Category: Uncategorized

Posted on by

The Sharp Breast Ultrasound Technologist: The Key To A Well Run Practice!

technologist

In a thriving radiology practice, all technologists contribute to the functioning of the whole. However, one sort of technologist, in particular, can tip the balance between a smoothly run practice and disaster. Which one would that be? Well, if you read the title, you would know immediately!

Why does a breast ultrasound technologist wield so much power over a successful radiology practice? Unlike other technologists, I came up with three reasons why we rely on them so much. First, these technologists are the most “independent” of all other technologists. Second, they require a good eye, more so than other technologists. And finally, they must have excellent hand-eye coordination. We will examine all three characteristics and what happens when your practice uses a suboptimal technologist.

Independence

Sure, most technologists have some autonomy. I mean, CT techs must set the parameters for the scans independently. And mammography techs must ensure they perform all the QI before beginning a study. But breast ultrasound technologists are unique in this regard. When breast sonographers leave the room to create their images, you cannot check the quality of their work directly. What do I mean by that? Sure, there are required images. However, the ultrasonographer can choose to show you whatever they deem crucial. Alternatively, this same tech can leave out what they think is “unnecessary.”

I can’t think of any other technologists with such independence of action. You can almost always check the work of a CT, mammography, MRI, or fluoro technologist. The body part is complete, or it isn’t. The breast tissue is all on the film, or it’s not. On the other hand, with ultrasound techs, you can never know if they have completed what they were supposed to. You must rely on their word and their word alone.

What happens when the ultrasound technologist does not act independently? These technologists come reeling in and out of the reading room incessantly, asking questions and interrupting the day’s workflow. Furthermore, the radiologist’s stomach churns when unsure if the technologist knows the morphology and location of what they are searching for. That means they must check and recheck everything the breast ultrasound technologist completes. It wastes so much time that the radiologist cannot attend to his other duties.

The “Good Eye”

Radiologists rely on the ability of breast ultrasound technologists to pinpoint a specific lesion on mammography. Or, they need to find the proverbial needle in a haystack on screening ultrasound. In other words, they must keep constant awareness of their search. In addition, they need to identify the shapes and abnormalities they see on the mammogram. This task becomes challenging when you have a 350-pound patient with a large amount of breast tissue! A “good eye” varies widely among technologists, similar to radiologists. But, good technologists will reliably find what is needed and discard the impertinent findings in the breast.

I can’t tell you how often a technologist without a “good eye” will search and search for something, only to have you, the radiologist, come in and find the lesion first. Imagine the hours over a lifetime that a radiologist must waste to compensate for the ultrasound technologist without a “good eye”!

Hand-eye Coordination

Finally, an ultrasound technologist’s ability to scan patients relies upon a baseline level of coordination. This baseline becomes vital for two main reasons. First, the ultrasound technologist needs to find and rediscover a lesion. For instance, some lesions are tiny or roll off the transducer very easily. Good ultrasound technologists need a steady hand to create images of these abnormalities.

Furthermore, breast ultrasound technologists, in particular, play an essential role in performing procedures to assist radiologists with cyst aspirations and biopsies. They need to be able to keep the transducer on a specific plane at the time of a biopsy.

Frustrating is the singular word for performing procedures with a breast ultrasound technologist with two left hands! Imaging studies and techniques can take triple the amount of time with a technologist with poor coordination. That does not include contamination of the sterile field!

The Sharp Breast Ultrasound Technologist- The Key To A Well-Run Practice

As you can see, a breast ultrasound technologist is much more than just another member of the imaging center team. Without a quality breast ultrasound technologist, the center becomes much less efficient and can fall apart at the seams. If you find a great one, this team member becomes the glue holding the imaging center together. Keep the tech even if at a higher-than-average cost. Why? Because the costs to a practice pale compared to the damage if they leave!

Posted on by

ESIR Programs: Let The Buyer Beware

Radiology programs, radiology program directors, Early Specialization In Interventional Radiology (ESIR) directors, and residents interested in interventional radiology are dealing with a mini-crisis. For years, programs have allowed residents to make a choice to start an interventional fellowship several years into residency. Instead today, new residents face the crunch of having to make this decision to join up with ESIR programs right away. And, they should not take this decision lightly. Why? Well, that is exactly what we are going to discuss today!

So, What’s The Urgency, Huh?

Like anything else in the world, when you have limited supply and excess demand, you create bottlenecks. And, unfortunately, in many programs across the country, the number of ESIR spots available does not equal the number of residents interested in the program. Therefore, this problem exists in some programs, right here right now.

