how many RVUs do 100% IR jobs (esp in academia) hit per year?

[IRorBustguy]

just wondering if anyone can shed some insight? It seems like at my academic institution, it’s extremely difficult to hit that 8000-10000 RVU mark purely doing IR.

Anyone else have any experience or input?

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[SeisK]

Senior faculty at my institution who established practice and only does high end cases and has clinic gets 8-8.5K annually. Most of the rest who do the regular hospitalist IR work get about 4.5K.

 

[Tiger100]

About 30% less than DR.

 

[NDcienporciento100]

Why do you care?

A busy neuroradiologist does way more RVUs than a neurosurgeon. In an academic setting the neurosurgeon, makes more money than the neuroradiologist. Why is that? A lot of reasons, but the amount of money that the neurosurgeon makes for the hospital is much more than the neuroradiologist when you factor in hospital length of stay for complex operations, the ability to designate themselves as a higher level acute care hospital by offering neurosurgical services and in turn attract in Patients in need of those services. when neurosurgical groups negotiate a contract with a Hospitals trust me, they know this.

Back to IR. Who makes more money for the hospital a busy clinical practice IR or a body radiologist. The busy clinical IR all day. Let’s take a simple procedure like an abscess drain for which many diagnostic radiologist don’t even want to do or the new clinical buz word “I don’t feel comfortable with that”. If they don’t have IR to drain that abscess. That means I have to transfer a patient to another hospital to have his abscess, drained, losing out on all those inpatient admission days. Look at Y90. You need and IR to be on a liver tumor board to be considered a center of excellence hospital gets to charge huge sums of money for the mapping procedure, after the mapping procedure the patient gets a scan for which the IR orders also making the hospital lots of money than the IR brings them back for the treatment on a separate day, making the hospital more money. Then the IR is going to order multiple abdominal MRIs, making a Hospital and exorbitant amount of money each time to follow that patient up all this makes the hospital a ton of money. The body Radiologist could not possibly add this kind of value to the hospital system. In fact, in a pinch it would be much easier to replace the body, radiology department, at an academic center than the IR department in a pinch. They could hawk body reads out to Tele Radiology in heart beat.

 

[irwarrior]

The professional fees are not that high but the global fees/facility fees for vascular procedures/embolization procedures is quite high. Also, admitting a thrombectomy patient stroke or PE etc generates revenue for the hospital. Agree downstream imaging revenue that IR can generate is high as it is often advanced imaging MRI, CT etc.

In a DR group you are more likely doing more of the biopsies, drains and lines etc that are not as lucrative but are required for a hospital to function and generate low RVU. More and more independent IR ask for a "call" stipend to cover all of these services and if they are not given it the smaller hospitals have to ship patient out to another facility that can offer such services.

But, if you are purely focused on finances and lifestyle radiology is far easier to generate a lot of revenue and a far better lifestyle . In fact for DR you can read remotely from home.

 

[Tiger100]

Why do you care?

A busy neuroradiologist does way more RVUs than a neurosurgeon. In an academic setting the neurosurgeon, makes more money than the neuroradiologist. Why is that? A lot of reasons, but the amount of money that the neurosurgeon makes for the hospital is much more than the neuroradiologist when you factor in hospital length of stay for complex operations, the ability to designate themselves as a higher level acute care hospital by offering neurosurgical services and in turn attract in Patients in need of those services. when neurosurgical groups negotiate a contract with a Hospitals trust me, they know this.

Back to IR. Who makes more money for the hospital a busy clinical practice IR or a body radiologist. The busy clinical IR all day. Let’s take a simple procedure like an abscess drain for which many diagnostic radiologist don’t even want to do or the new clinical buz word “I don’t feel comfortable with that”. If they don’t have IR to drain that abscess. That means I have to transfer a patient to another hospital to have his abscess, drained, losing out on all those inpatient admission days. Look at Y90. You need and IR to be on a liver tumor board to be considered a center of excellence hospital gets to charge huge sums of money for the mapping procedure, after the mapping procedure the patient gets a scan for which the IR orders also making the hospital lots of money than the IR brings them back for the treatment on a separate day, making the hospital more money. Then the IR is going to order multiple abdominal MRIs, making a Hospital and exorbitant amount of money each time to follow that patient up all this makes the hospital a ton of money. The body Radiologist could not possibly add this kind of value to the hospital system. In fact, in a pinch it would be much easier to replace the body, radiology department, at an academic center than the IR department in a pinch. They could hawk body reads out to Tele Radiology in heart beat.

