 118,189 dollars. Gardening and snow removal. Another 3000 dollars per year. or 115,189 dollars. Other expenses are out there that exist. But, we can’t go into too much detail. That sounds about right for a reasonable comparison.

Nebraska (Douglas County)

OK. In Omaha, Nebraska, the mean radiologist salary is similar to Northern New Jersey- 385,983 dollars. Based on the Zillow website, the average four-bedroom house is significantly lower at $254,000. Again, we will assume that you have 64,100 dollars already saved for a down payment and a 4% 30-year fixed mortgage (or a yearly payment of 10879 dollars with 7535 dollars in interest). Like before, based on an average student loan debt of $207,000 (Lendme) with an interest rate of 6.8% over five years, the amount paid per year will be 48948 dollars per year.

Property tax rates are slightly less in Omaha at approximately 2.1% of the assessed value or 5,334 dollars per year. Utilities are relatively similar in Omaha and Essex County at about 5976 dollars/year. Homeowner insurance is a lot less because of a significantly lower assessed house value at (254,000/641,000)* 1500 dollars or 594 dollars per year. And, food is somewhat cheaper at 14,400/1.2 or 12,000 dollars per year.

This time our income after taxes and deductions is 385983 dollars- 91,844 dollars (income tax) – 18,500 (retirement savings)- 23,437 dollars (state taxes) or 252,202 dollars per year. After taking away the annual student loan expense of 48948 dollars and the mortgage, property taxes, and insurance (10,879+5,334+594 or 16,807 dollars), we are down to a total of 186,447 dollars.

Cars in Omaha cost about 20% less overall, so let’s that that 30000 dollar car now costs 30,000/1.2 or 25,000. Assuming that you are going to pay it off over three years with an interest rate of 2% again, the total for the year would be 9,336 dollars. Now, we are at 177,111 dollars.

Clothing is about 10% less in Omaha, so your annual expense will be 12,000 dollars/1.1 or 10,909 dollars for the family. The total leftover now is 166,202 dollars. Maintenance on the house at 1% per year is 2,540 dollars per year, leaving over 163,662 dollars. Gasoline is similar in price at both locations at 1,250 dollars per year. Car insurance is lower, coming out to 1500 dollars per year. This expense takes us down to 160,912 dollars per year.

Entertainment expenses are about 30% less in Omaha, or 7,000 dollars, taking us down to 153,912 dollars per year. Gardening and snow removal are approximately 25% less at 2,250 dollars. Our final leftover take-home-pay after everything is 151,662 dollars.

Comparing A Radiologist Salary In Omaha And Northern New Jersey

The take-home pay difference between Nebraska and Northern New Jersey is at least 151,662- 115,189 or 36,473 dollars per year. That is significant dough! Theoretically, you can either put the additional money back into the mortgage or other investments, significantly increasing that sum over time. So, the question is- is living in Omaha worth at least 36,473 dollars of take-home worth it to you? Something to think about if you have lots of debt. It may make all the difference in the world!

 

 

 

 

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Top Eight Advantages Of Living Close To Work As A Radiologist

close

Driving 50 miles to and from work or over 1.5 hours each way is undoubtedly a recipe for a problematic residency or career. (I did that for six years as an attending!) So, I recommend that you heed the following advice. Live close to the hospital and enjoy life! We will go through eight tangible benefits I have discovered now that I live close to work to support this argument. Try to do the same!

Traffic And Stress

Arriving at work after a school bus, a large white van, and a Toyota Prius cut you off during your 1.5-hour journey versus stopping at the one traffic light between my house and the hospital. Which one is more stressful? Hmmmmm… I can say that stress levels have declined by 95 percent at the beginning of the workday. Who cares if that guy in front of you cuts you off in the parking lot when you are five minutes from the hospital. You’ll still arrive on time!!!

Forgetting Things

The feeling of forgetting something important halfway through a 1.5-hour journey still sends shivers down my spine. I can still remember filling out the medical staff renewal forms due the same day, only to discover they were not in the car halfway through my trek to the hospital. If that happens now, no big deal. I just go home in the middle of the day and pick it up!

