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Results of the 1996 survey of the American Association of Academic Chief Residents in radiology
Special Article
Results of the 1996 Survey of the American Association of Academic Chief Residents in Radiology Farrel K. VanWagenen, MD 1, Eric R. Weidman, MD 1,2, James R. Duncan, MD, PhD 1, Ronald G. Evens, MD ~
R a t i o n a l e a n d O b j e c t i v e s . Diagnostic radiology chief residents w e r e surveyed on issues related to residency training to c o m p a r e features and gauge trends in training. M e t h o d s . Questionnaires w e r e mailed to accredited programs in the United States. A variety of demographic and common-interest questions w e r e asked. Results. Forty-three percent of surveys w e r e returned. The percentage of female residents was similar to that reported in other recent surveys; however, the percentage of w o m e n a m o n g lst-year residents had decreased. Resident salaries had increased, although the average salary for a 4th-year resident had decreased w h e n adjusted for inflation. Most lst-year residents started participating in overnight hospital coverage by their 12th m o n t h of residency, and the total n u m b e r of call days during residency correlated inversely with the size of the residency program. Almost half of residency programs used a night-float resident to provide after-hours coverage. C o n c l u s i o n . The information derived from the survey should be useful for program evaluation and future planning. K e y W o r d s . Education; radiology and radiologists, departmental management. he American Association of Academic Chief Residents in Radiology eets annually to discuss training of diagnostic radiology residents. The organization n o w includes university, community, and military hospital radiology training programs. An annual survey of the current chief residents has b e e n conducted since 1971 [1-8]. Several general topics are included in the survey every year, including questions about staff demographics, salaries, and the hospital. Other topics are rotated on a 4-year schedule. In 1996, the focus was on resident call and the chief resident position. MATERIALS
AND METHODS
Data C o l l e c t i o n a n d A n a l y s i s
Questionnaires w e r e mailed to chief residents at 150 accredited diagnostic radiology residency programs at university, military, and c o m m u n i t y hos-
132
From the 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO. aCurrent address: David Grant Medical Center, Travis Air Force Base, Fairfield, CA. Address reprint requests to R. G. Evens, MD, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110.
Received and accepted for publication October 15, 1996. Acad Radiol 1997;4:132-137
©1997, Association of University Radiologists
Vol.4, No. 2, February1997
RESULTS OF THE 1996 A3CR 2 SURVEY
TABLE 1: Women in Diagnostic Radiology Residency Programs
TABLE 2" Difference in Size of 1st-year Resident Class versus 4th-year Resident Class by Region
NO. of Women (%) Region
No. of Programs
All Years
Pacific Central Northeast Southeast West All
8 12 21 17 7 65
26 22 28 26 16 25
First Year 28 20 31 19 2 22
TABLE 3: Difference in Size of 1st-year Residen t Class versus 4th-year Resident Class by Program Size Program Size
Difference (%)
Jumbo Large Medium Small
-8.6 -3.9 +7.7 +4.1
pitals in the United States. Data w e r e tabulated and analyzed by using commercial database software (Filem a k e r Pro 2.0vl; Clads Software, Cupertino, CA). Information regarding staffing, resident demographics, and salary from the 1991-1995 association surveys was incorporated into this database. For analysis, training programs w e r e grouped into five U.S. geographic regions: Pacific (AK, CA, HI. NV, OR, and WA); West (AZ, CO, ID, KS, MT. ND, NE, NM, OK. SD, TX; UT, and WY); Central (IA. IL, IN, MI, MN, MO. OH, and WI); Northeast (CT, DC, DE, MA, MD, NH, NJ., NY, PA. RI. and VT); and Southeast (AL, AR, FL. GA, KY, LA, MS. NC, SC, TN, VA, and WV). In prior surveys [7], Nevada had been included in the w e s t e r n region, but it was m o v e d to the Pacific region for this survey. Programs w e r e also grouped into four categories by size, based on the total n u m b e r of residents in each program: Small 0ess than 13 residents), m e d i u m (13-24 residents), large (25-40 residents), and jumbo (more than 40 residents). RESULTS Survey Response Rate Chief residents from 65 (43%) of 150 accredited diagnostic radiology programs c o m p l e t e d and returned the questionnaire. This response rate was similar to the
Region
Difference (%)
Central Northeast Pacific Southeast West
+2.8 +5.4 -9.1 +6.3 -3.1
