An unbiased view about Radiology

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Hey all, I just wanted to get an unbiased view on Radiology and it's future from all of you out there (not just people who frequent the radiology forum). What are your thoughts on the field? I may have an opportunity to match in my home program, but do you all think it's what it is cracked up to be? people on the radiology forum make it out to be eutopia for obvious reason (unless they're warning everyone that computers will take over the field... heh). This is a very vague question, but what are your thoughts on the field? It's hard to get a good understanding of it even from my 2 week elective.

Im in EM and might not enjoy rads from a day to day standpoint, hence my chosen field.

However, if you enjoy the work itself I suspect radiology is all that it is cracked up to be.
How often do you see a disgruntled rads resident (admittedly, how often do you SEE a rads resident)?

Interesting diagnostic work, neat technology, good money/hours and your services are in demand.

Thanks.... It's impossible to predict the future, but I just fear that all other fields (Cards, GI, etc...) will slowly encroach on the imaging techniques that radiology currently uses. Sure it's on it's growth phase right now, but it may not be like that for long.

I doubt that rads loses all of that. I think their argument about being responsible for the entire film (what if the cardiologist misses the noncardiac tumor on cardiac CT?) and generally being the experts when it comes to imaging and evaluating those images probably trump. Having said that, I am not actively involved in any of the above fields and have no idea what is actually going on between them, but it would make more sense to have the radiologist interpret the film.

As technology improves, and data transfers speeds move into the terabyte/sec range, I would personally worry about general radiology as a field because of overseas outsourcing. It's definitely cheaper to hire someone in India to read all of the films.

Go into interventional...

Originally Posted by nirvana23

As technology improves, and data transfers speeds move into the terabyte/sec range, I would personally worry about general radiology as a field because of overseas outsourcing. It's definitely cheaper to hire someone in India to read all of the films.

Go into interventional...

Doesn't liability serve to limit the role of outsourcing?

Originally Posted by toothless rufus

Doesn't liability serve to limit the role of outsourcing?

Sure, but outsourcing is always going to be an issue because of the soaring in the cost of healthcare. Is it worth paying a staff of radiologists to cover the hopital 24/7, or pay for the 1 or 2 lawsuits that actually are awarded money per year?

I'm not saying that outsourcing is a good idea, in fact I think its a bad idea. But if the cost of healthcare continues to soar, expect hospitals to try to cut corners.

Agree with above - with improvements in technology come marginalization of profits. The standard doc in a dark room will slowly be replaced by less expensive outsourced competitors.

Interventional Radiology is a great field to enter now, as it is at the forefront of techology and is actually taking procedures away from other specialists (splenectomy versus embolization and vertebroplasty versus spinal reconstruction off the top of my head). This will be stable and lucrative for a while, until speed and techology outpace demand and reimbursement drops.

I would say that if you like it, you will be VERY happy....

Originally Posted by NinerNiner999

Agree with above - with improvements in technology come marginalization of profits. The standard doc in a dark room will slowly be replaced by less expensive outsourced competitors.

Interventional Radiology is a great field to enter now, as it is at the forefront of techology and is actually taking procedures away from other specialists (splenectomy versus embolization and vertebroplasty versus spinal reconstruction off the top of my head). This will be stable and lucrative for a while, until speed and techology outpace demand and reimbursement drops.

I would say that if you like it, you will be VERY happy....

I had heard it was the other way around---- that primary services were starting to do their own procedures and thus taking away cases from IR (like vascular (peripheral stents) and GI (biliary stents) doing their own respective procedures instead of referring out). Is that not the case?

Probably depends on where you are.

However, if you can offer one stop shopping (shoot the image and perform the procedure at the same time) and similar or better results, why not do it?

