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Perception Of The General Public Of Radiologists Versus Reality

general public

Ever wonder what the general public thinks about us and what we do daily? Here are some thoughts and fallacies about their perception of us versus our reality!

General Public Thinks Radiologists And Radiology Technologists Are The Same!

Almost every radiologist gets questions from their family or friends about whether you help position the patients to take the images they interpret. Or, you’ll get the question of whether you had to attend medical school. Well, the reason for that most likely stems from their perception that there are no differences between what a radiologist versus a radiology technologist does for patients. And, if you think I am crazy, ask your great aunt or an old acquaintance. There is a better-than-even chance they will say the same thing!

We Exist In Lonely, Dark Rooms Only

If someone understands some of the tasks we do for our jobs, they will also likely imagine us working in a dark room day and night. Sure, some tele-radiologists live that life. But, most of us still meet with colleagues, technologists, nurses, and patients. We also participate in tumor boards, teaching residents, and administration. Those interactions keep us engaged in our careers for most of us who chose radiology.

Radiologists Are Not Sociable

Here, nothing could be further from the truth. As many of you are interviewing, you will find that radiologists are mostly friendly. Sure, there are some lemons out there. But, we tend to be much more easygoing than the surgeon around the corner or the cardiologists down the hall. Many of us are interventionists or mammographers who see patients daily. Yes, some of us are a little more introverted than the typical physician and don’t do much of that patient-face work. Nevertheless, we tend to have more time to invest in ourselves than many other medical professions because we are not always on the job. So, we have hobbies and more that lead us to interact with many people!

All Radiologists Are Tech Savvy

We need to know how to work with PACS systems and spend much time on computers. But you probably know that many radiologists are not the most facile users of social media, virtual reality, programming, or other technological activities. Herein lies a surprise for many. You need to know your anatomy and a little bit of technology. But you certainly don’t have to be a techno-geek!

All Radiologists Are Rich

There is a significant variation in jobs, debt levels, cost of living, and more. Many radiologists make a good living. But, if you are hundreds of thousands of dollars in the hole from your medical school training, it would be difficult or not impossible to call these radiologists rich. Also, although academics can and do generally pay a respectable salary, it is not what many Americans consider crazy high. If you listen to Dave Ramsey, doctors, in general (and probably including many radiologists!), do not crack the top ten professions that are millionaires. It shouldn’t be that way, but it is!

General Public Perception Of Radiology Versus The Reality

Our daily reality as radiologists is starkly different from the expected existence of those not embedded in medicine. Like why we never quite get the job of an investment banker at the trading desk that trades foreign bonds, most folks will never know the sense of accomplishment and pride we take in our radiology careers. The average person may not know the difference between radiologists and technologists, our daily roles, and that we are not all Bill Gates. But it is good to know what the majority probably thinks of us!

 

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What Character Traits Make A Great Lead Radiology Technologist?

lead radiology technologist

I don’t know about you, but life can turn into hell in a handbasket when my lead technologist is absent. Noticeably, details are left undone. And, the technologists under them don’t function quite as efficiently as they used to. Of course, the responsibilities at these sites slightly differ if they work in an office versus a hospital But, I have noticed that what makes a lead tech successful at both remains mostly the same. So, what are the lead radiology technologist critical roles at your imaging center or hospital? And, what are those traits that make your department run as smoothly as silk?

Keep Of Track Of All The Issues- Organization

All the lead techs I know that are worth their weight in gold maintain records of everything without fail. They follow unread films like hawks, ensuring they have someone looking after them. And they always keep track of accreditation deadlines, both for the site and their fellow technologists and the radiologists. In addition, they might keep track of the stock, whether it be gauze, contrast dye, or tea for the employees. All this work adds up to be for someone that can maintain an organization like no other (even more than most radiologists!)

