AA33CRCR22 Chief Resident Chief Resident SurveySurvey

Mallinckrodt Institute of Mallinckrodt Institute of RadiologyRadiology

St. Louis, MOSt. Louis, MO

PurposePurpose

Information GatheringInformation Gathering– Facts about the structure of training Facts about the structure of training

programs across the countryprograms across the country

– Opinions regarding features of the training Opinions regarding features of the training process and environmentprocess and environment

– Ideas for promoting or responding to Ideas for promoting or responding to change in academic and professional change in academic and professional arenasarenas

Survey FormatSurvey Format

On-line surveyOn-line survey

Predominantly multiple choicePredominantly multiple choice

Options for open response where Options for open response where appropriateappropriate

Survey LimitationsSurvey Limitations

Sampling biasSampling bias

Multiple responses from single Multiple responses from single institutioninstitution

Not a scientific processNot a scientific process

Survey TopicsSurvey Topics

Repeat Questions:Repeat Questions:– Basic Program Basic Program

DetailsDetails– Resident BenefitsResident Benefits– Chief Resident Chief Resident

DutiesDuties– ACGME GuidelinesACGME Guidelines– CallCall– Oral Board Oral Board

PreparationPreparation

New Questions:New Questions:– Plans After Plans After

ResidencyResidency– RRC Program RRC Program

ChangesChanges– Deficit Reduction Deficit Reduction

ActAct

2007 Chief Resident Survey2007 Chief Resident Survey

187 Surveys Requests187 Surveys Requests– 139 responses received139 responses received– 65% of respondents were incoming 65% of respondents were incoming

chiefschiefs– 84% from university affiliated programs84% from university affiliated programs– 74% response rate74% response rate

28% in 200528% in 2005 55% 200455% 2004

Thank you!Thank you!

Results…Results…

Basic Program DetailsBasic Program Details

Number of Hospitals Covered

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1 2 3 4 5 or m ore

2007

2005

2004

Basic Program Details

Total Number of Beds at Affiliated Institutions

0%

10%

20%

30%

40%

50%

60%

<500 500-999 1000-1499 1500-2000 >2000

2007

2005

2004

Basic Program Details

Total Annual Number of Diagnostic Studies Performed

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

<100,000 100K-250K 250K-500K 500K-750K >750,000

2007

2005

2004

2006-07 Residents2006-07 Residents

Total # of Residents:Total # of Residents:– R1: 6.8 (1-18)R1: 6.8 (1-18)– R2: 6.8 (1-18)R2: 6.8 (1-18)– R3: 6.8 (1-18)R3: 6.8 (1-18)– R4: 6.6 (1-17)R4: 6.6 (1-17)– Comparison to 2005: 5.8 (R1-R4)Comparison to 2005: 5.8 (R1-R4)

27% Female27% Female– Comparison to 2005: 34%Comparison to 2005: 34%

Basic Program Details

2006-07 Fellows2006-07 Fellows 39% Female39% Female

Basic Program Details

Number of Fellows

0%

5%

10%

15%

20%

25%

30%

35%

40%

0 1-5 6-10 11-20 21-30 >30

2007

2005

2006-07 Staff2006-07 Staff Female: 26%Female: 26%

Basic Program Details

Number of Staff

0%

5%

10%

15%

20%

25%

30%

35%

<10 11-20 21-30 31-40 41-50 51-75 75-100 >100

2007

2005

Resident BenefitsResident Benefits

Salary:Salary:– R1: $44,300 ($35,000-65,000)R1: $44,300 ($35,000-65,000)

2005: $43,1952005: $43,195 2002: $37,9132002: $37,913

– R4: $50,300 ($42,000-80,000)R4: $50,300 ($42,000-80,000) 2005: $49,4072005: $49,407 2002: $45,5222002: $45,522

Tax-Deferred Retirement Savings Plan:Tax-Deferred Retirement Savings Plan:– Available to 68% of residentsAvailable to 68% of residents– Only 26% receive matching fundsOnly 26% receive matching funds

Costs Assumed by Training Costs Assumed by Training ProgramProgram

Temporary Medical Temporary Medical License: 41%License: 41%– 50% in 200550% in 2005

