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Originally posted by juddson
I guess I can add rads to my growing list (Gas, path, psych) of specialties to worry about.
Originally posted by doepug
1. Shouldn't these physicians lose their malpractice coverage since, by interpreting their own studies, they are not meeting the basic standard of care?
2. What's really scary is that the patients probably have no idea that their doctor is reducing the quality of their care to make a quick buck.
Originally posted by MacGyver
Why do you put path and psych together with gas? Gas is in far greater danger than those other fields.
Originally posted by droliver
Two comments:
1. there is no "basic" standard of care for image interpretation. Many different specialties routinely interpret their own studies & have for decades. Its not much of a stretch to incorporate newer modalities (CT,MR,NM,U/S,PET) into their practice & learn to read certain focused studies to proficiency
2. Radiologists were first in line with sacrifice of quality vs the $$$$ (non-contrasted CT body scans, open MRI centers,etc....) Nobody's hands are completely clean in that respect.
Originally posted by juddson
I mention path for the same reason that Rads is woried about outsourcing. If you can send images to India, you can certainly send snapshots of biopsy samples. It might be suggested that much of path is hands-on, and that the reading itself is only part of it. But it seems to me that a PA can work up the sample, take the picture, and wooosh, off it goes to another country. Just a guess.
I think psych is in even worse trouble than Gas. psychologists with scripts, in my opinion, is a HUGE problem, if for no other reason that the science is not as well understood in psych. Harder to determine M&M rates, which works to the advantage of a less qualified practioner.
Geez, I thought the OB/Gyn looked bad, but I have to say from this angle, it's starting to look the best. Look, midwifery has been around for a long time, and it does not seem to have had much effect on OB/GYN practice. Even the insurance premium issue seems like a non-issue as far as I am concerned. The average draw after expenses is STILL $240k - that's damned high no matter how you look at it. And quite frankly, the field is "primed" for men who are interested in it. It is my feeling that a field dominated by women will experience shortages of care because the careers tend to be shorter and the practice more sporadic. I feel there will be PLENTY of work for male OB/GYN's in the future.
Anyway, just some relatively uninformed feelings. I don't even start med school till august - I might learn a lot more about this in a few years.
for ME, the following areas look promising:
ob/gyn, urology, general surgery, FP (yes, FP - my informal research suggests people only tolerate NP's for so long), hospitalist IM.
Judd
Originally posted by juddson
Goober,
I did not understand your explanation of how it works with non-rad owned machines. You said the rad gets a very small fee, but then say he gets most of the liability because he gets most of the money.
Can you explain this again - treat me like a 4 year old.
Judd
Originally posted by Goober
As for your second point, I don't see how you can blame noncontrast body scans on radiologists. It has not been adopted by radiology as a whole. Ameriscan, the biggest bodyscan company in the nation, was in fact sued by the ACR for misrepresentation. In any group of physicians there are always a small number who are doing things on the fringe.
Originally posted by droliver
I don't mean to imply blame. I'm just contrasting the point that someone made that all these "other" specialties are the ones cheapening radiologic studies for profit. Everyone's looking for new revenue & as the NYT article points out, these centers have been very profitable for many.
The open MRI thing is somewhat of a sales gimmic. There really aren't that many people who can't be done in a conventional magnet. The images I've seen from many of these free-standing open MRI centers have been very poor
Originally posted by juddson
Rads ought to think about refusing to do reads without a fair cut of the total fee.
Judd
Originally posted by AlexanderJ
Hey NY SkinDoc, the original poster for this thread. I suspect you are a derm resident from your name. I think I might be a little worried if I were you. As primary care physicians continue to feel the financial squeeze, they are going to look for ways to supplement their income other than reading rads. Its not going to take people very long to figure out that BoTox injections, dermabrasion, and cosmetic laser treatments are not rocket science. In reality, these procedures are so simple that they can be performed by nursing staff (or a monkey for that matter). Also, an outsourced teledermatology model is not out of the questions (again, with nurses or technicians or monkeys performing any necessary procedures). Just my two cents.
Originally posted by Goober
Well most radiologists hate to read off low field open scanners. Most of these freestanding centers are more often than not, owned by businessmen or non-radiologists physicians.