Can Rally The Troops

What good is a lead tech if the cavalry does not respect them? When a technologist is absent, who wants to pitch in to do extra if you don’t like who you work for? Well, that’s when a respected colleague enters the picture. Those techs that can command respect can also rally their colleagues to help the practice when times get tough, whether it is an absent tech or an inspection from JACHO. In times of need, you need a lead tech that will inspire hard work from their workers and colleagues.

Able To Fill The Gaps

A great lead tech won’t make excuses. They will help themselves to fill in coverage when others are unavailable. Likewise, they don’t sit on a high pedestal expecting everyone else to do their bidding. In a pinch, they will do the job of others. And it all happens so seamlessly that you may not even notice!

An Approachable Lead Radiology Technologist

In the game of medicine, personality is key. And a lead tech should also be someone everyone can come to in a time of need. If a colleague needs a sick day, they should not fear approaching their lead technologist for the possibility of retribution. Instead, they need to be someone people can talk to and trust. Otherwise, big surprises happen, And they are not necessarily for the betterment of the radiology practice.

Takes Care Of Issues Become They Become An Issue

In addition to the trait of organization, lead technologists need to follow through with tasks, so they don’t become a bigger problem later on. This knowledge takes experience, know-how, and grit. Furthermore, they must know the art of triage to decide which issue to tackle next. Knowing whether to prioritize the next hospital business meeting or a technical problem with a piece of equipment can be challenging. Which needs to come first? Well, this is up to the judgment and actions of the qualified lead tech!

A Lead Radiology Technologist Knows How To Deal With Errant Technologists And Staff

Almost all practices have employees that don’t necessarily follow the rules. And they need to call these inappropriate behaviors out, lest they become a problem for the business. An excellent lead tech can take care of these issues with style and prevent the behavior from blossoming into patient losses or lawsuits! Who said the work of a lead tech was easy?

Scheduling

Scheduling can be a constant headache. And this role is typically critical for the lead tech. Knowing where and when to schedule colleagues can be very tricky and time-consuming. But, an excellent lead technologist can easily manage the schedule, ensuring everyone is where they are supposed to be at any given time!

The Great Lead Radiology Technologist!

Bet you might not have thought about all these critical roles a lead tech plays. It’s much more than you might think. But, if you want to hire the right lead technologist, these skills are critical to the smooth running of any radiology imaging department. It takes the right person for this job, and it’s not by any means an easy one! 

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Good Radiologists Are Like Car Salespeople- Make Them An Offer They Can’t Refuse!

car salespeople

As I was on the phone with a colleague trying to convince the referrer of why I think a patient has Paget’s disease instead of metastases, I described the cortical thickening of the iliopectineal line and the lack of activity on the bone scan at the site and elsewhere throughout the body. And I mentioned the MRI was nonspecific, with some expansion of the ilium that went along with the case. The retort was that the alkaline phosphatase level was not high. And to that, I added that Paget’s disease in the chronic phase often does not demonstrate elevation of this enzyme. All this back and forth was to get my colleague to buy into my conclusion that the case was Paget’s disease, not metastases. At this point, I realized my job at that moment was just like all the other car salespeople I know! And allow me to tell you why.

After looking at and synthesizing all the images and analyzing other less definitive dictations and reports, I incorporated all the information. Then, my goal was to package all the data into one convincing deal- an offer the physician could not refuse, just like the car salesperson trying to get us to buy a car. So, how can we, as radiologists, convince colleagues of what we see, just like car salespeople persuade us to buy cars?

Give All The Evidence For Your Convictions

Like in the case above, I gave this referrer all the reasons why I thought the osseous lesions were not metastases and instead Pagetoid. This tactic is no different than that of used-car salespeople. They will try to persuade you to buy a car by explaining why it satisfies your needs. It’s safe for kids, has Apple Play, reliable ratings, etc. Does this technique sound familiar? Did you ever think radiologists and car salespeople are so similar?

