Tag: expectations

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Great Expectations For The Radiology Resident

great expectations

The wait has finally arrived. After years of biding your time in medical school and residency, you are finally en route to what you want to do: begin training as a radiologist. And radiology residency begins. But, is it all that you had expected after all these years? Are you getting unadulterated teaching from your faculty as you had hoped? Is the learning at noon conferences with enthusiastic and engaging staff? Do the fellow residents live up to the great expectations that you had in the first place?

Well, there is a good chance that any residency program that you choose will not entirely live up to your great expectations. So, coming from an associate program director, what are reasonable expectations for your residency program when you start? And what are some unreasonable expectations for your newfound position? Let’s discuss these expectations by expounding on what is reasonable and limited. Then we will summarize the best way to treat these expectations overall.

Reasonable Anticipation

Reading Alongside Attendings

Any program worth its salt needs to have some time dedicated to having residents listening and reading along with attendings. At the beginning of the residency, the only way to know radiology is to listen to how your mentors interpret films and dictate. And this means some dedicated time to watch, listen, and learn the ropes in real-time with a radiology faculty member. A residency cannot survive for long without this factor.

Ability To Ask Questions

If your faculty shuts you down or insults you whenever you ask a question, you cannot thrive in residency. We learn by asking questions. And in the beginning, there is no such thing as a stupid question. Heck, you don’t even know what to ask! But, if your faculty scolds you for asking questions from your mentors, this would be an example of a malicious program to residents and learning!

Monitoring Your Dictations

Any residency should ensure that its residents are dictating and interpreting films appropriately. It is the currency of radiology. The only way to do that is to assess the outcome of the radiology process. And that is the final report or dictation. All residencies should have a system for attendings to review resident dictations. This process is an essential factor for learning.

Feeling Safe

If you feel like faculty members threaten you or fear for your sanity (or life!), you have a real problem. No person can go through such a stressful learning situation in addition to the stresses of radiology residency (and yes, radiology training is considered stressful!). Nor should any resident have to encounter a problem such as this.

Unreasonable Expectations

Unadulterated Attention From Attendings At All Times

Whether you are in a research institution, University program, University-affiliated program, or community/private practice residency, you will not be the priority of most faculty. Most have research to publish, work to complete, and families to come home to. So, if you are too idealistic that you will receive the attention of all the faculty all the time, you will never feel satisfied.

Expectations That Everything Will Be Taught

Yes. For some concepts, it does help to have a teacher. But, no matter what anyone says, most radiology is self-taught. We need to see 100 cases of appendicitis, thousands of routine chest x-rays, and perform hundreds of paracenteses before we get it all right. No one but yourself can do that for you. And, that does not include all the concepts you need to reinforce and remember by reading in every area that radiology covers.

All Teachers And Colleagues WIll Be Your Friend

Just because we are all radiologists does not mean everyone will be your buddy. Similar to the “real” world, we all have different personalities and desires. And, not all people mesh well together, no matter how much we want that to happen. On the other hand, we all can learn from one another. If you apply every person in your program to this concept, regardless of how they feel about you, you will begin to appreciate them for who they are.

Great Expectations

We all come into new situations with great expectations. But, check for yourself. Are these expectations realistic or not? Any program should fulfill the basic requirements, such as working directly with attendings in a safe environment. But, you can’t expect any program to pull all the challenging weights for you. There is just some work you need to do for yourself. It’s the only way to become an excellent radiologist!

 

 

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What Does It Mean To Be One Of The Successful Radiology Residents?

successfui radiology residents

So, your residency director begins to talk about his most successful radiology residents over the past ten years. But what does that mean exactly? And do you want to be part of that list? Well, maybe or maybe not.

Most of the time, the resident’s and program director’s expectations align precisely. But other times, the definition of a successful resident from a residency director’s perspective may vary widely from yours. In this light, we will talk about the expectations of a residency director and your expectations of the meaning of a “successful” radiology resident. Moreover, we will look into those conflicts of interest that may arise between the two expectations.

Residency Director Expectations

So, what makes a residency director happy with his residents? Well, for many directors, it comes down to reducing the heavy workloads. And, to keep their work to a minimum, most residency directors want their residents to comply with the basic expectations of a radiology residency program during the four years. In other words, these are some of the phrases that a residency director would want to apply to their best residents.

1. Passes the core exam on the first try

2. Completes all the necessary work on his own

3. Doesn’t create too much noise during residency.

4. Is expeditious with his work

5. Gets along well with others

6. Completes fellowship after residency

7. Enters academics and has a radiology career

8. Creates his research projects independently

9. Continues to produce research independently after graduation

 

Radiology Resident Expectations

On the other hand, what does a resident think would make the best sort of resident during his training? Here are some short descriptive sentences.

