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A Review Of Med School Insiders Insights Into Radiology

med school insiders

If you are like me, I am an avid youtube fan. Since it is in my wheelhouse, one of the topics I occasionally search for is radiology (in addition to astronomy, Ukraine, and guitar lessons!). And as I was surfing the YouTube world on these topics. I hit upon a series of videos with the hypnotic voice of Dr. Jubbal from Med School Insiders, a business that caters to students who want to enter the field of medicine. Many of these videos claimed to review Radiology as a field, including salaries, types of residents, the culture, and more. But does that mesmerizing voice have it all right? Or, is much of what Dr. Jubbal says about radiology a farce? Here is a review of the world of Dr. Jabal, and Med School Insiders impression of the field of radiology and whether he gets it all right.

Salaries- In The Middle Of The Pack?

The videos emphasizing radiology talk about salaries and consistently talk about radiology as somewhere in the middle of the pack. That phrase can be very misleading. As someone within the field, knowing where we stand in the salary ranking, I know that salary is highly dependent on where you work, whether you are in private practice or academics, and a slew of other factors. Based on my own experiences with these factors, radiology has been more consistently toward the top of the salary distribution on average than most other specialties. But, of course, it is possible to find a lower-paying radiology job.

Med School Insiders Talk About Artificial Intelligence

This factor is where Dr. Jubbal gets it wrong. He uses artificial intelligence as a risk for new students entering radiology. Artificial intelligence has consistently been underwhelming for most radiologists out there as a way to replace radiologists. The best CAD detectors for mammo and lung nodules have consistently underperformed expectations. The biggest problem with artificial intelligence is that there are always new data sets that the researchers have not inputted into their algorithms. And, any independent reads by a computer will not be able to take these myriad factors into account for a very long time. I don’t see any chance of it taking over a radiologist’s job for more than fifty years from now.

Even if artificial intelligence becomes more successful, radiologist numbers  are still way too low relative to the amount of work out there. Artificial intelligence may even boost efficiency to get more done in less time, enabling radiologists to do more with less and increase earnings. (That would be a good thing) Artificial intelligence, therefore, is not much of a risk at all to the profession. Sorry, Jabal!

ROAD/Flexibility

Dr. Jabal constantly adds radiology as part of the lifestyle specialties. Sure, we have one of the most flexible specialties regarding work location, shiftwork, and type of work. However, many of us have become insanely busy because we are replacing a lack of physician staffing elsewhere, i.e., emergency medicine, family medicine, etc. For this reason, patients will often get pan-scans without being seen by clinicians first. So, many of us have become very busy trying to keep up with the demand. So, I’m not sure we belong on the ROAD list anymore!

More Introverted Specialty

On this subject, I would have to agree on a bit. Although I know lots of radiologists who are very outgoing and personable, many radiologists would prefer to work alone as well. In other specialties, this introversion does not fly as well when you have to see tens of patients daily—seeing patients could become exhausting for an introvert. Radiology is a way to avoid the constant bombardment of patient contact. (Of course, it does not have to be that way!)

Competitiveness

Here is another area where I would have to agree with Dr. Jabal. Although the trends have become more competitive lately since COVID, we are certainly not as competitive as dermatology or orthopedics. We place somewhere in the middle of the pack, maybe a bit more toward the upper end of the mid-tier lately. Dr. Jabal seems to emphasize a similar level of competitiveness, somewhere toward the middle of the middle, That ranks close enough to the mark.

Doctor Jubbal, Med School Insiders, And Radiology

So, yes, Dr. Jubbal does toot his own horn as he had formerly trained as a plastic surgeon and subtly suggests that plastic surgery is the epitome of being a physician. If you can get past that, he does get some impressions of radiology right, especially the appeal to introverts and the general competitiveness of radiology. On the other hand, he misses the mark a bit for others, such as salaries, artificial intelligence, and the ROAD concept for radiology. But, overall, he does not do so badly. His youtube segments are enjoyable to listen to and can help residency applicants in general. My advice, though, is never to use one source for anything. And try to find mentors in the residency space within your specialty of interest. The best advice will come from physicians within the area of training where you want to apply!

