Transcript Document
3
2
A CR
2013
Annual Chief
Resident Survey
Anup Shetty, MD
Mallinckrodt Institute of Radiology
St. Louis
AKA The Lou, Mound City, Gateway to the West
Survey Format
• Confidential online survey
(surveymonkey.com)
• Multiple choice questions
(single and multiple
answer), free text for
additional comments
Survey Purpose
• Share facts and information about the structure of
training programs
• Use information about resident benefits to address
shortfalls at individual programs
• Share opinions of fellow chief residents about
important issues facing radiology training
• Share ideas for how to deal with these important
issues
Survey Topics
• Recurring
–
–
–
–
Basic Program Information and Resident Benefits
Chief Resident Responsibilities
Call and Outside Hospital Studies
New Board Exam Format and its Impact On:
• Curriculum, Call System, Fellowships
– Ultrasound and MR interpretations on call
– Healthcare Reform and its Economic Impact on Residency Programs,
Fellowships, and the Job Market
– Practice Quality Improvement
• New in 2013
–
–
–
–
–
Overreads
Sick Resident Coverage
Senior Selectives/Mini-Fellowships
Core Exam Board Review Format
Feedback/Safety Training
Limitations
• Opinions and estimations
• Sampling bias (only chief residents included)
• Duplicate responses from programs with multiple chief
residents
– We attempted to exclude them from the relevant data sets
PROGRAM DETAILS
Participation
Number of Responses 2008-2013
Year
Individual
Responses
Unique
Programs
2013
134
99
2012
185
135
2011
259
148
2010
228
140
2009
143
112
2008
100
NORTHEAST (CT, DC, DE,
MA, MD, ME, NH, NJ, NY,
PA, RI, VT)
15%
12%
12%
43%
18%
---
CENTRAL (IA, IL, IN, MI,
MN, MO, OH, WI)
SOUTHEAST (AL, AR, FL,
GA, KY, LA, MS, NC, SC,
TN, VA, WV)
PACIFIC (AK, CA, HI, NV,
OR, WA)
WESTERN (AZ, CO, ID, KS,
MT, ND, NE, NM, OK, SD,
TX, UT, WY)
* Out of approximately 187 programs in the US
•
Results will be available to A3CR2 members by e-mail on request
•
Results will also be available to A3CR2 members in the newsletter and on the website
THANK YOU FOR PARTICIPATING!
Program Size
Average Number of Residents Per Program
30
25
Changes in Size
• Increase in program size over
10 years
– Total # residents increased 29%
from 2003 to 2013
– # women residents increased
47% from 2003 to 2013
20
15
10
5
0
2003
2009
2011
2012
2013
Gender Distribution of Residents Per Program
30
25
20
Male
15
Female
10
5
0
2003
2009
2013
Hospital Coverage
% Programs Covering Varying # of Hospitals
45
• More residency
programs are increasing
# hospitals they cover
for training
40
35
1
30
2
25
20
3
15
4
10
5+
5
0
2005
2009
2011
2013
Type of Institution
90.0%
80.0%
83.7%
85.7%
70.0%
60.0%
50.0%
54.1%
55.1%
NIH Cancer Center
Pediatric ED
40.0%
30.0%
20.0%
10.0%
0.0%
Level 1 Trauma
Stroke Center
Volume
Proportion of Programs with Specified Volume
of Radiologic Studies Per Year
50
45
40
35
30
25
20
15
10
5
0
Annual # CT scans (millions)
per year*
<100k
101k-250k
251k-500k
501k-750k
>750k
2004
2009
2013
* Brenner DJ, Hall EJ. Computed tomography--an increasing
source of radiation exposure. N Engl J Med. 2007 Nov
29;357(22):2277-84
Medical Student Recruitment
Medical Student Teaching/Recruitment
Provided formal teaching sessions for
USMLE Step 1/2
Integrate radiology basics into anatomy
courses/3rd year clerkships
Set up shadowing experiences in the
reading room/procedure rooms
Hosted Radiology Interest Group meetings
0%
10%
20%
30%
40%
50%
Others
• Integrate medical students into research projects
• Ultrasound workshops
60%
70%
80%
90%
RESIDENT BENEFITS
Resident Benefits
Tablets or other electronics for education
27
E-Anatomy
26
RAD Primer
56
STAT Dx
95
Review course tuition and/or travel stipend
49
Lead aprons
41
2008
AIRP housing and/or travel stipend
