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A 3 CR 2 Chief Resident Survey

A 3 CR 2 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

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A 3 CR 2 Chief Resident Survey

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  1. A3CR2 Chief Resident Survey Mallinckrodt Institute of Radiology St. Louis, MO

  2. 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

  3. Survey Format • On-line survey • Predominantly multiple choice • Options for open response where appropriate

  4. Survey Limitations • Sampling bias • Multiple responses from single institution • Not a scientific process

  5. 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 Survey Topics

  6. 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!

  7. Results…

  8. Basic Program Details

  9. Basic Program Details

  10. Basic Program Details

  11. 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

  12. 2006-07 Fellows • 39% Female Basic Program Details

  13. 2006-07 Staff • Female: 26% Basic Program Details

  14. 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

  15. Temporary Medical License: 41% 50% in 2005 Permanent Medical License: 17% 31% in 2005 Book/Travel Fund: 81% Average: $850 2005: $722 Lead Aprons: 48% BLS: 77% ACLS: 71% AFIP Tuition: 93% AFIP Housing Stipend: 75% Oral Board Review Course Tuition: 46% Oral Board Review Course Stipend: 28% Costs Assumed by Training Program Resident Benefits

  16. 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 Resident Benefits

  17. Chiefdom • Average of 2 chiefs per program • Range 1-4 • Term spans mid-third to mid-fourth year for 74% of respondents

  18. Chiefdom

  19. -Average Salary Bonus: $2,000 ($0-10,000)-Other: Chief mug and chair! Chiefdom

  20. 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% 12-15: 62% >15: 20% • <10: 11% in 2005 • 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

  21. ACGME Compliance • Required work hours log: 67% • Average call frequency per week: • 28%: <1 58%: 1 12%: 2 2%: 3 • 2005 Comparison: • 53%: <1 47%: 1-3 • Average days off per month: • 12%: ≤4 24%: 5 42%: 6 22%: ≥7 • 2005 Comparison: • 27%: 4-5 64%: 6-8

  22. 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

  23. Life After Residency

  24. Life After Residency

  25. Call • Average # of residents in-house on call: 1.8 • Range: 1-5 • In-house call shifts (excluding NF): • <50: 47% 51-75: 13% >75: 41% • 2005 Comparison: 58 (average) • Home/beeper call shifts (excluding NF): • 0: 36% 1-40: 29% 41-75: 27% >75: 10% • 2005 Comparison: 78 (average)

  26. Call • 73% of programs use night float system • 67% in 2005 • 61% in 2004 • Weeks on night float during residency: • 0-4 wks: 9% 4-8 wks: 20% • 8-10 wks: 21% >10 wks: 50% • Length of night float shifts (hours): • <8: 0% 8-10: 6.2% 10-12: 44% • 12-14: 46% >14: 4% • Frequency of night float shifts: • QD: 63% QOD: 3% Other: 35%

  27. Call

  28. Call

  29. 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%

  30. 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

  31. Oral Board Preparation

  32. 69% have core didactic lecture curriculum 80% give lectures as 1-hour block/day 6% group lectures into a larger block once/wk ACGME Program Requirements

  33. 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

  34. 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)

  35. 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

  36. ACGME Program Requirements

  37. 97% of attendings not in-house are available by pager ACGME Program Requirements

  38. 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%

  39. Deficit Reduction Act

  40. 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

  41. 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?”

  42. 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?

  43. 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.

  44. 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.

  45. 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

  46. Thank You

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