 

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Why Rapid Speech Can Destroy An Interview!

rapid speech

Rapid speech is prevalent when people are in unfamiliar situations. I, myself, tend to talk a bit quickly at times. But an excellent radiology residency interview can turn into something else if you don’t remember to take down the speed of speech a notch or two. We have seen it all too many times. Here are some reasons you should listen to yourself, pace your speaking, and prevent yourself from rapid speech with your interviewer at the speed of light.

Flight Of Ideas Suggests Lack Of Focus

Whether it may or may not be accurate, when you sputter, it implies that you may have difficulty concentrating on one topic at a time. Or, otherwise, this mental state we call a flight of ideas. Residency directors do not want residents that cannot focus on studying, reading films, and performing procedures. All these parts of radiology residency take tons of mental energy and focus. All this ability is cast into doubt when you are speaking rather quickly.

It Might Be Very Difficult To Understand

When you speak quickly and do not enunciate your words well, your speech can become very difficult to understand. Sometimes older folks have an even more challenging time comprehending what you are saying because their hearing is not as good. Regardless, if you are hard to understand because you are speaking so rapidly, imagine what might happen when you have a team of surgeons expecting a verbal wet read. Will you keep on talking incomprehensibly? These thoughts are, first and foremost, among the faculty interviewing you!

Rapid Speech Can Give Your Interviewer An Unsettling Feeling

Have you ever tried to interview a patient with hyperthyroidism? Many times you can’t get a word in edgewise. Why? Because all that thyroid hormone circulating in their system causes elevated metabolism, a rapid heart rate, and pressured speech. Moreover, a conversation usually involves a bit of give and take. In this situation, it is very unsettling to have a conversation with someone that barely lets you respond. The interviewer will most likely be trying to imagine what it would be like to have someone next to them for hours that didn’t ever stop yammering! This trait is not favorable for a radiology resident!

Trying To Hide Something?

In our culture, we perceive those that speak fast to be hiding something. It could be a personality flaw, an issue, or a problem with the application. Regardless, rapid speech could portend deeper issues with the interviewer at hand. We want our candidates to be open book and easy to approach. So, jabbering can destroy the impression that you are trying to make.

Rapid Speech While Interviewing

Talking too quickly is something that you can easily correct, but you will need to think about it and be deliberate. Listen to yourself by taping a mock interview with your colleagues or family on your smartphone or computer. And play it back and see how fast you are talking. If you find yourself hard to understand or with a bit of pressured speech, dial back your speed at the following conversation/interview. And be aware of the pace of your speaking. Although not harmful in and of itself, talking quickly can leave an impression of a lack of focus, incomprehensibility, unsettling feelings, and ideas that you may not be forthcoming. And this is an issue that you can quickly repair. So, fix this issue before you get to your following radiology interview. It can make the difference between achieving a spot in your desired program or not!

 

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Overcoming Radiology Research Writer’s Block

writer's block

For some residents, coming up with great ideas for radiology projects may seem next to impossible, especially when starting. Maybe you are less than a year out in training and don’t know where to begin. Or, perhaps, you are just unsure how to come up with excellent ideas that the journals will accept. Regardless, given that I have written extensively on this blog and written multiple papers, let me tell you how I find ideas that will work and interest your audience. Here’re some of the basic techniques I use to overcome writer’s block!

Have A Writer’s Mentality

If you are not hunting for ideas during the daytime when you are working, you will not find the next great project. Whenever I look at an interesting case or have a great discussion, I will think about whether there is some way to make it into an article or a great project. My philosophy is that the best projects are those that fascinate me or cause me significant irritation during the daytime. Maybe, you are very interested in a particular procedure or topic that will often spark your interest in a project. Or, if you notice a problem with the institution- that could be a safety project. Constantly keep an open mind, and you will easily find many potential ideas for your following excellent paper!

Keep A Record Of What You See

Nowadays, almost everyone walks around with some form of a cellphone. You can quickly turn that device into a mini-journal. Whenever I talk to residents or am sitting down looking at images, in the back of my mind, I will write down ideas and cases that I think might work for the following article. It could be an interesting comment, thought, or case study. Regardless, write it down. Often, you can convert that thought into something more substantive later on. But keeping a record is always an excellent starting point. If you don’t write it down somewhere, you will forget about it later.

