NY Times article: "Dream Jobs Disappearing for Radiology Trainees"

[Socrates25]

http://www.nytimes.com/2013/03/28/h...see-dream-jobs-disappearing.html?ref=nyregion

At St. Barnabas Hospital in the Bronx, a dozen radiologists in training, including Dr. Luke Gerges, 28, are suddenly stranded on an expensive road to nowhere. All received termination notices recently because their hospital is ending their residency program next year as part of a plan to replace its radiologists with a teleradiology company that reads diagnostic images remotely.

By 2001, with the supply of radiologists limited by a 1997 Congressional cap on all Medicare-supported residencies, nighttime demand was unmanageable for smaller emergency rooms. So-called nighthawk radiology services began pooling the diagnostic imaging loads of several hospitals and transmitting them electronically to American radiologists stationed overseas or working from home.

Though outsourcing to India grabbed headlines, the big growth in teleradiology was domestic. Now the nighthawk companies, staffed by recent radiology graduates, are competing for the daytime work, too.

This is what I dont understand. Are you seriously telling me there are that many AMERICAN TRAINED radiologists living overseas that they can handle the volume of work to replace American radiologists? I just dont get it. Why would an American radiologist want to move to India to live in some ****hole third world country? I have a hard time believing that very many people pursue this pathway.

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[Substance]

There are a few possibilities:

1. They live in Australia, not India. Clearly, I'd rather live in the former. Some rich-kid from my med school class had a dad whose group sent members over to Spain to do telerads from there. They'd each do a few weeks a year in a nice villa on the ocean.

2. They are originally from a 3rd world/BRIC country, received American residency training, and then went back home.

 

[DrBowtie]

They live in the US and work night shifts, same as anyone else doing night coverage. In order to bill Medicare, the read must be done on US soil/territories.

The old foreign enterprises were giving prelim reads. Reimbursements are getting cut so the margins are thinning making paying someone to give a prelim read and then duplicating the work not feasible. This is coupled with pressure from clinicians for 24/7 subspecialty coverage which is driving the domestic telerads biz.

 

[Textbookversion]

They live in the US and work night shifts, same as anyone else doing night coverage. In order to bill Medicare, the read must be done on US soil/territories.

The old foreign enterprises were giving prelim reads. Reimbursements are getting cut so the margins are thinning making paying someone to give a prelim read and then duplicating the work not feasible. This is coupled with pressure from clinicians for 24/7 subspecialty coverage which is driving the domestic telerads biz.

I don't get why it was ever acceptable for a radiologist to do a final read the next day. If it's urgent enough to do the scan at 2am, it's urgent enough for a radiologist to make the final read at 2am. Other services operate 24/7, why would radiology ever be exempt from this? Just seems weird to me. These new changes are a good move for patient care.

 

[DrBowtie]

I don't get why it was ever acceptable for a radiologist to do a final read the next day. If it's urgent enough to do the scan at 2am, it's urgent enough for a radiologist to make the final read at 2am. Other services operate 24/7, why would radiology ever be exempt from this? Just seems weird to me. These new changes are a good move for patient care.

Well first, not all scans done at 2am are stat and don't require a stat read. Often inpatients are done at odd hours because if scanner time is limited, outpatients are done during the day. That staging C/A/P isn't going to change management overnight.

For the stat stuff overnight, a prelim read stating whether there is an acute actionable finding or not is no different than calling a consultant at home and them telling you to stabilize overnight and they'll evaluate in the AM. The formal read and formal consult comes later.

 

[badasshairday]

Wow, they mentioned "online forums" and AuntMinnie in that article. They are watching us. HI!

 

[badasshairday]

Anyways, in all seriousness. Things aren't very good right now. Also it is really just wrong what happen to those residents. Job market is crap due to over supply. Spots need to be decreased, programs may need to close, but they should allow current residents to finish up.

 

[colbgw02]

If it's urgent enough to do the scan at 2am, it's urgent enough for a radiologist to make the final read at 2am.

Never mind the inpatients, magnets routinely schedule outpatients well after the end of the business day. No reason that a radiologist should be on duty at 11pm expressly to read the routine outpatient lumbar spine MRI.

Other services operate 24/7, why would radiology ever be exempt from this?

Not really. Lots of problems occur at night but don't get fixed until the sun comes up. I can't even remember the number of times that an acutely inflamed appendix didn't get removed until the next morning, which - coincidentally, I'm sure - was when the surgery attending got to work. Similarly, the BC radiologist hanging out at home, in Sydney, in Zurich, where ever, is perfectly capable of telling the ED that Joe Snuffy's appendix is about to burst that they shouldn't discharge him before the local guy gets to work to finalize the report.

The local radiologist providing 24-hour final reads is mostly about economics. Whether it's trying to avoid commoditization or trying to recapture reimbursement previously lost to preliminary reads, there's a financial motive behind 24-hour coverage.

