Effect of banking crisis and economic downturn on rads job market?

[redalert]

With all the tech layoffs, high inflation, SVB collapse and possible impending downfall of more banks, it looks like the economy will be in a rough shape for at least a couple years. Nobody can predict the future but what would be your guesses on how this would affect the rads job market, particularly for trainees who will be looking for a job in 2-3 years? My fear would be a situation like in 2012/13 when some people had to do multiple fellowships just to find a job.

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[vm26]

With all the tech layoffs, high inflation, SVB collapse and possible impending downfall of more banks, it looks like the economy will be in a rough shape for at least a couple years. Nobody can predict the future but what would be your guesses on how this would affect the rads job market, particularly for trainees who will be looking for a job in 2-3 years? My fear would be a situation like in 2012/13 when some people had to do multiple fellowships just to find a job.

It’s Tough to Make Predictions, Especially About the Future – Yogi Berra​

I finished training around 2013 and yes it was awful. Have a hard time seeing things pivoting to that degree in 2-3 years given where we are now.

 

[qxrt]

The job market can turn on a dime. Look at what happened to emergency medicine - the hottest specialty up until just the past couple years, when it suddenly crashed.

I got lucky that I applied to radiology around 2012 when the job market was terrible and med students were avoiding radiology. By the time I finished training around 2019, the job market was pretty good. Things could just as easily cycle back to a terrible job market by the time today's applicants graduate in 6 years. But who knows?

 

[vm26]

The job market can turn on a dime. Look at what happened to emergency medicine - the hottest specialty up until just the past couple years, when it suddenly crashed.

I got lucky that I applied to radiology around 2012 when the job market was terrible and med students were avoiding radiology. By the time I finished training around 2019, the job market was pretty good. Things could just as easily cycle back to a terrible job market by the time today's applicants graduate in 6 years. But who knows?

Agree that things can certainly change fast...ER debacle however has been in the works for a while. Combo of vast expansion of residency spots (significant chunk through Private Equity sponsored programs), and mid-level expansion. By 2030 there will be a significant surplus of ER docs (not to mention overall ED "providers").

Currently, there are about 33K rads working in the US. About 8k are radiologists that are past retirement age. We get about 1,200 new grads per year and imaging volume goes up about 5%year. I suppose if the economy tanks and portfolios take a big hit, the 8K rads will keep on working, but the numbers still point towards rad shortage with increasing demand and job security. FYI, the rad stats are from Daniel Corbett of Radiology Business Solutions (he posted them on AM).

Wildcards are AI and mid-level encroachment.

 

[Womb Raider]

Agree that things can certainly change fast...ER debacle however has been in the works for a while. Combo of vast expansion of residency spots (significant chunk through Private Equity sponsored programs), and mid-level expansion. By 2030 there will be a significant surplus of ER docs (not to mention overall ED "providers").

Currently, there are about 33K rads working in the US. About 8k are radiologists that are past retirement age. We get about 1,200 new grads per year and imaging volume goes up about 5%year. I suppose if the economy tanks and portfolios take a big hit, the 8K rads will keep on working, but the numbers still point towards rad shortage with increasing demand and job security. FYI, the rad stats are from Daniel Corbett of Radiology Business Solutions (he posted them on AM).

Wildcards are AI and mid-level encroachment.

At what point will hospitals become so desperate for radiologists that they will increase pay past professional fee by eating in to the technical fee?

 

[bronx43]

At what point will hospitals become so desperate for radiologists that they will increase pay past professional fee by eating in to the technical fee?

Why would they ever do that? Hospitals could care less if there are hundreds of studies on back log. Where I’m at, the turn around time for everything is weeks and nobody cares. Half the time the clinician already acted on the study themselves and if it’s truly emergent they can always call the reading room. Furthermore, if anything gets missed it’s the clinicians getting blamed/sued.

The anesthesia treatment where hospitals subsidize likely will never occur with rads, simply because outside of few rare situations, operation goes on regardless of whether there’s an impression from rads.

