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Lifestyle Specialties
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PM&R
Global Disrobal
Along for the ride
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15+ Year Member
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PM&R=Plenty of Money & Relaxation
Pathology
Radiology
Dermatology
Ophto
Pathology
Radiology
Dermatology
Ophto
ER
They average about 45 hours/wk with no beeper.
They average about 45 hours/wk with no beeper.
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I know an ER doc who only works every other year.
What does he do during that time off, you may ask?
Travel around on his boat. 😉
What does he do during that time off, you may ask?
Travel around on his boat. 😉
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You could argue either way, but I for one do NOT see ER as a lifestyle specialty.
Although the hours and pay can be good and flexible, there is the potential for MAJOR stress during a shift, and a high risk of lawsuits.
Love ER docs, nothing against them.
Although the hours and pay can be good and flexible, there is the potential for MAJOR stress during a shift, and a high risk of lawsuits.
Love ER docs, nothing against them.
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Lifestyle specialties? I always thought that to be an oxymoron in medicine but I know it's all relative.
If you want a truly relaxed lifestyle, you should look outside of medicine. Even the "cush" specialties are far more demanding on your time than most other professions out there.
If you want a truly relaxed lifestyle, you should look outside of medicine. Even the "cush" specialties are far more demanding on your time than most other professions out there.
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ER has a very flexible lifestyle in that you have a lot of flexibility due to the 'shift' nature of your scheduling, there are examples of people working mostly the begininning of one month, the end of the next month, and having essentially a month off in the middle. That and they get paid a lot
However, while I found the codes and resuss. exciting, a lot of the nitty gritty ER cases were pretty irritating. Who comes into the ER at three in the morning to get a pimple in their ear looked at?
However, while I found the codes and resuss. exciting, a lot of the nitty gritty ER cases were pretty irritating. Who comes into the ER at three in the morning to get a pimple in their ear looked at?
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Pyjamas (British spelling there, for ya), or silk boxers, with "lady friend" at the ready?
Then again, if you're smokin' stogies and drinking red wine at 9am, you're probably hanging out with Don King, anyhow.
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Or, the very teleradiology technology used to have you sipping wine at home will be used to outsource your job to someone in Asia willing to do it for 1/10th the salary.
Regulations can be changed, but technology that allows doctors to work at home and relax can easily be used to outsource that very work.
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Maybe I'm still naive, or maybe my personality is just different, but that sounds boring as hell. I mean, yeah it sounds nice, but I just keep thinking that doing this as your CAREER for the rest of your life would in the end not be as fulfilling. It's been a while since Psych, but in somebody's theory of development isn't the ego of the adult years defined by "career fulfillment vs. depression" or something like that? I know this is horribly wrong, but I hated psych and am too lazy to look it up. You get the idea.
Then again, I'm the guy who always wanted to go to the floor and eyeball a pt. when some f'ed up film would come up during my Rads rotation.
Maybe that's why I'm doing IM?
avend-- don't try to reason with these people... we all need to convince ourselves that our chosen career path is the best one. Some people just tend to be more outspoken about it than others.
MadC
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A good correlate of lifestyle is the number of work hours. See this thread:
http://forums.studentdoctor.net/showthread.php?threadid=101722
Of course there are other factors involved too, but hours are a major one.
http://forums.studentdoctor.net/showthread.php?threadid=101722
Of course there are other factors involved too, but hours are a major one.
Anybody know anything about those docs on cruise ships? Getting paid to lounge on a party boat would be pretty sweet.
(Waiting for someone to burst my bubble....)
(Waiting for someone to burst my bubble....)
