Transcript A3CR2 Chief Resident Survey

3
2
A CR
Chief Resident Survey
Mallinckrodt Institute of Radiology
St. Louis, MO
Purpose

Information Gathering
– Facts about the structure of training programs
across the country
– Opinions regarding features of the training
process and environment
– Ideas for promoting or responding to change
in academic and professional arenas
Survey Format

On-line survey

Predominantly multiple choice

Options for open response where appropriate
Survey Limitations

Sampling bias

Multiple responses from single institution

Not a scientific process
Survey Topics

Repeat Questions:
–
–
–
–
–
–
Basic Program Details
Resident Benefits
Chief Resident Duties
ACGME Guidelines
Call
Oral Board Preparation

New Questions:
– Plans After Residency
– RRC Program Changes
– Deficit Reduction Act
2007 Chief Resident Survey

187 Surveys Requests
– 139 responses received
– 65% of respondents were incoming chiefs
– 84% from university affiliated programs
– 74% response rate
 28% in 2005
 55% 2004

Thank you!
Results…
Basic Program Details
Number of Hospitals Covered
45%
40%
35%
30%
2007
25%
2005
20%
2004
15%
10%
5%
0%
1
2
3
4
5 or more
Total Number of Beds at Affiliated Institutions
60%
50%
40%
2007
30%
2005
2004
20%
10%
0%
<500
500-999
1000-1499
1500-2000
>2000
Basic Program Details
Total Annual Number of Diagnostic Studies Performed
50%
45%
40%
35%
30%
2007
25%
2005
20%
2004
15%
10%
5%
0%
<100,000
100K-250K
250K-500K
500K-750K
>750,000
Basic Program Details
2006-07 Residents

Total # of Residents:
– R1: 6.8 (1-18)
– R2: 6.8 (1-18)
– R3: 6.8 (1-18)
– R4: 6.6 (1-17)
– Comparison to 2005: 5.8 (R1-R4)

27% Female
– Comparison to 2005: 34%
Basic Program Details
2006-07 Fellows

39% Female
Number of Fellows
40%
35%
30%
25%
2007
20%
2005
15%
10%
5%
0%
0
1-5
6-10
11-20
21-30
>30
Basic Program Details
2006-07 Staff

Female: 26%
Number of Staff
35%
30%
25%
20%
2007
2005
15%
10%
5%
0%
<10
11-20
21-30
31-40
41-50
51-75 75-100 >100
Basic Program Details
Resident Benefits

Salary:
– R1: $44,300 ($35,000-65,000)
 2005: $43,195
 2002: $37,913
– R4: $50,300 ($42,000-80,000)
 2005: $49,407
 2002: $45,522

Tax-Deferred Retirement Savings Plan:
– Available to 68% of residents
– Only 26% receive matching funds
Costs Assumed by Training Program

Temporary Medical
License: 41%


BLS: 77%
ACLS: 71%
Permanent Medical
License: 17%

AFIP Tuition: 93%
AFIP Housing Stipend: 75%
– 50% in 2005

– 31% in 2005

Book/Travel Fund: 81%
– Average: $850
– 2005: $722


Lead Aprons: 48%


Oral Board Review Course
Tuition: 46%
Oral Board Review Course
Stipend: 28%
Resident Benefits
Child Care

80% provide paid
maternity leave
– Avg Length: 6 wks
– Range: 0-12 wks

68% provide paid
paternity leave
– Avg Length: 10 days
– Range: 0-6 wks
60%
50%
40%
30%
20%
10%
0%
On-Site
Paid by Subsidy or Tax-Free
Child Care Residency Discount Child Care
Facility
Program
Savings
Option
Other
Resident Benefits
Chiefdom

Average of 2 chiefs per
program
– Range 1-4
Chief Resident Selection
80%
70%
60%
50%

Term spans mid-third
to mid-fourth year for
74% of respondents
2007
40%
2005
30%
20%
10%
0%
Residents
Staff
Program
Director
Department
Chair
Other
Chief Resident Responsibilities
Other
Organize Board
Review
Medical Student
Teaching
Resident Teaching
Social Events
2005
2007
Resident Selection
Resident Recruiting
Curriculum Development
and Evaluation
Rotation Schedule
Call Schedule
0%
20%
40%
60%
80%
100%
Chiefdom
Chief Resident Benefits
Other
Salary Bonus
Chief Resident Office
2004
2005
Administrative Time Away
From Clinical Service
2007
Registration/Travel Costs
for Conferences
Extra Time Allotted for
Conferences
0%
20%
40%
60%
80%
100%
-Average Salary Bonus: $2,000 ($0-10,000)
-Other: Chief mug and chair!
Chiefdom
ACGME Compliance

