A3CR2 Chief Resident Survey

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. Survey Topics 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

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

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%

12. 2006-07 Fellows 39% Female

13. 2006-07 Staff Female: 26%

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. Costs Assumed by Training Program 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%

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

17. Chiefdom Average of 2 chiefs per program Range 1-4 Term spans mid-third to mid-fourth year for 74% of respondents Other: Include program coordinator selection, education committee selection, chief technologists, outgoing chief residentsOther: Include program coordinator selection, education committee selection, chief technologists, outgoing chief residents

18. Other: Medical student evaluations, chief conferences 2x/mth, resident education committee meetingsOther: Medical student evaluations, chief conferences 2x/mth, resident education committee meetings

19. -Average Salary Bonus: $2,000 ($0-10,000)-Other: Chief mug and chair! 2005: $1615 Other: Chief mug and chair! Comments: Big time commitment that detracts from time on clinical service and studying; � day per week administrative would not cover it, especially during interview season; undesirable given little benefit for a lot of extra time; busy but worth it to have better understanding of administrative and financial considerations in radiology2005: $1615 Other: Chief mug and chair! Comments: Big time commitment that detracts from time on clinical service and studying; � day per week administrative would not cover it, especially during interview season; undesirable given little benefit for a lot of extra time; busy but worth it to have better understanding of administrative and financial considerations in radiology

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 Comments: Most feel radiology not affected by ACGME compliance guidelinesComments: Most feel radiology not affected by ACGME compliance guidelines

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. Other: Involvement in decision making early in careerOther: Involvement in decision making early in career

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. 0% report extra pay for reviewing scheduled, non-emergent studies on-call For some residents who don�t have formal check-out, they are given copies of their reports with any attending changes; also graded 0-5 severity of the changes; cases presented at a noon conference0% report extra pay for reviewing scheduled, non-emergent studies on-call For some residents who don�t have formal check-out, they are given copies of their reports with any attending changes; also graded 0-5 severity of the changes; cases presented at a noon conference

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% Some programs cutting back meal vouchers because of float systemSome programs cutting back meal vouchers because of float system

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 Up to 80 hours of mock orals as part of preparation, with subsequent reviewsUp to 80 hours of mock orals as part of preparation, with subsequent reviews

31. Average Days Off: 14 ACGME had problem with � days and decreased call schedule for one program in regard to oral board preparationAverage Days Off: 14 ACGME had problem with � days and decreased call schedule for one program in regard to oral board preparation

32. ACGME Program Requirements 69% have core didactic lecture curriculum 80% give lectures as 1-hour block/day 6% group lectures into a larger block once/wk Refers to rotating 2-year curriculumRefers to rotating 2-year curriculum

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

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

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