So, if a program has two residents interested in this program, but it only has one spot available, the program director needs to make the final decision by either one of two methods. First, the program can decide on a first come first serve policy. But, let’s say that you have two residents that decide they want to join a program at the same time. Well then, that leads us to the other way to decide. And, that would be a long drawn out application process to determine the most “qualified” applicant.

Either way, this puts pressure on the applicant and the program to make a decision pronto. As you now understand, the resident and program need to make rushed decisions together.

Why Can This Decision To Join ESIR Have Permanent Implications?

OK. First, I will mention the positive. ESIR programs allow residents throughout the country to decrease the number of years of a fellowship from two to one. And, these residents will be able to hit the proverbial ground running at their interventional fellowships from the very beginning. But, at what cost?

Problem 1

Here comes the tough part. ESIR programs need to allow residents to complete approximately one year of interventional related activities during radiology residency. So, where does the time come from? It has to come from somewhere, right? Well, here is the rub. Programs need to draw the time allotted to ESIR from the normal diagnostic radiology activities. So, residents that complete an ESIR program have less overall experience in the standard rotations like MRI, ultrasound, etc. And therefore, the training of an ESIR resident is not truly equivalent to a standard diagnostic radiology resident.

So, what are the implications of this? In the workforce still, most practices need radiologists that can perform interventional radiology (IR) but can also help out with some of the general work. Well, residents that start a typical IR job will not have the same experience and comfort level with general radiology practice. As you can see, this creates a serious problem for the ESIR graduate.

Problem 2

Unfortunately, the problems do not end here. Let’s say that you start the ESIR program. And then, you then apply for fellowship toward the end of residency. Due to the changes in allocated slots for interventionalists with new DR/IR programs, ESIR programs, and “independent fellowships”, fewer residents can easily drop out of interventional radiology during residency. So, fewer spaces become available for interventional programs throughout the country. And therefore, you, as an ESIR applicant to fellowship, may have a lower likelihood of gaining admission to an interventional radiology fellowship than residents applying in prior years.

So, who is to say for sure that you can obtain an interventional fellowship after residency as an ESIR applicant? In this case, theoretically, ESIR programs have now doubly screwed this resident. First, they completed a program for which they have a real chance of not completing the required CAQ certification. And second, they have less diagnostic radiology experience.

Problem 3

Many folks that want to do interventional radiology really do not know what they want to do until they have completed several IR rotations. So, what happens if the ESIR program resident decides that they do not like interventional radiology toward the middle or end of their residency? Well, they potentially have prevented another interested applicant from getting a spot. In addition, they have again decreased their own training in diagnostic radiology- a lose-lose situation. They will potentially graduate as a “second-rate” diagnostic radiologist.

Bottom Line For The Applicant To ESIR Programs

For those of you applying to ESIR and know for sure that you want to do interventional radiology, well then, go for it. But, I have a sneaking suspicion that many ESIR applicants are not in this category. So, if the program offers you a choice to apply for an ESIR program, make sure to think twice. The implications of joining this program can be far-reaching for the rest of your career!

Posted on by

Radiology As A Backup Specialty: Should Radiologists Be Offended?

backup

During the AUR meeting a few years ago, one of the speakers announced that more medical students than ever used radiology as a backup specialty. Well, how can that be? I mean, radiology is a fantastic specialty, right? Yet, our medical students have chewed us up and spit us out. At that point, you could just about hear the moans and groans in the background of the lecture hall. But then, I thought about it and felt a bit differently. Why? Well, that is what I would like to delve into today.

Most Applicants Don’t Know What They Want

Over the years, I have found that most radiology applicants, like other specialties, think they know what they want. However, when you dig a bit deeper, you find out they are not sure. Hell, I had no clue when I entered the specialty. When you ask applicants why they want to join specialty X, many have difficulty verbalizing their true motivations. Often you hear, “I like using my hands” or” I like coming up with differential diagnoses.”

Truthfully, however, these reasons are, at best nonspecific. And, if you dissect what these residents are saying, you would recognize that the reasons why an applicant claims to have applied to a specialty have no bearing upon what he wants. You can apply to surgery, interventional radiology, urology, and other specialties because you want to use your hands. Or, you can come up with differential diagnoses in almost any specialty in the medical field.

Often, applicants bury the real reason for applying to a specific specialty deep within their psyche. Perhaps, they want to say it’s the lifestyle, the culture, or the money. So, how can we become offended by medical students that don’t know what they want?

