- Email: [email protected]
Results of the 2004 survey of the American Association of Academic Chief Residents in Radiology1
Results of the 2004 Survey of the American Association of Academic Chief Residents in Radiology1 Christine M. Peterson, MD, Ronald Gerstle, MD, Sanjeev Bhalla, MD, Christine O. Menias, MD, R. Gilbert Jost, MD
Rationale and Objective. Every year, the American Association of Academic Chief Residents in Radiology (A3CR2) conducts a survey of the chief residents in accredited radiology programs in the United States and Canada. The purpose of the survey is to evaluate current residents’ opinions regarding a number of different issues pertaining to their educational experience, work responsibilities, and benefits. This information is useful in monitoring patterns of change in resident attitudes toward their experiences within their residency training programs. Materials and Methods. Online surveys were made available to the chief residents from 193 training programs in North America. For the most part, the questions were presented in a multiple-choice format, with additional space for elaboration or comments provided for many of the items. Some questions are repeated annually, addressing general topics such as salary and hospital size. However, new questions are incorporated each year. In particular, this year’s survey included questions pertaining to Armed Forces Institute of Pathology course funding, and advanced cardiac life support (ACLS) /basic life support certification and changes in duty work hour and call requirements in the face of changing ACGME (Accreditation Council for Graduate Medical Education) regulations. Results. The results of the survey were then tabulated, and responses to several of the repeated questions were compared with those from prior surveys dating back to 1996. This year’s response rate was 55%, with 106 unique responses received. This represents an improvement since last year’s survey, when the response rate was 41%. In some cases, more than one response was generated by a given residency program, in which case the questionnaire that was more thoroughly completed was used for statistical analysis. Responses were received from chief residents in 37 states and in Canada. The largest number of respondents was from New York, and 80% percent of respondents were from programs affiliated with a university. Forty-two percent were incoming chief residents with less than 3 months’ experience, whereas 58% were outgoing chief residents with less than 9 months remaining in their tenure. Conclusion. The majority of respondents report that changes made by their respective programs as the result of new ACGME maximum duty hour standards have been viewed favorably by radiology residents. Many training programs have moved toward a night float based call system in order to maintain compliance. Nearly all programs have overnight inhouse radiology resident coverage, but there has been a slight decline in the percentage of programs that provide in-house attending coverage at night. The majority of residents, however, have access to attendings after-hours by pager. Finally, resident salaries and benefits continue to increase, as has been the trend over the past several years. Key Words. Survey; duty hours; staffing; call; night float; chief residents; salary; benefits. ©
AUR, 2005
Acad Radiol 2005; 12:373–378 1 From the Mallinckrodt Institute of Radiology, 660 South Euclid Avenue, Campus Box 8131, St. Louis, MO 63110. Received and accepted December 2, 2004. Address correspondence to: C.M.P. e-mail: [email protected]
©
AUR, 2005 doi:10.1016/j.acra.2004.12.014
373
PETERSON ET AL
Figure 1. Chart depicting the number of hospitals that residents cover during their training.
Academic Radiology, Vol 12, No 3, March 2005
Figure 2. Chart depicting the number of exams performed annually among the different hospitals covered by each residency program.
WORK HOURS Beginning July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new maximum duty hour standards for residents in accredited programs. The new standards include an 80-hour weekly work limit, a mandated 10 consecutive hours off duty between work shifts, a limit of up to 24 hours of continuous duty (with up to 6 additional hours for education and to ensure continuity of care), and at least 1 of every 7 days (averaged over 4 weeks) free from work responsibilities. In addition, residents are not to be on call more frequently than every third day or night. To ascertain the impact of these new requirements on radiology residents, several questions that dealt with this issue were included in the survey. With regard to the 80-hour work week duty limit, 73% of programs responded that no changes were required in their residents’ schedules to comply with this regulation. Twenty-four percent of programs needed to make a “few changes,” and 4% made “significant changes.” Significant changes included altering the number of hours that residents were on call and keeping duty hour logs to monitor work hours and ensure compliance. With respect to the 24-hour call period limit, 65% of programs stated that they were already in compliance. Thirty percent made a “few changes,” and 6% made “significant changes” consisting of modifying their call structure (one program changed call so that the resident shift would end at midnight) or switching to a night float system. Overall, 85% of chief residents responded that the new ACGME work requirements had improved their call experience, and 90% responded that their educational experience had been enhanced. Positive comments regarding the new
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work requirements included a general betterment of resident morale. Additionally, residents are better rested before work shifts leading to improvements in quality of patient care and resident learning, and they feel security in having a fixed work hour standard. Negative comments focused on the new call and duty hour requirements that have forced residents to have shorter but more frequent calls. This has resulted in less free time, as well as an increase in the work burden on more senior night float residents when the junior residents have to leave call earlier.
