Your leaders hate you

[Baller MD]

http://www.jacr.org/article/S1546-1440(13)00847-8/abstract

Their unwillingness to close the loophole means they don't care whether or not you have a job when you're done with 6 years of training after medical school.

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[gonogo]

This is absurd. In every other specialty you need to complete residency in the US before you can take the boards. It makes no sense that residency programs pretend to be competitive and make it difficult for students to match while at the same time people who don't even do internship or residency in the US can just go straight into fellowship.

 

[hal9000]

Don't be foolish. It's never that simple. More radiologists means more power for the collective, even if individually we aren't as well off. When there are fewer of us, then we become more apathetic about turf loss. In fact, this is a reason why the field has lost so much turf in the last couple decades to all these random specialties. We kept saying, "Cardiac U/S? Why should I do that when I can be an RVU machine just reading Knee MR's?" Then we completely lost cardiac imaging, including the NM studies. Over-supply of Cardiologists is interestingly also how Cardiology has poached so much, especially from the CT surgeons, starting 3 decades ago.

Of course, all this sucks as an individual rad trying to find a job. That's why it's about striking a balance between enough of us for the power to sustain the field and not enough of us to individually command/demand power/wealth.

Unless you're an old rad about to retire. In which case, there's no reason to think any way but "screw the collective, give me my money now".

 

[bronx43]

Don't be foolish. It's never that simple. More radiologists means more power for the collective, even if individually we aren't as well off. When there are fewer of us, then we become more apathetic about turf loss. In fact, this is a reason why the field has lost so much turf in the last couple decades to all these random specialties. We kept saying, "Cardiac U/S? Why should I do that when I can be an RVU machine just reading Knee MR's?" Then we completely lost cardiac imaging, including the NM studies. Over-supply of Cardiologists is interestingly also how Cardiology has poached so much, especially from the CT surgeons, starting 3 decades ago.

Of course, all this sucks as an individual rad trying to find a job. That's why it's about striking a balance between enough of us for the power to sustain the field and not enough of us to individually command/demand power/wealth.

Unless you're an old rad about to retire. In which case, there's no reason to think any way but "screw the collective, give me my money now".

You guys lost cardiac imaging not because of apathy or lack of collective power. What, you think a few more guys out there in private practice really matters at all what the trend is for turf wars? That really starts at the academia level. You lost the battle because you don't control patient flow. When you control patient flow, all you need are a few cardiac imaging specialists, and the rest will spread like wild fire. It is a stretch to assume that more radiologists means more clout, leading to protection of turf.

 

[hal9000]

But that same logic can be applied to areas of turf that we still hold on to. My point wasn't that we lost turf because there weren't enough of us. My point was that it was a factor. And I'm not disagreeing that patient flow isn't also a factor, but it too isn't sufficient by itself. One major aspect that allows us to continue to hold on to various areas of turf is litigation in conjunction with centrally located imaging available for retrospective viewing and bad outcomes (small lung nodule that turns out to be cancer 6 mo later, ultimately putting grandma in the ground). The heart is obviously not the best for that sort of thing, making it tough to hold on to as it is. Then you add in some of the other factors, with just enough apathy from us, and it was a perfect storm.

 

[shark2000]

Cardiac Echo and angio was completely lost in 80s, though was never completely a part of radiology. Cardiac Nucs was never lost completely. 70% is done by cards and 30% by rads. Cardiac MRI will stay in big academic centers and will never become a pp modality in the near future. Cardiac CTA is uncertain for now.

But in general you are right. If you control the patient flow, you have a huge leverage when it comes to turf battle. Also more radiologists never result in turf protection. Turf protection is a different story that does not have anything to do with the number of trainees, at least within reasonable limitations. There is not any justification for increasing the number of residency spots or designing these special tracks. Having more trainees is only good for academic people to have someone do their job for them. When I was a fellow, my attendings barely got to dictate anything. It was all fellows and residents.

 

[shark2000]

One thing that you have to consider about cardiac imaging that makes it different from other fields. With all my respects for all my cardiology friends (including my girlfriend) the pathology, anatomy and the whole imaging process is relatively simple. Cardiac SPECT is much easier to read than whole body PET-CT or even bone scan.

There reason I bring up this is to argue against what the last poster that encouraged having more trainees. There are parts of radiology/imaging that are prone to turf loss like cardiac Nucs or anything vascular. The main reason is the relatively simple pathology and anatomy. On the other hand, there are a lot of parts of radiology/imaging that are near impossible to be lost even if there is a shortage. For example, CT abdomen pelvis or whole body PET-CT. Too many organs and too many pathologies are involved. Even pulmonologists who claim that they can read lungs as good or better than radiologists, are very incompetent when it comes to mediastinum or bones.

