Experiences/opinions regarding non-independent call

[TTar30]

After wrapping up my interview season I have a rough rank list but the program sitting at tentative #1 has raised a question for me. I think the program has just about everything I'm looking for. The only factor that I'm not so enthusiastic about is their non-independent night call. Most of the other programs I interviewed with (including the other 4 programs in my top 5) had independent call and I tend to agree with the benefits that residents/faculty cite from the experience (more comfortable making decisions, improved efficiency/speed, etc...). When speaking with residents at this program they were supportive of their call structure but I thought asking for opinions/experiences anonymously may be more helpful. For some background I have an interest in working in academic radiology, more focus on education/training than pumping out research. Although who knows if I'll choose academics over private practice 6-7 years from now?

Thank you!

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[SeisK]

After two years of being an attending it doesn’t make a difference. The only difference it makes is it spreads out the anxiety of being a first year attending a little more into your residency years, so it may not be as intense.

 

[TTar30]

After two years of being an attending it doesn’t make a difference. The only difference it makes is it spreads out the anxiety of being a first year attending a little more into your residency years, so it may not be as intense.

I appreciate the response!

 

[clutch21]

I appreciate the response!

Just to give you an N=2, I agree that it shouldn’t be a big factor. I chose a non-independent call program over an independent call program, and had some reservations while doing it at the time.

Fast forward 5 years and I have zero regrets. I feel as ready for private practice as I think I could be. With that said, I chose a clinically oriented program with high volume available and have really tried to make the most of it during residency.

A lot of your progression towards autonomy will depend on your mindset. If you treat call as if you are the sole reader, the differences are largely negated in my opinion. This is harder though if staff is in the same room as you during call. Where I train, staff is in a different part of the hospital.

I’ll also add that there is some learning upside to having staff you can call when there are particularly difficult cases at 3a. You won’t feel like learning the nuances of these cases when your call shift ends at 7-8a and staff arrives to read out, and you just want to go home and sleep.

Good luck in formulating your rank list! Trust your gut and go for best fit. That is what matters most.

 

[Cognovi]

I believe there is value to subspecialty radiology overreads, as opposed to general radiologists.

 

[Warped Apostle]

When I interviewed last year I noticed the great divide of non-independent vs independent call. What I figured out was that people tend to favor whatever their program does. So I don't think it really matters and it didn't influence my rank list at all. Pick the program that you feel comfortable in because that is where you are going to spend most of your time. Good luck.

 

[Ho0v-man]

Can’t imagine thinking I should not try to make a good report bc my attending will see it soon instead of at the end of my shift.

 

[bobjonesbob]

I believe there is value to subspecialty radiology overreads, as opposed to general radiologists.

That's a different discussion than the question of how important independent call is for residents.

 

[Cognovi]

That's a different discussion than the question of how important independent call is for residents.

It's related – it benefits resident learning if their attending reads at a higher level and identifies more important discrepancies.

 

[SeisK]

If that happens to be how your independent call system is set up. Lots (most?) of places are moving / have moved to ED coverage for nights which are staffed by ED radiologists. You could call that a subspecialty morning readout, but you’re being readout by a subspecialist then regardless of independent coverage.

If you mean “neuro CTs are read out by neuroradiologists,” and the practice is setup so that resident night coverage rotation (ED) is readout by subspecialty attendings… well, I feel like most institutions don’t have organ-specific subspecialty readouts for residents anyway.

 

[bobjonesbob]

It's related – it benefits resident learning if their attending reads at a higher level and identifies more important discrepancies.

Sure but that doesn't necessarily mean independent or non-independent. Of the programs I've seen, the academic places that still have independent call are having their studies over read by subspecialists in the morning. Places without true independent call tend to have some mix of an ED division with its own attendings, fellows moonlighting, and / or telerads which more often ends up being non subspecialist final reads.

 

[Cognovi]

Sure but that doesn't necessarily mean independent or non-independent. Of the programs I've seen, the academic places that still have independent call are having their studies over read by subspecialists in the morning. Places without true independent call tend to have some mix of an ED division with its own attendings, fellows moonlighting, and / or telerads which more often ends up being non subspecialist final reads.

That is exactly what I mean.

 

[TTar30]

When I interviewed last year I noticed the great divide of non-independent vs independent call. What I figured out was that people tend to favor whatever their program does. So I don't think it really matters and it didn't influence my rank list at all. Pick the program that you feel comfortable in because that is where you are going to spend most of your time. Good luck.

I have certainly noticed the same! Thank you for your insight!

Can’t imagine thinking I should not try to make a good report bc my attending will see it soon instead of at the end of my shift.

Absolutely agree. It felt like some people tried to make the case that despite the effort to act as independent as possible, you'd still be missing out while having someone reading over you during call. I am leaning towards the side that it probably doesn't matter that much and you get out what you put in. Thank you!

It's related – it benefits resident learning if their attending reads at a higher level and identifies more important discrepancies.

The institution in question has a robust ED radiology section and fellowship, these are the physicians who would be overreading the residents while on call.


Thanks everyone!