 

[SeisK]

Why would they ever do that? Hospitals could care less if there are hundreds of studies on back log. Where I’m at, the turn around time for everything is weeks and nobody cares. Half the time the clinician already acted on the study themselves and if it’s truly emergent they can always call the reading room. Furthermore, if anything gets missed it’s the clinicians getting blamed/sued.

The anesthesia treatment where hospitals subsidize likely will never occur with rads, simply because outside of few rare situations, operation goes on regardless of whether there’s an impression from rads.

They already are doing so at a lot of institutions, and the trend will increase.

Bottom of the barrel contracts for hospitals are tele RP or vrad, and they are starting to require subsidization also in some locations.

 

[Womb Raider]

Why would they ever do that? Hospitals could care less if there are hundreds of studies on back log. Where I’m at, the turn around time for everything is weeks and nobody cares. Half the time the clinician already acted on the study themselves and if it’s truly emergent they can always call the reading room. Furthermore, if anything gets missed it’s the clinicians getting blamed/sued.

The anesthesia treatment where hospitals subsidize likely will never occur with rads, simply because outside of few rare situations, operation goes on regardless of whether there’s an impression from rads.

One would think there's a breaking point. If the list continuously grows larger and the turn-around time increases indefinitely... I can't see that being good for business. At some point, the patients are going to be pissed and that makes the hospital look bad.

 

[bronx43]

They already are doing so at a lot of institutions, and the trend will increase.

Bottom of the barrel contracts for hospitals are tele RP or vrad, and they are starting to require subsidization also in some locations.

Almost all hospitals are in the red now. Unless labor costs tank, more people get on private insurance and Medicare reimbursements go up (all are highly unlikely), I doubt a lot can even survive let alone turn a healthy profit in the future.
And the rainmakers like ortho and neurosurg will expect their cash bonuses in full every quarter. Maybe they can squeeze little guys in the ED or hospitalist groups but there’s only so much blood to be squeezed out of a rock.
When push comes to shove, I think hospital admin will not take away from themselves or their business bringers for any meaningful subsidies.

 

[bronx43]

One would think there's a breaking point. If the list continuously grows larger and the turn-around time increases indefinitely... I can't see that being good for business. At some point, the patients are going to be pissed and that makes the hospital look bad.

Sure but the pot is only so big and shrinking rapidly while everyone has their hand in it. From the admin standpoint which Peter can you take away from to pay Paul?

 

[DoctorMD1]

Why would they ever do that? Hospitals could care less if there are hundreds of studies on back log. Where I’m at, the turn around time for everything is weeks and nobody cares. Half the time the clinician already acted on the study themselves and if it’s truly emergent they can always call the reading room. Furthermore, if anything gets missed it’s the clinicians getting blamed/sued.

The anesthesia treatment where hospitals subsidize likely will never occur with rads, simply because outside of few rare situations, operation goes on regardless of whether there’s an impression from rads.

The last statement does not apply to the studies coming from ED. Hence it is not that rare for the hospitals to subsidize radiology calls.

 

[bronx43]

The last statement does not apply to the studies coming from ED. Hence it is not that rare for the hospitals to subsidize radiology calls.

Makes sense. With the way EM is going, admin would probably just cut their pay and use it to subsidize rads.

 

[vm26]

They already are doing so at a lot of institutions, and the trend will increase.

Bottom of the barrel contracts for hospitals are tele RP or vrad, and they are starting to require subsidization also in some locations.

Yes. My current group already gets this is various forms...Retainment/recruitment is an issue now and only so many rads out there...Hospitals/HC systems will have to decide what's cheaper-subsidizing groups for 24/7 IR coverage (as an example), or transferring pt out for procedure X since no IR

 

[vm26]

Sure but the pot is only so big and shrinking rapidly while everyone has their hand in it. From the admin standpoint which Peter can you take away from to pay Paul?