Healthier Lifestyle

All those hours on the road wreak havoc on your body. The body should not sit in a car for 3 hours a day. Fast food outlets become your friend. Fat accumulates in the wrong places. All that time that you lose, you can spend exercising or creating a healthier lifestyle for yourself.

Taking Care Of Things At Home

Occasionally, you need to drop off something at the house. Or, you may meet with a contractor to fix your ceiling leak. When you are 50 miles away, it is next to impossible. On the other hand, if you are right around the corner, you can usually stop by for a moment!

Community

Are you volunteering for the community? No problem. Want to coach a kid’s baseball team? You can manage it. Join a local symphony? It’s possible to find the time. Living close opens up many local opportunities you would never have otherwise!

Emergencies

Sometimes disaster strikes. When you live far away, it is almost impossible to help out. On the other hand, if your child injures a leg playing soccer or falls off a horse and you live right near the office or hospital, you are no more than a few minutes away. You can even pick him up and drive him to your hospital yourself!

Family Time

Want to spend quality time with the kids in the evening? You will now have the time. Think it’s essential to go on date night with your spouse? It’s possible to make plans, even during the week. Need to plan family outings- like the school picnic or that hockey game in the evening. Not a problem!

Call Issues

Have to reduce an intussception at 3 AM? At least you are around the corner. You can get in and out in minutes. And, before you know it, you are done. Need to check a scan because the internet froze? All you need to do is drive-in for a moment or two, not 1.5 hours!

Live Close To Work!

As you can see, living close to the hospital makes a world of difference. And the advantages are almost endless. So, go ahead and try to live reasonably close to your work. You can live your life the way you want while not burdened by all the time wasted in the car!

 

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The Isolated Specialist

isolated

No, this is not another article about physician burnout. Instead, today we will talk about why isolated specialists can lead to poor patient outcomes. So, why do I find this interesting? In my own experience, I have encountered multiple instances when I see isolated specialists as the cause of deficient patient care. Let me give you an example.

A radiologist will encounter a non-radiologist physician demanding that his patient receive unwarranted intravenous contrast for his CT scans every once in a while. What is the big deal about administering unwarranted intravenous contrast on CT scans? Well, say you perform a contrast-enhanced CT scan for a pulmonary nodule. Or perhaps, you decide to approve a contrast-enhanced CT scan of the abdomen to check for a retroperitoneal bleed with contrast while on Coumadin. The patient risks returning home with a “present”- acute renal failure in both situations.

Meanwhile, both CT scans would give you the same result regardless of whether we administer intravenous contrast. And both of these cases of acute renal failure are entirely preventable. If you perform the study as directed by the physician, you have complied with the order as the radiologist. Unfortunately, these cases can lead to a lawsuit that you have no hope of winning.

Poor Communication And The Isolated Specialist

So, what does this all have to do with the isolated specialist? The ordering physicians decided to order CT scans on their patients without consulting with the radiologist in both cases. Sometimes these orders can go through the system without the OK of the radiologist. And in both situations, communication with the radiologist could have prevented unnecessary contrast administration. Or in other words, lack of communication/isolation between the ordering specialist and the radiologist was the proximate cause of a bad patient outcome.

All this brings me to discuss the topic of today- the isolated specialist. I will divide it into two different sections: What are the effects of operating “in a bubble” isolated from our colleagues? And how can we prevent physicians from working in isolation from one another?

Effects Of Operating “In A Bubble”

Untoward Side Effects

Witnessed in the examples above, two patients that should have had a non-contrast scan instead had their scan “upgraded” to an intravenous contrast-enhanced CT scan. Instead, a simple phone call from the physician could have prevented the possibility of a bad outcome. And these examples are just the tip of the iceberg. Many other cases exist where the clinician could have communicated with the physician and prevented a bad outcome.

