Are Board-eligible Radiologists at a Disadvantage?

The 2010 class of radiology residents just finished their four years of training. And unlike the classes before them, they aren’t board-certified. They’re board-eligible. They can’t take the certification exam until 15 months after their residency ends, with the first such exam under the new paradigm scheduled for October 2015.

The new testing paradigm includes an all-encompassing core exam at the end of the residents’ third year, and a more specialized certifying exam 15 months later. This year’s core exam, given in June to the 2011 class, was the second time it was officially administered.

Impacted residents and fellows are wary about how the board eligibility status will affect their job prospects, moonlighting ability and studying while holding down a new job or fellowship.

“It is a concern, for every one of my colleagues in my class and the class ahead of me, who will be the first two under the new certification process,” said Tirath Patel, MD, a fourth year resident at the University of Toledo Medical Center. “There’s a lot of uncertainty out there,” especially given the tight job market.

“The feeling is that why would a group or hospital want to hire a board-eligible radiologist versus a board-certified radiologist who may be changing jobs?” he said. This is a change from the experience of most current radiologists, who were already board-certified before starting their first job.[[{"type":"media","view_mode":"media_crop","fid":"26825","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9202680710372","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2557","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

While this is new for radiologists, it’s standard for other medical specialties like orthopedic surgery, which requires residency plus two years working before taking the certification exam.

“When a new doctor applies to join our medical staff, a number of them can’t take their boards until a year from now. We adapt to that,” said Robert Pyatt, MD, a radiologist and the medical staff president of Chambersburg Hospital in Pennsylvania. Per hospital guidelines, “when you’re eligible, you take your boards and you have to pass within three years.” Contracts for radiologists are being adjusted at his hospital to reflect the change.

Hiring and Studying
Residents and fellows who aren’t yet board-certified are concerned that their status will be problematic when job searching. “The fact that we’re not board certified when we graduate is tough. No one knows how that will go,” said Shahrouz Tahvilian, MD, a fourth year radiology resident at Monmouth Medical Center in New Jersey.

The American Board of Radiology (ABR) knows about these concerns, and is spreading word about the change. They also offer radiologists a letter to attach to their job applications, explaining the situation. While those who just finished their fourth year residency aren’t able to be certified, “The fact that they’re not certified isn’t because they’ve failed. They’re able to practice independently,” per their program, said Kay Vydareny, associate executive director of the ABR for Diagnostic Radiology and the Subspecialties.

Pyatt doesn’t think it makes a difference that the new radiology hires are only board-eligible, since all the radiologists that year are in the same boat. “There’s not a new disadvantage compared to how it used to be. I’d have the same confidence for the same person coming in without the boards. They’re just trained. I wouldn’t hold it against them personally,” he said.  “When you interview candidates, you realize they can’t possibly have their boards,” he said. Most groups insist that in order to become a partner, though, you need to pass your boards. If you don’t pass the first year, you take them again.

That shouldn’t be such a problem. “In radiology prior to the change, there were only three radiologists in the whole state of 2,200 (Pennsylvania radiologists) who weren’t certified, and two of them were working privately,” said Robert Powell, executive director of the Pennsylvania Radiological Society and owner of Powell Healthcare Consultants.

One potential negotiating point, however, is whether to give the new hire time off to study for the exam. Instead of a signing bonus, one option is to give additional study time to the new hire, said Steve Thuahnai, MD, who graduated from his radiology residency as board-certified in 2012 and practices in Pennsylvania.

Asking for more time off may not go over well with all practices, though. Pyatt said that one candidate asked his practice for time off to study, in addition to vacation. “Most radiology groups have six to 15 weeks of vacation, typically. If a radiologist who is board-eligible is going to say ‘can I have extra, in addition to 12 weeks’ vacation?’ that won’t go over well with most groups. You have to figure out your own study routine,” Pyatt said.

Studying for certification while working full-time is a different beast than doing it during residency, when you’re in an academic facility and constantly up to speed. You may not have the stimulation of daily rounds or case presentations to keep you alert. “If you go into private practice and you’re busy working until six, and you get home and you’re tired, I think it might be challenging,” said Pyatt.

Salary
Some residents also expressed concern that salaries and offer quality will decrease based on the lack of board certification. “Overall the salaries are generally going to be going down,” said Thuahnai, but it’s not related to board certification, rather a result of a tight job market.

Pyatt agrees, and his facility is still giving the same pay to board-eligible radiologists as he’d give to a board-certified radiologist with the same training.

But Patel has heard different stories when speaking with several hiring groups. “Their hiring practice will change, hiring for maybe six months in a limited capacity with less money because you’re board eligible,” he said. Assuming the radiologist becomes board-certified, they’d then get a new partnership-track contract. “I got the impression that they can get away with it because it’s a tight job market,” and that radiologists might take that offer instead of being unemployed. “The change in the initial certification process really has been the catalyst as well.”

Moonlighting and Billing
Another potential issue for residents leaving their program board-eligible, is that they may not be able to moonlight during fellowship, said Thuahnai. “We all went into fellowship without having to study for another exam,” he said. “We could moonlight, with final reads.” Not all hospitals allow board-eligible radiologists to do final reads without an attending’s involvement, he said. “It all depends on the hospital.”

All insurance companies, including Medicare and Medicaid, pay for radiology billing, whether done by a board-certified radiologist or one who is board-eligible, said Powell, whose consulting company provides billing services to radiology practices.

However, residents are concerned that not every hospital will allow final reads for board-eligible radiologists. “I think over time this will change, and they’ll review their contracts and make the necessary adjustments, but it’s definitely an issue for my class and the ones on either side,” Patel said.