Interesting graph from this week's JAMA

[UnderDoc]

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An interesting graph from this week's JAMA correlating medical student interest in various specialties, as judged from fill-rates, with average salaries.

Discuss.

 

[Neuronix]

That GIF came out really blurry and was almost unreadable. So here's a link.

Future salary and US residency fill rate revisited. Ebell, MH.

http://jama.ama-assn.org/cgi/content/full/300/10/1131

There are far more residency spots than there are US Seniors. FMGs are filling the spots Americans don't want. Nothing new here. Main correlates?
1) Money
2) Lifestyle

 

[NPR]

Not at all surprising.

I would frankly be concerned if the graph showed otherwise.

 

[GatorHockeyDoc]

Studies like this don't tell us anything we didn't already know. All they do is make the general public talk about how greedy doctors are.

 

[PeepshowJohnny]

Studies like this don't tell us anything we didn't already know. All they do is make the general public talk about how greedy doctors are.

I agree, what's actually interesting about the graph is not looking at it and say "Look, doctors all want money!" Newsflash genius: So does everybody.

What IS interesting is the what specialties buck the curve. Pediatrics has a lot of interest relative to its interest to its pay while Family Medicine has low, which I think reflects the satisfaction of people in those fields.

 

[joe6102]

I agree, what's actually interesting about the graph is not looking at it and say "Look, doctors all want money!" Newsflash genius: So does everybody.

What IS interesting is the what specialties buck the curve. Pediatrics has a lot of interest relative to its interest to its pay while Family Medicine has low, which I think reflects the satisfaction of people in those fields.

ER bucks the curve as well, but if you factor in lifestyle that might explain it - no call to speak of and scheduled shifts.
And I've always thought pathology is very underrated.

 

[Amxcvbcv]

I talked to an ER attending here that makes ~$600000 before taxes. He works 18 12 hour shifts per month, though.

 

[Neuronix]

54 hours/week? I'm crying a river over here.

 

[staphaureus]

I wonder if the author ever thought that the correlation might be less dramatic factoring in time.. or at least graphing dollar/hrs vs fill rate .. then some how adjust for coming in the middle of the night, residency length, demands of residency.

 

[MacSooner]

.

 

[MacSooner]

these salary numbers are ridiculous if you don't include hours/wk and stress in the equation. everyone knows that ortho is long hrs and high stress compared to radiology, so don't radiologists make much more per hour than orthopods?

 

[schan]

ER bucks the curve as well, but if you factor in lifestyle that might explain it - no call to speak of and scheduled shifts.
And I've always thought pathology is very underrated.

I think pathology is also underrated--keep an eye for it. I think pathology will be the next hot field. All these years of research and development into biosciences will pay off in molecular diagnostics, namely pathology.

 

[schan]

I think pathology is also underrated--keep an eye for it. I think pathology will be the next hot field. All these years of research and development into biosciences will pay off in molecular diagnostics, namely pathology.

PS. But Radiology is still my favorite 🙂

 

[bananamed]

I think pathology is also underrated--keep an eye for it. I think pathology will be the next hot field. All these years of research and development into biosciences will pay off in molecular diagnostics, namely pathology.

I agree there's a lot of potential for growth in pathology. But in frequenting the pathology board, it seems like ever declining reimbursement is also a very serious threat.

 

[strv04]

I think pathology is also underrated--keep an eye for it. I think pathology will be the next hot field. All these years of research and development into biosciences will pay off in molecular diagnostics, namely pathology. 10-04-2008 12:50 PM

Even if there is a huge increase in demand for molecular diagnostics (which there likely will be) does it really take a pathologist to oversee and interpret each test? The increase utilization of medical imaging in the last 15 years has made radiology a great field in regards to income but interpretation of images is unlike a molecular test which is probably automated and very specific for what its is looking for. Interpretation of a CT/MRI or whatever new modality comes along in the next couple decades will always require a trained radiologist. Therefore despite the increase in molecular diagnostic pathologist income is less likely to increase the way it has for a radiologist. I'd be much more worried about computers replacing pathologist doing molecular test then I would be computers replacing radiologist or pathologist interpreting slides.

