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The Frustrations Of Starting Residency With Nuclear Medicine

nuclear medicine

Order matters. And when you are starting in a radiology residency, it makes the most sense to learn subjects logically to get the most out of your first year. First, start with rotations that overlap most radiology topics. Then, afterward, get a bit more specific and esoteric. Right? However, as often is the case, many chief residents and program directors only have so many open slots to fill the rotation schedule. And all of them need to get filled. One of those residents has to begin with nuclear medicine. Maybe that person is you.

So, from the mouth of a nuclear radiologist to you, why can beginning with nuclear medicine be such a frustrating specialty rotation? Well, let me give you some reasons why starting with this subspecialty can be formidable. And, then I will provide you with the information you need to resolve the issue!

Reasons Why Starting With This Subspecialty Can Be So Frustrating 

Some Nuclear Medicine Attendings Are Not Radiologists

Sometimes, especially in highly academic facilities, nuclear medicine attendings are strictly nuclear medicine trained. These attendings live and breathe a different world than the nuclear radiologist. They can’t take an overnight call as a typical radiologist would do. And, their perspective is very different from a radiologist. Not to say that they are not good doctors. But instead, you may not learn on that first rotation what you need to know to succeed in a radiology residency. Starting off the block in this situation can make your transition to radiology residency that much more difficult.

Lots of Cases Are Off the Beaten Path

In many nuclear medicine departments, most studies have less to do with the rest of radiology. For instance, many facilities perform an overwhelming number of cardiac myocardial perfusion scans. Sure, there is critical information on these studies. But, on-call, you may be very unlikely to see a cardiac perfusion case at nighttime. Or, you will catch lots of other more esoteric sorts of studies like gastric emptying to salivagrams. Although essential, learning these studies do not help much when you are taking cases at noon conference.

Need To Study Information Only Relevant To Nuclear Medicine

Finally, in nuclear medicine, you will need to learn lots of information only applicable to nuclear medicine. Learning about the dosage of radiopharmaceuticals will probably not help you much elsewhere in radiology. And, understanding radiopharmaceutical biodistribution, although critical to grasp the pathophysiology of a disease, in reality, will not go a long way toward helping you read a CT scan. This information takes time to learn and may replace the time you could discover other radiology topics. 

How To Resolve The Issues That Come With Starting With Nuclear Medicine

When starting residency on a nuclear medicine rotation, regardless of whether your faculty is nuclear medicine only or a radiologist, make sure to look at nuclear medicine with the lens of how what you see on rotation does overlap with other subspecialties. Even the lowly salivagram has some features that you may find on other imaging modalities. In this case, look at the neck CT and MRI. Check out the anatomy of what you see on the salivagram, such as parotid atrophy, inflammation, or stones. Or, for the cardiac studies, make sure to learn about the angiograms, the cardiac MRI, and the CT scan findings as well. If you stay isolated in your learning and thinking, you will find nuclear medicine more frustrating.

Also, make sure to start learning those areas that you need to know for an independent call. Understanding the relevancy will make it seem like what you are learning has more real-world applications. Check out hepatobiliary scans, V/Q scans, and GI bleeding studies first to increase relevancy. Learning to interpret these studies will have easily observable influences upon patient management. It will make you feel all the more relevant when you are first starting.

Finally, seek mentors and fellow residents who have been in a similar boat to you when you are starting. You are not the one who has had this issue. Other residents have done very well even after starting with nuclear medicine as a first rotation.

Nuclear Medicine Doesn’t Have To Be So Frustrating On That First Rotation!

Well, there you have it. You may not be starting as central to all of radiology as you might have liked. But, you can create an experience that is worthy of a great month. Just follow some of the steps I listed and above, and you will learn a lot and have an excellent experience!

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Benefits Of A Career At Your Home Residency Institution

home residency

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

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

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

The Resident’s Perspective

You Know What You Are Getting Into

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

It Feels Like Home

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

You Know Your Location Beforehand

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

The Program’s Perspective

You Know What You Are Getting Into

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

You Can Recruit For The Specialty You Need

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

You Can Choose Those Resident Features That Will Grow Your Practice

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

Working At Your Home Residency Base

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

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How Do I Find Hybrid Model Radiology Practices?

hybrid model radiology practices

Question About Hybrid Model Radiology Practices

 

Hi,

I just read the “Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money“?“. I am interested in the hybrid model for the same reason you mentioned and I love money :-). Also, I love teaching the residents. But I am not big on research, publishing, etc.