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Dr. Cuts, I sincerely hope you are just naive and don't truly see radiology the way you portray it. Radiology is an incredible field that I consider myself extremely fortunate to be in. There is nothing else in medicine that I can even picture myself doing. I play with the coolest toys every day and image human beings right down to the molecular level, often seeing things much clearer than can even be accomplished operatively. The only real limiting factor in the field is our ability to understand and harness the technology. Studies in our hospital have shown that we are the major contributing factor in making 80% of new diagnoses that come through the door. It is virtually unheard of for a patient to have a medical record and not have a radiologic study of some sort. What you must understand though is that we as radiologists are clinicians. Our job is so much more than just interpreting the data on a study. We have to look at the patients history, their age/sex/race/habitat, we have to rely on the clinical exam and history taking of our colleagues, we review the lab work and we try to put all these things together to help those taking care of the patient figure out the problem. We do not simply interpret the data on the film. If that were the case, then yes I could sit at home or on a boat or wherever and spit out blind interpretations all day with no real thought or care as to whether my work is at all useful. That would not only be excrutiatingly boring, but of little use and frankly dangerous. Besides I like going to work; I like speaking to the man that buffs the floors before most of the world wakes up or the night angio tech who has more war stories than Ike. It is true that you can work a 3 day or 5 day week 9-5 with no call, but that is not reality. If your just searching for the most money for the least amount of work, you picked the wrong profession and you will be miserable. Passion for your work is an absolute must regardless of what you do. Contentment in your career or life doesn't have that much to do with how many hours you work a week or how much money you make. Rather it has a lot to do with the little things that people tend to overlook. That man that buffs the floors every morning takes pride in what he does and I appreciate that. Don't let the smoke from that cuban cause you to miss that subtle aortic pseudoaneurysm that is seen on only the single very top image of that renal colic CT ordered for flank pain that will roll across your PACS station one day (Real case last month). Don't mean to rant or criticize, just my $0.02
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I agree 100%. Cuts is a good guy and contributes a lot, but some of his posts are frankly disgusting. His is too deluded by the thought of easy money. Boy will he be disappointed when he finishes his internship and actually starts learning something about radiology and doing it. He'll be much more disappointed when he finishes his residency and realizes that he has to work his ass off to make a good living. His dream of making a fortune doing teleradiology on a boat which he throws out ad nauseum on every other thread is exactly what it is, a dream. He needs to get a hang of reality.
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I actually inquired about this during a Caribbean cruise a few years back. The docs on board have one hour per day as "office hours." The rest of the time nurses cover anything that's not a true emergency. You do, however, have to be board certified in Emergency Medicine to serve in this capacity for most cruise lines. I talked to the doc on board, and he said that he does this for a week about 3 or 4 times a year. His family gets a DEEPLY discounted vacation, his is free (though no actual pay in most circumstances), and he only works an hour a day unless one of the geezers has an MI at the craps table....
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I agree he is deluded. I know a few radiologists right out of training that took teleradiology jobs. They all quit after a year or 2. The work is not stress free as he seems to portray it and you read a very high volume of cases under constant pressure. It is like reading in the ER on call as a resident but worse, because there is absolutely no let up. Not surprisingly there is a high burn out rate. Nobody is going to pay you big bucks to lounge around in your pajamas.
When I cruised on Carnival, our doc (as with the rest of the command staff, excepting the hotel manager) was Italian.
Everywhere you look for cruise lines, they tell you that the doc is an "independent contractor", so, unless the pt has money or insurance, you don't get paid (but, then again, I don't have stats on how many pts you see on board, and, as adawaal says, unless someone literally craps out...).
Then again, a lot of cruise lines (like Princess, Cunard, Royal Caribbean) have a HIGH volume of old AND rich passengers.
Everywhere you look for cruise lines, they tell you that the doc is an "independent contractor", so, unless the pt has money or insurance, you don't get paid (but, then again, I don't have stats on how many pts you see on board, and, as adawaal says, unless someone literally craps out...).
Then again, a lot of cruise lines (like Princess, Cunard, Royal Caribbean) have a HIGH volume of old AND rich passengers.
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Yet again Dr. Cuts, I ask you, what is to prevent Congress from realizing how easy radiologists can diagnose "films from their boat over the internet for 500k/year", realize that its increasing costs to consumers and the govt, and then saying, hmm, maybe if we outsource radiology to asia, we can save over 90% on film reads? I mean, "It will be immensely easier to consult the radiologist" by video conferencing, so why would it matter if theyre in the Carribean or in Bangalore or Shanghai? And dont give me this junk about regulations protecting radiology from outsourcing, once Congress sees how much radiologists are fleecing the government from their yachts, I think those regulations will be long gone.
The technology that results in the very ease with which you hope to telecommute to work from your yacht can and will be used to outsource that work to cut costs.
Irony is a beeyatch.
The technology that results in the very ease with which you hope to telecommute to work from your yacht can and will be used to outsource that work to cut costs.
Irony is a beeyatch.
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Im not saying radiology is dying, in fact, interventional will probably just keep growing and there will likely be new technologies out that will require radiologists to interpret.
But if rads becomes as easy as you describe it, with radiologists just working from their yachts reading films, that means the radiology community would have failed in making themselves UNIQUELY useful, thus creating a much greater danger of outsourcing.
So Im not saying radiology as a whole will be outsourced, but anyone reading films from their yachts (indicating that 1. personal interaction is not required 2. technology can transport the necessary info readily 3. the job doesnt even have to be done at the hospital) is just ASKING to be outsourced.
Outsourcing is inevitable, its a major part of American economic development. The only way to avoid it is to be uniquely good at your job, and to have a job whose inputs can be transferred and performed elsewhere rapidly resulting in outputs being sent back to the source (in an equally rapid fashion). You cant outsource the surgeon, for the forseeable future, you cant outsource the interventional radiologist whose face-to-face advice in a hospital setting is valued, but you CAN outsource someone who simply reads films that are transmitted to him and sends back a report from his yacht. That type of teleradiology is a recipe for outsourcing, and if I were a radiologist, I would actually oppose the use of teleradiology within my field for that very reason.