So I don't agree with your point. There is a core part of radiology that can almost exclusively be done by a radiologist and even if there is a shortage there will not be a turf loss. Vascular surgeons can read vascular US but when it comes to a patient in ED trauma to rule out aortic dissection, you need a radiologist to read the CT chest or And/pelvis. The vascular surgeon at most can look at aorta and says that it is normal, but he can not diagnose a bowel hematoma or sacral fracture.

 

[Silent Cool]

http://www.jacr.org/article/S1546-1440(13)00847-8/abstract

They're Their unwillingness to close the loophole means they don't care whether or not you have a job when you're done with 6 years if training after medical school.

Their, their, their!

Please subscribe to this facebook page:

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You are going to be a DOCTOR, afterall--write like one. Don't right like one. Or wright light one. Write like it.

Otherwise, nice post.

 

[Baller MD]

Their, their, their!

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You are going to be a DOCTOR, afterall--write like one. Don't right like one. Or wright light one. Write like it.

Otherwise, nice post.

My bad. I was typing on my phone.

 

[PL198]

I don't get how more attendings and residents don't b*tch enough to make the loophole be closed. It's a complete joke.

 

[bulletproof]

Radiologists are Eunuchs. They will just continue to bend over and take it.

 

[radman123]

Radiologists are Eunuchs. They will just continue to bend over and take it.

NO ONE CARES about radiology graduates, careers, job market etc. There is nothing being done about the glut because no one in a position to do something cares because it does not affect them.

Troll schmoll. Where were the trolls before the glut which is only getting worse? Back then it was mostly do I do a fellowship or get a fantastic job with terrific terms. It is truly unbelievable to me see such qualified applicants applying to the current state of the field. Is it denial, ignorance, inability to believe the truth, delusions that doing what you love will make it work out?

 

[deleted116380]

What I'm more interested in knowing is how many of these US fellowship-trained foreign-residency radiologists are taking away from US trained radiologists in terms of the actual attending jobs? I don't care if they take some extra fellowship spots no one else wanted if they aren't getting the jobs after it.

This is anecdotal, but there is a foreign trained radiologist that did MULTIPLE radiology fellowships at a program near my program, but never got a job offer. Could've been a personality thing, but he ended up applying and getting into a regular residency (I think IM of all things). So that particular person didn't really affect US-trained radiology residents and the job market even though he did the pathway that would've allowed him to be a radiologist in the US.

 

[radman123]

Look at the faculty rosters of many academic places like Iowa, U of C, etc. and you will see many attendings who have never done residency training in this country. Think the guy who wrote the big green Dahnert book never did residency here either. Think this is only a small slice of the problem however.

 

[shark2000]

Unfortunately, it seems that the academic places only think about themselves.

 

[radman123]

Unfortunately, it seems that the academic places only think about themselves.

Yes and I remember how during the shortage, academic places were desperate for help and grads were only thinking about themselves and the boatloads of money waiting for them. Some good times back then. Complete reversal now however.

 

[IJL]

Yes and I remember how during the shortage, academic places were desperate for help and grads were only thinking about themselves and the boatloads of money waiting for them. Some good times back then. Complete reversal now however.

1. Quit your job

or

2. Quit complaining

 

[PL198]

1. Quit your job

or

2. Quit complaining

I mean that's not really a logical dilemma. There are certainly lots of people unhappy with the current state of their job but can't do anything about it. I agree his complaining is overzealous, but it's silly to say that someone can't complain unless they quit their job.

 

[gonogo]

What I'm more interested in knowing is how many of these US fellowship-trained foreign-residency radiologists are taking away from US trained radiologists in terms of the actual attending jobs?

Where I did residency there were many attendings who didn't do residency here in the US and became attendings through the FMG loophole. I always found it interesting that my program was so competitive for residency yet they'd allow people who did residency abroad to go straight into fellowship, with many of them staying as faculty. So to answer your question, yes, a significant amount go on and become attendings. This is unique to radiology, or at least not nearly as common in other specialties.

 

[deleted116380]

Look at the faculty rosters of many academic places like Iowa, U of C, etc. and you will see many attendings who have never done residency training in this country. Think the guy who wrote the big green Dahnert book never did residency here either. Think this is only a small slice of the problem however.

Seems to me they took those spots up when they were likely harder to fill and not that competitive. I doubt many if any US-trained radiologists were turned down for those over the foreign trained Now I think if/when PP jobs pay comes down more toward academics and US trained radiologists start applying more to Universities, the foreign-residency US-trained fellows will not get those spots at all.

And as you said, it's a small % of the problem.

 

[nycitygas]

How many radiologists a year are produced through this loophole? 50-100?s

 

[shark2000]

It is less than 100. Used to be (much) more. I think last year it was about 20.

It is not by itself a big deal. But the whole philosophy is wrong at many levels. Also the number of residency spots should come down.

