2013 A3CR2 Annual Chief Resident Survey

Anup Shetty, MDMallinckrodt 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 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

• 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

2013 134 992012 185 1352011 259 1482010 228 1402009 143 1122008 100 ---

Number of Responses 2008-2013

* Out of approximately 187 programs in the US

43%

18%11%

12%

15%NORTHEAST (CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT)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)

Program Size

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

2003 2009 2011 2012 20130

5

10

15

20

25

30

Average Number of Residents Per Program

2003 2009 20130

5

10

15

20

25

30

Gender Distribution of Residents Per Program

MaleFemale

Hospital Coverage

• More residency programs are increasing # hospitals they cover for training

2005 2009 2011 20130

5

10

15

20

25

30

35

40

45

% Programs Covering Varying # of Hospitals

12345+

Level 1 Trauma Stroke Center NIH Cancer Center Pediatric ED0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

83.7% 85.7%

54.1% 55.1%

Type of Institution

Volume

Annual # 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

2004 2009 201305

101520253035404550

Proportion of Programs with Specified Volume of Radiologic Studies Per Year

<100k101k-250k251k-500k501k-750k>750k

Medical Student Recruitment

Hosted Radiology Interest Group meetings

Set up shadowing experiences in the reading room/procedure rooms

Integrate radiology basics into anatomy courses/3rd year clerkships

Provided formal teaching sessions for USMLE Step 1/2

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Medical Student Teaching/Recruitment

Others• Integrate medical students into research projects• Ultrasound workshops

RESIDENT BENEFITS

Book fund

Travel stipend

Conference registration fees

Time off for educational (non-presenting) conferences

ABR examination fees

AIRP tuition

AIRP housing and/or travel stipend

Lead aprons

Review course tuition and/or travel stipend

STAT Dx

RAD Primer

E-Anatomy

Tablets or other electronics for education

0 10 20 30 40 50 60 70 80 90 100

89

82

76

77

25

90

81

41

49

95

56

26

27

200820122013

Resident Benefits

Average Amount = $1800 ($400-$7500)

% Residents that attend AIRP = 96%

Other Benefits: meals, parking, computer fund, happy hours,

flexible funds

Vacation and Salary

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 3 4 5$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$52,279 $54,348 $56,519 $58,672

Average Salary by PGY 20092013

2%

31%

1%58%

3%

Proportion of Residencies by Weeks of Vacation

2.5 3 3.5 4

5

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

Yes 97%

No 3%

Yes 85%

No 15%

All 22%

None 44%

Some 34%All 27%

Some 25%

None 48%

CHIEF RESIDENT

Chief Resident Selection

Residents Choose 18%

Combination 51%

Chair-person and/or

Program Director Chooses

24%

Other 7%

OtherAll Seniors are Chiefs

All faculty and/or residents voteEducation committee chooses 1 2 3 4

0

10

20

30

40

50

60

70

10

64

12

4

Chief Residents Per Program

Chief Resident Responsibilities

Others• Emergency coverage• QA/town hall meetings• Physics curriculum

Call schedule

Rotation schedule

Vacation schedule

Attending lecture / conference schedule

Curriculum development and evaluation

Resident recruiting

Resident selection

Social events

Managing Disputes

Resident teaching

Medical student teaching

Boards review organization

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

96%

84%

85%

43%

60%

82%

81%

59%

89%

54%

39%

59%

Chief Resident Benefits

Average Salary Bonus$2248, previously $1932

Extra con-ference time

Conference costs paid

Administrative time off service

Chief office Salary or other bonus

0

10

20

30

40

50

60

70

80

46 46

3328

75

CALL, WEEKENDS, AND ATTENDING COVERAGE

0%

10%

20%

30%

40%

50%

60%

70%

19%16%

60%

5%

29%

20% 19%

60%

1%

19%19% 21%

56%

1%

14%

Type of On-Call Report

2011 2012 2013

Call and Weekend Coverage

• Short Prelim depending on modality (US, neuro)

• ER cases finalized with attending, inpatient cases prelimed

• Site dependent

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

24 Hour Sonographer Home Call Sonographer On-Call Resident0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

29%

44%

13%

46%

38%

16%

47%

37%

15%

2009

20122013

MRI Coverage

Specific SituationsEmergent MR Examinations only

“STAT” Examinations onlyER or Inpatient MR Exams only

Specific SituationsResidents provide Prelim ReportsTelerad 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)

Neuro Body MSK Vascular None0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 91%

71%

57% 54%

7%

Programs Reading After-Hours MRI*

On-Call Res-idents

Fellows Attendings Not read0%

10%20%30%40%50%60%70%80%90%

100% 87%

14% 15% 10%

Who Reads MRI After Hours

*No significant change from 2012

Weekend Coverage

Half Day Saturday Full Day Saturday Half-Day Sunday Full Day Sunday Not Provided0%