Contact Your Mentors To Avoid Writer’s Block

Whether it is your fellow chief resident, faculty, or chair, let them know that you might have an idea that will work for a journal article or book. Bounce the idea off your colleagues. Many have been through the process numerous times and can guide you to take an angle you might have thought about before. Or, they may say that others have already pursued that idea. Your mentors will know best because they have been through the process many times before.

Also, your mentors can guide you toward other folks that may be able to help you with the process. Perhaps, your institution has a statistician that everyone uses. Or they may have some research coordinators. All these individuals can help you along the way to hone your ideas.

Find An Angle

Maybe you have already come up with a great idea but are not sure how you will put pen to paper. In this situation, I usually like to think about how the topic would not only interest me but would catch the attention of others as well. You could twist or reverse the idea by taking a fresh approach. Many ideas die, not because someone else has already pursued them but because they have not taken a new direction. Perhaps you can look at it from a different population standpoint, more significant numbers, or even by adding other possible associations. All these add-ons can lead to something fresh and new from what researchers have already done.

Overcoming Radiology Writer’s Block!

Maintaining the proper mindset and creating a system is the key to overcoming writer’s block. Simple processes such as keeping projects in mind, writing ideas down when you have them, contacting others who can help, and thinking about a different angle are simple ways to prevent writer’s block from creeping up on you. These are the systems I practice every week when I write this blog (approaching 500 articles!) and they also work for creating research studies. So keep this advice in mind, and you will become a prolific writer too! 

 

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Don’t Let Significant Life Events Interrupt Residency!

significant life events

Many of you are guaranteed to have significant life events during your four years. Marriage, family crises, car accidents, and sickness are all part of life. And a four-year period of time is a large enough amount for something huge to change in your life. But, with the daily grind of residency, all these life events can become significantly more complicated. Who has time to be able to leave work at a moment while you are dealing with of myriad of possible life issues? So, what are some of the primary steps you can take to prevent your life from interfering with your work? How can you make sure to preserve your integrity within a radiology residency while these events happen during your radiology residency? Some of these obligations seem like common sense, but this is an excellent checklist for radiology residents. These steps can be easy to forget when life throws you a curveball.

Notify Relevant Faculty

You may be in an uproar because of a challenging event. However, most of your faculty will be understanding. If you are not going to be around because you need to go to court or a funeral, most faculty and attendings will understand. Additionally, you won’t be leaving them in the dust when you don’t show up for work at that time.

Get Coverage

By that same token as above, if you are not going to be around, try to find someone that can take your place if you need coverage for whatever rotation you are on. Now that you are a resident, you need to take responsibility for your actions, and getting coverage shows that you can handle the job.

Find Times That Don’t Interfere With Patient Care

OK. It is certainly not possible to change the time of a funeral. However, you can usually make many critical phone calls, heated conversations, and necessary appointments at times that don’t interfere with patient care. It is merely polite and appropriate to do so. Imagine you were the patient on the other end listening to a personal phone call from your doctor. That whole situation could be a bit embarrassing.

Try To Plan Events With Significant Notice

You can plan some significant life events with notice. Marriages, engagement parties, and meetings to discuss a will don’t have to occur in the middle of a typical workday. Try to plan these events well in advance, so they don’t have to interfere with your training and patient care.

Don’t Assume Everyone Knows Your Significant Life Events

When you are stressed out, not everyone may appreciate your situation. If you feel comfortable telling your colleagues and staff what is appropriate to divulge, let them know what is happening. Most folks will have some empathy for what you are going through at the time. It may even bring you closer to your residency. Most residencies are kind of like a family. Conflicts can arise when people in the family don’t know the issues.

Stay At Home If It Is Needed

Especially nowadays, since the beginning of the COVID pandemic, most faculty have become more sensitive to the issue of staying home if sick or can’t function appropriately at work. And, every once in a while, there is nothing wrong with taking a mental health day. If it makes you able to come back to work soon with renewed strength and attention, it may be worth the day or two that you need for yourself.