ORAL BOARDS The American Board of Radiology has stated that it is attempting to make the oral radiology board examination more clinically relevant. When asked if the fourth-year residents in their programs knew of this, 59% of chief residents responded that they did not. Ninety-one percent of respondents indicated that these changes in the exam’s focus had not changed residents’ attitudes toward studying for the exam. In past years, the possibility of delaying the oral board examination until after the completion of residency has been contemplated. Ninety-four percent of those surveyed believed this to be an unfavorable idea, with 91% stating that delaying the examination would put an undue hardship on the candidate during fellowship or early on in their practice. Only 30% felt that delaying the examination would have the desired effect of encouraging the senior residents to be more focused on clinical duties and involved in their radiology rotations.
Academic Radiology, Vol 12, No 3, March 2005
Figure 3.
2004 SURVEY OF THE A3CR2
Charts representing the number of fellows and faculty associated with each training program.
STAFFING Thirty-six percent of respondents stated that residents in their programs were responsible for studies performed at only one hospital. Twenty-five percent were responsible for two hospitals, 17% for three hospitals, 14% for four hospitals, and 8% for five or more hospitals (Fig. 1). Forty-six percent responded that their residents were responsible for 500 –999 total hospital beds, 18% for fewer than 500 beds, 24% for 1,000 –1,499 beds, 7% for 1,500 –1,999 beds, and 5% for greater than 2,000 beds. According to the respondents, 43% of surveyed radiology programs performed between 100,000 and 249,000 exams annually. Ten percent perform fewer than 100,000 exams annually, 29% perform 250,000 – 499,000 exams, 5% perform 500,000 –749,000 exams, and 12% perform more than 750,000 exams per year. With regard to number of faculty, 46% of responding programs had 25 or fewer full-time faculty members. Thirty-six percent had between 25 and 49 full-time faculty, 13% had between 50 and 74 full-time faculty, and 5% had greater than 75 full-time faculty. Thirty-one percent of programs had no fellows. Another 31% had 1–5 fellows, 26% had 5–15 fellows, 7% had 15–25 fellows, and 4% had more than 25 fellows in their program (Fig. 2). Given new duty-hour requirements, several questions pertaining to in-house radiology coverage were included in the questionnaire. Ninety-seven percent of programs have in-house radiology resident coverage from 5 to 10 PM, and 98% between 10 PM and 6 AM. Forty-five percent of programs have full-time faculty in-house from 5 to 10 PM, whereas only 7% have in-house faculty cover-
age from 10 PM to 6 AM. This represents a decrease from 2000 and 1999, when 10% and 15% of programs had in-house faculty coverage from 10 PM to 6 AM, respectively. Of these full-time in-house faculty members, 100% cover the emergency department, and 29% are responsible for other areas, such as inpatient computed tomography, ultrasound, conventional radiographs, or other “nighthawk” services (Fig. 3).
ACADEMICS AND RESEARCH That the majority of radiology residents do not pursue careers in academic institutions was addressed by this year’s survey. When asked why they thought this was, 86% of respondents sited relatively lower financial compensation as the major reason. Another 14% stated that the time required for resident teaching was the major drawback. Of note, there were only seven responses to this particular question.