Average Amount =
$1800 ($400-$7500)
% Residents that
attend AIRP = 96%
81
AIRP tuition
2013
90
ABR examination fees
25
Time off for educational (non-presenting) conferences
77
Conference registration fees
76
Travel stipend
Other Benefits: meals, parking,
computer fund, happy hours,
flexible funds
2012
82
Book fund
89
0
10
20
30
40
50
60
70
80
90
100
Vacation and Salary
Average Salary by PGY
2009
2013
$70,000
$60,000
$52,279
$54,348
$56,519
Proportion of Residencies by Weeks
of Vacation
2.5
$58,672
3.5
$50,000
3
4
5
$40,000
58%
$30,000
$20,000
$10,000
6%
$0
2
3
4
3%
5
31%
Resident Salaries have increased 8.2% for
PGY-2 and 6.9% for PGY-5, roughly in line
with core US inflation of about 7% from
2009 to 2013
2%
1%
Family Leave
For Pregnant Residents
No 3%
For Significant Others of
Pregnant Residents
No
15%
% Programs
offering Family
Leave
% Programs
offering Family
Leave
Yes
85%
Yes
97%
% Programs with
Family Leave taken
from All, Some, or
None of
Vacation/Sick Days
Some
34%
All
22%
None
44%
None
48%
All
27%
Some
25%
% Programs with
Family Leave taken
from All, Some, or
None of
Vacation/Sick Days
CHIEF RESIDENT
Chief Resident Selection
Other
7%
Chairperson
and/or
Program
Director
Chooses
24%
Chief Residents Per Program
Residents
Choose
18%
70
64
60
50
Combination
51%
40
30
20
Other
All Seniors are Chiefs
All faculty and/or residents vote
Education committee chooses
10
12
10
4
0
1
2
3
4
Chief Resident Responsibilities
Boards review organization
59%
Medical student teaching
39%
Resident teaching
54%
Managing Disputes
89%
Social events
59%
Resident selection
81%
Resident recruiting
82%
Curriculum development and evaluation
60%
Attending lecture / conference schedule
43%
Vacation schedule
85%
Rotation schedule
84%
Call schedule
96%
0%
10%
20%
30%
40%
50%
Others
• Emergency coverage
• QA/town hall meetings
• Physics curriculum
60%
70%
80%
90%
100%
Chief Resident Benefits
80
75
70
60
50
46
46
40
33
28
30
20
10
0
Extra
conference time
Conference
costs paid
Administrative
time off service
Chief office
Salary or other
bonus
Average Salary Bonus
$2248, previously $1932
CALL, WEEKENDS, AND
ATTENDING COVERAGE
Call and Weekend Coverage
70%
Type of On-Call Report
60%60%
60%
56%
2011
50%
2012
2013
40%
29%
30%
20%
19%20%19%
16%
19%21%
19%
14%
10%
5%
1% 1%
0%
Short Prelim
Report
Final Report
Complete Prelim
Report
Oral Report
Other
• Short Prelim depending on modality (US, neuro)
• ER cases finalized with attending, inpatient cases prelimed
• Site dependent
Ultrasound Coverage
50%
46%
47%
45%
44%
38%
40%
2009
37%
2012
35%
30%
29%
2013
25%
20%
16%
13%
15%
15%
10%
5%
0%
24 Hour Sonographer
Home Call Sonographer
On-Call Resident
Specific Situations
Ob-Gyn Service performs Pelvic US
Vascular Surgery Service performs DVT US
Resident performs certain studies
(RUQ, Scrotal, Renal)
In-house Sonographer depending on time,
hospital, and day of the week
MRI Coverage
Programs Reading After-Hours MRI*
100%
Who Reads MRI After Hours
91%
90%
80%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
71%
70%
57%
60%
54%
50%
40%
30%
20%
7%
10%
87%
On-Call
Residents
14%
15%
10%
Fellows
Attendings
Not read
0%
Neuro
Body
MSK
Vascular
None
*No significant change from 2012
Specific Situations
Emergent MR Examinations only
“STAT” Examinations only
ER or Inpatient MR Exams only
Specific Situations
Residents provide Prelim Reports
Telerad service reads MR exams
Read only by request (i.e. if clinician calls)
Complex cases read by attending only
Depends on study (i.e. Cardiac read only by fellows)
Weekend Coverage
Programs Covering Routine Services on the Weekend
70%
64%
2011
60%
53%
2012
50%
2013
40%
30%
20%
20%
16%
16%
10%
0%
Half Day Saturday Full Day Saturday
Half-Day Sunday
Full Day Sunday
Not Provided
Readout Format
How Often Post-Call Face to Face Readout Occurs
