M4 here -- would really appreciate any guidance on my dilemma between choosing EM vs Rads

[Dave1980]

Seriously?

There can be some very subtle findings on those exams.

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[808s&heartbreak]

Agreed. All this push to self-policing ourselves and cornering us into a PGY6 and PGY7 and possibly PGY8. Where does it end? Now, you have mid-levels that can practice whatever straight out of school. Why are we doing this to ourselves? Say no to endless fellowships. Life is short, dont spend a whole decade being a slave to the system.

Absolutely. With 10% reimbursement cuts on the horizon and NP/PAs inching closer to being able to do exams independently, if this self policing continues: in a few years after you finished pgy7 you'll find yourself competing for jobs that pay 200k with savvy NPs who had nowhere near as much training.

 

[Clean7795]

Seriously?

It's a joke.

 

[scoopdaboop]

Absolutely. With 10% reimbursement cuts on the horizon and NP/PAs inching closer to being able to do exams independently, if this self policing continues: in a few years after you finished pgy7 you'll find yourself competing for jobs that pay 200k with savvy NPs who had nowhere near as much training.

yeah nice meme dude. if NP/PA can penetrate radiology and do final reads, they already would have, considering they have already infiltrated other aspects of medicine.

 

[808s&heartbreak]

yeah nice meme dude. if NP/PA can penetrate radiology and do final reads, they already would have, considering they have already infiltrated other aspects of medicine.

I don't disagree with you. At yale, for example, RAs (radiology assistants) draft prelim reports for certain studies. They cannot final sign because the law does not allow them to go unsupervised. In California (in addition to many other states), there are new bills that will allow NPs/PAs to practice unsupervisedly.

Couple the two together in a health system and state where radiology apprenticeships are available for PAs/NPs , the writing is on the wall.

 

[medradthrowaway]

I don't disagree with you. At yale, for example, RAs (radiology assistants) draft prelim reports for certain studies. They cannot final sign because the law does not allow them to go unsupervised. In California (in addition to many other states), there are new bills that will allow NPs/PAs to practice unsupervisedly.

Couple the two together in a health system and state where radiology apprenticeships are available for PAs/NPs , the writing is on the wall.

Exactly. I wouldn't be surprised to see DNP "fellowships" in radiology in the near future, where these mid levels will compete with residents for cases and training. Of course, admins and the bean counters at your hospital will tell you that it's a team effort and you're being a "problem child" when you raise concerns.

These are already starting to pop up for other specialties. Every specialty should take this mid level threat seriously.

 

[scoopdaboop]

Exactly. I wouldn't be surprised to see DNP "fellowships" in radiology in the near future, where these mid levels will compete with residents for cases and training. Of course, admins and the bean counters at your hospital will tell you that it's a team effort and you're being a "problem child" when you raise concerns.

These are already starting to pop up for other specialties. Every specialty should take this mid level threat seriously.

Okay this makes more sense given fellowship etc. but I don’t think any hospital will hire a completely solo Np group and would still want a radiologist signing it off. If anything, it just adds more cost if a NP is giving prelim reads because the radiologist will have same workload to sign it off; the radiologist won’t assume the np read it correctly and simply sign off like you see sometimes in family practice where docs sign off charts. But if NPs suddenly decide they want to be in radiology and program with residency hospitals where they will also train with DR residents for the same time period, then it’ll be a problem.

 

[Cognovi]

the radiologist won’t assume the np read it correctly and simply sign off like you see sometimes in family practice where docs sign off charts

Those who are motivated primarily by making money and vacation time would gladly sign off.

 

[medradthrowaway]

Okay this makes more sense given fellowship etc. but I don’t think any hospital will hire a completely solo Np group and would still want a radiologist signing it off. If anything, it just adds more cost if a NP is giving prelim reads because the radiologist will have same workload to sign it off; the radiologist won’t assume the np read it correctly and simply sign off like you see sometimes in family practice where docs sign off charts. But if NPs suddenly decide they want to be in radiology and program with residency hospitals where they will also train with DR residents for the same time period, then it’ll be a problem.

That's only true if they're willing to stop at that. My guess is after getting "DNP fellowships" they will start claiming equivalence to current radiologists (same thing they did/doing to anesthesiologists) and lobby for reimbursements and the ability to independently interpret (which is already heading for approval in California). The admins and those in their ivory towers will be more than happy to support this.

 

[scoopdaboop]

That's only true if they're willing to stop at that. My guess is after getting "DNP fellowships" they will start claiming equivalence to current radiologists (same thing they did/doing to anesthesiologists) and lobby for reimbursements and the ability to independently interpret (which is already heading for approval in California). The admins and those in their ivory towers will be more than happy to support this.

Can you link me the bill Or copy and paste the specific part of the bill in Cali where it says NPs will be reimbursed for independently interpreting imaging studies.

 

[medradthrowaway]

Can you link me the bill Or copy and paste the specific part of the bill in Cali where it says NPs will be reimbursed for independently interpreting imaging studies.

Not yet, but I am sure they will lobby for that soon. Interesting, here is a commentary from Dr. Kendall in the latest issue of American Journal of Medicine highlighting the fact that the US Government Accountability Office is examining the possibility of diverting GME funding for medical students to fund NP and PA "residency" programs. So, no specialty should be brushing this threat off. These mid-levels will now be competing directly with residents for training/cases/experience. So yes, unless we start being more aggressive and push back, I foresee an NP radiology "residency" in the near future, along with all the other specialties.

https://www.amjmed.com/article/S0002-9343(20)30248-5/abstract

Every physician, fellow, resident, and medical student should read this.