Increased Expense

Imagine how much expense inappropriate imaging costs both the insurance company and the out-of-pocket expenses to the patient. It’s not just the additional unnecessary contrast. Instead, it is the additional weeks spent in the hospital, blood draws, nurses, physicians, and on and on. The physician could have avoided all of that with a simple discussion with the radiologist.

Prolonging Workups And Hospital Stays

In our example above, it is not just the untoward patient side effects and unmanageable expenses incurred. Instead, it is also the increased time the patient may need to stay in the hospital to figure out the patient’s disease entity. Very few patients say, “I have renal failure.” Patients may experience fatigue and other nonspecific symptoms. And a physician has to work up the clinical situation. Imagine the loss of time from work or other productive activities incurred by the patient and doctor.

Also, this is just one example. Lack of communication between radiologists and specialist cause all sorts of problems. Ridiculous unnecessary workups often ensue, wasting everyone’s time.

Radiologist Lawsuits

Don’t forget about the potential for lawsuits. All the factors from the above situation meet the criteria to allow a legitimate case. These would be breach, causation, and damages:

  1. The radiologist administered intravenous contrast inappropriately, breaching the standard of care.
  2. Contrast administration is the proximate cause of the patient’s renal failure.
  3. The patient suffered damages, including renal injury and a hospital stay.

A simple discussion between the physicians could have prevented a lawsuit.

Remaining Ignorant About Alternative Diagnoses and Treatments

Frequently, I learn about many of the most up-to-date patient diagnostic tests and treatments when I pick up the phone and discuss a case with a clinical colleague. In the situation above, a simple question about contrast could have avoided causing harm to a patient. This example is one where the ordering doctor remained ignorant about alternative methods of diagnosis (a non-contrast CT scan) when no communication ensued. Isolating oneself from phone calls with the specialist often prevents the best possible patient outcomes.

How Do We Prevent The Specialist Isolation?

Make It Easier To Contact Physicians

I think we have to blame both the ordering physician and the radiologist in these situations. Many physicians make it next to impossible to contact them by phone. Likewise, I know many radiologists who shun the phone under all circumstances. We have to make a conscious effort to make ourselves more available. Perhaps, it is a simple answering service that can solve the problem. Or, a radiology assistant may do the trick to improve communication.

Remember We Don’t Know Everything

Sometimes, we need to remind ourselves that each of our own experiences by ourselves is extremely limited. Only our interaction with others can allow us to understand patient issues best and give our patients the best care possible. We need to remain humble and ask for help from the radiologist and the ordering physician.

Computer Guidance

I hate to say it. But, clinical decision support systems have the potential to increase communications between clinicians and radiologists. When the computer detects the potential for a wrong imaging study order, it will force the clinician to interact with the radiologist. Potentially, this can relieve some of the issues of specialist isolation.

Attend Physician Friendly Events (Staff Meetings, Golf Outings)

Finally, many say that interdepartmental physician functions are unnecessary. But, I cannot disagree more. Making ourselves feel more comfortable with our colleagues allows physicians to be more likely to pick up the phone with a colleague who can become a friend. What better way to decrease isolation than sharing fun events with our colleagues?

Final Thoughts About The Isolated Specialist

Radiologists and specialists need to treat specialist isolation as a severe barrier to good patient care. And unfortunately, isolation is all too common. So, we need to make inroads to break down these barriers. Reducing specialist isolation will prevent patient side effects, reduce hospital stays, lessen patient expenses, decrease lawsuits, and increase diagnostic and treatment options. As specialist physicians, let’s all make a concerted effort to solve this critical problem together.

 

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How Much Work Is Too Much For A Radiologist? (Think RVUs!)

RVUs

You are excited to start your career as a radiologist. And, you are interviewing, hoping to find a job where you can make the most money and pay off your student debt. There is much more to find the correct position than just assessing the income. Of course, you should consider the location and job profile. Just as importantly, however, you also need to figure into your calculations the workload and relative value units (RVUs) you need to complete to reach that income.