Originally Posted by peduncle

Hey all, I just wanted to get an unbiased view on Radiology and it's future from all of you out there (not just people who frequent the radiology forum). What are your thoughts on the field? I may have an opportunity to match in my home program, but do you all think it's what it is cracked up to be? people on the radiology forum make it out to be eutopia for obvious reason (unless they're warning everyone that computers will take over the field... heh). This is a very vague question, but what are your thoughts on the field? It's hard to get a good understanding of it even from my 2 week elective.

great pay...but more like office work....does not feel like you are a "real" doc

Originally Posted by medgator

I had heard it was the other way around---- that primary services were starting to do their own procedures and thus taking away cases from IR (like vascular (peripheral stents) and GI (biliary stents) doing their own respective procedures instead of referring out). Is that not the case?

That's what I've heard as well. Pain docs doing Vertebroplasty, discography, vertebral bone biopsy. Isn't interventional Neurology coming into vogue as well?

Originally Posted by NinerNiner999

Interventional Radiology is a great field to enter now, as it is at the forefront of techology and is actually taking procedures away from other specialists (splenectomy versus embolization and vertebroplasty versus spinal reconstruction off the top of my head).

Vertebroplasty is performed for pain relief from compression fractures and not as a substitute for fusion of an unstable fracture.

Originally Posted by nirvana23

As technology improves, and data transfers speeds move into the terabyte/sec range, I would personally worry about general radiology as a field because of overseas outsourcing. It's definitely cheaper to hire someone in India to read all of the films.

Go into interventional...

I doubt this will ever happen. Many doctors and patients (rightly or wrongly, I don't care) have an issue with Indian docs coming to the US to practice so I highly doubt they're gonna be all for the Indian docs just because they're in Mumbai. This is just the cry of the doomsayers "The Indian docs are coming! The Indian docs are coming!" Now, if you said that there'd be large Radiology "practices" set up in the US that read films for multiple hospitals all over the country then yeah I'd be there with you. But it's not likely that the films are going to leave the continental USA.

Anyway, to answer the original question. I like more hands on time with my patients but you can't deny that Radiology is interesting and as more/better imaging modalities come along it will get even more interesting. The pay and the lifestyle are great and you won't want for a job. If I were to do Radiology, I'd go for Interventional but I didn't hate my Diagnostic Radiology rotation.

Obviously no one can predict the future, I might be wrong about India an all but even if stuff changes, it happens over time. It's not like you're going to wake up one day and hear that all radiologists have been fired and every film will now be read in India. If you like Radiology then do it.

Hey all, new to SDN; old to the Ways

PGY3+ in Radiology thought I would offer my thoughts

Radiology is definitely not going the way of outsourcing to any significant degree. When we as residents hear these scenarios we literally LOL. I know a lot of radiology residents and I can confidently say that we are all busier now than we were one year ago, two years ago... Every group in town is looking to hire. Everyone is looking for a way to manage the workload.

In the future, I still don't see it. Dictating reports is only part of what we do. Consulatations etc to primary teams consumes a lot of time (as it should). How often do you go down to the radiology dept to go over a study, get an opinion, etc? Would you call a physcian in India... "I just wanted to review this CT scan with you"

If you like radiology I would go for it. Do not think twice about the nebulous outsourcing. And I wish you the best of luck.

Everyone is always being screwed by someone else.

Cardiology is taking over Thoracic Surgery
PCP steps on Derm
Int. Medicine hates Cards and tries to step on them
Everyone wants to step on plastics

When something is lucrative in medicine, others will try to squander it. That is how the business world works.

Right now Radiology just seems to be the think to squander. Will it seriously hurt rads in the future? Who knows? But I can guarantee that people will try.

Originally Posted by Proton Dense

Hey all, new to SDN; old to the Ways

PGY3+ in Radiology thought I would offer my thoughts

Radiology is definitely not going the way of outsourcing to any significant degree. When we as residents hear these scenarios we literally LOL. I know a lot of radiology residents and I can confidently say that we are all busier now than we were one year ago, two years ago... Every group in town is looking to hire. Everyone is looking for a way to manage the workload.

In the future, I still don't see it. Dictating reports is only part of what we do. Consulatations etc to primary teams consumes a lot of time (as it should). How often do you go down to the radiology dept to go over a study, get an opinion, etc? Would you call a physcian in India... "I just wanted to review this CT scan with you"

If you like radiology I would go for it. Do not think twice about the nebulous outsourcing. And I wish you the best of luck.

haha, I like the use of the word NEBULOUS. Very radiology of you.