response rates for the two most recent surveys (34% and 42%). W o m e n in Diagnostic Radiology Residency Training Twenty-five p e r c e n t of all residents in the programs from w h i c h w e received responses w e r e w o m e n . In 1994 and 1992, this n u m b e r was also 25%, and in 1991 it was 26%. In 1996, w o m e n accounted for only 22% of all lst-year residents, however, c o m p a r e d with 29% in 1994 and 33% in 1993. In Table 1, the percentage of female radiology residents reported in the current survey is presented by region. During the 1990s, the annual percentage of w o m e n w h o are a m o n g U.S. medical school graduates reportedly has varied annually bet w e e n 34.2% and 37.9% [9,10]. Changes and Differences in Residency Class Size To gauge the change in residency class size during the past 4 years, the n u m b e r of 4th-year residents was c o m p a r e d with the n u m b e r of 1st-year residents in a given program. Programs with f e w e r 1st-year residents than 4th-year residents w e r e p r e s u m e d to be decreasing in size (volUntarily or involuntarily) and vice versa. The percentage differences b e t w e e n 1st-year class size and 4th-year class size are presented by geographic region in Table 2 and by overall program size in Table 3. In general, w e found that large programs and those in the western United States w e r e decreasing in size, while small- and medium-size programs and those in the East reported increasing in size. Staff Demographics and Caseloads The percentage of cases assessed by faculty alone without resident involvement varied inversely with program size (Table 4). The percentage of cases read by residents alone without faculty review or involvement, the average annual resident caseload (not including
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VANWAGENEN ET AL
Voi.4, No.2, February1997
TABLE 5: Average 1st-year and 4th-year Resident Salaries by Geographic Region
TABLE 4: Average Number of Annual Cases per Resident by Program Size
Salary ($)
Program Size Data
Jumbo
Cases read by faculty 7.0 only (%) Cases read by resident 0.5 only (%) No. of cases per resident 7,131 No. of faculty per resident 1.3 No. of fellows per resident 0.4 No. of hospital beds per 62 resident
Large
Medium
Small
15.7
20.6
34.7
0.6
3.2
0
7,362 1.5 0.4 41
7,027 1.4 0.3 47
8,662 1.6 0 59
Region Central Northeast Pacific Southeast West All
40000
1st Year
4th Year
31,479 33,886 33,670 30,026 28,483 31,824
35,400 39,086 41,937 34,129 32,908 36,795
4th YearSalary --O-- CPI-Predicted4th Yr. "- 1st YearSalary
37500 TABLE 6: Average Book and Travel Allowance Program Size
Allowance ($)
Jumbo Large Medium Small All
563 681 853 1,009 845
cases read by faculty only), faculty-to-resident ratios, fellow-to-resident ratios, and the n u m b e r of hospital beds per resident are also summarized in Table 4. This demographic information did not vary greatly among programs of different sizes except for small programs, which reported a higher annual resident caseload, no unreviewed resident image interpretation, and a lack of fellows. Resident Remuneration
Average salaries for lst- and 4th-year residents, $31,824 and $36,795, respectively, are presented by region in Table 5. Trends in lst- and @h-year resident salaries are plotted in Figure 1. Predicted salaries based on the annual consumer price index (CPI) [11] are also plotted in Figure 1. Mthough resident salary increases have generally paralleled the CPI in the past 5 years, the average @h-year resident salary increase did not match the CPI in 1996. Seventy-one percent of residency programs surveyed provided an allowance for books and travel for their residents, compared with 40% in 1993. The average book and travel allowance provided was $845, but the amount varied with program size (Table 6).
134
35000 32500 30000 27500 25000 1992
I
I
I
I
1993
1994
1995
1996
FIGURE 1. Resident salary trends and salaries predicted by means of CPI.
Overnight Hospital Coverage
Ninety-seven percent of residency programs from w h i c h responses were received required residents to participate in overnight hospital coverage. Forty-three percent of programs had dedicated "night-float" rotations during w h i c h residents worked overnight shifts and were off during daytime hours. In 54% of such programs, the night-float resident provided all after-hours coverage; traditional extended-shift overnight coverage had been eliminated at these institutions. The length of training residents received before beginning overnight coverage varied among programs (Fig 2). The duties expected of residents the day after overnight coverage also varied (Fig 3); 59% of programs allowed the resident to leave immediately after morning readout or early in the day. In 26%, the next work day was not an issue because overnight call either was not required (3%) or was provided entirely by a nightfloat resident (23%). Only 15% of programs required the resident to work a full day after overnight call.