Dealing With Significant Life Events During Residency

Four years is a relatively long time to be anywhere, let alone a residency. And personal disasters and happy life occasions/milestones are destined to occur. Some of these events will distract you from the focus of your training. Nevertheless, try to mitigate the effects by following some of these guidelines. Simply telling folks the issues, getting coverage, and finding times to take care of business can make a difference. Following these guidelines allow you to look responsible. And they are ways to ensure that your residency will run more smoothly and without bogging you down with miscommunications and problems during radiology residency. Life interruptions don’t have to ruin your residency experience!

 

 

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The Art Of The Last Minute Radiology Deal

last minute

Ever notice how most big financial deals are settled, not years or months before the deadline, but only a few days, hours, or minutes until the final click of the clock? Whether it’s the federal government’s budget, car purchases, or buying a house/investment property, the definitive signature and finalized contract only takes place at the 59th second of the last minute, right before the deal has to be done. Settling for a new radiology position or a contract with the hospital as a radiologist is no different. Many radiologists expect they will not have to play this game because they are physicians and not subject to the vicissitudes of the business world. Nothing is further from the truth. This dance is merely how businesses, including imaging practices, complete large financial packages. And, as we are part of the business world in the imaging world’s eyes, you should expect the same.

So, what are some last-minute items you should negotiate when you sit down at the table to create your final package? When and how should you walk away from the table to whet the appetite of the other party and enhance your party’s circumstances? We will divide the conversation about negotiating into two separate parts, the individual and the hospital. Let’s talk about the art of the last-minute radiology deal!

Nailing The Best Last Minute Radiology Package

Generally, the contract is partially negotiable when you finally go through the interview process and receive your offer in the radiology world. At this point, there is a bit of give-and-take with your future employers. Typically, the first parts to settle are the salary structure, years to partner, vacation time, and some of the oversized line items within the contract. Some of these items may be immutable, but what can you leave to the end so that you can harness the best deal possible?

Moving Expenses

Most practices will flip the bill for this service for two reasons:

  1. It is a tax-deductible expense for the business.
  2. It ties the applicant to the imaging company because they will need a residence close to the job. In all my positions after fellowship, moving expenses were available as an option paid for by the practice.
  3. You can request it at the last moment.

Malpractice Tail Coverage

Typically, most malpractice insurance companies do claims-made coverage. And, if a plaintiff sues after you leave the practice, you will still need malpractice coverage. This detail is where malpractice tail coverage comes into play. If an imaging business wants you as an employee, they may very well tack this bonus onto your contract at the last moment.

Percent Working At Specific Roles

Nowadays, there are fewer and fewer generalist radiologists. So, you may not want to practice mammography if you had little experience of comfort in the modality during residency. So, practices will often accept additional clauses securing the percentage of time that you want to work in a specific modality, especially if they need this service anyway. You can often easily tack this stipulation onto the contract at the final moments.

Getting The Most Out Of Your Hospital Deal Last Minute

Similar to negotiating as an individual for a position, often, you may play the role of negotiating a contract with a hospital. The extensive line items usually come first, like contracts, the functions that the practice will need to fulfill, etc. But what are some other critical parameters you can negotiate at the end?

Separation Clauses

Sometimes the deal does not work out the way that both parties expect. Therefore, you may want to find a way for the hospital and practice to part without too much hardship. This separation clause is a stipulation that may not seem important at the time of the deal signing. But, it is critical to have an out when things go south. So, it may not be the priority, but it is something that you can negotiate later on.

Support For Other Services (Chairman, etc.)

Some radiology services can be very costly but not considered at first glance. Here is where you can negotiate for extra support. Line items such as residency management, chairmanship, or other ancillary roles are some examples of fees that the institution should pay because they don’t come for free. These are great add-ons at the end of the deal.

The Art Of The Last Minute Radiology Deal!

Consider these line items to add to the contracts you might negotiate. Of course, they may not be the first items you would consider when starting a negotiation. But, they can be critical add-ons once at the end of the talks that can make a significant difference in your final contract. Every little bit counts when you are about to strike a deal in your favor!