With the same logic, ER should make the most in the hospital. Because ER orders the most imaging studies, admits the largest number of patients by a huge margin. After all, if ED doesn't admit the patient or doesn't order consults, the other specialties won't have anything to do.

You are wrong about Neurosurgery. Neurosurgery definitely makes more RVU than Neurorad. If you doubt it, look at the professional fee for spine fusion. You will get depressed when you compare it DR and IR RVUs.
Just to give you an idea:
Most high end vascular procedures are about 12-25 RVUs. I think TACE is something like 20-25.
Spine decompression and fusion: The first level is 22 RVU and any additional level is around 5-7. So when you see a 7 level fusion which is pretty common that is equal to 2-3 TACE.
Do the math yourself.

 

[Tiger100]

Why do you care?

A busy neuroradiologist does way more RVUs than a neurosurgeon. In an academic setting the neurosurgeon, makes more money than the neuroradiologist. Why is that? A lot of reasons, but the amount of money that the neurosurgeon makes for the hospital is much more than the neuroradiologist when you factor in hospital length of stay for complex operations, the ability to designate themselves as a higher level acute care hospital by offering neurosurgical services and in turn attract in Patients in need of those services. when neurosurgical groups negotiate a contract with a Hospitals trust me, they know this.

Back to IR. Who makes more money for the hospital a busy clinical practice IR or a body radiologist. The busy clinical IR all day. Let’s take a simple procedure like an abscess drain for which many diagnostic radiologist don’t even want to do or the new clinical buz word “I don’t feel comfortable with that”. If they don’t have IR to drain that abscess. That means I have to transfer a patient to another hospital to have his abscess, drained, losing out on all those inpatient admission days. Look at Y90. You need and IR to be on a liver tumor board to be considered a center of excellence hospital gets to charge huge sums of money for the mapping procedure, after the mapping procedure the patient gets a scan for which the IR orders also making the hospital lots of money than the IR brings them back for the treatment on a separate day, making the hospital more money. Then the IR is going to order multiple abdominal MRIs, making a Hospital and exorbitant amount of money each time to follow that patient up all this makes the hospital a ton of money. The body Radiologist could not possibly add this kind of value to the hospital system. In fact, in a pinch it would be much easier to replace the body, radiology department, at an academic center than the IR department in a pinch. They could hawk body reads out to Tele Radiology in heart beat.

I have barely seen any academic department replaces its diagnostic radiologists.

 

[NDcienporciento100]

With the same logic, ER should make the most in the hospital. Because ER orders the most imaging studies, admits the largest number of patients by a huge margin. After all, if ED doesn't admit the patient or doesn't order consults, the other specialties won't have anything to do.

You are wrong about Neurosurgery. Neurosurgery definitely makes more RVU than Neurorad. If you doubt it, look at the professional fee for spine fusion. You will get depressed when you compare it DR and IR RVUs.
Just to give you an idea:
Most high end vascular procedures are about 12-25 RVUs. I think TACE is something like 20-25.
Spine decompression and fusion: The first level is 22 RVU and any additional level is around 5-7. So when you see a 7 level fusion which is pretty common that is equal to 2-3 TACE.
Do the math yourself.

Multi level fusions can take 6 hours in some cases, so it better be a lot of RVUs in many scenarios it will be the surgeons only case of the day. ER doctors don’t admit patients they call the internist and they admit the patient. Or in today’s world the more likely scenario is the patient sees a PA in the ER and gets admitted by a PA internist and never sees a doctor. As I said there are a lot of reasons why a neurosurgeon makes more money than a neuroradiologist in the academic setting. I just talked about a few.

