Tag: changes

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9-11: Now And Then: A Radiologist’s Perspective

9-11

9-11 is one of a few days frozen in time for my generation. For the Baby Boomers, it was also the assassination of JFK and the landing on the moon. But for us, it was this day. Most of us remember exactly where we were and what we were doing at the time on this twentieth anniversary. So, like many, I have been reflecting on my experience, the meaning of 9-11, and how the world has changed. For radiology, in particular, the technologies since that time have significantly evolved. The attitude/culture of physicians and patients have transformed. And, the general sense of security and well-being is no longer the same.

It turns out that on 9/11, I was amid my radiology residency as a 3rd-year resident. And, so I will share my own experiences of what happened while I was working as a radiology resident on that fateful day. And, then I will shift gears toward the seismic changes that we have experienced over the past 20 years in radiology since that day.

My 9-11 Experience

Ironically, that morning, I donned a gown and was helping out with thyroid biopsies on my ultrasound rotation at Rhode Island Hospital. As the procedure ensued, at some point, a medical student walked int0 the room and exclaimed, “An airplane hit one of the world trade centers!” My first thoughts were about how that made no sense. Maybe he had gotten something wrong. So, within a few more minutes, we completed the biopsy, and I walked toward the patient TV area to see for myself. There was a jumble of confusing voices on the TV screen with the pictures of the first world trade center alight with billowing dark smoke. They said that a plane had hit the tower, but no one was certain if it was a terrorist attack or an accident.

Affixed to the TV screen, watching the first trade tower live, all of a sudden, the cameras shifted to the second tower, which was now also on fire. At this initial time, the cameras did not catch the second plane hitting the building. It took some time to figure out that another plane crashed the second world trade center. And, then the secretary called me into the following procedure as I was concerned about friends that I knew that worked near the area in Manhattan. It was a harrowing experience completing the ultrasound procedure, not knowing what was happening in Manhattan at the time.

Eventually, I found out that everyone I knew that might have been in or near the towers was alright. One friend who was a resident physician in medicine had tried to help out downtown, but the officials turned him away. After the incident, some other friends I knew had started their long trek to leave Manhattan from their jobs. And a family member was on the road at the time, nestled in traffic and watching the billowing smoke from the trade centers from afar. Fortunately, that was the closest that I had come to the 9/11 incident.

Nevertheless, the nonstop drumbeat of media reports issuing terrorist threats would continue over the next several weeks and months. And, you could not watch TV the constant replay of the videos of the trade centers. There was a perpetual reminder of the incident for a long time.

Some Of The Changes For Radiologists Since 9-11

Travel– (To And From Conferences)

Most notably for radiologists, the way we travel and getting back and forth to conferences has become a little more involved. 9/11 spurred the development of the TSA. Shampoos and drinks all had to be small in size to get on the plane. Lines have become longer, and we now have to leave much sooner to the airport to get there on time. And, air travelers are a little bit more irritable than ever before, both from the long lines and from thoughts about the terrorist attacks on 9-11.

Technology:

A lot has changed over the past 20 years, yet much has stayed the same. The bare bones of the hardware, including ultrasound, CT, MRI, and PET scans, were available at the time. But, the applications have since multiplied. PET-CT was more of a research tool at the time. It came into its own a few years later. But, FDG was used.

Applications of Technology

MRI and CT

Body MRI and MSK MRI is much more common today than it was back then. Now we order MRIs on all the joints routinely. Back then, it was a bit more sparingly used. Larger institutions were introducing CT applications such as Chest CTA for pulmonary embolism due to the faster speed of the scanners. . Having a sixteen multidetector or more CT scanner was a big deal back then. And only specific experienced radiologists could read them.

PET/ PET-CT

Pet scanner applications were much more limited by medicare/insurance reimbursement. Medicare and insurance companies would only pay for lung cancers, solitary pulmonary nodules, and several other indicators. You had to pay for others out of pocket if you wanted it done. And, as mentioned above, PET-CT and its applications mainly were a research tool with a lot of debate whether it was better than PET!

Ultrasound

We used breast ultrasound primarily for diagnostic purposes at that time. Most institutions would perform breast ultrasounds only sparingly for screening. For better or for worse, screening ultrasounds have become much more part of our culture.

PACs

PACs machines were not yet ubiquitous. Fifty percent of institutions had them back them. And, they were much slower than they are today, with more crashes and less flexibility. (Although not all these issues are resolved!)

General Attitude of Physicians, Patients

Now, this part might be a bit controversial. Some of you might think that what I will describe happened before 9/11. And others might feel a bit differently. But, I believe this event contributed, at least in part, to the tribalistic nature of our society today. Everyone had differing strong feelings about what happened and who was responsible. And everyone retreated to their tribe. Republicans and Democrats became more fixed in their thoughts, unwilling to compromise or hear the other side. And, this event along with social media, was one of the foundations for this shift in attitude and politics. 

