Can you guys read X-rays?

[Merely]

I am shadowing an FM doc that owns his own practice. He sees many patients a day and orders probably 10-20 x rays a day for various things like chest x ray, sinusitis, bone pain, etc. I am wondering, is he qualified to interpret these chest x rays? Why do we have radiologists if FM docs can set up their own x ray lab and interpret their own x rays? Thanks.

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[JonMonkey]

XRs are a tool and your ability to use that tool depends on the amount of time you actually use it. Yes there are radiologists out in the world that are specifically trained to look at and interpret imaging studies but the average physician can also do the same. When you are on your IM rotation you will be looking at chest films all the time and in most cases will not have the luxury of waiting for a final read before your create and implement a care plan. I am currently working in a primary care sports medicine fellowship and we probably order nearly 60-70 XRs per day, reading them all ourselves. In most cases our reads are better than some of the radiologists unless it happens to be an MSK radiologists that sees our films. You also have to remember that in some places the FM doc is all there is for that area, they have to be able to do a little of everything from primary care to peds to OB to hospital medicine to radiology. As a word of advice you should learn to ALWAYS read and interpret your own films, let the radiologist report tell you if you are correct or not.

 

[Gadofosveset]

XRs are a tool and your ability to use that tool depends on the amount of time you actually use it. Yes there are radiologists out in the world that are specifically trained to look at and interpret imaging studies but the average physician can also do the same. When you are on your IM rotation you will be looking at chest films all the time and in most cases will not have the luxury of waiting for a final read before your create and implement a care plan. I am currently working in a primary care sports medicine fellowship and we probably order nearly 60-70 XRs per day, reading them all ourselves. In most cases our reads are better than some of the radiologists unless it happens to be an MSK radiologists that sees our films. You also have to remember that in some places the FM doc is all there is for that area, they have to be able to do a little of everything from primary care to peds to OB to hospital medicine to radiology. As a word of advice you should learn to ALWAYS read and interpret your own films, let the radiologist report tell you if you are correct or not.

Amusing.


In the U.S. we also have radiologists to protect against imaging self-referral from docs who own their own "x ray lab" and order unnecessary imaging. For the best reasons, of course.

 

[JonMonkey]

True....this also assumes that the doc is charging for the imaging. It would highly unlikely that someone would spend all that money on an imaging unit and not charge to recoup that investment cost but we use ultrasound, for example and hardly ever bill for it.

 

[VA Hopeful Dr]

Amusing.


In the U.S. we also have radiologists to protect against imaging self-referral from docs who own their own "x ray lab" and order unnecessary imaging. For the best reasons, of course.

Yeah my first thought reading the OP was "Man, I didn't order that many x-rays seeing 60 patients/day in Urgent Care" followed shortly by "X-ray for sinus infections, that's nonsense"

 

[deleted87716]

Plain films don't really reimburse that much, and many practices have found it cost-prohibitive to have in-house x-ray once you factor in the costs for the equipment and x-ray tech. I started out in a practice that had in-house x-ray. We would do an initial read ourselves, but always had our films over-read by a radiologist, which cut further into profits. It was necessary from a liability standpoint, however. From a reimbursement standpoint, we would bill the technical component, and the radiologist would bill the professional component. Ultimately, it was a money-loser, and they stopped doing it (and that was with old, fully-capitalized equipment and an underpaid tech).

 

[Merely]

I'm not clear on what you guys are saying, so u guys r saying that he has an x ray and is losing money on it? I don't get that. Also someone said it's nonsense that he orders that many..can u elaborate? Lastly I don't see how he can read them and not be scared to get sued. Sorry for being obtuse I'm a medical student.

 

[deleted87716]

I'm not clear on what you guys are saying, so u guys r saying that he has an x ray and is losing money on it? I don't get that. Also someone said it's nonsense that he orders that many..can u elaborate? Lastly I don't see how he can read them and not be scared to get sued. Sorry for being obtuse I'm a medical student.

Well, obviously we can't know for certain without seeing his numbers. I can tell you, however, that plain films are no money-maker. Our group has a very well-run centralized imaging center, and plain films are barely profitable, even in volume. We do it for convenience and to help keep costs down in our ACOs.

Unless he's doing a ton of ortho, he's ordering way too many x-rays. I don't order 20 x-rays in a week.

Why isn't he afraid of being sued...? I'd say he's taking a stupid risk (assuming his films aren't being over-read by a radiologist). If he's ever sued over mis-reading a film, he'll be held to the same standard of care as a radiologist.

 

[Merely]

What are the very profitable ancillary services fm docs can provide?

 

[deleted87716]

What are the very profitable ancillary services fm docs can provide?

9 Ancillary Services That Can Boost Practice Revenue
http://www.medscape.com/viewarticle/828246

Interestingly, they include radiography. So, I'd take their list with a grain of salt. There are lots of variables that will affect profitability for any of these.

 

[primadonna22274]

I ALWAYS read my own films. Have done so since PA training in the late 90s--just the way I was trained. You bet I do it as a FM PGY3--I frequently moonlight in urgent care and rural hospitals where we don't have radiologist in-house and it might be awhile before the films get read. I always go back and see if my read corresponds with the radiologist's--experience is a great teacher
I teach my medical students and residents to read their own films. Most have at least some experience but need to gain confidence. I do document that I personally reviewed the films in my medical decision-making.
That said, I don't ever bill for reading the films myself. There's a radiologist paid for that liability and it's unethical to double-bill.
I worked the longest year of my life in a SUPER busy ridiculous FM/urgent care practice where the docs absolutely refused to pay a radiologist to read their films. A handful of questionable films were sent out daily (probably 50+ chest, skeletal films every day). I was NEVER comfortable with that and think it's a terrible practice.


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