Definitively Lead The Referring Doctor Toward The Correct Treatment Goal

Using more absolute terms can lead our referrers toward the correct diagnosis and, ultimately, the proper treatment for the patient. Avoid using equal probabilities and weights in our speech and our written descriptions. We can almost always come up with a likelihood for one or another diagnosis. Make sure to relay that information to our referrers. Also, try to eliminate words like “appears,” “maybe,” and “cannot exclude” from our communications. Rarely are these terms practical. And these words connote insecurity, not the message your clinician wants to hear when trying to determine what to do next. Likewise, if car salespeople told you the car might be safe, you probably would not be too interested in it. But if they told you it is the safest car on the market, that’s another story!

Be Convincing In A Nice Way, Just Like Car Salespeople

We may sometimes feel like the referrers are dullards (and it might be true!). Nevertheless, it is critical to relay our issues in a way that is not aggressive or toxic. Talking down to our colleagues or yelling at them will not get the point across as well as a friendly conversation or chat. Likewise, it never pays to put provocative subjective terms in our dictations as these are legal records for the patient. You certainly don’t want negative phrases like these to be present when you are involved in a lawsuit; it doesn’t make you look too professional! Car salespeople need to do the same. They may secretly hate you, but they must be nice to make the sale!

Radiologist As Car Salespeople- Make Them An Offer They Can’t Refuse!

We, as radiologists, rarely realize all the roles that we play in our organizations. And excellent radiologists need not only to make the correct diagnoses but also to play the role of salespeople. We need to give all the evidence, lead definitely, and be nice to our colleagues to persuade them about the final disposition and diagnosis. In a way, we are no different than car salespeople that need to make the next sale. We must convince our colleagues just as they would need to persuade their customers to buy a car. But, I would like to think that we also use extensive training and depth of knowledge (more so than a car salesman) to get to the point of excellent patient care!

 

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How Much Detailed Description Belongs In Your Report As A Resident?

detailed description

Exceptionally few things can be more confusing as a resident than how much to put in a report. Each faculty member tells you something slightly different. Some want every little detailed description. And others want a dictation that is so short it may even skip over some of the relevant findings. Since the diverse dictations you read are so vast, and each attending does it differently, the variety of recommendations you receive is also all over the map. So, how do you decide what kind of dictation detail is right for you? Well, let me give you some pointers.

Don’t Get Too Deep Into The Weeds

Like I did when I started, I had noticed that many new radiologists would get into the nitty-gritty of the technical aspects of a dictation while forgetting about the ultimate desired result. We shoot for an answer to a question that the referrer is providing. And that is the main reason for the report itself. So, when you see a dictation continuing to harp on T1 and T2 weighting as well subtle points of artifacts and the finer points of a description that no one will use (including the subsequent radiologist that reads the report), it is probably too much. These reports typically have an impression that is a mile long and a result section that needs a table of contents! So, avoid too much technical jargon description.

Keep It A Little Bit Longer With More Detailed Description Than Your Attending- 

At the same time, for most attendings, you probably want to make sure that your dictation is a little bit longer than they would write. Why? Because your faculty precisely knows what the clinician needs from a report and the audience they are writing to address. You don’t know these factors as well. So, it pays to describe a little more than what they would place in their dictation. Additionally, as most attendings do, you should use the dictation as a guide so that you won’t forget what to add to your final note.

Make Sure All The Relevant Findings Are Present

If you are reading a trauma chest CT scan, make sure to put in the dictation that there is no mediastinal hematoma. That statement is probably not valuable if the patient is here for pneumonia instead. So, think about the pertinent negatives and positives you would need to rule in or rule out the diagnosis that the referring physician needs. Even if this adds a few lines to your report, it’s probably a good idea to add it because it can help to figure out the patient’s final disposition.

Be Sure To Make The Detailed Description As Objective As Possible

Objectivity trumps subjectivity any day of the week. Statements should be a matter of fact and not an opinion as much as possible. The extra vocabulary and detail that goes into a report with all the subjective phrases such as “I believe” or “appears/seems” are superfluous at best and harmful at worst. They indicate insecurity to the reading physician. And you probably know what that means! They are going to order more unnecessary tests based on your uncertainty. So, please keep your objectivity in your dictation!