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I am with gleevec with this one. Sooner or later, people realize the profit margins in some of the fields and start to question the system; especailly when lack of health care due to skyrocketing costs is one of the current epidemics. Rads is definately on that route as is Dentistry🙁 .
2nd as far as rads is concerned, I recently had the opportunity to see some of the outfits in India and it really shook me up, they are up to date on the technology and most of all their docs are brilliant/ quality of care is comparable to any place in the US... hospitals here would be stupid not to outsource their work. Truth of the matter is that all of us (me most of all) are going to have to get a reality check and become more competetive on the global market = more hours for a lesser pay.
This is not to say however that it is the end of rads, it just means it might be the end of an era of super luxury... we still need in house diag rads as well as interventional rads
2nd as far as rads is concerned, I recently had the opportunity to see some of the outfits in India and it really shook me up, they are up to date on the technology and most of all their docs are brilliant/ quality of care is comparable to any place in the US... hospitals here would be stupid not to outsource their work. Truth of the matter is that all of us (me most of all) are going to have to get a reality check and become more competetive on the global market = more hours for a lesser pay.
This is not to say however that it is the end of rads, it just means it might be the end of an era of super luxury... we still need in house diag rads as well as interventional rads
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I have a couple things to add. First of all, most radiologists work pretty good hours! It's nothing like surgery, but very few actually do the 40 hr per week thing.
Secondly, I think it would be incredibely difficult to get non-US licensed physicians the ability to read films independately. Does anybody actually believe that the US public is going to put their faith into India's physician licensing system? HAHAHAHAHA! You'd need a licensed US radiologist to at least sign for them, and imagine the punitive damages when the doc signing for all of them gets sued? I'm also pretty skeptical about Indian radiologists being just as good. It's NO WAY NEAR as competitive to become a radiologist over there as it is here. Basically, we're a long way from out-sourcing any kind of medicine.
Teleradiology does have another sort of threat though. If hospitals don't need radiologists at the hospital, what will happen is private teleradiology groups will sign contracts with various hospitals. Eventually, there may only be a couple huge radiology groups in each city doing a lot more work for a lot more money. Hence the number of needed radiologists will decrease, and if you want to join one of these groups you'll have to be an associate making 100k for 7 years first.
Ofcourse that's just a theory, there's no telling where radiology will go in future. It's a technologically driven field though, so it will always be high paid. I tried really hard to like radiology! I wish I found it more fun b/c it's one of the best fields.
Secondly, I think it would be incredibely difficult to get non-US licensed physicians the ability to read films independately. Does anybody actually believe that the US public is going to put their faith into India's physician licensing system? HAHAHAHAHA! You'd need a licensed US radiologist to at least sign for them, and imagine the punitive damages when the doc signing for all of them gets sued? I'm also pretty skeptical about Indian radiologists being just as good. It's NO WAY NEAR as competitive to become a radiologist over there as it is here. Basically, we're a long way from out-sourcing any kind of medicine.
Teleradiology does have another sort of threat though. If hospitals don't need radiologists at the hospital, what will happen is private teleradiology groups will sign contracts with various hospitals. Eventually, there may only be a couple huge radiology groups in each city doing a lot more work for a lot more money. Hence the number of needed radiologists will decrease, and if you want to join one of these groups you'll have to be an associate making 100k for 7 years first.
Ofcourse that's just a theory, there's no telling where radiology will go in future. It's a technologically driven field though, so it will always be high paid. I tried really hard to like radiology! I wish I found it more fun b/c it's one of the best fields.
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I don't know much, but here is one thing I think is interesting.
Too me, radiologists are pathologists of the 21st century (not to diss on path). They do tests, diagnose, and consult on patients. What I don't understand is why radiologists make a lot more than pathologists. Yes, I know it all comes down to reimbursements, but it seems strange to reimburse a pathologist a lot less than a radiologist when they are doing similar tasks. I doubt outsourcing will occur, but I do think they will be taking a huge paycut in the near future.
I don't think outsourcing will occur, because 1) people don't want to have their doctors overseas 2) don't radiologists consult with physicians? Time zone differences can create huge problems 3) a lot would have to change to allow this at the the national level, which I think is unlikely. 4) REgardless of how good Indian radiologists are, they are always a little bit behind. This was true in teh computer industry too....when US was programming stuff for Windows 98, they were still programming in DOS......
For the record. Certain areas that have demanding customers are reversing outsourcing. While most call centers (for support) are now in india, Dell and others are brining back their corporate support because of numerous complaints.
Just my $.02.
