Tag: jobs

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Should You Join A Practice With Skeleton Coverage?

skeleton coverage

We are in a brave new world. A great job market for starting radiologists is associated with a tough time with radiologist recruitment. And it’s a nationwide problem—tons of work but few radiologists to complete it. So, like many new radiologists, what do you do if you consider joining a practice with skeleton coverage? Should you join these practices or move on to the next “fully staffed” large conglomerate? What are the main risks that you will encounter when starting? Is it at all worth thinking about these practices with skeleton coverage? Let’s figure out if you are the type of person who should consider such a practice!

Advantages Of Skeleton Coverage

Lots Of Opportunities For Moonlighting

When I started, I was hungry for additional shifts to help pay down my student loans. And those spots were not always available. But, in an environment like this, with thinly covered practices, you will have many opportunities. Nights, weekends, and teleradiology coverage will all most likely be available to you, ripe for the picking. You can pay down your debts and save a bit for a new house in no time!

Opportunities For Leadership Positions

A thin bench will create many opportunities for you to become part of almost any organization role right from the bat. If you are interested in hospital administration, you can begin on this path to fulfill your ambitions from the beginning. Are you interested in teaching? Start on your merry way toward becoming a program director, no competition! Or want to become the practice’s CEO eventually? Take on financial roles immediately. You will have very little competition to get started at these positions!

Potentially A Quicker Path To Partnership/Owner

The more needed you are, the more leverage you have. And, if you have enough radiologists barely to fill the rosters, guess what? You may be able to use that leverage to up your time until you can become an owner. Think about it. You have the potential to increase your earnings significantly, more than you may have thought when you first started looking.

Disadvantages/Risks Of Skeleton Coverage

Ripe For Buyout

A thin bench can mean that radiologists can no longer take on the extra workload. It’s just not sustainable. And the casualty can be the sale of the practice to a private equity firm. Caveat emptor- may the buyer beware!

Unhappy Radiologists

More than any other factor, working with fellow radiologists with low morale can be a real downer. And, no factors more than a thin shell of coverage can cause your fellow radiologists to be stressed and miserable. Especially when you are raring to start at your first new practice, this is not the toxic environment you had signed up for when you first applied for the job.

Forced Coverage

Sure, you have all these extra opportunities. But, at what cost? Now that you are missing out on a nucs guy, you have to cover the PET-CTs. Or, maybe you have to cover all these extra available shifts you were not planning to work. If you’ve recently had a baby or have lots of other hobbies that you want to pursue, additional opportunities can be a curse instead of a blessing.

Should You Join A Practice With Skeleton Coverage?

It can be a tough call. But, it depends on your needs and wants. For the new radiologist with lots of ambition, it can be the right decision with lots of opportunities and time to make extra money. But be careful. It can be at the expense of a sell-out by your fellow radiologists or just a plain old miserable environment. So, consider all these factors when joining a practice with a thin bench!

 

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Rural Versus Urban Radiology- Who Wins?

urban radiology

Go to any radiology forum, and you will see an ongoing battle. Everyone wants to prove their point that where they work is the best. Some vouch for working in an urban radiology setting, and others espouse the benefits of working out in the middle of “nothing and nowhere.” Either way, I’m sure there are merits to both. But, let’s pick this topic apart and check out the overall best place to work for the average radiologist resident that is thinking about looking for their first attending job? To do so, we will enumerate and describe the main advantages and disadvantages of each of these choices. In the end, let’s look at the evidence and conclude as to which one is the most desirable outcome!

Rural Radiology

Advantages

More Benefits/Money

Indeed, this perk is the one everyone hears about the most. The farther away from civilization, the more money that most physicians make. And, why is that? Usually, hospitals need to supplement your salary to get you to work there! Nevertheless, it is a fact, and you can use it to your advantage in the outback!

Slower Pace

Everything work-related crawls at a slower pace in rural radiology. You are simply not going to see those crazy enthesioblastomas as often as you might like. On the other hand, because you are not a tertiary referral center, you can scroll the cases at twice the speed since they are much less fraught with complications.