Am I off base or underestimating the role of pathologist with this line of thought? Or does this make sense to anyone else?

 

[Gyric]

The AMA and other organizations have clearly defined diagnostic testing as the practice of medicine. The question is why wouldn’t a pathologist get reimbursed for managing a clinical laboratory on a per test basis, after all without experienced oversight, incorrect values are reported and medical decisions are made that can be disastrous (just because it seems like a black box to you does not mean that there is not someone behind the scenes making it all work).

Pathologists can and do bill PC on many laboratory tests; this has been challenged and defended in a number of courts. The basic logic that lawyers and judges seem to understand is that if you can be held liable for it you can bill for it.

Molecular testing is being incorporated into the current reporting infrastructure through which we make diagnoses. For example once I might have only been able to look at a few slides when issuing a report on bone marrow. Now, I can review flow cytometry, cytogenetics, and molecular data and incorporate my findings into the final diagnosis (and yes I can bill for interpreting all of these components). Pathology is not limited in its scope of practice to any one technology/modality and I am in no way worried about being outsourced.

 

[120300]

"The association between physician salary and residency fill rate described in 1989 has persisted. County, state, and international comparisons have consistently shown that having a greater percentage of physicians in primary care specialties is associated with better population health outcomes, including reduced all-cause, cardiovascular, infant, and cancer-specific mortality.5 However, rising levels of student debt, considerably lower salaries in primary care specialties, and a perception that primary care may have a less rewarding lifestyle have led to a potential workforce crisis given the aging US population. Addressing disparities in salary by specialty may need to be part of a solution to this problem." (Bold italics added for emphasis).

Wow! Imagine a system in which monetary rewards encourage people to be more competitive. It's called a free market. But in this environment of tearing down free markets in the US, the author's sentiment is not surprising. I am not tone deaf to the point about "better population health outcomes", but I'm sure we all know classmates who committed to primary care in a rural area and in return had their medical school paid for. The author does not mention these sources of funding, he only points out that low salaries and high debt will make it unattractive for students to choose primary care. Moreover, the author seems bitter that some doctor's make more than others. Instead of pitting doctors against doctors, the author should focus on how much is wasted by US health insurance companies that could be used to pay PCP's more. Or why not rail against the big pharma about how much their SGA expense is while patients go underserved? All docs will lose if we fight against each other. We have to show America where the real waste is, and it is certainly not in physician salaries!

 

[yaah]

Molecular diagnostic testing is not exactly trivial. But the main point is that it doesn't reimburse well anyway, at least for now. So it isn't really a goldmine for pathologists. It provides good business for labs that do esoteric or rare testing. But most of the money that is made on these tests go to the bioscience companies who create (or purchase) the technology and patent it, and then license it out for use. Much of the test cost that patients pay goes to covering these costs as well as the extensive tech time that is required. As for declining reimbursement, this is happening and will continue to happen everywhere. Radiology is probably due for a big cut due to the current imbalance which appears to reimburse radiologic tests at higher rates than other things in medicine.

 

[120300]

As a physician it turns my stomach to see our profession accepting these salary cuts as fact. Yes, we all know that healthcare costs must be cut, but physician salaries are not the problem. The AMA is doing what it can, but it simply cannot compete with the pharm and insurance lobbies, who are simply delighted that physicians are fighting each other. Relatively high radiology salaries are not why PCP's are paid so little. PCP's are paid so little because the insurance companies waste so much money and pay their executives sums physicians can only dream about.

 

[Neuronix]

Radiology is probably due for a big cut due to the current imbalance which appears to reimburse radiologic tests at higher rates than other things in medicine.

http://forums.studentdoctor.net/showpost.php?p=7254566&postcount=13

This post sums up my feelings on the topic nicely.

I hear every year that Radiology is going to get cut big time. There's always some new bill. There's always some Medicare change. There's some election. Every year I get to listen to the academics rant about how the private guys are going to lose their asses for reasons that are patently false or don't end up happening/being a big deal.

The sky is falling Henny Penny! Yet somehow every year it doesn't happen. But we'll ignore the fact that it didn't fall last year, or the year before that, or the year before that, or even the year before that x10. IT'S FALLING THIS YEAR! THIS TIME IT'S OBAMA AND HE'S TOTALLY CEREAL.