After All Of That, It May Depend On Your Faculty Member

The final consideration you need to determine the length of your dictation is the faculty member reviewing your report. Unfortunately, at your stage, your dictation is not quite yet your own. So, make sure to write the specific details your attending requests. They are often apt to change whatever you finally say anyway. Therefore, make sure to do it the way they want the first time!

How Much Detailed Description Belongs In A Resident Report?

It’s a fine line between too much, too little, and just right in the resident’s report. So, please don’t go too deep into the technical jargon; keep it a little bit longer than your attending; ensure relevant positives and negatives are present; keep it objective, and remember your report is for your attending. These guideposts will eventually get your dictations to the appropriate mean that satisfies your faculty and the referrers so that they can interpret and understand your final read!

 

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What To Do With A Large Windfall During Residency

windfall

You may think it is just a pipe dream, getting an unforeseen large windfall. (and I’ve spoken about small windfalls before). Nevertheless, throughout my years of stewardship in the residency program, I have encountered a few residents who have had a significant life-changing amount of money fall into their hands. Some with cryptocurrency, others with family inheritance, and others with a stock pick that rose much more than expected. So, what is the best way to deal with a substantial windfall like this? OK. It might not happen to you. But it still occurs more often than you might think. And, if it doesn’t happen to you, it is still fun to mull over. So, let’s talk about some general advice about what to do with a windfall.

Give The Large Windfall A Little Bit Of Time To Sink In

In general, when you receive a windfall of a significant amount, your first thought is to do something immediately with the cash hoard. But your brain needs to catch up a bit with the reality of the situation. Typically, it would help if you waited a bit until the initial circumstances of the windfall had settled out. When it comes to money, emotion can interfere with the best and most rational choices that we need to make. So, give it some time. Waiting a bit won’t cause that much harm (just a little bit of a loss to inflation). But the opportunity cost of doing something rash with the money is much worse!

It’s Not All Or Nothing!

Just like you don’t want to put all your money on 00 on a roulette wheel (you will lose much more often than you will win!), don’t put all your money into one financial basket. Diversification is the name of the game. And you may want to consider not putting it all into one debt repayment or investment. Consider spreading out your newfound fortune on a host of different opportunities. It’s tough to predict the future. So, you are generally better off spreading your money into multiple options.

Consider Repayment Of Debt/Student Loans

Although many of your student loans are at low interest (or 0 interest rate currently), you should consider putting a large chunk of your fortune into your student loans. Why even at these interest rates? Well, there is always a risk that you may not be able to complete a residency, or an unforeseen event can happen that can prevent you from paying them back when the interest returns to normal. And student loans are generally not dischargeable in bankruptcy. So, taking these risks off the table is enormous. Furthermore, the peace of mind of knowing that your student loans are significantly smaller or even gone is priceless.

Savings/Investments

In addition to student loans, also consider putting some money away for a rainy day. Some good options you might want to consider as a low-paid resident will be an emergency fund for savings, a Roth IRA, or a hospital 401k if there is a match. And try not to buy individual stocks or bonds. That situation can lead you to a very undiversified state that can lose all your hard-earned money.

Other Depreciating Assets

Finally, if you still have some money left over, there is nothing wrong with a bit of enjoyment in your life. Just beware of taking too much to buy things like cars, boats, planes, or whatever else floats your boat. You may regret it later on. I recommend using no more than 10 percent for personal enjoyment related to these items. Otherwise, there is a good chance that you will regret any rash decisions you make for your future self!

Let A Large Windfall Be A Blessing!

Whatever the reason for the windfall, it is your opportunity to make it into a blessing instead of a curse. It’s an opportunity to make your life better and your future self happier. So, give it some time to sink in; don’t spend it all on one thing; consider repayment of debt/student loans, and enjoy a bit of it. Following these rules will make that obscene sum of money into something more than just a number. Grandma would be proud!