 

[GoPelicans]

I'm at a very busy trauma hospital and I really cannot imagine how much it would suck as a new second year without having the safety net of an attending seeing my report. After second year it matters less becasue I almost never miss pertinent stuff anymore, but I honestly missed many important things early in call due to inexperience that would've negatively impacted patient care if an attending didn't catch them a few minutes later. Most rads departments do what is appropriate for their call volume and complexity - places with attendings on overnight generally do so because they have a larger volume of more complex and sicker patients.

 

[CorneliaSt]

We had independent overnight call run by the R3 and R4 residents after 10PM. This was at a large level 1 trauma academic center with high volumes of very complex patients. Personally, I thought it was a great experience and helped with my growth as a radiologists knowing my reads dictated the care of the patient after hours.

 

[Tiger100]

Having solo call as a resident is a huge plus for the first 2-3 years of working as an attending.

 

[cecumbowels]

I'm at a very busy trauma hospital and I really cannot imagine how much it would suck as a new second year without having the safety net of an attending seeing my report. After second year it matters less becasue I almost never miss pertinent stuff anymore, but I honestly missed many important things early in call due to inexperience that would've negatively impacted patient care if an attending didn't catch them a few minutes later. Most rads departments do what is appropriate for their call volume and complexity - places with attendings on overnight generally do so because they have a larger volume of more complex and sicker patients.

I will start by saying that I am currently a R1 at a program that takes complete independent call during our second year with no senior supervision. Honestly, with R1 more than halfway finished, the idea that I will be signing studies on my own with no supervision is making me really nervous. It has been really on my mind lately even to the point where I am thinking about switching specialties. Not only for that reason but other reasons as well. To add, I have not been a good first year resident and have spent very little time studying. I am just having a tough time studying during my 1st year and it feels like I am in medical school all over again.

I honestly was unsure of my decision to go into radiology in the first place. Now that I am learning more about the field I am not sure if it is as good as people make it out to be. Looking 5 years down the road I will probably end up in private practice grinding out studies like a cog in the system. I hear private practice is not fun with the volumes from attendings at my institution that were previously in private practice. Honestly, that sounds depressing. Just sitting in a dark room all day with little interaction with other people during the day. A lot of people will make a counter argument and say that you get to interact with your colleagues or other doctors in radiology. Yes there are certain instances where you do, but for majority of the day you cannot afford to do that because of the amount of studies you have to read. Honestly not sure if I should stick it out or switch specialties. Lack of motivation to study is not helping this situation. I just want to end by saying that radiology as a specialty is not as good as people make it out to be. Also I dont like the passive aggressive personalities in radiology.

Also I apologize in advance if I am hijacking this thread.

 

[MadRadLad]

I will start by saying that I am currently a R1 at a program that takes complete independent call during our second year with no senior supervision. Honestly, with R1 more than halfway finished, the idea that I will be signing studies on my own with no supervision is making me really nervous. It has been really on my mind lately even to the point where I am thinking about switching specialties. Not only for that reason but other reasons as well. To add, I have not been a good first year resident and have spent very little time studying. I am just having a tough time studying during my 1st year and it feels like I am in medical school all over again.

I honestly was unsure of my decision to go into radiology in the first place. Now that I am learning more about the field I am not sure if it is as good as people make it out to be. Looking 5 years down the road I will probably end up in private practice grinding out studies like a cog in the system. I hear private practice is not fun with the volumes from attendings at my institution that were previously in private practice. Honestly, that sounds depressing. Just sitting in a dark room all day with little interaction with other people during the day. A lot of people will make a counter argument and say that you get to interact with your colleagues or other doctors in radiology. Yes there are certain instances where you do, but for majority of the day you cannot afford to do that because of the amount of studies you have to read. Honestly not sure if I should stick it out or switch specialties. Lack of motivation to study is not helping this situation. I just want to end by saying that radiology as a specialty is not as good as people make it out to be. Also I dont like the passive aggressive personalities in radiology.

Also I apologize in advance if I am hijacking this thread.

You're also an R1 so everything is hard and new right now. I think many/most of us felt this way, rads has an enormous learning curve and it can be mentally draining to have to learn so much that you didn't learn in medical school. You will get better with time and experience. You can find jobs that suit your style more, if you prefer a slower pace or a more social setting, teaching, procedures etc. You seem to be stuck in this mindset that PP is the only option, but it's really not and there is a lot of variety in terms of what type of PP you want.

In regards to personalities, this is institutionally dependent but grass isn't always greener. In any field you will have in your face jerks, passive aggressive people, and just unpleasant/lazy/boring people that you have to deal with. In many other fields, these are patients that you can't really get around interacting with.

There are pros and cons to every field. You have to figure out what works best for your personality and future goals. I knew some really smart people who did family med and they got done in 3 years, get to work 30 hrs/week, sometimes telehealth visits, build relationships with their patients and feel good about what they do. On the flip side they are always nervous about the PA/NP creep, they have so much in terms of notes/social work/documentation, have to deal with difficult problem patients and dumps, and they don't really make great money relative to specialists. My surgical colleagues get to feel like the big boss and do very meaningful work but they get destroyed during residency with the workload and malignant personalities, their lifestyle for the most part is worse than mine, and the damage to their bodies and souls in that kind of training also has its costs. Working part time or limited hours as a surgeon is difficult early in training and tele-surgery doesn't exist (yet).