😴

 

[echod]

http://forums.studentdoctor.net/showpost.php?p=7254566&postcount=13

This post sums up my feelings on the topic nicely.

I hear every year that Radiology is going to get cut big time. There's always some new bill. There's always some Medicare change. There's some election. Every year I get to listen to the academics rant about how the private guys are going to lose their asses for reasons that are patently false or don't end up happening/being a big deal.

The sky is falling Henny Penny! Yet somehow every year it doesn't happen. But we'll ignore the fact that it didn't fall last year, or the year before that, or the year before that, or even the year before that x10. IT'S FALLING THIS YEAR! THIS TIME IT'S OBAMA AND HE'S TOTALLY CEREAL.

😴

What do you think about the possibility of foreign radiologists diagnosing films streams over the internet? Radiologists' salary has to decrease when supply increases but demand stays constant. Isn't radiology already the only specialty that grants US licenses w/o having to do a residency in the US?

 

[Neuronix]

What do you think about the possibility of foreign radiologists diagnosing films streams over the internet?

It seems to me that it can't possibly happen en masse due to legal liability. There always has to be someone on US soil to be held accountable when things go wrong. Are you going to trust your license to someone reading your films for you overseas? Is the hospital going to just say "We missed this easy and killer call to a foreign trained and based MD"? No, they're going to get sued into oblivion. The legal and political backlash would be tremendous.

Why exactly is teleradiology going to kill Radiology now anyways? The technology has existed for at least 10 years to do it.

Isn't radiology already the only specialty that grants US licenses w/o having to do a residency in the US?

It's not that common and they still have to do fellowship and work here for years. Once people train here they almost never want to go back. Everyone is fighting to get in here because US docs are paid so well. That's sort of an issue of FMGs taking over a specialty, and this is much more common in the lower paid specialties like IM and FP since AMGs don't want those spots. Regardless, the FMGs aren't going to just run away and practice from the third world again because the pay here is so good and the US is a nice stable place to raise a family and get your kids into medical school and such.

The real threat to Radiology as I see it is encroachment from other medical specialties. One that is common to all medical specialties but more prevalent in others is the expansion of midlevels.

But what do I know... I only got my PhD in Radiology. It's a whole nother world in the clinics.

 

[echod]

Why exactly is teleradiology going to kill Radiology now anyways? The technology has existed for at least 10 years to do it.

I think it takes time. It's hard to imagine entrepreneurs wouldn't seize on an opportunity like this, especially given that the profits are so big. We think in 100s of thousands but they think in millions of Ks. It's easy to predict which side will win. I'm actually hoping to be proved wrong though.

 

[OHMAN0125]

I think it takes time. It's hard to imagine entrepreneurs wouldn't seize on an opportunity like this, especially given that the profits are so big. We think in 100s of thousands but they think in millions of Ks. It's easy to predict which side will win. I'm actually hoping to be proved wrong though.

I think Telerads had a "peak" ~2 years ago. Just look at stocks for NHWK and etc. Now the stocks sunk. As another poster said, there is too much legal and regulation issues. Hence investors didnt see a significant return and they pulled out.
In truth, teleradiology works FOR radiologists in the states,. You pay them so ur group doesnt have to be on call at night. They can provide prelim read but a final read has to be done by a radiologist on US soil. So in other words the group is losing money since they can only bill medicare for the final read but they have to pay the telerad also. But hey i dont want to be on call at night when im 50. Also you can work for a Telerad company. I think the pay is pretty good in general but the hours suck unless u move to australia or asia.

Also to provide a prelim read u have to be US trained. No hospital will want a prelim read from a non-US trained radiologist. So ur taking workforce from US anyways. Thus the supply is still abuot the same.

 

[gonogo]

The real threat to Radiology as I see it is encroachment from other medical specialties. One that is common to all medical specialties but more prevalent in others is the expansion of midlevels.

I think this is exactly the biggest issue. It's cardiologists taking over cardiac imaging, neurologists over neurorads, etc...