 

 

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Half The Battle Of Residency Is Just Showing Up!

showing up

During residency, life will present you with many options. Sometimes you can decide to study for the boards instead of actively seeking to learn new procedures or experiences. Or, there will be times when you can get out of work early in the afternoon because you went to a half-day conference, and no one is taking attendance anyway. But, radiology residency is only four years. And, the time you have to learn new procedures with experienced professionals and make the mistakes you need to make before you go out into the real world is limited. You may not realize now how critical it is to spend extra time learning what you can and taking advantage of each moment you have as a resident to know your future trade. Hopefully, you will have decades to practice and form the basis of this career in these four years. And half the battle of residency is just showing up. Here is why.

Technical Procedure Practice

Every procedure you complete later adds to your work’s cognitive and muscle memory. And, each time you do a technique again, you are adding a body of knowledge that you will eventually refer to you. It can be something simple as the best way to position a patient. Or, it can be a more complex set of wire movements. We become a bit better each time we complete one of these procedures.

Making Mistakes Now Instead Of Blindly Later

Because we are human, we will make mistakes. And the more mistakes you can make in a protected environment, the less likely you will make those same mistakes later in your career. If you miss a pulmonary nodule as a resident, it’s not a big deal. If you miss that same pulmonary nodule as an attending, it could be the beginning of a horrible lung cancer and a potential lawsuit. The more you miss now that your faculty picks up, the more you are likely to concentrate on those same areas later on so that you will never forget them again.

Showing Up To Expose Yourself To More Incidental Findings

In practice, some of the most complex parts of radiology are not necessarily the specific disease entities. Instead, it is those pesky findings that we make that we can’t but see. Some of them, like pulmonary nodules, have defined Fleishner criteria for following them. However, most don’t have particular rules. And, sometimes, you have to rely on your experience to figure out what to do next. That is something that you can only receive by showing up and reading!

New Disease Entities/Presentations

The more times you see cases, the more likely you will see new presentations of diseases that you know and other findings of pathology that you don’t. It’s like a lottery. Eventually, after a certain number of times, your number will come up due to the odds alone. Why not increase those odds by showing up to your training during residency?

Subconscious Identification Of Normal Variants

Finally, sometimes it’s not the material that we know. Instead, it might be the little findings that we don’t pick up. Subtle curves and lines we all pick up each time we look at an image. Sometimes, we are unsure which ones we can disregard and which are critical. It is only through putting through the motions of reading lots of cases that we can get to the point of confidence. All it takes is to show up!

Every Moment Of Showing Up To Residency Is Important!

Those moments you take advantage of instead of sitting back contribute to your overall body of knowledge even though you may not think much about it at the time. So, take the bull by the horns and practice technique, make mistakes now, and expose yourself to incidental findings, new disease entities, and normal variants to become the seasoned radiologist you need to be. Showing up is half the battle!

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Be Careful Of Some Of Dave Ramsey’s Financial Advice. It May Not Apply To Radiologists!

financial advice

Over the past six months or so, I started to listen to Dave Ramsey. He is a no-nonsense straight shooter who gives excellent financial advice to folks who call into his show. Moreover, he has an infectious laugh and is very witty. If the topic of finance interests you, once you start listening, it will become addicting! Nevertheless, we as radiologists must be careful when we take some of his advice at face value. Some of his advice does not apply well to late-blooming indebted radiologists who make a very high income. So, what parts of his advice should we think twice about? Here are several recommendations that probably will not apply to you.

Save Only 15 Percent Of Your Income

As radiologists, we are late bloomers. We enter the workforce much later than non-physicians. And we start working a bit after our general medicine colleagues. Therefore, the time value of money does not work in our favor. This rule makes a lot of sense for most people who start working somewhere in their twenties and continue working through retirement. But, for us, we cannot capture the benefits of compounding interest. Therefore, we need to save far more than 15 percent. Fortunately, most of us can do so, given that our salaries are far from the average worker in the United States.