I posted the article because I thought people here would find it interesting.I may be in the minority of dermatologists who enjoy treating people with medical derm problems.I'm happy to leave Botox to others.There are plenty of FPs,Internists,OBs who now offer all sorts of cosmetic treatments to their patients including Lasers,Botox etc.Hopefully the monkeys working in their offices are adequately trained and experienced.I would check into it before allowing someone to put a laser to your patients (or wife's) face. I'm confident enough about the skills I have to offer that I won't lose sleep over teledermatology treatments in India.(I dont think there are too many US board certified dermatologists residing in India at present anyway!)Originally posted by AlexanderJ
Hey NY SkinDoc, the original poster for this thread. I suspect you are a derm resident from your name. I think I might be a little worried if I were you. As primary care physicians continue to feel the financial squeeze, they are going to look for ways to supplement their income other than reading rads. Its not going to take people very long to figure out that BoTox injections, dermabrasion, and cosmetic laser treatments are not rocket science. In reality, these procedures are so simple that they can be performed by nursing staff (or a monkey for that matter). Also, an outsourced teledermatology model is not out of the questions (again, with nurses or technicians or monkeys performing any necessary procedures). Just my two cents.
I mention path for the same reason that Rads is woried about outsourcing. If you can send images to India, you can certainly send snapshots of biopsy samples. It might be suggested that much of path is hands-on, and that the reading itself is only part of it. But it seems to me that a PA can work up the sample, take the picture, and wooosh, off it goes to another country. Just a guess.
Originally posted by pathstudent
As far as docs wanting to read their own x-rays and mris, that is one place where pathologists are one up on radiologists as no surgeon or GI guy or Urologist or Gynecologist wants to look at their own slides and put their name on the diagnosis. But everyone thinks they can read the chest x-ray or CT of the abdomen.
Originally posted by MacGyver
Good point. All the non-path docs I know would never want to read/interpret their own slides, although they love to do their own x-rays, CT, and MRIs without a moment's hesitation.
Originally posted by pathstudent
No of course not. Pathology is much more precise as it is the final word as to what something is. In path, especially with breast biopsies, I can't tell you how many times the final diagnosis isn't even in the radiologist's differential.
Nobody want to read their own slides because it is tedious and boring as ****.
Originally posted by bosky
"In any case, there have been studies coming out showing how imaging costs are driving up health care costs, and how most of this is due to self-referral. It will not be long until those paying the bill realize that it is best to have radiologist run medical imaging, because we have the knowledge and skill to run it in an efficient, high quality and more cost effective manner."
RADRULES,
Do you have references for these studies? I would enjoy reading them and would find it re-assuring....
Originally posted by Docxter
Take a look at this one:
Levin, DC Rao, V. J Am Coll Radiol 2004; 1: 169-172 (March 2004)
Originally posted by WaitingForJuly
I hope the ACR is forwarding a copy of this to every congressional office. Anyone here from Pete Stark's district? He'd probably be interested to see it, especially if it arrived with a letter from one of his constituents.
Originally posted by droliver
Docxter,
do you have the full text of that article available. It sounds from the abstract that its just a review of some previous articles on the subject rather then fresh data. A number of those previous articles (I'm presuming he's looking @ some of the same ones I looked @ on Medline) identify some of the utilization trends cited, but do not come out and make the bold & very political conclusions that this author seems to in the abstract.
I'm curious to see the break down of exactly what the procedures (is this including nuclear med & cardiology studies? )were surveyed & whether you can break it down even further by specialty of the ordering physician (FP vs orthopod vs. Neurosurgeon vs Hand Surgery, etc.....). The $16 billion figure is pretty staggering. I'm curious as to how you reach that number & how unless they personally surveyed hundreds of thousands of charts & requisitions could they make a judgement about the appropriateness of a given study. That number is so ridiculously large as to raise some red flags about the methodology
Originally posted by Docxter
Actually, the greatest increase in utilization of imaging is by cardiologists (39% vs. 7%).
Originally posted by Docxter
The problem is that Stark's law is useless. The non-selfreferral laws doesn't apply if the imaging equipment is in the doctor's "office". Now go define "office".