Changes After 9-11: A Mixed Bag

Of course, 9-11 and the ensuing days were a rough time. But, some good has happened since. The adaption of new technologies has increased radiology’s footprint in medicine over the past twenty years, probably for the better. Yet, the decreased ease of travel and the new tribalistic attitude of patients and physicians has partially counteracted some positives.

The base notion about 9-11 is that it is one of those days that have shifted everyone’s lives in one way or another. The world and radiology will never be the same!

 

 

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Top Eight Radiology Residency Changes Since The Pandemic

radiology residency changes

Covid-19 has changed the face of radiology residencies throughout the country in a matter of months. But, what are some of the most significant differences compared to life before all of this started? Let’s go through the top eight most significant radiology residency changes since the pandemic began.

Noon Conferences

Before

Rows and rows of residents and students would gather in the conference room to listen to the faculty member lecturing. Attendings would call on the folks to answer questions.

After

Who would have ever thought that you would receive your lectures on a computer screen in any location of your choosing? That has precisely happened over the past several months—no more in-person lectures at many institutions. And, you are much less likely to get called on in the middle of a conference!

Empty Reading Rooms

Before

Reading rooms were much quieter than they were twenty years ago since the advent of PACS, reducing the number of physicians visiting the reading rooms. But, you could still find some activity with residents and faculty present, discussing cases.

After

Now more and more faculty are not showing up at all. They are working from home. In many cases, all you have is a resident fielding occasional phone calls. But, for the most part, you can hear a pin drop!

Learning To Dictate With A Mask

Before

You would pick up a microphone and start dictating. And, that was hard enough as a first-year radiology resident.

After

Now first-year residents no longer only need to learn to dictate. They also need to learn with an encumbrance on their face, making sure a mask does not stifle their voices. They will become the most articulate class ever!

Extensive Cleaning Procedures

Before

You would enter a reading room and pick up a microphone. Only a minority of physicians would come in and wipe down the desk, microphone, and computer. And, many folks thought these doctors were crazy neat freaks!

After

Instead, you now come in with an arsenal of cleaning supplies to ensure you don’t get Covid-19. Those faculty members that don’t use all those cleaning supplies are considered nuts!

Less Residency Social Events

Before

Not that we considered radiology residency to be party central, but residents and faculty would get to know each other well on the outside of work. Or, at least you would have a few arranged meet and greet sessions.

After

Residents are lucky if they get to know the new first-year residents’ names! And, attendings are even having a harder time. It’s much more challenging to get to know your colleagues when you need to stay away.

Less Elective Cases/Decreased Volumes

Before

Patients would get mammograms, thyroid screening, DEXA scans, virtual colonoscopies, and more with impunity. Residents and attendings needed to read tons and tons of these scans all times.

After

We have seen a noticeable drop in elective volumes. Patients think twice about completing their screening or low-impact studies because of the inherent risk of personal interaction.

Less Free Food

Before

The hospital was a food fiesta of sorts. On any given day, you could find attendings purchasing pizza for residents, resident appreciation day festivities, and corporate-sponsored lunches.

After

It has become much harder to find free food in the hospital. Although occasionally available, far fewer purchasers and employees want to risk having physicians to dive into a free sandwich!

Easier Commutes

Before

Traffic may catch you on a bridge, a tunnel, or a highway for hours if you have a terrible morning while you were driving to work. You were not the only working soul!

After

Both unemployment and more remote working have taken a toll on the number of cars on the road. You can now enjoy speeding into your rotations in the morning. It is harder to blame being late on the traffic. See, there are one or two benefits to this unfortunate pandemic!

Radiology Residency Changes- A New Way Of Life

It’s remarkable to see the myriad of radiology residency changes in our daily lives. Only four or five months ago, Covid-19 was barely an afterthought. Now, it encompasses our whole way of being. And radiology residency is affected just like everything else!

 

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Radiology In The Post Covid-19 Era: How Will The Specialty Change?

covid-19

For almost all of us, the COVID-19 pandemic has affected our daily lives in some form or another. Some folks have been temporarily furloughed or lost their jobs. Other radiologists are infected and sickened by the virus. And, we all feel a level of heightened anxiety. But, one day, this situation shall end, hopefully, sooner rather than later. Moreover, with the end of the pandemic, the field of radiology will never be the same. It will be a post-COVID-19 era, a new world for radiology.