Less Competition

Typically, you don’t need to vie for every patient and every dollar. The subsequent radiologist may be as far as 500 miles from you. So, you just don’t need to worry. You’ve just gained a few anti-stress points and lost a few pounds right there!

Nicer More Open Facilities

In the rural world, land and buildings are generally cheaper. So, you may notice larger and more modern reading rooms, better IR suites, and more well-designed hospitals in general. Lower costs for facilities usually mean more space for you.

Fresh Air

You probably know that smell when you walk outside into the natural world. Simply put, there is much less soot and grime in the air. So, all the flowers and pollen are hitting your sensory receptors as soon as you walk out the door. But, it is true. Your nose will know the difference when you work in a rural environment. And, you will gain a few extra years of life too!

Appreciative Patients

When medical resources are more scarce, patients tend to be more appreciative. You have a better shot at receiving a box of chocolates every year for your services. What you do is hypercritical in a place where fewer physicians work.

Mixed Results/Depends

You Do More Of Everything

Plus or minus. You may get to do more. Now, this may float your boat. Or it may be a cause for your concern. Either way, you will more likely be doing the arthrograms even though you are not an MSK-trained radiologist. Or you will read the mammo, even though you are not breast imaging trained. It’s part of the rural expectations!

Disadvantages

Less Collaboration

Fewer physicians mean less collaboration. That’s just how the math works. Also, it may be a little bit harder to get other expert opinions from your colleagues and your fellow specialists because they just don’t exist. Something to consider before you start a rural radiology career.

Loneliness,

For some folks, family is everything. And, when you live rurally, you have to consider that you may not have your usual family support structure. If you expect the in-laws to come by to help out with the baby, it is unlikely that will happen too often. Just something to think about when you decide to work rurally.

Different/Lack of Cultural Activities

You will not find as much theater and opera out in El Ranchero. But, you may have an excellent Strawberry festival! You just have to have expectations that you will have to travel to get some of the cultural activities you might expect in a large city.

 

Urban Radiology

Advantages of Urban Radiology

Culture

Some rads love the option to go out and watch the newest incarnation of West Side Story with the most famous actors and actresses. Others not as much. In any case, you will have more cultural options for all these activities.

Restaurants

If you like to eat out, the city is just a better environment. You have much more to choose from. And, you can have your Ethiopian fix (I like that cuisine!) and your Afghan meal for the next. It is just more readily available.

More Physicians/Collaboration

More people means more collaboration. You will have more subspecialists at your fingertips to contact and bounce ideas. It often helps when the cases are more complicated. Second opinions sometimes can be a lifesaver.

More Prestige

Larger cities and larger hospitals offer more powerful titles and sometimes more national/international respect. Working at Mass General does mean something to many other physicians and patients. Your name may carry more weight in the big city if you are into prestige.

Better High End/Tertiary Care

If you need treatment for rare diseases, most patients need to go to the big city. These places tend to be hotbeds of research and new therapies and diagnostic tools. The city is the place to be for this work.

Disadvantages Of Urban Radiology

Decreased Pay And Benefits

With all of these perks come the decreased pay because of the desirability of the location. This factor is more pronounced if you decide on a partnership track somewhere. These imaging businesses can afford to pay their radiologists less because they will come anyway!

Increased Competition In Urban Radiology

More physicians mean more competition for every dollar earned. You can’t just build a new imaging center and expect patients to come. Why can’t they get imaged at the business down the street instead?

Higher Living Expenses

Along with lower pay comes higher living expenses. Costs in cities like New York and San Francisco are out of control. And, even as a physician, the economy may force you to rent. Those Benjamins just don’t go anywhere near as far with those high housing and food costs.

Less “Outdoor” Activities

Cities are more conducive to the museums and theaters but less so to hiking up a beautiful green mountain somewhere. For you, that fact may be a game-changer.

So, Who Wins The War- Rural Or Urban Radiology?