Too me, radiologists are pathologists of the 21st century (not to diss on path). They do tests, diagnose, and consult on patients. What I don't understand is why radiologists make a lot more than pathologists. Yes, I know it all comes down to reimbursements, but it seems strange to reimburse a pathologist a lot less than a radiologist when they are doing similar tasks. I doubt outsourcing will occur, but I do think they will be taking a huge paycut in the near future.
I don't think outsourcing will occur, because 1) people don't want to have their doctors overseas 2) don't radiologists consult with physicians? Time zone differences can create huge problems 3) a lot would have to change to allow this at the the national level, which I think is unlikely. 4) REgardless of how good Indian radiologists are, they are always a little bit behind. This was true in teh computer industry too....when US was programming stuff for Windows 98, they were still programming in DOS......
For the record. Certain areas that have demanding customers are reversing outsourcing. While most call centers (for support) are now in india, Dell and others are brining back their corporate support because of numerous complaints.
Just my $.02.
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I think the telerads services have coverage 24/7 and I believe they do teleconferencing if there are any questions. I also believe ISRO (Indian Space Research Organization) has planned the launch of 3 more satellites strictly dedicated to telemedicine. Having said that I don?t think on site radiologists can be replaced. These services are mostly reserved for over flow and night. As far as laughing at their competency, I don?t know, they have a very rigorous education system, which trains them very well in medicine or otherwise (IIT& IIM) School of engineering and management. Interventional rads is still ours🙂
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I've heard complaints from surgeons at my school that sometimes the Radiologists make more on a surgical patient than the surgeon due to higher reimbursements for RADS. I believe this trend will definitely reverse in the near future. I also think the misuse/overuse of radiological studies will be curtailed in the future leading to lower Rads salaries. It's crazy when you see one study done only to have the Radiologist equivocate on the findings leading to an even more expensive study being ran, and yet another after that to confirm what was believed to be the diagnosis in the first place. That's the way to make money in Rads; start off with the most unreliable study you can order, equivocate, then work your way up to the most expensive study, racking up major bucks along the way, then look like the hero when you finally confirm the diagnosis.
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More power to the Rads guys if they can make their wheelbarrow full of cash. The flip side of your PACS-on-a-boat, Cuts, is to do what I hear the US Military does after hours, having a centralized operation that reads all images from a region. While the idea of outsourcing Rads/Path overseas is still in it's infancy due to medical licensing and medical-legal issues, I sure as hell can see some people with the startup capital building a huge imaging center in Podunk USA with low overhead costs (and low malpractice) and bidding on outsourcing telerads contracts across the US. Kinda like the Wal-Mart of radiology; small local groups wouldn't be able to compete with the low overhead and volume discounts this place would be able to offer. Hell, I would drop my measly savings into that concept ASAP.
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I think a lot of docs would take the cheaper route and screw over their colleagues; look at the prolif. of physician extenders. Like I read on pol.net; "Doctors are like rabbits, rabbits like eating all the lettuce in the garden, but they love screwing over other rabbits more."
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you can outsource some surgical procedures: robotic laparoscopic surgery
procedures have been done from the US to patients in europe, why not operate from india on US patients?
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I seriously doubt that radiologists will ever take a huge pay cut, at least not anytime soon. The reason is very simple, it's a tech driven field. The newest procedures and technology always get re-imbursed better, meanwhile the old fashion stuff (eg looking at slides in path) gets its reimbursements progressively cut. I imagine the reimbursment for MRI's will eventually go down, but by then the radiologists will have other new expensive imaging modalities.
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the thing is, as a patient you actually MEET and WORK WITH your surgeon.
a lot of times, the patient never sees the radiologist, the doctor responsible for the patient simply confers with a radiologist.
that's why im NOT saying radiology is going to go away, but if teleradiology becomes so prevalent that radiologists are simply reading films at home, then the field can readily be outsourced.
i find it funny how people assume that outsourcing will somehow diminish the quality of the work. i think the companies and the doctors taking part in the outsourcing know what they're doing. they're not going to cut costs in the short-term if its just going to lead to malpractice suits. that's the beauty of markets in a way.
in any case, if radiologists are reading film hundreds of miles away, do you think a patient will care (or even know) whether they are being read on a yacht or in India or Australia?
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Well, its funny in a way. Some of the radiologists (or rads-to-be) are talking about great they will have it working at home or in a yacht. So theyre not going to be interacting with patients anyway. Their doctors will still be American, but the images will be interpreted elsewhere (in fact, some hospitals already send transcript services and image processing tasks to india to be done overnight and be ready by the next day in the US).
I think docs do like consulting with radiologists, but what's the difference between consulting with a rads at home over the phone versus consulting with a rads in Asia?
