Posted on

New Radiologist Wanting Locum Work? Think Twice!

locum

Have you ever thought about living in different places for a little a bit at a time? Maybe you have always wanted to do some traveling before starting to work? Of course, it sounds exciting to go from Honolulu for six months and then onto Dayton for the next six. Indeed, I thought about the locum lifestyle when I first started.

But, are you missing out on by taking this route instead of the established full-time job career path? Potentially. As much as the ability to travel for your job may entice you, think twice before embarking down this infrequently traveled road as a new radiologist. Let me give you some good reasons for turning this opportunity down.

Pigeon Holed/Loss of Skills

Do you want your new practice to call you that temporary plain film reader gal? Unfortunately, this sort of attitude prevails among many groups. And, imaging groups tend to place you in a particular role based on the desperate needs of the practice. So, if you sign up for XYZ, the group may utilize you in Y capacity. Over the years, this is a surefire way to lose your skills in other areas that you trained for in residency.

Will The Good Times Last?

What do you think happens when the bottom drops out of the radiology job market? Perhaps, imaging reimbursements drop precipitously. Or, suddenly, the stock market crashes and older radiologists stay in the field. And, yes, unfavorable radiology job markets like this have happened in two separate cycles since I started medical school.

In these situations, what happens first? Well, the excess fat gets cut. And, what exactly is the excess fat? It tends to be the locums’ jobs! When you start, you certainly don’t want to be in that first wave of job cuts. It becomes challenging to recover.

Locums Looked Upon Unfavorably

At many practices, the question that arises when they consider a new locum radiologist is: WHY ARE YOU A LOCUM RADIOLOGIST? From my experience, many radiologists believe (rightfully or wrongfully so) that locums radiologists have a defect. Perhaps, they read to slow and cannot hold a job. Or, maybe, the individual cannot get along with others and drifts from job to job. So, if you have a track record of only holding locum work, you have painted a particular picture of yourself that may not be attractive if you ever want to find a longer-term career!

Never Quite Maximize Efficiency

When you drift from place to place, you never get to learn all the systems in place to maximize your output. PACs machines, paperwork, clinician demands, and technology continually change. And, they differ from one practice to another. By definition, you remain less efficient and slower just because you do not have the long-term knowledge you need to keep up with your colleagues at a job using the same technology for the past ten odd years!

Difficult To Establish Long Term Relationships

What do I value most from my current job? I treasure the relationships that I have made with my colleagues, residents, and fellow clinicians. How do you create and maintain these relationships as a locum? Well, it can become very challenging at the very least. You are new the kid on the block and will remain that way until your short term tenure as a locum radiologist ends.

Locum Work: A Dangerous Road To Travel

Now, locums can be an excellent opportunity for specific individuals. If you have a family and want to fill in some time with some extra hours, it can make some sense. Or, maybe you want to retire soon and desire some additional inconsistent or occasional work. Finally, perhaps, you are independently wealthy, and a full-time career does not matter for you. But, for the typical fresh graduate with a lot of debt and wanting to begin a new locum path, you will encounter many obstacles that can affect your future career and growth. So, think twice if you choose to become a locum radiologist when you start. It may become one of your biggest regrets!

 

Posted on

Poor Step I USMLE Scores- What Do I Do?

USMLE Step I

Hello Dr. Barry Julius, 

Question About Step I USMLE Scores And Application:

I am a foreign medical graduate that finished Med School in 2016. During this 2 years I’ve been studying and taking the USMLE steps, I took my step I USMLE and got an unsatisfactory score of 209 for multiple reasons. Then, I took my step II CS, passed the first attempt, and received a step II CK score of 250. I have an upcoming paid rotation (very hard to find in radiology) in a large city for 3 months starting in February 2019. Unfortunately, I don’t see myself doing anything else than radiology. Since I grew up with it and came from a family full of radiologists back home, this is what I see myself doing and breathing.

Am I dreaming about getting into a radiology residency? Or, is it possible and should I keep on pursuing it? I have all the upcoming months to make my application stronger and more appealing to apply in 2019. I am thinking about taking the step 3 USMLE if that would help my application. However, I have heard mixed opinions about completing it before applying. Also, I don’t have any research. Moreover, I have also found conflicting information on the importance of research for radiology applications.

I would really love to enter a radiology residency but I want to keep it real. Can I have your professional opinion on whether it will be possible. Also, what should I do this time to improve my chances. Or, should I just wake up and look for another option?

Thank you very much for your response,

Concerned Applicant

Answer:

Honestly, since you are a foreign grad, a score of 209 on Step I USMLE may limit your ability to obtain interviews. However, some programs may still give you one because you did so well on the step II exam. I think it is worthwhile to attempt the application process. You never know. But, I agree that it may be very challenging for you this year. You should temper your expectations for getting into a radiology residency.

In terms of the USMLE series, in your case, I would probably consider taking the USMLE Step III and try to ace the examination. A good score would confirm that the initial Step I exam results were a fluke. But, be careful. If you perform poorly on it, you can ruin your application. So, you need to study hard! (Not that I expect that you wouldn’t do so)

Also, it is often just as competitive to get into a prelim year prior to starting radiology residency. All foreign grads need a clinical year in an ACMGE certified program in the United States. So, make sure that you also apply for this as well. Foreign clinical programs are not a substitute.

Finally, as I’ve told some other foreign grads before, you need to make sure that you get to know the program director at the site of your paid rotation, This will help you get your foot in the door for an interview at least at that site. Also, this person can be a great resource to find a way to get involved in radiology research that can also bolster your application. Potentially, this person can also give you a good recommendation. That would help as well.
Let me know if you have any other questions,

Regards,

Barry Julius , MD

Follow-up Question:

Thank you very much for your answer.  I have to apply to both programs at the same time, meaning the first categorical year and radiology at the same time. Is that correct? Is there a possibility to start a separate IM program and then transfer after the first year to radiology?

I think it’s a little bit easier to get into internal medicine residency for the IMG. And, some programs require a lower Step 1 grade. As per your advice, I will definitely take the step III before applying and try to complete some research. It is hard to find, but hopefully, during my upcoming rotation, I can get my hands on something. 

Finally, I forgot to mention that I have a U.S. residency. So, I think that would improve my chances a little bit since I have seen lots of programs not interested in sponsoring VISAS, is this correct? I just want to make my case as strong as possible when applying to improve my chances, but I’m also considering internal medicine residency as another possibility because of my bad STEP 1 grade. 

Thanks again for your reply,
Concerned Applicant

Follow Up Answer:

It is possible to start a separate internal medicine program and then transfer over to radiology. However, I would recommend applying to both a preliminary clinical year and the categorical program as well as the three-year IM program. But, I would make sure to rank the categorical radiology and prelim clinical year programs first. You should be able to use the IM three year program as a backup if all else fails.

And, I agree. U.S. residency will help you a bit to secure a residency slot. It’s one less problem for the residency programs to worry about when you apply.


Good luck!

Barry Julius, MD

Posted on

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!