RESIDENCY PROGRAM COMPOSITION The average number of residents in each class is six, and the number of women in each class varies from 1.3 to 1.8. Thus women make up approximately 27% of their residency programs, a number very similar to survey results in 1992. To evaluate trends in residency program size, a question dealing with changes in class size was added to the survey. Fifty-three percent of respondents stated that the number of positions available in their respective programs had increased over the past 5 years. Thirty-four percent of
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Figure 4. The results of this year’s survey question addressing the responsibilities of the postcall resident when compared to 2000 and 1996.
programs had experienced no change, and 6% had a decrease in their number of residents. The programs that decreased their number of residency positions did so by an average of 4.5 residents over all four classes. One program lost all residents due to loss of accreditation. On the other hand, of the programs that increased their number of residency positions, 46% did so by one position, 28% increased by two or three positions, 14% increased by four or five positions, and 8% increased their program size by more than five positions.
ON-CALL RESPONSIBILITIES In 73% of programs, the residents begin in-house call between their sixth and twelfth months of residency. Twenty-two percent delay call until after the twelfth month, and 5% begin call within the first 6 months of residency. Residents take an average of 114.5 in-house overnight calls during their residencies, and 63 beeper call shifts. In 2000, residents took an average of 104 inhouse calls and 57 beeper calls; in 1996, they took an average of 95 in-house calls and 73 beeper calls. Sixty percent of programs have incorporated a night float system into their rotation schedule as an alternative to the traditional night call system. This reflects an increase from 44% in 2000 and 42% in 1996. Residents were also questioned about their responsibilities for scheduled inpatient and outpatient studies performed after hours, such as nonemergent computed tomography, magnetic resonance, and ultrasound studies. Fifty-three percent of respondents stated that they were responsible, to some degree, for these studies. This has not changed appreciably since 2000. However, only 12%
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Academic Radiology, Vol 12, No 3, March 2005
Figure 5. Chart depicting who is responsible for interpreting studies after-hours, including computed tomography, ultrasound, emergency department and inpatient conventional radiographs (CR), nuclear medicine studies, magnetic resonance imaging, and interventional procedures. Respondents were asked if the studies were interpreted or performed by residents, faculty/fellows, or by consultation only.
of the programs provided supplemental remuneration for these residents, as opposed to 33% in 2000. This usually takes the form of overtime pay. In light of the new ACGME duty hour regulations, chief residents were asked about the responsibilities of the postcall resident. Half of the respondents stated that their programs excuse the postcall resident from work responsibilities on the day following the in-house call, and 13% allow the resident to leave work early on the postcall day. For 38% of programs, this issue is circumvented by having a night float rotation instead of traditional call, where after-hours coverage is provided by a resident or group of residents who work only during the evening hours (Fig. 4). There is a growing trend toward having 24-hour attending coverage in emergency radiology departments across the country. Several questions dealing with this topic were included in this year’s survey. Fifty-nine percent of respondents stated that their attendings are available to them after hours by pager. Sixteen percent had attending coverage in the emergency department after hours, and in 26% of programs, attendings were available to residents only during daytime working hours. In addition to covering the radiology department after hours, 41% of respondents stated that residents in their programs provide on-call teleradiology services for remote sites (Fig. 5).
CHIEF RESIDENTS Sixty-six percent of residency programs employ two chief residents, 24% have one chief resident, and 8%
Academic Radiology, Vol 12, No 3, March 2005
2004 SURVEY OF THE A3CR2
Figure 6. Responsibilities of the chief residents in 2004, compared with 2000 and 1996.
Figure 7. Chief resident benefits in 2004 compared with 2000 and 1996.
have three. Fifty-six percent of programs elect their chief residents during the third year, whereas 44% elect fourth year residents. In 43% of programs surveyed chief residents are elected by their peers. In another 28%, they were chosen by the program director, by staff in 22% of programs, and by the department chairperson in 5%. Two percent of respondents stated that the chief resident responsibilities were shared by all senior residents on a rotating basis. Responsibilities of the chief residents include generation of the call schedule in 95% of programs, development of the resident rotation schedule in 84% of programs, resident selection in 62% of programs, resident teaching in 51%, medical student teaching in 52%, board review organization in 48%, and social event coordination in 65%. Benefits of being chief resident include the ability to attend national meetings in 88% of programs, time away from clinical services for administrative duties in 21%, and having an office in 34%. In addition, 70% of chief residents receive a salary bonus. This has decreased from 75% in 1996 and 73% in 2000. However, the average bonus amount has increased from $1,475 in 2000 to $1,600 in 2004 (Fig. 6,7).
course as either very important or essential to their overall training. Ninety percent of polled radiology training programs strongly encourage resident attendance of the course, and 92% of programs provide tuition funding. Of these, 98% pay the full tuition of the course and 83% provide resident attendees with a housing stipend. This has increased from 41% in 1999.
