Career Overview: What I Do As a Radiologist
When you stop and think about it, it’s amazing how thoroughly we can examine the inside of the human body using non-invasive methods. X-rays, MRIs and computed tomography are important tools in the diagnosis of patients, and specialized radiologists are required to apply these imaging techniques.
To learn a little about what it means to be a radiologist, we spoke with Associate Professor Frank Gaillard. Dr. Gaillard is a neuroradiologist specializing in brain and spinal cord imaging at Royal Melbourne Hospital in Australia. He also runs the online educational resource Radiopaedia.org , which collects data on radiology research for doctors and students. He says radiologists are sometimes referred to as the “physician’s doctor” because they are often sought out by their colleagues to help interpret the scan results.
First of all, tell us a little about your current job and how long you have been doing it.
There are two interrelated parts in my current job. On the one hand, I am a Scientific Consultant Neuroradiologist (a radiologist specializing in imaging the brain and spinal cord) at the Royal Melbourne Hospital in Melbourne, Australia. I have been working in this department as a consultant (this is called service personnel in the US) for 5 years after my internship in Australia and Canada.
I am also the Editor-in-Chief and Founding CEO of Radiopaedia.org , the largest available collaborative radiology resource that I founded 10 years ago.
What prompted you to choose your career path and how did you come to work? What kind of education and experience did you need?
I have had a lot of exposure to medicine in general and radiology in particular. When I was a boy, let’s say 13 years old, I thought cutting open someone’s skull was pretty cool, so I started telling everyone that I was going to become a neurosurgeon. I have always been quite science-minded (read: computer scientist), and since medicine demanded the highest marks on admission, I worked on the principle that if I didn’t like it, I could always change “down” for something else. I didn’t actually revisit my “ head opening is cool ” career choice for another 14 years (graduated from high school, 6 years of medicine at university and 3 years as an intern / home medical practice), where I ended up at the beginning of my neurosurgery training.
A month after my first year in neurosurgery, I realized that this was not for me. Not because it’s not cool, but because the operations seemed long and boring to me. I left out my extremely short attention span. 4-10 hour surgeries were unbearable and I knew I was going to make a lousy surgeon. So I set my splash screen to count down to the end of the year with over 300 days left and thought what I could do next. I met a wonderful woman, now my wife, who was also a physician and planned to become a radiologist. I never thought of radiology as a career, pathology or taxidermy. But then, after going through so many years of surgery and completely falling out of love with the idea of cutting and suturing, I thought, “Why not?”
I was fortunate enough to get a position in the radiology program at Royal Melbourne Hospital, and I quickly discovered that what I had taken all these years to be an interest in brain surgery was actually an interest in brain pathology, and naturally gravitated towards neuroradiology.
What are you doing besides what most people see? What do you actually spend most of your time on?
I spend most of my time sitting in a rather dark room in front of a computer with three high-quality monitors, looking at MRI scans of people’s brains. In some cases, I am looking for something abnormal to explain the symptoms (eg headaches). In many other cases, the anomaly is obvious (like a mass or a bump), trying to figure out what it is; is it a tumor or an infection? If a tumor, what kind of tumor is it? What other parts of the body can be involved and need to be examined?
We perform scans to track known and cured conditions to see if therapy is working. For example, did a brain tumor that was removed two years ago come back?
Radiologists are also sometimes referred to as “doctor’s doctors” because other clinicians often seek us out, not only because of our interpretation of the scanned images, but also because of how we think these images fit into the overall clinical scenario. We hold numerous interdisciplinary meetings at which many specialists (in my specialty, a typical meeting includes neuroradiologists, neurosurgeons, neurologists, neuropsychiatrists, neuropathologists) discuss difficult or interesting cases.
Another important component of my work is teaching and supervising our trainees, who usually interpret the scanned images themselves, and then we go through their entire list together, checking if I agree with their interpretation and training, where appropriate. In this sense, specialized medicine is still largely an apprenticeship.
