Tag: radiologist

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Top Ten Signs It’s Time For A Radiologist To Retire!

retire

I’m sure many of you have encountered radiologists who should have retired years ago but are still hanging around. Maybe they are burnt out. Or, perhaps, life has thrown them a few curveballs. Here are some of the top ten reasons why you know it’s time for your fellow radiologist to retire!

One Extra Case Sets Them Off

You probably know one or two radiologists like this. If anyone asks them to help with another case, they will lay it thick on you. Perhaps, they will yell and kick, or they will say they need to get home and can’t afford the time it takes to complete it!

They Can Only See Films From One Eye In A Certain Position

Some radiologists will do almost anything not to go to the doctor. They hang around longer than necessary in practice. I have known a few that would practice with ailments for which I am not sure they can compensate. For many of these radiologists, it may be time to pack your bags!

Spend More Time Napping During The Day Than Reading Cases

In the past, I used to know a radiologist or two who would spend a few hours in their office while everyone else was working hard. Some residents saw them getting shut-eye while everyone else struggled to keep up with the work. If you get to this point, maybe you should be getting up late every day at home without having to read films!

New Ailment Every Day

I’m sure you have heard of a radiologist who always seems to get sick. One day a heart condition, the next day, a limp, and the next day a raging cough. Some folks are too frail to make it to work. If that is you, it may be time for you to nurse yourself back to health and take some time off. It will do you some good.

Yells At The Medical Students Upon Arrival

Poor students. The wrath of some attendings manifests itself on the underlings that come in to visit. They are angry at the world and take it out on the learner. No, it isn’t right. But, it does happen. These folks need some time off to think about their behavior!

They Are Reading 400 Cases Per Day

Most practices have one radiologist that reads too much to be safe. If you are reading four hundred or more cases per day, I feel you are missing a lot of critical findings. Think again if that is what you want or if it’s simply time to slow down.

Flagged Cases So That A Particular Radiologist Will Not Read!

If you have your name tagged on one too many cases, it may be that another one of the radiologists is not allowed to read this referrer’s studies. Or, some physicians whisper about another radiologist and don’t want this person reading the cases. Either way, it’s not a good sign. It likely means that this radiologist is not doing his job well. This radiologist may want to give up and stay home.

Their Cases Always Seem To Make To Morbidity And Mortality Conference

Ever notice that the same radiologist’s cases make it to morbidity and mortality conferences? Well, perhaps, it is for a good reason. All their misses contribute to the holistic lousy patient care. Be on the lookout if this radiologist is in your department!

No One Can Speak To Them Anymore Or Ask Questions

Some radiologists stay away from this one colleague. Unlike most colleagues you can bounce ideas off of, they can’t ask any questions of this person for fear of yelling and negativity. You probably have someone like this in your practice. There is a good chance that it is time for this radiologist to retire!

Always Complaining That They Should Retire

Everyone knows of a radiologist that constantly talks about retiring. They say it in myriad ways, and it becomes a real bear to hear. “I can’t stand work it’s time to retire,” “I can’t take it any more and it is time to go” are the statements they make all the time. Well, do it already!

Reasons It’s Time For Radiologist To Retire

No one can work forever. But, I think that these reasons to retire soon do justice to those folks that should pack it in sooner rather than later!

 

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Will I Be Able To Save Five Million Dollars As A Radiologist With Large Student Loans?

five million

There is something mythical about the number five million dollars. Medscape’s annual net worth survey for physicians uses that barrier as one of the leading wealth accumulation goalposts for their survey and has been doing so for years. The media has created a monicker that they love to use as well called pentamillionaire. And, it is a number that makes sense for those of you that eventually want to retire in today’s dollars.

Imagine. You can reasonably safely withdraw 4 percent of five million dollars per year and have an income of about two hundred thousand dollars while still allowing for capital appreciation. It may not be a king’s ransom in some parts of the country. (California, New York) But, it is undoubtedly a decent nest egg that can allow most folks the ability to live out their years comfortably. This five million dollar number most likely seems very large to those of you in residency that live frugally off of much smaller dollar amounts. But, believe it or not, it will all seem like a lot less when you live like an attending. 

Additionally, inflation will most likely eat into the principal of this dollar amount so that we will account for inflation on that five million dollars in today’s dollars. We will assume an inflation rate of 3 percent to be conservative.

Is It Even Possible To Achieve Five Million Dollars With High Debt Loads On One Radiologist Income?