ARMED FORCES INSTITUTE OF PATHOLOGY COURSE The Armed Forces Institute of Pathology conducts a 6-week course several times throughout the year, which is open to radiology residents from around the world. This year’s tuition was $1,500. Seventy-three percent of respondents had attended the course at the time of the survey, and another 24% were planning to attend. Ninetytwo percent of chief residents described the utility of the
NATIONAL MEETINGS Residents may attend several yearly national radiologic meetings. Thirty-five percent of respondents stated that their training programs encouraged attendance at these meetings, whereas 54% described their program’s attitude toward their attendance as ambivalent. Seventy-two percent of respondents had themselves attended a national meeting. The training programs typically pay between 75% and 100% of the resident’s expenses while attending the conference.
ACLS AND BASIC LIFE SUPPORT TRAINING Basic life-support training fees are paid by the department in 78% of training programs, whereas ACLS is paid for by 74%.
RESIDENT SALARIES The average salary for a first year radiology resident is $41,500. This represents an increase compared with $37,913 in 2002. The average salary for fourth-year residents increased from $45,522 in 2002 to $49,500. The chart below
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CONCLUSION
Figure 8. Ranges in first- and fourth-year resident salaries in 2004.
demonstrates the range of first- and fourth-year resident salaries according to this year’s survey (Fig. 8).
OTHER BENEFITS Several questions addressing resident benefits other than salary were included in this year’s survey. They included a number of topics such as maternity/paternity leave, book and travel funds, and licensure. Sixty percent of programs pay for temporary resident licensure, whereas only 15% reimburse for permanent licensure. Seventy-five percent of programs provide residents with a book and travel fund, which they can use to purchase texts or use toward attending national meetings. This has increased from approximately 65% in 1999. The average amount currently allotted per resident is approximately $750. There is wide variation among programs in the way the fund is applied; however, very few programs distribute the funds in the form of cash. The average fund value has varied widely over the years from $650 in 1998 to $1,243 in 2002. The average maternity leave offered by training programs is 7 weeks. Some programs, however, offer as much as 6 months of leave. Paternity leave is usually substantially less, with the average allotted time being approximately 2 weeks. Again, there is much variation among programs in this matter, with paternity leave ranging from 0 to 12 weeks. Twenty-seven percent of programs provide some form of childcare for residents. Sixty-eight percent of programs provide their residents with retirement plans, but only 37% will match funds.
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This year’s survey included a number of questions focusing on changes that residents have experienced in light of the new ACGME duty hour requirements. For the most part, resident attitudes toward the new requirements are favorable. Most programs did not have to institute any major changes to maintain compliance, and the vast majority of respondents stated that the new requirements have improved their overall call and educational experience. There has been an increasing trend over the past few years toward a night-float based call system, which circumvents many of the duty hour limit issues encountered by programs with a traditional call system. Similarly, an increasing number of programs are dismissing residents from clinical duties on their postcall days, with fewer programs simply allowing the post call resident to go home earlier than usual. In spite of the movement toward night float call systems, residents report an increase in the number of both in-house and pager calls over the past years. It is unclear as to whether some of the respondents may have included night float shifts into their overall call tally, as one would expect the number of calls to decrease as night float systems are instituted. Residents also report a decrease in attending coverage of the emergency department from 10 PM to 6 AM. According to the results of the survey, in 26% of programs attendings are not available to the residents after-hours at all. In approximately 75% of programs, however, attendings either are in the emergency department after hours or are available to their residents by pager. Although there has been little change in the percentage of programs where residents are responsible for afterhours scheduled nonemergent studies, fewer programs provide supplementary salary for residents performing such exams. However, resident salaries continue to increase, and many resident benefits such as book and travel funds and Armed Forces Institute of Pathology funding are becoming more widely available. Lastly, chief residents are becoming increasingly responsible for schedule generation, curriculum development, and social events, and less responsible for resident and medical student teaching. However, benefits, such as time to attend national meetings have slightly increased, as has salary bonus amount, although the number of chief residents who receive the bonus has declined.