But I do not have any idea, and I do not seem to find any information about the hybrid model. Is it a rare breed? I am a PGY4 resident and working in one of the hybrid model radiology group led residency training on the East coast.

Any ideas about some of the hybrid radiology groups along the east coast or anywhere in the US?

Answer

 

Great question!

 

There are probably more hybrid model radiology type jobs than you might think at first glance. However, not enough such that it can potentially limit you when it comes to living circumstances/location. You may need to be flexible on where you eventually want to settle down if this is the type of practice you want. It worked out well for me at Saint Barnabas in New Jersey (Imaging Consultants of Essex), and it happened to be in a place that I wanted to live.

If I were to start looking for places with a hybrid business model, I would start by looking at community residencies throughout the country. Or, you can look at “minor” affiliate hospitals that have residents rotating through the department. These sorts of programs are more likely to house hybrid model radiology practices as well. Not all of these are private practices; however, Some will be hospital run practices, and others will be purely academic.

You can certainly give these folks a call and find out what kind of business model they follow. I believe that this sorting method will provide you with the most excellent chance of finding hybrid type practices. Like your residency, my old stomping grounds at Brown University/Rhode Island Hospital used to be a hybrid model practice. But, I think it has changed to more of a hospital-based imaging practice if I am not mistaken. Unfortunately, some of these hybrid practices have become hospital-owned for a myriad of reasons.

 Regardless, try this method out. I think it will help you find some of these sorts of practices.

 

Regards,

Barry Julius, MD

 

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Why Radiology?

why radiology

Interestingly enough, at this point, we at radsresident.com have published around 500 posts on all sorts of topics. Yet, I have never addressed why radiology might be the right fit for you. Strange. Well, better late than never!

Let me also direct you to my previous post on how I decided to go into radiology (which certainly was not a straight path!). As a supplement to this article, hopefully, it will allow you to understand that you can enjoy a specialty even though you may not know what you want to accomplish in your career yet!

Now, with all that background, we are ready to go through some radiology features that present unique reasons for new students to consider entering the field.

Intellectual Stimulation

If you like intellectual challenges, radiology offers more than most specialties. To this day, I remember presenting the topic of histiocytosis X (eosinophilic granuloma) as an internal medicine resident and hearing jeers from my general medicine colleagues because the disease was “too rare” for a presentation. Well, in radiology, we are all about the rare and unusual. That is what makes our specialty tick. We love our cases of eosinophilic granuloma, Henoch-Schoelin purpura, and more. For us, seeing all these zebras is not a burden but a reward. And, with the number of films that radiologists read in the tens of thousands per year, we are much more likely to see many of these rare birds than our fellow medical colleagues and specialists. Welcome to our world!

Flexibility- Business, Hours, Location, Etc.

Radiology has some of the most flexible working environments. If you want to work from home, you can. Want to read films from California yet live in New York? No problem. We can more easily work remotely than most other specialties. If you like late-night shifts, go for it. Or, if you want to own your practice, it is still possible. The world is your oyster and the flexibility and ways we can practice dwarf most other medical specialties out there.

As Much Patient Contact As You Want (Or As Little!)

We’ve got specialties like mammography, interventional radiology, radiopharmaceutical treating nuclear medicine physicians, and more for those who love to see patients. Yet, for every track with significant patient contact, several do not. And, when Covid-19 came around, some radiologists were as happy as a clam to sit on the sidelines. Others had the opportunity to become a central part of treating Covid patients. Regardless, all these possibilities can allow you to practice how you want without being drained by constant patient care or insufficient patient contact.

Lots Of Contact With Fellow Physicians

There is no doubt about it. We speak and consult with more of a smattering of all physicians than almost all other medical specialties. I talk to physicians in every subspecialty for cases I have read (even the occasional dermatologist and psychiatrist!). Most other specialties cannot boast about the wide range of medicine that we cover as we can.

You Don’t Have To Be All In (Like A Surgeon)

Radiology is one specialty that allows you to practice medicine without living and breathing daily. Unlike a surgeon who must be on all the time because of the hours and pressure, many radiologists can practice as little or as much as possible. I know many senior radiologists who read films a few days a week. Likewise, if you want, you can also work a ton. The opportunities abound!