Permanent Medical Permanent Medical License: 17%License: 17%– 31% in 200531% in 2005

Book/Travel Fund: 81%Book/Travel Fund: 81%– Average: $850Average: $850– 2005: $7222005: $722

Lead Aprons: 48%Lead Aprons: 48%

BLS: 77%BLS: 77% ACLS: 71%ACLS: 71%

AFIP Tuition: 93%AFIP Tuition: 93% AFIP Housing Stipend: AFIP Housing Stipend:

75%75%

Oral Board Review Oral Board Review Course Tuition: 46%Course Tuition: 46%

Oral Board Review Oral Board Review Course Stipend: 28%Course Stipend: 28%

Resident Benefits

Child CareChild Care

80% provide paid 80% provide paid maternity leavematernity leave– Avg Length: 6 wksAvg Length: 6 wks– Range: 0-12 wksRange: 0-12 wks

68% provide paid 68% provide paid paternity leavepaternity leave– Avg Length: 10 Avg Length: 10

daysdays– Range: 0-6 wksRange: 0-6 wks

Resident Benefits

0%

10%

20%

30%

40%

50%

60%

On-SiteChild Care

Facility

Paid byResidencyProgram

Subsidy orDiscount

Tax-FreeChild Care

SavingsOption

Other

ChiefdomChiefdom

Average of 2 chiefs Average of 2 chiefs per programper program– Range 1-4Range 1-4

Term spans mid-Term spans mid-third to mid-fourth third to mid-fourth year for 74% of year for 74% of respondentsrespondents

Chief Resident Selection

0%

10%

20%

30%

40%

50%

60%

70%

80%

Residents Staff ProgramDirector

DepartmentChair

Other

2007

2005

Chiefdom

Chief Resident Responsibilities

0% 20% 40% 60% 80% 100%

Call Schedule

Rotation Schedule

Curriculum Developmentand Evaluation

Resident Recruiting

Resident Selection

Social Events

Resident Teaching

Medical Student Teaching

Organize BoardReview

Other

2005

2007

Chiefdom

Chief Resident Benefits

0% 20% 40% 60% 80% 100%

Extra Time Allotted for Conferences

Registration/Travel Costs for Conferences

Administrative Time Away From Clinical Service

Chief Resident Office

Salary Bonus

Other

2004

2005

2007

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

ACGME ComplianceACGME Compliance 100% report complete compliance100% report complete compliance

– 97% Positive effect on resident quality of life97% Positive effect on resident quality of life– 94% Positive effect on resident education94% Positive effect on resident education

Average hours off between shifts:Average hours off between shifts:– <10: 0% 10-12: 18% 12-15: 62% >15: 20%<10: 0% 10-12: 18% 12-15: 62% >15: 20%– <10: 11% in 2005<10: 11% in 2005

Average work week:Average work week:– 57% Report between 51-60 hours57% Report between 51-60 hours– Averages on busiest rotation:Averages on busiest rotation:

61-70 hours: 32%61-70 hours: 32% 71-80 hours: 28% >80 hours: 71-80 hours: 28% >80 hours: 10%10%

– 80-hour work week is an average over 4 weeks80-hour work week is an average over 4 weeks

ACGME ComplianceACGME Compliance Required work hours log: 67%Required work hours log: 67%

Average call frequency per week:Average call frequency per week:– 28%: <128%: <1 58%: 158%: 1 12%: 212%: 2 2%: 32%: 3– 2005 Comparison:2005 Comparison:

53%: <153%: <1 47%: 1-347%: 1-3

Average days off per month:Average days off per month:– 12%: ≤412%: ≤4 24%: 524%: 5 42%: 642%: 6 22%: ≥722%: ≥7– 2005 Comparison:2005 Comparison:

