Tag: hospital

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Not Sure What You Want? Private Practice, Hospital Based, Or Academic Residency: Find A Radiology Program With All Three!

not sure

Usually, I’m not particularly eager to toot my own horn. But, with the new merger of our three residency programs, we have established a unique situation that very few programs throughout the country can boast. Residents can now experience what it is like to work as a trainee in private practice, a practice with radiologists directly hired by a hospital, and an academic hospital, all under the roof of one residency program. Why is this situation so helpful for residents who have graduated from a program like this? Well, if you are not sure now, later, it can minimize the chances that, as a new hire, you will pick the wrong career path. And that decision can be challenging. Let me explain why.

Not Sure? Pick Among All The Experiences!

Private Practice Experience 

Welcome to our world. When you attend a residency with a private practice-based mentality, the program becomes very different than a standard residency program. Private practice’s priority is getting through a significant number of cases daily. Every study you read is extra cash in the group’s pocket (and yours too if you are a partner) So, we need to complete all the work as soon as possible. So, the main goal is to maximize efficiency. If you have a residency program associated with a private practice, you will see how this way of thinking affects your faculty. Around ninety percent of radiologists eventually go into some form of private practice. So, you must discover what you are in for when you get out of training! (Most residents have no idea!)

Hospital Based Experience

This experience is the most common for radiology residency programs. The typical structure is that the hospital hires individual radiologists. Perhaps, they have some form of incentives for efficiency, teaching, and participation in hospital committees. But, radiologists don’t get a specific piece of the professional or technical fee action. So, these hospital-based groups are more aligned with the needs of the hospital than the needs of the other partners. Therefore, in most of these sorts of practices, there is only a monetary incentive for getting the work done, no more than what the individual hospital contract asks. If there are no riders for reading other films, most likely, these employees will not read them without additional incentive. This structure causes a different mentality than the typical ownership mentality of private practice. Yet, it does have some alignment with the standard private practice in terms of primary efficiency goals.

Government/Academic Experience

Here is the typical large university center structure. In this structure, your salary is more based on academic achievement than efficiency for reading films. You get your raises and your bonuses based on academic grant production, teaching residents, and giving lectures at conferences throughout the country. Attendings in the situation will align with some private entities they are researching. And they will get some form of a stipend for studying their equipment, drugs, procedures, etc. Academic practices often do not incentivize efficiency as much as the other models. This mentality is not the real world for most radiologists, but those intellectual sorts will live like this. Some love the academic experience; others do not so much!

Not Sure? With A Wealth Of Different Residency Experiences, The World Is Your Oyster

Finding a residency program that encompasses all three experiences, private practice, hospital-based, and academic, allows the resident participant to get a feel for the world post-residency in most potential career paths. If I had such an opportunity, I probably would have stuck to one job post-residency because I would have known the practice scenario I would have wanted. So, if you have the rare opportunity to get a residency spot that allows you to experience all three ways of working, seriously consider it over others. It’s a great way to avoid the wandering situation where you work at multiple practices until you find the right one!

 

 

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The Art Of The Last Minute Radiology Deal

last minute

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

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

Nailing The Best Last Minute Radiology Package

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

Moving Expenses

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

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

Malpractice Tail Coverage

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

Percent Working At Specific Roles

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

Getting The Most Out Of Your Hospital Deal Last Minute

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

Separation Clauses

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

Support For Other Services (Chairman, etc.)

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

The Art Of The Last Minute Radiology Deal!

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

 

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Are You Getting the Outpatient Experience You Need In Your Residency Program?

outpatient experience

Some radiology residency programs throughout the country often claim a great outpatient experience. And others, if you ask, they won’t mention it at all. As an interviewee, you may not think about this segment of radiology. But, as a practicing radiologist, this is where you will spend a good chunk of your time.

