Impending oversupply of Radiologists

[bronx43]

I'm curious to hear your list. My belief is that primary care and any cosmetic/elective specialties will do very well in the future.

I'm not high on cosmetic/elective specialties. In fact, I'm heavily bearish on certain types of elective care. This really reflects my conclusion that the economy as a whole will contract, and not just the health care sector. There's two end games in play here - one is a slow and painful deterioration should the US go into austerity measures, and the other is a relatively maintenance of status quo until a rather rapid hyperinflationary event should the US undertake its current financial policies. Either way, the same picture is painted for non-essential health care. When resources dwindle, you spend on necessities before amenities. This applies well to health care in that you would pay for an appendectomy before you get a boob job, or seek a doctor for antibiotics before one for botox. This doesn't mean that there won't be a market for this type of service. There will always be a demographic that will have the means to have both necessary care and un-necessary, elective care. However, in a contracting economy that market will become drastically smaller and the current pool of providers will have to share the crumbs.
And as I've said before, there are even differences amongst primary care doctors. As these things happen, doctors of all fields will try to crowd the primary care market, and the PCPs with an established patient base will fare the best.
This scenario that I've offered is based on an extension of this current system that we have in place. It's also possible (though less likely) that the government will take the reigns of health care and simply reduce cost by force during true austerity measures. In that case, specialists may still retain their "market," but overall use of medical care will need to be drastically cut and you'll see pretty much a flat salary rate across the board, as we'll all be employees of a government system.

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[naus]

There's always a struggle between the normalcy bias and gloom and doom. On the one hand, the world would have ended an infinite number of times according to the ever-present apocalyptic prophets. On the other hand, massive changes in history have always been met with stubborn resistance and appeals to a stable equilibrium.

Underemployed CT surgeons always come to mind when I think of stubborn resistance to change and the unwillingness to see trends.

I strongly agree with your economic outlook.

If QE3 happens, I'm going to take as much loans as I can and delay paying them back as long as I can, because I know the dollar will be worthless by the time I'm out of residency. Inflation was the strategy France took, which used to pay their doctors very well. They kept physicians salaries constant as inflation roared and everyone else in France got raises. Now French physicians make the equivalent of $60k year, just slightly above median wage in France. But at least they only work 35 hours a week and get months of vacation, had free tuition, and no medical liability.

In another thread, union RN nurses already make $53 an hour at Kaiser in the bubble zones, while primary care physicians haven't had a raise in a decade.

 

[cowme]

The worlds gonna end in 2012. Quit freaking out about the dollar value 5 years from now and enjoy life while you can

 

[Radonkulous]

The worlds gonna end in 2012. Quit freaking out about the dollar value 5 years from now and enjoy life while you can

Cowme, since you're a resident and are in the Radiology trenches, how do you see the next 5+ years playing out with regards to the job market? I like Rads/IR, but I have a hard time getting past the fact the market is saturated or maybe AM/SDN has warped my reality. Your thoughts?

 

[cowme]

Cowme, since you're a resident and are in the Radiology trenches, how do you see the next 5+ years playing out with regards to the job market? I like Rads/IR, but I have a hard time getting past the fact the market is saturated or maybe AM/SDN has warped my reality. Your thoughts?

Well, I just graduated, so I'm still about 13+ months from being a radiology resident. Even in a year, or two, I will have no idea what the market will be like by the time I leave residency.

I will say this, though. Reading AM forums, it sounds like the market is bad, but EVERYONE finds a job by the time they are out of fellowship. I have seen a grand total of TWO posts about people on auntminnie who have not found jobs (and both were by people who were still in the middle of fellowship).

I don't think the market is saturated, I just think there is a lot of uncertainty given recent reimbursement cuts and the recession. As a result, older radiologists are working longer instead of retiring, and are working harder rather than hiring recently trained residents. The sheer volume in PP sounds so overwhelming that there is no chance in hell that there is actually a saturated market right now.

Now, residents have to look longer and seek the jobs themselves. But as far as I've seen, they all get one, even if its not their dream job in Manhattan. Oh, and you mentioned IR: there is a moderate IR shortage (and mammography) right now, and IR and mammo fellows have no problem landing a job wherever they want.

There are a lot of doom and gloomers on this forum who really have no insight into what radiologists actually do. They are med students who think that a nurse can do their job. The main one on this thread is someone from a business background who probably has no insight into radiology other than from a referring physicians standpoint. And not to poke fun at him/her, but people with business/finance backgrounds don't always have the best vision of future (cough, late-2000's recession, cough).

One thing you have to realize: People are terrible at predicting the future. See quote below.

"The Graduate Medical Education Advisory Committee (GMENAC) predicted a surplus of radiologists by 1990, with that surplus growing even larger by 2000. In fact, the number of radiologists in practice in 1990 was 15% less than the GMENAC had predicted [11], and 2000 was characterized by a shortage."

http://www.ajronline.org/cgi/content/full/178/5/1075

So, I am not going to sit here and look into the crystal ball and tell you what the field will be like in five years, but I will say that if you really like the field, and think you'd be happiest as a radiologist/IR, don't let this forum dissuade you. If you want it for the salary and ideal lifestyle, maybe think more about it.