Our Specialty Is Getting Noticed!

For applicants to apply to our specialty, even as a backup, it means that they must have some foreknowledge about us, to begin with. That means we are doing something right. Maybe, we are training more medical students about imaging in medical school. Or, perhaps, they hear about an improving job market. In either case, residents have found reasons to apply to us, even though it may not be their first choice!

A Badge Of Honor

Only a few years ago, the radiology applications had dropped precipitously. In addition, the quality of applications had significantly decreased as well. Instead, today, we have become respectable enough to apply to! We are returning to the old norm. So, we should feel excited that qualified applicants are again considering our specialty.

So, We Are A Backup Specialty. Should We Be Offended?

Back to the original question again… Let’s look at radiology for what it is. It’s one of few specialties that allow physicians the flexibility to pursue so many avenues and satisfy the academic and clinical wants of most. And now, if we dissect why residents perceive us as a backup, I think we should not become offended. Instead, we should give the new applicants some credit. They are beginning once again to recognize the specialty of radiology for what it is: an excellent choice for a great career!

Posted on by

Dealing With The Abusive Nighttime Physician: Rules Of The Road

abusive

Picture this scenario. A Napoleon-like 5 foot 2 verbally abusive surgeon enters the reading room. He begins to yell at you for not performing an intussusception reduction the way he likes. Moreover, a team of surgical residents stand behind him, each member turning red with embarrassment as he continues with his tirade. His verbal abusiveness becomes more and more aggressive. He uses terms such as “idiot” and “moron” to describe you as you attempt to get a word in edgewise. You feel like you want to strike your fist in his face. Does this situation sound vaguely familiar? How would you deal with this everyday but unfortunate situation when you are alone at nighttime?

#MeToo

First, no one should have to contend with harassment such as this. I don’t care if you are a resident, nurse, janitor, or attending. Unfortunately, although society has finally come to terms with refusing such abusive behavior and isolating these individuals, many hospitals still silently condone it. How and why? Perhaps, the hospital is understaffed and would rather have someone to fill the gaps even though he has an abusive personality. Or, the hospital may hire an inappropriate physician because she has a good reputation and brings many patients into the system. Regardless, the behavior is unacceptable and needs to be dealt with accordingly. So, let’s go through some of the processes you need to complete to prevent this harassment again.

Engage Softly With Team Response

The last thing you want to do as a resident is fight fire with fire. If you continue to raise your voice and tussle with this attending, you are making a containable situation into a nuclear bomb! Instead, what is the appropriate course of action?

You can say to this individual quietly, “I am just trying to help you care for your patients appropriately. We are in this together. I will talk to you again when you speak to me professionally so we can help your patient together.” Usually, the raving physician calms down if you maintain a quiet and calm demeanor. At this point, the situation usually de-escalates. Who knows? You may even receive an apology. But that may or may not be the case.

Document, Document, Document

So, what next, assuming the situation does not calm down? If the surgeon has been harassing you, it is most likely a long-standing observable pattern of inappropriate behavior. And this physician has likely affected many other employees within the hospital as well. Therefore, you should document the behavior in written form. State the time, place, and situation as objectively as you can. Then, place the document on the side for further use, if necessary.

Next, you may want to ask other observers, if present, to create a supporting document. This report lends credence to your inappropriate interaction. You are better off gathering multiple documents to establish a pattern of behavior.

And finally, for each time you encounter these behaviors with this individual, you create another document. You are making a paper trail that will help remedy this situation.

Speak To Your Supervisor

As for the next step, you must contact your residency director or associate residency director first thing in the morning. Speak to them and give them the documentation. If possible, leave the wheeling and dealing in the hands of the local administration. Why? Well, often, the lowly resident does not have the influence upon human resources or senior administration like a long-standing faculty member does. And, the administration can turn back the blame on you.

Last Resort- Human Resources

OK. So, your supervisor has not yet fixed the situation. Or, maybe she settled it for that one time, but the abuse is recurrent. Where do you go next? Sometimes you have to go right for the horse’s mouth. You may need to talk directly to human resources and hand in the documentation yourself. Usually, this will begin a full investigation into the matter. Of course, hopefully, you can avoid this situation. Unfortunately, on occasion, you need to act to protect yourself in this way.

