Are radiologists needed?

[Teragen]

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I watch trauma life in the ER every monday and it seems to me that all the doctors do their own readings for xrays and the sort. So why are radiologists needed when the doctors read and diagnose the results themselves it seems. I'm probably just wrong but oh well.

 

[bigbaubdi]

ER docs are OK for emergency cases but for regular cases, radiologists are absolutely required. A variety of studies have been done comparing ER docs to full time radiologists and the full time radiologists have come out on top each time.

 

[tugbug]

In the ER where I work all Xrays get an "official" reading by a Radiologist after the ER docs look. The hospital wont even release copies to the patient until theyve been checked by the Rads.

 

[johnhopeful]

MRI, CT Scans

 

[periodic]

As everyone else has implied, it's a matter of expertise. They are the experts in reading some of these charts and can pick up things an ER or primary care doc might miss. You can imagine that the growth in types and complexity of imaging, the amount of knowledge to properly asses the results has grown too.

A better question might be whether we'll have an oversupply of radiologists because it's a sought-after field right now and/or more radiological interpretation will be outsourced to docs in other countries. The nature of radiology lends itself to being transmitted over wires..

 

[johnhopeful]

Periodic,

That's an interesting point. I'm curious as to how radiology could be outsourced to other countries? Wouldn't US regulations object to non-US licensed radiologists interpreting US Patient's radiographs?

 

[Gleevec]

bigbaubdi, could you link one of these studies, Id be interested to see this data.

 

[bigbaubdi]

Originally posted by Gleevec
bigbaubdi, could you link one of these studies, Id be interested to see this data.

http://www.ajronline.org/cgi/content/abstract/175/5/1233

The full paper is not accessible online w/out a subscription but you can at least take a look at the abstract.

I can email you the paper if you are interested.

 

[xanthines]

There was an article in the NY Times a month or two ago about outsourcing radiology to India. It stated that there there is a shortage of radiologists in the U.S. right now and becuase of that, they command high salaries. Since you can just scan films and transmit data over the internet, a radiologist in India can probably read it just as well as one could in the U.S (and by that, I mean the presence of information, not comparisons of training; that's another thread altogether!).

There's been a minor backlash as HIPAA rules have gone into effect and as people find out about outsourcing healthcare. There's concern over quality, liscensing, and privacy.

I don't know how I feel about outsourcing medicine, truth be told.

-X

 

[medstylee]

yeah - i think they're probably needed in certain areas at least. my dad is on the board of a rural hospital and they are short on radiologists. in fact, most of the time, they send their images and scans over to Australia using some special service (i forgot the acronym for it) and then they send back a diagnosis or a recommendation by the next morning. pretty crazy, right?

 

[periodic]

Thanks for the paper, bigbaubdi.

I'm not disputing the claim that radiologists are measurably better at interpreting images than a non (it makes intuitive sense and seems to be confirmed by their validation and acceptance in health care), but it is also interesting to note that the study was done by the Hopkins radiology department.

They may be the best placed to do such a study, but they do have their own interest in its results. I heard a doc present findings from his study about the growth of free-standing or office-based imaging facilities, and how detrimental it was for regular non-radiologists to be doing imaging, some even putting MRI's/CT's in their offices. He was a radiologist working off a grant from the American College of Radiology. Just another side to keep in mind, people look out for their own more often than we think (being idealist pre-meds for the most part).

Outsourcing is a reality of a globalized economy, but who knows how all that will play out, not just radiological services. If radiologists in another country can read charts as good or better than US docs at a lower cost, there will be a push by their countries and our health care payers here to allow them to do so. Maybe even patient advocacy groups, if the issue permeates far enough.

Radiologist supply is tight here because residency slots are tight. Radiology slots are tight partly because radiologists want them to be, so they remain highly-paid.

Right now, people are clawing hand over foot to try to get into the field because of the good lifestyle and pay. Residency slots in general follow the amount the government pays for residents through GME (graduate medical education). The government has and does alter its policies towards FMGs (foreign medical graduates) to shore up undersupply in certain areas, if American docs don't step up. The same thing is happening in nursing right now (there was a recent article talking about hospitals recruiting from abroad for nurses - I can dig for support if need be).

This is a 1995 report by the Congressional Budget Office on physician/resident supply and the factors that affect it:
http://www.cbo.gov/showdoc.cfm?index=17&sequence=3

I'm sure there's more recent stuff out there, but I'm leaving work now :0

 

[JohnHolmes]

Originally posted by johnhopeful
MRI, CT Scans

Word.

Also, complex or tricky fractures and breaks. Radiologists are often "consulting" physicians.

Coops

 

[Downhill Racer]

Check out the Radiology Forum (link below)
http://forums.studentdoctor.net/showthread.php?s=&threadid=90913&perpage=20&pagenumber=2

Esp. page 2, generally the thoughts from those posters is that legal issues, malpractice concerns may be major reasons maintaining the role of radiologists but outsourcing remains an issue.

Another reason for the popularity of the field is the potential for future innovations in the field leading to more procedures and my opinion is a more technologically-savvy med student is graduating whose interests can be served by the field of radiology....

 

[goobernaculum]

radiologists are definitely needed. they have a broad knowledge base of anatomy that helps them diagnose pathologies other doctors would have considerable difficulty in doing (that's with xrays, mri's, and ct's). I guarantee you that many internists or surgeons would look at a CT scan and have a tough time trying to figure out what's wrong whereas a radiologist would be specially trained to make a quick diag.
Furthermore, interventional radiologists are a hot commodity who do surgical procedures with nifty little trinkets that other surgeons would never dream of doing (except Interventional cards). not only that, but they do amazing non-invasive surgeries that allow shorter hospital stays for patients. who would have thought radiology would have a surgical subspecialty?

 

[dentate_gyrus]

Radiologists here in Cali sometimes have to have priveleges at a dozen or so hospitals to pay the bills. Getting those priveleges is no trivial task. I wonder how foriegn groups can get all of that done?

 

[periodic]

1) Wow, so much hostility in that radiology thread...look what we have to look forward to 🙂

2) That's true, interventional radiology sounds awesome. Or will it be interventional [insert other subspecialty] by the time we get there?

dentate_gyrus:
I don't know the whole story, but from the sounds of that link, US firms/doctors are driving teleradiology growth. That stands to reason. Find cheaper labor elsewhere, manage the contracts and negotiate for privileges here, and milk the profit.