Relatively Decent Compensation

OK. We may not make as much as some orthopods or neurosurgeons. But, we certainly make a respectable income compared to most other specialties. (Check out the Medscape compensation survey from 2020) Of course, that can change on a dime. But, as it stands now, we are in relatively good shape. If you compare the highest and the lowest-paid specialties, it has never been near the bottom!

Can Be Academic Or Non-Academic

Some medical specialties are conducive to either academic or non-academic medical practice. In ours, we have a choice. Want to become the “supersubspecialist” who writes tons of papers? Practice as a neuro-interventionalist or an academic pain medicine MSK radiologist, and you’ll have many opportunities to publish. Or, if you want to work as a generalist and never see a student again, go for it! In almost any radiological subspecialty, there are many opportunities to practice in either setting!

First Clinician Users Of High Tech

Finally, we often adopt new complex technologies before almost all the other medical specialties. Whether it’s artificial intelligence, new MRI contrast agents, better PET-MR equipment, and more, we usually get the privilege of operating these bad boys before anyone else gets a hold of them. And for the tech-savvy among us, it can be a dream come true!

Why Radiology?

Well, I think these reasons say enough about why radiology can be an excellent choice for you. Our specialty may be an ideal match if you like flexibility, intellectual stimulation, reasonable compensation, high tech, and many options. Think about it. And don’t let the primary care-biased medical school Deans sway you from pursuing this specialty if these are the career options that you want. As far as I know, you only live once!

 

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Independent Call: Which Radiology Residency Year Should Take The Most?

independent call

Call burdens can vary widely in residency programs throughout the country. You have those programs with the dreaded 2nd-year crush. Others distribute calls more equally. Some have the third and fourth years taking the majority of overnights. Whatever the case, each program weighs its independent call schedule slightly differently by residency year. Any program can choose to structure the burdens however appropriate. (as long as 1st years are not taking independent calls as per the ACGME guidelines.) However, educationally speaking, who should bear the brunt of coverage and why? Let’s go through some of the more common call structures and the advantages and disadvantages of the call’s different weightings.

Front Loaded Independent Call For R2 Residents

Although not the most desired distribution of calls by emergency room physicians, residents get the most experience early on in their residency with this structure. It allows the R2 resident to build the radiologist’s confidence early on to practice as a radiologist. This resident can take this experience and apply the rules to the remainder of their residency. As I always have said, you are not an actual radiologist until you have had a call, a venue where you can make independent decisions. Until then, you will always be a student.

Moreover, it allows the current 2nd years to have a cushier future R4 year filled with electives and mini-fellowships (assuming they have passed the core exam). It also gives the resident extra time to study for the core exam at the end of the R3 year. And it allows for time at the AIRP during the R3 year.

Back Weighting For R3 and R4 Residents

Theoretically, weighing the call to the R3 and R4 years gives residency programs the advantage of having their more experienced residents take the most overnights. But, there is a catch-22 to this philosophy. If you want more experienced residents, you must give them independence earlier! Just because you put more senior residents on call does not mean you are getting more experienced reads. Call itself is the most critical experience for building practical knowledge, not studying from a book or reading a faculty radiologist’s final reads.

Whatever the case may be regarding back weighting and experience, the experience of having more calls toward the end of the residency sets the resident up better for independent work and moonlighting in their fellowship or as a full-fledged radiologist. The recency of critical training prepares residents better for the practice of radiology. When you finish the fellowship, it is possible to complete all your calls during your R2 year and not work independently as a radiologist three or four years later. That situation might put you in dire straits for making independent decisions at your first job. By backweighting the call, this issue is no longer a threat.

Even Distributions of R2, R3, R4 Calls (As Much As Possible)

Of course, an even distribution is the least burdensome of call distributions. It allows the resident to experience calls without the burdens of doing them all at once. Moreover, an even distribution gives the resident some experience early on. And it allows the resident to maintain skills throughout the residency. Finally, it even gives the resident the confidence to know that she has the experience to function as faculty when done.

Although it is impossible to make any call exactly, even given the constraints of studying for the core exam and the AIRP, this distribution can benefit from early experience and late reinforcement.