Final Thoughts About The Abusive Physician

We all went to medical school and began training to become consummate professionals. Along the way, unfortunately, you will encounter abusive physicians that do not follow these rules of professionalism. Often they have issues of their own. But that does not excuse the actions of these individuals. We, as clinicians, should act according to the rules of civil behavior. And if these abusive physicians cannot play by the rules, either they need to change their ways, or they should not be able to practice medicine. So, we serve all by taking action and not remaining silent.

Posted on by

Eight Ways To Find Inspiration During Residency

inspiration

You wake up to go to work. Maybe, you grind through what seems like a hundred films with your attending. And then, you arrive home exhausted, only to start reading books and case reviews. The work of a radiology resident never ends. So, how do residents find the inspiration to get through the day, study for the core exam, and get through the entire residency? And, what can residents do to have a fulfilling four years? Unfortunately, very few radiologists have the time to consider the resident’s plight. But I plan to tackle these issues today. Think of this post as chicken soup for the radiology resident, concepts one needs to tough things out for four brutal years.

 

Yes, You Will Save Some Lives

Never forget this fact. Imaging saves lives. And who interprets the images? You! So, get yourself right out of that funk. And, remember, we are not financiers, accountants, or lawyers. We directly prevent significant injuries and death!

Have A Hobby/Life Outside Of Residency

As much as you may love radiology, actively seeking other interests is just as important. I don’t care if it is swimming, stamps, reading, or traveling. Having a hobby enables you to return to work fresh and ready for the next day. Sometimes, studying and working improve when you have an unencumbered mind with the same old studying routine. Studies have shown that creativity and productivity also improve when you pursue activities outside your main interests. Why not let that be you? (1)

Sometimes It’s Not Just About The Work; It’s About You!

Inspiration does not only come from your patients and your films. Instead, feeling inspired stems from your moods and wants. To take care of others, you must also take care of yourself. So, remember… You have a responsibility to yourself to cater to yourself at times. Take a little time to yourself when things become tough studying. Or, if you lose focus during the day, sometimes you need to step away for a few moments. To regain your concentration, you need to refresh yourself!

Maintaining Health

It sounds strange that maintaining health can inspire you to become a great radiologist, right? Well, if you do not eat well, exercise, and sleep, it becomes much more likely for a resident to burn out before finishing residency! So, make sure to treat your body right!

Learning From Mistakes Can Be Inspiring

Mistakes are depressing and ugly, correct? If you continue to think that way, you should not become a radiologist. Expect mistakes. It’s part of the risk profile of our job (Although attorneys would think otherwise!). One study reported a significant error rate that ranges between 2 and 20% of all radiologist reports. (Br J Radiol. 2001 Oct;74(886):949-51.)

So, we need to become inspired to do better. How do we do that? Well, think of each mistake you or others make as an opportunity to prevent significant errors from happening again. If we want to get closer to perfection, we must inspire ourselves to learn from these mistakes, knowing we will not miss that finding or commit that knowledge error again!

Appreciate What You Have Accomplished

Think about the goals you have met to become a radiologist. You have completed college, medical school, and an internship. And remember all those tests that you have aced and passed to get to this point. This successful journey is a real accomplishment! Be proud of what you have achieved. You are not an average Joe. Instead, you have done what many folks can only dream about. And, if you have already gotten this far, imagine how far you can go… If that doesn’t inspire you, I don’t know what will!

Think About The End Goal

Inspiration often does not come from what you are doing right now. Many times, it comes from dreaming about what will be. So, it’s not about repeatedly reading that same paragraph to remember or understand a single concept. Instead, it is about how this pertains to the final goal of becoming a great radiologist. Therefore, don’t get stuck in the minutia. It’s about the big picture!

Education As Fun

Education is about the journey, not the destination. That is because we never really arrive. There is always more to learn and see. And what can be more exciting than discovering new ideas and concepts and applying them to the practical world? As radiologists, that is what we do! So, take each pillar and block of knowledge to form new and exciting structures. This process involves taking new ideas to create research projects or looking at studies in a different way that no one has thought about before. You are only limited by your imagination!

Final Thoughts About Finding Inspiration

Inspiration is what makes us tick. It gives us the passion for completing our dreams and going one step further. However, it does not come from the daily grind. Instead, it comes from our beliefs, hopes, dreams, and goals. So, appreciate what you have accomplished, think about what you do daily (and yes, that includes saving lives!), and remember your goals for the future. It’s all pretty amazing. That should be inspiration enough!