10%

20%

30%

40%

50%

60%

70%

20%

64%

16%

53%

16%

Programs Covering Routine Services on the Weekend

2011

2012

2013

Readout Format

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

Most/All of the Time Some of the Time No Face to Face Readout

In-House Attending0%

10%

20%

30%

40%

50%

60%

35%

18%

28%

16%

How Often Post-Call Face to Face Readout Occurs

2011 2012

2013

Overread Procedure

Specific SituationsNot applicable to programs with overnight in-house attendings

Resident C

alls R

eferrin

g Doc

Attending calls

Referring Doc

Referri

ng Doc C

ontacts Patient

Residen

t Contacts

Patient

Attending Contacts Patient

Overread Docu

mented

Informal

Overread

0%

10%

20%

30%

40%

50%

60%

70% 66%58%

40%

0% 2%

54%

2%

After Hour Attending Coverage

• Frequently section-dependent• ER-specific coverage 24 hrs

3% programs plan to implement extended in-house attending coverage (5-10pm) within the next year

7% programs plan to implement overnight in-house attending coverage within the next year

29% programs do not plan to implement extended in-house attending coverage

Normal attending work day

Extended Attending Hours

24/7 Attending Coverage

Attendings Review All Cases at Home

Attendings Review Select Cases at Home

External telerads over-reads residents

Other

0% 10% 20% 30% 40% 50% 60%

40%

46%

24%

3%

43%

15%

18%

2013

2012

2010

Sick Resident Coverage

Resident P

ulled Fr

om Other S

ervice

"Jeopardy"

Resident

No Resident P

ulled

Other0%

10%20%30%40%50%60%70% 59%

12%

34%

15%

Regular Shift Coverage

"Jeopardy" Resident

Chief Finds Coverage

Resident Finds

Coverage

No Resident Pulled

Other0%

10%

20%

30%

40%

50%

60%

70%

16%

63%

40%

5% 4%

Call Shift Coverage

Specific SituationsMore frequently pulled for procedural

services (IR, US)Service dependent

Specific SituationsResident scheduled for next shift coversStaff may cover if no other alternative

EXAM OF THE (VERY NEAR) FUTURE

ABR Core Exam

Disadvantages Expressed

Loss of focused period of consolidating knowledge, not just for exam but for future career 15 month wait period post-graduation to be board-certified No testing of interpersonal skills Studying for MCE, less real-world application of knowledge

Advantages Expressed Incorporates physics into clinical knowledge Synthesizes knowledge earlier in training Fairness of testing

Very Pos-itive

Positive Mixed Negative Very Negative

0%

10%

20%

30%

40%

50%

60%

70%

2%

9%

56%

21%

7%

Sentiment Towards New Exam Style

2012

2013

Changing Board Examination

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

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

5%

19% 18% 17%

34%

46%

7%

13%

41%

35%

7%

17%

45%

22%

18%

6%

Plan to Change to 3 Year "Core" Curriculum

2010

2011

2012

2013

Continue Normal Rotations

Selectives/"Mini-Fellowships"

Start Fellowship ("3+2 Curriculum")

Research

Fill in Deficits From 1st 3 years

Combination

Undecided

Other

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

21%

61%

6%

1%

16%

15%

29%

13%

26%

60%

7%

1%

12%

17%

23%

18%

26%

82%

6%

4%

26%

24%

6%

18%

Plans for 4th Year (PGY-5) Curriculum

2013

2012

2011

Changing Board Examination

Other PlansContinue fulfilling Mamms and Nucs

requirementsRemediation in sections of poor

performance“Mini-fellowships” are optional

Time Off Service

Time Out of Call Pool

Lighter Rotations

No Protected Study Time

Undecided

0% 10% 20% 30% 40% 50% 60% 70%

21%

40%

11%

45%

25%

50%

13%

36%

21%

62%

50%

18%

18%

Plans for 3rd years (PGY-4) Preparing for the Core Exam

2013

2012

2011

Changing Board Examination

Changing Board Examination

Junior Residents Fellows Attendings I don't know Other (please specify)0%

10%

20%

30%

40%

50%

60%

70%

80% 73%

0% 0%

10% 14%

Coverage for Residents Studying for Exam

Average Weeks Out of Call Pool / Off Service (If Given)Call Pool

10.2 weeks (2-52)

Off Service

5.7 weeks (1-12)

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

Internal Board Review

No Internal Review, Time for External Review

No Internal or External Review

0% 10%20%

30%40%

50%60%

70%80%

90%100%

79%

20%

1%

84%

13%

3%

87%

11%

2%

Oral Board Review

2013

2012

2011

0%

10%

20%

30%

40%

50%

60%

70%

80%

29%

38%

3%

20%

8%

29% 29%

Core Board Review

2011 2012 2013

Changing Board Examination

0%20%40%60%80% 77%

4%27%

13% 8%

Preparation for Non-Interpretative Skills (e.g. Physics, Safety)

