1. A 3 CR 2 Chief Resident Survey Mallinckrodt Institute of Radiology St. Louis, MO

2. Purpose Information Gathering 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 On-line survey Predominantly multiple choice Predominantly multiple choice Options for open response where appropriate Options for open response where appropriate

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

5. Survey Topics Repeat Questions: Repeat Questions: –Basic Program Details –Resident Benefits –Chief Resident Duties –ACGME Guidelines –Call –Oral Board Preparation New Questions: New Questions: –Plans After Residency –RRC Program Changes –Deficit Reduction Act

6. 2007 Chief Resident Survey 187 Surveys Requests 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! Thank you!

7. Results…

8. Basic Program Details

11. 2006-07 Residents Total # of 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 27% Female –Comparison to 2005: 34% Basic Program Details

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

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

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

16. Child Care 80% provide paid maternity leave 80% provide paid maternity leave –Avg Length: 6 wks –Range: 0-12 wks 68% provide paid paternity leave 68% provide paid paternity leave –Avg Length: 10 days –Range: 0-6 wks Resident Benefits

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

20. ACGME Compliance 100% report complete compliance 100% report complete compliance –97% Positive effect on resident quality of life –94% Positive effect on resident education Average hours off between shifts: Average hours off between shifts: – 15: 20% –<10: 11% in 2005 Average work week: 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% Required work hours log: 67% Average call frequency per week: Average call frequency per week: –28%: <158%: 112%: 22%: 3 –2005 Comparison:  53%: <147%: 1-3 Average days off per month: Average days off per month: –12%: ≤424%: 542%: 622%: ≥7 –2005 Comparison:  27%: 4-564%: 6-8

22. Life After Residency 91% pursuing fellowship training 91% 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 program for entering academic practice

23. Life After Residency

25. Call Average # of residents in-house on call: 1.8 Average # of residents in-house on call: 1.8 –Range: 1-5 In-house call shifts (excluding NF): In-house call shifts (excluding NF): – 75: 41% –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% –2005 Comparison: 78 (average)

26. Call 73% of programs use night float system 73% of programs use night float system –67% in 2005 –61% in 2004 Weeks on night float during residency: 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): 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: Frequency of night float shifts: –QD: 63% QOD: 3%Other: 35%

27. Call

29. Call Process for approving studies ordered on-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% 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% On-call McMeal vouchers or other free food: 87%

30. Oral Board Preparation 79% of programs provide their own oral board review and curriculum 79% of programs provide their own oral board review and curriculum Structured review begins: Structured review begins: –Jan-Feb: 62% –March-April: 33% –Before Jan: 5% Oral board review: Oral board review: –Lectures given by faculty: 97% –Lectures organized by faculty: 30% 70% of programs include a mock exam as part of preparation 70% of programs include a mock exam as part of preparation

31. Oral Board Preparation

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

33. ACGME Program Requirements Required research/academic project: 64% 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 69% of programs currently require maintenance of a learning portfolio 75% currently employ 360° evaluations 75% currently employ 360° evaluations 95% of programs currently require an annual objective examination (e.g. ACR Inservice) 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): Duration of training after which call currently begins (in months): – 12: 12% 66% of residents stop taking call midway through fourth year 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 97% of attendings not in-house are available by pager ACGME Program Requirements

38. 92% of resident reviewed studies on-call are currently reviewed within 24 hrs 92% of resident reviewed studies on-call are currently reviewed within 24 hrs Restricting call until ≥12 month of radiology residency training will change… 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: Unique program structures: –3/2 programs –9 clinical months spread throughout 5-year training program rather than doing PGY1 internship Props: 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: Yikes: –We cover outside imaging centers to subsidize staff incomes

41. Discussion AFIP 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 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 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) 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 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