 

[shark2000]

Also increase in volume is another factor.

If you do 2 CTs a night, there is not enough justification to have a radiologist on site to read it. You may argue it is not good patient care. But the same is for many other services. Believe it or not, many US ERs do not have Neurosurgery service 24/7 or do not have trauma surgeon, orthopod, cath lab for acute MI 24/7. They claim that they can not have specialists on call for once in a blue moon case of epidural hematoma.

These days, the night volume is high, high enough that justifies having a radiologist on call to read the studies.

My experience with many groups in my area, is that teleradiology is becoming less and less. Still it may play a role esp for remote sites, but not at least in big cities.

I myself always thought that there is huge surplus of radiologists. However, recently I have found out that nation wide there is not really. People told me how groups in undesirable areas have problem hiring. On the other hand, for every job in big cities there are 100 applicants. So, really I don't know decreasing spots is the way to go.

 

[RadDoctor]

First time poster. My relative, a nurse in NJ, made me aware of this (new AOA radiology residency):

http://opportunities.osteopathic.or...program_id=349621&hosp_id=348741&returnPage=1

As a radiology resident at a major academic center I have a lot of issues with this. First of all, there is the obvious problem of training too many radiologists. But more importantly, how did this even get accredited? I understand that the AOA is more relaxed when it comes to standards, but this is just ridiculous. I have been to MHMC a few times because my family is from the area. It is hardly a real hospital. They don't even have an IR suite. It is a 250 bed hospital which is barely at 50% capacity at any given time. According to their website, they only have one radiologist and one tech on staff: http://www.meadowlandshospital.org/our-staff/clinical-staff/radiologists

I can only hope, for the safety of the public, that this program ends up like St. Barnabas and closes down, but how are programs like these allowed to even come to be? Shouldn't medical education be held to some sort of standard? Is it ok to "train" these people at a tiny community hospital with no trauma or IR and allow them to practice in the real world? What do you guys think?

 

[DrBowtie]

Update:
http://www.auntminnie.com/index.aspx?sec=sup&sub=res&pag=dis&ItemID=102975

Is there really only 7 rads in the group? Is that really all it takes to house a residency program for 12 residents?

 

[colbgw02]

Update:
http://www.auntminnie.com/index.aspx?sec=sup&sub=res&pag=dis&ItemID=102975

Is there really only 7 rads in the group? Is that really all it takes to house a residency program for 12 residents?

You've never heard an attending say that residents create more work than they do? That's not universally true, but there are definitely some residents that make me feel that way.

Conversely, there are plenty of attendings at teaching programs who have gotten way too comfortable with a relatively slow pace to be able to go back and work at a private practice pace.

But overall, yes. Seven efficient PP-style rads is plenty to take over for 12 residents.

 

[shark2000]

Update:
http://www.auntminnie.com/index.aspx?sec=sup&sub=res&pag=dis&ItemID=102975

Is there really only 7 rads in the group? Is that really all it takes to house a residency program for 12 residents?

Simple math. The radiology group started a residency program to have night coverage, which is cheaper than paying Tele-rad. Now the hospital wants them to cover the nights, because they want final reads. Radiologists in the groups already have made enough money, so they don't want to work nights even if they lose their job.

Why should ABR, ACGME or .... let them start such ridiculous residency program? And surprisingly, graduates of such programs claim that they are better trained than MGH or Hopkins trainees.

On one hand ABR encourages sub-specialization by changing board format or mandating fellowships and on the other hand, they open these sloppy residency programs.

 

[DrBowtie]

You've never heard an attending say that residents create more work than they do? That's not universally true, but there are definitely some residents that make me feel that way.

Conversely, there are plenty of attendings at teaching programs who have gotten way too comfortable with a relatively slow pace to be able to go back and work at a private practice pace.

But overall, yes. Seven efficient PP-style rads is plenty to take over for 12 residents.

I was saying that only 7 staff seems low to supervise a 12 position residency program.
Seems like most places when I interviewed were 1.5-2:1 staff to resident ratio.

 

[shark2000]

I was saying that only 7 staff seems low to supervise a 12 position residency program.
Seems like most places when I interviewed were 1.5-2:1 staff to resident ratio.

It is not about supervision. The resients cover after hours, weekends and more importantly nights.

7 is nothing for starting a residency. It means that you have at most one subspecialist in each field.

I feel for those residents in the program. They have lost their job. However, I think they have to close these type of residency programs in the long run. It only hurts the field.

 

[colbgw02]

I was saying that only 7 staff seems low to supervise a 12 position residency program.
Seems like most places when I interviewed were 1.5-2:1 staff to resident ratio.

I was under the impression that you had to have a 1:1 staff to resident ratio to be accredited.