60%
2011
50%
40%
2012
35%
2013
28%
30%
18%
20%
16%
10%
0%
Most/All of the Time
Some of the Time
No Face to Face
Readout
In-House Attending
Specific Situations
Face-to-face readout for Neuro Studies only
Face-to-face readout for junior residents only
Face-to-face readout only if there is a question on the study
Overread Procedure
70%
60%
66%
58%
54%
50%
40%
40%
30%
20%
10%
2%
0%
0%
Resident Calls Attending calls Referring Doc
Referring Doc Referring Doc
Contacts
Patient
Resident
Contacts
Patient
Attending
Contacts
Patient
2%
Overread
Documented
Specific Situations
Not applicable to programs with overnight in-house attendings
Informal
Overread
After Hour Attending Coverage
0%
10%
20%
30%
Normal attending work day
40%
3% programs plan to
46%
24/7 Attending Coverage
24%
3%
Attendings Review Select
Cases at Home
External telerads over-reads
residents
Other
60%
40%
Extended Attending Hours
Attendings Review All Cases
at Home
50%
2010
2012
7% programs plan to
2013
implement overnight inhouse attending coverage
within the next year
43%
15%
18%
• Frequently section-dependent
• ER-specific coverage 24 hrs
implement extended in-house
attending coverage (5-10pm)
within the next year
29% programs do not plan
to implement extended inhouse attending coverage
Sick Resident Coverage
Regular Shift Coverage
Call Shift Coverage
70%
60%
70%
59%
63%
60%
50%
50%
40%
40%
40%
34%
30%
30%
20%
15%
12%
20%
10%
10%
0%
0%
Resident Pulled
From Other
Service
"Jeopardy"
Resident
No Resident
Pulled
Other
16%
5%
"Jeopardy" Chief Finds
Resident
Coverage
Resident No Resident
Finds
Pulled
Coverage
4%
Other
Specific Situations
Specific Situations
More frequently pulled for procedural
services (IR, US)
Service dependent
Resident scheduled for next shift covers
Staff may cover if no other alternative
EXAM OF THE (VERY
NEAR) FUTURE
ABR Core Exam
Sentiment Towards New Exam Style
Advantages Expressed
70%
60%
56%
Incorporates physics into clinical
knowledge
Synthesizes knowledge earlier in
training
Fairness of testing
2012
50%
2013
40%
Disadvantages Expressed
30%
21%
20%
9%
10%
7%
2%
0%
Very
Positive
Positive
Mixed
Negative
Very
Negative
Loss of focused period of
consolidating knowledge, not just for
exam but for future career
15 month wait period postgraduation to be board-certified
No testing of interpersonal skills
Studying for MCE, less real-world
application of knowledge
Changing Board Examination
Plan to Change to 3 Year "Core" Curriculum
50%
46%
45%
45%
2010
41%
40%
2011
35%
34%
35%
2012
30%
2013
25%
22%
19%
20%
18%
18%
15%
17%
13%
10%
5%
17%
7% 7%
5%
6%
0%
3 yr "core" curriculum in
place
Plan to have 3 yr "core"
curriculum before EOF
Plan to have 3 yr "core"
curriculum after EOF
No plan to change to 3 yr
"core" curriculum
Changing Board Examination
Plans for 4th Year (PGY-5) Curriculum
0%
10%
20%
30%
21%
Continue Normal Rotations
70%
80%
90%
26%
6%
7%
6%
1%
1%
2012
12%
2013
16%
26%
15%
17%
Combination
82%
2011
4%
Fill in Deficits From 1st 3 years
Other
60%
61%
60%
Start Fellowship ("3+2 Curriculum")
Undecided
50%
26%
Selectives/"Mini-Fellowships"
Research
40%
Other Plans
24%
23%
6%
13%
18%
18%
29%
Continue fulfilling Mamms and Nucs
requirements
Remediation in sections of poor
performance
“Mini-fellowships” are optional
Changing Board Examination
Plans for 3rd years (PGY-4) Preparing for the Core Exam
0%
10%
20%
30%
40%
50%
60%
70%
21%
25%
Time Off Service
21%
40%
50%
Time Out of Call Pool
62%
Lighter Rotations
No Protected Study Time
50%
2011
11%
13%
18%
2012
45%
Undecided
36%
18%
2013
Changing Board Examination
Coverage for Residents Studying for Exam
80%
73%
70%
60%
50%
40%
30%
14%
10%
20%
0%
10%
0%
0%
Junior Residents
Fellows
Attendings
I don't know
Other (please
specify)
Average Weeks Out of Call Pool / Off Service (If Given)