So, what will change in our field after the dust settles, and we approach a more “normal” life once again? This question is what I will attempt to answer to give us an idea. So, let’s divide my predictions into the following categories: demand for radiology residency, remote learning, teleradiology, and finally, numbers of onsite radiologists. No, I am not the oracle of Delphi, and I cannot foretell the future with certainty. However, my sixteen-year experience in the field of radiology and work with radiology residents allows me to make some educated guesses about what we can expect to change in radiology at the end of this pandemic.  Let’s give this a whirl!

Increased Demand For Radiology Post Covid-19

Medical students throughout the country are in the thick of the action. And, they can now see the role that different physician specialists play in a pandemic. I am sure that many medical students will notice that radiologists play a vital role in the diagnosis and management of COVID-19. Yet, they tend not to be on the front lines like the Emergency Physicians, internists, and surgeons. Not to say we don’t come in contact with these patients. But, for many medical students, I believe this critical role we play, and our overall relative decreased exposure to contagious disease will become an attractive feature that draws more applicants into the fold. I would imagine seeing more applications to radiology residency for the next several match cycles.

Remote Learning For Radiology Residents

Due to the restrictions on group meetings, most programs, by now, have shored up their capabilities to give teleconferences and administer online learning materials. Before, for many residencies,  it was only an adjunct to learning. Now, just like for public education, it has become a necessity and will become ingrained into the fabric of all residencies throughout the country. I believe this will stick.

Universal Teleradiology

For practices that didn’t have much of an online presence outside the hospital, they now will. If you read my previous article, Coronavirus: A Clarion Call For Universal Home Teleradiology, you will understand that it is incumbent on practices to develop an online presence to decrease exposure to disease, and increase efficiency and workforce flexibility. Hospitals and practices are waking up to these issues. And, these changes are taking place right now forever transforming radiology.

Fewer Onsite Radiologists

Of course, hospitals and practices need onsite radiologists to fulfill their obligations. We need to do the biopsies, treatments, direct patient care, interventions, and more.  However, we do not need to do much of the work onsite. And, all radiologists will, therefore, have more flexibility to read from home, outside the normal confines of an office or hospital. Teleradiology will no longer be only for teleradiologists, but rather a tool for all radiologists. And, thus, you will see fewer radiologists sitting at hospital workstations. Instead, clinicians will call many more radiologists at their home offices with their questions.

Radiology In A Post Covid-19 Era

Yes. The field of radiology will never be quite the same. We are moving toward different practices and norms. And, increase demand/applications for our specialty, ubiquitous remote learning, universal teleradiology, and a leaner number of radiologists stationed at hospitals and practices are some of the features that you will most likely notice in a post-Covid era. Although some of you may disagree, it makes logical sense as we are developing the infrastructure for these changes as the pandemic continues to smolder. So, look around your departments over the next several months and years. Just like the addition of PACs, or when CT became part of bread and butter radiology, you will be taking part in the next sea change of our field!

If you think of other changes or disagree with my predictions, shoot me some comments or an email about what you think.  I would be interested to hear your opinions!

 

 

 

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USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective!

grading

Every year, program directors spend large amounts of time and effort in the application process to select qualified radiology residents. Currently, we rely upon sparse information to ensure we get capable residents. And, one of those pieces of data includes one of a few items that discriminate all applicants equally regardless of institution, nationality, or sort of medical school degree: the USMLE Step 1 examination. But, that stream of information will become even more meager. As some of you may have heard, as of 2022, this USMLE Step 1 examination will become a pass/fail examination. As a result, we lose out on a discriminator that can assess a resident’s ability to pass exams and correlates to passing our radiology core examination. Unfortunately, these changes render the test useless for our purposes.

So, we will need to rely upon other methods to select residents that can pass a radiology board examination. In this case, let’s take this issue on step further. How is the new grading system going to affect applicants? And, who will be the winners and losers? Let me guide you through what I predict will happen once the new grading system for this exam begins.

Winners

Ivy League Medical Graduates/Medical Schools

Since we are losing out on one of the few means of equalizing all applicants, we will have to rely more upon the “name” of the school rather than the individual data points. Therefore, known medical schools will take on higher importance in the application process. Regardless of quality, the system is forcing us to use the institution’s reputation over the quality of the individual’s data.

Poor Test Takers

For those folks with problems passing an examination, this change will help somewhat. You will have one less exam to obsess about your score, now that you only have to pass the test. Of course, you will now need to do well on the Step II examination. And, this test will probably replace the Step I exam as a screening tool for the ERAS application to our specialty. But, it is one less hoop for the average poor exam taker to jump through.

Step II USMLE Examination Review Courses

Now that acing the Step I examination no longer becomes significant, program directors will need to rely on another indicator for test-taking abilities. And, the only one left during the residency will be the Step II examination. So, this will force applicants to take this examination m0re seriously. So, you will probably see more Step II courses sprouting up to help applicants score well on this test.