 

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What Was Radiology Life Like Without PACS?

without pacs

I may be dating myself, but I am the last generation that did a radiology residency without PACS. Yes. I lived and breathed the pre PACs era. Some of it was pretty good. And, other parts of it, not so much.

Nevertheless, radiology was very different before hospitals started to add these systems to their networks. So, what are some of the most significant changes I have seen throughout my career when I compare the two eras? What was life like before the advent of PACS? Let’s go through some of the most critical differences in radiology.

Many More Films Got Lost Without PACS

On any given night, you would expect a good percentage of cases to remain in absentia without a dictation. Unsurprisingly, the orthopedic surgery residents would stealthily slip into the reading room when the radiology resident stepped out. And this person would steal the films so that the surgeons could use them for orthopedic surgeries at nighttime. Or, the alternators (the old defunct machines that you might see in the back of a reading room somewhere nowadays) would suck up several films, and they would get lost in the device or even shredded to pieces. Many cases would simply no longer be available for dication either for a delayed period or never. Film loss was just a fact of life. Nowadays, it is only the rare irretrievable case that you will need some help with from the IT folks.

Saw A Lot More Clinicians

Today, our reading rooms fill up with primarily residents and a smattering/skeleton crew of a couple of attendings. Back in the day, the reading room was hustling and bustling. Surgeons, Ob-Gyns, and more would regularly show up to look at their cases with you because they couldn’t look at them themselves on a PACS system. You got to know each clinician by name and personality. It was more than just a tryst in the reading room. Of course, that came with the upside of meeting great physicians and the downside of discovering a few jerks here and there. Nevertheless, the reading was much less of a lonely place. And, you would learn about the final disposition of cases more often because we kept in close contact with our physician brethren.

Had To Produce Your Films For Case Conferences

Have any of you ever encountered a dark room? Back in the day, it was a regular event for radiologists. We would have to develop our copies to present for case conferences. It was a big deal and somewhat time-consuming. But, we all got to know this haven of darkness every so often. It was much more intricate than just downloading a case on PACS or snapping a picture on an iPhone for a presentation on a Powerpoint. These technologies were available but still uncommonly used at the end of the pre-PACS era. It was a pain in the-you-know-what!

Priors Were Less Common

Getting priors was a real pain in the neck back then. We would somehow have to go down to the file room and retrieve them. Therefore, we would dictate many more cases without them because they could be hard to come by. So, you could imagine we lost some specificity and sensitivity in these dictations. And, then, when you did retrieve the priors, you would receive these enormous folders where you had to find suitable films. You would be lucky if you didn’t get a paper cut in the process. (They were much more prevalent back then and hurt like hell!)

Less Windows Available Without PACS

Nowadays, we click a button and re-window a case. Back then, you couldn’t look at the bones if you didn’t have the bone windows on film. So, the techs would print fewer windows to save on film. Often, if the reason for the study had nothing to do with the window, you would not have them available to read. I’m sure we missed tons of osseous lesions!

Keep Lists Of Results On Overnight Cases

Instead of having a PACS system to look cases up, we would have to keep a running tab of the patient studies we read, especially on CT rotation. Clinicians would come down and check out the results on the list and chat with the resident. Every room would have a list of cases from the previous night. Eventually, they would make their way onto the Radiology Information System. But until then, the responsibility was ours to keep tabs on everything in the reading room.

Working From Home, Ha!

And finally, working from home was a figment of one’s imagination. We needed to perform all reads and procedures in-house. Imagine being unable to take off to let the Verizon folks fix something in the house. That was our world. We lived and breathed the hospital in those days!

Radiology Life Without PACS

We lived in a different world back then. Radiology lifestyle and culture have changed dramatically over the years since hospitals have installed PACS. Yes, we had more contact with other physicians, but it came at the expense of many problems. Nevertheless, although mostly better today, some good did happen before hospitals introduced PACS to our world. Would I want to go back to those times? Probably not. But they were a great experience that new radiologists cannot imagine today!

