In residency training, we were advised that it was better to start off slow and be accurate, generate good reports, and then slowly build up speed when starting out as a new attending. The confidence will come with time. I found this to be good, helpful advice.
Siobhan Alexander, MD, realized early on in her residency that she wanted to be a radiologist who was directly involved in patient care, and that interest ultimately led her to a breast imaging fellowship at the University of California, San Francisco.
"I knew that I really enjoyed being hands-on doing procedures," Dr. Alexander shared. That understanding and her passion to be part of an organization where she could help influence and improve health care led her to Wake Radiology, a leading imaging practice in Raleigh, NC. The group covers five hospitals and operates 14 imaging centers—including two dedicated breast centers—in partnership with UNC Rex Healthcare.
The ability to provide high-level, patient-centered care in a group that puts patients at the forefront of decision-making was another factor for Dr. Alexander in deciding where she would practice.
"I can have more control in determining how things are done for patients in private practice," she said. "I've found that it is much easier to go above and beyond for patients. For example, as a breast imager, if I see that a patient has a BI-RADS 5 breast mass that looks like cancer or a very anxious patient needs a biopsy, I'm often able to add on the biopsy same day to help efficiently diagnose the patient and reduce patient anxiety. There is less red tape involved."
Navigating the Transition from Training
Just a few years out of a breast imaging fellowship at the University of California, San Francisco, Dr. Alexander functions as a breast radiologist working at the breast centers on weekdays and as a general radiologist for the hospital on occasional evenings and weekend call shifts. All 12 of Wake Radiology's breast imaging locations are Breast Imaging Centers of Excellence as designated by the American College of Radiology.
"There is little overlap between breast imaging and general radiology, so I enjoy being able to maintain the fund of knowledge acquired during training," Dr. Alexander explained. "As much as I appreciate catching a small or subtle breast cancer and knowing the positive impact I am making in a woman's life, it is also rewarding to diagnose a subtle hip fracture on X-ray or come across an "Aunt Minnie" type of interesting case — most recently a case of gallstone ileus with cholecystoduodenal fistula."
Dr. Alexander acknowledges the challenges of transitioning to become an attending radiologist, including gaining reading speed and confidence. "In residency training, we were advised that it was better to start off slow and be accurate, generate good reports, and then slowly build up speed when starting out as a new attending," she said. "The confidence will come with time. I found this to be good, helpful advice."
A Framework for Success
She highly recommends that newly hired radiologists get involved in a practice-building initiative during their first year in practice to help them assimilate into the group. "Another colleague and I helped develop a radiologist review program for all radiologists in the practice, but particularly for the new and junior radiologists," she shared. "It provides a framework for tracking progress and helps to keep junior radiologists on the right track for partnership."
In addition to providing new radiologists with guardrails for job performance and other contributions including practice building, the framework has created a feedback loop for all radiologists to better understand the quality of their technologist and patient interactions.
"All radiologists meet with a section mentor periodically to review and assess their progress," explained Dr. Alexander. "The intention is to help radiologists improve patient and support staff interactions."
Investing for the Future
Now in her third year with Wake Radiology, Dr. Alexander has transitioned from trainee to become a contributing member of a strong and supportive team.
"I feel lucky to be part of a group that welcomes new radiologists and is eager to have them get involved with practice building from the start, even if this is their first job out of training," she noted. "It helps young radiologists feel like they have a voice and can influence positive change in practice operations and structure."
"It's smart too," she continued. "By investing in young radiologists, a practice is investing in its future."
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