1. Reads enough during residency to have a good background for his career

2. Experiences and learns about all the procedures and modalities in the field.

3. Gets along well with colleagues and attendings

4. Makes connections for fellowship and beyond

5. Does not get sued

6. Can find a quality job in a desirable location with reasonable income after his residency

 

What Are The Potential Conflicts Of Interest Between The Resident’s and Program Director’s Expectations?

Research

The program gains more clout for a residency director when it produces large amounts of academics. For one, the Radiology Review Committee/ACGME will be much less likely to cite a residency if they have sent many abstracts to national conferences and have written numerous publications. On the other hand, many residents can care less about pursuing research and utilize it only as an avenue to graduate residency.

Making Noise

Often, residency directors like the status quo. To accomplish this, they would rather have their residents go through the motions of completing their work without changing the system. It becomes a less complex pathway with fewer chores to do. However, on some occasions, by not vocalizing educational issues, radiology residents may sacrifice their education and career. So, the resident may not find it appropriate to maintain silence.

Finding A “Good” Job

Sometimes, the program director’s definition of an acceptable career choice differs widely from his radiology residents. For instance, she may expect residents to go on to academic or prestigious private practice careers to maintain the “lineage” of the program. Nevertheless, the best career pathway may not always apply to each resident who comes through the system. Some residents may have business interests or may not have the desire to enter a typical career.

Taking And Passing The Boards

For most residents, completing the radiology boards become a critical step to obtaining a desirable job. And it also adds to the positive statistics of a program. But sometimes, passing the big exam is unnecessary to get the career the radiology resident wants. Perhaps, they want to enter the business world. Or, they have a job lined up in some other area. Taking and passing a board may become less critical to this resident than the radiology program.

Bottom Line About “Successful” Radiology Residents

The program director’s and the radiology resident’s expectations of the “successful” resident usually align. However, occasionally they don’t match up. It’s like parenting. Sometimes, we need to let our residents take an untraversed pathway. We, as program directors, cannot always force our residents down the same well-trodden trails. And radiology residents should not expect that they always need to perform the desired requirements. Instead, radiology residency directors, residents, and the external regulating bodies should redefine their expectations for success with the understanding that “successful” residents do not always fit an identical mold.

 

 

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Work Expectations For New Attendings: How To Know If You Meet Them

work expectations

Every career stage has its difficulties. And you thought figuring out the ropes as a resident was difficult? Working as a new board-certified radiologist in your career of interest is no different. Just like you have in the past, you will worry about both the quality and quantity of your work. So, how do you know what you do is enough to make a good impression on your future partners and colleagues? Some would say that if you have to ask this question, you are probably not reading enough. But I think that answer is way too simplistic. Instead of relying on aphorisms, let’s go through some work expectations for completing enough studies at each early stage during the first few months and years before starting as a partner in a practice.

First Few Months Of Work Expectations

At the beginning of your first employment opportunity, most practices tend to give new employees a bit more leeway (although not all!). Rather than focusing on quantity, most practices would want you to concentrate your efforts on maintaining the quality of your work. That said, if you garner a reputation of working slowly as a slug, that is not likely to do wonders for your likelihood of becoming a partner or a long-term employee within a practice. Most practices have unstated minimum work expectations. And as a new employee, you should expect to try to take as much work as you can reasonably muster so long as you are not overdoing it and you are not sacrificing the quality of your work.

You should always try to help by taking extra cases, performing as many procedures as possible, and becoming the “invaluable go-to guy or gal.” Don’t let yourself get stuck in the mind frame of “that is not my responsibility.” Of course, if the folks that run the practice are assigning you duties that you have not trained for and cannot complete, you need to say something. But for the most part, you should welcome the additional responsibilities and expectations the owners have given you.

So, what are some signs that you are not reading enough to maintain weight and meet practice work expectations? If you notice the partners are frustrated that they have to take over much of your work because you are not working fast enough, then maybe you need to consider taking it up a notch. Fortunately, most practices, however, will give you a little bit of leeway at this point in your career.

First Few Years

After the initial probation period, you really have to consider whether you are keeping up with the appropriate amount of RVUs and meeting work expectations. No longer can you rest on your laurels because you are the new gal in town. It’s not just about quality anymore!

At this point, your colleagues expect you to pull your weight by completing your assigned lists, which is why they hired you. In addition, you should be helping out with others; if the day ends at 5 pm and you can help others complete their work after this time, by all means, go ahead. Especially when you have your sights on the partnership, you should put your best efforts forward. At most practices, your performance still counts toward your group’s chances of adding you to their fold.

Which candidates will your practice cut during the first few years? Essentially, any partnership track employees who did not fulfill the expectations of their initial reasons for hiring. If you feel that this includes you in this category, beware!

