Attention DR applicants: ranking advice

[DrfluffyMD]

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I am a 4th year DR resident going to IR. Just have one piece of ranking advice.

In general, there are three type of radiology residency: academic, pseudoacademic/hybrid practice or private practice based residency.

My advice: stay AWAY from private practice or hybrid private practice residency if you can.

Many years ago, the production pressure in radiology was lower and many private practice groups found themselves able to teach residents and still make adequate income. Unfortunately that has been changing.

The current reality is that in many private practice residencies, you generate reports for attendings and act as their scribe. Your effort directly contribute to their income but many of them do not do adequate teaching.

Additionally, those programs are also often small with ridiculous call schedule and night float system.

Important questions to ask

1. Do attendings go over cases one on one / read out with junior residents. Evidently some programs don't even read out. You aren't going to learn if you don't read out eary on.

2. Who are your attendings? How many hospitals do they cover? How is the group run? Google the group. Is it a department? Is it a section employed by the hospital? Is it a PP group with contract?

3. What are the call schedule? Do I have more than one evening call a week on the average as a second year outside of night float? (That's too much). There shouldn't be more than 6-8 weeks of night float.

4. What's the catchment area of the hospital? Is it the ultimate referall center in its area? Is it a regional powerhouse or does it refer any complicated case out to the big shop cross town and you never see follow up imaging to complicated cases?

I ran into residents who work for sweatshop programs in big cities where they take overnight call every three days. Be smart, don't be swindled to match programs that prioritze turn-around-time, production and service coverage requirement and sacrifice your education.

 

[DJNYY]

I am a 4th year DR resident going to IR. Just have one piece of ranking advice.

In general, there are three type of radiology residency: academic, pseudoacademic/hybrid practice or private practice based residency.

My advice: stay AWAY from private practice or hybrid private practice residency if you can.

Many years ago, the production pressure in radiology was lower and many private practice groups found themselves able to teach residents and still make adequate income. Unfortunately that has been changing.

The current reality is that in many private practice residencies, you generate reports for attendings and act as their scribe. Your effort directly contribute to their income but many of them do not do adequate teaching.

Additionally, those programs are also often small with ridiculous call schedule and night float system.

Important questions to ask

1. Do attendings go over cases one on one / read out with junior residents. Evidently some programs don't even read out. You aren't going to learn if you don't read out eary on.

2. Who are your attendings? How many hospitals do they cover? How is the group run? Google the group. Is it a department? Is it a section employed by the hospital? Is it a PP group with contract?

3. What are the call schedule? Do I have more than one evening call a week on the average as a second year outside of night float? (That's too much). There shouldn't be more than 6-8 weeks of night float.

4. What's the catchment area of the hospital? Is it the ultimate referall center in its area? Is it a regional powerhouse or does it refer any complicated case out to the big shop cross town and you never see follow up imaging to complicated cases?

I ran into residents who work for sweatshop programs in big cities where they take overnight call every three days. Be smart, don't be swindled to match programs that prioritze turn-around-time, production and service coverage requirement and sacrifice your education.

There may be some that fit your description but this is an over generalization. You have some private practice gems like Florida Hospital where teaching is prioritized, residents consistently score >90th%ile on the in service exam with 100% boards pass rate, and residents benefit from things like some of the most hands on IR experience you could hope for as well as a lot of dedicated faculty that can help residents produce research (I.e: they have people who will write an IRB proposal for you). And as someone going into IR, it shouldnt be lost on you that they matched one to Miami vascular recently. They had a neurointerventional bound trainee who was teaching his cofellows how to do stuff, because he was technically starting at a far advanced level.

 

[DrfluffyMD]

There may be some that fit your description but this is an over generalization. You have some private practice gems like Florida Hospital where teaching is prioritized, residents consistently score >90th%ile on the in service exam with 100% boards pass rate, and residents benefit from things like some of the most hands on IR experience you could hope for as well as a lot of dedicated faculty that can help residents produce research (I.e: they have people who will write an IRB proposal for you). And as someone going into IR, it shouldnt be lost on you that they matched one to Miami vascular recently. They had a neurointerventional bound trainee who was teaching his cofellows how to do stuff, because he was technically starting at a far advanced level.