A Program Director’s Perspective of Independent Call Weighting In Today’s Environment

As program directors, we have political and educational concerns when a chief resident gives us a sample schedule for overnight coverage. The program directors and the chief resident often do not have complete control over distributing calls throughout the residency. Sometimes, the emergency department requires more senior residents. Other times, individual rotations such as interventional radiology prohibit residents from taking calls. So, giving the resident the perfect “educational” call weighting during residency is not always possible.

Nevertheless, some call throughout residency seems to give the most balanced education. As much as the ABR leaders say the core exam shouldn’t interfere with this training, the core exam does. A poorly thought-out core exam strikes again! Until we develop a better system than the core examination to test residents, it will always prevent programs from having the optimal mix!

 

 

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Non-Traditional Student: A Disadvantage For Radiology Residency Application?

non-traditional

Non-Traditional Student Question:

 Hello, Dr. Julius!

My question is regarding the perception of non-traditional medical students during the radiology residency match process. I am a current MD student who is ten years older than the average admission statistic for my school with class rank and scores well within the published ranges for a successful match. Should I expect my non-traditional status to be an extra hurdle during residency interviews? If so, what advice can you offer to help ease residency directors’ concerns? Also, would you recommend addressing it in my personal statement?

Your thoughts on the subject would be much appreciated!

Regards,

Non-Traditional Student

 

Answer:

From my experience and I believe from most program directors’ experiences, your older age will be a plus at application time. I have found that non-traditional applicants tend to be more mature, precisely know what they want, and are more conscientious than their younger peers. Additionally, they tend to become less distracted by the minutia of a residency and are more goal-driven. You should never apologize for your additional years of wisdom. Instead, embrace it.

When you write your personal statement, you should expound on your vast experiences that a younger resident does not have. Remember, also, to check out my blog called How To Create A Killer Radiology Personal Statement. Honestly, though, I would not worry about your age either when you write your personal statement or at the interview time. If this was an average job on the street, age could be a detriment. But, in the world of radiology,  it is a plus, not a minus!

 

Respectfully,

Barry Julius, MD

 

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Do Board Review Companies Help With The USMLE?

board review

Not all students learn the same way. And, each method of studying has different pitfalls and benefits. For a distractible student, you need an isolated organized environment to study. And, a large group may not benefit this individual. As a kinetic learner, the action of performing a lab or dancing while reciting study material may allow you to absorb the material better. But, sitting in one place staring at a book may not work as well. My point is that board review is not a “one size fits all” activity. And I recognize that.

Moreover, in my experience, I have seen board review companies giving an unqualified boost to some test-takers in question. And, others who have not taken a board review course do just fine So, to answer the question posed on this post, do board review companies help medical students and residents with the USMLE, I will have to be a little wishy-washy and give you an unqualified maybe!

But if you are reading this post, what you are asking is will a board review company help me. And, perhaps, even more importantly, is the course a waste of money and time? So, another way to word the question would be, what types of medical professionals would and would not benefit from using a board review company? And, those are just the questions that I will answer!

Students That Benefit From Using Board Review

Residents Without Organizational Skills

What board review companies do best is to provide you with a routine and a defined way to study for the examination. They give you the material that you will need to make sure that you will pass the exam. For some students and residents, the course leaders’ material and the demands provide a bit more structure. Of course, a system and a routine can allow these test-takers to focus on studying for the exam.

Poor Test Takers

Some residents and ‘medical school students either develop anxiety or think too deeply about a question and perseverate for a half hour. Board review companies are good at making sure you understand the how’s and why’s of taking tests to improve your test-taking skills. What’s interesting about many poor test-takers is that they don’t necessarily translate into bad radiologists. In this situation, a board review company can provide a bit of a boost to your scores. It is most likely worth your time and money for that extra help if you consider how much more you will make in your lifetime.

Previous USMLE Low Board Scores Failures

They say that the definition of crazy is expecting a different outcome after doing the same thing again. Well, anyone that has not done well on a board exam beforehand should utilize the extra help to get you over the hump to increase your chances of acceptance into the radiology fold! Board review companies can help to change the way you study the next time around.