 

(1) http://www.cofcogroup.com/want-more-productivity-get-a-hobby/

Posted on by

Should I Join A Practice With A High Buy-in?

buy-in

As of the end of 2020, the job market is beginning to improve post-covid. And, for those of you considering your first job nowadays, you may receive offers from multiple practices. And, some of those offers may seem enticing. Perhaps, you hear that the partners make 600,00o, 700,000, or 800,000 dollars or more. And when you interview, the President of the private practice tells you that you will have to pay a large sum of money into the business. This sum of cash called a buy-in can range from zero to as high as into the millions. So, here are the questions you need to answer. Is a high buy-in ever worth your while? In fact, should you even entertain the possibility of starting at one of these practices that come with an enormous buy-in? Well, I am here to help you to answer these questions today!

 

 

The Hope

OK, all things considered, paying into a practice a large sum of money doesn’t sound so bad if the practice guarantees that you will bring in gobs of money each year, right? If you are paying a million to own a radiology practice’s technical shares, you can potentially receive outsized benefits in return. For one, your salary can become much higher. That initial sum of money that you add to the practice equity can significantly increase in value if the practice does well. You can also diversify your income a bit by collecting the professional fees and the technical component. These hopes can all come true.

But Then…

OK. There is always more to the story. Practices can dash hopes in an instant. Let’s say you don’t receive a share of the partnership during your partnership track. Where does that leave you? A lot poorer!

Or, perhaps, the practice equity declines as you finally earn the golden ring of partnership. Can a practice’s equity decline that much? Sure, can! Assets can not only decline to zero but can become a debt burden as well. Think about it. Equipment depreciates. And physical properties can decrease in value. The money you put in can no longer exist after you put all that equity into the business. And some!

Besides, you may overpay for the practice more than it’s worth. Who is to say that you have paid a fair price to become a partner? The practice partners? How do you know if they know how to value the practice. Or, maybe, they are trying to defraud you. You never know.

Weighing The Risks Versus Benefits Of A Large Buy-in

So, let’s see. The potential for large rewards versus the possibility of paying into something that is not worth it. What should you do? As always, this comes back to a trust and numbers game. Only by vetting the practice’s balance sheet and getting detailed information about the practice owners can you make the decision. So, how do you go about making this weighty decision?

Of course, you need to assess the people that run the practice. But how? Track record becomes very important. Have they strung along with multiple employees on partnership track to never make them a partner in the business? Are these physicians respected members of the radiology community? Do your residency and fellowship directors know something about the practice?

To get at the matter of trust, you must research the practice well. Check for lawsuits and hiring indiscretions. These can all become red flags that the imaging business may not be what you think.

And then get to the bottom of the balance sheet. Be wary of any practice that does not let you know what the partners have made in the past. Think twice if the practice does not allow you to talk to the business manager about the finances and the assets the practice owns. I know of several radiologists who had been through an extended partnership track to find out that they became partners in only the professional component, not the technical component/equipment and real estate. They were sorely disappointed when the time came to make “partner.” So, make sure to find out what you are really “buying-into”!

Finally, you need to consider the current environment of the practice. Are private equity firms or large hospitals in the area taking control of practices? Is the area economically growing or contracting? These factors may influence the risk of entering a partnership track that you may not be able to complete.

A High Buy-in And Your Final Decision

Depending on the situation and the practice, a high buy-in may or may not be worth the risk. Take into account not just the great potential of the business. Instead, you also need to consider the risks you need to take to earn that potential outcome. It might turn out well, but it might not. So, maximize your probabilities of success. Do your due diligence!

Posted on by

Can You Pass The 2018 Saint Barnabas Precall Quiz?

Due to the popularity of last year’s precall quiz post, I am back at it again. Today, I am posting 10 cases from the real 2018 quiz that we used to ensure our residents are ready prior to beginning call. Of course, we used our PACS system to see if they could not only understand the disease entities but also make the findings as well. Unfortunately, you will not have the same option. However, these cases will help to benchmark where you may stand.

When you go through the test, come up with the findings, diagnosis, and if asked/relevant, management. In order to see how you did, answers are at the bottom of this page. (Don’t peek until you are finished!) One more thing… in order to pass the test without conditioning, you need to get at least 70 percent right. Enjoy!

Precall Quiz

Case 1

 

Case 2

 

 

Case 3

 

 

How would you manage this case?

Case 4

 

 

 

 

 

 

 

 

 

 

 

Case 5

 

What questions do you need to ask?

How do you manage this case?

 

Case 6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 7

part A

 

 

 

 

 

 

 

 

 

1st film- 2 years ago

2nd film- today

What is the differential diagnosis?

What do you want to do next?

