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Is radiology call absolutely insane during residency? Is it true you never sleep? After going through clerkship I've seen how many imaging studies are ordered per night in the ER etc and can't imagine there is much down time at all. How does it compare to the call schedules of medicine and surgery at your program? Is call every 4 days or does it vary per program?

My home school doesn't allow us to do radiology during clerkship and all I have really been able to do is shadow physicians so I was hoping to get some insight from residents/fellows.

 

Thanks!

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at my centre - and most centres I know of - call if very busy. Personally I do find it busier than internal (CCU/ICU although they have to I guess as a result work to noon the next day, while we go at 8-9am), and on average busier or on par with many surgery call (in terms of shear time I found my neuro surg call - which was the busiest surgery call to roughly be the same as radiology in terms of business). 

It isn't just call I should add - we are busy in everything we do now - people just need so much imaging ha. People in surgery often say they work their residents hard because in the end that is the actual job and simply have to be ready for it. Radiology now is quite similar - staff rads are very busy people with call demands as well. This is simply the reality of the profession in 2017 ha. 

Call would vary by centre - most programs do about 5-6 call shifts every 4 weeks (so more like 1 in 5/6). That is similar again to most internal programs. Surgery closer to the max which is actually 1 in 4. 

Just because it is busy doesn't mean I don't like it though - we clearly are in demand and at the centre of many of the important decisions in the hospital.  

 

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I think of it as simply an overnight shift - after your regular day has ended, continue working straight through until the next morning. Don't expect downtime or sleep, and you won't be disappointed.

The frequency of call is simply a function of how many shifts there are in the schedule, relative to the number of residents in the call pool.

It is however a very valuable educational experience that allows residents to develop their judgment and ability to make critical calls while they have the safety net of everything being overread afterwards as well as backup if needed, before they eventually become staff covering overnight call.

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What is the quality of life of residents in radiology versus neurosurgery? What about neurosurgery attendings and diagnostic radiology attendings?

How is call managed for attendings at academic centers? Do they stay at home and read on their own computers? Must they come to the hospital at night? Do they spend every call night at the hospital? What about IR?

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3 hours ago, CampusUdeM1 said:

What is the quality of life of residents in radiology versus neurosurgery? What about neurosurgery attendings and diagnostic radiology attendings?

How is call managed for attendings at academic centers? Do they stay at home and read on their own computers? Must they come to the hospital at night? Do they spend every call night at the hospital? What about IR?

always tough to compare some things as simply put we don't do both. 

Neuro surg probably has one of the worst quality of life for the residents in the hospital -  worse than rads. They start early (6am), the go until at least 5 daily, and they have frequent busy call (and usually ignore the post call rules for taking that day off). They work a ton of hours. 

Rad residents do work very hard - but a lot of that is because we have a ton of studying to do. We usually start 7:30-8:30 at most places and go until 5-5:30. On top of that is the study plan (for me that has increased as my call has dropped down - about to start the end run of 3-4 hours a night of studying during the week. 

The advantage rad attending have is they don't really have much call responsibilities - they don't (yet) read from home at most places. That is why call is so busy and so educational for residents - we effectively ARE the staff that night and have to learn to be both quick and correct under a lot of pressure. In the community it is different and varies (and most rads are community rads) and some of them are quite heavily involved in doing call. 

Now looking forward more academic centres are going 24/7 on call with staff in house all the time. That is probably ultimately the way of the future. Imaging is just too important and too in demand now to just have junior residents doing it independently overnight (my opinion there). 

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4 hours ago, rmorelan said:

always tough to compare some things as simply put we don't do both. 

Plus there is the question of how to quantify job satisfaction (see: recent thread on why or why not family medicine).

Attending academic radiologists must overread all the residents' work on call (plus cover plain films on weekends). While some institutions may have the preliminary reports sit until the next morning, there is increasing expectation that the reports will be finalized within a defined period of hours.

This means reading all studies done until a certain time (e.g. 10 p.m.) and starting early the next morning (e.g. 6 a.m.), which could be at home or in-house, depending on the institution. Only a few places have staff ER radiologists in-house 24/7 at present I believe, although late shift is certainly becoming more common.

IR would need to come in at all hours of the night if called - non-IR procedures would be more variable and less frequent (e.g. pediatric fluoroscopy). 

 

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3 hours ago, Lactic Folly said:

Plus there is the question of how to quantify job satisfaction (see: recent thread on why or why not family medicine).

Attending academic radiologists must overread all the residents' work on call (plus cover plain films on weekends). While some institutions may have the preliminary reports sit until the next morning, there is increasing expectation that the reports will be finalized within a defined period of hours.

This means reading all studies done until a certain time (e.g. 10 p.m.) and starting early the next morning (e.g. 6 a.m.), which could be at home or in-house, depending on the institution. Only a few places have staff ER radiologists in-house 24/7 at present I believe, although late shift is certainly becoming more common.

IR would need to come in at all hours of the night if called - non-IR procedures would be more variable and less frequent (e.g. pediatric fluoroscopy). 

 

Yeah the 24/7 is not yet common for sure - I have to think there "blood in the water" now with it. Literature in the States shows a better outcome, and two major centres in Canada have started. I don't think it would be a big surprise that academic ER departments are pushing for it - some are pushing pretty hard. That is just my opinion - but things don't "roll back" in medicine often. Particularly with radiology services ha.