Rads isn't going to be taken over by C3PO any time soon.

I'm in EM and there are several times a week I need to call the radiologist to ask for a clarification of a read. Alot of times it is with the "Virtual Radiology" doc. I know many in my field know these docs and can name them.

They are competent radiologists but they can and do miss things. Usually it is because they misunderstand my reasonings for ordering the study. For instance, I might order a chest CT with contrast to eval a questonable mass and it gets read as a PE study. Subtle difference but potentially significant.

I've had several occasions over the last few months where I swear I see a hip or neck fx that the radiologist read as negative. When I call him on it, he takes another look and agrees with my findings. This is just medicine and human nature. Not meant to bash the radiologist.

My point is that I can't very well call a computer and ask it to reconsider it's findings.

I believe that Radiology remains a superb career choice for those competitive enough to obtain a residency in it. The private practice pay and lifestyle are among the very best that a medical career can offer. The new technology that they utilize is fascinating.

I don't believe that outsourcing or "C-3PO" will take-over this area of medicine.

As for encroachment by other specialties like Cardiology, Gastroenterology, Neurology, et cetera? Sure, it happens. Same goes for any specialty, though. This shouldn't discourage you. The only constant to medicine is the fact that time changes all of the jobs, and it's very hard to predict what's going to occur next sometimes. New technology revolutionizes the specialties. So pick a job that you love...because you never know what's going to change with tech, Medicare, Medicaid, reimbursement, and insurance company coverage.

..by thomas freidman, gives an excellent overview of outsourcing. when the momentum of fiber optic cable production was at its highest, $3 trillion was invested in laying cable across the ocean floor. once the momentum slowed, the cable had already been installed, leading to explosions in the economies of cities such as Bangalore, India.

proponents of outsourcing claim that we can send all of our more mundane tasks overseas, which will allow creative minds to flourish at home while focusing on the non-mundane

freidman discusses how fields of medicine are suseptible as well. i was a bit disappointed that he didn't delve too far into the complexities of medical outsourcing- especially the litigious and 'customer service' aspects that have been mentioned on this forum. at the very least, it seems likely that w/ fields like radiology and path, cities such as bangalore could employ docs who would read much of the bread and butter cases, and have them signed off by US MDs willing to take litigious and 'customer service' responsiblity, effectively creating a group of relatively underpaid physician assistants.

what people fail to appreciate when they bring up outsourcing is that it implies that you'll have non-US boarded, non-credentialed docs practicing medicine on US patients...About as likely as saying that cardiology is in trouble because some doc from (the favorite country to pick on is India...) will come here and set up a cath lab and start cathing people for half price without US boards, licence, credentials etc...

Obviously that wouldn't fly, and neither will having someone not licenced, credentialed and boarded reading films, or prescribing exams.

KG

Originally Posted by Koil Gugliemi

what people fail to appreciate when they bring up outsourcing is that it implies that you'll have non-US boarded, non-credentialed docs practicing medicine on US patients...About as likely as saying that cardiology is in trouble because some doc from (the favorite country to pick on is India...) will come here and set up a cath lab and start cathing people for half price without US boards, licence, credentials etc...

Obviously that wouldn't fly, and neither will having someone not licenced, credentialed and boarded reading films, or prescribing exams.

KG

Agreed. The day that they allow rads in other countries to do final reads is the day that all of medicine, not just rads, should be afraid of (prelim reads can be done by foreign-located rads but not final ones). If they start to loosen the regulations, then it would not be confined to just rads. All medicine would be targeted. What's to stop hospitals from "insourcing" docs then? If rads in India, China, or Philipines can read a film just as good as an US rad, why isn't it true for other branches of medicine? A Russian-trained cardiologist is just as good as an American one, right? And he works longer hours, doesn't complain, and he's only 1/4 of the salary because he's desperate to get citizenship! Sounds like a great deal to me.

It cuts both ways, folks. Lawyers get a bad rap from docs, but I think they serve a very useful purpose. They keep these crazy ideas in check. Without them, healthcare in the US may look like the IT industry - a free for all.