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Top Ten Signs You’re Not Ready For Call

ready for call

Last week we discussed the Top Nine Signs You Are Ready To Take Call. So, I figured I would not do justice to the topic of being ready for call without also creating a list of those signs that you might not be ready to take radiology overnights. Therefore, I have dedicated this list to those that think they are ready but are not. Maybe this is you? Check it out if any of these signs apply to you!

Never Double Checks Anything (Anything Goes!)

Our words matter, and anything that you say, the ER can use against you later on. If you recommend another test, guess what? You will probably get that test the same night! So, the resident who never checks their dictations to make sure everything makes sense and is corrected is in a world of hurt.

Anger Management Issues

If you constantly fight with your fellow residents or, even worse, your faculty, you probably need to settle down a bit before taking overnights. Ready residents can control their anger and not take it out on others because they know what they are doing. If you are in the former category, think about why that is!

You Repeat The Nighthawk Dictation Verbatim

If you rely on the nighthawk dictation as a crutch, it probably means you are not ready to strike it out on your own. You should go through every case as if it is new, even if another radiologist has already dictated it. You never know what they are going to miss. And, you certainly don’t want to miss the same things!

Never Looks Up History/Priors/Call For More Information

If you think you know it all and don’t ever need additional history or the need for priors, you are in for a rude awakening. The number of findings that you miss will be incalculable. And, you will miss the point of your imaging studies more often! It is one surefire way to mess up your cases at nighttime!

Assumes The History Is Correct And Relies On It Explicitly

Using history as a crutch is an elementary mistake that can lead to disaster. I can’t tell you how often the ER calls for hepatobiliary scans to rule out cholecystitis, even though the patient doesn’t even have a gallbladder! We need to check and recheck our work and compare it to priors to ensure we are doing a good service for the patient!

Disorganization And Routinely Forget Cases

If you forget to read films or complete your work during the daytime, do you think you will remember to finish everything at nighttime? Disorganization can lead to disaster. You can wind up dictating the wrong case on the wrong patient if you don’t watch what you are doing. So, get yourself into shape before starting!

Cannot Get Through The Daytime Cases on Time

It’s not just accuracy that matters at nighttime. Speed is critical as well. And, if you cannot get through work during the daytime, what makes you think you will get through everything at night? Cases will often come in batches, and everyone needs a timely report when this situation happens. Make sure that you are up to the task!

Only Knows The Aunt Minnie Diagnoses And Never Scrolls Through Cases

There is a big difference between knowing the diagnosis based on a solitary image and having to make your finding on an entire case that has hundreds of pictures. If you think you can get through your studies without the experience of scrolling through lots of cases, you will have lots of problems when you have to make all the findings at night.

Unintelligible Dictations

Do your attendings always tell you to edit your dictations because they can’t understand what you are trying to say? Well, listen to these folks very carefully. Dictations are the final product of what radiologists do. And, if you cannot say something intelligible, you have no business being on call!

Lack Of Rigorous Search Patterns

Every resident needs a rigorous search pattern when they are working at nighttime. Lacking a search pattern is a recipe for missing all the critical findings. If you never look for the spleen, you will never know it is absent. And so on. Hone in on your search pattern skills before starting to take call!

Are You Not Ready For Call Yet?

If one or more of these signs describes you, you may not be ready to take your first call. However, there is still a bit of time. So, go ahead and make adjustments before it’s too late!

 

 

 

 

 

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Top Nine Signs That You Are Ready To Take Call

take call

Are you wondering if you are at the level of a second-year resident, ready, able, and willing to handle overnight shifts independently so early in the year? Here are the top nine ways you know if you are prepared to take call!

Methodical Thinking/Search Patterns For Each Imaging Study

Do you have a search pattern for every case you attempt to tackle? When reading a CT scan, you should have the same search pattern for every study, including abdomens, necks, heads, legs, and more. Do you have a specific way you approach each of the sequences on an MRI? This approach is the minimum for starting as a resident on call!

Know When To Get Help

If you are not sure about a finding, what do you do? To answer this question, if you are ready for overnights, you will not blurt out the first idea that comes to your mind. Instead, maybe you will contact the ER physician to get more information or do a google search. Knowing when you don’t know something takes maturity and poise.