 

[fizzle]

I wonder if this article will spur the ACR to take any action...nah, who am I kidding?

 

[FLpk1girl86]

Is it ok to "train" these people at a tiny community hospital with no trauma or IR and allow them to practice in the real world? What do you guys think?

A lot of programs do not have trauma, this isn't the first for sure.

Wondering if the job market for Radiologists is really that crappy or is this all boy who cried wolf?

 

[radman123]

A lot of programs do not have trauma, this isn't the first for sure.

Wondering if the job market for Radiologists is really that crappy or is this all boy who cried wolf?

Yes job market is awful. We had an opening in my practice and 50 people applied, many of whom were qualified and the ones we interviewed all said it was brutal out there.

 

[IJL]

Why exactly is the job market so bad? And when is it going to open up?

 

[radman123]

Why exactly is the job market so bad? And when is it going to open up?

Many factors. Slow down in imaging growth. No significant reduction in residents trained. Decreasing reimbursements and radiologists working harder to preserve income. Uncertainty about future with Obamacare and continued cuts. Reduction in autonomy with many rads worried they will be employees or taken over by telerad companies. Decrease in net worth with housing market and stock market crashes just now recovering. Teleradiology companies and corporations taking traditional in house jobs away in community hospitals. I would say the perfect storm.

As far as turn around no one knows. Have we entered a permanently poor market like pathology? Is this another downturn before prosperity (doubt it) like in the mid 90s? One thing for sure is that salary will only go down even more than it seems if you factor inflation.

 

[IJL]

Many factors. Slow down in imaging growth. No significant reduction in residents trained. Decreasing reimbursements and radiologists working harder to preserve income. Uncertainty about future with Obamacare and continued cuts. Reduction in autonomy with many rads worried they will be employees or taken over by telerad companies. Decrease in net worth with housing market and stock market crashes just now recovering. Teleradiology companies and corporations taking traditional in house jobs away in community hospitals. I would say the perfect storm.

As far as turn around no one knows. Have we entered a permanently poor market like pathology? Is this another downturn before prosperity (doubt it) like in the mid 90s? One thing for sure is that salary will only go down even more than it seems if you factor inflation.

I know radiologists salaries are going down, but that is along with many other specialties

 

[deleted116380]

Yes job market is awful. We had an opening in my practice and 50 people applied, many of whom were qualified and the ones we interviewed all said it was brutal out there.

What city are you in if you don't mind me asking?

 

[radman123]

I know radiologists salaries are going down, but that is along with many other specialties

Yes, but radiology is taking one of the worst beatings over the last decade, and will likely continue. They did the technical side in to the point that independent outpatient imaging can not survive, and now they will chop away at the professional side without a floor in site.

I am in a desirable locale to above poster.

 

[Radiola]

Yes, but radiology is taking one of the worst beatings over the last decade, and will likely continue. They did the technical side in to the point that independent outpatient imaging can not survive, and now they will chop away at the professional side without a floor in site.

I am in a desirable locale to above poster.

Do you have advices for residents to more them attractive radiologists in the future? Multiple fellowships? Multiple of publications?

 

[radman123]

Do you have advices for residents to more them attractive radiologists in the future? Multiple fellowships? Multiple of publications?

Work hard, get along well with other residents/fellows/attendings and build contacts. Multiple fellowships is what happens when the market stinks, like now. Instead, call groups where you want to live and see what their needs are. Publications will be good for academics.

 

[tennischamp822]

.

 

[bronx43]

I know radiologists salaries are going down, but that is along with many other specialties

Radiology is worse than some of the other specialties, but no one is being spared. All the IM subspecialties are becoming saturated rather quickly. The only favorable job markets currently are primary care and EM. Hospitalist is still a viable option, but I think they're about to tip over the edge as well.

 

[Taurus]

People are overexaggerating the situation. Is it more difficult to find a job today than 5 years ago when practices were cold calling reading rooms looking to hire? Sure. But pretty much everyone finds a position somewhere. It may not be the location, salary, or work that they desire but beggars can't be choosers. If they are unemployed, it's usually because they limit their geographic area. Because of Obamacare, many specialties are facing uncertainties and cuts, such as radiology, cardiology, etc. With IPAB, many more specialites I predict like ortho, spine, etc will get hit hard.

The question people need to ask themselves is this. Is the volume of imaging staying constant or increasing? With 30 million more people being added to the system, you can bet it will go up significantly soon. Furthermore, with more NP's and PA's ordering studies, they are driving up the volume too because they tend to take a shotgun approach to ordering tests. You may not make the same money as before. Heck, no one will. At least, you'll have a job.

It's like the stock market. You can't time it. You have to look at the fundamentals of a company and determine if it has a bright future. Don't be like my uncle who bailed out of the stock market in 2008 when it was tanking. He missed one of the greatest bull runs ever. The stock market is reaching new highs now. Everyone has their opinion, but I believe the fundamentals are still there. Only time will tell who's right.