It's already happening in the interventional field, these specialties are trying to take over rads. In fact, cardiologists already took a big piece. The advantage specialties like cardio and neuro have is that they have their own patients. So I think they're the real threat.

 

[radslooking]

I think Telerads had a "peak" ~2 years ago. Just look at stocks for NHWK and etc. Now the stocks sunk. As another poster said, there is too much legal and regulation issues. Hence investors didnt see a significant return and they pulled out.
In truth, teleradiology works FOR radiologists in the states,. You pay them so ur group doesnt have to be on call at night. They can provide prelim read but a final read has to be done by a radiologist on US soil. So in other words the group is losing money since they can only bill medicare for the final read but they have to pay the telerad also. But hey i dont want to be on call at night when im 50. Also you can work for a Telerad company. I think the pay is pretty good in general but the hours suck unless u move to australia or asia.

Also to provide a prelim read u have to be US trained. No hospital will want a prelim read from a non-US trained radiologist. So ur taking workforce from US anyways. Thus the supply is still abuot the same.

You know, why can't the legal structure change on this? Why must someone be accountable on US soil for an image to be read. To me this seems like it could be worked around somehow. Also-the designation that a final has to be read by someone in the US also seems like it could be negotiated.

Perhaps everyone is right, and the legal aspects will prevent streams of films being sent to a radiologist reading films in a mud hut in indonesia, but I just am not convinced it couldnt be done.

 

[hans19]

You know, why can't the legal structure change on this? Why must someone be accountable on US soil for an image to be read. To me this seems like it could be worked around somehow. Also-the designation that a final has to be read by someone in the US also seems like it could be negotiated.

Perhaps everyone is right, and the legal aspects will prevent streams of films being sent to a radiologist reading films in a mud hut in indonesia, but I just am not convinced it couldnt be done.

Do you know how easy it is to get credentialed in a hospital EVEN IF you are an American trained, American citizen rad. Let me tell you how it is, and I have a clean clear record. How the F--- are you gonna check the creds of a some schmo working out of a mud-hut in indonesia?

Lets not even get into having accountability for errors--- will patients tolerate it when a mistake is made by some anonymous figure from indonesia who doesn't necessarily practice at the same standards as in the US with the same standards of training in the US?

Hey if you are THAT worried about radiology, look elswhere to find your bullet-proof specialty. You'd be hard-pressed to find a field in the US that DOESN'T face of decreased reimbursement from the government or competition from another specialty.

If you are still set on radiology, but still unsure of the future here, then feel free to look for a rad residency in Indonesia, there are plenty of students here that wouldn't mind one less person to compete with.

 

[hans19]

I think this is exactly the biggest issue. It's cardiologists taking over cardiac imaging, neurologists over neurorads, etc...

It's already happening in the interventional field, these specialties are trying to take over rads. In fact, cardiologists already took a big piece. The advantage specialties like cardio and neuro have is that they have their own patients. So I think they're the real threat.

YES, but its a dynamic process. IR developed and 'took' what was not originally in their 'turf'.

IE angioplasty and stenting developed by IR took away business from Vascular surgeons who then only knew how to do by pass and do open thrombolectomies.

There used to be a diagnostic component to general surgery. Remember before CT, and CT guided biopsies, diagnosis of cancer was made via open biopsies. The number of Ex-laps performed has drastically decreased. The biopsy / diagnostic aspect of medicine has fallen into the realm of radiology.
The same is true for abdominal abcess drainages.

Vascular access is a relatively easy and lucrative aspect of medicine once dominated by vascular surgery, which is now more easily done with image guidance.

Pneumoencephalography and cerebral angiography was once in the domain of neurosurgeons, but with the advent of crosssectional neuroimaging those modalites fell into the realm of neuroradiology.

Depending on how you look at it, the first 20 years of IRs history, IR had stolen lots of turf from other specialties.
What looks like 'loss' of turf from IR is the regain of turf from IR by other specialties.

Meanwhile turf is gained by IR as we speak. UFE is a great procedure which directly competes with myomectomy and hysterectomy for fibroids. In the field of oncology Chemoembolization and radioembolization as well as other loco-regional image guided ablations are giving viable and EFFECTIVE alternatives to the standbys of surgery (not everyone is a candidate), chemo (systemic side effects), radiation.