Vol.4, No. 2, February 1997
RESULTS OF THE 1996 A3CR 2 S U R V E Y
25% >12 Months
26% Not Applicable 3% o Call FIGURE 2.
27% 6-12 M o n t h s
45% • 6 Months
Length of training before residents begin overnight coverage.
15% Full Day
25% Excused FIGURE 3. Resident work responsibilities after overnight call.
34%
Leaves Early
TABLE 7: Average Number of Call Nights Assigned to Each Resident during Training Program Size
Table 8: Number of Chief Residents by Program Size
Call Type
Jumbo
Large
Medium
Small
All
In-house Beeper All
89 21 111
86 73 158
98 79 177
103 81 184
95 73 168
181 I-1Benefits
Added Meetings
==Duties
20
Admin. Time Office Stipend Org. Board Review Med. St. Teaching Res. Teaching Res. Selection Curiculum Dev. Vacation Sched. Call Schedule Rotation Sched.
Program Size
No. of Chief Residents 1
2
3
Share
Average No, of Residents per Chief Resident
Jumbo Large Medium Small All
0 0 11 9 20
2 14 15 5 36
3 3 0 0 6
0 0 0 3 3
20 14 13 9 13
12s 175 45 51
77
0
10
20
30 40 50 60 70 80 Percentage of Chief Residents
90 100
FIGURE 4. Benefits and duties of chief residents.
The total n u m b e r of call days assigned to a resident during the 4 years of residency varied depending on program size (Table 7). The n u m b e r of home- and beeper-call days differed considerably, but differences in the number of in-house call days were more modest. Chief R e s i d e n t T o p i c s
The year during w h i c h residents served as chief resident varied. Sixty-two percent of residents surveyed served primarily during their 4th year of residency, and 38% served mainly in their 3rd year. The average number of chief residents per program and the average number of residents per chief resident varied with program size (Table 8). In three small programs, the responsibilities of chief resident rotated among all 4thyear residents. Figure 4 illustrates the duties performed by chief residents (in addition to their clinical responsi-
bilities) and the benefits provided in return. Resident scheduling was required of responding chief residents relatively consistently, whereas educational duties (teaching and organizing board reviews) were required more variably. Three-fourths of responding chief residents received additional remuneration for their work, with an average annual chief resident stipend of $1,481. Eighty-one percent were given the opportunity to attend additional national meetings. A minority of chief residents were given offices (28%) or additional administrative time (20%) away from their clinical work to perform chief resident duties. S t a n d a r d i z a t i o n of F e l l o w s h i p A p p l i c a t i o n P r o c e s s
Eighty-two percent of responding chief residents believed that national guidelines should be created to establish standard dates for fellowship application and acceptance. This finding contrasts sharply with that of the 1993 survey, in which only 19% favored such standardization. None of the residents believed it was possible to make an informed decision regarding the area in w h i c h to seek fellowship training before the 3rd year of residency training. Twenty-five percent believed the decision could be made early in the 3rd year of residency, and 57% favored making a selection late in the 3rd year; 18% would delay until early in the 4th year.