27%: 4-527%: 4-5 64%: 6-864%: 6-8

Life After ResidencyLife After Residency

91% pursuing fellowship training91% pursuing fellowship training

Military Service: 7%Military Service: 7%

Private Practice: 65%Private Practice: 65%

Academic Practice: 35%Academic Practice: 35%– 11% of programs offer monetary incentive 11% of programs offer monetary incentive

program for entering academic practiceprogram for entering academic practice

Life After Residency

Primary Reason for Entering Private Practice

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Location

Read MultipleSubspecialties

MonetaryCom pensation

Vacation/Benefits

Favorable CallSchedule

Other

Life After Residency

Primary Reason for Entering Academic Practice

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

Location

Read Single Subspecialty

Teaching Interes t

Research Interes t

Monetary Com pensation

Vacation/Benefits

Favorable Call Schedule

Other

CallCall

Average # of residents in-house on call: 1.8Average # of residents in-house on call: 1.8– Range: 1-5Range: 1-5

In-house call shifts (excluding NF):In-house call shifts (excluding NF):– <50: 47%<50: 47% 51-75: 13% 51-75: 13% >75: 41%>75: 41%– 2005 Comparison: 58 (average)2005 Comparison: 58 (average)

Home/beeper call shifts (excluding NF):Home/beeper call shifts (excluding NF):– 0: 36% 1-40: 29% 41-75: 27% >75: 10%0: 36% 1-40: 29% 41-75: 27% >75: 10%– 2005 Comparison: 78 (average)2005 Comparison: 78 (average)

CallCall 73% of programs use night float system73% of programs use night float system

– 67% in 200567% in 2005– 61% in 200461% in 2004

Weeks on night float during residency:Weeks on night float during residency:– 0-4 wks: 9%0-4 wks: 9% 4-8 wks: 20%4-8 wks: 20%– 8-10 wks: 21%8-10 wks: 21% >10 wks: 50%>10 wks: 50%

Length of night float shifts (hours):Length of night float shifts (hours):– <8: 0%<8: 0% 8-10: 6.2%8-10: 6.2% 10-12: 44% 10-12: 44%– 12-14: 46%12-14: 46% >14: 4%>14: 4%

Frequency of night float shifts:Frequency of night float shifts:– QD: 63%QD: 63% QOD: 3% QOD: 3% Other: 35%Other: 35%

Resident Responsibilities On-Call

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EmergencyDepartment

InpatientServices

ScheduledRoutineStudies

RemoteLocations

2007

2005

Check-Out After Call

0%

10%

20%

30%

40%

50%

60%

70%

80%

DictateFindings;

SubsequentRead-out

DicateFindings; No

Read-out

PreviewFindings;

SubsequentRead-out

PreviewFindings; No

Read-out

Call

Call

Teleradiology

0%

10%

20%

30%

40%

50%

60%

70%

Provided toresidents to read

studies from homewhile on-call

Provided to staff toread studies from

home while on-call

Provided to stafffor resident

consults on-call

Not available

CallCall Process for approving studies ordered on-call:Process for approving studies ordered on-call:

– Sieve: 35%Sieve: 35%– Ordering MD speaks directly to resident: 43%Ordering MD speaks directly to resident: 43%– Ordering MD speaks to physician extender first; Ordering MD speaks to physician extender first;

appropriate calls forwarded to resident: 25%appropriate calls forwarded to resident: 25%– Other: 30% (Computer based, Resident only called for Other: 30% (Computer based, Resident only called for

protocols)protocols)

In-house moonlighting: 39%In-house moonlighting: 39%– Examples:Examples:

Weekend Neuro Call: $720/dayWeekend Neuro Call: $720/day Assist ED Attending On-Call: $100/hrAssist ED Attending On-Call: $100/hr Overflow Studies in evenings, weekends: $600-800/dayOverflow Studies in evenings, weekends: $600-800/day Contrast Injection Monitoring: $50-60/hrContrast Injection Monitoring: $50-60/hr IR Home Call: $1,000/weekIR Home Call: $1,000/week

On-call McMeal vouchers or other free food: 87%On-call McMeal vouchers or other free food: 87%

Oral Board PreparationOral Board Preparation 79% of programs provide their own oral board 79% of programs provide their own oral board

review and curriculumreview and curriculum

Structured review begins:Structured review begins:– Jan-Feb: 62%Jan-Feb: 62%– March-April: 33%March-April: 33%– Before Jan: 5%Before Jan: 5%

Oral board review:Oral board review:– Lectures given by faculty: 97%Lectures given by faculty: 97%– Lectures organized by faculty: 30%Lectures organized by faculty: 30%