Losers

Foreign Applicants

As program directors, we like to compare apples to apples when assessing resident applications. And, many times, it is harder to determine the quality of a medical school when it does not adopt the standards of the ACGME. So, we need to rely on other means to assess the residents. Now, we lose out on another data point to do so. Therefore, foreign residents will be the first to lose out in the selection process at the expense of other standardized medical institutions.

Radiology Program Directors

For several reasons, this will hamper our radiology residency selection process. First of all, we are losing out on one of the only examinations that correlate with passing the core exam. Therefore, theoretically, we will be accepting more residents that will not be able to pass a standardized test, the core examination. Second, we will have a smaller pool of applicants from which to choose, now that many of us will require applicants to take the USMLE Step II as our “test-ability discriminator.” Third, we will be more delayed in waiting for Step II exams to come in for the ERAS application. And, finally, we will have one less data point to use in our assessment arsenal.

Step I Pass-Fail Grading: Changing The Playing Field!

Tweaking the testing process always changes the outcomes for those applicants that take them. And, the new grading system for the USMLE Step I is no exception. In the radiology application process, there will be clear winners and losers. Foreign applicants and radiology program directors will get the short end of the stick. Meanwhile, Ivy League applicants and poor test-takers will benefit a bit more. And, to assess applicants, we will become more reliant on Step II USMLE examination. So, these are the main changes that lurk over the horizon. Get ready to change accordingly!

 

 

 

 

 

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Top Ten Differences Between A Senior Resident And Radiology Attending

differences

You may be more than halfway through your residency program or about to graduate residency. And it may feel like you have been through the wringer. Not only have you made it through the call, but you have also studied all the minutia that you need to know to take the core exam. So, can life change that much more when you become an attending? I mean, it’s only a few years or less away. Well, for your education (and entertainment, of course!), we will go through the top ten differences between a senior resident and an attending. Let’s go from least to most noticeable!

Shallower Breadth And Increasing Depth Of Knowledge

Believe it or not, beginning a full-time job still changes what you know. Remember all that detailed information from the case review series and the survey books? And, of course, all that detail you learned from studying for the core examination? Where does it go? Let’s put it this way; your brain begins to trim out what you no longer use. So, that full breadth of knowledge you learned from studying for your core exam? Yes, gone! Instead, one of the biggest differences is that you remember the relevant information you need to know daily for your specific areas of expertise.

You’re Now The Expert

For the first time, you da’ man (or woman!). Regardless of your feelings, your colleagues see you as a guru in your specialty. A very different feel from your previous work as a resident or fellow in training!

Horses First, Then Zebras

As an attending, you know what you see because you have experienced it many times. The zebras only come out when you have exhausted all the horses first. Usually, not the case for residents!

Patients And Doctors Want To See You!

No longer are you an intermediary in the way of your attendings. Patients and doctors ultimately want to hear from the man or woman of final reckoning in the report. And that is you! Feels good to be desired. One of the biggest differences!

Need To Get A Move On!

No longer can you rest on your laurels as you did as a resident during the daytime. You have a job to do, and it must get done. If not you as an attending, then who? A hundred cases? If they do not get read by the end of the day, you hear and see a queue of angry clinicians and patients!

More Vacation But Perhaps Not At The Best Times!

You may notice that you took a vacation during residency, usually at the standard times- Christmas, spring break, or summer. And although the residency required some coverage from one or two of your fellow residents, most could still take off at those times. Well, alas, this is all about to change! And although you may receive more vacation in general, your practice will still need significant coverage during these favorite vacation slots. And who needs to work at these times? You!

Increased Liability

In the end, no longer can a senior cover for your mistakes. You are coming onto a shift in the morning and looking at the night resident’s dictations. Well, you own them. His and your mistakes are your problems! Miss cancer, your reputation, license, and nest egg are on the line!

Loans Come Due

You think all the money you earn as an attending is your own, right? Wrong! On day one, as you start your first job, the loan servicers ask for their due. Forbearance of your loans is no longer an option. Thousands of dollars per month only to service your student loan debt. Welcome to the real world.

Increased Pay

Imagine rolling along for years at a time, garnering biweekly or monthly paychecks, and coming home with a few thousand dollars a pop. And, then suddenly, Whoosh! You notice that the direct deposit fills your account with something more substantial. Feels good, doesn’t it?

Expenses Rise

Now for the bad news. The more significant paycheck comes with more considerable account drainage from those expenses. Those larger paychecks suddenly drain rapidly from your bank account with new costs from a new house, car, loan payments, and child care. Where did all that increased pay go?

 

Final Thoughts About Differences Between A Senior Resident And A Radiology Attending

So, there you go. Perhaps, not what you thought? Or, maybe it was? Regardless, now you know what to expect to change once you graduate!