Rationale and Objective. Every year, the American Association of Academic Chief Residents in Radiology (A3CR2) conducts a survey of the chief residents in accredited radiology programs in the United States and Canada. The purpose of the survey is to evaluate current residents’ opinions regarding a number of different issues pertaining to their educational experience, work responsibilities, and benefits. This information is useful in monitoring patterns of change in resident attitudes toward their experiences within their residency training programs. Materials and Methods. Online surveys were made available to the chief residents from 193 training programs in North America. For the most part, the questions were presented in a multiple-choice format, with additional space for elaboration or comments provided for many of the items. Some questions are repeated annually, addressing general topics such as salary and hospital size. However, new questions are incorporated each year. In particular, this year’s survey included questions pertaining to Armed Forces Institute of Pathology course funding, and advanced cardiac life support (ACLS) /basic life support certification and changes in duty work hour and call requirements in the face of changing ACGME (Accreditation Council for Graduate Medical Education) regulations. Results. The results of the survey were then tabulated, and responses to several of the repeated questions were compared with those from prior surveys dating back to 1996. This year’s response rate was 55%, with 106 unique responses received. This represents an improvement since last year’s survey, when the response rate was 41%. In some cases, more than one response was generated by a given residency program, in which case the questionnaire that was more thoroughly completed was used for statistical analysis. Responses were received from chief residents in 37 states and in Canada. The largest number of respondents was from New York, and 80% percent of respondents were from programs affiliated with a university. Forty-two percent were incoming chief residents with less than 3 months’ experience, whereas 58% were outgoing chief residents with less than 9 months remaining in their tenure. Conclusion. The majority of respondents report that changes made by their respective programs as the result of new ACGME maximum duty hour standards have been viewed favorably by radiology residents. Many training programs have moved toward a night float based call system in order to maintain compliance. Nearly all programs have overnight inhouse radiology resident coverage, but there has been a slight decline in the percentage of programs that provide in-house attending coverage at night. The majority of residents, however, have access to attendings after-hours by pager. Finally, resident salaries and benefits continue to increase, as has been the trend over the past several years. Key Words. Survey; duty hours; staffing; call; night float; chief residents; salary; benefits. ©
AUR, 2005
Acad Radiol 2005; 12:373–378 1 From the Mallinckrodt Institute of Radiology, 660 South Euclid Avenue, Campus Box 8131, St. Louis, MO 63110. Received and accepted December 2, 2004. Address correspondence to: C.M.P. e-mail: [email protected]
©
AUR, 2005 doi:10.1016/j.acra.2004.12.014
373
PETERSON ET AL
Figure 1. Chart depicting the number of hospitals that residents cover during their training.
Academic Radiology, Vol 12, No 3, March 2005
Figure 2. Chart depicting the number of exams performed annually among the different hospitals covered by each residency program.
WORK HOURS Beginning July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted new maximum duty hour standards for residents in accredited programs. The new standards include an 80-hour weekly work limit, a mandated 10 consecutive hours off duty between work shifts, a limit of up to 24 hours of continuous duty (with up to 6 additional hours for education and to ensure continuity of care), and at least 1 of every 7 days (averaged over 4 weeks) free from work responsibilities. In addition, residents are not to be on call more frequently than every third day or night. To ascertain the impact of these new requirements on radiology residents, several questions that dealt with this issue were included in the survey. With regard to the 80-hour work week duty limit, 73% of programs responded that no changes were required in their residents’ schedules to comply with this regulation. Twenty-four percent of programs needed to make a “few changes,” and 4% made “significant changes.” Significant changes included altering the number of hours that residents were on call and keeping duty hour logs to monitor work hours and ensure compliance. With respect to the 24-hour call period limit, 65% of programs stated that they were already in compliance. Thirty percent made a “few changes,” and 6% made “significant changes” consisting of modifying their call structure (one program changed call so that the resident shift would end at midnight) or switching to a night float system. Overall, 85% of chief residents responded that the new ACGME work requirements had improved their call experience, and 90% responded that their educational experience had been enhanced. Positive comments regarding the new
374
work requirements included a general betterment of resident morale. Additionally, residents are better rested before work shifts leading to improvements in quality of patient care and resident learning, and they feel security in having a fixed work hour standard. Negative comments focused on the new call and duty hour requirements that have forced residents to have shorter but more frequent calls. This has resulted in less free time, as well as an increase in the work burden on more senior night float residents when the junior residents have to leave call earlier.