135
VANWAGENEN
ET A L
DISCUSSION Overall, the percentage of w o m e n in radiology training appears stable at 25%, although it continues to be lower than the percentage of U.S. medical graduates w h o are w o m e n (approximately 36%). The percentage of w o m e n among lst-year residents (22%) in 1996 was lower than that seen in the previous few years. This difference may simply represent a sampling error. Given recent changes in the radiology resident applicant pool, however, this difference may represent a real change. It is possible that w o m e n in particular are becoming less inclined to enter careers in radiology. Although only approximations have been made, it appears that residency class sizes are changing among certain demographic groups. Larger programs and those in the western United States appear to be decreasing in size, while programs of medium or small size and those in the eastern United States may be increasing in size. Further study of these possible trends may be warranted given recent concerns about job availability and residency applicant pools. Annual resident caseloads are similar for residency programs of all sizes except for small programs, w h i c h reported a significantly higher caseload per resident. This finding may reflect a true difference in the n u m b e r of cases each resident reads or it may be partly due to differences in the types of cases read. The survey requested that annual relative value units (RVUs)billed be reported so that differences in case type could be corrected, but none of the responding residents provided this information. It is also possible that the apparent difference in resident caseload is due to underestimation of the percentage of cases read by.faculty alone without resident involvement, an error that would have the greatest importance in the small-program category. In 1996, 4th-year resident salaries did not keep pace with the CPI, and there was a decrease in salary w h e n it was corrected for inflation. A similar relative decrease was seen in the 1993 survey and was likely erroneous, given the subsequent rebound in salaries in 1994. Whether the curbing of 4th-year resident salaries in the current study marks a trend or is an aberration will likely be discovered once the 1997 chief resident survey has been completed. The percentage of programs that provide resident book and travel allowances appears to have increased from 40% in 1993 to 71% in 1996. Small programs tend to provide larger allowances than large programs. This
136
Vol.4, No. 2, February 1997
larger allowance may be due to the need for residents of smaller programs to travel and pay tuition to take advantage of educational opportunities (board review courses, etc) w h i c h are often provided on site and free of cost at larger programs. Nearly all residents participate in after-hours radiology coverage. It is not surprising that residents at smaller programs are assigned a greater number of call days than residents at larger programs. The difference in the n u m b e r of beeper- and home-call days is considerable, but the difference in in-house call days is more modest. Only 15% of residents are required to work a full day after overnight call, a finding that may perhaps compensate for differences in the total number of call days assigned at various programs. It is interesting to note that 43% of residency programs use a night-float resident to provide after-hours coverage, a practice that may be gaining popularity. Although chief resident responsibilities vary among programs, more than three-fourths of residents are involved in scheduling resident rotations, vacations, and call. A total of 60%-72% of residents influence the quality of their residency program through involvement in resident selection and curriculum development and evaluation. Slightly more than half of chief residents are involved in teaching of residents and medical students. In exchange for these additional administrative responsibilities, most (75%) receive a chief resident stipend. The majority are also allowed to attend additional national meetings, primarily meetings of the American Association of Academic Chief Residents in Radiology and the Association of University Radiologists. A minority of responding chief residents have access to their o w n or a shared office or receive additional time to perform their added duties. The majority (82%) of responding chief residents favor standardizing the fellowship application process. Disadvantages of the current system include the need for residents to select a fellowship before they have had adequate exposure to the various radiology subspecialties and the need for them to decide on a fellowship offer before other interviews have been completed. Use of standard application dates would allow both the applicants and the program administrators to fully consider all options before committing to a partnership. Although the time period favored for selecting fellowships varies among chief residents, a majority (82%) believe an informed decision could be reached by the latter half of the 3rd year. Further consideration
Vol. 4, No. 2, February 1997
regarding standardization of the fellowship application process, including discussions of the costs, effectiveness, and implementation, seems warranted. REFERENCES 1. Evens RG. Report on a survey of chief residents in academic departments of radiology. Invest Radio11972;27:61-62. 2. Getz TA, Evens RG. Residencies in diagnostic radiology and perception of residents: 1987 A3CR2 survey. Invest Radiol 1988;23:308-311. 3. Bower BL, Engels JT, Evens RG. Results of the 1989 survey of the American Association of Academic Chief Residents in Radiology. Invest Radiol 1991 ;26:99-102. 4. Evert MB, Schertz LD, Wilson AJ, Evens RG. Results of the 1990 survey of the American Association of Academic Chief Residents in Radiology (AaCR2) emphasizing data about chief residents in radiology. Invest Radiol 1991 ;26:773-776. 5. Perry MA, Smith DK, Wilson A J, Evens RG. Results of the 1991 survey
RESULTS OF THE 1996 A3CR 2 SURVEY
6.
7.
8.
9.
10. 11.
of the American Association of Chief Residents in Radiology. Invest Radiol 1992;27:402-405. Horstman WG, Kang E, Wilson A J, Evens RG. Results of the 1992 survey of the American Association of Chief Residents in Radiology. Invest Radio11993;28:96-99. Oser AB, Baker SM, Wilson AJ, Evens RG. Results of the 1993 survey of the American Association of Chief Residents in Radiology. Acad Radiol 1994; 1: 154-158. Duncan JR, Derdeyn CP, Evens RG. Results of the 1994 survey of the American Association of Chief Residents in Radiology. Acad Radiol 1996;3:71-76. U.S. National Center for Education Statistics. Digest of education statistics. Washington, DC: U.S. Government Document NCES 95-029, 1995. Physician characteristics and distribution in the U.S.: 1990-present. Chicago, IL: American Medical Association, 1995. Consumer price index for all urban consumers: all U.S. cities. In: January monthly labor report and CPI detailed review 1990-1995. Washington, DC: U.S. Bureau of Labor Statistics, 1995.