70% of programs include a mock exam as part of 70% of programs include a mock exam as part of preparationpreparation

Oral Board Preparation

Hours of Scheduled Review

0%

5%

10%

15%

20%

25%

30%

35%

1-10 10-25 26-50 51-75 >75

Protected Time for Board Review

0%

10%

20%

30%

40%

50%

60%

Reducedhours on

daily clinicalservice

Occasionalearly

dismissalfrom clinical

service

No protectedtime

Days off Other

2007

2005

ACGME Program RequirementsACGME Program Requirements

69% have core 69% have core didactic lecture didactic lecture curriculumcurriculum

80% give lectures 80% give lectures as 1-hour as 1-hour block/dayblock/day– 6% group lectures 6% group lectures

into a larger block into a larger block once/wkonce/wk

Protected Time for Didactic Lecture Curriculum

0%

10%

20%

30%

40%

50%

60%

All Services MostServices

SomeServices

Noprotected

time

Total Number of Didactic Lecture Hours/Wk

0%

5%

10%

15%

20%

25%

30%

35%

0 1-3 4-5 6-8 9-10 >10

ACGME Program ACGME Program RequirementsRequirements

Required research/academic project: Required research/academic project: 64%64%

– Current protected academic time for Current protected academic time for project:project: 25% Yes25% Yes

– Anticipate giving protected academic time:Anticipate giving protected academic time: 23% Yes23% Yes Most suggested 4 weeks of elective timeMost suggested 4 weeks of elective time

ACGME Program ACGME Program RequirementsRequirements

69% of programs currently require 69% of programs currently require maintenance of a learning portfoliomaintenance of a learning portfolio

75% currently employ 360° evaluations75% currently employ 360° evaluations

95% of programs currently require an 95% of programs currently require an annual objective examination (e.g. ACR annual objective examination (e.g. ACR Inservice)Inservice)

ACGME Program ACGME Program RequirementsRequirements

Duration of training after which call Duration of training after which call currently begins (in months):currently begins (in months):– <6: 18% 6-9: 57% 9-12: 12%<6: 18% 6-9: 57% 9-12: 12% >12: >12:

12%12%

66% of residents stop taking call 66% of residents stop taking call midway through fourth yearmidway through fourth year– 11% stop at end of third year11% stop at end of third year– 14% continue throughout fourth year14% continue throughout fourth year

Person Responsible for On-Call Study Interpretation

0% 20% 40% 60% 80% 100%

ER Radiographs

Inpt Radiographs

Fluoroscopy

Nuclear Medicine

General US

OB US

Vascular US

Body CT

MSK CT

Neuro CT

Body MRI

MSK MRI

Neuro MRI

VIR

Pediatrics

Attending

Fellow

Resident

ACGME Program Requirements

After Hours Attending Coverage

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

No attending in-

house

5pm-10pm

10pm-7am

24-Hour attending

coverage

Available by

teleradiology

Other

After Hours Attending Responsibilities

0% 20% 40% 60% 80% 100%

Evening ED

Overnight ED

Emergent Inpt

Scheduled,

Routine

Other

2005

2007

• 97% of attendings not in-house are available by 97% of attendings not in-house are available by pagerpager

ACGME Program Requirements

ACGME Program ACGME Program RequirementsRequirements

92% of resident reviewed studies on-92% of resident reviewed studies on-call are currently reviewed within 24 call are currently reviewed within 24 hrshrs

Restricting call until ≥12 month of Restricting call until ≥12 month of radiology residency training will radiology residency training will change…change…– Resident call system: 73%Resident call system: 73%– Attending/fellow call system: 18%Attending/fellow call system: 18%

Deficit Reduction ActDeficit Reduction Act

Anticipated Changes Due to DRA

0%

10%

20%

30%

40%

50%

60%

70%

Expand hrs ofscheduled exams

Increased volumeduring nl hrs

Decreasedancillary/technical

staff

Switch to voicedictation

Decrease AFIPfunding

Other

DiscussionDiscussion Unique program structures:Unique program structures:

– 3/2 programs3/2 programs– 9 clinical months spread throughout 5-year 9 clinical months spread throughout 5-year

training program rather than doing PGY1 training program rather than doing PGY1 internshipinternship