If anything, maybe cuts is right, maybe most radiologists will initially be able to work on a boat, with a few rads in the hospital for consulting. But as soon as nytimes.com reports that story, I have a feeling that lifestyle will be shortlived.
You cant get something for nothing for very long in the US-- especially when its in a field that most people consider a right, not a privilege.
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I for one hope Rads enjoys the golden goose as long as possible. Can't fault anyone for making a little money. I personally love radiologists and value their expertise.
However, I do think it is a real possibility that medicare will reduce their fee schedule dramatically in the coming years. We've seen that what medicare does, private insurance copys. It will only be exacerbated by the fact that rads is becoming a popular specialty and supply may soon equal or out-pace demand.
I agree that the day to day radiology services should remain strong, especially with the interventional advances being made. On the other hand, the "night owl" model of practice may soon creep into the mainstream of rads, which will ultimately increase competition and/or decrease reimbursement.
Ultimately though, I hope the rads guys can make their pile and enjoy life on a boat or small island!
However, I do think it is a real possibility that medicare will reduce their fee schedule dramatically in the coming years. We've seen that what medicare does, private insurance copys. It will only be exacerbated by the fact that rads is becoming a popular specialty and supply may soon equal or out-pace demand.
I agree that the day to day radiology services should remain strong, especially with the interventional advances being made. On the other hand, the "night owl" model of practice may soon creep into the mainstream of rads, which will ultimately increase competition and/or decrease reimbursement.
Ultimately though, I hope the rads guys can make their pile and enjoy life on a boat or small island!
The one thing you are all (mostly) missing is that it is happening already (Cuts' scenario): how many Rads are doing it from home now? You'd be VERY surprised. The only other question is where that home is.
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Radiologic diagnosis is the wave of the future. You can palpate, percuss, illuminate, squeeze, and sniff all you want but more often than not the burden of the final clue for diagnosis lies on the shoulder of the radiologist/pathologist. Of course clinicians have a tendency not to beleive what the radiology report says but as the technlogy improves radiologists will be able to make their dx with much more acuracy and confidence.
In the future, the physical exam will be done by affordable non physician professionals as a first step while the final dx is dicated by the radio-molecularpathologist.
There is already talks about combining general surgery with formal radiology training. Although this is unlikley to happen anytime soon, it points to the fact that the future surgens/clinicians must become not only technology savy but also very comfortable with using and interpreting imaging modalites if they are to protect and ensure their usefulness.
In the future, the physical exam will be done by affordable non physician professionals as a first step while the final dx is dicated by the radio-molecularpathologist.
There is already talks about combining general surgery with formal radiology training. Although this is unlikley to happen anytime soon, it points to the fact that the future surgens/clinicians must become not only technology savy but also very comfortable with using and interpreting imaging modalites if they are to protect and ensure their usefulness.
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Cuts,
For $329,000 you can buy 25 hours of uber-firstclass air time in a GIV-SP complete with two pilots and your own personal flight attendant (www.marquisjet.com). Don't think they've got on-board PACS set up yet though😀
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Concierge/bar tender at an exquisite hotel in Ibiza. Thats your lifestyle job buddy. Just make sure your shipment of ecstasy/cocaine comes in every week, cause you'll be moving tons of it.
VIP manager for Mandalay Bay's Foundation Room in Vegas would be so F'n sweet. You would be the man. Too late for me though.
Doh! I forgot to mention medically related. Pet psyciatrist? Do you have to go to vet school to be one of those or can you just set up shop as an MD/DO? I'd have every gerbile in the midwest on Zyprexa. Owners get Zoloft starter packs for free.
Actually my mom goes to a doc who gave up IM to work with and give advice on natural suppliments/diets. She makes plenty of money and offers people fairly sound alternative ADJUNCTS to western medical therapy.
VIP manager for Mandalay Bay's Foundation Room in Vegas would be so F'n sweet. You would be the man. Too late for me though.
Doh! I forgot to mention medically related. Pet psyciatrist? Do you have to go to vet school to be one of those or can you just set up shop as an MD/DO? I'd have every gerbile in the midwest on Zyprexa. Owners get Zoloft starter packs for free.
Actually my mom goes to a doc who gave up IM to work with and give advice on natural suppliments/diets. She makes plenty of money and offers people fairly sound alternative ADJUNCTS to western medical therapy.
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What amazes me is that some people out there think that radiology is equivocal to the computer-programming and textile industry. If radiology was not in the medical field and held to U.S. Malpractice Laws and Licensing certifications, then maybe it would become as such. Sure if you get a faulty computer or program or underwear, you can go and return it, but when the issue comes to a wrong diagnosis and a patient dies because of it... consumer protection/AMA/ACR lobby groups will have the last word.