ORAL BOARDS The American Board of Radiology has stated that it is attempting to make the oral radiology board examination more clinically relevant. When asked if the fourth-year residents in their programs knew of this, 59% of chief residents responded that they did not. Ninety-one percent of respondents indicated that these changes in the exam’s focus had not changed residents’ attitudes toward studying for the exam. In past years, the possibility of delaying the oral board examination until after the completion of residency has been contemplated. Ninety-four percent of those surveyed believed this to be an unfavorable idea, with 91% stating that delaying the examination would put an undue hardship on the candidate during fellowship or early on in their practice. Only 30% felt that delaying the examination would have the desired effect of encouraging the senior residents to be more focused on clinical duties and involved in their radiology rotations.
Academic Radiology, Vol 12, No 3, March 2005
Figure 3.
2004 SURVEY OF THE A3CR2
Charts representing the number of fellows and faculty associated with each training program.
STAFFING Thirty-six percent of respondents stated that residents in their programs were responsible for studies performed at only one hospital. Twenty-five percent were responsible for two hospitals, 17% for three hospitals, 14% for four hospitals, and 8% for five or more hospitals (Fig. 1). Forty-six percent responded that their residents were responsible for 500 –999 total hospital beds, 18% for fewer than 500 beds, 24% for 1,000 –1,499 beds, 7% for 1,500 –1,999 beds, and 5% for greater than 2,000 beds. According to the respondents, 43% of surveyed radiology programs performed between 100,000 and 249,000 exams annually. Ten percent perform fewer than 100,000 exams annually, 29% perform 250,000 – 499,000 exams, 5% perform 500,000 –749,000 exams, and 12% perform more than 750,000 exams per year. With regard to number of faculty, 46% of responding programs had 25 or fewer full-time faculty members. Thirty-six percent had between 25 and 49 full-time faculty, 13% had between 50 and 74 full-time faculty, and 5% had greater than 75 full-time faculty. Thirty-one percent of programs had no fellows. Another 31% had 1–5 fellows, 26% had 5–15 fellows, 7% had 15–25 fellows, and 4% had more than 25 fellows in their program (Fig. 2). Given new duty-hour requirements, several questions pertaining to in-house radiology coverage were included in the questionnaire. Ninety-seven percent of programs have in-house radiology resident coverage from 5 to 10 PM, and 98% between 10 PM and 6 AM. Forty-five percent of programs have full-time faculty in-house from 5 to 10 PM, whereas only 7% have in-house faculty cover-
age from 10 PM to 6 AM. This represents a decrease from 2000 and 1999, when 10% and 15% of programs had in-house faculty coverage from 10 PM to 6 AM, respectively. Of these full-time in-house faculty members, 100% cover the emergency department, and 29% are responsible for other areas, such as inpatient computed tomography, ultrasound, conventional radiographs, or other “nighthawk” services (Fig. 3).
ACADEMICS AND RESEARCH That the majority of radiology residents do not pursue careers in academic institutions was addressed by this year’s survey. When asked why they thought this was, 86% of respondents sited relatively lower financial compensation as the major reason. Another 14% stated that the time required for resident teaching was the major drawback. Of note, there were only seven responses to this particular question.
RESIDENCY PROGRAM COMPOSITION The average number of residents in each class is six, and the number of women in each class varies from 1.3 to 1.8. Thus women make up approximately 27% of their residency programs, a number very similar to survey results in 1992. To evaluate trends in residency program size, a question dealing with changes in class size was added to the survey. Fifty-three percent of respondents stated that the number of positions available in their respective programs had increased over the past 5 years. Thirty-four percent of
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PETERSON ET AL
Figure 4. The results of this year’s survey question addressing the responsibilities of the postcall resident when compared to 2000 and 1996.
programs had experienced no change, and 6% had a decrease in their number of residents. The programs that decreased their number of residency positions did so by an average of 4.5 residents over all four classes. One program lost all residents due to loss of accreditation. On the other hand, of the programs that increased their number of residency positions, 46% did so by one position, 28% increased by two or three positions, 14% increased by four or five positions, and 8% increased their program size by more than five positions.