Call Pool
Off Service
10.2 weeks (2-52)
5.7 weeks (1-12)
Changing Board Examination
Plans for board reviews for the new board exam structure
Oral Board Review
0%
20%
40%
Core Board Review
60%
80%
100%
79%
Internal Board Review
84%
87%
80%
70%
2011
50%
2011
30%
13%
2012
20%
11%
2013
No Internal Review, Time
for External Review
2013
60%
38%
40%
20%
2012
29%
29%
29%
20%
10%
3%
8%
0%
1%
No Internal or External
Review
3%
2%
Internal
Review
With
Few/No
Changes
Internal
Review
With
Many
Changes
Stop Continue Stop All
Internal External board
Review, Review Review
Allow
Time For
External
Review
Have Unsure
Current
3rd Years
Sit In On
4th Year
Review
Changing Board Examination
Preparation for Non-Interpretative Skills (e.g. Physics,
Safety)
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
77%
27%
13%
4%
Already Have
Regular
Lectures
Planning to
Planning for Dedicated SelfHave Regular Lectures During Study Time
Lectures
Board Review
Other Schemes
• Funding for external physics review course
• Physics problem-based learning in lieu of traditional lectures
8%
Other
Selectives/”Mini-Fellowships”
Purpose of Selectives
100%
80%
60%
82%
40%
62%
51%
20%
0%
Provide Additional Concentration of
Supplemental Knowledge in
Knowledge Outside of Fellowship Planned Fellowship Subspecialty
Fill In Gaps of Knowledge Prior to
Graduation
How Many Individual Selectives Are
Available to 4th Years
30%
Weeks Allotted in 4th Year
24.4 weeks average
(8-52 weeks)
26%
27%
25%
20%
14%
15%
10%
12%
12%
6
7
7%
3%
5%
0%
1
2
3
4
5
Selectives
Selective Details
0%
10%
20%
30%
40%
50%
35%
Functions as Fellow
38%
Some Responsibilities of Fellow
54%
Functions as Senior Resident
8%
Academic Time
Out of Call Pool
60%
1%
Notes
• Space limitations on high demand mini-fellowships (e.g. Breast, MSK)
• Research track mini-fellowship a possibility
FELLOWSHIPS
Fellowships
How Are Fellowship Applicants Interviewed?
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
This fellowship program
interviews outside
applicants before offering
positions to internal
candidates
This fellowship program
has an early acceptance
policy in place for internal
candidates
There is no fellowship
program for this
subspecialty at my
institution
Fellowships
25%
What Fellowships 4th Years are Pursuing
22%
2009
2012
2013
20%
18%
15%
15%
13%
12%
10%
8%
5%
5%
3%
1%
2%
1%
1%
1%
0%
Abdomen
Body
Breast
Cardiac
Chest
MRI
MSK
Neuro
Neuro IR
Nucs
Peds
VIR
Other
Fellowships
25%
Distribution of Internal vs External Fellowships
External Fellowship
20%
Internal Fellowship
7% of Residents Planning on Doing
Two Fellowships
13%
15%
9%
7%
10%
7%
8%
5%
4%
0%
1%
7%
6%
5%
6%
9%
2%
0%
0%
1%
1%
1%
1%
1%
1%
1%
1%
9%
ED
Onc Imaging
Private practice
1%
0%
HEALTHCARE ECONOMICS
AND THE JOB MARKET
Healthcare Economics and the Job Market
45%
Sentiment About Current Job Market
40%
40%
2011
36%
35%
2013
33%
Already
Have One,
1%
29%
30%
26%
Yes, 24%
25%
20%
Have You Started Looking for a Job?
18%
No, 75%
15%
9%
10%
5%
1%
0%
Very Worried
Worried
A Little Worried Not Worried
Healthcare Economics and the Job Market
Short-Term Plans Following
Graduation
Private
Practice
2%
Academic
2%
Long Term Plans After Graduation
Military
1%
Private
Practice
30%
Undecided
34%
Fellowship
95%
Military
1%
Academic
35%
Healthcare Economics and the Job Market
How the Current Economic Environment and
Current Job Market Influences Career Plans
50%
What are you willing to compromise
to obtain a job?
48%
80%
45%
40%
37%
2012
71%
2012
70%
35%
30%
25%
2013
53%
0%
51%
50%
13%
44%
12%
10%
5%
60%
60%
22%
20%
15%
2013
40%
3%
30%
20%
10%
0%
Less
Lower Salary More Call
Vacation
Shifts
Time
More
Weekend
Shifts
Less Ideal
Location
Healthcare Economics and the Job Market
What effects do you think healthcare
reform will have on radiology?