 

[LADoc00]

So, is radiology the next pathology?

I think it would be torture to go through 4 years of medical school, do a 5 year residency + at least 1 year of fellowship and then end up jobless.

short answer: yes. I have begun dining regularly with my Radiology colleagues in the staff room as...almost all of the sudden...they seem much more open to my constant ranting about the End of Days.

 

[shark2000]

So, is radiology the next pathology?

I think it would be torture to go through 4 years of medical school, do a 5 year residency + at least 1 year of fellowship and then end up jobless.

short answer: yes. I have begun dining regularly with my Radiology colleagues in the staff room as...almost all of the sudden...they seem much more open to my constant ranting about the End of Days.

Short answer No.

Job market is bad. Reimbursement is going down. But, it is not pathology.

Pathology is suffering from chronic lack of new innovations. Their major work has not changed since 70s. I don't talk about research level work, I am talking about the daily practice.

Radiology is an ever changing field. The frontier of medicine. What a radiologist used to do in 70s, was a whole lot different from 80s, was totally different from 90s and 90s was a whole different world from now.

We are in the worst position of radiology in the last 40 years. But the field will adjust itself. Even in this bad economy, a lot of new modalities are on their way. I don't see the same thing for pathology.

You can take my job from me. You can take money from me. But radiology is radiology and pathology is pathology. My impact on patient care, in a Saturday 12 hour shift, is way beyond every other doctor in the hospital.

Job market is bad, but not really as bad as what people say. The problem is, people have seen a rapid change from the best job market in 2003-2004 to a bad job market in 2009. It was such a short time that people and their expectations could not adjust. Working nights did not exist 10 years ago for many radiologist, now the same people should read 100 studies a night.

 

[LADoc00]

Shark,

Everyone is entitled to an opinion even if it is as fantastical as the last Indiana Jones movie. You can definitely spin quite a yarn about how the weight of collective lives of your community rests on your shoulders during that harrowing 12 hr shift. I almost cued up 'One Day More' from Les Miserables for you.

The only problem is hospital admin isnt buying it and surgeons often think they can interpret scans better than you guys...interestingly I have yet to have a surgeon happen down to my lab and think they know better looking through the scope at a frozen section.

Regardless, the collective arrogance of the Rads community in allowing Nighthawks to infiltrate their operations has been their undoing. Rads is a commodity now, better stick to interventional stuff and pray Vascular Surgery etc doesnt decide to just snatch the profitable procedures away from you.

My guess long after all Rads comes out of some collective mega facility outside of Bombay, I will still be sitting in my dark hole in the lab like Blattodea in a lab coat. I may be living off formalin exhaust and free donuts from the staff lounge, but I will still be there...

Oh and welcome to the world Pathology has been in for the last 20 years.

Cue 'Sympathy for the Devil'

thanks for reading.

 

[shark2000]

Shark,

Everyone is entitled to an opinion even if it is as fantastical as the last Indiana Jones movie. You can definitely spin quite a yarn about how the weight of collective lives of your community rests on your shoulders during that harrowing 12 hr shift. I almost cued up 'One Day More' from Les Miserables for you.

The only problem is hospital admin isnt buying it and surgeons often think they can interpret scans better than you guys...interestingly I have yet to have a surgeon happen down to my lab and think they know better looking through the scope at a frozen section.

Regardless, the collective arrogance of the Rads community in allowing Nighthawks to infiltrate their operations has been their undoing. Rads is a commodity now, better stick to interventional stuff and pray Vascular Surgery etc doesnt decide to just snatch the profitable procedures away from you.

My guess long after all Rads comes out of some collective mega facility outside of Bombay, I will still be sitting in my dark hole in the lab like Blattodea in a lab coat. I may be living off formalin exhaust and free donuts from the staff lounge, but I will still be there...

Oh and welcome to the world Pathology has been in for the last 20 years.

Cue 'Sympathy for the Devil'

thanks for reading.

Thanks for your response.

Please do me a favor. Next time when your mother goes for a screening mammogram or a liver MRI, please disregard the radiology report. Ask the surgeon to interpret scans better than the radiologist or ask whoever is in in the mega facility outside of Bombay to read those.

The fact that the hospital needs some type of radiologist to interpret the images, either teleradiology or local group, is self explanatory that clinicians need radiology interpretation.Otherwise, hospital admin could just fire radiology group without replacement.

I am not a fan of IR myself, but FYI, IR has one of the best job markets among all the surgical fields. And FYI, most of these jobs do not have any PAD work. The scope of the IR practice is outside the understanding of a pathologist.