So, I ask: Is it even possible to save this much with all the student debt you have accumulated and salaries that may not keep up with inflation? Let’s do the calculations for two sorts of residents: Those of you who decide to live in high cost of living areas with significant student debt; those who choose to live in low cost of living areas with considerable student debt. You can skip to the bottom if you want to see the final results. Or, you can peruse all the nitty-gritty details if you are so inclined.

Assumptions For Accumulating Five Million Dollars

We will assume in all cases that you have higher than average debt (400,000 dollars) when you finish residency, that you have a family of four, with a spouse that is taking care of the kids and is not working. We will assume that you want to buy a decent size four-bedroom house in a nice area. Let’s also start with the assumption that you will male the mean income for a radiologist based on the 2021 Medscape compensation survey (413,000). Of course, you can make more or less depending on the practice. But, for simplicity’s sake, we will use this number.

Then we will assume that on average inflation rate is around 3 percent, with a worst-case scenario of radiology salaries that are relatively stagnant due to declining reimbursements. And, we will assume an interest rate on student loans of 4 percent. Finally, we will take that you will put aside a nice chunk of change for each of your kids to go to college (250,000 dollars). Of course, I want to make these circumstances as if you live like an attending instead of a resident. And, then we will go through how long it may take you to accumulate this amount of wealth given your circumstances as a radiologist.

High cost of living areas with significant student debt

Additional numbers for this assumption:

  1. House will cost 1,000,000 dollars with a down payment of 200,000 dollars, saved over your first 5 years of working. (40,000 dollars saved per year)
  2. Student debt will be paid off over 10 years (4049 dollars per month*12 months)= 48,588 per year
  3. Practice puts away 30,000 dollars including match into your 401k starting 1st year
  4. Investment rate of return 8%
  5. Federal Income Taxes after deduction will be 76182 dollars per year based on a calculator
  6. State Income Taxes will be around 6 percent or (413,000*0.06)=24,780 dollars
  7. You have twins beginning at the of your attending work and are putting away 556 dollars per month per kid to get to 250,000 dollars at age 18. (13,344 dollars per year)
  8. Rental of a 3 bedroom house for 5 years at 4000 dollars per month

First 5 years

Total Salary 413000

Expenses

401k: 30,000 (383000 left)

Taxes : 76182 (Federal) + 20290 (State) (286528 left)

Loan payments and house savings and children 529 plan: 48,588 (student loans) + 40,000 (house down payment) + 13,344 (529 plan) (184596 left)

Rental/heating/electricity  48,000  (136596 left)

Subtracting food for family 10000 (126596 left)

Transportation expenses 2 cars/insurance 10000 (116596 left)

Vacations 10,000 dollars (106596 left)

Computers/Cellphones/Electronics/Cable Bill 3600  (102996 left)

Preschool/Day Care Expenses for two kids 24,000 (78996 left)

Clothes 5ooo dollars (73996 left)

Life and Disability Insurance  9600 (64396 left)

Dues and License and CME 5000 (59396 left)

Miscellaneous Entertainment  10,000 (49396 or around 50000)

Saved

Remaining available to save around 50000 per year (not including 401k)

30,000 dollars in 401k

Assuming 8% rate of return on 80,000 over 5 years- 469000 dollars in savings

Next 5 years (Own house)

Expenses

401k: 30,000 (383000 left)

Taxes : 76182 (Federal) + 20290 (State) (286528 left)

Loan payments and house savings and children 529 plan: 48,588 (student loans) + 40,000 (house down payment) + 13,344 (529 plan) (184596 left)

Salary after mortgage payments and taxes (800,000 mortgage -30 year fixed at 3.5 percent 3592*12 (141492 left)

Salary after property taxes and insurance 14,400 (127092 left)

Home maintenance= 10000 (117092 left)

Subtracting food for family 10000 (107092 left)

Transportation expenses 2 cars/insurance 10000 (97092 left)

Vacations 10,000 dollars (87092 left)

Computers/Cellphones/Electronics/Cable Bill 3600 (83492 left)

Education and Expenses for two kids 12,000 x2 (59492 left)

Clothes 5000 dollars  (54492 left)

Life and Disability Insurance 9600 dollars 44892

Dues and License and CME (5000 dollars per year)= 39892

Miscellaneous Entertainment (10000 dollars per year)=29892 dollars

Saved

Remaining available to save around 29892 per year (not including 401k)

30,000 dollars in 401k

Assuming 8% rate of return on 59892  over 5 years +469000 in savings= 1040000 dollars