Avoid the following situation: an insurmountable daily imaging workload with a queue of patient studies that never ends. A job like this is bound to end badly. But, what is an unsafe workload for you, the radiologist? Or, more accurately, when looking for a job, how many studies are too much to read daily? Let’s investigate these issues together by examining some of the markers of workload and then get to some more specifics about the appropriate RVUs for an individual radiologist.

The Lowly RVU

Before we conclude how much work is too much, we first have to define a unit of work. The essential measurement of work is the RVU or relative value unit. According to an excellent presentation on the history of insurance, the first “RVU” came out in 1992 (1). It defined a relative value unit as three different components- physician work, practice expense, and malpractice. Most of the cost/workload of the RVU relates to physician work and practice expenses.

So, who decides the cost of an RVU? The American Medical Association defined a committee called the AMA Specialty Society Relative Value Update Committee (the RUC). It consists of an expert panel of an individual from the 21 major national specialty societies, two IM specialists, one primary care practitioner, one specialist, and six additional committee members. They assign explicitly what the Medicare costs are for each procedure. (1)

Why Is The Average RVUs Per Radiologist Is Important? (And Why It’s Not!)

OK. So, we have defined what makes an RVU and who creates an RVU for any given procedure. The following important question: What is the median number of RVUs per radiologist throughout the country. Well, I found a relatively recent article in The Reading Room that reports just that. (2) To summarize, it says that the average radiologist performed 10,020 RVUs in a 2020 survey. Now that we know the average RVUs per radiologist, it’s a relatively simple step to ask the average number of RVUs per radiologist per year in any given practice. Usually, the business or practice manager can obtain the number if you ask. If you find that the number deviates significantly from the mean, perhaps, you are looking at too few or too many studies.

But wait… There’s more to the equation! Let’s say you are a neuroradiologist that reads almost exclusively high-value RVU MRIs. Perhaps, you may read them significantly quicker than a general radiologist. Then, you can probably handle more RVUs than the average radiologist. Or, let’s say you just started and have not yet picked up speed with dictating. In that case, you will likely read lower amounts of RVUs. Therefore, you have to put in your weighted factor to determine how much work is reasonable.

Why Are Daily RVUs Even More Important?

Finally, we have developed your individual optimal yearly RVU number where you should lie within a reasonable spectrum. But, it is impossible to conform to that number precisely every day in any given practice. Some days you will have more studies and others less.

To add even more variation, in some practices, the radiologists may take 16 weeks of vacation, leaving only 36 weeks to complete all the work. To make the appropriate calculation of RVUs in this sort of practice, you would need to take the individual practice’s annual RVU number and divide it by the number of days per year worked. In actuality, that yearly average total RVU number does not measure the amount of daily work. A more appropriate calculation would be the daily RVU number. Therefore, a practice with a seemingly ordinary yearly RVU number can have an exceedingly high daily RVU number.

The RVU Tipping Point

What happens when a radiologist reaches the daily RVU tipping point beyond which they are comfortable? Well, most practicing radiologists have had bad days like this at some point. (Hopefully not every day!) You cut corners; your mind drifts elsewhere; burnout ensues; eye strain develops. Not only is it a wrong place for you, but it is also terrible for patient care. Let’s try to avoid that situation as much as possible.

How Much Is Too Much?

Back to the original question again. Too much work can vary widely for any individual. But at least, you now have a feel for calculating how much is too much. So, go forth and ask about the RVU number when you interview for a job, calculate the daily RVU value and compare it with your comfortable RVU numbers. That way, you are much more likely to find appropriate work for you!

(1) http://www.rsna.org

(2) https://thereadingroom.mrionline.com/2020/11/radiologist-alary-update-2020-show-me-the-money/

 

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

radiology swap

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

University Radiologist Goes To Private Practice

Day 1 Radiology Swap:

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

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

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

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

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

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

Day 15 Radiology Swap:

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

Day 30 Radiology Swap:

Assessment day for Radiology Swap!!!

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

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

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

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

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

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

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

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

 

The Radiology Swap Meetup

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

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

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

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

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

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

Academic: True. We both earned some stiff ones.

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

THE END

(until next time!)