HC systems/hospitals seem to find the money when they need to...May have to start dipping into technical fee to subsidize rads while hiring more "cost-effective" mid-level hospitalists/ER providers etc

 

[Rads4lyfe]

With all the tech layoffs, high inflation, SVB collapse and possible impending downfall of more banks, it looks like the economy will be in a rough shape for at least a couple years. Nobody can predict the future but what would be your guesses on how this would affect the rads job market, particularly for trainees who will be looking for a job in 2-3 years? My fear would be a situation like in 2012/13 when some people had to do multiple fellowships just to find a job.

Probably not in the next few years. The current shortage of radiologist is quite bad.

 

[Rads4lyfe]

Why would they ever do that? Hospitals could care less if there are hundreds of studies on back log. Where I’m at, the turn around time for everything is weeks and nobody cares. Half the time the clinician already acted on the study themselves and if it’s truly emergent they can always call the reading room. Furthermore, if anything gets missed it’s the clinicians getting blamed/sued.

The anesthesia treatment where hospitals subsidize likely will never occur with rads, simply because outside of few rare situations, operation goes on regardless of whether there’s an impression from rads.

They will will definitely subsidize. They already do at my practice. Not sure where you are getting your information. Are you a radiologist?

 

[bronx43]

They will will definitely subsidize. They already do at my practice. Not sure where you are getting your information. Are you a radiologist?

I’m not. I said I don’t understand why they would but I guess some do. I stand corrected. they don’t at my shop and our turnaround time is quite bad.

If they end up doing so, I don’t know whose pockets these subsidies come out of but def not mine…

 

[bobjonesbob]

You don't understand why they would? Because the ED would grind to a halt without radiology. Same with the inpatients. The hospitals can easily replace EM physicians with midlevels. The patients get worse care, but the hospital rakes in the technical fees from all the unnecessary imaging and labs so the hospital doesn't care.

 

[CCM-MD]

Critical care, hospitalist and anesthesia are already subsidized. Especially for night time coverage. The whole clinicians look at their own scans is nice and I look at all of mine too, but doesn’t come close to replacing a radiology read. If there is enough push from a supply/demand standpoint, I don’t see why rads wouldn’t become subsidized. Maybe hard in the current environment but enough push and it will happen. If subsidies start you can fully expect more hospital employment and increased presence of the same corporations in EM/anesthesia like Sound/Team Health etc. None of that will be a good thing.

 

[Tiger100]

The best thing to do is to enjoy your life, save some money and don't take things seriously.

 

[bronx43]

Critical care, hospitalist and anesthesia are already subsidized. Especially for night time coverage. The whole clinicians look at their own scans is nice and I look at all of mine too, but doesn’t come close to replacing a radiology read. If there is enough push from a supply/demand standpoint, I don’t see why rads wouldn’t become subsidized. Maybe hard in the current environment but enough push and it will happen. If subsidies start you can fully expect more hospital employment and increased presence of the same corporations in EM/anesthesia like Sound/Team Health etc. None of that will be a good thing.

Sure but with most hospitals being in the red, who does admin cut in order to subsidize more doctors? Maybe they can squeeze EM a bit more but there’s a limit to that. Do you think they’ll start squeezing CC in favor of rads? They certainly won’t touch a penny that goes to their money maker surgeons or their nurses who are probably already on the cusp of striking.

 

[Womb Raider]

Sure but with most hospitals being in the red, who does admin cut in order to subsidize more doctors? Maybe they can squeeze EM a bit more but there’s a limit to that. Do you think they’ll start squeezing CC in favor of rads? They certainly won’t touch a penny that goes to their money maker surgeons or their nurses who are probably already on the cusp of striking.

Hopefully some of the administration.

 

[CCM-MD]

Sure but with most hospitals being in the red, who does admin cut in order to subsidize more doctors? Maybe they can squeeze EM a bit more but there’s a limit to that. Do you think they’ll start squeezing CC in favor of rads? They certainly won’t touch a penny that goes to their money maker surgeons or their nurses who are probably already on the cusp of striking.

They could if there is enough push to do so. If CC starts looking like EM in the future. Same with hospitalists. Pop some more mid levels in there and you got your cost savings to subsidize rads.