 

[NDcienporciento100]

I have barely seen any academic department replaces its diagnostic radiologists.

Never said it was common. Said it would be easier to replace their job then IR and I’m not wrong.

 

[SeisK]

With the same logic, ER should make the most in the hospital. Because ER orders the most imaging studies, admits the largest number of patients by a huge margin. After all, if ED doesn't admit the patient or doesn't order consults, the other specialties won't have anything to do.

You are wrong about Neurosurgery. Neurosurgery definitely makes more RVU than Neurorad. If you doubt it, look at the professional fee for spine fusion. You will get depressed when you compare it DR and IR RVUs.
Just to give you an idea:
Most high end vascular procedures are about 12-25 RVUs. I think TACE is something like 20-25.
Spine decompression and fusion: The first level is 22 RVU and any additional level is around 5-7. So when you see a 7 level fusion which is pretty common that is equal to 2-3 TACE.
Do the math yourself.

Yeah except the ERs task is easily replaced by PA / NP labor, the latter of which is market oversupplied. In fact, since they often inappropriately order imaging, the oversupplied labor may well make the hospital *more* than the appropriately trained physician force. ND is making some correct assumptions that do not apply to your counterpoint.

I mean all of this is self evident in that IR labor IS being subsidized by hospitals increasingly, and that rad groups that neglected their IR labor briskly lost contract. Regardless of whatever this or other argument you may make.

 

[Tiger100]

Never said it was common. Said it would be easier to replace their job then IR and I’m not wrong.

Not that hard to hire new IR doctors.
The doctors that are hard to replace are the fields that have long term continuity of care or are the ones who make a big name for themselves.

For example if you are an oncologist who has 1000 Myeloma patients and have been treating them for 10 years, it is hard to replace you.
If you are a big name Prostate surgeon then it is a huge money loss to fire you.

Otherwise, there is not significant difference between different fields in employed positions. Hospitals can replace their trauma surgeon as easy as their pathologist or dermatologist.

 

[Tiger100]

Multi level fusions can take 6 hours in some cases, so it better be a lot of RVUs in many scenarios it will be the surgeons only case of the day. ER doctors don’t admit patients they call the internist and they admit the patient. Or in today’s world the more likely scenario is the patient sees a PA in the ER and gets admitted by a PA internist and never sees a doctor. As I said there are a lot of reasons why a neurosurgeon makes more money than a neuroradiologist in the academic setting. I just talked about a few.

The one that you mentioned is the wrong reason.

 

[Tiger100]

Yeah except the ERs task is easily replaced by PA / NP labor, the latter of which is market oversupplied. In fact, since they often inappropriately order imaging, the oversupplied labor may well make the hospital *more* than the appropriately trained physician force. ND is making some correct assumptions that do not apply to your counterpoint.

I mean all of this is self evident in that IR labor IS being subsidized by hospitals increasingly, and that rad groups that neglected their IR labor briskly lost contract. Regardless of whatever this or other argument you may make.

It was IR that wanted to separate from DR and not the opposite.But off course DR is fine with that since most DRs see 30% decrease it their income because they are subsidizing IR.

In the last decade, most radiology groups that lost contract already had a good IR department. Once the hospital decides to replace a group of physicians, it can do it.

A DR group that does mammo, Fluoro, Nucs, bread and butter body procedures and admin work is as stable as a radiology group that does IR. Anyway, if for any reason they need IR they can always hire. I can see a day that DR groups hire one or two IRs as employee to just check this box.

Being at the mercy of the hospital to subsidize your income is a disaster. They can fire you overnight and give the job to someone who asks for less.

 

[Tiger100]

Multi level fusions can take 6 hours in some cases, so it better be a lot of RVUs in many scenarios it will be the surgeons only case of the day. ER doctors don’t admit patients they call the internist and they admit the patient. Or in today’s world the more likely scenario is the patient sees a PA in the ER and gets admitted by a PA internist and never sees a doctor. As I said there are a lot of reasons why a neurosurgeon makes more money than a neuroradiologist in the academic setting. I just talked about a few.