 

[bronx43]

Well, I just graduated, so I'm still about 13+ months from being a radiology resident. Even in a year, or two, I will have no idea what the market will be like by the time I leave residency.

I will say this, though. Reading AM forums, it sounds like the market is bad, but EVERYONE finds a job by the time they are out of fellowship. I have seen a grand total of TWO posts about people on auntminnie who have not found jobs (and both were by people who were still in the middle of fellowship).

I don't think the market is saturated, I just think there is a lot of uncertainty given recent reimbursement cuts and the recession. As a result, older radiologists are working longer instead of retiring, and are working harder rather than hiring recently trained residents. The sheer volume in PP sounds so overwhelming that there is no chance in hell that there is actually a saturated market right now.

Now, residents have to look longer and seek the jobs themselves. But as far as I've seen, they all get one, even if its not their dream job in Manhattan. Oh, and you mentioned IR: there is a moderate IR shortage (and mammography) right now, and IR and mammo fellows have no problem landing a job wherever they want.

There are a lot of doom and gloomers on this forum who really have no insight into what radiologists actually do. They are med students who think that a nurse can do their job. The main one on this thread is someone from a business background who probably has no insight into radiology other than from a referring physicians standpoint. And not to poke fun at him/her, but people with business/finance backgrounds don't always have the best vision of future (cough, late-2000's recession, cough).

One thing you have to realize: People are terrible at predicting the future. See quote below.

"The Graduate Medical Education Advisory Committee (GMENAC) predicted a surplus of radiologists by 1990, with that surplus growing even larger by 2000. In fact, the number of radiologists in practice in 1990 was 15% less than the GMENAC had predicted [11], and 2000 was characterized by a shortage."

http://www.ajronline.org/cgi/content/full/178/5/1075

So, I am not going to sit here and look into the crystal ball and tell you what the field will be like in five years, but I will say that if you really like the field, and think you'd be happiest as a radiologist/IR, don't let this forum dissuade you. If you want it for the salary and ideal lifestyle, maybe think more about it.

Did I already not address this? Jesus Christ, do you people actually read the posts? And explain to me what insight into radiology I'm missing as far as my prediction into the future of American health care as a whole (not just radiology). If you have objections or input, then by all means share. I will read and respond.

 

[cowme]

Did I already not address this? Jesus Christ, do you people actually read the posts? And explain to me what insight into radiology I'm missing as far as my prediction into the future of American health care as a whole (not just radiology). If you have objections or input, then by all means share. I will read and respond.

I have read all of your posts and re-read them. And you still haven't provided a shred of concrete data to suggest that the radiology market is actually going to hit a wall. I don't care about arguing about salary...that is not the topic of this thread. I appreciate your input, but just having a background in business doesn't mean you can accurately predict issues as complex as this.

 

[bronx43]

I have read all of your posts and re-read them. And you still haven't provided a shred of concrete data to suggest that the radiology market is actually going to hit a wall. I don't care about arguing about salary...that is not the topic of this thread. I appreciate your input, but just having a background in business doesn't mean you can accurately predict issues as complex as this.

What concrete data do you need to predict trends? I don't understand what you're trying to ask for, here. Do you really NEED me to link you to graphs showing federal and private sector debt levels? Or the purchasing power of the USD? Or the M2 graphs post-QE? Or the rising price of commodities, specifically oil?
I can't frickin' offer you a graph showing "future" plotted against "diagnostic imaging market." I can only give you reasoning to why current and additional health care spending cannot continue to happen. If you can tell me how it can, please do share, because I would love to hear it. And how can I talk about the market without discussing salary? That's the entire point - the amount of money circulating in the system split amongst a pre-set number of providers.
I'm not saying I can accurately predict anything, but at least I can back up what I'm predicting with some sort of reasoning that isn't a concession to ignorance and maintenance of status quo. And that's really the best myself or anyone can offer.

 

[cowme]

What concrete data do you need to predict trends? I don't understand what you're trying to ask for, here. Do you really NEED me to link you to graphs showing federal and private sector debt levels? Or the purchasing power of the USD? Or the M2 graphs post-QE? Or the rising price of commodities, specifically oil?
I can't frickin' offer you a graph showing "future" plotted against "diagnostic imaging market." I can only give you reasoning to why current and additional health care spending cannot continue to happen. If you can tell me how it can, please do share, because I would love to hear it. And how can I talk about the market without discussing salary? That's the entire point - the amount of money circulating in the system split amongst a pre-set number of providers.
I'm not saying I can accurately predict anything, but at least I can back up what I'm predicting with some sort of reasoning that isn't a concession to ignorance and maintenance of status quo. And that's really the best myself or anyone can offer.

I'll respond to this in 6 years.

 

[Radonkulous]

LOL. My solution to present any sort of oversupply would be to cut the spots for residents. Is there any other specialty minting 1100 new physicians a year?