Just a marginal excess makes things MUCH MUCH harder. I think there is just marginal surplus now. Let's say there is just 50 less jobs than the number of trainees. It means that for every job that is advertised in addition to the usual applicants there are 5o more candidates who apply. Now add the psychological effect to that. Because of the psychological effect of it, for every job there will be tons of applicants because people are stressed about not being able to find a job. The end result will be 200-300 or even more applicants for every job. It does not mean that there is 300 less jobs that the number of applicants if 300 people apply for the same spot. Somehow similar to applying to a competitive specialty. Even the most competitive fields have about 2 spots for 3 applicants. But in practice there are 100 applicants for each spot.

So yes, even if you train 20 more people it has a huge indirect effect on the market.

 

[Silent Cool]

It is less than 100. Used to be (much) more. I think last year it was about 20.

It is not by itself a big deal. But the whole philosophy is wrong at many levels. Also the number of residency spots should come down.

Just a marginal excess makes things MUCH MUCH harder. I think there is just marginal surplus now. Let's say there is just 50 less jobs than the number of trainees. It means that for every job that is advertised in addition to the usual applicants there are 5o more candidates who apply. Now add the psychological effect to that. Because of the psychological effect of it, for every job there will be tons of applicants because people are stressed about not being able to find a job. The end result will be 200-300 or even more applicants for every job. It does not mean that there is 300 less jobs that the number of applicants if 300 people apply for the same spot. Somehow similar to applying to a competitive specialty. Even the most competitive fields have about 2 spots for 3 applicants. But in practice there are 100 applicants for each spot.

So yes, even if you train 20 more people it has a huge indirect effect on the market.

Or you could just hire more people, not work 70 wtf hours per week, make a bit less money, or even just hire people to cover the night shift and OUTCOMPETE nighthawk and radisphere for those contracts. You could also OUTCOMPETE those same companies for telerads.

Just a thought.

 

[shark2000]

Or you could just hire more people, not work 70 wtf hours per week, make a bit less money, or even just hire people to cover the night shift and OUTCOMPETE nighthawk and radisphere for those contracts. You could also OUTCOMPETE those same companies for telerads.

Just a thought.

We cover our nights ourselves. There is one partner who loves to work nights. He covers about 1/3 of the nights and the rest is split between us.

We work very hard, but nobody wants to make less and hire a new person. I am totally fine with working 20% less and making 20% less. 20% less of what I make now is still a good money, even among specialist salaries. But you can not choose your hours. Private practice is all or none these days.

Ironically, this year we are going to work more, albeit for more money. Our volume is a little up and we recently made a new contract equal to one FTE (one full time employee). We are not hiring anybody new. If you ask the group why, they will tell you that this gives us job stability. Right now, even if we lose 2 of our contracts, still we will be guaranteed X salary. But they will tell you that if we hire someone and we lose a contract later, then we won't be guaranteed the X salary. It seems that we HAVE TO make a certain minimum amount of money (X). Like everything else, if you want to be guaranteed X, you should have a marginal safety (Y). The bigger the Y, the more secure you feel that X is obtainable.

 

[Silent Cool]

We cover our nights ourselves. There is one partner who loves to work nights. He covers about 1/3 of the nights and the rest is split between us.

We work very hard, but nobody wants to make less and hire a new person. I am totally fine with working 20% less and making 20% less. 20% less of what I make now is still a good money, even among specialist salaries. But you can not choose your hours. Private practice is all or none these days.

Ironically, this year we are going to work more, albeit for more money. Our volume is a little up and we recently made a new contract equal to one FTE (one full time employee). We are not hiring anybody new. If you ask the group why, they will tell you that this gives us job stability. Right now, even if we lose 2 of our contracts, still we will be guaranteed X salary. But they will tell you that if we hire someone and we lose a contract later, then we won't be guaranteed the X salary. It seems that we HAVE TO make a certain minimum amount of money (X). Like everything else, if you want to be guaranteed X, you should have a marginal safety (Y). The bigger the Y, the more secure you feel that X is obtainable.

So you are a private practice group with contracts at various hospitals? In what part of the country are you located?

 

[cbtk18]

I swear I think shark is the only person around here with any sense. Hat's off to you brotha

 

[Baller MD]

So you are a private practice group with contracts at various hospitals? In what part of the country are you located?

I think he's in San Diego.

 

[TrueAntagonist]

.

 

[shark2000]

Rumor has it that he's located in a small town east of the India-Pakistan border, near Kashmir.

The town has no name nor does it need one. The town is known for producing some the freshest papayas in the world and for being one the last places on Earth where the near-extinct species of Australian Were-Sheep still lives.

They also have a robust MSK radiology department.

What was the point of this post?

 

[TUGM]

What was the point of this post?

Apparently you're The Stig of radiology.