Next 8 years (Student Loans Paid Off)

Savings After Expenses

Savings now 29892+48588 +30000 (401k)=108480 per year

Assuming 8% rate of return on 108480 over 8 years +1040000 in savings= 3080000 dollars

Next 5 Years (No More 529 plans)

Savings now 113480+13344= 121824 per year

Assuming 8% rate of return on 121824 over 5 years +3080000 in savings= 5240000 dollars or 2655000 in today’s dollars with 3 percent inflation

Next 10 years (No More Kid Expenses)

Saving now: 121824+24000= 145824 dollars per year

Assuming 8% rate of return on 145824 over 10 years +5428000 in savings= 13240000 dollars or approximately 5 million in today’s dollars with 3 percent inflation

 

Low cost of living areas with significant student debt

Additional numbers for this assumption:

  1. House will cost 500,000 dollars with a down payment of 100,000 dollars, saved over your first 5 years of working. (20,000 dollars saved per year)
  2. Student debt will be paid off over 10 years (4049 dollars per month*12 months)= 48,588 per year
  3. Practice puts away 30,000 dollars including match into your 401k starting 1st year
  4. Investment rate of return 8%
  5. Federal Income Taxes after deduction will be 76182 dollars per year based on a calculator
  6. State Income Taxes are 0 dollars
  7. You have twins beginning at the of your attending work and are putting away 556 dollars per month per kid to get to 250,000 dollars at age 18. (13,344 dollars per year)
  8. Rental of a 3 bedroom house for 5 years at 2500 dollars per month

First 5 years

Total Salary 413000

Expenses

401k: 30,000 (383000 left)

Taxes : 76182 (Federal) + 0 (State) (306818 left)

Loan payments and house savings and children 529 plan: 48,588 (student loans) + 20,000 (house down payment) + 13,344 (529 plan) (224886 left)

Rental/heating/electricity  30000  (194886 left)

Subtracting food for family 10000 (184886 left)

Transportation expenses 2 cars/insurance 10000 (174886 left)

Vacations 10,000 dollars (164886 left)

Computers/Cellphones/Electronics/Cable Bill 3600  (161286 left)

Preschool/Day Care Expenses for two kids 24,000 (137286 left)

Clothes 5ooo dollars (132286 left)

Life and Disability Insurance  9600 (122686 left)

Dues and License and CME 5000 (117686 left)

Miscellaneous Entertainment  10,000 (107686 left)

Saved

Remaining available to save around 107686 per year (not including 401k)

30,000 dollars in 401k

Assuming 8% rate of return on 137686 over 5 years- 807690 dollars in savings

Next 5 years (Own house)

Expenses

401k: 30,000 (383000 left)

Taxes : 76182 (Federal) + 0 (State) (306818 left)

Loan payments and house savings and children 529 plan: 48,588 (student loans)  + 13,344 (529 plan) (244886 left)

Salary after mortgage payments and taxes (400,000 mortgage -30 year fixed at 3.5 percent 1796*12 (223334 left)

Salary after property taxes and insurance 12000 (211334 left)

Home maintenance= 5000 (206334 left)

Subtracting food for family 10000 (196334 left)

Transportation expenses 2 cars/insurance 10000 (186334 left)

Vacations 10,000 dollars (176334 left)

Computers/Cellphones/Electronics/Cable Bill 3600 (172734 left)

Education and Expenses for two kids 12,000 x2 (148734 left)

Clothes 5000 dollars  (143734 left)

Life and Disability Insurance 9600 dollars (134134 left)

Dues and License and CME 5000 dollars  (129134 left)

Miscellaneous Entertainment  10000 (119134 left)

Saved

Remaining available to save around 119134 per year (not including 401k)

30,000 dollars in 401k

Assuming 8% rate of return on 149134  over 5 years +807690 in savings= 2061000 dollars

Next 8 years (Student Loans Paid Off)

Savings After Expenses

Savings now 119134+48588 +30000 (401k)=197722 dollars per year

Assuming 8% rate of return on 197722 over 8 years +2061000 in savings= 5918000 dollars or 3476201 in today’s dollars

Next 5 Years (No More 529 plans)

Savings now 197722+13344= 211066 per year

Assuming 8% rate of return on 211066 over 5 years +5918000 in savings= 9934000 dollars or 5033000 in today’s dollars with 3 percent inflation

Next 10 years (No More Kid Expenses)- if you were to go past 5,000,000 dollars

Saving now: 211066 +24000= 235066 dollars per year

Assuming 8% rate of return on 235066 over 10 years +9934000 in savings= 24854000 dollars or approximately 9.4 million in today’s dollars with 3 percent inflation

 

Can You Accumulate Five Million Dollars In A High or Low-Cost Area?