The reason for Pathology's poor job marker is lack of innovation in the field. The field has been practically frozen in 70s. If we were frozen in 70s, reading Xrays and doing barium, we could barely make more than a taxi driver. Sooner or later, with the advent of new radiotracers for PET scan , the need for biopsy will decrease substantially. It will be a great jump in our field. You may lose your job as it will decrease the need for pathologist.

Bad job market and decreasing reimbursements in radiology, has had one great advantage. It helped all those people who are jealous of us, cool down a little bit.

Thanks.

 

[Silent Cool]

Thanks for your response.

Please do me a favor. Next time when your mother goes for a screening mammogram or a liver MRI, please disregard the radiology report. Ask the surgeon to interpret scans better than the radiologist or ask whoever is in in the mega facility outside of Bombay to read those.

The fact that the hospital needs some type of radiologist to interpret the images, either teleradiology or local group, is self explanatory that clinicians need radiology interpretation.Otherwise, hospital admin could just fire radiology group without replacement.

I am not a fan of IR myself, but FYI, IR has one of the best job markets among all the surgical fields. And FYI, most of these jobs do not have any PAD work. The scope of the IR practice is outside the understanding of a pathologist.

The reason for Pathology's poor job marker is lack of innovation in the field. The field has been practically frozen in 70s. If we were frozen in 70s, reading Xrays and doing barium, we could barely make more than a taxi driver. Sooner or later, with the advent of new radiotracers for PET scan , the need for biopsy will decrease substantially. It will be a great jump in our field. You may lose your job as it will decrease the need for pathologist.

Bad job market and decreasing reimbursements in radiology, has had one great advantage. It helped all those people who are jealous of us, cool down a little bit.

Thanks.

This is great. LADoc and Shark going at it.

 

[Socrates25]

Furthermore, with more NP's and PA's ordering studies, they are driving up the volume too because they tend to take a shotgun approach to ordering tests.

This is exactly right. As long as radiology keeps unlicensed foreigners from being able to read scans overseas, you'll be alright. I have a hard time believing that there are thousands and thousands of American board certified/trained radiologists who want to go live in Australia to read nighthawk studies.

The primary care NPs and PAs who order x-rays and CT scans on every single patient will keep you in business.

 

[Substance]

Thanks for your response.

Please do me a favor. Next time when your mother goes for a screening mammogram or a liver MRI, please disregard the radiology report. Ask the surgeon to interpret scans better than the radiologist or ask whoever is in in the mega facility outside of Bombay to read those.

The fact that the hospital needs some type of radiologist to interpret the images, either teleradiology or local group, is self explanatory that clinicians need radiology interpretation.Otherwise, hospital admin could just fire radiology group without replacement.

I am not a fan of IR myself, but FYI, IR has one of the best job markets among all the surgical fields. And FYI, most of these jobs do not have any PAD work. The scope of the IR practice is outside the understanding of a pathologist.

The reason for Pathology's poor job marker is lack of innovation in the field. The field has been practically frozen in 70s. If we were frozen in 70s, reading Xrays and doing barium, we could barely make more than a taxi driver. Sooner or later, with the advent of new radiotracers for PET scan , the need for biopsy will decrease substantially. It will be a great jump in our field. You may lose your job as it will decrease the need for pathologist.

Bad job market and decreasing reimbursements in radiology, has had one great advantage. It helped all those people who are jealous of us, cool down a little bit.

Thanks.

I agree with Shark on this one. Technological advancements in imaging will destroy the need for biopsies. Progress on molecular diagnostics will kill the microscope. Since PhDs can do the latter for a very cheap price, that leaves the pathologist in the autopsy room.

Pathology's days are numbered. Rads might be hit hard, and might see the job market that path has been suffering through since the 80s, but it won't die. Path will.

 

[yesno]

This is great. LADoc and Shark going at it.

Not so great if those posts affect my desire to go into a particular specialty.

 

[LADoc00]

Thanks for your response.

Please do me a favor. Next time when your mother goes for a screening mammogram or a liver MRI, please disregard the radiology report. Ask the surgeon to interpret scans better than the radiologist or ask whoever is in in the mega facility outside of Bombay to read those.

The fact that the hospital needs some type of radiologist to interpret the images, either teleradiology or local group, is self explanatory that clinicians need radiology interpretation.Otherwise, hospital admin could just fire radiology group without replacement.

I am not a fan of IR myself, but FYI, IR has one of the best job markets among all the surgical fields. And FYI, most of these jobs do not have any PAD work. The scope of the IR practice is outside the understanding of a pathologist.

The reason for Pathology's poor job marker is lack of innovation in the field. The field has been practically frozen in 70s. If we were frozen in 70s, reading Xrays and doing barium, we could barely make more than a taxi driver. Sooner or later, with the advent of new radiotracers for PET scan , the need for biopsy will decrease substantially. It will be a great jump in our field. You may lose your job as it will decrease the need for pathologist.