 

[bronx43]

They could if there is enough push to do so. If CC starts looking like EM in the future. Same with hospitalists. Pop some more mid levels in there and you got your cost savings to subsidize rads.

CC isn’t anywhere near EM now, so I doubt admin can easily push you guys around just yet. Hospitalist may be an easy target but so far they’ve proven quite resilient.
I guess my overall gut feeling on this is that it’ll come down to which hospital based specialties have the highest bargaining power. If it’s rads then all the power to them, but there’s a brick wall not far ahead. Then at that point it’s going to be impenetrable as far as the surgical specialties and the high demand outpatient specialties.

 

[RadJon]

You don't understand why they would? Because the ED would grind to a halt without radiology. Same with the inpatients. The hospitals can easily replace EM physicians with midlevels. The patients get worse care, but the hospital rakes in the technical fees from all the unnecessary imaging and labs so the hospital doesn't care.

This. No radiology and a hospital cannot function. Especially with a lack of radiologists and a mass retirement coming up. Radiologists will come at a premium. I love my job

 

[GadRads]

This. No radiology and a hospital cannot function. Especially with a lack of radiologists and a mass retirement coming up. Radiologists will come at a premium. I love my job

Why do we anticipate a mass retirement? And as the older guys retire, there will be an influx of new radiologists. I think the biggest factors in our favor are the rising volumes and abuse of medical imaging.

 

[Womb Raider]

Given telerads radiology will never have the bargaining power of procedural specialties. The pros are there is a big shortage of radiologists with volumes increasing faster than residents are being pumped out, and our field is relatively resistant to mid level encroachment. Just hope I can build my nest egg before the world goes to ****.

 

[bronx43]

Given telerads radiology will never have the bargaining power of procedural specialties. The pros are there is a big shortage of radiologists with volumes increasing faster than residents are being pumped out, and our field is relatively resistant to mid level encroachment. Just hope I can build my nest egg before the world goes to ****.

that’s the actual kicker. The way things are currently playing out, the risk for most specialties will be how they fare after possible collapse of the whole system. Hospitals may not be able to run under current rules without certain specialties, but that’s under the assumption that hospitals will even exist in its current form.
My hospital is usually very financially robust due to the strong local economy and lack of competition. But we are in the deep red and the recession hasn’t even started in full yet. Every neighboring hospital is in similar if not more dire straits. With most recent numbers, I’m not even sure they can last another 2 years, and this isn’t even factoring in the possibility of more nursing strikes/raises and staff shortages.
The future is gonna be a bumpy ride and nothing is guaranteed for anyone- even the rainmaker surgeons.

 

[Rads4lyfe]

Sure but with most hospitals being in the red, who does admin cut in order to subsidize more doctors? Maybe they can squeeze EM a bit more but there’s a limit to that. Do you think they’ll start squeezing CC in favor of rads? They certainly won’t touch a penny that goes to their money maker surgeons or their nurses who are probably already on the cusp of striking.

Radiology is a huge money maker for any institution. The technical fee for keeping the scanners running is just as much if not more lucrative then keeping the ORs runnings.

If we are talking about cost cutting, probably smarter to cut administrators and figure out nursing shortages. Locum nurses are making physician pay at a lot of places, which is ridiculous.

 

[Splenda88]

CC isn’t anywhere near EM now, so I doubt admin can easily push you guys around just yet. Hospitalist may be an easy target but so far they’ve proven quite resilient.
I guess my overall gut feeling on this is that it’ll come down to which hospital based specialties have the highest bargaining power. If it’s rads then all the power to them, but there’s a brick wall not far ahead. Then at that point it’s going to be impenetrable as far as the surgical specialties and the high demand outpatient specialties.

I am sure they probably look at length of stay [LOS] between hospitalist vs midlevels. Before I got into hospital medicine [HM], I thought we could be replaced easily. But after supervising a couple of NPs in my group, there is no way in hell we will be replaced anytime soon.