ON-CALL RESPONSIBILITIES In 73% of programs, the residents begin in-house call between their sixth and twelfth months of residency. Twenty-two percent delay call until after the twelfth month, and 5% begin call within the first 6 months of residency. Residents take an average of 114.5 in-house overnight calls during their residencies, and 63 beeper call shifts. In 2000, residents took an average of 104 inhouse calls and 57 beeper calls; in 1996, they took an average of 95 in-house calls and 73 beeper calls. Sixty percent of programs have incorporated a night float system into their rotation schedule as an alternative to the traditional night call system. This reflects an increase from 44% in 2000 and 42% in 1996. Residents were also questioned about their responsibilities for scheduled inpatient and outpatient studies performed after hours, such as nonemergent computed tomography, magnetic resonance, and ultrasound studies. Fifty-three percent of respondents stated that they were responsible, to some degree, for these studies. This has not changed appreciably since 2000. However, only 12%
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Academic Radiology, Vol 12, No 3, March 2005
Figure 5. Chart depicting who is responsible for interpreting studies after-hours, including computed tomography, ultrasound, emergency department and inpatient conventional radiographs (CR), nuclear medicine studies, magnetic resonance imaging, and interventional procedures. Respondents were asked if the studies were interpreted or performed by residents, faculty/fellows, or by consultation only.
of the programs provided supplemental remuneration for these residents, as opposed to 33% in 2000. This usually takes the form of overtime pay. In light of the new ACGME duty hour regulations, chief residents were asked about the responsibilities of the postcall resident. Half of the respondents stated that their programs excuse the postcall resident from work responsibilities on the day following the in-house call, and 13% allow the resident to leave work early on the postcall day. For 38% of programs, this issue is circumvented by having a night float rotation instead of traditional call, where after-hours coverage is provided by a resident or group of residents who work only during the evening hours (Fig. 4). There is a growing trend toward having 24-hour attending coverage in emergency radiology departments across the country. Several questions dealing with this topic were included in this year’s survey. Fifty-nine percent of respondents stated that their attendings are available to them after hours by pager. Sixteen percent had attending coverage in the emergency department after hours, and in 26% of programs, attendings were available to residents only during daytime working hours. In addition to covering the radiology department after hours, 41% of respondents stated that residents in their programs provide on-call teleradiology services for remote sites (Fig. 5).
CHIEF RESIDENTS Sixty-six percent of residency programs employ two chief residents, 24% have one chief resident, and 8%
Academic Radiology, Vol 12, No 3, March 2005
2004 SURVEY OF THE A3CR2
Figure 6. Responsibilities of the chief residents in 2004, compared with 2000 and 1996.
Figure 7. Chief resident benefits in 2004 compared with 2000 and 1996.
have three. Fifty-six percent of programs elect their chief residents during the third year, whereas 44% elect fourth year residents. In 43% of programs surveyed chief residents are elected by their peers. In another 28%, they were chosen by the program director, by staff in 22% of programs, and by the department chairperson in 5%. Two percent of respondents stated that the chief resident responsibilities were shared by all senior residents on a rotating basis. Responsibilities of the chief residents include generation of the call schedule in 95% of programs, development of the resident rotation schedule in 84% of programs, resident selection in 62% of programs, resident teaching in 51%, medical student teaching in 52%, board review organization in 48%, and social event coordination in 65%. Benefits of being chief resident include the ability to attend national meetings in 88% of programs, time away from clinical services for administrative duties in 21%, and having an office in 34%. In addition, 70% of chief residents receive a salary bonus. This has decreased from 75% in 1996 and 73% in 2000. However, the average bonus amount has increased from $1,475 in 2000 to $1,600 in 2004 (Fig. 6,7).
course as either very important or essential to their overall training. Ninety percent of polled radiology training programs strongly encourage resident attendance of the course, and 92% of programs provide tuition funding. Of these, 98% pay the full tuition of the course and 83% provide resident attendees with a housing stipend. This has increased from 41% in 1999.