Buy No More House Than 25 Percent Of Take Home Pay With A Fifteen-Year Fixed Mortgage

On this point, we partially disagree. Dave Ramsey is not steadfast with this rule but recommends this protocol to his callers. Spending less on the house allows us the freedom to save for other events like college for kids or retirement savings. Nevertheless, many of us have rapidly rising incomes right after residency. And just because you are making a particular salary directly after you finish does not mean you will stay at that number much longer. Many of you will become partners and shareholders in practices and may have buy-ins that will temporarily decrease your salary. And, you may live in an expensive part of the country. With the expectations for increasing wages, you should be able to buy a bit more house based on a than 25 percent based on a reasonable expectation of making more money in the future. So, consider your future earnings when you buy a house so you don’t have to move twice!

Use Managed Stock Mutual Funds With A Great Track Record Instead Of Low-Cost Index Funds

Generally, most index funds beat managed funds over the long term as an investment vehicle. Dave Ramsey tends to say that his managed funds tend to outperform. But, for most, the outperformance is usually limited in scope and doesn’t last for long-term managed mutual fund holds. Furthermore, the fees in an actively managed fund tend to be a bit higher. So, consider opting for the lower-cost index mutual fund if possible!

Dave Ramsey Financial Advice Doesn’t Talk About Real Estate Syndications As An Option

Since we are high-income professionals, many of us don’t have the time or inclination to buy and take care of houses for investment. Additionally, buying stocks in taxable accounts can cause radiologists to pay significant capital gains and dividend taxes (as high as 33 percent or more if you include both federal and state taxes!). One excellent option he does not discuss is using private syndications and real estate funds as an investment tool for increasing wealth and cash flows and decreasing the tax burdens you might face with other types of investments. These investments can be low maintenance and strategies for building wealth for the high-income professional!

Dave Ramsey And Financial Advice

Dave Ramsey does a great job of spreading great information to the average financial media consumer. But no one is perfect, and personal finance is personal. Therefore, one talking head that generally gives excellent personal finance advice may not apply to your particular situation as a radiologist. So, although this show is entertaining and often relevant, do your due diligence when considering your options!

 

 

 

 

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Radiology Practices Feeling The National Radiologist Shortage Crunch!

shortage crunch

I can’t speak for everyone. But, nowadays, most practices throughout the country feel the pinch of an acute radiologist shortage crunch. For those on the job seeker’s side, the news right now is a mixed blessing. It is excellent for those of you searching for a job. But, once you set your career path, you may notice longer-term issues until the crisis resolves. Here are some of the problems you may encounter once you start working.

New Radiologists Making More At The Expense Of Future Earnings

Most of you probably see some of the advertisements for new radiologists on the web. Starting salaries of 400,000, 500,000, or more are not uncommon. But all this money needs to come from somewhere. Well, it is coming out of the pockets are practices, hospitals, or corporate radiology, to meet the coverage needs of the radiology work that needs completion. It just means that new radiologists are less likely to see the more significant raises they typically get when they achieve parity with the partners or own shares in the practices. Every dollar comes from somewhere!

Larger Stipends From Hospitals Means Increased Dependency

The lack of radiologists also means that hospitals are committed to ensuring that radiologists stay in the fold. Commonly, hospitals are issuing increasing stipends to practices throughout the country. Unfortunately, this process increases the dependency of radiologists on the hospital and not their work. So, when conditions change (and they certainly will at some point!), it can make it all the more painful when hospitals pull the rug out from the radiologist and stop issuing stipends upon leaner times. Eventually, hospitals are more likely to be able to take over lesser well-run practices. Too much dependency on other institutions is not ideal for the solvency of radiologists in the long run!