Students/Residents With Borderline Credentials For Acceptance

If you are a resident toward the middle or bottom of your medical school class, a higher score on Step I (Or now Step II USMLE with the new changes) can make all the difference between acceptance to residency/fellowship and rejection. Many residencies (and to a lesser extent fellowships) will use cutoffs in Radiology to ensure that the accepted class will pass the core exam. Why? Because there is a correlation between doing well on the USMLE exams and passing the core exam. And, a boost of only 5 points on your exam can make all the difference between capturing that interview and total rejection. It’s probably worth it to shell out that extra dough.

Foreign Applicants

Finally, if you are coming from another country, the programs will scrutinize your application more. Any advantage can help your case. If you have reached this far, you are better off taking a course even if it only increases your score by a few points. It may make all the difference!

Students That Don’t Need The Extra Help

Natural Born Test Takers

Yes. Some students and residents can take almost any test and pass it with flying colors. (Aren’t you jealous?) They have just mastered the art of examination to a tee. Based on the question itself, regardless of the information at hand, they can almost sniff the right answer. If that is you, then forget about board review. Save your money!

Honors in Every Course With Twenty Papers Already Completed

Check. Some folks have had an incredible academic record, and no matter what will get into the residency of their choice with or without excellent board scores. If this person is you, why bother to pay up for another exam?

You Get The Point!

I think you see what I am getting at here. Some folks don’t need to pay for that extra boost of a few points. It may not be worth the extra outlay of cash for those folks.

Board Review Companies Work Well For The Right Fit!

I know how painful it can be to shell out a bit more money when you already have umpteen gazillions of dollars of debt. But, sometimes, it is worth it to pay up for the additional help, especially if it may mean the difference between having a long career in the specialty you want. Having a guide that can get you through the pitfalls of studying for these tests is invaluable for the right sort of test-taker. So, consider where you stand and decide if it is right for you. Here are some of the more frequently used board review companies below that my residents have used to help you along with your decision. You can click on them if you are interested. I am an affiliate of both! (Princeton Review currently has a discount that expires on September 3!)

 

 

 

 

 

 

 

 

 

 

 

Academic Tutor LOL (24 hrs) – $180 Off!

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

malpractice tail insurance

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

What Are The Different Types Of Malpractice Insurance?

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

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

Malpractice Tail Insurance- A Gap Filler!

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

How Can Practices Weaponize This In A Negotiation?

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

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

The Key To Knowing About Malpractice Tail Insurance!

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

 

 

 

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Going Through A Covid Surge? It May Help Your Career!

surge

Yes. Covid-19 has been an epic disaster. But, in any emergency, opportunities arise. And a new Covid surge is no exception. Sure, the hospital may curtail or delay some of your training in radiology. However, this pandemic affords you other chances to establish a reputation for yourself in your hospital and community. And, you will learn other clinical skills that are just as critical as radiology. Demonstrating your prowess in these dark times can lead to unforeseen possibilities in the future. These opportunities can prove themselves more valuable for your future than you might think at first glance.

So, what are these potentialities that I am referring to? Your experiences and performance during the Covid era can lead to job openings, better recommendations, networking, improved clinical skills, better awareness of the community, and more if you play your cards right. Let’s talk about how.

Increased Contact With Hospital Administration

In a typical environment, most residents have very little to do with the hospital administration. At the beginning of the first year, they may hear a few words from the executives to introduce them to the hospital. And at the end of the last year, they help to hand out the diplomas. That’s about it. But, in many departments, this paradigm has shifted.

Now that you are providing a service for the hospital under extenuating circumstances, you are more likely to have the ear of the administration. If you ever want to start looking for a job in the hospital and perform well, they will more likely remember you when the time comes to search. Even better, if you ever want to look for a career in hospital administration, there is no better time to prove your worth and team-building skills than now.

Better Recommendations

Tough times call for more teamwork. And, what better way to get to know your attendings than a stressful situation such as this? In actuality, faculty are more likely to get to know their residents when you are in close contact. You are no longer just another resident! And, this will show in the recommendations that you receive.

Increased Intra-Departmental Networking/Learning

Since you will most likely work with different teams of subspecialty physicians throughout the hospital during a covid surge, you will get to know your colleagues better. Believe it or not, cross-currents of learning and insights into other specialties also help with becoming a better radiologist. It could be pulmonary, cardiology, or pathology. All subspecialties overlap with ours!

Just as critical, establishing relationships with other physicians that you would never have seen as a radiology resident, will make you more valuable. Who would other physicians instead refer patients, a radiologist that they know well, or someone else?