Don’t Get Too Shaken By The Mob

It’s always tough when you have a team of tired surgeons hanging on your every word. And they want a STAT read yesterday. Nevertheless, you have the confidence to plow through any case with a stream of eyes and ears watching your every move. They will have to wait until you are ready to give them your impression!

You Know All The More Common Disease Entities And Findings That Will Kill Patients Or Cause Severe Morbidity

If you can make the findings of a patient with diverticulitis, aortic ruptures, bleeds, pneumothoraces, and more, you are more than halfway to your goal of taking call. When taking cases independently, these entities should be on top of your mind. And, you should be actively looking for them when you take any study. Those that do will be unlikely to make any significant misses!

Can Tell Normal Versus Abnormal Fairly Quick

When you have seen enough cases, your brain can tell if an image is normal or abnormal before you can verbalize what the problem might be. You have already trained your brain to know what the general findings of a normal case should be. Therefore, you can look at almost any study and know that you should pursue it further if you assess it as abnormal!

You Make The Findings Before Your CT Attending Does

This one is not a requirement. Nevertheless, it is a good sign. If you can make the findings before your faculty member does, you have already been preparing for the time you would start to take calls. Kudos to you!

Notice A Sigh Of Relief When Your Attending Knows You Are On

Knowing when you are wanted can take a bit of emotional EQ. But, if you notice that your attending’s blood pressure drops by a bit and calms down when you arrive in the morning to work on the day’s rotation, this is generally a good sign. You have your faculty trained to know that you do good work.

You Get Phone Calls From ER Physicians To Ask Your Opinion

You are probably doing a fabulous job if you are getting phone calls asking for you by name because they like your reads. Most ER physicians will not actively seek out a junior radiologist instead of faculty to see what you think. You should be honored that they respect your judgment!

Seasoned Technologists Actively Look For You During The Day

Yes, technologists do know a lot. They most likely have been in the same job for years and have seen many cases. If these folks actively seek you during the day to get your opinion over others, you probably know a thing or two. That’s the ultimate compliment!

Are You Ready To Take Call?

Don’t worry if none of these statements pertain to you early in the year. You still have a bit of time. However, try to make some of these signs your goal before the start of your first call. At that point, you will get the hint that you are ready!

 

 

 

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Should You Join A Practice With Skeleton Coverage?

skeleton coverage

We are in a brave new world. A great job market for starting radiologists is associated with a tough time with radiologist recruitment. And it’s a nationwide problem—tons of work but few radiologists to complete it. So, like many new radiologists, what do you do if you consider joining a practice with skeleton coverage? Should you join these practices or move on to the next “fully staffed” large conglomerate? What are the main risks that you will encounter when starting? Is it at all worth thinking about these practices with skeleton coverage? Let’s figure out if you are the type of person who should consider such a practice!

Advantages Of Skeleton Coverage

Lots Of Opportunities For Moonlighting

When I started, I was hungry for additional shifts to help pay down my student loans. And those spots were not always available. But, in an environment like this, with thinly covered practices, you will have many opportunities. Nights, weekends, and teleradiology coverage will all most likely be available to you, ripe for the picking. You can pay down your debts and save a bit for a new house in no time!

Opportunities For Leadership Positions

A thin bench will create many opportunities for you to become part of almost any organization role right from the bat. If you are interested in hospital administration, you can begin on this path to fulfill your ambitions from the beginning. Are you interested in teaching? Start on your merry way toward becoming a program director, no competition! Or want to become the practice’s CEO eventually? Take on financial roles immediately. You will have very little competition to get started at these positions!

Potentially A Quicker Path To Partnership/Owner

The more needed you are, the more leverage you have. And, if you have enough radiologists barely to fill the rosters, guess what? You may be able to use that leverage to up your time until you can become an owner. Think about it. You have the potential to increase your earnings significantly, more than you may have thought when you first started looking.

Disadvantages/Risks Of Skeleton Coverage

Ripe For Buyout

A thin bench can mean that radiologists can no longer take on the extra workload. It’s just not sustainable. And the casualty can be the sale of the practice to a private equity firm. Caveat emptor- may the buyer beware!

