2012 A2012 A33CRCR22 Annual Chief Annual Chief Resident SurveyResident Survey

Steve Sauk, MDSteve Sauk, MDMallinckrodt Institute of RadiologyMallinckrodt Institute of Radiology

St. LouisAKA 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 increase benefits 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

• New in 2012– Ultrasound and MR interpretations on call– Healthcare Reform and its Economic Impact on

Residency Programs, Fellowships, and the Job Market– Quality Improvement

Limitations

• Opinions and estimations

• Sampling bias (only chief residents included)

• Duplicate responses from programs with multiple chief residents– We tried excluding them from the data

PROGRAM DETAILSPROGRAM DETAILS

Participation

• 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!

Year Individual Responses

Unique Programs

2012 185 1352011 259 148

2010 228 140

2009 143 112

2008 100 ---

Number of Responses 2008-2012

* Out of approximately 218 programs in the US

Program Size

Changes in Size• Increase in program size over

9 years– Total # residents increased 29%

from 2003 to 2012– # women residents increased

16% from 2003 to 2012

Hospital Coverage

Decrease since 2011 (85%) and ‘09-’10 (80%)

More residency programs are increasing # hospitals they cover for training

Type of Institution

Volume% Programs with Varying # Radiologic

Studies on Selected YearsAnnual # CT scans (millions)

per year*

* Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007 Nov

29;357(22):2277-84

RESIDENT BENEFITSRESIDENT BENEFITS

Resident Benefits

Average Amount = $1793 ($300-$6000)

% Residents that attend AIRP = 94%

Other Benefits: iPads, No healthcare co-pay, Gym

membership, Meals

Vacation and Salary

Average Resident Salary per Class % Programs vs. # weeks of Vacation

Resident Salaries have increased 2.6 % for PGY-2 and 0.7% for PGY-5 since 2009

53% of programs offer 4 weeks of vacation34% of programs offer 3 weeks

Family Leave

% Programs offering Family

Leave

% Programs with Family Leave taken from All, Some, or

None of Vacation/Sick Days

% Programs offering Family

Leave

% Programs with Family Leave taken from All, Some, or

None of Vacation/Sick Days

For Pregnant Residents For Significant Others of Pregnant Residents

Family Leave

• 5/129 programs report that residents can take more weeks of family leave, unpaid.• Restrictions

• Negotiated for programs needs• Medical Necessity

% Programs Offering # Weeks of Family Leave for Pregnant Residents

% Programs Offering # Weeks of Family Leave for Significant Others

CHIEF RESIDENTCHIEF RESIDENT

Chief Resident Selection% Programs with Varying # Chief Residents

Other

All attendingsEducation Committee

Chief Resident Responsibiltities

• Others• Budget management• Banquet Planning• Serving on Hospital and GME boards• “Keeping everybody happy”

Chief Resident Benefits

Average Salary Bonus$1932 (0-$7500)

CALL, WEEKENDS, AND CALL, WEEKENDS, AND ATTENDING COVERAGEATTENDING COVERAGE

Call and Weekend CoverageType of Reports while On-Call

• Short Prelim for Neuro studies only

• Full Report on Radiographs only

• Junior resident gives complete prelim report

• Senior resident gives short prelim report.

• Depends on time of day, or day of the week

Ultrasound CoverageAfter Hour Ultrasound Coverage

Specific SituationsOb-Gyn Service performs Pelvic US

Vascular Surgery Service performs DVT USResident performs certain studies

(RUQ, Scrotal, Renal)

In-house Sonographer depending on time, hospital, and day of the week

US Studies Performed After Hours

MRI Coverage% Programs Performing MRI Exams

After Hours

Specific SituationsEmergent MR Examinations only

“STAT” Examinations onlyER or Inpatient MR Exams only

Who Reads the MR Examinations After Hours?

Specific SituationsResidents provide Prelim ReportsTelerad service reads MR exams

Read only by request (i.e. if clinician calls)

Complex cases read by attending onlyDepends on study (i.e. Cardiac read only by fellows)

Weekend Coverage% Programs Covering Routine Radiology Services Over the Weekend

Readout Process

Specific SituationsFace-to-face readout for Neuro Studies only

Face-to-face readout for junior residents onlyFace-to-face readout only if there is a question on the study

How often are face-to-face readouts performed?

