2012 A 3 CR 2 Annual Chief Resident Survey

2. 2012 A3CR2 Annual Chief Resident Survey Steve Sauk, MD Mallinckrodt Institute of Radiology

3. St. Louis AKA The Lou, Mound City, Gateway to the West

4. Survey Format • Confidential online survey (surveymonkey.com) • Multiple choice questions (single and multiple answer), free text for additional comments

5. 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

6. 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

7. 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

8. Program details

9. Participation Number of Responses 2008-2012 • 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! * Out of approximately 218 programs in the US

10. 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

11. Hospital Coverage Type of Institution Decrease since 2011 (85%) and ‘09-’10 (80%) More residency programs are increasing # hospitals they cover for training

12. Volume % Programs with Varying # Radiologic Studies on Selected Years 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

13. RESIDENT benefits

14. Resident Benefits Average Amount = $1793 ($300-$6000) % Residents that attend AIRP = 94% Other Benefits: iPads, No healthcare co-pay, Gym membership, Meals

15. Vacation and Salary % Programs vs. # weeks of Vacation Average Resident Salary per Class Resident Salaries have increased 2.6 % for PGY-2 and 0.7% for PGY-5 since 2009 53% of programs offer 4 weeks of vacation 34% of programs offer 3 weeks

16. Family Leave For Significant Others of Pregnant Residents For Pregnant Residents % Programs offering Family Leave % Programs offering Family Leave % Programs with Family Leave taken from All, Some, or None of Vacation/Sick Days % Programs with Family Leave taken from All, Some, or None of Vacation/Sick Days

17. Family Leave % Programs Offering # Weeks of Family Leave for Pregnant Residents % Programs Offering # Weeks of Family Leave for Significant Others • 5/129 programs report that residents can take more weeks of family leave, unpaid. • Restrictions • Negotiated for programs needs • Medical Necessity

18. CHIEF resident

19. Chief Resident Selection % Programs with Varying # Chief Residents

20. Chief Resident Responsibiltities • Others • Budget management • Banquet Planning • Serving on Hospital and GME boards • “Keeping everybody happy”

21. Chief Resident Benefits Average Salary Bonus $1932 (0-$7500)

22. Call, weekends, and attending coverage

23. Call and Weekend Coverage Type 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

24. Ultrasound Coverage After Hour Ultrasound Coverage US Studies Performed After Hours

25. MRI Coverage % Programs Performing MRI Exams After Hours Who Reads the MR Examinations After Hours?

26. Weekend Coverage % Programs Covering Routine Radiology Services Over the Weekend

27. Readout Process How often are face-to-face readouts performed?

28. After Hour Attending Coverage 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 • Only Neuro studies read by attendings after hours • Depends on the day of the week

29. Changing board examination

30. Changing Board Examination Sentiment re: New Board Exam Format

31. Changing Board Examination Plans to change to the new 3 yr “core” curriculum

32. Changing Board Examination Plans for 4th year (Pgy-5) once the new examination is in place

33. Changing Board Examination Plans for 3rd years (PGY-4) preparing for the “core” examination

34. Changing Board Examination Plans for board reviews for the new board exam structure Current Oral Boards Plans for “Core” Exam

35. Fellowships

36. Fellowships How are fellowship applicants interviewed?

37. Fellowships What fellowships are the 4th years (PGY-5) going into?

38. Fellowships Distribution of Internal vs. External Fellowships (2012) ED Combined Private practice

39. Fellowships How is your institution planning on dealing with the expected increase in fellowship applicants once the new board format is in place?

40. Fellowships Sentiments 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”

41. Healthcare Economics and the Job Market

42. Healthcare Economics and the Job Market Sentiments about Current Job Market Have you started looking for a job?

43. Healthcare Economics and the Job Market SHORT-Term Plans After Graduation LONG-Term Plans After Graduation

44. Healthcare Economics and the Job Market How the Current Economic Environment and Current Job Market Influences Career Plans* What are you willing to compromise to obtain a job?** ** Some not willing to compromise anything for a job * Similar trend in 2011

45. 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? • 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.”

46. 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 • 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

47. Quality improvement and audience response systems

48. 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 How many PQI projects have you taken part in? What does your program do to support residents on PQI projects?

49. Audience Response How often are Audience Response Systems used? How useful are Audience Response Systems?

50. discussion