Props:Props:– Excellent pathology; Excellent equipment and Excellent pathology; Excellent equipment and

PACS technology; Medical records easy to use; PACS technology; Medical records easy to use; Stable environment conducive for learning; Stable environment conducive for learning; Attendings are professional and easy to work Attendings are professional and easy to work with with

Yikes:Yikes:– We cover outside imaging centers to subsidize We cover outside imaging centers to subsidize

staff incomes staff incomes

DiscussionDiscussion

AFIPAFIP– Loss of stipend, making cost of attending Loss of stipend, making cost of attending

prohibitiveprohibitive– Funding received likely will be affected by Funding received likely will be affected by

change to 4 week programchange to 4 week program– Several programs will not send residents Several programs will not send residents

to the AFIP starting this yearto the AFIP starting this year– ““Our chair is very committed to AFIP, but Our chair is very committed to AFIP, but

obviously, how many years can this last?”obviously, how many years can this last?”

DiscussionDiscussion CallCall

– 50% with >10 weeks of NF during residency50% with >10 weeks of NF during residency– 41% with >75 additional in-house overnight 41% with >75 additional in-house overnight

call shiftscall shifts– Decreased elective timeDecreased elective time– Often unable to attend didactic conferencesOften unable to attend didactic conferences– Expected to increase due to DRA and ACGME Expected to increase due to DRA and ACGME

changes; Current increases result of volumechanges; Current increases result of volume More moonlighting options for overflow studies?More moonlighting options for overflow studies?

– Decreased home call compared to 2005Decreased home call compared to 2005 Resident teleradiology?Resident teleradiology?

DiscussionDiscussion

ACGME Program RequirementsACGME Program Requirements– Most of the concerns refer to R1 call restrictionMost of the concerns refer to R1 call restriction

Requiring a resident to have at least a 1 month rotation Requiring a resident to have at least a 1 month rotation on the modality/section in which they will be taking call on the modality/section in which they will be taking call makes more sense than not allowing a resident to take makes more sense than not allowing a resident to take any independent call throughout the first year. After any independent call throughout the first year. After having been in the program for one year, they may not having been in the program for one year, they may not have any more exposure to these modalities than they have any more exposure to these modalities than they had at the 6 month point. had at the 6 month point.

We have a high volume of trauma at our hospital. It will We have a high volume of trauma at our hospital. It will be very difficult for residents to start call in July- the peak be very difficult for residents to start call in July- the peak of trauma season- for little added benefit of a few more of trauma season- for little added benefit of a few more months of training. months of training.

DiscussionDiscussion ACGME Program Requirements (cont’d)ACGME Program Requirements (cont’d)

– Proposed changes of restricting the R1 call Proposed changes of restricting the R1 call responsibilities will be detrimental to resident responsibilities will be detrimental to resident education. What an R1 learns by taking education. What an R1 learns by taking weekend and overnight call during the second weekend and overnight call during the second half of their first year cannot be reproduced or half of their first year cannot be reproduced or replaced by any other study tool.replaced by any other study tool.

– Early exposure to independent interpretation Early exposure to independent interpretation and interactions with referring physicians is and interactions with referring physicians is crucial to resident education and developing crucial to resident education and developing the skills needed to excel as a radiologist in the skills needed to excel as a radiologist in the real world. the real world.

DiscussionDiscussion Academics vs. Private PracticeAcademics vs. Private Practice

– 35% of respondents entering academics35% of respondents entering academics Higher than average due to selection bias?Higher than average due to selection bias?

– $$ listed as primary reason for entering private $$ listed as primary reason for entering private practicepractice Better retirement savings plans for residents and staffBetter retirement savings plans for residents and staff Loan repayment programsLoan repayment programs Monetary incentive programs to encourage academic Monetary incentive programs to encourage academic

careerscareers

– Teaching interest listed as primary reason for Teaching interest listed as primary reason for entering academic practiceentering academic practice Majority of chiefly duties are administrativeMajority of chiefly duties are administrative Consider more teaching opportunities, involvement in Consider more teaching opportunities, involvement in

curriculum development, academic days and teaching curriculum development, academic days and teaching electiveselectives

Thank YouThank You