The results are stark. Yes, you can accumulate 5 million dollars in a high cost of living area in today’s dollars with high student loan debt if you are willing to wait 33 years based on these numbers. On the other hand, if you decide to live in a low cost of living area, you can expect to accumulate 5 million dollars 10 years earlier. Now, money may not be everything. But, if you decide you want to change your lifestyle earlier than you expect, there will be many more doors accessible to you in your career if you choose to live in a lower-cost area. And, if you wanted to work a whole 33-year career, you would accumulate a large nest egg for your heirs. Something to think about!

 

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Virtual Radiology Conferences: Are They Worth It?

virtual conferences

Nowadays, when you look online for your favorite conferences, most of them have still not returned to the live format. For me, it is RSNA, AUR, and SNMMI. (of which I believe RSNA will be going live later this year). And this goes for most radiology and radiology subspecialty conferences. So, what have we lost by going to the virtual meeting format? And, why have I not signed up for virtual radiology conferences this year (I also have a sneaking suspicion that many of you are in the same boat!) We will embark on all these issues and more as we delve into the frailties of the virtual conference.

Hard To Concentrate At Home On a Computer – Kids, Dogs, etc.

I don’t know about you, but home is a different environment compared to a conference. Many of us have constant interruptions from all sorts of creatures, kids, relatives, love ones, and more. It is challenging to listen to a conference when the dog is barking and the kids need dinner. Virtual radiology conferences provide an escape from the daily trials and tribulations of home and allow you to learn without interruptions!

No Meetings With Colleagues Over Lunch/Dinner

At conferences, I often learn more from my colleagues than I do from the speakers themselves. Going to events, dinners, and scheduled meetings allows you to learn about other radiologists’ practices and issues throughout the country. These meetings are where I often find out about what is going on in other residencies or the radiology business world. And, many times, I will try to apply it to our own. Going to virtual conferences does not allow you to have these experiences without a significant challenge!

Loss Of Esprit De Corps

Then, of course, something about attending a meeting and being in the same boat as the other hundreds or thousands of attendees rejuvenates my excitement for all the new possibilities in the world of radiology. Knowing that you are there and not alone makes you feel like part of a large team. Listening to miscellaneous lectures anonymously on the computer does not have the same effect, even though many others are also attending!

Can’t Check Out The New Wares

It’s hard to get a feel for the latest and greatest equipment when you cannot see the demos, play with the software, and check out the sizes and shapes of the new PET-CTs, MRI, etc. Going to conferences allows you to talk to the vendors and get an idea of what to push your hospital to purchase. It’s kind of hard to do all this from home.

Opportunity For Side Vacations Gone

Ever thought about bringing your whole family to check out the scenery while you are at a conference? Or have a desire to take a few hours or a day off to check out the local sightseeing and food? It’s kind of challenging to do that from home. One of the reasons to go to a conference is to experience something new. Traveling allows you to do all that.

Virtual Radiology Conferences: It’s Just Not The Same!

For me, virtual radiology conferences are a no-go. All the interruptions, lack of interpersonal connections, loss of the ability to check out all the new gadgets, and the lack of ability to explore the area do not make these semblances of conferences worth my while. Until we return to a fully open live conference format again, I’d instead just get my CMEs the old-fashioned way: at home!

 

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Top Ten Reasons To Be An Urban Radiologist! (From A Suburbanite!)

urban radiologist

Last week I gave you all a top ten list for becoming a rural radiologist. But, I have received a few complaints from my urban colleagues that believe they have been shortchanged. Despite all the advantages of rural radiology, there are still some significant advantages for urban radiologists. Today, to be evenhanded and in honor of the city life, here are the top ten reasons to migrate to the city as an urban radiologist!

Concentration Of Specialized Radiologists In One Place

Where else can you find a subspecialist that specializes in neuro intervention of vascular malformations as well as a Xofigo center of excellence? Unlikely that you will find this in the middle of rural Nebraska. But, in a big city, you can find a subspecialist in almost anything. And, you can become that specialist because of the high concentration of patients in one place!