Bad job market and decreasing reimbursements in radiology, has had one great advantage. It helped all those people who are jealous of us, cool down a little bit.

Thanks.

Shark,

Next time YOUR mother has a radiologic shadow or whatever crap you guys fence call everything to CYA and she has a biopsy, hop down to the lab and read it yourself. Of course, maybe your mother is rich and you are looking for a payout, dunno.

Your ignorance of Pathology is striking. The innovations in molecular testing are coming in monthly updates, not the decade+ long like Rads precious breast MRI...and I interpret my own FISH, do molecular and happen to bill quite a pretty penny for it too. On the order of about 2 grand/hr.

On top of my "retro" skills you mock, I also bill every facility I work at a management fee including time on call...making any call bucks lately?

The problem with you guys is think you are special...youre not. The more you think you are special and immune, the more everything will come as a big shock to you and your "people."

You will all be hospital/ACO/HMO employees making a sad scratch 15% more than a primary care doc once the Obamacare wave goes completely into effect.

Youre a big fish Shark, I get it. Youre a total bad ass, probably driving around in a Porsche Carrera GT, living in Malibu and your GF is a part time model/part time porn star. I get it.
Maybe you hit the gym alot and think you can even roll people in a fight if you needed to. I get it.

But Im glad I came from world where we always beat down because in Pathology, the beat downs have made us strong, cunning and suspicious.

But you guys in Rads, youre like balling around in Izod shirts and golf pants on top of the world and when they finally come for you, you wont have the slighest clue what to do.

Signed Respectfully,
~Jean Valjean

 

[yesno]

Shark,

Next time YOUR mother has a radiologic shadow or whatever crap you guys fence call everything to CYA and she has a biopsy, hop down to the lab and read it yourself. Of course, maybe your mother is rich and you are looking for a payout, dunno.

Your ignorance of Pathology is striking. The innovations in molecular testing are coming in monthly updates, not the decade+ long like Rads precious breast MRI...and I interpret my own FISH, do molecular and happen to bill quite a pretty penny for it too. On the order of about 2 grand/hr.

On top of my "retro" skills you mock, I also bill every facility I work at a management fee including time on call...making any call bucks lately?

The problem with you guys is think you are special...youre not. The more you think you are special and immune, the more everything will come as a big shock to you and your "people."

You will all be hospital/ACO/HMO employees making a sad scratch 15% more than a primary care doc once the Obamacare wave goes completely into effect.

Youre a big fish Shark, I get it. Youre a total bad ass, probably driving around in a Porsche Carrera GT, living in Malibu and your GF is a part time model/part time porn star. I get it.
Maybe you hit the gym alot and think you can even roll people in a fight if you needed to. I get it.

But Im glad I came from world where we always beat down because in Pathology, the beat downs have made us strong, cunning and suspicious.

But you guys in Rads, youre like balling around in Izod shirts and golf pants on top of the world and when they finally come for you, you wont have the slighest clue what to do.

Signed Respectfully,
~Jean Valjean

I wish I had the same gf as you

 

[shark2000]

Shark,

Next time YOUR mother has a radiologic shadow or whatever crap you guys fence call everything to CYA and she has a biopsy, hop down to the lab and read it yourself. Of course, maybe your mother is rich and you are looking for a payout, dunno.

Your ignorance of Pathology is striking. The innovations in molecular testing are coming in monthly updates, not the decade+ long like Rads precious breast MRI...and I interpret my own FISH, do molecular and happen to bill quite a pretty penny for it too. On the order of about 2 grand/hr.

On top of my "retro" skills you mock, I also bill every facility I work at a management fee including time on call...making any call bucks lately?

The problem with you guys is think you are special...youre not. The more you think you are special and immune, the more everything will come as a big shock to you and your "people."

You will all be hospital/ACO/HMO employees making a sad scratch 15% more than a primary care doc once the Obamacare wave goes completely into effect.

Youre a big fish Shark, I get it. Youre a total bad ass, probably driving around in a Porsche Carrera GT, living in Malibu and your GF is a part time model/part time porn star. I get it.
Maybe you hit the gym alot and think you can even roll people in a fight if you needed to. I get it.

But Im glad I came from world where we always beat down because in Pathology, the beat downs have made us strong, cunning and suspicious.

But you guys in Rads, youre like balling around in Izod shirts and golf pants on top of the world and when they finally come for you, you wont have the slighest clue what to do.

Signed Respectfully,
~Jean Valjean

I never claimed I or someone in India can read pathology better than you. You claimed that surgeons read their scans better and you got your answer. So your argument is totally nonsense.

If you read my posts, I did not talk about money. Boy, you are money hungry and you have chosen the wrong field. First medicine and then pathology.