More Awareness Of Clinical Medicine

Sometimes in radiology, we can grow farther away from the real reason why we went into medicine in the first place, to help patients. Having more direct interaction with patients, even in an unforeseen emergency such as this one, can lead us back to our clinical roots and remind us why we are radiologists in the first place. It allows us to rehone our clinical skills that will come in handy later on as an attending.

Getting To Know The Community

Some residents go to residencies based on the quality of the program alone, ignoring the community. However, you also serve a community, and sometimes getting into the clinical nitty-gritty can allow you to understand the patient populations for which you work. If you doubt the importance of your role in helping out the community, look at the media presentation of healthcare workers. Typically, they present all of us (even radiologist residents) serving the hospital as heroes. Heck, in our community, the leaders hosted a parade for the folks at the hospital to demonstrate their appreciation. So, if you think that you do not influence the community, you are dead wrong. Getting back to these roots will allow you to appreciate once again where you work!

Time To Prove Your Mettle During A Covid Surge!

I know. You may not have bargained for these circumstances. However, there are always a few golden nuggets that we can take away in almost any bad situation. So, even though you think there is no value to having work other roles in a surge, it may be more helpful to your career growth than you think!

 

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Check With Your Faculty Before Letting A Barium Patient Go!

barium patient

Barium slinging is harmless, right? I mean, what’s the big deal about letting a patient go after you complete a standard esophagram or barium enema? How often have you, as a resident, completed one of these studies without checking the results with your attending, only to let the patient go home right afterward? I bet most of you have done so at one point or another. If there is any complexity in the case whatsoever, I would think twice before letting the barium patient leave before checking it. Why? Well, for lots of reasons. And I will divide them into the following broad categories, legal, lack of experience, extra scrutiny, patient-related issues, and lack of insight into history. Let’s go through them one by one.

Legal Issues

Residents are not the final interpreters of any study, whether it be a plain film, CT scan, or ultrasound. Additionally, distinct from most other imaging modalities (except for ultrasound), the resident is responsible for showing and carefully examining the findings. If she does not technically demonstrate the findings based on history, the study becomes useless to the ordering physician. Consider the resident not spotting the terminal ileum in a small bowel series for inflammatory bowel disease. Or, maybe he doesn’t complete a cine of the upper esophagus in a patient with dysphagia. Who is responsible for the lack of information targeted to patient history? The attending, of course! Just read this AJR article about barium enemas and malpractice, and you will think again. Radiologists are liable for the missed interpretation based on resident imaging!

Relative Lack Of Training

When barium slinging was more common years ago, it used to be one of the more litigious radiology areas. Just like mammography, you could easily miss all sorts of colon cancers, ulcers, and more. Typically, it would take years of experience to develop the trained eye to find these abnormalities. Don’t think that barium work is easy, so much so that you can blow it off as a low tech waste of time. On the contrary, one inexperienced resident may not be enough to catch the pathology that you will need to find. There is hubris in thinking you know more than you do! Moreover, think of this opportunity to go over the case as an additional learning opportunity to become better.

Second Set Of Eyes

On that same notion, having a second set of eyes can be a critical adjunct to making the finding. It’s like breast imaging. Often, the ultrasound technologist cannot find a blessed thing corresponding to the patient’s lump. But, as soon as you, the physician, walk into the room, WHAM! It’s right in front of your face as clear as day. Sometimes, you need that second set of eyes to get you out a particular mindset. It’s worth it.

It’s A Big Deal To Bring The Patient Back

Finally, if you miss looking for a finding on the study, the patient may not return so quickly, especially as an outpatient. For instance, in the patient population with dysphagia, many of these patients may come from rehabilitation facilities or nursing homes. Did you ever think about how hard it was to get the patient to the study in the first place? Or, maybe the person has a hectic job and made special arrangements to complete the procedure. Now, you need to bring the patient back. You may not think so, but it can become a huge issue!

Check With Your Faculty Before Letting The Barium Patient Go!

Don’t take these studies for granted. Allowing for these studies to go unchecked can cause all sorts of trouble, including legal dilemmas, missing findings, and having to bring unavailable patients back for more imaging. So, please, if you are on the fence, think twice before sending that patient home without having your attending check it. It could be lousy patient care!