• 92% (prev 86%) feel practices will try
to increase their volume to maintain
a similar salary despite the lower
reimbursement rates
• 70% (prev 65%) feel it will discourage
top-tier medical students from
choosing radiology
– 0% feel it will encourage top-tier
medical students to choose radiology
• 40% (prev 36%) feel that practices
are going to be looking for
radiologists trained in more than one
fellowship
Does your program offer
some training in
healthcare economics and
radiology business?
None
31%
Inadequate
37%
Adequate
32%
Healthcare Economics and the Job Market
Poor economic climate has lead to budget issues at some
programs, esp. programs that have more trainees than its
training “cap,” paying for a certain # trainees out of pocket.
such programs may need to downsize # trainees
• 61% programs with # trainees = training “cap”
• 12% programs with # trainees > training “cap”
• 13% programs planning on increasing # trainees
• 7% programs planning on decreasing # trainees
• 34% programs not planning on changing # trainees
• 2% programs planning on increasing # fellows
• 12% programs planning on decreasing # fellows
• 23% programs not planning on changing # fellows
MISCELLANEOUS
Quality Improvement
Not at
All 10%
How well does your training program prepare
you for ABR’s PQI requirements?*
ABR requires radiologists to document participation in 3 successful
PQI projects every 10 years to maintain board certification
Inadequ
ate 25%
Adequa
te 64%
*No significant change from 2012
PQI Projects Participated In*
Program Support for Resident PQI*
57%
60%
70%
60%
60%
50%
46%
50%
40%
40%
30%
20%
30%
17%
17%
10%
20%
3%
6%
1
2
3
13%
10%
4%
0%
0%
0
30%
4+
Nothing
Time Off Financial
Clinical Support
Service
Faculty
Other
Mentor Resources
Resident Feedback and Requirements
Resident Performance Feedback
69%
57%
70%
60%
50%
40%
30%
20%
10%
0%
29%
15%
Signing Time
Volume
Overread Rate
Dictation
Corrections
Safety Training (Radiation, MRI, Contrast, Sedation)
78%
67%
80%
Simulation Lab
70%
60%
44%
50%
30%
40%
30%
7%
20%
10%
0%
Regular Lectures
Computer-Based
Modules
Teaching at
Workstation
Self-Study
Other
Resident Feedback and Requirements
Procedure Logging
70%
60%
60%
52%
50%
40%
30%
16%
20%
4%
10%
0%
Procedure Logging
Software
Program-Specific
Database
Residents Keep Own
Other
Procedure Competency Notes
• About 50 % of programs have minimum procedure requirements, apart from I-131 mandated
by NRC
• In IR, competency may need to be demonstrated prior to performing procedure independently
• Competency requirements can be by individual procedure such as knee MRI, LP or PICC
DISCUSSION
Discussion
• Total # residents increased 29% from 2003 to 2013,
with greater proportional increase of female residents
(47%)
• Resident salaries have increased at roughly the same
pace as U.S. inflation since 2009
• E-Anatomy (3% -> 16%) and RadPrimer (16% -> 56%)
have increasingly been provided as resources to
residents
• About 96% of residents attend AIRP, with an average
stipend of $1800
• Slightly more programs offering full-day
Saturday/Sunday services
Discussion
• Fewer programs consistently read-out post-call
residents face to face (49% -> 35%), with more
programs not having post-call readout (21% -> 28%)
• Only ~50% of programs document overreads
• 24 hour attending coverage has doubled from 2009
(12%) to 2013 (24%)
• Chiefs are concerned about the Core Exam format not
testing the skills that will be valuable in practice
• 82% of programs plan to offer 4th year minifellowships; average of 24 weeks allotted
Discussion
• Programs giving 3rd years study time plan to offer 10
weeks of time off call and 5.5 weeks off of service
• 73% of residents are worried or very worried about
their job prospects now, compared with only 47% in
2011, and are willing to make more compromises to
secure a job
• 70% feel health care reform efforts will discourage
top-tier medical students from a career in radiology
Future Directions
• How successful were our board preparations
for the core exam
• How senior selectives were received
• ACGME residency milestones
• Informatics
Thanks!
• Chief Resident Participants
• Laurie May at RSNA
• Gautham Reddy and the A3CR2 Leadership
• Jennifer Gould and Ron Evens
• Steve Sauk, Elizabeth Sheybani, Colin Thompson,
David Slat and Taylor Stone
• To Request Data from this Survey:
[email protected]