100% report complete compliance
– 97% Positive effect on resident quality of life
– 94% Positive effect on resident education

Average hours off between shifts:
– <10: 0% 10-12: 18%
– <10: 11% in 2005

12-15: 62%
>15: 20%
Average work week:
– 57% Report between 51-60 hours
– Averages on busiest rotation:
 61-70 hours: 32%
71-80 hours: 28%
>80 hours: 10%
– 80-hour work week is an average over 4 weeks
ACGME Compliance

Required work hours log: 67%

Average call frequency per week:
– 28%: <1
58%: 1
– 2005 Comparison:
 53%: <1

12%: 2
2%: 3
47%: 1-3
Average days off per month:
– 12%: ≤4
24%: 5
– 2005 Comparison:
 27%: 4-5
64%: 6-8
42%: 6
22%: ≥7
Life After Residency

91% pursuing fellowship training

Military Service: 7%

Private Practice: 65%

Academic Practice: 35%
– 11% of programs offer monetary incentive program
for entering academic practice
Primary Reason for Entering Private Practice
Other
Favorable Call
Schedule
Vacation/Benefits
Monetary
Compensation
Read Multiple
Subspecialties
Location
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Life After Residency
Primary Reason for Entering Academic Practice
Other
Favorable Call Schedule
Vacation/Benefits
Monetary Compensation
Research Interest
Teaching Interest
Read Single Subspecialty
Location
0%
10%
20%
30%
40%
50%
60%
70%
Life After Residency
Call

Average # of residents in-house on call: 1.8
– Range: 1-5

In-house call shifts (excluding NF):
– <50: 47%
51-75: 13%
– 2005 Comparison: 58 (average)

>75: 41%
Home/beeper call shifts (excluding NF):
– 0: 36% 1-40: 29% 41-75: 27%
– 2005 Comparison: 78 (average)
>75: 10%
Call

73% of programs use night float system
– 67% in 2005
– 61% in 2004

Weeks on night float during residency:
– 0-4 wks: 9%
– 8-10 wks: 21%

Length of night float shifts (hours):
– <8: 0%
– 12-14: 46%

4-8 wks: 20%
>10 wks: 50%
8-10: 6.2%
>14: 4%
10-12: 44%
Frequency of night float shifts:
– QD: 63%
QOD: 3%
Other: 35%
Resident Responsibilities On-Call
Check-Out After Call
100%
80%
90%
70%
80%
60%
70%
50%
60%
2007
50%
2005
40%
40%
30%
30%
20%
20%
10%
10%
0%
0%
Emergency
Department
Inpatient
Services
Scheduled
Routine
Studies
Remote
Locations
Dictate
Findings;
Subsequent
Read-out
Dicate
Findings; No
Read-out
Preview
Findings;
Subsequent
Read-out
Preview
Findings; No
Read-out
Call
Teleradiology
70%
60%
50%
40%
30%
20%
10%
0%
Provided to
Provided to staff to
residents to read read studies from
studies from home home while on-call
while on-call
Provided to staff
for resident
consults on-call
Not available
Call
Call

Process for approving studies ordered on-call:
– Sieve: 35%
– Ordering MD speaks directly to resident: 43%
– Ordering MD speaks to physician extender first; appropriate calls
forwarded to resident: 25%
– Other: 30% (Computer based, Resident only called for protocols)

In-house moonlighting: 39%
– Examples:






Weekend Neuro Call: $720/day
Assist ED Attending On-Call: $100/hr
Overflow Studies in evenings, weekends: $600-800/day
Contrast Injection Monitoring: $50-60/hr
IR Home Call: $1,000/week
On-call McMeal vouchers or other free food: 87%
Oral Board Preparation

79% of programs provide their own oral board review
and curriculum

Structured review begins:
– Jan-Feb: 62%
– March-April: 33%
– Before Jan: 5%

Oral board review:
– Lectures given by faculty: 97%
– Lectures organized by faculty: 30%

70% of programs include a mock exam as part of
preparation
Protected Time for Board Review
Hours of Scheduled Review
35%
60%
50%
30%
40%
25%
2007
30%
2005
20%
20%
15%
10%
10%
0%
Reduced
hours on
daily clinical
service
5%
0%
1-10
10-25
26-50
51-75
>75
Occasional No protected
early
time
dismissal
from clinical
service
Days off
Other
Oral Board Preparation
ACGME Program Requirements

69% have core didactic
lecture curriculum

80% give lectures as
1-hour block/day
– 6% group lectures into
a larger block once/wk
Protected Tim e for Didactic Lecture
Curriculum
Total Num ber of Didactic Lecture Hours/Wk
35%
60%
30%
50%
40%
25%
30%
20%
20%
15%
10%
10%
0%
All Services
Most
Services
Some
Services
No
protected
time
5%
0%
0
1-3
4-5
6-8
9-10
>10
ACGME Program Requirements