Unending Work And Shift Coverage

Sure, extra work is great when you are starting and are hungry for more business and money. But as you get along over time, the extra work is not so desirable. Many of you will likely have families and other obligations to which you will attend. Nevertheless, the streams of work keep on flowing to no end. And who will be covering all this work? Most likely you, whether you like it or not!

Shortage Crunch Increasing Long-Term Competition And Midlevels

I’m all for physician assistants, nurse practitioners, and other mid-levels to help the radiologist. However, suppose radiologists cannot meet the demands of the radiology world. In that case, different professionals will likely replace our roles due to a lack of ability to meet the needs of today’s imaging. These include increasing independent procedures and reads performed by these helpers. In addition, it also makes us more likely to lose work to other physicians. Cardiologists, urologists, and neurologists are just some physicians who would be happy to take over some of our business. Over the long run, this situation does not bode well for radiology practices.

More Films Going Unread And Increasing Liability

With the inability to command more staffing, more films will go unread. Patients will have more complications from a lack of appropriate imaging workups. And this can all lead to increased liability for radiology practices that are obligated to read all the films promptly. An incomplete workforce of radiologists hampers medical care and increases the potential for lawsuits!

The Shortage Crunch Continues! 

Although I do not have a crystal ball, I don’t see an abrupt end to this acute radiologist shortage crunch; The imaging loads increase every year with new technologies and the increasing age of our population. The numbers of new radiologists are not significantly increasing to meet the demands. And it takes ten years to create new radiologists starting from the beginning of medical school, so creating more radiologists is like turning a large aircraft carrier- it takes forever. Moreover, based on recent experiences with artificial intelligence, it has not replaced us or made us significantly more efficient. If these trends continue, we will continue to dive into the abyss of a shortage crunch. Good news, we’ll all be in high demand. Bad news, these pressures will probably continue for years to come!

 

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Not Sure What You Want? Private Practice, Hospital Based, Or Academic Residency: Find A Radiology Program With All Three!

not sure

Usually, I’m not particularly eager to toot my own horn. But, with the new merger of our three residency programs, we have established a unique situation that very few programs throughout the country can boast. Residents can now experience what it is like to work as a trainee in private practice, a practice with radiologists directly hired by a hospital, and an academic hospital, all under the roof of one residency program. Why is this situation so helpful for residents who have graduated from a program like this? Well, if you are not sure now, later, it can minimize the chances that, as a new hire, you will pick the wrong career path. And that decision can be challenging. Let me explain why.

Not Sure? Pick Among All The Experiences!

Private Practice Experience 

Welcome to our world. When you attend a residency with a private practice-based mentality, the program becomes very different than a standard residency program. Private practice’s priority is getting through a significant number of cases daily. Every study you read is extra cash in the group’s pocket (and yours too if you are a partner) So, we need to complete all the work as soon as possible. So, the main goal is to maximize efficiency. If you have a residency program associated with a private practice, you will see how this way of thinking affects your faculty. Around ninety percent of radiologists eventually go into some form of private practice. So, you must discover what you are in for when you get out of training! (Most residents have no idea!)

Hospital Based Experience

This experience is the most common for radiology residency programs. The typical structure is that the hospital hires individual radiologists. Perhaps, they have some form of incentives for efficiency, teaching, and participation in hospital committees. But, radiologists don’t get a specific piece of the professional or technical fee action. So, these hospital-based groups are more aligned with the needs of the hospital than the needs of the other partners. Therefore, in most of these sorts of practices, there is only a monetary incentive for getting the work done, no more than what the individual hospital contract asks. If there are no riders for reading other films, most likely, these employees will not read them without additional incentive. This structure causes a different mentality than the typical ownership mentality of private practice. Yet, it does have some alignment with the standard private practice in terms of primary efficiency goals.