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Results of the 1996 Survey of the American Association of Academic Chief Residents in Radiology Farrel K. VanWagenen, MD 1, Eric R. Weidman, MD 1,2, James R. Duncan, MD, PhD 1, Ronald G. Evens, MD ~
R a t i o n a l e a n d O b j e c t i v e s . Diagnostic radiology chief residents w e r e surveyed on issues related to residency training to c o m p a r e features and gauge trends in training. M e t h o d s . Questionnaires w e r e mailed to accredited programs in the United States. A variety of demographic and common-interest questions w e r e asked. Results. Forty-three percent of surveys w e r e returned. The percentage of female residents was similar to that reported in other recent surveys; however, the percentage of w o m e n a m o n g lst-year residents had decreased. Resident salaries had increased, although the average salary for a 4th-year resident had decreased w h e n adjusted for inflation. Most lst-year residents started participating in overnight hospital coverage by their 12th m o n t h of residency, and the total n u m b e r of call days during residency correlated inversely with the size of the residency program. Almost half of residency programs used a night-float resident to provide after-hours coverage. C o n c l u s i o n . The information derived from the survey should be useful for program evaluation and future planning. K e y W o r d s . Education; radiology and radiologists, departmental management. he American Association of Academic Chief Residents in Radiology eets annually to discuss training of diagnostic radiology residents. The organization n o w includes university, community, and military hospital radiology training programs. An annual survey of the current chief residents has b e e n conducted since 1971 [1-8]. Several general topics are included in the survey every year, including questions about staff demographics, salaries, and the hospital. Other topics are rotated on a 4-year schedule. In 1996, the focus was on resident call and the chief resident position. MATERIALS
AND METHODS
Data C o l l e c t i o n a n d A n a l y s i s
Questionnaires w e r e mailed to chief residents at 150 accredited diagnostic radiology residency programs at university, military, and c o m m u n i t y hos-
132
From the 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO. aCurrent address: David Grant Medical Center, Travis Air Force Base, Fairfield, CA. Address reprint requests to R. G. Evens, MD, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110.
Received and accepted for publication October 15, 1996. Acad Radiol 1997;4:132-137
©1997, Association of University Radiologists
Vol.4, No. 2, February1997
RESULTS OF THE 1996 A3CR 2 SURVEY
TABLE 1: Women in Diagnostic Radiology Residency Programs
TABLE 2" Difference in Size of 1st-year Resident Class versus 4th-year Resident Class by Region
NO. of Women (%) Region
No. of Programs
All Years
Pacific Central Northeast Southeast West All
8 12 21 17 7 65
26 22 28 26 16 25
First Year 28 20 31 19 2 22
TABLE 3: Difference in Size of 1st-year Residen t Class versus 4th-year Resident Class by Program Size Program Size
Difference (%)
Jumbo Large Medium Small
-8.6 -3.9 +7.7 +4.1
pitals in the United States. Data w e r e tabulated and analyzed by using commercial database software (Filem a k e r Pro 2.0vl; Clads Software, Cupertino, CA). Information regarding staffing, resident demographics, and salary from the 1991-1995 association surveys was incorporated into this database. For analysis, training programs w e r e grouped into five U.S. geographic regions: Pacific (AK, CA, HI. NV, OR, and WA); West (AZ, CO, ID, KS, MT. ND, NE, NM, OK. SD, TX; UT, and WY); Central (IA. IL, IN, MI, MN, MO. OH, and WI); Northeast (CT, DC, DE, MA, MD, NH, NJ., NY, PA. RI. and VT); and Southeast (AL, AR, FL. GA, KY, LA, MS. NC, SC, TN, VA, and WV). In prior surveys [7], Nevada had been included in the w e s t e r n region, but it was m o v e d to the Pacific region for this survey. Programs w e r e also grouped into four categories by size, based on the total n u m b e r of residents in each program: Small 0ess than 13 residents), m e d i u m (13-24 residents), large (25-40 residents), and jumbo (more than 40 residents). RESULTS Survey Response Rate Chief residents from 65 (43%) of 150 accredited diagnostic radiology programs c o m p l e t e d and returned the questionnaire. This response rate was similar to the
Region
Difference (%)
Central Northeast Pacific Southeast West
+2.8 +5.4 -9.1 +6.3 -3.1