So, what are the different sorts of outpatient experiences? And, is this outpatient experience even critical to your training? Or, is it something that you can forego because the hospital covers it? The bottom line, are you getting the outpatient time that you need?

Let’s investigate the world of outpatient radiology and what it all means for the typical radiology resident. To do so, I am going to discuss why it is critical to your training. Then, I will split the categories out outpatient imaging into those that you might encounter. And finally, I will talk about what you genuinely need in radiology residency to make your outpatient experience complete.

Why Is Outpatient Imaging So Important?

They say that about 90 percent of radiologists go into private practice (me included!), and the other 10 percent become hospital academics. And, a large swath of those 90 percent practices some form of outpatient imaging. Moreover, the imaging mix differs in outpatient imaging compared to the standard hospital menu of cases. So, if you want to simulate the real practice of radiology, you need some form of outpatient experience.

Three Different Types Of Outpatient Environments

Hospital Outpatient

Almost all hospitals have nonemergent patients that will show up to receive their imaging. The extent can vary from hospital to hospital depending on the location, patient mix, etc. However, the sort of patient that shows up for nonemergent imaging at a hospital tends to differ from the standard clinic patient that wants imaging. These studies often are more complex. And, they show up to the hospital either because they have some complicating issue that prevents them from getting outpatient center imaging (asthma, contrast reaction, etc.) Or, they may have an appointment at the hospital and may as well get their studies. Finally, less likely, a patient will show up here because he wants to go to a hospital rather than an imaging center.

Regardless, these outpatients will less likely have complaints like osteoarthritis or a superficial lump on the back. Instead, the patients will overall have more complex and involved issues. So, your mix of patients will not be the same.

Hospital Owned Outpatient Center

This experience is a hybrid between private practice imaging and the outpatient hospital experience. Here, you will get complex referrals from a hospital center. But, you will also receive the more typical outpatient type of studies. When you sit down and read, you will find a mix of patients with widely varying difficulty levels of cases.

Private Practice Outpatient

And most likely, private practice is what you think of as the “pure” outpatient experience. Here you get referrals almost exclusively from local doctors. Or, you will get patients who come in independently to receive screening tests like mammograms. Cases tend to be more one complaint sort of issues with more “normals.”

How You Might Experience Outpatient Radiology

Sampling

Depending on how the residency arranges your outpatient experience, you may be an occasional observer. Perhaps, the attendings dictate the outpatient cases because they get paid for them. And, you get to watch them interpret the studies. Or, it may be a random sampling as you are reading hospital outpatients. In either case, this is not the immersive type of outpatient experience.

Immersive

Here, you will be primarily interpreting outpatient cases and having your attendings sign off on them. It is much more similar to the daily workflow you might encounter in any given private practice. You will have a more similar experience as an outpatient private practice radiologist.

What Is The Best Outpatient Experience?

Well, as usual, the answer depends. Though, the key to becoming an excellent radiologist, in general, is to have varied experiences across the board. It is possible to have too much outpatient radiology at the expense of inpatient imaging, especially if you want to become a hardcore academic. So, you need to ask yourself, am I getting a broad enough experience concerning all the other segments of radiology training for my interests?

Nevertheless, I would recommend searching for a program that gives you the capability of reading and interpreting all sorts of “simple” and complex outpatient cases. And, I also believe that immersive experience is better. Why? Well, it allows you to get a feel for private outpatient practice. And, it will enable you to make a more informed choice of practice situations when you ultimately decide to settle on a final path.

Are You Getting What You Need To Become An Excellent Radiologist?

Having all the ingredients available for you to get the training you need to become a radiologist, well, that is the main point of residency. So, if you are in a situation that does not give you the right mix outpatients, look into ways that you can get the appropriate outpatient experience. Take some time and effort on your part to create a custom rotation. Or, push your faculty to allow you to get the proper exposure. In any case, make sure not to skip out on this subsegment of radiology. Without this experience, you will not be the consummate well-trained radiologist you want to be!