After Hour Attending Coverage

• Only Neuro studies read by attendings after hours• Depends on the day of the week

10% programs plan to implement extended in-house attending coverage (5-10pm) within the next year

7.5% programs plan to implement overnight in-house attending coverage within the next year

55% programs do not plan to implement extended in-house attending coverage

CHANGING BOARD CHANGING BOARD EXAMINATIONEXAMINATION

Changing Board ExaminationSentiment re: New Board Exam Format

Disadvantages Expressed Decreased emphasis on Verbal Communication, an invaluable skill 15 month wait period post-graduation to be board-certified, making it more difficult to find a job

Advantages Expressed Incorporates physics into clinical knowledge Removes 4th year hiatus for oral boards prep Encourages more trainees to pursue fellowships Allows more focused training during 4th year

Changing Board Examination

Plans to change to the new 3 yr “core” curriculum

Changing Board ExaminationPlans for 4th year (Pgy-5) once the new examination is in place

Other PlansContinue fulfilling Mamms and

Nucs requirementsRemediation in sections of poor

performance“Mini-fellowships” are optional

Plans for 3rd years (PGY-4) preparing for the “core” examination

Specific Management Issues 2-3 months off the call-pool Placed on lighter rotations Afternoons off for 1-3 months No nightfloat 3-6 months prior to exam Negotiations with faculty

Any combination of the above

Changing Board Examination

Changing Board ExaminationPlans for board reviews for the new board exam structure

Current Oral Boards Plans for “Core” Exam

FELLOWSHIPSFELLOWSHIPS

FellowshipsHow are fellowship applicants interviewed?

FellowshipsWhat fellowships are the 4th years (PGY-5) going into?

FellowshipsDistribution of Internal vs. External Fellowships (2012)

EDCombined

Private practice

FellowshipsHow is your institution planning on dealing with the expected increase

in fellowship applicants once the new board format is in place?

FellowshipsSentiments re: Change to limit interviews

starting Feb. and offers to external candidates starting May of the R3 year

Preference for the fellowship application process

Comments:“Encourages residents to stay at their program”“Collides with ‘core’ exam prep”

HEALTHCARE ECONOMICS HEALTHCARE ECONOMICS AND THE JOB MARKETAND THE JOB MARKET

Healthcare Economics and the Job Market

Sentiments about Current Job Market Have you started looking for a job?

Healthcare Economics and the Job Market

SHORT-Term Plans After Graduation LONG-Term Plans After Graduation

Healthcare Economics and the Job MarketHow the Current Economic Environment and Current Job Market Influences Career Plans*

* Similar trend in 2011

What are you willing to compromise to obtain a job?**

** Some not willing to compromise anything for a job

• 86% feel practices will try to increase their volume to maintain a similar salary despite the lower reimbursement rates

• 65% feel it will discourage top-tier medical students from choosing radiology– 5% feel it will encourage top-tier medical

students to choose radiology

• 36% feel that practices are going to be looking for radiologists trained in more than one fellowship

• “Worst possible effect. Game over. Medicine as we know it is done.”

Healthcare Economics and the Job Market

What effects do you think healthcare reform will have on radiology? Does your program offer

some training in healthcare economics and

radiology business?

Healthcare Economics and the Job Market

• 51% programs with # trainees = training “cap”• 13% programs with # trainees > training “cap”

• 16% programs planning on increasing # trainees• 4% programs planning on decreasing # trainees• 44% programs not planning on changing # trainees

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

QUALITY IMPROVEMENT QUALITY IMPROVEMENT AND AUDIENCE RESPONSE AND AUDIENCE RESPONSE

SYSTEMSSYSTEMS

Quality Improvement

How many PQI projects have you taken part in?

What does your program do to support residents on PQI projects?

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

Audience Response

How often are Audience Response Systems used?

How useful are Audience Response Systems?

DISCUSSIONDISCUSSION

DiscussionProgram Details

• Interval decreased number of responses compared to 2011, but increased since 2009– likely related to shorter time frame to complete the survey this year

• Total # residents increased 29% from 2003 to 2012, with a proportionately smaller increase in percentage (16%) of women residents from 2003 to 2012

• Decrease in university affiliation from 85% to 76% since 2011• Hospital Coverage and Volume

– Overall increase in the number of programs which cover 4 or more hospitals since 2005 (44% increase)

– 140% increase in programs which read > 750k radiologic studies• Reflective of the general trend of higher volume of radiologic studies in the US

DiscussionResident Benefits• Interval increase in overall benefits since 2008

– Book funds, conference fees, ABR examination fees, Lead aprons, oral board review course tuition/travel stipend

– AIRP coverage varies from %300-$6000 (average $1793), with ~94% residents attending AIRP

• 2.6% and 0.7% increase in resident salaries since 2009 for PGY-2 and PGY-5, respectively

• 90% programs offer 3-4 weeks of vacation• Family Leave

– 94% and 79% programs offer family leave for pregnant residents and significant others, respectively

– 46% and 43% programs offer family leave without taking from some/all vacation/sick days

• Vast majority of programs offering 6-7 weeks and 1-2 weeks of family leave for pregnant residents and significant others

DiscussionChief Residents

• 49% programs choose their chief residents by a combination of program director/chair + resident

• 81% programs have 2-3 chief residents• Responsibilities managed by majority of programs

– Call schedule*, Rotation Schedule, Vacation Schedule, Curriculum development and evaluation, resident recruiting/selecting, social events, managing disputes*, and teaching residents

• Responsibilities managed by a minority of programs– attending lecture / conference schedule, medical student

teaching, boards review organization, budget management, banquet planning, and serving on hospital/GME boards

• Majority of programs offer extra time/paid fees for conferences and salary bonus (average = $1932)

DiscussionCall, Weekends, Attending Coverage

• Slight increase in the number of final reports given while on-call with decline in number of oral reports since 2011

• Ultrasound Examinations– Who performs them?

