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Seven Ways Administration Can Destroy A Radiology Residency Program

administration

Like it or not, all radiology programs need the backing of their administrators to succeed. Unless faculty and residents want to pay for residency out of their own pockets and manage all the day-to-day issues themselves, it is the only way to survive. So, with all this power in the hands of the administrators, it is no wonder that they can direct a residency in ways they see fit. And they can use their power for the good of the program or to the detriment of everyone. So, if you are wondering how the administration can pull strings to destroy a radiology residency program, here are the top seven ways!

Lack Of Financial Support

Unfortunately, a residency cannot run itself without money. Whether it is the reading resources, Radexam, equipment, or teaching, all these line items cost money. If the administration takes all the money for themselves and is unwilling to cough it up for the residency program, a residency cannot continue functioning.

Lack Of Human Resources

It’s not all about equipment and stuff. It would help if you also had the workforce to make a residency function. These folks include program directors, residency coordinators, faculty, statisticians, and more. If you can’t hire or maintain these folks, you may as well pack it all in!

Unrealistic Expectations By The Administration

We all want the best for our residents. But, when administrators expect to create an academic powerhouse but are unwilling to hire the proper faculty, or if you want a class of incredible residents but are not willing to pay for the latest and greatest equipment and technology, do not expect to create a residency that will function!

Administration Culture Clash/Backseat Driving

Administrators and faculty often have different ideas about how to run a program. Just because you, as an administrator, provide the funds to operate a radiology residency doesn’t mean you can control everything. For instance, recruiting residents from only certain institutions because you get a kickback doesn’t work.

And, just because you, as a radiologist or program director, think you know everything about running a residency doesn’t mean you know enough about managing a program’s business. Spending money without controls can lead to poor hospital financial outcomes. Either side pulling all the strings can lead to a disaster!

No Backup For Program Directors/Department

To maintain respectability within an institution, program directors need support from their administration. They may encounter problems getting a statistician to help residents with studies to meet the requirements of the ACGME. Perhaps there are conflicts with another department overstepping its bounds and using radiology residents for non-educational purposes. In either case, the administration must back up the program directors and radiology department to maintain the department.

Unwilling To Update Old Equipment To Save A Buck

Yes, institutions do like to keep that ancient CT scanner or MRI. Why? Well, it becomes a cash cow when it is all paid off. No more hardware expenses mean higher profit margins. But there comes a time when you are just out-of-date and can’t keep up with the competition. And guess what? That also affects the residency. Residents don’t get the training they need, and fewer patients come to the institution because they don’t get the advanced imaging they need!

Loathe To Adopt New Technologies- Too Many Hoops

Sometimes, you need to adopt new technologies, but there is so much bureaucracy that you can never push the capital budget through. Perhaps the administration makes it so hard to obtain the correct paperwork. Or maybe they only meet in committee once every six months and are not quick to decide. In any event, if you snooze, you lose!

Yes, Administration Can Destroy A Radiology Residency Program!

Radiology residency programs are only as good as their weakest link. And if that link is the administration, the whole residency can fall apart. Whether the issues are financial, cultural, or bureaucratic, each factor can result in the program’s demise. So, when you choose a training program, make sure to look into who administers it!

 

 

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ESIR Programs: Let The Buyer Beware

Radiology programs, radiology program directors, Early Specialization In Interventional Radiology (ESIR) directors, and residents interested in interventional radiology are dealing with a mini-crisis. For years, programs have allowed residents to make a choice to start an interventional fellowship several years into residency. Instead today, new residents face the crunch of having to make this decision to join up with ESIR programs right away. And, they should not take this decision lightly. Why? Well, that is exactly what we are going to discuss today!

So, What’s The Urgency, Huh?

Like anything else in the world, when you have limited supply and excess demand, you create bottlenecks. And, unfortunately, in many programs across the country, the number of ESIR spots available does not equal the number of residents interested in the program. Therefore, this problem exists in some programs, right here right now.

So, if a program has two residents interested in this program, but it only has one spot available, the program director needs to make the final decision by either one of two methods. First, the program can decide on a first come first serve policy. But, let’s say that you have two residents that decide they want to join a program at the same time. Well then, that leads us to the other way to decide. And, that would be a long drawn out application process to determine the most “qualified” applicant.

Either way, this puts pressure on the applicant and the program to make a decision pronto. As you now understand, the resident and program need to make rushed decisions together.

Why Can This Decision To Join ESIR Have Permanent Implications?

OK. First, I will mention the positive. ESIR programs allow residents throughout the country to decrease the number of years of a fellowship from two to one. And, these residents will be able to hit the proverbial ground running at their interventional fellowships from the very beginning. But, at what cost?

Problem 1

Here comes the tough part. ESIR programs need to allow residents to complete approximately one year of interventional related activities during radiology residency. So, where does the time come from? It has to come from somewhere, right? Well, here is the rub. Programs need to draw the time allotted to ESIR from the normal diagnostic radiology activities. So, residents that complete an ESIR program have less overall experience in the standard rotations like MRI, ultrasound, etc. And therefore, the training of an ESIR resident is not truly equivalent to a standard diagnostic radiology resident.

So, what are the implications of this? In the workforce still, most practices need radiologists that can perform interventional radiology (IR) but can also help out with some of the general work. Well, residents that start a typical IR job will not have the same experience and comfort level with general radiology practice. As you can see, this creates a serious problem for the ESIR graduate.

Problem 2

Unfortunately, the problems do not end here. Let’s say that you start the ESIR program. And then, you then apply for fellowship toward the end of residency. Due to the changes in allocated slots for interventionalists with new DR/IR programs, ESIR programs, and “independent fellowships”, fewer residents can easily drop out of interventional radiology during residency. So, fewer spaces become available for interventional programs throughout the country. And therefore, you, as an ESIR applicant to fellowship, may have a lower likelihood of gaining admission to an interventional radiology fellowship than residents applying in prior years.

So, who is to say for sure that you can obtain an interventional fellowship after residency as an ESIR applicant? In this case, theoretically, ESIR programs have now doubly screwed this resident. First, they completed a program for which they have a real chance of not completing the required CAQ certification. And second, they have less diagnostic radiology experience.

Problem 3

Many folks that want to do interventional radiology really do not know what they want to do until they have completed several IR rotations. So, what happens if the ESIR program resident decides that they do not like interventional radiology toward the middle or end of their residency? Well, they potentially have prevented another interested applicant from getting a spot. In addition, they have again decreased their own training in diagnostic radiology- a lose-lose situation. They will potentially graduate as a “second-rate” diagnostic radiologist.

Bottom Line For The Applicant To ESIR Programs

For those of you applying to ESIR and know for sure that you want to do interventional radiology, well then, go for it. But, I have a sneaking suspicion that many ESIR applicants are not in this category. So, if the program offers you a choice to apply for an ESIR program, make sure to think twice. The implications of joining this program can be far-reaching for the rest of your career!