A Neurosurgeon makes more per hour than a DR and a DR makes more per hour than an IR. It is not brainer.
You are arguing over obvious facts.

 

[NDcienporciento100]

DR is not subsidizing us. They need us! We are part of the reason you have the Cush contract. When a group negotiates a contract they say “oh yes Hospital administration your hospital will have access to our IRs”. We are part of the reason you got the contract! These statements are the problem with the DR/IR relationship today. You think because you spend all day reading negative head cts you’re carrying us when we are the reason you got the contract in the first place. Snap of fingers a hospital admin can replace you with radpartners remote coverage. Peds makes less money than neuro is neuro carrying peds? Nope peds is also why you got the contract. Takes a little more time finding someone willing to coil that GDA at 3:00 am then does finding a rad to read an appy ct from Hawaii. Lastly you’re not an IR, stop saying you are. I know your type and you’re your typical private practice DR and there is nothing wrong with that. But stop saying you’re an IR.

 

[Tiger100]

DR is not subsidizing us. They need us! We are part of the reason you have the Cush contract. When a group negotiates a contract they say “oh yes Hospital administration your hospital will have access to our IRs”. We are part of the reason you got the contract! These statements are the problem with the DR/IR relationship today. You think because you spend all day reading negative head cts you’re carrying us when we are the reason you got the contract in the first place. Snap of fingers a hospital admin can replace you with radpartners remote coverage. Peds makes less money than neuro is neuro carrying peds? Nope peds is also why you got the contract. Takes a little more time finding someone willing to coil that GDA at 3:00 am then does finding a rad to read an appy ct from Hawaii. Lastly you’re not an IR, stop saying you are. I know your type and you’re your typical private practice DR and there is nothing wrong with that. But stop saying you’re an IR.

Believe it or not, it is harder to find a DR these days than an IR. Most telerad companies are 3-4 hours behind at night. You don't believe me, ask any group that uses telerad at night. It is easier to find someone to coid GDA at 3:00 these days than finding someone who reads your CT within half an hour.

Radpartners are not some aliens. Many radiologists are working for them and make good money. They take away 25% of their rads productivity. If you consider that a typical DR contract consists of subsidizing IR and going to hospital committees and commuting and hospital BS, a radiologist who spends similar amount of effort at telerad makes similar salaries.

Saying that DR is reading negative head CTs all day is like saying that IR is PICC Lines, Paras and thoras all day. In fact, DR reads all high end imaging in the hospital, however high end vascular procedures are done by vascular surgery and cardiology in most places and not IR.

 

[NDcienporciento100]

Believe it or not, it is harder to find a DR these days than an IR. Most telerad companies are 3-4 hours behind at night. You don't believe me, ask any group that uses telerad at night. It is easier to find someone to coid GDA at 3:00 these days than finding someone who reads your CT within half an hour.

Radpartners are not some aliens. Many radiologists are working for them and make good money. They take away 25% of their rads productivity. If you consider that a typical DR contract consists of subsidizing IR and going to hospital committees and commuting and hospital BS, a radiologist who spends similar amount of effort at telerad makes similar salaries.

Saying that DR is reading negative head CTs all day is like saying that IR is PICC Lines, Paras and thoras all day. In fact, DR reads all high end imaging in the hospital, however high end vascular procedures are done by vascular surgery and cardiology in most places and not IR.

Never said there was anything wrong with radpartners….

 

[irwarrior]

DR market has exploded and it is very hard to keep up with DR volumes. There are simply not enough DR in its current state to read all of the imaging. This is not sustainable and either you train more DR, recruit DR from abroad or have others interpret imaging (Extenders/other physicians).

In the current state with IR doing mostly bread and butter in mixed groups ie biopsies, drains and lines it has to be subsidized for IR to maintain a semblance of the radiology salary and whether it be the hospital or the DR group or a mix of both is part of the contract.