High Quality Of The Urban Radiologist

That is not to say that rural radiologists are bad, but it does take a lot to survive in the city. And finding that job usually requires some high falootin’ credentials. It would help if you had the right hybrid of certificates and connections. So, you do find a large proportion of overachieving physicians in the city. It even goes the same for radiologists!

More Cross-Pollination With The Urban Radiologist

What happens when you gather a bevy of doctors in one place? Well, you get to hear the war stories in other departments. And you are more likely to discuss other physician areas of interest. Of course, this discussion will often lead to distinct outcomes, whether creating research or treating patients differently. For instance, you have an all-star thyroid pathologist on the premises, so you are more likely going to do lots of thyroid biopsies, more so than other institutions. Cross-pollenation changes the dynamic.

Convenience

Where else can you walk a few hundred feet away from your site of work or residence and go to a supermarket, drug store, and dog training facility? I certainly can’t think of any. There’s no need to maintain a car or means of transportation. It’s all at your fingertips by walking or public transit.

Easier For The Urban Radiologist To Get A Date

Maybe you are single and looking? When you out in the middle of rural Idaho, you might have a more challenging time finding a significant other. And many young radiologists are still single. So, think about that urban job. You are more likely to find like-minded folks and, of course, get hitched!

Larger Diversity Of Patients

Are you looking to become more culturally aware? Well, look no further than the city. You will see all types of folks and have the opportunity to communicate and learn from them. It just doesn’t happen to the same extent out in the hinterlands. It’s only one of those advantages of city life.

Greater Swath Of Pathology

Along with the more significant cultural diversity comes an increased variety of pathology unique to every culture and country worldwide. You will find all sorts of weird and bizarre diseases in the middle of a city you won’t find elsewhere. These can include all kinds of genetic and environmental pathology. Want to swing for fences with differential diagnoses with zebras? Go practice in the city!

Cultural Opportunities

Do you like the opera or want to see a heavy metal rock concert? Maybe you want to check out the local happenings at the new dinosaur exhibit? There is no better place for this than a large city. You will never get the same opportunities out in the country.

Lots Of Shopping

Folks come all over the world to shop at select stores in large cities. And, you can find goods and services that you would seldom find anywhere else. It may be a market for ancient lamps or a store for hand-hewn mannequins. You can find it all, and it may only be a few footsteps from your urban job!

Restaurants/Food

For the eclectic culinary lover of a radiologist, there is no better place to try out the flavors of the world. Olive Gardens and Chili’s (as much as I like them) don’t always do the trick. Sometimes you want to eat out or pick up food from a culinary king. And, even better, when you step out of your imaging center to go to pick it up next door!

Being An Urban Radiologist- Not So Bad!

Yes, rural radiology does have its advantage when it comes to the cost of living and pay. But life is not all about money. You miss out on a whole world of opportunities when you live outside the city in rural America. So, if you like culture, entertainment, and convenience, consider a life in the city as an urban radiologist. You won’t regret it!

 

 

 

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Top Ten Reasons To Work As A Rural Radiologist (From A Suburbanite!)

rural radiologist

Go onto any radiology forum, and you will hear a perpetual argument about who has it better, an urban or rural radiologist. So, let’s nip this in the bud once and for all. Let’s give a top ten list as to why you should look for a career as a rural radiologist (coming from a suburban radiologist, of course!)

Top Ten Reasons To Practice As A Rural Radiologist!

Better Pay

This one is the most obvious, but it is true. Check out any of the want ads, and you will see sky-high salaries enticing you to drop on by. Typically, they may not say the name of the town. Why? because they know that you have never heard of it! How can this happen? Well, they need to incentivize you, the radiologist, to want to come there. So, why not take advantage of it? Make those big bucks!

Cheaper Cost Of Living

Not only do you have the advantage of extra pay, but your cost of living can be more than 50 percent or even 75 percent less than living in a city. Think about a three-bedroom apartment in New York or San Francisco for umpteen million dollars. What would that cost in a rural area? A few hundred thousand dollars at best. Think about all that cash you can save with that huge salary that you have.

Less Daily Pressure

More than the money, this one attracts me the most. The lifestyle of the inhabitants of the rural world tends to be less pressured. Less screaming and arguing. More space away from others to prevent kerfuffles. Why not work and live in such an environment?

Appreciative Patients

In rural communities, you tend to have patients that appreciate your work. Why? Well, they can’t simply go to the imaging center down the block. There isn’t any! Your word is valuable, and you are an integral part of the community. It’s just part of the package of rural America.