There's no perfect gig. Radiology is not perfect - but for some people it is much better than the alternatives.

 

[cecumbowels]

I appreciate your post. It is really helpful in painting a different perspective about things.

You're also an R1 so everything is hard and new right now. I think many/most of us felt this way, rads has an enormous learning curve and it can be mentally draining to have to learn so much that you didn't learn in medical school. You will get better with time and experience. You can find jobs that suit your style more, if you prefer a slower pace or a more social setting, teaching, procedures etc. You seem to be stuck in this mindset that PP is the only option, but it's really not and there is a lot of variety in terms of what type of PP you want.

In regards to personalities, this is institutionally dependent but grass isn't always greener. In any field you will have in your face jerks, passive aggressive people, and just unpleasant/lazy/boring people that you have to deal with. In many other fields, these are patients that you can't really get around interacting with.

There are pros and cons to every field. You have to figure out what works best for your personality and future goals. I knew some really smart people who did family med and they got done in 3 years, get to work 30 hrs/week, sometimes telehealth visits, build relationships with their patients and feel good about what they do. On the flip side they are always nervous about the PA/NP creep, they have so much in terms of notes/social work/documentation, have to deal with difficult problem patients and dumps, and they don't really make great money relative to specialists. My surgical colleagues get to feel like the big boss and do very meaningful work but they get destroyed during residency with the workload and malignant personalities, their lifestyle for the most part is worse than mine, and the damage to their bodies and souls in that kind of training also has its costs. Working part time or limited hours as a surgeon is difficult early in training and tele-surgery doesn't exist (yet).

There's no perfect gig. Radiology is not perfect - but for some people it is much better than the alternatives

 

[qwerty89]

You're also an R1 so everything is hard and new right now. I think many/most of us felt this way, rads has an enormous learning curve and it can be mentally draining to have to learn so much that you didn't learn in medical school. You will get better with time and experience. You can find jobs that suit your style more, if you prefer a slower pace or a more social setting, teaching, procedures etc. You seem to be stuck in this mindset that PP is the only option, but it's really not and there is a lot of variety in terms of what type of PP you want.

In regards to personalities, this is institutionally dependent but grass isn't always greener. In any field you will have in your face jerks, passive aggressive people, and just unpleasant/lazy/boring people that you have to deal with. In many other fields, these are patients that you can't really get around interacting with.

There are pros and cons to every field. You have to figure out what works best for your personality and future goals. I knew some really smart people who did family med and they got done in 3 years, get to work 30 hrs/week, sometimes telehealth visits, build relationships with their patients and feel good about what they do. On the flip side they are always nervous about the PA/NP creep, they have so much in terms of notes/social work/documentation, have to deal with difficult problem patients and dumps, and they don't really make great money relative to specialists. My surgical colleagues get to feel like the big boss and do very meaningful work but they get destroyed during residency with the workload and malignant personalities, their lifestyle for the most part is worse than mine, and the damage to their bodies and souls in that kind of training also has its costs. Working part time or limited hours as a surgeon is difficult early in training and tele-surgery doesn't exist (yet).

There's no perfect gig. Radiology is not perfect - but for some people it is much better than the alternatives.

Can confirm. I am in a coastal outpatient private practice with much lower volume expectations and maybe 2 weekends of "call" a year. Call merely consists of reading a normal workdays worth of studies (60 RVU) from home from 8-5pm with some urgent care xrays and ultrasound. Essentially never work after 5pm.

Now I also get paid a lot less too but that's the trade off.

Too many people get married to the idea that they must make the big bucks and completely discount the volume necessary to make that kind of income. There are groups where you can read 60 cross sectional plus 60 xr/us a day. That seems insane to me. I'd rather take an hour for lunch and read maybe 40-45 neuro CT/MR with zero xr/us and call it a day.

A former fellow I know was always talking about money. Got a job at a $$$ private practice in WA (partners make almost 1 mil). Left before 1 year since volumes were crazy. Read well over 300 studies (large percentage of which were cross sectional) in a 10-12 hour weekend call shift.

There are a wide variety of jobs out there. Just don't take the best parts of jobs that you hear about and think that they can all co-exist. You can't get a job in a major metro, reading only what you did your fellowship in, with infrequent/no call, with no procedures, lots of vacation (12-16 weeks) and make the really big bucks. The highest paying jobs are typically small private practices that run lean. Everyone reads everything and everyone does everything, excluding high end vascular work. It's the only way scheduling can work. You can't do a neuro fellowship and only read neuro.

 

[Clean7795]

Skills evening out after some year(s) in practice can be said for almost anything. Even if your residency program barely teaches you any body MR or basic radiology procedures, if your future practice needs you to do it, you will eventually pick it up and learn to do it. Hence, I don't think it makes sense to discount good training just because you will keep learning and refining skills in independent practice.

The traditional strong training paradigm would be independent call at a high volume, high complexity center. There's really no better motivation to build speed & work through tough cases. That said, I think having high volume & high complexity is a lot more important than independence overnight.