The main issue is that you have to be U.S. Licensed and at least board eligibile to read films for the U.S. You can have preliminary films read overseas, but the reimbursment from insurances will be for the primary read by a U.S. radiologist. Prelim (overseas) reads are great for over night call so that the residents can have a back up, are great for the radiology staff so they don't have to overnight call, and will probably be great for U.S. radiologists because you can pay 1/10th for an oversees (non-U.S. licensed) radiologists read films then bill overall for many, many more films (since 1/3 will already be more or less read - so that you can read more films than usual) and have a net profit.
MGH has BACKED OFF its 'outsourcing plan," that WOULD HAVE tried to accept indian radiologists into their program for 1-2 years, say that they are well-qualified then send them back to india for 'final' reads. That is not a problem anymore.
The true NightHawks are companies that hire board certified U.S. Licensed radiologist and have officies overseas to read films (teleradiology) for the U.S. primarily at night (since there is the time difference). This has been going on for years and just making the life of U.S. based radiologists (staff and residents) better while not breaking any U.S. Laws.
Reading films from your yatch may be possible in the near future, however since you are technically not in the U.S., you may need for follow some of the reimbursement rules of these NightHawk companies follow. About the resolution of the images on PACS... on a regular monitor,. not so much of an issue with CT or MR, but for plain films and specifically mammograms, you most likely will need a high-res PACS monitor. But then again, why get a yatch when you can do it on a Carnival Cruise boat alongside the ship doc.
I'm starting Rads this coming July 2004 and have read a lot about this outsourcing issue and overall, I am not worried. In the end some sort of outsourcing may occur.. probably to the point where salaries and job market are unaffected and with less overnight call (primarily for residents).
The main issue is that you have to be U.S. Licensed and at least board eligibile to read films for the U.S. You can have preliminary films read overseas, but the reimbursment from insurances will be for the primary read by a U.S. radiologist. Prelim (overseas) reads are great for over night call so that the residents can have a back up, are great for the radiology staff so they don't have to overnight call, and will probably be great for U.S. radiologists because you can pay 1/10th for an oversees (non-U.S. licensed) radiologists read films then bill overall for many, many more films (since 1/3 will already be more or less read - so that you can read more films than usual) and have a net profit.
MGH has BACKED OFF its 'outsourcing plan," that WOULD HAVE tried to accept indian radiologists into their program for 1-2 years, say that they are well-qualified then send them back to india for 'final' reads. That is not a problem anymore.
The true NightHawks are companies that hire board certified U.S. Licensed radiologist and have officies overseas to read films (teleradiology) for the U.S. primarily at night (since there is the time difference). This has been going on for years and just making the life of U.S. based radiologists (staff and residents) better while not breaking any U.S. Laws.
Reading films from your yatch may be possible in the near future, however since you are technically not in the U.S., you may need for follow some of the reimbursement rules of these NightHawk companies follow. About the resolution of the images on PACS... on a regular monitor,. not so much of an issue with CT or MR, but for plain films and specifically mammograms, you most likely will need a high-res PACS monitor. But then again, why get a yatch when you can do it on a Carnival Cruise boat alongside the ship doc.
I'm starting Rads this coming July 2004 and have read a lot about this outsourcing issue and overall, I am not worried. In the end some sort of outsourcing may occur.. probably to the point where salaries and job market are unaffected and with less overnight call (primarily for residents).
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Hmmm...I don't know why Dr. Cuts thinks Radiology is so well shielded against medicare cuts. 10 years ago, ophthalmologists were makine $2000 per eye to do cataracts...now they make around $600. Similar cuts in reimbursements have struck nearly every field of medicine. Radiology will get it's share in due time.
As for the supposed "shortage" of radiologists which is driving salaries up....maybe there wouldn't be a shortage of those guys wouldn't take 20 weeks of vacation per year. All the more reason to cut reimbursements....get these vacationing radiologists back to work. It would ease the "shortage" and reduce overall cost for the system.
Anyway....now that we're all done yanking off about lifestyle specialties, maybe you should all do something you might actually be interested in. I cringe everytime I hear of someone doing a certain specialty because of the lifestyle.
How many of you told your interviewers in medical school that you wanted to become a doctor so you could eventually become a radiologist, ophthalmologist or dermatologist so you could make lots of money and work only 40 hours per week? Don't you think it's a little unethical to lie your way into medical school?
I would bet everyone that does a specialty purely for the lifestyle probably gave the "i wanna be a general practicioner in a rural setting just so I can help people" line when the interviewed.
Speaking of interviews...what do you tell the selection committees when you interview for your lifestyle specialty? Do you speak the truth and say that you are interested in the specialty because of the great money and lifestyle? OR, do you lie?
For such a fine, upstanding lot of people as get accepted to medical school, I sure am apalled at all of the lying, backstabbing, and gluttony that exists.