The problem is that most IR in current training are trained to do IO and the evidence primarily exists in HCC which mostly goes to liver transplant centers /academics. In order to build a reasonable revenue stream as an IR you have to go out and build a patient panel and manage diseases which many IR are not trained to do. You have to be able to and willing to compete clinically with vascular surgery and cardiology. As an IR who wants to build service lines PAD, DVT/PE, fibroids, prostates, hemorrhoids, knee pain (GAE) etc you have to have weekly clinic and be comfortable getting an undifferentiated consult (which most IR in its current state of training are not). This will take a paradigm shift in training and jobs to enable this.

Another way for IR to achieve success would be outside the hospital in the OBL/ASC environment where you capture the globals but it requires a great deal of financial capital and overhead and you will be in the red for a few years (hard for most fresh grads with a large debt and families to navigate). The path of least resistance is to join a subsidized job where you are cleaning the list and doing the hospital IR work and cover call.

IR when done right with comprehensive vascular clinics including medical management /wound care, BPH clinic, knee and back pain clinics etc could be something that hospitals may seek out , but it is currently the exception rather than the norm. Hard to compete with cardiac (cardiac surgery/cardiology), Neuro (neurosurgery, spine, stroke) service lines that hospitals will seek out. Radiology, ER, path, anesthesia, shift workers (hospitalists (surgical/IM) ) are becoming commoditized. anesthesia has extenders to help lessen the burden, perhaps DR will ease the burden of imaging by doing the same. Currently imaging reimburses extremely well, but as volumes continue to rise that will likely take a hit as all high volume things in medicine eventually do.

It is best for IR and DR to continue to collaborate but they need to understand each other and their needs. DR needs to clean the list and provide quality imaging interpretation to their referring and IR needs a clinic and its incumbent overhead (office staff, billers, marketing, schedulers, EMR).

 

[Tiger100]

They have talked about commoditization of radiology in the last 30 years.
In a system that physician's autonomy is gone, there is not such thing as non-commoditized physician.
In my neck of woods, practically no other physician owned office is left. Most physicians work for a hospital system or are employees of a tiered group that is owned by 2-3 older physicians. It is interesting that IR wants to do the opposite of what family physicians, Orthopods, cardiology, Vascular surgeons, oncolgoists and rad oncs did.
Just a few weeks ago, the most successful oncology group in our area was bought by the new cancer center. A few older ones cashed out and retired. The younger ones are going to become the employee of "XXX cancer center". From now on patients are not going to Dr. Jones for their cancer care. Instead they are going to Cancer center XXX.

 

[IRorBustguy]

The professional fees are not that high but the global fees/facility fees for vascular procedures/embolization procedures is quite high. Also, admitting a thrombectomy patient stroke or PE etc generates revenue for the hospital. Agree downstream imaging revenue that IR can generate is high as it is often advanced imaging MRI, CT etc.

In a DR group you are more likely doing more of the biopsies, drains and lines etc that are not as lucrative but are required for a hospital to function and generate low RVU. More and more independent IR ask for a "call" stipend to cover all of these services and if they are not given it the smaller hospitals have to ship patient out to another facility that can offer such services.

But, if you are purely focused on finances and lifestyle radiology is far easier to generate a lot of revenue and a far better lifestyle . In fact for DR you can read remotely from home.

Not focused on lifestyle at all. But need to justify my salary! If you aren't on the table, if you don't know your worth, you're on the chopping block

 

[OnlyScans420]

DR market has exploded and it is very hard to keep up with DR volumes. There are simply not enough DR in its current state to read all of the imaging. This is not sustainable and either you train more DR, recruit DR from abroad or have others interpret imaging (Extenders/other physicians).

In the current state with IR doing mostly bread and butter in mixed groups ie biopsies, drains and lines it has to be subsidized for IR to maintain a semblance of the radiology salary and whether it be the hospital or the DR group or a mix of both is part of the contract.