 

[scoopdaboop]

Not yet, but I am sure they will lobby for that soon. Interesting, here is a commentary from Dr. Kendall in the latest issue of American Journal of Medicine highlighting the fact that the US Government Accountability Office is examining the possibility of diverting GME funding for medical students to fund NP and PA "residency" programs. So, no specialty should be brushing this threat off. These mid-levels will now be competing directly with residents for training/cases/experience. So yes, unless we start being more aggressive and push back, I foresee an NP radiology "residency" in the near future, along with all the other specialties.

https://www.amjmed.com/article/S0002-9343(20)30248-5/abstract

Every physician, fellow, resident, and medical student should read this.

Yeah, I remember reading something about that too. The report was based around the fact that there is a physician shortage, yet, they outline a whole article on how NP's and PA's can benefit, and how they can increase the number of students they accept into their schools if they get this funding. The backwards idea to reduce physician shortage/make up for it was to take money away from physician residencies and direct them towards NP's and PA's. LOL.

 

[Steve_Zissou]

Can you link me the bill Or copy and paste the specific part of the bill in Cali where it says NPs will be reimbursed for independently interpreting imaging studies.

They lobbied for it in the bill (AB 890?) that is currently still being deliberated on afaik. Verbiage was changed from “order and interpret” to “order.” So NPs will be able to order without a physician sign off, but no chance to interpret.

 

[scoopdaboop]

They lobbied for it in the bill (AB 890?) that is currently still being deliberated on afaik. Verbiage was changed from “order and interpret” to “order.” So NPs will be able to order without a physician sign off, but no chance to interpret.

Ah. Even interpret is vague. I mean, if a NP working in an ER orders a x-ray for a kid with positive Influenza A to r/o pneumonia, doesn't see pneumonia, then sends kid home. That's interpret i'm guessing. If that's the case, that's probably happening in a lot of areas. Or am I misinformed? That NP's aren't doing this and I'm giving them too much credit.

 

[YeOleBoneWiz]

RADs not going to be overrun by mindless midlevels. One reason I picked it over EM.

 

[CherryRedDracul]

Those who are motivated primarily by making money and vacation time would gladly sign off.

Sad but true.

There are a lot more garbage radiology reports out there than I'd like to imagine.

 

[2brads]

As regards EM vs rads, they are VERY different. I don't know anyone who was stuck deciding between these 2 specialties in med school. Do you like getting your hands dirty, triaging and then never seeing that patient again? Or do you prefer to never see the patient at all?

The schedules and lifestyles are also quite different. Both are generally shift work, but that's where the similarities end. In rads, you can work banker's hours all day everyday (no weekends/no holidays) if you want, or you can do just nights or something in between. You can be on site or you can work entirely remotely. You can do procedures or not. You can just do your subspecialty or you can be a generalist.

Most of the EM docs I know work rotating shifts over 24 hours (8-9 hour shifts) 7 days per week. I doubt there are many "day only" jobs in EM. From a lifestyle perspective, very few jobs can beat rads.

As far as not "feeling" like a doctor; that thought literally never crosses my mind. There may be that sentiment held by a portion of the general public, but rads are well respected by their professional peers. You are the doctor's doctor and you make them look good when you call a subtle appy or malignancy or make some life-altering zebra diagnosis.

Also interested in both specialties, but M2. How does vacation time work in rads? So if you have 12 weeks vacation a year, can you schedule that up for 2-3 week blocks 4-6 times a year? Or is it like 3-4 day chunks if you're on call every 3-4 days?

Also, because fellowship is required, can't you do the 2 yr IR fellowship to alleviate the AI worrying, if there is anything to worry about. I mean it's 7 instead of 6, which in the long run is pretty mute, because I imagine you can moonlight a lot in IR fellowship.

Also, what is this CMS 0 percent rule? So let's say in 2021 they release their next (for 2022) CMS reimbursements increases/decreases, because it's a 0 percent change across the board, radiology could get a 5 percent bump say in 2022, and another specialty takes the hit right.

The floor for vacation in private practice radiology is 8 weeks (10-12 weeks is typical). Academics is usually 4 day work weeks with 5 weeks off. Night only work is usually 7 on 14 off. Vacation blocking is totally practice dependent, but most practices will allow up to 2 weeks off. I have known some to allow 3, but that requires some fancy scheduling. You will have more flexibility with employed model than true private practice.

Practicing rads are not concerned AI is coming to take our jobs. When you are a radiologist, you will know why, but there's a reason it takes 5 years of training. AI will probably provide some usefulness as aides - pulmonary nodules, subtle hemorrhage, suspicious breast calcs. In other words, I would not do an IR fellowship solely for job security from AI. If you do IR, you better love catheters, needles and wires.

CMS does whatever it wants, like the tide it ebbs and flows. Radiology is well compensated. I don't expect that to end soon.

 

[geniegirl1]

Don’t do EM over rads

 

[odyssey2]

Don’t do EM over rads

why?

 

[scoopdaboop]

Lmao, couldn't you just do a private convo instead