I am personally familiar with that trainee. That trainee matched there DESPITE the place. If I remember correctly he also posted somewhere (probably here) to sell this particular residency. I am sure his home institution treated him very well, but unsure if his success would be generalizable.

No to call out any institution. But read more about sheridan radiology or HCA EM residency, or read about what others have to say about sheridan or coporate radiology outfits in the other discussion board and form your own opinion.

Just remember, for profit outfit has profit first, education second. There are still places where education is just as important as clinical productivity. Find those places yourself.

 

[knosway14]

I am personally familiar with that trainee. That trainee matched there DESPITE the place. If I remember correctly he also posted somewhere (probably here) to sell this particular residency. I am sure his home institution treated him very well, but unsure if his success would be generalizable.

No to call out any institution. But read more about sheridan radiology or HCA EM residency, or read about what others have to say about sheridan or coporate radiology outfits in the other discussion board and form your own opinion.

Just remember, for profit outfit has profit first, education second. There are still places where education is just as important as clinical productivity. Find those places yourself.

Could you please answer the following questions for me:

1) what's the average difference in % board passing rate in a "profit" vs "academic" institution?

2) does the board score influence on fellowship placement ?

3) do you genuinely think board scores represent the quality of a radiologist? (There is some research about mortality in patients with heart failure and medicine doctors whit board passing being prove to reduce mortality, but that's internal medicine).

4) does board score/ passing influence on job placement ?

 

[knosway14]

I am personally familiar with that trainee. That trainee matched there DESPITE the place. If I remember correctly he also posted somewhere (probably here) to sell this particular residency. I am sure his home institution treated him very well, but unsure if his success would be generalizable.

No to call out any institution. But read more about sheridan radiology or HCA EM residency, or read about what others have to say about sheridan or coporate radiology outfits in the other discussion board and form your own opinion.

Just remember, for profit outfit has profit first, education second. There are still places where education is just as important as clinical productivity. Find those places yourself.

I think independent on how heavily academic or profit a program is managed, we as a individual must be driven by goals and motivation.

That been said if I'm a good test taker , I could overcome pitfalls of a program by studying hard by myself on free time ? (I.e. radstats, RadPrimer, core book.)

 

[DrfluffyMD]

Could you please answer the following questions for me:

1) what's the average difference in % board passing rate in a "profit" vs "academic" institution?

2) does the board score influence on fellowship placement ?

3) do you genuinely think board scores represent the quality of a radiologist? (There is some research about mortality in patients with heart failure and medicine doctors whit board passing being prove to reduce mortality, but that's internal medicine).

4) does board score/ passing influence on job placement ?

1. I am not sure. I go to a community/pseudoacademic program and we have 100% passrate. There is an overall 90% pass rate in the country. A lot of community programs have three months off to study for the board. On the other end of the spectrum, Wash U/Mallincrokt reportly does not have any board study time.

2. Fellow matches occurs before the board exam. Intraining score has no bearing on fellowship match. I've matched at one of the best IR fellowship in the country. My first year in training score was 12%, second year was 8%.

3. I do not believe in training or board score represent quality of diagnostic interpretation because the scenarios are so different. There is very little clinical data on the board exam. To illustrate the absurbness of using intraining score as a matrix, there is NO way to report in training scores to fellowships unless you write it out in your CV or tell your PD to write it in. Further more, I am almost 200 points above average score on the real board exam. This is from a guy whose intraining score were never above 15% percentile.

4. Not passing board = not Board ellgible = can't find job. Most people pass on their second try. Some of the most briliant faculty I know including IR chairmen did not pass their board on the first go though.

Board score have no bearing on jobs.

