Tag: practice

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Why Working From Hawaii Doesn’t Work For Most Of Us!

Hawaii

“The best laid plans of mice and men often go awry” is a famous quote that cannot be more true for us radiologists. I’m sure many of you have thought about what it would be like to work from a tropical island like Hawaii to read teleradiology cases several weeks out of the year in practice. Doesn’t sound too bad? How about reading evening studies and frolicking on the beaches with a Mai-Tai in hand in the daytime? Well, sorry to be the bearer of bad news; I will have to squash that thought for most of you. And here are some of the most likely reasons it won’t work.

It’s Still Relatively Easy To Hire Tele-radiologists

Although it is more expensive than a few years ago, if a practice has to choose between hiring overnight teleradiologists or a nighthawk and paying for a place in Hawaii for radiologists to read 6 hours every day, it is a lot less expensive to hire the overnight radiologist. Paying for a home for radiologists can be costly. And not everyone may want to go!

Not Everyone Can Get To Hawaii From Practice 

Believe it or not, if you create an outpost for radiologists to practice on a tropical island, not all of them can pack their bags and go. Some have families, and others have obligations that root these radiologists to the motherland. It is just not easy to get there for everyonee.

Additional IT Headaches

When creating a new outpost, you must ensure it runs well. The last thing a practice wants is a malfunctioning PACS system in a faraway outpost. That burden means the imaging business must pay for excellent IT support. And, with IT support comes additional expenses to maintain the site. Moreover, if the site goes down, other radiologists in the hometown will have to come to the hospital in the wee hours.

Billing Problems

Although not a complete game changer, with all the other issues, the location of dictations can create a headache for billing. Insurance companies do take into account the locale of the dictations. And this can make the process somewhat harder to get reimbursed. Let’s just add-on another issue to the whole!

Not Everyone Likes The Beach In Hawaii

Although going to Hawaii every once in a while to read some cases may sound great, not everyone loves the beach. Yet, your group will have to flip the bill for this privilege. Working from a beach location means you have to like crystal clear water and coconuts. What floats your boat may not be attractive to everyone!

Time Of Working May Not Be Optimal 

The time difference of 6 hours is not a reversed schedule. That means that when you go to bed at 10 PM EST, it is 4 PM in Hawaii. So, if you want coverage from 10 PM until 8 AM EST, you must go to work from 4 PM to 2 AM in Hawaii. Although better than working entirely overnight, it is not perfect for many radiologists. Some radiologists are early birds!

It Takes A Bit Of Extra Effort

Finally, creating another outpost outside your location takes some work and time. And most radiologists don’t want to have to deal with extra burdens. So, although it may be nice in theory, in practice, there are lots of other issues to worry about, first and foremost!

Nice Thought, But Hawaii Probably Will Not Happen In Your Practice!

Sorry to burst your bubble. I didn’t mean to put a kibosh on your hopes and dreams. Nevertheless, we need to be realistic. As you can see, all the headaches you need to work from Hawaii will probably not be worth the effort. Although a great idea, in theory, that’s another story in practice. If you like Hawaii, you may have to go there on vacation or work in Hawaii as your primary job!

 

 

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Why Standards Of Care Are Important To Fight For!

standards of care

I don’t know if you have noticed, but you have probably heard the term standard of care bandied about a bit during your residency program at some point.  But, first of all, what does the standard of care mean? Well, according to MedicineNet, it is “A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.”

However, not all standards are the same. Some measures are national standards, and others are merely within one’s department or practice. But, why is it so important to all physicians, and more importantly, specifically for radiologists? And, what happens if we all don’t meet the “standard of care”? Well, the result may not be so beneficial for you or your practice. Consequently, standards of care are of critical relevance to our world. And, that’s the topic for today!

Legal Reasons To Follow National And State Standards Of Care

OK. Let’s first start with the bugaboo. If a practice or its members are not following the best national/state standards of care, they are prime candidates for a lawsuit. To that end, one of the three pillars of a successful malpractice lawsuit is not meeting the standard of care, So, that alone should make you quake in your pants if you do not abide by these norms.

Importance of Individual Practice Standards

Well, it’s not only about the legal issues when you do not follow national and state standards. Additional trouble can ensue if you do not apply standards within your group. What do I mean by that? Well, not all practices follow the same rules because norms throughout the country and state can differ widely. Let me give an example.

If you decided to look up the requirements for how to determine which patients are appropriate candidates for a hysterosalpingogram (a test to check the anatomy of the uterus and fallopian tubes), the information is all over the map. At best, the data about how you should decide which patients should get the test is scattered and based on differing experiences. Some groups advise that you should perform the procedure between 6-10 days after a menstrual period without additional testing. Others recommend that patients should also have a urine B-HCG level before considering the patient for the test.

In either case, each practice standard is theoretically acceptable. However, if each member of radiology practice uses different criteria for deciding upon when to perform the procedure, what happens? The secretaries become confused about how and when to schedule the examination. And, the technologist or nurses can easily forget what each radiologist requires before the exam. It becomes a mess of confusion. So, practices need standards to prevent these inefficiencies.