Cleaner Living – Nice Smell

You know that sweet smell of nature when you leave to go on a trip to the country. Well, if you work at a rural site, you can have that all the time. You don’t smell the exhaust pipes of tons of cars. Nor do you smell rotting garbage on the streets. You just have the crisp, clean air of nature.

Rural Radiologist: One With Nature

Like going for brisk walks with your dog? Or, you enjoy hiking on mountainous nature trails? Maybe, you want to go swimming in a lake? All you have to do is walk out your door, and it’s available. Not a bad gig for the nature-loving radiologist!

No Traffic

Imagine leaving your doorstep and driving to the hospital with no more than a few other cars driving on the road? That is a pipe dream for a city radiologist. But, it is the real world for the rural one. Get to work fast and without the hassle of not knowing exactly when you will arrive.

Larger Spaces/Newer Hospitals

Rural hospitals tend to be more open and modern. Why? Most were not built at the beginning of the 20th century. Therefore, you’ll find open floor plans for interventional suites and widely spaced modern reading rooms. These are features of most rural hospital centers.

Lower Decibel Levels-Better Health

When you step outside, you don’t hear the honks of cars or the screams of fighting neighbors. Instead, you hear the rustle of the leaves or the chirping of the birds outside. Furthermore, you don’t live in an area with as many pollutants in the air and water. It’s a setup for a healthier lifestyle.

A Rural Radiologist Can Do Everything

Finally, because you don’t have tons of competition in the neighborhood, you can do almost any type of procedure that interests you. You won’t be butting heads with the cardiologist who wants to take all the Cardiac MRIs or the vascular surgeon with all the peripheral vascular patients for angiography/peripheral vessel disease. The world is your oyster!

The Life Of A Rural Radiologist- Not So Bad!

So, there you have it. Here’s a top ten list for why to choose rural radiology from a local suburbanite. Take it or leave it. But, there are lots of advantages to rural life!

 

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How To Decrease Radiologist Hospital Presence Without Jeopardizing Care

jeopardizing care

For years, the mantra of quality radiology groups was to provide excellent service. And that would involve establishing a presence at all times. But, like many other former tenets of radiology practices, Covid has been turning over many assumptions about our work. Now that we have a situation where physical presence in the hospital can jeopardize radiologist safety, radiology groups have been decreasing their in-hospital staffing. However, potentially reducing staffing can increase patient barriers to quality care. So this begs the question, how are radiologists replacing physical presence in the radiology department without jeopardizing care? I am going to talk about how many groups are going about this process. Then, let’s discuss the reasons why some radiologists will always still need to remain on-site. Finally, we will use a crystal ball and decide where this is all heading.

Ways Radiologists Are Decreasing Physical Presence Without Jeopardizing Care

Less Physical Patient Facetime And More Apple Facetime!

Interventionalists and mammographers, if they haven’t already, will followup patients without an on-site visit. We see even more utilization of online communications via Zoom, Google Meet, Facetime, and whatever other technology rears its head. It also enables radiologists to maintain efficiency and have office hours between reading films at home.

Increased Ordering Of Hands-off Testing

We are noticing an increase in those tests that do not involve a radiologist presence. For instance, if a mammographer cannot be on the site to see patients, instead of a hands-on ultrasound for a positive mammographic finding, he may recommend a breast MRI. Or, radiologists will be more apt to followup findings when they may have suggested a physical procedure such as a biopsy in the past. All these changes are presently occurring below the surface, but they are happening.

Replacing In-Person Interaction With Referring Clinicians

Since the advent of PACS, most radiologists have already noticed a steady decline in direct physical interactions with their clinicians. Surgeons and internal medicine physicians come down much less frequently to review films than ever. And, today’s pandemic is further catalyzing this change. We are seeing even fewer of our colleagues and having more phone interactions than ever before. Even extracurricular activities with our fellow physicians are decreasing. Hospital meetings are becoming online.

More Tech Issues Resolved Remotely

Many radiologists are increasing the physical barriers between the technologist and the radiologist. In the past, radiologists would often ask a question from their technologist, and she would stop by. No longer. Radiologists are tackling these same issues with a phone call or a text. It has become less feasible to have that direct physical technologist interaction.

More Remote Teaching For Residents

And, finally, training is not immune to the Covid world. Already, online seminars have replaced in-house lectures at most training programs throughout the country.  And, I would not expect that to go back to the traditional in-person norm entirely. It becomes more accessible than ever before to teach from a remote site.

So, What’s Left For The Radiologist To Do At The Hospital?