The problem is that most IR in current training are trained to do IO and the evidence primarily exists in HCC which mostly goes to liver transplant centers /academics. In order to build a reasonable revenue stream as an IR you have to go out and build a patient panel and manage diseases which many IR are not trained to do. You have to be able to and willing to compete clinically with vascular surgery and cardiology. As an IR who wants to build service lines PAD, DVT/PE, fibroids, prostates, hemorrhoids, knee pain (GAE) etc you have to have weekly clinic and be comfortable getting an undifferentiated consult (which most IR in its current state of training are not). This will take a paradigm shift in training and jobs to enable this.

Another way for IR to achieve success would be outside the hospital in the OBL/ASC environment where you capture the globals but it requires a great deal of financial capital and overhead and you will be in the red for a few years (hard for most fresh grads with a large debt and families to navigate). The path of least resistance is to join a subsidized job where you are cleaning the list and doing the hospital IR work and cover call.

IR when done right with comprehensive vascular clinics including medical management /wound care, BPH clinic, knee and back pain clinics etc could be something that hospitals may seek out , but it is currently the exception rather than the norm. Hard to compete with cardiac (cardiac surgery/cardiology), Neuro (neurosurgery, spine, stroke) service lines that hospitals will seek out. Radiology, ER, path, anesthesia, shift workers (hospitalists (surgical/IM) ) are becoming commoditized. anesthesia has extenders to help lessen the burden, perhaps DR will ease the burden of imaging by doing the same. Currently imaging reimburses extremely well, but as volumes continue to rise that will likely take a hit as all high volume things in medicine eventually do.

It is best for IR and DR to continue to collaborate but they need to understand each other and their needs. DR needs to clean the list and provide quality imaging interpretation to their referring and IR needs a clinic and its incumbent overhead (office staff, billers, marketing, schedulers, EMR).

Regarding your point about DR market being unsustainable, I think your wrong in the sense that you can't just just train physician extenders/other physicians to read most studies. There's so much **** on even just plain films/ultrasounds that you can miss if you haven't done an obscene amounts of reps and each miss is a possible lawsuit. Given that most physician extenders don't practice under their own license that liability would fall on the hospital if they are independent or the attending physician if they are true extenders. Don't think that would make economic sense for a hospital and as far as the work flow would go, it may even slow down some radiologists. Cardiac imaging is an exception in that it is an easily isolated organ and can be read in isolation. A general surgeon will likely never be able to properly read a CT abdomen without years of direct training under a radiologist. Same with an ENT and neck imaging or a urologist and prostate mri. Theirs too much info to just casually start reading. The jump from 2 dimensional imaging to cross sectional is also exponential in regards to information needing to be processed. People act like DR is easier to learn than surgery but you need just as many years and far more reps to learn how to do it. Basic procedures are way easier to learn than reading basic DR studies IMO. DR isn't anesthesia and it isn't ER. There's a reason CRNAs with experience can practice independently and mid levels can run the ED. This is all too say unless they start allowing radiologists from abroad and letting them practice, the obscene volumes are on our side. I don't think their will be any other solution other than paying more for reads. Hospitals can't run without radiologists and mid levels/other physicians can't fill that role.

 

[NDcienporciento100]

Regarding your point about DR market being unsustainable, I think your wrong in the sense that you can't just just train physician extenders/other physicians to read most studies. There's so much **** on even just plain films/ultrasounds that you can miss if you haven't done an obscene amounts of reps and each miss is a possible lawsuit. Given that most physician extenders don't practice under their own license that liability would fall on the hospital if they are independent or the attending physician if they are true extenders. Don't think that would make economic sense for a hospital and as far as the work flow would go, it may even slow down some radiologists. Cardiac imaging is an exception in that it is an easily isolated organ and can be read in isolation. A general surgeon will likely never be able to properly read a CT abdomen without years of direct training under a radiologist. Same with an ENT and neck imaging or a urologist and prostate mri. Theirs too much info to just casually start reading. The jump from 2 dimensional imaging to cross sectional is also exponential in regards to information needing to be processed. People act like DR is easier to learn than surgery but you need just as many years and far more reps to learn how to do it. Basic procedures are way easier to learn than reading basic DR studies IMO. DR isn't anesthesia and it isn't ER. There's a reason CRNAs with experience can practice independently and mid levels can run the ED. This is all too say unless they start allowing radiologists from abroad and letting them practice, the obscene volumes are on our side. I don't think their will be any other solution other than paying more for reads. Hospitals can't run without radiologists and mid levels/other physicians can't fill that role.