Other Schemes• Funding for external physics review course• Physics problem-based learning in lieu of traditional lectures

Selectives/”Mini-Fellowships”

0%30%60%90%

82%51% 62%

Purpose of Selectives

Weeks Allotted in 4th Year24.4 weeks average

(8-52 weeks)

1 2 3 4 5 6 70%

5%

10%

15%

20%

25%

30%

7%

26% 27%

14%

3%

12% 12%

How Many Individual Selectives Are Available to 4th Years

Selectives

Functions as Fellow

Some Responsibilities of Fellow

Functions as Senior Resident

Academic Time

Out of Call Pool

0% 10% 20% 30% 40% 50% 60%

35%

38%

54%

8%

1%

Selective Details

Notes• Space limitations on high demand mini-fellowships (e.g. Breast, MSK)• Research track mini-fellowship a possibility

FELLOWSHIPS

Fellowships

Ab-domen

Body Breast Cardiac Chest MRI MSK Neuro Neuro IR

Nucs Peds VIR0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%How Are Fellowship Applicants Interviewed?

This fellowship program in-terviews 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 subspe-cialty at my institution

Fellowships

Abdomen Body Breast Cardiac Chest MRI MSK Neuro Neuro IR Nucs Peds VIR Other0%

5%

10%

15%

20%

25%

5%

12%13%

1%1%

3%

15%

18%

1%2%

8%

22%

1%

What Fellowships 4th Years are Pursuing

2009 2012 2013

Ab-domen

Body Breast Cardiac Chest MRI MSK Neuro Neuro IR

Nucs Peds VIR Other0%

5%

10%

15%

20%

25%

1%

5%6%

0% 1% 1%

7%9%

1% 1% 1%

9%

0%

4%

8%

7%

0% 1%2%

7%

9%

1%1%

6%

13%

1%

Distribution of Internal vs External Fellowships

External Fellowship Internal Fellowship

Fellowships

EDOnc Imaging

Private practice

7% of Residents Planning on Doing Two Fellowships

HEALTHCARE ECONOMICS AND THE JOB MARKET

Healthcare Economics and the Job Market

Very Worried Worried A Little Worried

Not Worried0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

18%

29%

36%

9%

33%

40%

26%

1%

Sentiment About Current Job Market

2011

2013

No; 75%

Yes; 24%

Already Have One; 1%

Have You Started Looking for a Job?

Healthcare Economics and the Job Market

Fellowship95%

Private Practice2%

Academic2%

Military1%

Short-Term Plans Following Graduation

Private Practice30%

Academic35%

Mil-itary1%

Undecided34%

Long Term Plans After Gradu-ation

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

What are you willing to compromise to obtain a job?

Little/N

o Influence

on Career Planning

Academic M

ade More Appealin

g

Private Practi

ce M

ade More Appealin

g

Increases In

terest in Fe

llowship Training

Decreases In

terest in Fe

llowship Training

Change Fello

wship Choice0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50% 48%

22%

13%

37%

3%

12%

2012

2013

Less Va-cation Time

Lower Salary

More Call Shifts

More Weekend

Shifts

Less Ideal Location

0%

10%

20%

30%

40%

50%

60%

70%

80%

53%

71%

51%

44%

60%

2012

2013

• 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

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?

None31%

Adequate32%

Inadequate37%

Healthcare Economics and the Job Market

• 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

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

MISCELLANEOUS

Quality Improvement

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 Ad

equate 64%

Inadequate 25%

Not at All 10%

0 1 2 3 4+0%

10%

20%

30%

40%

50%

60%

17%

57%

17%

3%6%

PQI Projects Participated In*

Nothing

Time O

ff Clinica

l Service

Financia

l Support

Facu

lty M

entor

Other Reso

urces

0%10%20%30%40%50%60%70%

30%

13%4%

60%

46%

Program Support for Resident PQI*

*No significant change from 2012

Resident Feedback and Requirements

Signing Time Volume Overread Rate Dictation Corrections0%

10%

20%

30%

40%

50%

60%

70%

15%

69%

29%

57%

Resident Performance Feedback

Regular Lectures Computer-Based Modules

Teaching at Workstation

Self-Study Other0%

10%

20%

30%

40%

50%

60%

70%

80%

78%

30%44%

67%

7%

Safety Training (Radiation, MRI, Contrast, Sedation)

Simulation Lab

Resident Feedback and Requirements

Procedure Logging Software

Program-Specific Database

Residents Keep Own Other0%

10%

20%

30%

40%

50%

60%

70%

52%

16%

60%

4%

Procedure Logging

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 mini-

fellowships; 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: shettya@mir.wustl.edu