Alright, even with all these factors allowing radiologists to practice off-site, some radiologists must remain as a physical presence in the hospital. Of course, some procedures will always involve a human being. Administration of radioactive treatments, interventional procedures, and emergency coverage for contrast injections will continue to require a radiologist on-site. But, compared to all the roles a radiologist can perform off-site, it is indeed limited. Don’t expect to see as many radiologists sticking around the treatment facilities as they did before. Many practices have reduced their on-site staffing by as much as 30-70% during this crisis.

How Will Radiologist’s Presence At The Hospital Ultimately Evolve?

Many changes are currently in motion, making it even easier to perform more activities outside the confines of a typical hospital or imaging center without jeopardizing care. And, facetime, ordering preference changes, and other remote capabilities are some ways that radiologists have been decreasing physical presence at primary sites. In time, we may begin to see some return of radiologists back to the hospital as the risks to radiologists dwindle. Nevertheless, don’t expect radiologists to return to the same complement on-site after the dust settles as the tools for remote patient care have developed. When culture changes, even temporarily, some of it always sticks. Radiologists are by no means immune!

 

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Don’t Skip Around! A Radiologist’s Mantra

skip around

Round, round, get around, don’t skip around. Reminds me a bit of the Beach Boys tune I Get Around. Regardless of the weak attention-grabbing first sentence, I think this advice is vital for the radiologist.  And it applies to us in many ways. First and foremost, it helps to ensure that you are covering all the findings. But, it is far more than this. Keeping reads in order without skipping around also will enable you to triage appropriately, allows you not to piss off your colleagues, and most critically, ensures that you don’t forget the reason for reading a study. So, let’s delve a little bit more behind each of the reasons behind the nitty-gritty of this philosophy.

Covering All The Findings

What is the best way to make your dictations less accurate? Well, have as many interruptions as possible! And what is it about these interruptions that cause missed findings? Typically, most radiologists will forget what they were doing before.

Since it is impossible to prevent all interruptions (although you can mitigate them), you can avoid loss of sensitivity by sticking to a routine without skipping around. So, the next time the surgeon barges into the room with a question while you are dictating, you will know exactly where to return your focus when the interruption ends. If you repeat a similar routine without skipping around, you will rarely lose your place for long!

Triage

What is it about skipping around through a list of patients that can cause triage issues? Well, it’s not fair to read a study first on a patient with similar urgency to others when he was the most recent one completed, right? How would you like it if someone cut in front of you in line at a supermarket? It’s the same philosophy.

But more critically, you should be reading the tech flagged positive findings first, the “STATS” second, the expedites third, and the routines last. Subverting this order can cause clinical disasters, potentially delaying reads on patients with positive results. Why would you want to read a routine oncology workup before a possible intracranial bleed after trauma? Finding a lung nodule is not equivalent to discovering an epidural hemorrhage. Triage in order and don’t skip around!

Order Among The Rank And File

When all members of a practice are working hard, they don’t want to worry about radiologists that are cherry-picking the most straightforward cases to spruce up their RVU numbers. How can a practice avoid such an issue? Well, have the readers read studies in order of when they were performed. Practices often perceive those members that skip around to be skirting the rules.  So, sticking to the list order can help morale!

Circling Back To The Impression

And then finally, to come up with an appropriate impression in any case you read, you should never jump to it without analyzing all the findings first. Skipping around and getting to the conclusion right away is a formula for disaster. Think of it like watching the end of a movie or novel without watching the beginning. How can you figure out the real answers to the clinician questions without going through an entire case? I know that just the mere description of the findings helps me to come up with an appropriate conclusion. Without that process, my impressions are more likely to be off-the-mark. Don’t’ skip this routine!

Following A Radiologist’s Mantra: Don’t Skip Around!

Order matters. Whether you are skipping around instead of using routine search patterns, reading cases in an illogical order, or creating an impression before looking at and analyzing all the findings, you can negatively affect both your partners and patients. We want to do the best for our patients and work partners. So, the next time you decide to accomplish a professional task out of order, think twice. It may not be the best for patient care!

 

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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!

 

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Do Average RVUs Matter For Private Practice And Academic Radiologists?

average RVUs

Question About Average RVUs:

 

Do you know the average RVUs per shift for radiologists and the differential between private practice and academic radiologists?