In addition, those folks on the chopping block include employees that cannot adapt to workload changes and work expectations. Practices are not stagnant. Instead, you can’t expect to read the same amount of studies in any given year. Working conditions can become busier, or your practice may add new modalities and procedures. So, always ask if you are keeping up with their expectations even after your first few months. You are not quite at the end of the tunnel until the group has officially voted you in!

Final Thoughts On Work Expectations

Working at a job where you intend to stay for years is more of a marathon than a sprint. Therefore, your mentality needs to be one of “what can I add to the practice?” rather than “why should I do extra work?” or “it’s not my job!” If you maintain this attitude toward your work, you will not only form good employment habits, but you will also think of your role as part of a team effort, not just pulling for oneself. And in the end, that is what most partnerships expect. So, go forth and put your best foot forward. Then, you, too, will find success!

 

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Expectations vs Reality Upon Graduating Radiology Residency (I Hate To Burst Your Bubble!)

expectations

During residency, most physician trainees are studying and working so hard that they vaguely realize what is in store for them when they finish their training and begin their first job. What they often expect differs dramatically from reality. So, I thought this would be the post to give you the lowdown on some expectations versus reality when you start as an attending. We will cover six employment topics: money, job performance expectations, the importance of the bottom line, teamwork, case sign-off, and feedback.

Money Issues

Scenario

You begin residency and see these large salaries that come across in your email from recruiters. And, you hear stories of friends doing well at their first job, making tons of money that they don’t even know what to do with.

The Reality:

Many residents consume themselves thinking about the relatively “large salaries” they will earn once they finish their residency. You may think, well, if I can do that for ten years, I will be out of debt and rich. However, every large salary comes with a price. Either you will be working like the proverbial “dog,” or you may be located in a place very far from your friends and family.

Other new attendings also do not realize the costs that accrue from debts, buying a house, and maintaining a luxury lifestyle. Often, these folks go into further debt, funding a lifestyle that they cannot afford. Don’t let that be you!

Job Performance Expectations

Scenario:

You have just graduated as a neuroradiologist, and you are ready to take your first job. The job post said you would be performing 50 percent neuroradiology and no mammography while on a partnership track. You are excited as can be not to have to read any mammography!!!

The Reality

As soon as you start, one of the partners asks you to help out reading mammography by taking a course and over reading one of the other radiologists’ mammograms. Since one of their mammographers left, they need the help until they can hire another.

This situation is commonplace in the world of private practice. Sometimes, undue circumstances arrive beyond the practice’s control, and your expectations for your work will not precisely align with reality. If you cannot be somewhat flexible, you may not become a partner in the practice!

Importance of the Bottom Line

Scenario:

Your academic nuclear medicine position at a high-powered center of excellence is about to begin in a few days. Since it is a large academic center, you figure you will have lots of administrative time to pursue your research interests. I can’t wait!

The Reality:

After a few days of working in your position, the institution issues rules regulating administrative time. If you cannot obtain a grant to support the institution, you will have very little administrative time.

Don’t assume that a large academic institution does not care about how much money it earns. It needs radiologists to financially support the institution by reading films just as a private practice needs to perform procedures and interpret enough films to stay solvent. An academic institution does not mean lots of free time!!!

Teamwork Expectations

Scenario

You are about to begin your first private practice job, and they told you that they treat all employees and partners equally. So, you are very excited to start a career with an equal footing to everyone else.

The Reality:

In your first week of work, a partner asks if you could help him out with reading some extra films because he and his wife want to go to a concert. You tell him that you had early dinner plans with your wife, but he continues to insist. You feel you have to stay to complete the work because he is an influential partner in the practice. Bottom line… Everyone is equal, but partners are often more equal than others!!!!

Case Sign-off

Scenario:

You are sick of waiting for your attending radiologist to sign off the reports you dictated a few hours ago. When you finish residency, now you will be able to complete your dictations whenever you are ready!

The Reality:

Now that you are the final reader and the buck stops with you, you become unsure of the findings and want to ask your colleagues before completing some of your more complex reports during your first days of work. Well, now you don’t have to wait for someone else to sign off your reports. Instead, you may need someone else to look at the cases for a second opinion before completing the study!!!

Feedback

Scenario:

The practice partners state that you will get immediate feedback about your progress after six months. Furthermore, they say that they can even tell who will be partnership material by the first year.

The Reality:

Six months roll around, and no one lets you know about your progress. You think you are doing well, but you are not sure. The patients and the clinicians seem to like you. After one year, no one lets you know if you will make a partnership after the three years they promised you. Unlike residency, feedback can be much more challenging to obtain since it is not designated. There is no guarantee!!!

Expectations For The New Attending!

Becoming a radiology attending is not like entering Shangri-La. There will be new challenges that you do not expect. Along with the added respect, you will have many additional responsibilities. So remember, as a radiology resident, try to prepare yourself for the reality of becoming a radiology attending. So, you will not be surprised about what to expect when you begin!!!