In addition, HM docs only make between 270-340k/yr, so I am not sure how much they can squeeze from them.

 

[Splenda88]

that’s the actual kicker. The way things are currently playing out, the risk for most specialties will be how they fare after possible collapse of the whole system. Hospitals may not be able to run under current rules without certain specialties, but that’s under the assumption that hospitals will even exist in its current form.
My hospital is usually very financially robust due to the strong local economy and lack of competition. But we are in the deep red and the recession hasn’t even started in full yet. Every neighboring hospital is in similar if not more dire straits. With most recent numbers, I’m not even sure they can last another 2 years, and this isn’t even factoring in the possibility of more nursing strikes/raises and staff shortages.
The future is gonna be a bumpy ride and nothing is guaranteed for anyone- even the rainmaker surgeons.

At least 50% of money we spend in health care is a complete waste, and I am not exaggerating. I think the system will collapse in less than 10 yrs.

 

[bronx43]

Radiology is a huge money maker for any institution. The technical fee for keeping the scanners running is just as much if not more lucrative then keeping the ORs runnings.

If we are talking about cost cutting, probably smarter to cut administrators and figure out nursing shortages. Locum nurses are making physician pay at a lot of places, which is ridiculous.

Inpatient DRGs don't pay for technical component since it's all lump sum for diagnoses. Doesn't matter if you order 100 MRIs or 1 xray. Sure, outpatient imaging is still FFS, but I don't think it's anything close to OR fees (unless you have data to suggest otherwise). I used to be part of multispecialty physician owned group who got the TC for all imaging ordered. It honestly wasn't that much after you account for overhead. Medicare pays like $300 TC for a knee MRI which takes 45 minutes. They pay around $12k facility fee for a knee replacement which takes 1-2 hours.

But my overall point is that the landscape is pretty bleak looking at these current numbers. Admin won't cut too many admin, and there's no easy fix to nursing or overall staff shortages. And the recession hasn't even hit yet. Once it does, we'll see payer mix truly deteriorate, along with reduced outpatient volumes. It may soften the labor shortage, but it's in no way going back to pre-covid salaries or availability. My bet is that we may be looking at a post-corporate landscape, and it's unclear which specialties will be in the best position at that point. Make your money now cuz who knows if any money can be made (and by whom) in the not so distant future.

 

[bronx43]

At least 50% of money we spend in health care is a complete waste, and I am not exaggerating. I think the system will collapse in less than 10 yrs.

I’m not sure many of these hospitals can hold on for 2 years let alone 10. They need continuous bailout to make their payments. But with inflation, it’s unclear that the government is willing or able to do this.

 

[Tiger100]

Inpatient DRGs don't pay for technical component since it's all lump sum for diagnoses. Doesn't matter if you order 100 MRIs or 1 xray. Sure, outpatient imaging is still FFS, but I don't think it's anything close to OR fees (unless you have data to suggest otherwise). I used to be part of multispecialty physician owned group who got the TC for all imaging ordered. It honestly wasn't that much after you account for overhead. Medicare pays like $300 TC for a knee MRI which takes 45 minutes. They pay around $12k facility fee for a knee replacement which takes 1-2 hours.

But my overall point is that the landscape is pretty bleak looking at these current numbers. Admin won't cut too many admin, and there's no easy fix to nursing or overall staff shortages. And the recession hasn't even hit yet. Once it does, we'll see payer mix truly deteriorate, along with reduced outpatient volumes. It may soften the labor shortage, but it's in no way going back to pre-covid salaries or availability. My bet is that we may be looking at a post-corporate landscape, and it's unclear which specialties will be in the best position at that point. Make your money now cuz who knows if any money can be made (and by whom) in the not so distant future.

People have been talking about the bleak landscape of medicine for over 60 years and it has not happened yet.

Just live your life, make some money, save some and enjoooy. Don't kill yourself by working like a dog. There will always be some money in healthcare to be made. Doctors are doing fine all around the world. Even in the very poor countries, doctors are living a reasonable life.