 

[rrxr]

I'd like to hear how you positioned yourself for fellowship coming from your program. I'm a big believer in going (if you can) to a place where you don't need to be a superstar to do well later on, but clearly you managed to survive and even thrive, so I think your example might be interesting.

 

[DrfluffyMD]

I'd like to hear how you positioned yourself for fellowship coming from your program. I'm a big believer in going (if you can) to a place where you don't need to be a superstar to do well later on, but clearly you managed to survive and even thrive, so I think your example might be interesting.

Research and participation in the society of interventional radiology / whatever professional society of your choice.

 

[rrxr]

Research and participation in the society of interventional radiology / whatever professional society of your choice.

That's not hard at a community program? Maybe I'm too used to the ivory tower (7T magnets!) but it seems nontrivial to me.

 

[DrfluffyMD]

That's not hard at a community program? Maybe I'm too used to the ivory tower (7T magnets!) but it seems nontrivial to me.

I came up with my own projects. Maybe that's why I stood out from the crowd. People I know who've done well all have came up with their own projects.

 

[DrfluffyMD]

That been said if I'm a good test taker , I could overcome pitfalls of a program by studying hard by myself on free time ? (I.e. radstats, RadPrimer, core book.)

Unless the said program need you to work nights every 3 days to provide their night coverage.

 

[LifeWaterCheeseyBread]

I am an MS4 who has only done a radiology elective at my home program which is a considered pseudoacademic/hybrid program.

The typical day on Body/CT is the resident and attending arrives around 0730 and both start reading from the list. The resident dictates the report and saves it as a draft. Depending on the attending's preferences, the resident will check out 1 case at a time or a batch of cases with the attending. This involves the resident saying the findings and the attending agreeing/disagreeing and pointing out any other findings. Sometimes if the list isn't huge, the attending will teach about certain findings (but this is dependent on the attending as some like to teach while others do not). The resident then goes back to the draft and updates it, and sends it off to the attending for approval. The resident is usually done at 1700.

I have never done a rotation at an academic place, but the attendings here said that at some academic places, the attendings will be gone the entire day and you check out all your cases at the end of the day which isn't that great for learning.

Can you comment on if this pseudoacademic model is good for education and what differences there are with an academic model?

Thanks

 

[DrfluffyMD]

I am an MS4 who has only done a radiology elective at my home program which is a considered pseudoacademic/hybrid program.

The typical day on Body/CT is the resident and attending arrives around 0730 and both start reading from the list. The resident dictates the report and saves it as a draft. Depending on the attending's preferences, the resident will check out 1 case at a time or a batch of cases with the attending. This involves the resident saying the findings and the attending agreeing/disagreeing and pointing out any other findings. Sometimes if the list isn't huge, the attending will teach about certain findings (but this is dependent on the attending as some like to teach while others do not). The resident then goes back to the draft and updates it, and sends it off to the attending for approval. The resident is usually done at 1700.

I have never done a rotation at an academic place, but the attendings here said that at some academic places, the attendings will be gone the entire day and you check out all your cases at the end of the day which isn't that great for learning.

Can you comment on if this pseudoacademic model is good for education and what differences there are with an academic model?

Thanks

Again this all have to do with production pressure and how the group is run.

If there is a pressure to produce and salary is directly linked to production, there tend to be less teaching. Maybe in your instiution, there is less connection between production and salary. It's more rare in private practice to have this type of compensation structure.

 

[LifeWaterCheeseyBread]

Again this all have to do with production pressure and how the group is run.

If there is a pressure to produce and salary is directly linked to production, there tend to be less teaching. Maybe in your instiution, there is less connection between production and salary. It's more rare in private practice to have this type of compensation structure.

The group that runs the residency here is RVU based. Can you describe what the teaching environment one can expect day to day at an academic center? I expected that at any type of residency (academic/private/hybrid), self-studying after work is how you do the majority of your learning.

 

[DrfluffyMD]

The group that runs the residency here is RVU based. Can you describe what the teaching environment one can expect day to day at an academic center? I expected that at any type of residency (academic/private/hybrid), self-studying after work is how you do the majority of your learning.