response rates for the two most recent surveys (34% and 42%). W o m e n in Diagnostic Radiology Residency Training Twenty-five p e r c e n t of all residents in the programs from w h i c h w e received responses w e r e w o m e n . In 1994 and 1992, this n u m b e r was also 25%, and in 1991 it was 26%. In 1996, w o m e n accounted for only 22% of all lst-year residents, however, c o m p a r e d with 29% in 1994 and 33% in 1993. In Table 1, the percentage of female radiology residents reported in the current survey is presented by region. During the 1990s, the annual percentage of w o m e n w h o are a m o n g U.S. medical school graduates reportedly has varied annually bet w e e n 34.2% and 37.9% [9,10]. Changes and Differences in Residency Class Size To gauge the change in residency class size during the past 4 years, the n u m b e r of 4th-year residents was c o m p a r e d with the n u m b e r of 1st-year residents in a given program. Programs with f e w e r 1st-year residents than 4th-year residents w e r e p r e s u m e d to be decreasing in size (volUntarily or involuntarily) and vice versa. The percentage differences b e t w e e n 1st-year class size and 4th-year class size are presented by geographic region in Table 2 and by overall program size in Table 3. In general, w e found that large programs and those in the western United States w e r e decreasing in size, while small- and medium-size programs and those in the East reported increasing in size. Staff Demographics and Caseloads The percentage of cases assessed by faculty alone without resident involvement varied inversely with program size (Table 4). The percentage of cases read by residents alone without faculty review or involvement, the average annual resident caseload (not including
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Voi.4, No.2, February1997
TABLE 5: Average 1st-year and 4th-year Resident Salaries by Geographic Region
TABLE 4: Average Number of Annual Cases per Resident by Program Size
Salary ($)
Program Size Data
Jumbo
Cases read by faculty 7.0 only (%) Cases read by resident 0.5 only (%) No. of cases per resident 7,131 No. of faculty per resident 1.3 No. of fellows per resident 0.4 No. of hospital beds per 62 resident
Large
Medium
Small
15.7
20.6
34.7
0.6
3.2
0
7,362 1.5 0.4 41
7,027 1.4 0.3 47
8,662 1.6 0 59
Region Central Northeast Pacific Southeast West All
40000
1st Year
4th Year
31,479 33,886 33,670 30,026 28,483 31,824
35,400 39,086 41,937 34,129 32,908 36,795
4th YearSalary --O-- CPI-Predicted4th Yr. "- 1st YearSalary
37500 TABLE 6: Average Book and Travel Allowance Program Size
Allowance ($)
Jumbo Large Medium Small All
563 681 853 1,009 845
cases read by faculty only), faculty-to-resident ratios, fellow-to-resident ratios, and the n u m b e r of hospital beds per resident are also summarized in Table 4. This demographic information did not vary greatly among programs of different sizes except for small programs, which reported a higher annual resident caseload, no unreviewed resident image interpretation, and a lack of fellows. Resident Remuneration
Average salaries for lst- and 4th-year residents, $31,824 and $36,795, respectively, are presented by region in Table 5. Trends in lst- and @h-year resident salaries are plotted in Figure 1. Predicted salaries based on the annual consumer price index (CPI) [11] are also plotted in Figure 1. Mthough resident salary increases have generally paralleled the CPI in the past 5 years, the average @h-year resident salary increase did not match the CPI in 1996. Seventy-one percent of residency programs surveyed provided an allowance for books and travel for their residents, compared with 40% in 1993. The average book and travel allowance provided was $845, but the amount varied with program size (Table 6).
134
35000 32500 30000 27500 25000 1992
I
I
I
I
1993
1994
1995
1996
FIGURE 1. Resident salary trends and salaries predicted by means of CPI.
Overnight Hospital Coverage
Ninety-seven percent of residency programs from w h i c h responses were received required residents to participate in overnight hospital coverage. Forty-three percent of programs had dedicated "night-float" rotations during w h i c h residents worked overnight shifts and were off during daytime hours. In 54% of such programs, the night-float resident provided all after-hours coverage; traditional extended-shift overnight coverage had been eliminated at these institutions. The length of training residents received before beginning overnight coverage varied among programs (Fig 2). The duties expected of residents the day after overnight coverage also varied (Fig 3); 59% of programs allowed the resident to leave immediately after morning readout or early in the day. In 26%, the next work day was not an issue because overnight call either was not required (3%) or was provided entirely by a nightfloat resident (23%). Only 15% of programs required the resident to work a full day after overnight call.