Unhappy Radiologists

More than any other factor, working with fellow radiologists with low morale can be a real downer. And, no factors more than a thin shell of coverage can cause your fellow radiologists to be stressed and miserable. Especially when you are raring to start at your first new practice, this is not the toxic environment you had signed up for when you first applied for the job.

Forced Coverage

Sure, you have all these extra opportunities. But, at what cost? Now that you are missing out on a nucs guy, you have to cover the PET-CTs. Or, maybe you have to cover all these extra available shifts you were not planning to work. If you’ve recently had a baby or have lots of other hobbies that you want to pursue, additional opportunities can be a curse instead of a blessing.

Should You Join A Practice With Skeleton Coverage?

It can be a tough call. But, it depends on your needs and wants. For the new radiologist with lots of ambition, it can be the right decision with lots of opportunities and time to make extra money. But be careful. It can be at the expense of a sell-out by your fellow radiologists or just a plain old miserable environment. So, consider all these factors when joining a practice with a thin bench!

 

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What Is The Optimal Call Situation For Radiology Residents?

opitmal call situation

Almost every program has its method of giving radiology residents the “call” experience. But, by no means is it standardized. Some programs have in-house attendings to back up the residents. Others use nighthawk, some all the time, and others sparsely. Some don’t have much in-house backup at all. And others weigh CT scans more highly than other modalities. And the list of possibilities for any given program can vary on and on. So, what critical elements of the optimal call situation should you look for when you are thumbing through the different radiology programs out there to find the one that best fits you? Of course, I will give you my two cents!

Independence Of Decision Making For The Optimal Call Situation

First and foremost, unless you want to do research permanently and cannot give a lick about making independent decisions, you should consider this priority one when searching for a call experience. At some point during your residency, you must make your own decisions, which need to count. Without this factor, you will never truly leave your first year of residency. The ability to make sound decisions is the difference between a student and a radiologist. So, make sure you have the power to make some decisions in each of the different modalities. Each modality that you cannot make an independent decision for is one less modality your residency will prepare you for when you finish!

Meaningful Decisions To Have Some Affect On Patient Management

To be clear, making a decision is not enough. The decisions that you make need to have some impact on your workup. The pressure of worrying about patients will keep you up at night, both as a resident and as an attending. Making calls that go nowhere will not be enough to satisfy the requirement of independent call. Every radiologist needs to know the consequences of what we do. Otherwise, you will become powerless to make these same decisions in practice.

A Reasonable Quantity Of Cases

It is easily possible to veer on either side of this equation. Some residencies are so overburdened with cases that the resident has no time to think and make decisions. So, too many of the decisions are bad ones. Likewise, if you are working call at a podunk hospital that is about to close from a lack of patient visits each year, this is not such an optimal call situation for learning either. At nighttime, your residency should have enough work to teach you how to become a radiologist. It’s hard to give you an exact number, but it’s usually a little more than you might think!

A Good Mix Of Cases

Some institutions are in counties where everyone comes from the same culture/background. This mix of cases is not such a great recipe for learning about the diversity of radiology. Also, if the program relegates you to read CT only and gives you no opportunities to look at MRI and plain film cases, this situation will not serve you so well. Find a residency where you can get sufficient studies in all modalities and patients.

Nighthawk Vs. Q Night

Finally, I have always been a proponent of the nighthawk system. I believe it will make your residency life a whole lot better for most of you. I find it very hard to adjust my sleep schedule to the every 4th-day rhythm. On the other hand, your body will get used to the nighthawk sequence reasonably quickly so that you no longer have the 4:30 am blues when you cannot see straight. This factor may not matter much for some with different circadian rhythms. But for me, it makes a humongous difference!

The Optimal Call Situation For Radiology Residents

No call situation is perfect. However, to optimize your overnight learning during your radiology residency, find programs where you have independence and meaning in your decisions, a decent number and mix of cases, and a nighthawk rotation. You will discover that these features will enhance your learning once you practice more independently, which will eventually spill over to your work as an attending. At that point, you will feel comfortable in your skin, knowing that you had excellent training!