As for the supposed "shortage" of radiologists which is driving salaries up....maybe there wouldn't be a shortage of those guys wouldn't take 20 weeks of vacation per year. All the more reason to cut reimbursements....get these vacationing radiologists back to work. It would ease the "shortage" and reduce overall cost for the system.
Anyway....now that we're all done yanking off about lifestyle specialties, maybe you should all do something you might actually be interested in. I cringe everytime I hear of someone doing a certain specialty because of the lifestyle.
How many of you told your interviewers in medical school that you wanted to become a doctor so you could eventually become a radiologist, ophthalmologist or dermatologist so you could make lots of money and work only 40 hours per week? Don't you think it's a little unethical to lie your way into medical school?
I would bet everyone that does a specialty purely for the lifestyle probably gave the "i wanna be a general practicioner in a rural setting just so I can help people" line when the interviewed.
Speaking of interviews...what do you tell the selection committees when you interview for your lifestyle specialty? Do you speak the truth and say that you are interested in the specialty because of the great money and lifestyle? OR, do you lie?
For such a fine, upstanding lot of people as get accepted to medical school, I sure am apalled at all of the lying, backstabbing, and gluttony that exists.
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You need to get off your high horse. People have different prioritiies in life--and knocking them for having ones that are apparently different than yours is a load of bull. And besides, EVERY single optho applicant, resident, and ATTENDING that I know cites lifestyle and compensation considerations as some of the major forces that attracted them to the field. Not the only reasons, but HUGE factors in their decisions. I'm sure your reasons for choosing optho are entirely altruistic, and that you plan to spend a significant chunk of your future career treating poor elderly women with cataracts. My ass.
Stop being such a hypocrite. And quit with the moralizing, please.
Stop being such a hypocrite. And quit with the moralizing, please.
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Jeeva, where did you get those marquisjet/netjets prices? I can't find any on their sites.
sam,
Just happened to read that price quote in the March issue of Motor Trend magazine. Sorry, I hadn't actually gone to the web site (I'm not currently in the market for a Gulfstream) 😀
Just happened to read that price quote in the March issue of Motor Trend magazine. Sorry, I hadn't actually gone to the web site (I'm not currently in the market for a Gulfstream) 😀
Andrew_Doan
Ophthalmology, Aerospace Medicine, Eye Pathology
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I've listed some of the things you've requested in my FAQ for ophthalmology.
http://forums.studentdoctor.net/showthread.php?s=&threadid=66427
http://forums.studentdoctor.net/showthread.php?s=&threadid=66427
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The fundamental flaw in your argument is that you don't consider that radiologists don't order the studies; other doctors do, many indicated, many not. Radiologists for the most part don't control who gets what study. The surgeons in your school almost certainly don't even know how much the radiologsists make and just have the "grass is greener on the other side mentality". In my hospital, the surgeons make much more that the radiologists. Also, those surgeons are not considering that there is a cap on the the number and amount of imaging reimbursements for imaging studies for inpatients in a hospital, and probably more than half of the studies they order all too frequently every day will never be reimbursed and are essentially done for free. Radiology departments often either make little or literally lose money on inpatients because of the caps. Outpatients are the ones that bring money.
The practice of defensive medicine is what's causing the majority of the problem with medical costs, and imaging costs are only a small, but growing fraction. If you get a CT scan every other day for every pancreatitis patient fearing that THEY MAY DEVELOP a pseudocyst, if you get a head CT for every patient who falls down in the hospital regardless of symptoms or whether they hit their head or not, if neurologists and surgeons consulted by ER docs are only willing to even see the patients after a full expensive imaging workup, if you get an MRI for every patient with back pain, if you get a shoulder MRI for every geriatric patient with DJD of the shoulder, if you get a CT pulmonary angiogram for every dyspneic patient without a wheeze, even those with a negative D-dimer, etc., well what do you expect? Of course costs are going higher.
In a study done as a internal quality control measure at UCSF, it was shown that the rate of pulmonary embolism in patients getting chest CT to "r/o PE" was less than those who got a CT for other unrelated clinical indications!! In my hospital, the rate of positivity for PE in patients sent for "r/o PE" was a mere 1.5%!, but those who got the study in a technical development project without clinical suspicion of PE, 2% had incidental subsegmental PE. Talk about some physician's "index of clinical suspicion" and laugh out loud.
Interesting enough, this month there was an article published in JACR which noted that yearly imaging utilization increase was 3.6% by radiologists and 37% by cardiologists, the largest increase in imaging utilization. Also, nonradiologist physicians who own or have shares in their imaging equipment (e.g. vascular surgeons, neurologists, orthopedists, cardiologists, etc.) utilize imaging 1.7 -10 times more than physicians who do not own imaging equipment and send patients to radiologists. So, the story is much more complicated than what you think. Based on these studies, a lot of healthcare dollars can be saved if the Stark law is actually enforced, preventing physicians from self-referral.