I agree that mid levels should not be allowed to read. I also believe the volume is unsustainable. I think we need to train more radiologists. Because one thing is for sure no one will stop providers from ordering unnecessary studies. And ER doctor will be wrong on a dissection 1000 times and will justify it with the 1/1000 it was positive. I disagree with the notion that some procedures are easy I think that doctors that are procedurally minded find them easier. Mostly International Radiologist should be performing the vast majority of procedures in today’s world. I know diagnostic radiologist that Don’t even want to give extra lidocaine because they’re scared that it will go intravascular and cause a horrible event they should stick to what they know, what they like as diagnostic radiologist and leave procedures to people that like to do them, and they feel comfortable doing them.

 

[OnlyScans420]

I agree that mid levels should not be allowed to read. I also believe the volume is unsustainable. I think we need to train more radiologists. Because one thing is for sure no one will stop providers from ordering unnecessary studies. And ER doctor will be wrong on a dissection 1000 times and will justify it with the 1/1000 it was positive. I disagree with the notion that some procedures are easy I think that doctors that are procedurally minded find them easier. Mostly International Radiologist should be performing the vast majority of procedures in today’s world. I know diagnostic radiologist that Don’t even want to give extra lidocaine because they’re scared that it will go intravascular and cause a horrible event they should stick to what they know, what they like as diagnostic radiologist and leave procedures to people that like to do them, and they feel comfortable doing them.

Again, I'm not talking about "should or should not be allowed". I'm talking about they are literally unable to without thousands of reps with direct feedback from an overseeing radiologist. What I'm saying is DR is way harder to learn than some people give it credit for and that extenders do not alleviate the work load of DR like the do in other specialties. Nor is it as easy to train a mid-level to read as it is to train a CRNA to give fluids and push one of like six drugs when the BP goes down. That's why it's not under threat from mid-levels . Anyone can do a para, Thora, joint injection, take a history and pan scan/lab patients. The number of reps it takes to master a simple procedure is far less than the number of CTs you have to read before you can competently read one independently. It's not feasible to train radiology mid-levels or other physicians to read imaging in the litigious US healthcare system. I'm all for IR doing as many procedures as they want, they're better at it. But the amount of knowledge and experience needed to competently read a scan is grossly underestimated by everyone else it medicine. But it's also the reason we are not getting encroached on.

Hopefully, this just becomes a simple supply and demand problem. Unless the government forces ACGME to open more radiology residencies or allows foreign radiology reads, the only solution to address the overwhelming volumes is paying more per scan and hospitals subsidizing groups even if RVUs for studies go down.

 

[Tiger100]

I agree that mid levels should not be allowed to read. I also believe the volume is unsustainable. I think we need to train more radiologists. Because one thing is for sure no one will stop providers from ordering unnecessary studies. And ER doctor will be wrong on a dissection 1000 times and will justify it with the 1/1000 it was positive. I disagree with the notion that some procedures are easy I think that doctors that are procedurally minded find them easier. Mostly International Radiologist should be performing the vast majority of procedures in today’s world. I know diagnostic radiologist that Don’t even want to give extra lidocaine because they’re scared that it will go intravascular and cause a horrible event they should stick to what they know, what they like as diagnostic radiologist and leave procedures to people that like to do them, and they feel comfortable doing them.

Interventional radiologists are so special that only they should be allowed to give lidocaine to people.

There are several deaths and morbidities that happen every year because diagnostic radiologists do thyroid FNAs, thoras, paras, liver biopsies and put in drains. It should be stopped.

I also know IRs who miss simple fractures and simple head bleeds. So all IRs should be stopped reading studies and leave them to the people that like to do them and feel comfortable doing them.