 

part B

 

 

 

Case 8

 

 

 

 

Case 9

 

 

 

Case 10

 

 

 

 

 

 

Answers:

Case 1:

Right thalamic/basal ganglia intraparenchymal bleed with intraventricular extension.

Accompanying early transtentorial herniation. (needs to be mentioned for full credit!)

Case 2:

Right-sided pyelonephritis/early abscess formation. Renal mass/neoplasm can be within differential diagnosis.

Case 3:

Aortic dissection extending from the inferior thoracic cavity to iliac arteries.

Accompanying perivascular fluid and effusion- possibly blood products, consider ruptured dissection

For full credit-need to mention that you would call the vascular surgeons

Case 4:

Ultrasound appendicitis with appendicoliths

Case 5:

You need to ask history. (?B-HCG positive)

Ruptured ectopic pregnancy.

Case 6:

Homolateral Lisfranc fracture dislocation

Case 7:

Part A

New prominent bilateral hila- Interval development of adenopathy or pulmonary arterial hypertension

CT of the chest recommended for further characterization.

Part B

Bilateral chronic pulmonary emboli with pulmonary hypertension

Case 8:

Acute biliary leak with extraluminal radiopharmaceutical.

Focus within the hepatic hila- most likely biloma/origin of the biliary leak

Case 9:

Distal left ureteral stone with left renal hydronephrosis and hydroureter. Accompanying inflammatory change at the left kidney and ureter.

Case 10:

No acute disease. Possible recently ruptured left ovarian cyst.

 

 

Posted on by

Radiology Residency Day One – How To Start On The Right Foot

residency day one

Last week, I wrote about what to do on the first day on the job as a radiology attending. For those of you about to begin radiology residency, I thought it would be unfair to leave you in the dust. So, today, we will talk about what to do on day one of the radiology residency. For this discussion, we will disregard all the formal introduction courses from the hospital. Mostly, that is a passive activity. Instead, I need you to know what you must do on your first day in the department. So, let’s start!

Get To Work Early

On that first day, I recommend arriving early. Get to know the parking, the bathrooms, and the building. You never know how long things will take until you arrive. And as a resident, impressions become exceedingly important. The last thing you want to do is to arrive late on that first fateful radiology residency day one!

Introductions And Thank You

OK. This one does not differ much from your attending’s first day. Your new colleagues and faculty want to make sure they made the right choice when they selected you. So, do this right. Make sure to thank all the folks who helped to get you into the program. This gratitude goes a long way to building solid relationships for the next four years!

Don’t Stand Out Too Much

When you begin your first rotation, be careful about what you say. You certainly don’t want your attendings tagging you as the class troublemaker. That can lead to undue negative attention later on. So, if you think you may say something that may upset your new employers, I would hold back until they get to know you later!

Ask About Special Programs (If Interested)

Some radiology programs have Early Specialization In Interventional Radiology (ESIR) slots. If you do not inform your program directors early on that you maintain interest in the program, the program may fill up, and the ESIR program may exclude you. So, ask to sign up, if interested, on that residency day one.

Ask About Expectations For The Rotation

Different from starting as an attending, most of you have no clue what you should begin to do on residency day one. On day one of our nuclear medicine program, the technologist showed the residents how myocardial perfusion scans work. But, in the following days, you would sit with an attending to learn the basics. You certainly would not want to miss either of those opportunities. On the other hand, if you start on fluoroscopy, perhaps you need to watch a few esophagrams on the first day. And then, a few days later, the attending may expect you to attempt one on your own. Without these clear expectations, perhaps not in the manual, you will start your rotation at a disadvantage. It is hard to meet expectations you don’t have!

Learn The PACS

Like a new attending, you must learn how to look at cases at your institution. Therefore, it behooves you to play around with the PACS system a bit. Also, make sure to ask for tips from your colleagues and attendings. Many times, if you don’t ask at the beginning, you will only learn much later after you have wasted many hours. Remember: these tips can save significant amounts of time and headaches!

Start Learning How To Dictate

Again and again, you will hear that learning to dictate has a steep learning curve. Therefore, there is no time like the present to learn. Begin with a few simple cases. But start now if you can. As a resident, this activity is one of the most active ways to learn radiology. It reinforces the buttonology of the PACS and the learning of the basics of radiology. In addition, it can help the attending out during the daytime. So, why not start on day one?

Let Your Attending Know The Plans

On that first day, you will often need to attend several activities that are integral to starting but maybe off-rotation. As a courtesy, let your attending for the day know when and what you need to do. This act of doing this establishes a rapport between you and your faculty!

