Figure Stuff Out

When applying to residency, and perhaps to no one’s surprise, I always wanted to be asked during interview, “Why do you want to be a radiologist?” The “Why” question was an easy one to answer. After all, there was plenty to love about radiology – the challenge of solving a clinical diagnostic dilemma, the impact of catching an unsuspected Pancoast tumor, the satisfaction of revascularizing precious cerebral pneumbra. A better qualified medical student than I could discuss her scientific breakthrough, global health endeavor, and political leadership.

Change can unsettle even the best-prepared residents.

As medical students, we loved radiology for all the right reasons and wanted to talk about them. However, my generation of radiology trainees, the medical students who so eagerly entered this profession now grow concerned.

Indeed, my upper class colleagues were among the first to experience the radiology core exam. They were the first to experience the fourth year clinical concentration. They were the first to finish training not as board-certified radiologists, but board eligible. The changes do not end with training. No, the world we graduate residency into is brimming with uncertainty. My generation of radiologists will face evolving hiring trends, increasingly impersonal workflow, and dwindling Medicare reimbursement rates. We will be frontline soldiers in the ongoing battle between on-site radiologists and evolving teleradiology practices. We will comprise the proud new face of our profession, tasked to prove its value.

Change can unsettle even the best-prepared residents. I attended a recent Philadelphia Roentgen Ray Society meeting on the impact of the new American Board of Radiology examination changes followed by a panel discussion. Trainees and established radiologists filled the room, the air thick with uncertainty. I sat in the audience trying to absorb all the changes in the new ABR examination, the curricular changes in the final year of radiology, and the rippling effects they may have on the hiring process. Dazzled, I wondered how a modern radiology resident could expect to succeed when the metrics of success is a moving target. Eager for fresh air, I walked around the city before returning home.

Treading the paved urban sidewalk that evening, I walked past one of the new high-rise apartments in the city. When I began residency training three years ago, it was a construction site, little more than a steel frame wrapped in concrete. A year later, the building stood tall with large glass window panes, its lobby furnished with chiseled marble and glistening tiles. A little further to the east, a fresh construction site broke ground, born from the husk of an old store. Nascent city-sponsored self- service bicycle renting eased busy traffic, and pedestrians hurried past taxicabs in favor of rides hailed from the Internet.

Trainees who joined the profession looking for opportunities to improve care quality will find external change the best platform to introduce innovation.

Our world changes by the day, and it brings a nervous energy that is equal parts uncertainty and excitement. Practice change occurs at all levels in radiology, often for the better. Increasing awareness of radiation exposure in the public brought dose reduction techniques and dual energy systems into the forefront of CT research. The evolving reimbursement patterns fueled the American College of Radiology’s increasing emphasis on value-based imaging. Trainees who joined the profession looking for opportunities to improve care quality will find external change the best platform to introduce innovation.

Finally, some changes are frightening and some exciting, but parts of radiology simply have not changed at all. During a night shift several months ago a neurology resident asked me to review a head CT. The ordering provider did not see an abnormality but, “just wanted to be sure.” On a careful second perusal, a thin sheet of dense material revealed to be layering hemorrhage in the left middle cranial fossa, subtle but unmistakable when viewed from proper projection. The patient received close follow- up and the expanding hematoma expediently managed overnight.

The fulfillment of peering into a clinical problem to make an impact on a person’s life is a constant in radiology. In fact, so are most of those good answers that had compelled us to choose this profession in the first place. Perhaps therein lies the importance of asking ourselves the “Why” question. During this lengthy and rewarding training process, our answers to, “Why did I want to be a radiologist?” too will change. These answers form the compass as we wade through new uncharted waters. They give us the courage to sail ahead knowing the right direction, ready to tackle the thundering clouds that loom ahead.

I would not have a career any other way.

This post originally appeared in the January, 2015 Pennsylvania Radiology Society Newsletter.