Independent radiology residents more productive on overnights than those in 24-7 attending models
Radiology residents working independently on overnight shifts are more productive than those operating in 24-7 attending models, according to a small study published Saturday.
For decades, the specialty has utilized this arrangement, with early-career docs providing autonomous after-hours interpretation and supervising rads reviewing their reports again in the morning. But today, more than half of programs have shifted to continuous attending supervision, one survey found, hoping to remediate any mistakes faster, among other reasons.
Wanting to understand the impact of this shift, imaging experts from several institutions compared data from both types of programs. They found that radiologists working in the fully independent training model were about 33% more productive, experts detailed in the Journal of the American College of Radiology.
“Our data suggest that there is a significant benefit to subsequent work productivity for radiologists who train in programs with independent, autonomous call as compared with a 24-7 attending radiologist training model, although this training model advantage rather quickly disappears statistically into the noise of interindividual performance variability,” Alexia Tatem, MD, with the University of California, San Francisco, and co-authors wrote July 17, adding that there was no difference in interpretive accuracy between the two groups.
To reach their conclusions, Tatem et al. tapped the employment database of Virtual Radiologic, a large, U.S.-based teleradiology firm. VRad’s records uniquely identify employed docs by their training background, number of cases interpreted per unit time worked, and adjudicated major error rate. They pinpointed 96 employed radiologists who met the study’s criteria.
Of those, 85% were trained in programs with independent, after-hours call systems versus 15% utilizing 24-7 attending supervision. A subset of 49 rads was evaluated in their first year of work following training. All told, average productivity equaled 21.03 cases interpreted per hour in the independent model compared to 14.08 in the attending group. However, there was large variance from one individual to the next, resulting in difference between averages that was not statistically significant (P = .16). Focusing only on those in their first year, Tatem and colleagues found a smaller but noteworthy productivity difference (P = 0.23).
Error rates were “uniformly very low” across all study subjects. The study has several limitations, including a lack of info on other program variances that may have contributed to the productivity disparity. Nor did the authors have information on radiologists’ sense of struggle or stress in their first year of practice.
“But one might expect that graduates of 24-7 attending radiologist programs may experience more subjective stress and a more difficult adjustment to independent practice after fully supervised training as compared with those who experienced autonomy and independence during their residency,” the authors speculated.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.