Listen Carefully To The Program Director (Or Associate Program Director) Welcome

Most programs have an early morning or noon conference from the program director or associate program director. This conference is crucial! Most of the time, the program directors will give you their expectations and requirements. Usually, they will not repeat the tips and advice you will get from this session. So, take notes, and don’t miss a beat!

Borrow, Rent, Or Buy Books

By the end of the first day, you should know what you will need to complete your first rotation successfully. Most of the time, you will discover what to purchase, rent, or borrow books from your colleagues in digital or print form. So, make sure to get these necessary resources on day one!

Radiology Residency Day One- Final Thoughts

As with any first day of a new job, the first day of residency can become a nerve-racking experience. But don’t let it be. Instead, try to absorb all the unique experiences that you encounter. So, make sure to take in the new situation, the people, and your place of work. And most importantly, don’t be too hard on yourself. The staff and your colleagues have low expectations for the residents on your first fateful day. Later on, you will have many more days ahead of you to stress about giving that next tumor board or taking the core exam. For today, you can relax and enjoy!

 

 

Posted on by

Radiology Attending Day One: How To Get Started On The Right Foot

day one

Imagine: Your whole adult life consisted of schooling, including four years of college, four years of medical school, one year of internship, four years of residency, and perhaps one or two years of fellowship. And you will finish it all in a few days. This situation will be yours at some point. (If not at this moment!) Now, it’s day one, and you embark upon your new life as an attending.

For most, this transition is like moving from the confines of jail to the free world. No longer do you have someone to monitor you all the time. Now you become the arbiter of last resort. The buck stops with you. (All those hackneyed phrases are true!)

The transition to becoming an attending is enormous. And you want to make sure that you do it right. So, what are the most important tasks to accomplish on day one of your new job? What do you want to avoid? Assuming you have completed your administrative tasks before starting, we will go through some boxes you should check off on your first fateful work day.

Introduce Yourself To All The Staff

After the hospital orientations, ALS courses, and all that jazz has died down; you need to make a good impression on day one. The people you meet on that first may work with you for the next 30 years! So, make your introductions to all staff. That includes fellow attendings, technologists, nurses, secretaries, and janitors. By introducing yourself to everyone, you make yourself seem like a team player that is not “standoffish.” Who wants to work with someone who can’t talk to anyone in the department?

Dress The Part Of An Attending

You don’t want to stand out too much on that fateful day. So, make sure that your attire is appropriate to the department. I remember a few attendings at my prior residency that arrived at the department without a tie for the first time. The department chairman made these attendings return home and get a tie from their closet! You don’t want to start on the wrong foot in a department where you expect to work for many years.

Make Sure To Listen Carefully To Your New Colleagues

You will hear much on the first day of your new life. Sometimes, however, you will receive invaluable advice from your colleagues that you may never get again. So, pay attention. And, take notes if you don’t have a photographic memory. You are better off having the information you will need now than having to find someone to get the same information later on when you become really busy!

Stake Out The Joint

The first days are the time to explore your surroundings (Don’t break into the chairman’s office, though!) Discover the locations of the best bathrooms, cafeteria locations, local restaurants (if at an imaging center), physician and secretarial offices, reading rooms, interventional suites, and more. Become as familiar with the surroundings as you can. This is your new home!

Ask Lots Of Questions

OK. You don’t want to ask too many indiscriminate questions (It may seem like you don’t know anything!) But you do want to ask lots of important and relevant questions. Get to the practice’s expectations, pitfalls, and more. After the first day, your colleagues may become less attuned to answering these questions, as you will no longer be the new kid on the block. Get those questions in before it is too late!

Discover Your Boundaries

Especially on that first day, you do not want to step on anyone’s toes. Ask first if you want to help with a study that may not be in your daily expected routine. The last thing you want to do: is dictating a case only to find out that the clinical attending wanted a read from someone else. It does not look good for you or the practice. So, get to know and ask what you can and cannot do.

Get Dictation Standards

Different practices have specific requirements for all radiologists’ dictations. Some want structured reports, and others need the impression at the beginning. Make sure to ask your colleagues what exactly they expect before beginning your work. You certainly don’t want to rock the boat too much!

Learn The PACS and EHR

The PACS and Electronic Health Records systems have become crucial for relevant and quality reports. In addition, knowing these systems will significantly help your efficiency (You want to get out of work on time, don’t you?) Therefore, you need to spend your first day working to make sure that you get to know the PACS and EHR well. A little time now will save tons of time in the future. Think of it as an investment.