 

Thank you,

Wondering About RVUs

 

_____________________________________________________-

Answer:

I have not found a specific breakdown of work RVUs per radiologist regarding academic versus private practice. I can shout out to my audience and see if anyone has this information. Has anyone found any valuable data about this? If so, please write something in the comments section!) However, to figure out the average RVU per shift, you can take the average RVU of 10020 in 2023 (from Lifetrack Medical Systems) and divide that by approximately 200 days per year. (around the average number of days worked per radiologist) That would give you around 50 RVUs per day shift.

However, the question may not matter concerning practicality and potential job search. I know of private practices where they have a “lifestyle” practice and complete very low RVUs. Likewise, I know of academic centers where the radiologists work like dogs and meet ungodly RVUs. So, using this information to determine whether to go into private practice versus academia would be a mistake. You need to approach this issue individually, not on a global academic versus private practice basis. On the other hand, if you are using the information for research purposes, it may have an alternative use.

Assuming that you are using RVU data to look for jobs using this criterion, I would look at the specific RVUs of a group and, even more importantly, remember to also look at your particular role in the academic or private practice. Some “academic” centers do very little research and expect some radiologists to do almost entirely clinical work. Likewise, other private groups have a partial academic bent and are less heavily RVU-oriented.

Good luck with your search!

Director1

 

tomatoes

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Top Ten Differences Between A Senior Resident And Radiology Attending

differences

You may be more than halfway through your residency program or about to graduate residency. And it may feel like you have been through the wringer. Not only have you made it through the call, but you have also studied all the minutia that you need to know to take the core exam. So, can life change that much more when you become an attending? I mean, it’s only a few years or less away. Well, for your education (and entertainment, of course!), we will go through the top ten differences between a senior resident and an attending. Let’s go from least to most noticeable!

Shallower Breadth And Increasing Depth Of Knowledge

Believe it or not, beginning a full-time job still changes what you know. Remember all that detailed information from the case review series and the survey books? And, of course, all that detail you learned from studying for the core examination? Where does it go? Let’s put it this way; your brain begins to trim out what you no longer use. So, that full breadth of knowledge you learned from studying for your core exam? Yes, gone! Instead, one of the biggest differences is that you remember the relevant information you need to know daily for your specific areas of expertise.

You’re Now The Expert

For the first time, you da’ man (or woman!). Regardless of your feelings, your colleagues see you as a guru in your specialty. A very different feel from your previous work as a resident or fellow in training!

Horses First, Then Zebras

As an attending, you know what you see because you have experienced it many times. The zebras only come out when you have exhausted all the horses first. Usually, not the case for residents!

Patients And Doctors Want To See You!

No longer are you an intermediary in the way of your attendings. Patients and doctors ultimately want to hear from the man or woman of final reckoning in the report. And that is you! Feels good to be desired. One of the biggest differences!

Need To Get A Move On!

No longer can you rest on your laurels as you did as a resident during the daytime. You have a job to do, and it must get done. If not you as an attending, then who? A hundred cases? If they do not get read by the end of the day, you hear and see a queue of angry clinicians and patients!

More Vacation But Perhaps Not At The Best Times!

You may notice that you took a vacation during residency, usually at the standard times- Christmas, spring break, or summer. And although the residency required some coverage from one or two of your fellow residents, most could still take off at those times. Well, alas, this is all about to change! And although you may receive more vacation in general, your practice will still need significant coverage during these favorite vacation slots. And who needs to work at these times? You!

Increased Liability

In the end, no longer can a senior cover for your mistakes. You are coming onto a shift in the morning and looking at the night resident’s dictations. Well, you own them. His and your mistakes are your problems! Miss cancer, your reputation, license, and nest egg are on the line!

Loans Come Due

You think all the money you earn as an attending is your own, right? Wrong! On day one, as you start your first job, the loan servicers ask for their due. Forbearance of your loans is no longer an option. Thousands of dollars per month only to service your student loan debt. Welcome to the real world.

Increased Pay

Imagine rolling along for years at a time, garnering biweekly or monthly paychecks, and coming home with a few thousand dollars a pop. And, then suddenly, Whoosh! You notice that the direct deposit fills your account with something more substantial. Feels good, doesn’t it?

Expenses Rise

Now for the bad news. The more significant paycheck comes with more considerable account drainage from those expenses. Those larger paychecks suddenly drain rapidly from your bank account with new costs from a new house, car, loan payments, and child care. Where did all that increased pay go?

 

Final Thoughts About Differences Between A Senior Resident And A Radiology Attending

So, there you go. Perhaps, not what you thought? Or, maybe it was? Regardless, now you know what to expect to change once you graduate!