2 hospitals I am reqired to do rotations have something at night called "night Hawk". It's basically a radiologist in India who does all the radiology reading at night. (ONLY AT NIGHT) Its kind of frustrating because sometimes when I have to get a verbal reading its hard to understand the radiologist. I'm just an intern, so this was a new concept to me: outsourcing for radiology. Is this common?

Originally Posted by Babe

2 hospitals I am reqired to do rotations have something at night called "night Hawk". It's basically a radiologist in India who does all the radiology reading at night. (ONLY AT NIGHT) Its kind of frustrating because sometimes when I have to get a verbal reading its hard to understand the radiologist. I'm just an intern, so this was a new concept to me: outsourcing for radiology. Is this common?

the most common country it goes to for NIGHT HAWK is actually australia NOT india. Other companies prolly do go to india.

and yes...very common in community hospitals in the tristate area.

Originally Posted by Proton Dense

Hey all, new to SDN; old to the Ways

PGY3+ in Radiology thought I would offer my thoughts

Radiology is definitely not going the way of outsourcing to any significant degree. When we as residents hear these scenarios we literally LOL. I know a lot of radiology residents and I can confidently say that we are all busier now than we were one year ago, two years ago... Every group in town is looking to hire. Everyone is looking for a way to manage the workload.

In the future, I still don't see it. Dictating reports is only part of what we do. Consulatations etc to primary teams consumes a lot of time (as it should). How often do you go down to the radiology dept to go over a study, get an opinion, etc? Would you call a physcian in India... "I just wanted to review this CT scan with you"

If you like radiology I would go for it. Do not think twice about the nebulous outsourcing. And I wish you the best of luck.

If there is a cheaper alternative, it will eventually be utilized. In my area many of the ICUs are already being monitored by doctors that are 50 to 100 miles away via cameras, monitors, computers, ...etc It doesnt mean that there are no Docs in the ICU, just a significantly less number of them. They are pretty much there to take over when things go wrong (alerted by the people who are staffing the monitoring centers).

I can imagine something like this occuring for radiology. The doctor ordering the xray, mri, cat scan....etc can give the order a score based on its urgency and degree of expected seriousness. The more or less routine orders could go to India/China and be read there quickly and sent back, while the more serious ones can be read in the US or read in India/China and rechecked by a Radiologist in the hospital.

I can also imagine Rad tech/ nurse type of fields opening open in the future analagous to the crna positions.

Maybe even computer programs that can read xrays/ MRIs; the ER doc can enter what they are looking for in the XRAY and enter the patients symptoms, history...etc and have the computer give its diagnosis based on the patterns it sees.

Again with all these scenarios I doubt it will put Radiology as a field out of business, but the number of radiologist that need to be in the hospital will be far less........essentially putting SOME radiologist out of business or reducing their hours and pay.

Originally Posted by Shah_Patel_PT

great pay...but more like office work....does not feel like you are a "real" doc

are you kidding me?

Originally Posted by NRAI2001

Again with all these scenarios I doubt it will put Radiology as a field out of business, but the number of radiologist that need to be in the hospital will be far less........essentially putting SOME radiologist out of business or reducing their hours and pay.

Rads is a diverse and flexible specialty. Changes will happen like in all fields of medicine, but rads will evolve with those changes too. As long as you have that mindset, you'll be fine.

The article is two years old, but still a pretty good read:

Hospital Services Performed Overseas

If something can be outsourced, then it can also be insourced. While the countries on the opposite side of the globe like Japan, South Korea, India are nighttime, it's daytime here. Someday, we'll be doing reads for them too. It may be a while though until their economies are stronger.

