Losing the Track is Part of Tracking

From The Lion Tracker’s Guide To Life by Boyd Varty:

You must train yourself to see what you are looking for.

Perhaps the most concise description of radiology training.

“I don’t know where we are going but I know exactly how to get there,” he says.

Process > outcome.

I think of all the people I have spoken to who have said, “When I know exactly what the next thing is, I will make a move.” I think of all the people whom I have taught to track who froze when they lost the track, wanting to be certain of the right path forward before they would move. Trackers try things. The tracker on a lost track enters a process of rediscovery that is fluid. He relies on a process of elimination, inquiry, confirmation; a process of discovery and feedback. He enters a ritual of focused attention. As paradoxical as it sounds, going down a path and not finding a track is part of finding the track.

Uncertainty is part of life, but a search pattern helps.

On the long list for second place

It was a nice surprise to see over my busy call long weekend that I was nominated as a semifinalist for Aunt Minnie’s “most effective radiology educator” this year.

Or something like that:

 

As always, thanks for reading.

We’re hiring!

Well, not me/this little site.

But my organically-growing 100%-independent physician-owned radiology practice of which I am a partner/shareholder is hiring in most subspecialties including breast, body, neuro, ER, and general. Basically everything except IR at the moment.

The market is hot, as I’m sure every radiologist and resident has heard.

I’ve written before about why I believe some job healthcare models are problematic, and why not all attending jobs are created equal. I’ve also written before about how to approach getting your first job out of training. My perspective and biases about radiology practice are on full display.

Our group was/is my first job out of training. I made partner last year and recently began serving on our board of directors. It was the job I wanted–so much so that the day I got the interview invitation email (after already having job offers waiting for a response), I did an actual Street Fighter dragon punch of victory and told the others they were going to have to wait past their response deadlines. I was drawn by two things:

  1. A well-established successful privademic model combining teaching-focused academics with the no-BS of private practice (with positions leaning more in different directions based on interest including pure no-teaching PP), which gave me the chance to teach and work with trainees in a more flexible environment than a traditional big academic bureaucracy. I’m currently the associate program director for our residency, and our residents are awesome.
  2. A sustainable job model combining high-quality (as opposed to only high-volume) radiology practice with reasonable daily expectations and the goal of a standard 4-day workweek (today is my day off!). I wanted the time and mental space to also be a partner at home and have the flexibility to do the other things that are important to me (like this). My colleagues are good at what we do, and I learn from them every day.

So if you’re in the market, come work with me and check out our great team in Dallas. If you’re interested, send me your CV at ben.white@americanrad.com and I’ll make sure it gets where it needs to go.

You Should Be Correlating Clinically

While I generally like to stay away from absolutely prescriptive advice, I think most radiologists would agree that the specific phrase “correlate clinically” is basically a microaggression against clinicians. It’s a triggering common joke that automatically lowers your work in the eyes of the reader. If somebody must correlate, then they should be told what they should correlate with: direct inspection, physical exam, CBC, a possible history of X symptom, sign, or disease, etc. Most of the “never say this” and “always say that” saber-rattling in radiology is nonsense, but this is an easy way make to make friends.

Going further:

A new radiology resident typically begins training without much meaningful radiology experience but with substantial clinical knowledge. Don’t give it up. Of course, you will likely not stay up-to-date with every specific medical therapy used to treat the diseases you used to manage as an intern, but good radiologists retain a significant fraction of the pathophysiology that underlies the imaging manifestations of the diseases we train to discern and then supplements that foundation with a growing understanding of subspecialized management. That combination informs their approach in creating actionable reports for referring clinicians, reports that contain more of the things they care about and fewer that they don’t.

In the world of outpatient radiology, it’s common for patient histories to be lackluster. Frequently the only available information from the ordering provider is the diagnosis code(s) used to justify insurance reimbursement. In many cases, radiologists rely more on a few words provided by the patient directly (filtered through the technologist that performs the imaging study). We don’t always have the context we need to do our best work. It’s as frustrating as it is unavoidable.

In the more inpatient (or academic medical center) world that dominates residency training, it’s common to see at first glance a similar diagnosis code or short “reason for exam” text from the EMR, frequently limited in length and sometimes further limited to specific indications in the name of appropriate use (e.g. “head trauma, mod-severe, peds 0-18y”).

As a young radiologist, it is in your best interest to not rely on so thin a justification as what is readily dropped into the report via a Powerscribe merge field if you have access to richer information. You may know very little radiology, but you remain literate. You will do yourself and your patients a favor by supplementing your nascent diagnostic acumen with a real history obtained from reading actual notes written by actual humans. So often the provided “reason for exam” is willfully incomplete or frankly deliberately misleading, like the patient with acute-onset left hemiparesis resulting in a ground-level fall arriving with a history of “head trauma” instead of stroke. Or pretty much everyone with a history of “altered mental status.” So often, the clinical correlation was there all along. It’s part of the learning process that helps make the most of your limited training time.

“You can’t see what you’re not looking for” is a classic adage for a reason. You sometimes have to know the real history–as much as realistically feasible–in order to either make the finding or to put them into context.

So, before you ask anyone else to “correlate clinically,” maybe see if you can do it yourself.

Working for Private Equity: A Radiologist’s Experience

This is part three in a series of posts about private equity in radiology. The first was this essay. The second was an interview with former PE analyst and current independent radiologist Dr. Kurt Schoppe.

This third entry is a Q&A with a radiologist who recently left a PE-owned practice and their experience as someone who joined a freshly purchased practice, made “partner,” and then left anyway.

I suspect this radiologist’s experience is very generalizable, but regardless it’s a rare and interesting perspective to hear, especially regarding their equity/stock holdings. The person providing their perspective will remain anonymous, and I’m also not interested in naming and shaming the group. This is intended to share a novel viewpoint and be helpful for trainees (and maybe also be interesting to spectators):

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