Moreover, god forbid if somehow, a patient discovered that they were pregnant before the test, and one radiologist did not test the patient with a B-HCG level (unlike all the others in the practice), then that radiologist did not meet the standard of care for the practice. Theoretically, that could also open up the radiologist to additional legal actions.

Standards Of Care From The Patient Side

Finally, from the patient point of view, nowadays patients can look up information about best practices and procedures online before deciding to get a test. If your group does not meet these standards, and the patient becomes aware of a subsequent complication related to not meeting these norms, at best, the patient may never return. And, at worst, your practice becomes at increased risk of receiving legal action.

Fight For Group Standards Of Care!

As you can see, we all need to be on the same page in any radiology group. Changing practice standards to vary from national and state norms can lead to disaster for the group and the individual radiologist. Moreover, creating specific practice standards within a group can be critical to maintaining efficiency and reducing confusion among the staff. So, think twice if you decide to be OK with not meeting standards in your practice, it may be your future career at stake!

 

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Radiology Golden Niches: Do What Others Don’t Want To!

golden niches

What do the following jobs have in common? Garbage Workers, Oil Cleanup Crews, Sewage Treatment Workers, and Doggy Pickup Services. No, it’s not just that they all clean the environment and serve essential functions in our society. These are jobs that very few people want to perform. And therefore, those that do can charge high rates to complete the services. And, you know what? It is harder to find employees for these professions. I call these sorts of jobs: golden niches.

How is this relevant to radiology? It’s simple. Find an area (or even better, more than one!) that no one else in practice wants to do, and make it your life’s work. Then, you have a job for life (assuming that the business is not bought out or downsized!)

So, this brings me to the topic for today, the golden niches. What radiology specialties are ripe for a new radiologist to practice that can lead to this extraordinary situation and why? Well, we will go through several radiology procedures and modalities that can potentially qualify for one of the golden niches. However, not all practices are the same. And therefore, I must put in this qualifier, golden niches in one hospital or imaging center may not be so in another. You may find that you may have many MRI MSK readers in your practice, and in another, you may have a few. Or, some centers have little need for some of these golden niches. I will point you toward some modalities and procedures that you should think about reading and performing when you interview for your next job!

MRI Cardiac/Cardiac CTA

In our practice, we have limited numbers of radiologists that read these modalities. It is also costly and time-consuming to learn if you did not complete a fellowship. So, if you come aboard and have lots of cardiac work, you can be the hero!

Cardiac Nuclear Medicine

During residency, many residents do not get a chance to dictate these cases since the cardiologists perform them. And, at some centers, they require their radiologists to be nuclear trained. Therefore, fewer radiologists tend to read these studies, allowing you to take over!

MSK Musculoskeletal MRI and Ultrasound

Still, many radiology residencies throughout the country provide limited MSK MRI experience and even fewer MSK ultrasound. So, you may be one of a few in the practice that feels comfortable with these modalities!

Facet Injection For Pain Management

In some centers, practices farm out these cases to the anesthesiologists or the pain medicine physicians. However, in some hospitals, radiologists do the work. And you know what? Only a few MSK radiologists feel comfortable with this procedure.

Informatics

How many of you know the latest about pdfs, HLA, and more? I thought so. And, some practices need these radiologists to run the show!

Virtual Colonoscopies

Most residents are not trained well in this modality during residency. And, even fewer take courses when they finish up. So, you want to run a virtual colonoscopy program in an institution that has the demand. Here’s your niche!

Nuclear Medicine Therapies

Drug companies have developed loads of new nuclear medicine therapies like Xofigo. Moreover, many radiologists do not feel comfortable treating even the old standby of I-131. So, here is an opportunity for you to take charge!

MR Spectroscopy/Perfusion Studies/Neck CTAs

MR spectroscopy/perfusion/neck CTA studies tend to be more esoteric modalities reserved for the neuroradiologists. So, if you have trained as a neuroradiologist, make sure not to skip out on instruction in these areas. You can become instrumental!

Complicated Neck/Temporal Bone Work

Have you ever noticed the remaining cases at most imaging centers and hospitals? It tends not to be the head and body CTs. Instead, no one wants to pick up the CT soft tissue neck and temporal bone studies. So, don’t forget to learn about these topics during residency and fellowship!

Neurointerventional

To feel comfortable performing neurointerventional procedures, you generally need one year of diagnostic neuroradiology and two years of interventional radiology training. That limits the playing field for this work. Need I say more?

Breast MRI

Almost universally, non-breast imagers want nothing to do with these procedures. You have liability issues and inexperience that prevent many from wanting to read these cases. Time to step in!

The Golden Niches

Well, there you have it. Here were some undesirable (and therefore most desirable!) jobs you should consider performing when you start. And, I’m sure there are a few more that I forgot. In any case, it’s not about love. Instead, it’s about job security, my friends. So, go forward and find your golden niches. You won’t regret it!