My buddy at UCSF told me that the workstation training was so well done that he did not need to read as much as I did.

If you don't have the option to go to this type of residency, you will still be a competent radiologist. Just generate some RVU for the pp guys and cover their nights etc.

Speaking of which, I didn't quite define that word. Don't you think it's awfully early for a MS4 to learn the meaning of RVU? Or is it tossed around the reading room all the time?

 

[charleston27]

I mean I knew what RVU’s were before I even came to med school. MS4 is hardly too early to understand the business of medicine.

My buddy at UCSF told me that the workstation training was so well done that he did not need to read as much as I did.

If you don't have the option to go to this type of residency, you will still be a competent radiologist. Just generate some RVU for the pp guys and cover their nights etc.

Speaking of which, I didn't quite define that word. Don't you think it's awfully early for a MS4 to learn the meaning of RVU? Or is it tossed around the reading room all the time?

 

[DrfluffyMD]

I mean I knew what RVU’s were before I even came to med school. MS4 is hardly too early to understand the business of medicine.

Good for you. Then you would understand why some want to learn in an academic setting and work in a pseudoacademic setting.

 

[charleston27]

(Un)Ironically enough that’s exactly my plan.

Good for you. Then you would understand why some want to learn in an academic setting and work in a pseudoacademic setting.

 

[YellowTurtle]

3. What are the call schedule? Do I have more than one evening call a week on the average as a second year outside of night float? (That's too much). There shouldn't be more than 6-8 weeks of night float.

6-8 weeks of night float per year is too much? I saw one place that only has 12 weeks of night float throughout all of residency. What would be a good number to aim for? Also what about evening and weekend call? I don't have any reference point for what a good amount of call is. I switched from almost applying to surgery so my previous mentality was to expect to be overworked and it's a complete shift in mentality. I would like as little call as possible, but I know it's important for learning purposes. I wouldn't even know if a number was too much or too little.

 

[recycledpaper]

+! would like to some guidance on how much call is considered average, too much, too little, etc.

 

[Rads4lyfe]

6-8 weeks of night float per year is too much? I saw one place that only has 12 weeks of night float throughout all of residency. What would be a good number to aim for? Also what about evening and weekend call? I don't have any reference point for what a good amount of call is. I switched from almost applying to surgery so my previous mentality was to expect to be overworked and it's a complete shift in mentality. I would like as little call as possible, but I know it's important for learning purposes. I wouldn't even know if a number was too much or too little.

I'm at a large academic center and we have about 7-8 weeks of night float our 2nd year. Then maybe 3-4 our 3rd and 4th year. No other nights otherwise. Not sure what's it's like elsewhere.

 

[DrfluffyMD]

6-8 weeks of night float per year is too much? I saw one place that only has 12 weeks of night float throughout all of residency. What would be a good number to aim for? Also what about evening and weekend call? I don't have any reference point for what a good amount of call is. I switched from almost applying to surgery so my previous mentality was to expect to be overworked and it's a complete shift in mentality. I would like as little call as possible, but I know it's important for learning purposes. I wouldn't even know if a number was too much or too little.

If there is more than 6 weeks a year for three years than it’s way too much.

 

[tco]

If there is more than 6 weeks a year for three years than it’s way too much.

How'd you pick this magic number?

 

[DrfluffyMD]

How'd you pick this magic number?

Because that’s slightly above the amount of night float a low tier academic program have. Many places with less residents than 6 are going to have a lot of night floats and honestly, most smaller programs aren’t that great (there are exceptions).

 

[tco]

Because that’s slightly above the amount of night float a low tier academic program have. Many places with less residents than 6 are going to have a lot of night floats and honestly, most smaller programs aren’t that great (there are exceptions).

Yeah, I'm deleting this currently being edited post because I still need a LOR.

Suffice it to say, I agree with you. I just don't know that I can pin a number on it.