Sorry. But, not every location will float everyone’s boats. However, I can say the following. Consider the rural job if you have significant debt because the cost of living can outweigh almost any other advantages of living in the city. The expenses alone will cause you to delay any such hope of financial freedom. Otherwise, find a place that will suit your needs for a long-term relationship. And that can be either rural or urban depending on your family and personality. Just remember. Weigh the pros and cons!

 

 

 

 

 

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Why Artificial Intelligence (AI) Will Not Take Over Radiology!

AI

Artificial intelligence (AI) is still front and center for the layperson when discussing radiology. Family and friends always ask me why AI will not take over my day job. I had one of those “aha” moments in one of those discussions recently. We discussed how many factors will prevent AI from taking over our jobs anytime soon. These included legal, ethical/moral, and financial reasons. As I was droning on, I realized I could argue why AI could overcome these issues. However, one reason not related to these is why we won’t see a blank screen or a computer person from India, China, or any other country for that matter replacing our presence for a very long time. And that is that medicine is local, not universal. 

Medicine Is Local, Not Universal- AI Cannot Account For It!

“Standards”

Why would differing local “standards” be the most critical reason for keeping radiologists busy? Well, every country and every physician has their opinions about the best way to treat patients. Medicine is not universal. It is local. Yes, a few standards are omnipresent, like the Hippocratic Oath not to harm. But, other standards like lung nodule management vary widely among physicians, counties, states, and countries. The Fleishner criteria for managing pulmonary nodules are not standard. Some folks use that criterion; Others use LI-RADS.; And even others use ELCAP. 

I also know some clinicians that modify all these criteria to fit their patient populations. Therefore, it is only possible to standardize standards in an AI computer algorithm when your physician wants to use a different bar from the rest. One great way to lose the radiology business is to make recommendations that run counter to your referrers!

Management Differences Between Places

Different countries have different standards of care. For example, it would not be appropriate to recommend imaging a patient with an MRI of the shoulder in Canada due to lack of availability. Over there, physicians may be more apt to order a musculoskeletal ultrasound. Likewise, a radiologist in Canada may be more likely to recommend a musculoskeletal ultrasound for a possible rotator cuff tear. Yet, an MRI is part of a routine workup in the United States. Why? Because they have a much more significant backlog of patients waiting to get their studies done with fewer MRIs than we do in the United States.

In China, clinicians may regularly recommend “cupping” for different ailments. How can AI programs account for each cultural difference among countries, states, or counties based on availability, preferences, and cultural norms? These obstacles would be exceedingly difficult to overcome.

Differences Between Surgical And Medical Preferences

We work for other physicians. Our role is to make it easier for them to treat patients. And each clinician has specific needs for caring for their population. Oncologists look at assessment criteria differently from surgeons. Neurosurgeons have different interests than internal medicine doctors when they order a study. An AI program needs to consider all these factors when it summarizes findings and makes recommendations. AI is not ready to make different individualized reports for each subspecialist clinician. It would take massive programming power for which it’s not ready!

Differences Among Individual Patients

And finally, even among patients, culturally speaking, some patients want more aggressive workups, and others are more conservative. For instance, I may have a patient who can’t live with a small complex cyst in their breast and wants it drained. Meanwhile, another patient might be more willing to follow it. Some of these differences may be cultural or related to individual differences. How would an AI program account for that? AI is not ready to interpret every patient’s cultural and emotional status to make these decisions. Again, no supercomputer could make these individual recommendations for patients.

A Radiologists Job Is Still Way Too Complex For AI!

Whether it is differing standards, cultural differences, physician preferences, or individual patient preferences, radiology, in particular, is not a one-size-fits-all discipline. No program can consider all of these issues to replace a radiologist within the foreseeable future. The processing power required to figure this out for every clinician’s report would be enormous. Of course, 500 years later, a program may accomplish all these tasks and replace radiologists. But, by then, the same computer will replace every other job, and no trace of humans may exist as the singularity has come and gone! So, for those thinking about entering radiology, keep these issues from dissuading you. Over your career lifetime, you will still have a job!