 

[Tiger100]

Again, I'm not talking about "should or should not be allowed". I'm talking about they are literally unable to without thousands of reps with direct feedback from an overseeing radiologist. What I'm saying is DR is way harder to learn than some people give it credit for and that extenders do not alleviate the work load of DR like the do in other specialties. Nor is it as easy to train a mid-level to read as it is to train a CRNA to give fluids and push one of like six drugs when the BP goes down. That's why it's not under threat from mid-levels . Anyone can do a para, Thora, joint injection, take a history and pan scan/lab patients. The number of reps it takes to master a simple procedure is far less than the number of CTs you have to read before you can competently read one independently. It's not feasible to train radiology mid-levels or other physicians to read imaging in the litigious US healthcare system. I'm all for IR doing as many procedures as they want, they're better at it. But the amount of knowledge and experience needed to competently read a scan is grossly underestimated by everyone else it medicine. But it's also the reason we are not getting encroached on.

Hopefully, this just becomes a simple supply and demand problem. Unless the government forces ACGME to open more radiology residencies or allows foreign radiology reads, the only solution to address the overwhelming volumes is paying more per scan and hospitals subsidizing groups even if RVUs for studies go down.

It is much easier to learn a procedure than reading an imaging study. period. Take a look at cardiologists and vascular surgeons. They've never touched CTA lower extremities or carotid CTA or MRA. However in many markets they have taken over lower extremity angio or carotid angio completely from IR.

 

[irwarrior]

There are some cardiologists Budoff etc that are pushing to read vascular cta and mra. More and more cardiologists are doing cardiac mri/coronary ct.

Anyone can be trained to do anything including much of what is performed in IR. There were some radiologists at large academic centers, teaching extenders to interpret MSK MRI as just one example.

The breadth of radiology can not be taught easily to an extender, but a single organ or series of studies can be. ie American society of neuroimaging supports neurologists in brain and spine imaging. Home | The American Society of Neuroimaging Chest physicians are becoming pretty good at PE detection and even ILD and CXR. Liver surgeons are pretty good at looking at liver imaging and tumors. ENT doctors are good at looking at specific things.

What the other specialties are not comfortable with is normal variants and some of the more esoteric imaging findings and they are unable to put an entire series of organ systems and put it together, this is where radiologists shine. The surgical specialists though good at their specific imaging don't have the bandwidth to read the ever increasing volume generated by the hospital ER and outpatient and inpatient imaging. This will for the foreseeable future be mostly offered by diagnostic radiologists.

The challenge with ever increasing volumes, lower reimbursements is that the quality of imaging interpretations and the delay in interpretations are negatively impacting care. If anything with EMR, the radiologist should start to incorporate more of their medical school and clinical training and open up the electronic chart and do a deeper dive into the history and labs when generating an imaging report. Reimbursements in all of medicine are likely to continue to take a hit and much of clinical work will be subsidized by the government and hospital networks.

The challenging part of IR is not the procedural aspect it is the medical decision making. Current IR training does not prepare most to be comfortable with medical management of the diseases that they perform procedures on. Luckily it is changing as more and more programs adapt to modern day VIR, but it is a slow work in progress. Lots of subspecialties of radiology can and do perform procedures (neurorads/MSK/peds/ mammography/ Body/ Chest etc) and they should continue maintaining that skillset and patient interaction. These procedural radiologists are extremely good at what they do (Damian Dupuy, Fred lee for example are some of the best interventional ablationists in the country).

 

[Smoking Jay Cutler]

Can be 14k

 

[NDcienporciento100]

Can be 14k

?

 

[SeisK]

?

He’s saying a productive IR can generate 14k wRVU annually. Which is probably true if they’re in an OBL setting, or they work in PP where they perform higher end procedures and the lower end stuff is handled by DR or midlevels.

 

[Tiger100]

In many private practices, IR reads a fair amount of DR studies. This boosts the IR RVU a lot.

In academic centers, IR does a lot of oncology work which has high RVUs.