• 59% increase in programs with 24-hour sonographer coverage– may depend on hospital, time, and day of the week

• 14% decrease in programs with home-call sonographer• 23% increase in programs with residents performing ultrasounds while on-call• Specific Situations

– Ob-Gyn performs Pelvic US– Vascular surgery performs DVT studies

– What kinds of studies?• all programs perform ED ultrasounds, and 88% perform emergent inpatient

ultrasounds

DiscussionCall, Weekends, Attending Coverage

• MRI Examinations– Majority of programs performing Neuro and Body MRs– 54% performing musculoskeletal and vascular studies

• What indications? • Are these read overnight or read the next day?

– 95% progams have the on-call resident read the MR examinations over night

• Type of report variable prelims, depends on the study• Weekend Coverage

– Minimal change in % programs covering services over the weekend• Majority of programs working full day Saturday• 49% programs provide services on a full day Sunday

– Why?• Increase in radiologic studies would be too overwhelming for the following Monday?• Higher demands from clinical services for imaging over the weekend?• How much of these examinations change the management over the weekend?

DiscussionCall, Weekends, Attending Coverage

• Read out Process– % programs doing face-to-face readout hasn't changed since 2011

• Attending Coverage– 67% increase in 24/7 in-house attendings since 2009 (12% 20%)– 41% increase in extended hour in-house attendings since 2009

(32% 45%)– ~18% programs plan to implement either 24/7 or extended hour

attending coverage next year– Why?

• A result of clinical services demanding final reads during the night?• How much resident variance is there?

DiscussionChanging Board Examination

• How do people feel about the new board exam format?– Majority = mixed + negative– Major disadvantages = decreased emphasis on verbal communication

and delay in being board-certified• Will this affect the clinicians interactions with radiologists? • Will this affect the job search after several years?

• Implementing the 3 year "core" curriculum– # programs with 3 year curriculum have increased 7-fold since 2010– 17% programs do not plan to change to a 3 year core curriculum– What will 4th years do?

• Selectives / mini-fellowships• Continue normal rotations• Less common: start fellowship, fill in deficits from the first 3 years

DiscussionChanging Board Examination

• How will you manage 3rd years preparing for the "core" examination?– 75% programs plan to have them take time out of the call pool or

time off-service (increased since 2011)• Variable amount of time (1-3 months)

– How will they make up for the time off-service or off-call, if at all?– Who will cover for their call? 4th year class? 2nd year class?

• How will 3rd years study for their "core" examination?– 67% programs are not sure– 15% programs keeping the same internal board review, while

there is an general increase in % programs stopping internal board review, to allow time for external review

DiscussionFellowships

• Large majority of fellowship programs has an early acceptance policy for internal candidates– disadvantage for those applicants in programs without

specific fellowships• % applicants going into fellowships since 2009:

– Decreased: Breast (13% 11%), MSK (19% 14%) Neuro IR (2% 0%)

– Increased: Neuro (15% 20%), Peds (2% 5%), VIR (15% 22%)

• For these fellowships, there is a larger percentage of fellows from outside institutions than from within the same institution

DiscussionFellowships

• Once the new board format is in place, an increase in fellowship applicants is expected– majority of programs do not plan to expand their programs or are

not sure• Fellowship interviews will start Feb 2013 with offers given

starting May 2013– Majority agree that the change is more fair, but may be difficult

to enforce– strong sentiment about interviews occuring the same time during

"core" exam prep– Majority would prefer a common deadline for all fellowship

applications (increased in number since 2011)

DiscussionHealthcare Economics and the Job Market

• Increased concern about attaining a job since 2011– People willing to compromise lower salary over vacation time,

location, and call/weekend shifts to obtain a job• Majority have not start looking for a job

– Short-term, 92% going into fellowships– Long-term, split nearly evenly between academics, private

practice, and undecided• Similar impact of the economic environment and current

job market on residents this year, compared to 2011– Majority feel little/no influence on career plans– Majority feel that the economy increases the interest in doing

fellowship

DiscussionQuality Improvement and Audience Response Systems

• 62% programs feel their training program prepares them for the ABR's PQI requirements– May be reflective of the 75% those surveyed who have

taken part of a PQI project this year

• 36% those surveyed feel audience response systems is valuable

Future Directions• Continued impact of new board exam format• Continued impact of evolving ACGME duty

hour restrictions• New ideas for the upcoming 2012-2013

academic year in light of the new “core” examination

Thanks!• Chief Resident Participants

• Laurie May at RSNA

• Gautham Reddy and the A3CR2 Leadership

• Jennifer Gould and Ron Evens

• Clint Jokerst, Amy Fowler, Doug Kitchin, Elizabeth Sheybani, and Colin Thompson

• To Request Data from this Survey: Ssauk@mir.wustl.edu