Vol.4, No. 2, February 1997
RESULTS OF THE 1996 A3CR 2 S U R V E Y
25% >12 Months
26% Not Applicable 3% o Call FIGURE 2.
27% 6-12 M o n t h s
45% • 6 Months
Length of training before residents begin overnight coverage.
15% Full Day
25% Excused FIGURE 3. Resident work responsibilities after overnight call.
34%
Leaves Early
TABLE 7: Average Number of Call Nights Assigned to Each Resident during Training Program Size
Table 8: Number of Chief Residents by Program Size
Call Type
Jumbo
Large
Medium
Small
All
In-house Beeper All
89 21 111
86 73 158
98 79 177
103 81 184
95 73 168
181 I-1Benefits
Added Meetings
==Duties
20
Admin. Time Office Stipend Org. Board Review Med. St. Teaching Res. Teaching Res. Selection Curiculum Dev. Vacation Sched. Call Schedule Rotation Sched.
Program Size
No. of Chief Residents 1
2
3
Share
Average No, of Residents per Chief Resident
Jumbo Large Medium Small All
0 0 11 9 20
2 14 15 5 36
3 3 0 0 6
0 0 0 3 3
20 14 13 9 13
12s 175 45 51
77
0
10
20
30 40 50 60 70 80 Percentage of Chief Residents
90 100
FIGURE 4. Benefits and duties of chief residents.
The total n u m b e r of call days assigned to a resident during the 4 years of residency varied depending on program size (Table 7). The n u m b e r of home- and beeper-call days differed considerably, but differences in the number of in-house call days were more modest. Chief R e s i d e n t T o p i c s
The year during w h i c h residents served as chief resident varied. Sixty-two percent of residents surveyed served primarily during their 4th year of residency, and 38% served mainly in their 3rd year. The average number of chief residents per program and the average number of residents per chief resident varied with program size (Table 8). In three small programs, the responsibilities of chief resident rotated among all 4thyear residents. Figure 4 illustrates the duties performed by chief residents (in addition to their clinical responsi-
bilities) and the benefits provided in return. Resident scheduling was required of responding chief residents relatively consistently, whereas educational duties (teaching and organizing board reviews) were required more variably. Three-fourths of responding chief residents received additional remuneration for their work, with an average annual chief resident stipend of $1,481. Eighty-one percent were given the opportunity to attend additional national meetings. A minority of chief residents were given offices (28%) or additional administrative time (20%) away from their clinical work to perform chief resident duties. S t a n d a r d i z a t i o n of F e l l o w s h i p A p p l i c a t i o n P r o c e s s
Eighty-two percent of responding chief residents believed that national guidelines should be created to establish standard dates for fellowship application and acceptance. This finding contrasts sharply with that of the 1993 survey, in which only 19% favored such standardization. None of the residents believed it was possible to make an informed decision regarding the area in w h i c h to seek fellowship training before the 3rd year of residency training. Twenty-five percent believed the decision could be made early in the 3rd year of residency, and 57% favored making a selection late in the 3rd year; 18% would delay until early in the 4th year.