Originally Posted by ApacheIndian

I'm a PGY-4 rads resident. I love what I do. It feels like I play video games for a living. No BS from other services -- we are the uber consultants and people come to us for help -- never the other way around. My specialty is technology based and hence contactly moving forward, not stagnant like some other fields. I never get my hands dirty, I never get bodily fluids on me, I never have patient's spit on me, I never spend inordinate amounts of time talking to patients and family who don't have the capacity to understand what I'm saying. I don't deal with GOMERS. I earn $5000 per weekend moonlighting locally -- this year as a resident my total earnings will be 150K+ -- more than many of our hospitals trauma surgery attendings. I am doing a cardiothoracic imaging fellowship and can easily make 1+ mill working 50 hours/week after that. I can work from home, in any country, on ski slopes, or on a tropical island -- if I really want I can work from a yacht out in the ocean. I can scale back my work to 20 hours/week and earn 250K/year -- and do some entrepreneurship and business on the side -- and we all know that's where the real money is anyway.

Radiology is the only true white-collar specialty in all of medicine and surgery. Radiology transcends all the other specialties. It is hands-down the best field for one to go into -- bar none.

IMHO there's two types of people out there: The type who chose to go into radiology, and the type who wish they would have.

peace out

Just for that post I hope Hillary gets elected...

Originally Posted by ApacheIndian

I'm a PGY-4 rads resident. I love what I do. It feels like I play video games for a living. No BS from other services -- we are the uber consultants and people come to us for help -- never the other way around. My specialty is technology based and hence contactly moving forward, not stagnant like some other fields. I never get my hands dirty, I never get bodily fluids on me, I never have patient's spit on me, I never spend inordinate amounts of time talking to patients and family who don't have the capacity to understand what I'm saying. I don't deal with GOMERS. I earn $5000 per weekend moonlighting locally -- this year as a resident my total earnings will be 150K+ -- more than many of our hospitals trauma surgery attendings. I am doing a cardiothoracic imaging fellowship and can easily make 1+ mill working 50 hours/week after that. I can work from home, in any country, on ski slopes, or on a tropical island -- if I really want I can work from a yacht out in the ocean. I can scale back my work to 20 hours/week and earn 250K/year -- and do some entrepreneurship and business on the side -- and we all know that's where the real money is anyway.

Radiology is the only true white-collar specialty in all of medicine and surgery. Radiology transcends all the other specialties. It is hands-down the best field for one to go into -- bar none.

IMHO there's two types of people out there: The type who chose to go into radiology, and the type who wish they would have.

peace out

We were wondering where you went. WB Cuts...

Originally Posted by ApacheIndian

IMHO there's two types of people out there: The type who chose to go into radiology, and the type who wish they would have.

peace out

O rly? Well, there's 2 types of radiologists: those who have p***ies, and those who are p***ies.

Originally Posted by ApacheIndian

.

Radiology is the only true white-collar specialty in all of medicine and surgery. Radiology transcends all the other specialties. It is hands-down the best field for one to go into -- bar none.

I love radiology too, man, but come back down to earth.

The only white on my uniform is barium and my scrubs don't have collars.

Originally Posted by ApacheIndian

I'm a PGY-4 rads resident. I love what I do. It feels like I play video games for a living. No BS from other services -- we are the uber consultants and people come to us for help -- never the other way around. My specialty is technology based and hence contactly moving forward, not stagnant like some other fields. I never get my hands dirty, I never get bodily fluids on me, I never have patient's spit on me, I never spend inordinate amounts of time talking to patients and family who don't have the capacity to understand what I'm saying. I don't deal with GOMERS. I earn $5000 per weekend moonlighting locally -- this year as a resident my total earnings will be 150K+ -- more than many of our hospitals trauma surgery attendings. I am doing a cardiothoracic imaging fellowship and can easily make 1+ mill working 50 hours/week after that. I can work from home, in any country, on ski slopes, or on a tropical island -- if I really want I can work from a yacht out in the ocean. I can scale back my work to 20 hours/week and earn 250K/year -- and do some entrepreneurship and business on the side -- and we all know that's where the real money is anyway.

Radiology is the only true white-collar specialty in all of medicine and surgery. Radiology transcends all the other specialties. It is hands-down the best field for one to go into -- bar none.

IMHO there's two types of people out there: The type who chose to go into radiology, and the type who wish they would have.

peace out

As you stated rads as being so technology dependent....I can imagine a computer program doing the same job as a radiologist; with some sort of a tech or nurse entering history, vitals,..etc and perhaps a single radiologist managing 5 or 6 techs.