What misconceptions do people often have about your job?
The greatest delusion is that we do not exist. Most of the population, thanks to TV shows and the clinicians themselves, believe that the pictures are taken by technicians (i.e. radiologists) and interpreted directly by the clinician (i.e., neurosurgeon or neurologist). While it is certainly true that doctors look at their patients’ pictures and can in many cases interpret them correctly, all the good doctors I work with rely on our interpretation as the gold standard.
What’s your average uptime? Typical 9-5 thing or not?
Full-time work is 40 hours a week, from about 8 to 6, but this varies from hospital to hospital. A full-time job for us is four 10-hour days a week, with weekends and on-call requirements. I only work 75% of the time at the hospital (three days a week) and the rest of the time at Radiopaedia.org where I guide the development team (at Trikeapps.com) to create our new features, etc.
What personal tips and shortcuts have made your job easier?
Radiology itself is sporadic. Interpretation of each exam takes a different time, depending on whether it is a chest x-ray or a complex MRI. Some of them take only a few seconds, others up to half an hour. In my specialty, most of them, I believe, are between the 5-15 minute mark. As a result, the temptation to try multiple tasks at the same time is quite strong, and it is very important to limit distractions. I try to prevent my Gmail account or other distracting pages from opening while I work; [instead] I only check my email a few times a day. We use voice recognition with many templates for general reports, which helps as well.
What are you doing differently from your colleagues in the same profession? Well, this may not apply to the medical professions as your peers are working towards the same goal!
Yes. This is hard. I think I regularly do a couple of things that, in my opinion, are very important, but not so many for many colleagues, especially those who are engaged in private practice, where the time pressure is clearly different. First, I write down almost all my predictions (for example, I think this lump will turn out to be glioblastoma [a type of brain tumor]) and how confident I am about it.
I use the Quick Encrypt Chrome extension and record my predictions on PredictionBook.com (predictions are also kept private) to ensure patient privacy. PredictionBook allows you to add not only a forecast and confidence level, but an email trigger for the “you should know if you are right now” date … This means I can quickly review the histology and see if I was correct.
I also collect cases and post them to Radiopaedia.org. We are fortunate to have a great IT team in our department and have used the Radiopaedia.org API to create a downloader that makes it easy to download completely anonymous cases. Over the years, I have accumulated over 3000 case studies that are available to other people to learn from them or teach with them.
What’s the worst part of a job and how do you deal with it?
I don’t really have the terrible part of my job; lucky me. I think that interruptions are probably the biggest disappointment, but it is difficult to avoid interruptions without eliminating time-critical interactions with clinicians who help them manage their patients.
What is the most enjoyable part of the job?
Radiology in general and neuroradiology in particular (at least for me) are fascinating, because every year there is so much new knowledge and so many new discoveries that complete mastery of them is an impossible but tantalizing goal. My work with Radiopaedia.org also allows me to share my knowledge with colleagues around the world, many of whom work in countries with far less successful medical systems than Australia.
How much money can you expect at your job?
The income of radiologists (or physicians in general) varies greatly depending on where you work (private or public, urban or rural) and the type of work you do (interventional or diagnostic). As such, it is difficult to put a number on it. I assume (though I really don’t know) that we earn the same as many other doctors.
Is there a way to “advance” in your field?
As an academic radiologist “progresses upward” through publications and research grants, he eventually becomes an assistant professor and then a professor, but at least for my practice this has no financial implications. You can go to the administration and become the head of a department.
There are many more business opportunities in the private sector; creating your own practice in which other radiologists work, etc.
What advice would you give to those who want to become your profession?
Take action. This is the best decision I have ever made. I really enjoy my job and I think I can actively make the world a little better, both locally (the patients I help by interpreting their images) and more broadly by teaching a new generation of radiologists in Melbourne and elsewhere. using Radiopaedia. org.