Also, another complicating problem is getting the inappropriate radiological test in the first place. Yesterday, I got a call from an internist who insisted on an MRI of the kidneys in an 18 y/o with a bout of acute pyelo and recurrent upper UTI!!! This patient hadn't even got the basic workup. Not even a simple inexpensive VCUG to look for reflux (the most common cause of upper UTI in this age group)!!! I totally trashed and embarrassed him, but in the real world out in practice, I probably could not have refused the study or do what I did. Many docs think MRI is better than CT which is better than radiographs. Simply not true. The best test is the test appropriate for the clinical indication, not the most expensive or even the least expensive one. The radiologists in most instances cannot refuse a unindicated study (though it's sometimes done in university settings) because of medicolegal issues, even if it is clearly not indicated and even if they know they won't get paid a dime for it. At our hospital, less than a third of radiology studies for inpatients get paid for by third party payors just because physicians order too many/frequent studies for each patient. I see bogus studies and wrong studies everyday, I would say at least a quarter of all studies we do everyday, certainly contributing to increased costs. Again defensive medicine, lack of knowledge on part of some physicians, and lack of confidence in some physicians to just follow patients clinically on problems that can be followed complicate matters. Incompetent radiologists recommending other confirmatory studies are also practicing defensive medicine too just like everyone else, complicating the matter. They, too, are protecting their asses, just like the surgeon or internist who got that bogus study to cover their respective asses in the first place. Defensive medicine is so prevalent in healthcare that the poor medical students and interns sometimes confuse it with "good" medicine.
Remember, imaging is just another test. It is just one element of the patient's diagnostic workup, granted it is becoming a more and more central part of medical diagnosis. Just like every other test, the physician primarily taking care of the patient should be able to collect the various consultation reports and patient workup data (including radiology findings) to synthesize an overall diagnosis and management plan. Prior probabilities, test sensitivities, and specificities are all important concepts that should be implicitly utilized on a day-to-day basis rather than sticking to one piece of information. All too often, especially junior attendings and physicians-in-training rely on a single test that may not give the whole answer.
The next issue is that a lot a of docs in many specialties have come to believe that radiological tests are definitive studies. NO, MANY OF THEM ARE NOT. And within the spectrum of any imaging finding, there are variations, normal variations that mimic disease, multiple etiologies causing the same finding (e.g. bronchoalveolar carcinoma and bronchopneumonia are identical on imaging), artifacts mimicking real pathology, and varying degrees of confidence whether a finding is really present to begin with. There are multiple books in radiology with the theme "Atlases of normal imaging variants that mimic disease". And remember the fact that there are "radiological differential diagnoses" for almost every imaging finding you can imagine, some of them very long lists with multiple etiologies for the same finding. Failure to provide an adequate history also does not help at all to narrow the wide differential. Most radiologists are actually pretty good in narrowing their differential diagnosis or providing a specific diagnosis if they have some clinical info available. In our hospital, we have an electronic medical record so we routinely look at the patients' charts and labs when reading scans. But if this is not possible or feasible, a little relevant clinical info will go a long way in helping patients. Getting a CT of the chest, abdomen, pelvis and putting "pain" or "r/o pathology" as the clinical history is ridiculous. The docs giving these useless and misguiding histories should go to jail if you ask me. Not too often we even get frankly incorrect histories about problems that the patient does not even have, because of ignorance of the docs or because they were just too lazy and some idiot secretary chose to put the easy generic history of "headache" instead of "right seventh nerve palsy". The MRI study was incorrectly protocolled because of the incorrect/inadequate history and the patient's parotid cancer was not seen. Most nonradiologists don't know that there are "very different" ways of doing the same radiology study, esp. CT and MRI and if you don't give an adequate history, an incomplete/suboptimal/useless study will be done and interpreted. You are doing yourself and your patient a major disfavor by being lazy or cocky and not putting that extra line or two of relevant clinical info on the request sheet or computer request.
Finally, the reigning days of general radiology are over. No radiologist can be an expert in even a quarter of radiology. Those that do everything and read everthing, are jacks of all trades and masters of none. They will often waffle and fail to commit because they just can't know everthing. Having been denied relevant clinical info by the requesting physician makes the situation much worse. There will always be a need for general radiologists, just like general IM and general surgeons, but I think subspecialist radiologists are the ones who should be consulted for difficult cases. Just like the IM and general surgery fellowship trained subspecialists. There about nine different subspecialties and fellowships within radiology, about half with subspecialty board examinations. I would not want your average general radiologist reading my brain or shoulder MRI.
Sorry for the long reply
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