Government/Academic Experience

Here is the typical large university center structure. In this structure, your salary is more based on academic achievement than efficiency for reading films. You get your raises and your bonuses based on academic grant production, teaching residents, and giving lectures at conferences throughout the country. Attendings in the situation will align with some private entities they are researching. And they will get some form of a stipend for studying their equipment, drugs, procedures, etc. Academic practices often do not incentivize efficiency as much as the other models. This mentality is not the real world for most radiologists, but those intellectual sorts will live like this. Some love the academic experience; others do not so much!

Not Sure? With A Wealth Of Different Residency Experiences, The World Is Your Oyster

Finding a residency program that encompasses all three experiences, private practice, hospital-based, and academic, allows the resident participant to get a feel for the world post-residency in most potential career paths. If I had such an opportunity, I probably would have stuck to one job post-residency because I would have known the practice scenario I would have wanted. So, if you have the rare opportunity to get a residency spot that allows you to experience all three ways of working, seriously consider it over others. It’s a great way to avoid the wandering situation where you work at multiple practices until you find the right one!

 

 

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Why Working From Hawaii Doesn’t Work For Most Of Us!

Hawaii

“The best laid plans of mice and men often go awry” is a famous quote that cannot be more true for us radiologists. I’m sure many of you have thought about what it would be like to work from a tropical island like Hawaii to read teleradiology cases several weeks out of the year in practice. Doesn’t sound too bad? How about reading evening studies and frolicking on the beaches with a Mai-Tai in hand in the daytime? Well, sorry to be the bearer of bad news; I will have to squash that thought for most of you. And here are some of the most likely reasons it won’t work.

It’s Still Relatively Easy To Hire Tele-radiologists

Although it is more expensive than a few years ago, if a practice has to choose between hiring overnight teleradiologists or a nighthawk and paying for a place in Hawaii for radiologists to read 6 hours every day, it is a lot less expensive to hire the overnight radiologist. Paying for a home for radiologists can be costly. And not everyone may want to go!

Not Everyone Can Get To Hawaii From Practice 

Believe it or not, if you create an outpost for radiologists to practice on a tropical island, not all of them can pack their bags and go. Some have families, and others have obligations that root these radiologists to the motherland. It is just not easy to get there for everyonee.

Additional IT Headaches

When creating a new outpost, you must ensure it runs well. The last thing a practice wants is a malfunctioning PACS system in a faraway outpost. That burden means the imaging business must pay for excellent IT support. And, with IT support comes additional expenses to maintain the site. Moreover, if the site goes down, other radiologists in the hometown will have to come to the hospital in the wee hours.

Billing Problems

Although not a complete game changer, with all the other issues, the location of dictations can create a headache for billing. Insurance companies do take into account the locale of the dictations. And this can make the process somewhat harder to get reimbursed. Let’s just add-on another issue to the whole!

Not Everyone Likes The Beach In Hawaii

Although going to Hawaii every once in a while to read some cases may sound great, not everyone loves the beach. Yet, your group will have to flip the bill for this privilege. Working from a beach location means you have to like crystal clear water and coconuts. What floats your boat may not be attractive to everyone!

Time Of Working May Not Be Optimal 

The time difference of 6 hours is not a reversed schedule. That means that when you go to bed at 10 PM EST, it is 4 PM in Hawaii. So, if you want coverage from 10 PM until 8 AM EST, you must go to work from 4 PM to 2 AM in Hawaii. Although better than working entirely overnight, it is not perfect for many radiologists. Some radiologists are early birds!

It Takes A Bit Of Extra Effort

Finally, creating another outpost outside your location takes some work and time. And most radiologists don’t want to have to deal with extra burdens. So, although it may be nice in theory, in practice, there are lots of other issues to worry about, first and foremost!

Nice Thought, But Hawaii Probably Will Not Happen In Your Practice!

Sorry to burst your bubble. I didn’t mean to put a kibosh on your hopes and dreams. Nevertheless, we need to be realistic. As you can see, all the headaches you need to work from Hawaii will probably not be worth the effort. Although a great idea, in theory, that’s another story in practice. If you like Hawaii, you may have to go there on vacation or work in Hawaii as your primary job!