 

[colbgw02]

LOL. My solution to present any sort of oversupply would be to cut the spots for residents. Is there any other specialty minting 1100 new physicians a year?

Can't tell if this is a serious question or not. Of course there are.

 

[NAGNAM]

Oversupply is not better than a shortage. There's a shortage of dermatologists right now-- waiting lists for appointments in some areas can be months to get what results in a five minute appointment. They could add residency spots, but don't. This way derm stays competitive.

The result? NPs doing derm procedures. Disaster.

 

[fun8stuff]

Oversupply is not better than a shortage. There's a shortage of dermatologists right now-- waiting lists for appointments in some areas can be months to get what results in a five minute appointment. They could add residency spots, but don't. This way derm stays competitive.

The result? NPs doing derm procedures. Disaster.

There is a demand for a greater number of radiologists than derms... radiology is intertwined with the entire medical system, whereas derm only has a small niche. Comparing the number of residency spots is like comparing apples to oranges...

The other aspect which I think you are hinting at here is that if there are decreased radiologists, than other people will start doing rads procedures... or trying to read their own films. In a way, it is good or the field to have prominence so referring docs think and are trained to consult us for the CT biopsies, interventional procedures, head MRIs, etc.

 

[Radonkulous]

Can't tell if this is a serious question or not. Of course there are.

Should have clarified this statement by saying that those 1100 are having a tougher time finding a job. It seems to me in my limited exposure to the field that influx > efflux + "growth/demand"

Maybe you disagree?

 

[colbgw02]

Should have clarified this statement by saying that those 1100 are having a tougher time finding a job. It seems to me in my limited exposure to the field that influx > efflux + "growth/demand"

Maybe you disagree?

I took your question at face value. Now, if you consider that radiologists aren't considered "generalists", in the way that FPs and general internists are, then yes, the number of radiologists is quite remarkable. I think that reflects the central role and volume that imaging has in modern medicine. If you plot a graph showing the number of imaging studies performed and number of radiologists trained versus time, you'll find that those lines have been divergent for quite awhile. I think only in the last couple of years have those lines started to approach parallel, thanks mostly to ALARA awareness. Combine that with reimbursement cuts, and you see a slightly tighter job market. The jobs are still out there; they're just not there at the salary and location that the people now entering the market came to expect when they applying to the field in the "good old days" of 2004 and 2005.

 

[Radonkulous]

I took your question at face value. Now, if you consider that radiologists aren't considered "generalists", in the way that FPs and general internists are, then yes, the number of radiologists is quite remarkable. I think that reflects the central role and volume that imaging has in modern medicine. If you plot a graph showing the number of imaging studies performed and number of radiologists trained versus time, you'll find that those lines have been divergent for quite awhile. I think only in the last couple of years have those lines started to approach parallel, thanks mostly to ALARA awareness. Combine that with reimbursement cuts, and you see a slightly tighter job market. The jobs are still out there; they're just not there at the salary and location that the people now entering the market came to expect when they applying to the field in the "good old days" of 2004 and 2005.

So what do you think the future holds?

 

[colbgw02]

So what do you think the future holds?

The short answer? I have no clue.


My suspicion is that, like most of medicine, radiology will take a hit. Given that medical imaging is over-utilized, that hit will probably be bigger than in other fields. However, I do not think that the coming cuts represent a sea change in radiology or its role in medicine. Rather, I think it will reflect a correction of the unsustainable growth that the field has seen over the last 15 years. I think radiology's growth and the associated prosperity has resulted in many people having unreasonable expectations about the job market.

Overall, I think radiology is a great field, and it remains positioned to be a cornerstone of medicine. The specialty has issues it needs to address, just like everything other field, but I still think the future is bright. My advice to medical students is the same as it was before the recession: do what you love. That way, if/when things change, you'll still be happy with your choice.

 

[fun8stuff]

The short answer? I have no clue.


My suspicion is that, like most of medicine, radiology will take a hit. Given that medical imaging is over-utilized, that hit will probably be bigger than in other fields. However, I do not think that the coming cuts represent a sea change in radiology or its role in medicine. Rather, I think it will reflect a correction of the unsustainable growth that the field has seen over the last 15 years. I think radiology's growth and the associated prosperity has resulted in many people having unreasonable expectations about the job market.

Overall, I think radiology is a great field, and it remains positioned to be a cornerstone of medicine. The specialty has issues it needs to address, just like everything other field, but I still think the future is bright. My advice to medical students is the same as it was before the recession: do what you love. That way, if/when things change, you'll still be happy with your choice.

I had a lecture from a physicist the other day who stated that the big companies are working on reducing CT radiation by ~70-80% with improved picture quality by improved post processing with "gaming computers". I don't anything to support this, as I think he said he heard it from a friend in the industry. If this were the case, the CT may become the new CXR....

However the main point, is that it is very hard to predict the future because of the possible curveballs that could drastically change everything. I think as medicine progresses, we will move toward more objective, noninvasive, fast diagnosis via imaging. However, if the US economy collapses, it will certainly take longer to reach this point.