I cannot compare to neuro surg (why that particular surgical discipline?) staff work levels except they are of course busy. New community radiologists are worked and worked hard. What the prior residents describe to me during their visits are kind of terrifying (ie first 2-3 years as staff are worse than anything in residency including 5th year.)

 

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Neurosurg is the absolute worst residency (at least in my experience). Not only are the daily hours brutal, the patients are sick as hell (an therefore a ton of floor work) plus the call is frequent and they seem to be in the OR very frequently overnight doing long (3-6 hour) cases. Plus the outcomes aren't the best (vs. other surgical specialties) so it would wear on you I imagine. 

Rads seems pretty good lifestyle wise, minus the crap call.

 

The 3-4 hours of studying a night in 5th year is pretty routine for most specialties. For example, when I was in 5th year (in say July - December) I'd do 3-4 hours in the hospital after my cases were done and then another 3 hours when I got home after supper (I'd take about 2 hours to play with my kid and eat supper). Friday evening was free to spend with my spouse.  On the weekends I would study about 5-6 hours on Saturday afternoon (the AM was sports with my child).  Sunday's was about 8 hours. January till the exam you could add about 2 more hours to the Friday, Saturday and Sunday. 

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3 hours ago, rmorelan said:

What the prior residents describe to me during their visits are kind of terrifying (ie first 2-3 years as staff are worse than anything in residency including 5th year.)

More hours, yes (essentially replace all those hours of studying in 5th year with reporting). It's a transition like starting call, but expanded from being responsible for the management of acute issues overnight to being the final word on everything, which really highlights the need to avoid overcalling findings leading to unnecessary anxiety and workup, while at the same time not neglecting any subtle findings or nuances that could have ramifications down the line.

The challenge is that the field is so broad, especially in a general practice, that Ian Wong has described the feeling of just having scratched the surface at the end of training (though Royal College assures basic competency). Plus, if in academics, a significant proportion of time off will be used for academic work (preparing teaching material, administering programs, etc.).

That's why most posters here advise selecting a specialty based on intrinsic satisfaction, as 'worse' is inherently subjective, and one can make the best of each stage by appreciating what it has to offer, whether that's a chance to focus wholeheartedly on learning, or grow through increased responsibility, etc. :) 

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On 7/16/2017 at 0:12 AM, CampusUdeM1 said:

What is the quality of life of residents in radiology versus neurosurgery? What about neurosurgery attendings and diagnostic radiology attendings?

How is call managed for attendings at academic centers? Do they stay at home and read on their own computers? Must they come to the hospital at night? Do they spend every call night at the hospital? What about IR?

Our quality of life is by far better than neurosurgery's. The attendings' lifestyles are also comparably better from what I've observed.

Call is managed for attendings like they are for residents: everyone does an equal amount (or proportional to their pay). Yes they stay at home and read from their own computers. They can even do it while out of the country on occasion. The diagnostic rads don't come to hospital at night. They may stay a bit later after work on the evening of their call but they certainly spend most of their call nights at home, sound asleep. IR is variable but is generally busier with more frequent call.

Edited by W0lfgang

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2 hours ago, W0lfgang said:

Our quality of life is by far better than neurosurgery's. The attendings' lifestyles are also comparably better from what I've observed.

Call is managed for attendings like they are for residents: everyone does an equal amount (or proportional to their pay). Yes they stay at home and read from their own computers. They can even do it while out of the country on occasion. The diagnostic rads don't come to hospital at night. They may stay a bit later after work on the evening of their call but they certainly spend most of their call nights at home, sound asleep. IR is variable but is generally busier with more frequent call.

Who pays for the equipment at home?

Does IR basically have to stay at the hospital during call since they have to see the patients?

For residents, I guess you never have the option of staying at home and reading from your computer?

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It's all out of pocket, at least at our institution. IR doesn't stay over night, but they stay later on their call evenings, maybe to 6 or 7pm. I'm not sure how often they get called in. Might be less than half the time, but it could be any time of night obviously.

We currently don't have the option of staying at home with our own station.

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1 hour ago, W0lfgang said:

It's all out of pocket, at least at our institution. IR doesn't stay over night, but they stay later on their call evenings, maybe to 6 or 7pm. I'm not sure how often they get called in. Might be less than half the time, but it could be any time of night obviously.

We currently don't have the option of staying at home with our own station.

For training purposes I don't think being off site is that great of an idea anyway (plus there are procedures etc that rads at my centre at least have to do on call from time to time). It is better patient service if we are there.

ha, plus those stations are extremely expensive (at least for a resident)

 

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Agree with above. Personally, I too LOVE what I do as a resident. Staff say they are busiest and most stressed the first 1-2 years of practice.

We have a call centre model at my institution and we cover all affiliated local hospitals (academic) as well as 3 urgent care centres and 2-3 community hospitals. Volumes are consistently 50-80+ studies per night/call shift. Volumes have gone up recently with many many more trauma pan-CTs and CTAs for strokes. Call freq is 1 in 5 to 6.

Nothing like a nice big, hot fire under the butt to accelerate learning/maturing.

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In-person consultations enrich the experience. Often, trauma cases are checked on the scanner to allow immediate management by the trauma team who will be standing around the console (takes a bit of time to send images to PACS).

Also, it's helpful to have someone in-house to support the techs and patients: dealing with interstitial injections and contrast reactions (thankfully infrequent), speaking to patients who may be pregnant or have some other relative contraindication. 

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