neuro imaging - current state?

[ewon2004]

---

Members don't see this ad.

With the radiologists officially fighting back since 2008

http://annalsofneurology.wordpress.com/2008/07/22/neuroimaging-turf-battles-flare/

I am wondering what is the current status and future outlook for neurology residents considering doing imaging?

One new big factor I can think of, is the cut back on imaging profit due to changes in healthcare - even the cardiologists are fighting the government (? I think they are suing uncle sam).

It seems like imaging will become much less well compensated in the future - will it still be profitable for neurologist to do imaging on the side?

 

[typhoonegator]

Would you trust the read of a general radiologist who did neuroradiology "on the side"? I wouldn't. In fact, I don't really trust the reads of several real neuroradiologists that I know.

I have no problem with neurologists who want to become formally trained in neuroradiology. This issue has been discussed at length previously on these boards. We have a good background for it, we've already looked a thousands of scans, and we can learn the techniques and physics.

I do have a problem with neurologists who have the hubris to think that this is a skill that you can formally master on the verges of your day as an avenue to make more money. I know several neurologists who are neuroimaging fellowship trained who do not read scans because they don't feel that the training was enough to allow them to confidently read independently. I also know 2 neurologists who trained in neuroradiology fellowships who have dual appointments in neurology and neuroradiology. They read all day and do research.

 

[ewon2004]

At my institution, we get a total of 2-3 months of radiology training in residency - that is all. After the 2 months, I am comfortable reading ER brain CTs, and can make an attempt at MR brain. I haven't touch much of spine. Head and neck was definitely outside of my scope (it's so freaking complicated!!!). I can't do peds brain stuff or ultrasound.

In my observation, the radiologists at my institution are definitely reading at a (much) higher level than our neurologists, to be honest. Though we kinda have clinical info to help, but that can also make us less objective on the imaging and in some instances have led down the wrong pathway.

So do I trust reports from radiologists? well I guess I have no other option. I still review with radiology residents when on call before making any decisions on my own if it comes down to findings on the scan.

Given the kind of income on the lower end of spectrum that neurology has, most of the residents in my institution are interested in imaging to augment income. Some are considering doing intervention and suck up the surgeon's lifestyle if money is important enough for them. But we do not want to become radiologists like you described above sitting down all day and just reading scans. I am not shy about admitting that money is an important factor for me.

Hence I'd like to find out more about the current status and political climate for doing imaging, and possibly intervention.

Thanks in advance for info.

 

[typhoonegator]

It takes a very long time to get good at something. After you're good at it, it takes a lot of work to maintain the skill. This is why we aren't all radiologists in addition to our normal jobs. This is also why the principal violinist of the Chicago Symphony doesn't have another career.

I'm a neurocritical care physician. I'm the first to admit that my outpatient neurology skills have atrophied somewhat. Why? Because I don't get a chance to take care of patients in clinic anymore. It would be a disservice to the patient to have me as their doctor when there are so many qualified and savvy outpatient neurologists around.

The work of a neuroradiologist goes far beyond just looking at the brain and dictating. There is very little overlap between the skillsets of clinical neurology and diagnostic neuroradiology. This is why it is difficult to do both. Skills like EMG/NCS and EEG are a bit different, because those studies are built into our training, and are a part of our patient care on a daily basis.

What I'm saying is that it is very hard to have it both ways. Besides, if you get reading privileges in your hospital (and that is a VERY big "if"), and there are scans for you to read for $60 a pop, why would your chair/managing partners let you see patients for $30 a visit? You benefit yourself and the whole practice more if you just read all day.

 

[Strokeguy]

Agree with all above.
As a stroke neurologist you can make acute treatment decisions after reading CT/CTA/perfusions or MRIs on your own. This is what the stroke fellowship trains you for. Obviously, you cannot bill for reading those images. You may discuss images on more complex cases with a neuroradiologist later on, but you are still the decision maker in terms of pt management. In addition, you can be certified for TCDs and Carotid US and also bill for these. INR is a different deal though.

 

[neuropathy123]

To make money in imaging as a neurologist, you have essentially 2 options

(1) diagnostic imaging

complete a neuro-imaging fellowship as i doubt you'll get neuro-radiology fellowship, and get certified from neurology organizations

then buy/lease CT or MRs and self-refer your patients to these machines - you'll make both technical and interpretation fees - as long as the loop hole of Stark law is still not patched

(though I know rad groups are aggressively trying to close it thru lobbying)

this is essentially what others like ortho, cardiology etc are doing

HOWEVER,

given the current cuts and changes in reimbursement in diagnostic imaging, there is a good chance the this outpatient model will die as centers no longer be profitable

just go to cardiology forum and your see the gravity of these changes and how depressing it'll be for others to do diagnostic imaging - I think the rads have won, though unintentionally, this turf war.

this leaves you to joint a radiology group, but no private practice group will hire you because you cannot read anything else but the brain, so your only hope is to joint some academic group in which case you may make slightly more than doing full time neurology

(2) interventional

I think there are more places now to train neurologists, but you'll be competing with grads from radiology and neurosurgery - who are MUCH MUCH preferred by most programs over you, the neurology resident.

If you actually get one, get at least an ok training, and get privilege to do full time NIR - then you may double your income.

BUT,

the call is hell and the procedures are high risk. I've personally witnessed many disastrous iatrogenic complications, like carotid artery dissection or glues mistakenly lodged into basilar artery in a procedure to embolize AVM.

This is a high stress job, and the added compensation probably won't justify the sacrifice unless that is your calling.

This is why radiology gigs don't like it with decreasing number residents apply to NIR year after year.

--

So pick your poison, hahaha

Fellows and attendings, if there is other options I have left out, please let me know.