Radiology is radiology. The cutting edge of technology in medicine. I can discuss any disease from head to toe with a subspecialist from Mutliple sclerosis to Pancreatic Divisum to SLAP tear. I mentioned in my first post. You can take money from the field, you can take my job. But radiology is and will be radiology.Almost every interesting case in hospital pass through my department. Open any journal from GI to Urology. The most interiguing part is Imaging.

Good Luck.

 

[LADoc00]

Yes yes. Definitely no one goes into Rads for the money

They go into Rads soley because its so...stimulating eh? I guess what makes you sleep better at night.

Shark, Im not here to imply you are useless and BombayMegaRadiologyExpress is better either. Its clearly not.

The point is Radiology (and other fields) is about to experience extraordinary business pressures it has never encountered and frankly is very ill prepared to deal with as a collective trade group. And your business model has 4+ mouths to feed for every 1 Pathologist at most hospitals. Your part of the pie needs to be big, but will it be?

When hospital payments for docs get bundled, how much do you think a Neurologist might dole out to a Rads guy who read a "few hyperintense lesions" on the brain MRI? Do they really treat based on brain MRI of MS to use your example? No...no they dont.

Drum roll...

They need retro 'Napolean Dynamite' level lab tests to treat, you know that stuff you think is going to magically go away when you invent that new super duper Harry Potter MRI. The one imaging test that will rule them all and in darkness bind them, you know: the one that is complete fiction but lives so vividly in the mind of every Radiology Director in America.

Your piece of the pie is looking mighty small from where Im standing.

 

[LADoc00]

Shark,

they are pressing to open the training floodgates to Rads at the moment. Coming to a city near you: dozens of starving 'Les Miserables' likely FMG Rads boarded docs.

Congress Tackles Graduate Medical Education, Seeks to Fill Physician Shortage
Legislation that would increase the number of Medicare-supported residency positions was recently reintroduced by U.S. Representatives Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.), and U.S. Senators Bill Nelson (D-Fla.), Charles Schumer (D-N.Y.), and Senate Majority Leader Harry Reid (D-Nev.).

“Because it takes seven to 10 years to train a doctor, Congress must act now to increase Medicare’s support for graduate medical education [GME],” said Darrell G. Kirch, MD, Chief Executive Officer of the American Association of Medical Colleges. “We commend the leadership and long-term vision these lawmakers have shown in reintroducing this measure.”

The Training Tomorrow’s Doctors Today Act (H.R. 1201 ) and The Resident Physician Shortage Reduction Act of 2013 (S. 577) would both phase in 15,000 Medicare-supported residency positions over five years. At least 50 percent of the available new slots each year must be used for shortage specialty residency programs, as identified by a U.S. Government Accountability Office report (GAO). ASCP supports the legislation and would like to have pathologists classified as primary care physicians (this is HILARIOUS!).

 

[foo]

See: http://www.healthimaging.com/topics...presents-rads-choice-about-specialty’s-future

And: http://www.diagnosticimaging.com/practice-management/radiology-job-market-will-improve-eventually

Relax, it will all work out.

 

[LADoc00]

As those links clearly indicate, Radiology HAD the option to keep control of call coverage, nights and weekends and dropped the ball.

That horse has left the barn and its only a matter of time now before large Hospital systems simply centralize imaging services to core facilities with employee Radiologists leaving only token outposts of interventionalists in the community.

 

[IamnotFreud]

As those links clearly indicate, Radiology HAD the option to keep control of call coverage, nights and weekends and dropped the ball.

That horse has left the barn and its only a matter of time now before large Hospital systems simply centralize imaging services to core facilities with employee Radiologists leaving only token outposts of interventionalists in the community.

See, the problem is that training in rads is long, difficult, and the practice of radiology at an attending level is also complex. So think about this- even in something like IM where IMGs/FMGs can get into, most of them want to specialize, because they don't really want to do IM, and that is 3 years only. You really think that foreigners want to do 6 years of residency to make a bit more than they can as internists? I don't think so. So they can continue chipping away at it, but eventually, something will have to give inevitably. If you want to pay rads say 250-300k permanently you will have a lot less people going into it, and a shortage will occur. You think the current dino-rads can practice indefinitely? Unlikely.

Why do you think that IM/EM salaries have skyrocketed recently? Because of a huge shortage and need of those docs. The gov is short sighted and outright blind. I think if an IM doc can make 300k+, then it's not unreasonable for a rad to make 400k+. But they are short sighted and have an inability to make good decisions, so when in 5-8 years there is a huge shortage of rads, given the retiring dino-rads, the med students who have fled rads, the influx of 30 million new patients, and the army of midlevels who will image everything because they really don't know what they are doing - what do you think will happen?