Maintanence of AV shunts and grafts mean that vascular surgeons are putting in less shunts and grafts than before.

Hardly anyone does surgical splenorenal shunts for portal hypertension anymore thanks to TIPS.

Yes IR is under attack, but in spite of this, IR continues to evolve and stay ahead of the curve, and according to salary figures from recent threads -- is doing this quite well I might add! 😀

 

[Llenroc]

Pneumoencephalography and cerebral angiography was once in the domain of neurosurgeons, but with the advent of crosssectional neuroimaging those modalites fell into the realm of neuroradiology.

Don't know what that is, but it just flat out sounds unpleasant and risky.

Anyway to add to interventional cardiology and interventional pain, I've heard that interventional nephrology and even interventional pulmonology are emerging fields, heavy on the image guided procedures.

 

[Amxcvbcv]

Don't know what that is, but it just flat out sounds unpleasant and risky.

Look up a picture of the restraint chairs they used for those - eek.

The procedure even made it into the Exorcist during one of the hospital scenes.

From what I've read, it was one of the most exquisitely painful procedures in medical history, possibly just shy of pre-anesthetic surgeries.

 

[Taurus]

YES, but its a dynamic process. IR developed and 'took' what was not originally in their 'turf'.

IE angioplasty and stenting developed by IR took away business from Vascular surgeons who then only knew how to do by pass and do open thrombolectomies.

There used to be a diagnostic component to general surgery. Remember before CT, and CT guided biopsies, diagnosis of cancer was made via open biopsies. The number of Ex-laps performed has drastically decreased. The biopsy / diagnostic aspect of medicine has fallen into the realm of radiology.
The same is true for abdominal abcess drainages.

Vascular access is a relatively easy and lucrative aspect of medicine once dominated by vascular surgery, which is now more easily done with image guidance.

Pneumoencephalography and cerebral angiography was once in the domain of neurosurgeons, but with the advent of crosssectional neuroimaging those modalites fell into the realm of neuroradiology.

Depending on how you look at it, the first 20 years of IRs history, IR had stolen lots of turf from other specialties.
What looks like 'loss' of turf from IR is the regain of turf from IR by other specialties.

Meanwhile turf is gained by IR as we speak. UFE is a great procedure which directly competes with myomectomy and hysterectomy for fibroids. In the field of oncology Chemoembolization and radioembolization as well as other loco-regional image guided ablations are giving viable and EFFECTIVE alternatives to the standbys of surgery (not everyone is a candidate), chemo (systemic side effects), radiation.

Maintanence of AV shunts and grafts mean that vascular surgeons are putting in less shunts and grafts than before.

Hardly anyone does surgical splenorenal shunts for portal hypertension anymore thanks to TIPS.

Yes IR is under attack, but in spite of this, IR continues to evolve and stay ahead of the curve, and according to salary figures from recent threads -- is doing this quite well I might add! 😀

My concern and I think many people's as well is whether IR is breaking new ground fast enough to replace the turf that they are losing to other specialties like cards, vascular surgery, neurosurgery, interventional neurology, urology?

 

[deltamed]

Whats to stop some greedy US radiologist from setting up a "reading shop" in another country and have highly-trained foreginers read his films for him? In other words, the US radiologist "reads" the films by signing his name to it and in exchange for the millions and millions in extra revenue takes legal responsibility for the read?

I could imagine that working, especially if theres some shady setup like the US radiologist looking at each film real quick (like 5 seconds) and approving/editing the read the foreign doc did.

I hope this doesnt happen, just wondering why it couldnt?

 

[Mariah246]

Whats to stop some greedy US radiologist from setting up a "reading shop" in another country and have highly-trained foreginers read his films for him? In other words, the US radiologist "reads" the films by signing his name to it and in exchange for the millions and millions in extra revenue takes legal responsibility for the read?

I could imagine that working, especially if theres some shady setup like the US radiologist looking at each film real quick (like 5 seconds) and approving/editing the read the foreign doc did.

I hope this doesnt happen, just wondering why it couldnt?

Mistake #1 and the operation goes the way of poop in the toilet.