As I stated before.....IMHO I dont think radiologist will ever be completely replaced or outsourced...but the current status of radiology wont last for long. There will be fewer radiologists needed bc of 1) computer programs 2) outsourcing or insourcing to central locations.

Meaning: 1) fewer radiologists making the same money 2) same number of radiologists making much less money...

We ll see.........I like radiology but I would be very wary to enter the field.

If these situations pan out, what alternative fields can radiologists go into? Do another residency? Teach? Consult? Professional SDN Moderators?

Originally Posted by NRAI2001

As you stated rads as being so technology dependent....I can imagine a computer program doing the same job as a radiologist; with some sort of a tech or nurse entering history, vitals,..etc and perhaps a single radiologist managing 5 or 6 techs.

As I stated before.....IMHO I dont think radiologist will ever be completely replaced or outsourced...but the current status of radiology wont last for long. There will be fewer radiologists needed bc of 1) computer programs 2) outsourcing or insourcing to central locations.

Meaning: 1) fewer radiologists making the same money 2) same number of radiologists making much less money...

We ll see.........I like radiology but I would be very wary to enter the field.

If these situations pan out, what alternative fields can radiologists go into? Do another residency? Teach? Consult?

The state of computer aided detection at the moment is a JOKE. And thats just for mammography. I think CAD for MRI or CT, even for other plain films is a looooong ways off. The only thing that helps increase sensitivity in detecting breast cancer is a double read with a lot of coffee.

Why would you be wary? Radiology is still one of the most promising fields in medicine.

In the non-medical realm look at the IT sector, sure many jobs have been off-shored, but it is still undeniably THE field of the early 21st century. If you have the talent, I wouldn't let that scare you off from pursuing that field. Youtube, Myspace, Google all made it big after the bust.

Originally Posted by hans19

We were wondering where you went. WB Cuts...

That was exactly the thought that crossed my mind when I read it.

I think back then there was some mention of a tiki hut in bora-bora included, but the story is the same.

(oh, tomorrow morning, just for old times sake I'lll spill some pus onto my shoes. I have a nice juicy liver abscess brewing on the floor....)

what ever you chose make sure you enjoy it even if the salary takes a big hit. Rads took a huge hit this past year, and it will likely get worse. Before anyone says after a 16% or so cut that will be it, it won't go down more. That's what a lot of ophtho guys thought when cataracts took a 50 % hit late 80's to early 90's and since then almost another 50% cut not adjusted for inflation. we get about 30% of what a cataract paid, in the 80's. Ask almost any surgeon and they will tell you the same. Rads will probably get many more cuts as CT and MRI's which were viewed as new technology by insurance companies a few years ago become devalued. Ask a radiologist what they get for reading a chest x ray.

Here's my somewhat biased, but honest view:

The current salaries in radiology are unlikely to last more than a few more years, mainly due to decrease in reimbursement. I expect in 10 years from now, salaries will be more in line with pathology, which is still pretty damn good.

I do think more clinicians will be doing imaging, but I don't see that cutting into the volume of work that we do since much of this will be imaging that is developing to replace current invasive tecniques (cardiac ct, virtual colonscopy). Also, most clinicians will likely want the images to be reviewed by a radiologist, since the liability is high because these clinicians are not trained in imaging the whole body as radiologists are. I don't think outsourcing will be an issue due to quality/liability issues.

In terms of job prospects, I don't see there being a problem finding a job for many years given the current continued shortage and the expected continued increase in the amount of imaging performed. More desirable cities will always be harder to find a "perfect" position in, but this is the case for all specialties.

So I geuss, in the end, the people that will be unhappy with radiology will be those that entered the field primarily for sky high salaries and those who really love patient care, but gave it up for this reason. If you truly enjoy radiology, I think its a great field with a bright future and is at the forefront of medicine. Practitioners will continue to enjoy a very good income in line with the middle tier surgical and procedural subspecialists, but probably not in the realm of ortho spine or neurosurgery.