As I see it, salaries will once again skyrocket, PCP salaries will inevitably drop, and the cycle will begin again. There is currently an increase in people going into IM/EM because that's where the hot job market is at right now, with good pay, flexibility, plenty of job options. Many AMGs are even foregoing IM fellowships to go the hospitalist route. You think that gravy train will last forever? Unlikely. Just like the continuous chipping away of rad/rad onc salaries cannot continue indefinitely.

 

[dhavalp]

You really think that foreigners want to do 6 years of residency to make a bit more than they can as internists? I don't think so. So they can continue chipping away at it, but eventually, something will have to give inevitably. If you want to pay rads say 250-300k permanently you will have a lot less people going into it, and a shortage will occur.

I know of IMGs that would take any open residency position... there are thousands that go unmatched each year. There may be less AMGs going into radiology but the residency spots will continue to fill each year, probably with more IMGs. I don't see the amount of radiology graduates decreasing unless programs close.

 

[bronx43]

See, the problem is that training in rads is long, difficult, and the practice of radiology at an attending level is also complex. So think about this- even in something like IM where IMGs/FMGs can get into, most of them want to specialize, because they don't really want to do IM, and that is 3 years only. You really think that foreigners want to do 6 years of residency to make a bit more than they can as internists? I don't think so. So they can continue chipping away at it, but eventually, something will have to give inevitably. If you want to pay rads say 250-300k permanently you will have a lot less people going into it, and a shortage will occur. You think the current dino-rads can practice indefinitely? Unlikely.

Why do you think that IM/EM salaries have skyrocketed recently? Because of a huge shortage and need of those docs. The gov is short sighted and outright blind. I think if an IM doc can make 300k+, then it's not unreasonable for a rad to make 400k+. But they are short sighted and have an inability to make good decisions, so when in 5-8 years there is a huge shortage of rads, given the retiring dino-rads, the med students who have fled rads, the influx of 30 million new patients, and the army of midlevels who will image everything because they really don't know what they are doing - what do you think will happen?

As I see it, salaries will once again skyrocket, PCP salaries will inevitably drop, and the cycle will begin again. There is currently an increase in people going into IM/EM because that's where the hot job market is at right now, with good pay, flexibility, plenty of job options. Many AMGs are even foregoing IM fellowships to go the hospitalist route. You think that gravy train will last forever? Unlikely. Just like the continuous chipping away of rad/rad onc salaries cannot continue indefinitely.

People fail to realize that nowadays, it's just a game of musical chairs. There will be no more "shortage" as the number of medical students will soon outnumber the number of available residency spots. So, if radiology salaries drop and they flee from the field, where would they go? What would they go into? IM? Ok... so they all go into IM, where do the displaced IM people go? EM? Ok... so where do all the displaced EM ppl do? You get the point. And this will permeate even into fellowships. Right now, people are foregoing fellowships more and more in IM, but if that continues, then the hospitalist and outpatient market will become oversaturated to a point where people will HAVE to do a fellowship. The market equalizes all.

 

[Silent Cool]

People fail to realize that nowadays, it's just a game of musical chairs. There will be no more "shortage" as the number of medical students will soon outnumber the number of available residency spots. So, if radiology salaries drop and they flee from the field, where would they go? What would they go into? IM? Ok... so they all go into IM, where do the displaced IM people go? EM? Ok... so where do all the displaced EM ppl do? You get the point. And this will permeate even into fellowships. Right now, people are foregoing fellowships more and more in IM, but if that continues, then the hospitalist and outpatient market will become oversaturated to a point where people will HAVE to do a fellowship. The market equalizes all.

BOOM. Bronx is right on the money. There will be no shortage of any doctor because residency slots are relatively stagnant while med school spots are increasing. As the Obama administration has made clear, parity in pay between specialties is the name of the game.

It's funny because all of this has occurred so suddenly. The market for every field has changed abruptly. I can recall reading threads years ago in the Rads forum about the futility of fellowship training because jobs were so abundant. Then the market turned on a proverbial dime. Amazing.

 

[IamnotFreud]

BOOM. Bronx is right on the money. There will be no shortage of any doctor because residency slots are relatively stagnant while med school spots are increasing. As the Obama administration has made clear, parity in pay between specialties is the name of the game.

It's funny because all of this has occurred so suddenly. The market for every field has changed abruptly. I can recall reading threads years ago in the Rads forum about the futility of fellowship training because jobs were so abundant. Then the market turned on a proverbial dime. Amazing.

What they are trying to do will crash and burn. Mark my words. Keep this point and read it in a few years. Who wants to go to med school, do 8 years of undergrad and med school plus 3-6 extra years of training for 200-300k? You realize that you can do finance, marketing, consulting, etc and make that kind of money with farrrrrr less training and work. They can try what they want but if they continue chipping away at salaries there will be no doctors left. Why would peopl ewaste years of their life on this if they can choose a different field that's easier and pays similarly?

 

[IJL]