Work Slowly And Deliberately

As a fresh radiologist right out of fellowship, you don’t want to be known as the gal who does careless dictations. So, especially on that first day, slow down. Make sure everything you dictate is correct. You have years and years to pick up speed with your work. Now is not the time to rush, and newbies make more mistakes. Don’t add to the reputation!

Radiology Attending Day One- Final Thoughts

The first day as an attending is tough. You are transitioning to a new world, just like the many worlds you had transitioned to before. So, go forward and welcome the changes with open arms. Believe it or not, you will find your comfort zone one day. It just takes a bit of time!

 

 

 

Posted on by

Is The Specialty of Radiology Better Off With Increased Competition?

increased competition

With the increasingly hot job market for new radiologists, medical student applications to residency programs have steadily increased over the past several years. But that got me thinking. Is the specialty of radiology better off with more hardcore medical students wanting to enter the profession? Or does radiology benefit more from residents who genuinely want to be here when times are tough? So, let’s go through the advantages and disadvantages of having both a competitive and a non-competitive application process. And then, we will come up with a conclusion to the final question: Is the specialty of radiology better off with increased competition?

 

What Happens With A Competitive Application Process

Advantages

From a program director’s perspective, let’s begin by saying that a program director’s job becomes much easier with increased competition. To find applicants, you do not have to interview as many candidates. And the applications tend to have fewer “blemishes.” That said, as much as it helps me, this factor impacts the specialty very little.

So, what other advantages does a competitive process offer? First, the candidates will often have more experience in research. But does this create better radiologists? Depending on whether the resident wants an academic career, that is up for debate. However, I can say that it again makes the program director’s job a little bit easier because the faculty do not need to teach some of the primary research mechanics to get them started. Additionally, this resident will also likely produce more research during residency.

With increased competition, residents tend to be slightly more attentive to keeping up with reading. Moreover, these residents tend to be more motivated by passing tests. In other words, they may be a bit more “obsessive-compulsive.” Now, this would theoretically work in favor of passing the boards. However, according to the infinite wisdom of the test makers (the ABR), this doesn’t change the pass rates since they opt to create tests based on curves, not content.

Disadvantages:

Over the years, I have noticed that competition also motivates applicants who want radiology because of the competition, not necessarily for the love of radiology. In the long run, this can lead to increased burnout. Furthermore, it can change the culture of radiology residency and radiologists into a less forgiving and highly pressured environment. Again, this is more of a tendency rather than a truism.

Increased competition also brings out fewer nontraditional applicants to radiology. These include folks who have completed other residencies and different careers. In the setting of increased competition, they have a much harder time receiving interviews because programs often screen them out of the system due to their increased time in or before residency. However, nontraditional applicants bring a different perspective to residencies. Moreover, they have been through more, are more mature, and often make better leaders.

What Happens With A Non-competitive Application Process

Advantages

Residents who apply during a less competitive time are a different group of candidates. I like to call them type B personalities. These folks create a less pressured environment and a calmer culture for the residency program. This decreased stress can make the four-year residency process more tolerable for everyone.

Likewise, during tough times, the limited selection of candidates forces residency programs to accept nontraditional candidates. As stated, these candidates lend a mature perspective to a residency program. In addition, these residents want to be involved in radiology for the love of the specialty rather than the competition and the “great” job market.

And then, programs will often downgrade their expectations of these non-competitive residents. Decreased expectations lower the pressures on the residents during their program and can create a less harried culture with reduced burnout.

Disadvantages

I don’t have the statistics to back this up. But, from my experience, tough times lead to residents with a higher dropout rate. Sometimes, these residents cannot meet the rigorous academic challenges of residency. When this occurs, residencies can lose their precious spots to other specialties like primary care.

Also, these residents have overall less experience with research. So, most residencies with non-competitive applicants will create less output during these challenging times. (This is a disadvantage for the more academic residency!)

And then, finally, residencies have more work cut out for them. They must put more time into teaching and spoon-feeding the residents to ensure they complete the program.

Weighing The Balance- Is Increased Competition Better For The Specialty?

So, where do I stand in this controversy? Well, residency directors and their programs must put more work into the residents during the “tough” years to get them “up to snuff.” But, you know, I’ve seen great residents during the lean times and times of abundance. So, I think we put more emphasis on competition to get better residents than we should. In the end, good residencies mold their residents into great radiologists regardless of the zeitgeist of the times. And that’s the way it should be!