Required research/academic project: 64%
– Current protected academic time for project:
 25% Yes
– Anticipate giving protected academic time:
 23% Yes
 Most suggested 4 weeks of elective time
ACGME Program Requirements

69% of programs currently require
maintenance of a learning portfolio

75% currently employ 360° evaluations

95% of programs currently require an
annual objective examination (e.g. ACR
Inservice)
ACGME Program Requirements

Duration of training after which call
currently begins (in months):
– <6: 18% 6-9: 57% 9-12: 12%

>12: 12%
66% of residents stop taking call midway
through fourth year
– 11% stop at end of third year
– 14% continue throughout fourth year
Person Responsible for On-Call Study Interpretation
Pediatrics
VIR
Neuro MRI
MSK MRI
Body MRI
Neuro CT
MSK CT
Attending
Body CT
Fellow
Resident
Vascular US
OB US
General US
Nuclear Medicine
Fluoroscopy
Inpt Radiographs
ER Radiographs
0%
20%
40%
60%
80%
100%
ACGME Program Requirements
After Hours Attending Responsibilities
After Hours Attending Coverage
Ot her
Ot her
Available by
Scheduled,
t eleradiology
Rout ine
24-Hour at t ending
coverage
2005
Emergent Inpt
2007
10pm-7am
Overnight ED
5pm-10pm
Evening ED
No at t ending inhouse
0%
10%
20%
30%
40%
50%
60%
0%
20%
40%
60%
80%
100%
• 97% of attendings not in-house are available by pager
ACGME Program Requirements
ACGME Program Requirements

92% of resident reviewed studies on-call
are currently reviewed within 24 hrs

Restricting call until ≥12 month of
radiology residency training will change…
– Resident call system: 73%
– Attending/fellow call system: 18%
Deficit Reduction Act
Anticipated Changes Due to DRA
70%
60%
50%
40%
30%
20%
10%
0%
Expand hrs of
scheduled exams
Increased volume
during nl hrs
Decreased
ancillary/technical
staff
Switch to voice
dictation
Decrease AFIP
funding
Other
Discussion

Unique program structures:
– 3/2 programs
– 9 clinical months spread throughout 5-year training
program rather than doing PGY1 internship

Props:
– Excellent pathology; Excellent equipment and PACS
technology; Medical records easy to use; Stable
environment conducive for learning; Attendings are
professional and easy to work with

Yikes:
– We cover outside imaging centers to subsidize staff
incomes
Discussion

AFIP
– Loss of stipend, making cost of attending
prohibitive
– Funding received likely will be affected by
change to 4 week program
– Several programs will not send residents to
the AFIP starting this year
– “Our chair is very committed to AFIP, but
obviously, how many years can this last?”
Discussion

Call
– 50% with >10 weeks of NF during residency
– 41% with >75 additional in-house overnight
call shifts
– Decreased elective time
– Often unable to attend didactic conferences
– Expected to increase due to DRA and ACGME
changes; Current increases result of volume
 More moonlighting options for overflow studies?
– Decreased home call compared to 2005
 Resident teleradiology?
Discussion

ACGME Program Requirements
– Most of the concerns refer to R1 call restriction
 Requiring a resident to have at least a 1 month rotation on the
modality/section in which they will be taking call makes more
sense than not allowing a resident to take any independent
call throughout the first year. After having been in the
program for one year, they may not have any more exposure
to these modalities than they had at the 6 month point.
 We have a high volume of trauma at our hospital. It will be
very difficult for residents to start call in July- the peak of
trauma season- for little added benefit of a few more months
of training.
Discussion

ACGME Program Requirements (cont’d)
– Proposed changes of restricting the R1 call
responsibilities will be detrimental to resident
education. What an R1 learns by taking weekend
and overnight call during the second half of their
first year cannot be reproduced or replaced by
any other study tool.
– Early exposure to independent interpretation and
interactions with referring physicians is crucial to
resident education and developing the skills
needed to excel as a radiologist in the real world.
Discussion

Academics vs. Private Practice
– 35% of respondents entering academics
 Higher than average due to selection bias?
– $$ listed as primary reason for entering private
practice
 Better retirement savings plans for residents and staff
 Loan repayment programs
 Monetary incentive programs to encourage academic careers
– Teaching interest listed as primary reason for
entering academic practice
 Majority of chiefly duties are administrative
 Consider more teaching opportunities, involvement in
curriculum development, academic days and teaching
electives
Thank You