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VANWAGENEN
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DISCUSSION Overall, the percentage of w o m e n in radiology training appears stable at 25%, although it continues to be lower than the percentage of U.S. medical graduates w h o are w o m e n (approximately 36%). The percentage of w o m e n among lst-year residents (22%) in 1996 was lower than that seen in the previous few years. This difference may simply represent a sampling error. Given recent changes in the radiology resident applicant pool, however, this difference may represent a real change. It is possible that w o m e n in particular are becoming less inclined to enter careers in radiology. Although only approximations have been made, it appears that residency class sizes are changing among certain demographic groups. Larger programs and those in the western United States appear to be decreasing in size, while programs of medium or small size and those in the eastern United States may be increasing in size. Further study of these possible trends may be warranted given recent concerns about job availability and residency applicant pools. Annual resident caseloads are similar for residency programs of all sizes except for small programs, w h i c h reported a significantly higher caseload per resident. This finding may reflect a true difference in the n u m b e r of cases each resident reads or it may be partly due to differences in the types of cases read. The survey requested that annual relative value units (RVUs)billed be reported so that differences in case type could be corrected, but none of the responding residents provided this information. It is also possible that the apparent difference in resident caseload is due to underestimation of the percentage of cases read by.faculty alone without resident involvement, an error that would have the greatest importance in the small-program category. In 1996, 4th-year resident salaries did not keep pace with the CPI, and there was a decrease in salary w h e n it was corrected for inflation. A similar relative decrease was seen in the 1993 survey and was likely erroneous, given the subsequent rebound in salaries in 1994. Whether the curbing of 4th-year resident salaries in the current study marks a trend or is an aberration will likely be discovered once the 1997 chief resident survey has been completed. The percentage of programs that provide resident book and travel allowances appears to have increased from 40% in 1993 to 71% in 1996. Small programs tend to provide larger allowances than large programs. This
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larger allowance may be due to the need for residents of smaller programs to travel and pay tuition to take advantage of educational opportunities (board review courses, etc) w h i c h are often provided on site and free of cost at larger programs. Nearly all residents participate in after-hours radiology coverage. It is not surprising that residents at smaller programs are assigned a greater number of call days than residents at larger programs. The difference in the n u m b e r of beeper- and home-call days is considerable, but the difference in in-house call days is more modest. Only 15% of residents are required to work a full day after overnight call, a finding that may perhaps compensate for differences in the total number of call days assigned at various programs. It is interesting to note that 43% of residency programs use a night-float resident to provide after-hours coverage, a practice that may be gaining popularity. Although chief resident responsibilities vary among programs, more than three-fourths of residents are involved in scheduling resident rotations, vacations, and call. A total of 60%-72% of residents influence the quality of their residency program through involvement in resident selection and curriculum development and evaluation. Slightly more than half of chief residents are involved in teaching of residents and medical students. In exchange for these additional administrative responsibilities, most (75%) receive a chief resident stipend. The majority are also allowed to attend additional national meetings, primarily meetings of the American Association of Academic Chief Residents in Radiology and the Association of University Radiologists. A minority of responding chief residents have access to their o w n or a shared office or receive additional time to perform their added duties. The majority (82%) of responding chief residents favor standardizing the fellowship application process. Disadvantages of the current system include the need for residents to select a fellowship before they have had adequate exposure to the various radiology subspecialties and the need for them to decide on a fellowship offer before other interviews have been completed. Use of standard application dates would allow both the applicants and the program administrators to fully consider all options before committing to a partnership. Although the time period favored for selecting fellowships varies among chief residents, a majority (82%) believe an informed decision could be reached by the latter half of the 3rd year. Further consideration
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regarding standardization of the fellowship application process, including discussions of the costs, effectiveness, and implementation, seems warranted. REFERENCES 1. Evens RG. Report on a survey of chief residents in academic departments of radiology. Invest Radio11972;27:61-62. 2. Getz TA, Evens RG. Residencies in diagnostic radiology and perception of residents: 1987 A3CR2 survey. Invest Radiol 1988;23:308-311. 3. Bower BL, Engels JT, Evens RG. Results of the 1989 survey of the American Association of Academic Chief Residents in Radiology. Invest Radiol 1991 ;26:99-102. 4. Evert MB, Schertz LD, Wilson AJ, Evens RG. Results of the 1990 survey of the American Association of Academic Chief Residents in Radiology (AaCR2) emphasizing data about chief residents in radiology. Invest Radiol 1991 ;26:773-776. 5. Perry MA, Smith DK, Wilson A J, Evens RG. Results of the 1991 survey
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of the American Association of Chief Residents in Radiology. Invest Radiol 1992;27:402-405. Horstman WG, Kang E, Wilson A J, Evens RG. Results of the 1992 survey of the American Association of Chief Residents in Radiology. Invest Radio11993;28:96-99. Oser AB, Baker SM, Wilson AJ, Evens RG. Results of the 1993 survey of the American Association of Chief Residents in Radiology. Acad Radiol 1994; 1: 154-158. Duncan JR, Derdeyn CP, Evens RG. Results of the 1994 survey of the American Association of Chief Residents in Radiology. Acad Radiol 1996;3:71-76. U.S. National Center for Education Statistics. Digest of education statistics. Washington, DC: U.S. Government Document NCES 95-029, 1995. Physician characteristics and distribution in the U.S.: 1990-present. Chicago, IL: American Medical Association, 1995. Consumer price index for all urban consumers: all U.S. cities. In: January monthly labor report and CPI detailed review 1990-1995. Washington, DC: U.S. Bureau of Labor Statistics, 1995.
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