ARMED FORCES INSTITUTE OF PATHOLOGY COURSE The Armed Forces Institute of Pathology conducts a 6-week course several times throughout the year, which is open to radiology residents from around the world. This year’s tuition was $1,500. Seventy-three percent of respondents had attended the course at the time of the survey, and another 24% were planning to attend. Ninetytwo percent of chief residents described the utility of the
NATIONAL MEETINGS Residents may attend several yearly national radiologic meetings. Thirty-five percent of respondents stated that their training programs encouraged attendance at these meetings, whereas 54% described their program’s attitude toward their attendance as ambivalent. Seventy-two percent of respondents had themselves attended a national meeting. The training programs typically pay between 75% and 100% of the resident’s expenses while attending the conference.
ACLS AND BASIC LIFE SUPPORT TRAINING Basic life-support training fees are paid by the department in 78% of training programs, whereas ACLS is paid for by 74%.
RESIDENT SALARIES The average salary for a first year radiology resident is $41,500. This represents an increase compared with $37,913 in 2002. The average salary for fourth-year residents increased from $45,522 in 2002 to $49,500. The chart below
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CONCLUSION
Figure 8. Ranges in first- and fourth-year resident salaries in 2004.
demonstrates the range of first- and fourth-year resident salaries according to this year’s survey (Fig. 8).
OTHER BENEFITS Several questions addressing resident benefits other than salary were included in this year’s survey. They included a number of topics such as maternity/paternity leave, book and travel funds, and licensure. Sixty percent of programs pay for temporary resident licensure, whereas only 15% reimburse for permanent licensure. Seventy-five percent of programs provide residents with a book and travel fund, which they can use to purchase texts or use toward attending national meetings. This has increased from approximately 65% in 1999. The average amount currently allotted per resident is approximately $750. There is wide variation among programs in the way the fund is applied; however, very few programs distribute the funds in the form of cash. The average fund value has varied widely over the years from $650 in 1998 to $1,243 in 2002. The average maternity leave offered by training programs is 7 weeks. Some programs, however, offer as much as 6 months of leave. Paternity leave is usually substantially less, with the average allotted time being approximately 2 weeks. Again, there is much variation among programs in this matter, with paternity leave ranging from 0 to 12 weeks. Twenty-seven percent of programs provide some form of childcare for residents. Sixty-eight percent of programs provide their residents with retirement plans, but only 37% will match funds.
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This year’s survey included a number of questions focusing on changes that residents have experienced in light of the new ACGME duty hour requirements. For the most part, resident attitudes toward the new requirements are favorable. Most programs did not have to institute any major changes to maintain compliance, and the vast majority of respondents stated that the new requirements have improved their overall call and educational experience. There has been an increasing trend over the past few years toward a night-float based call system, which circumvents many of the duty hour limit issues encountered by programs with a traditional call system. Similarly, an increasing number of programs are dismissing residents from clinical duties on their postcall days, with fewer programs simply allowing the post call resident to go home earlier than usual. In spite of the movement toward night float call systems, residents report an increase in the number of both in-house and pager calls over the past years. It is unclear as to whether some of the respondents may have included night float shifts into their overall call tally, as one would expect the number of calls to decrease as night float systems are instituted. Residents also report a decrease in attending coverage of the emergency department from 10 PM to 6 AM. According to the results of the survey, in 26% of programs attendings are not available to the residents after-hours at all. In approximately 75% of programs, however, attendings either are in the emergency department after hours or are available to their residents by pager. Although there has been little change in the percentage of programs where residents are responsible for afterhours scheduled nonemergent studies, fewer programs provide supplementary salary for residents performing such exams. However, resident salaries continue to increase, and many resident benefits such as book and travel funds and Armed Forces Institute of Pathology funding are becoming more widely available. Lastly, chief residents are becoming increasingly responsible for schedule generation, curriculum development, and social events, and less responsible for resident and medical student teaching. However, benefits, such as time to attend national meetings have slightly increased, as has salary bonus amount, although the number of chief residents who receive the bonus has declined.