Radiology becoming the next pathology

[Baller MD]

Obviously radiology seems to be more technologically driven than pathology, which can create new avenues for reimbursements and job opportunities. OTOH, radiology is a victim of its own success - the more efficient things become, the more it seems to lower reimbursements (see PACs). So it seems that the new effects of technologies may be negligible if you also consider that there are currently too many radiologists.

One can argue that a lot of radiologists may be retiring soon but that doesn't change the fact that we are also churning out record numbers of new graduates per year either.

BTW people were already complaining of a bad job market online since 2006...

So what is preventing radiology from becoming the next pathology?

I'm not trolling, I'm seriously curious.

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[avatar2525]

I would be happy if rads is the next path. Their pay is still decent and their lifestyle is sick.

 

[colbgw02]

OTOH, radiology is a victim of its own success - the more efficient things become, the more it seems to lower reimbursements (see PACs).

How did you come to this conclusion? Lower reimbursements are only tangentially related to efficiency, but I don't see a causal relationship. Radiology has been cut because it's a huge target, and it's a huge target because of the rampant (over)utlilization of medical imaging. If anything, efficiency is a byproduct of increased utilization, just as the reimbursement cuts are. Now, efficiency certainly has an effect on the job market, as radiologists have chosen to maximize their workload to maintain income rather than hire new radiologists to handle the increase in utilization.

 

[bronx43]

I would be happy if rads is the next path. Their pay is still decent and their lifestyle is sick.

Zero hours a week is the sickest lifestyle, brah. I agree that the unemployment check is decent, too. At least the per hour rate is.

 

[deleted116380]

How did you come to this conclusion? Lower reimbursements are only tangentially related to efficiency, but I don't see a causal relationship. Radiology has been cut because it's a huge target, and it's a huge target because of the rampant (over)utlilization of medical imaging. If anything, efficiency is a byproduct of increased utilization, just as the reimbursement cuts are. Now, efficiency certainly has an effect on the job market, as radiologists have chosen to maximize their workload to maintain income rather than hire new radiologists to handle the increase in utilization.

Overutilization is an understatement. There are far too many weak indications for exams ordered that I've seen. It needs to come down one way or another. Its' too easy for a clinician to order a test (radiology, labs, echo) without having to critically think what the indications are, how it will change management, and what side effects are (health and financial). It's been going on for too long and needs to come to an end.

 

[shark2000]

Overutilization is an understatement. There are far too many weak indications for exams ordered that I've seen. It needs to come down one way or another. Its' too easy for a clinician to order a test (radiology, labs, echo) without having to critically think what the indications are, how it will change management, and what side effects are (health and financial). It's been going on for too long and needs to come to an end.

Won't come to an end. period.

People who talk about imaging over-utilization are the same people who write articles on NY times and talk about non-indicated breast biopsies. There was one article recently that said "because the result of the biopsy is negative for cancer, the biopsy was not indicated in the first place."

Imaging is like a double sword. On one hand it is costly, but on the other hand it decreases the medical cost. Believe it or not. There was a study a few years ago about CT utilization in ER. They found out that CT scans in fact decrease the cost of ER visits. If you don't do the CT abdomen, you have to monitor the patient in the ER for endless number of hours, which turned out to be more expensive than doing a CT.

Never underestimate the value of a negative imaging study, including management implications, saving hospital bed, decreasing hospital stay time, decreasing referrals, decreasing the number of required medical staff, ...

Example: If you fall down and there is a concern for scaphoid fracture, doing an emergent MRI wrist is less costly (or at least no more expensive) than the alternative (if it is not fractured). The alternative is to put a cast, repeat the study in 10 days and send the patient to ortho clinic. In the first route the cost is ER visit, Xray and MRI. In the second route, the cost is ER visit + Xray + cast + repeat Xray + ortho clinic visit.

A lot of insurance companies are very well aware of this concept. As a result, nobody really tries to decrease the number of imaging studies. Instead, they try to decrease the reimbursement per study.

 

[colbgw02]

Won't come to an end. period.

Agreed. As frustrating as it can be, it's better to see the silver lining here. To wit, we're an integral part of healthcare delivery, and - as much as people like to boast to the contrary - things would grind to a halt without us. Need proof? Get backed up covering the ED one day and see the hissy fit they throw.

People who talk about imaging over-utilization are the same people who write articles on NY times and talk about non-indicated breast biopsies. There was one article recently that said "because the result of the biopsy is negative for cancer, the biopsy was not indicated in the first place."

Imaging is like a double sword. On one hand it is costly, but on the other hand it decreases the medical cost. Believe it or not. There was a study a few years ago about CT utilization in ER. They found out that CT scans in fact decrease the cost of ER visits. If you don't do the CT abdomen, you have to monitor the patient in the ER for endless number of hours, which turned out to be more expensive than doing a CT.

Never underestimate the value of a negative imaging study, including management implications, saving hospital bed, decreasing hospital stay time, decreasing referrals, decreasing the number of required medical staff, ...

Example: If you fall down and there is a concern for scaphoid fracture, doing an emergent MRI wrist is less costly (or at least no more expensive) than the alternative (if it is not fractured). The alternative is to put a cast, repeat the study in 10 days and send the patient to ortho clinic. In the first route the cost is ER visit, Xray and MRI. In the second route, the cost is ER visit + Xray + cast + repeat Xray + ortho clinic visit.

A lot of insurance companies are very well aware of this concept. As a result, nobody really tries to decrease the number of imaging studies. Instead, they try to decrease the reimbursement per study.

The rest of the post is a false dichotomy. There's a wide gulf between the out-of-touch, ivory tower, NY Times author lamenting false-positive breast cancer work-ups and the r/o scaphoid fracture MRI from the ED. Yes, some imaging studies when performed emergently - to include the aforementioned wrist MRIs - confer a cost savings, but we shouldn't therefore conclude that all imaging tests do the same. That's textbook sampling bias with extrapolation.

 

[Over9000]

Radiology is probably the field most likely in danger of being commoditized as pathology has been.

The worst thing radiology can do is saturate the market with radiologists. This has been discussed before ad nauseum.

Pathology's biggest weakness is that patients do not come to us. Radiologists still have that in some ways, and should fight tooth-and-nail to preserve it. Which leads me to my second point: the second-worst thing radiologists can do is sell out their independent practices to hospital systems.You can be sure that hospital systems will try to buy-out all existing independent imaging centers and then lobby for imaging to be a wholly hospital-run specialty. You have to make sure this does not happen.

Combine that with a glut of radiologists, and the hospitals will name the price you will work at, the worthless protocols and meetings you must kowtow to, and the techs and admins from whom you will take orders. No doubt there will be some among your craft that will "sell out" and support the hospital systems to the detriment of their colleagues to support their own employment or to secure a cush admin job to wind down into retirement.

 

[Silent Cool]

Radiology is probably the field most likely in danger of being commoditized as pathology has been.

The worst thing radiology can do is saturate the market with radiologists. This has been discussed before ad nauseum.

Pathology's biggest weakness is that patients do not come to us. Radiologists still have that in some ways, and should fight tooth-and-nail to preserve it. Which leads me to my second point: the second-worst thing radiologists can do is sell out their independent practices to hospital systems.You can be sure that hospital systems will try to buy-out all existing independent imaging centers and then lobby for imaging to be a wholly hospital-run specialty. You have to make sure this does not happen.

Combine that with a glut of radiologists, and the hospitals will name the price you will work at, the worthless protocols and meetings you must kowtow to, and the techs and admins from whom you will take orders. No doubt there will be some among your craft that will "sell out" and support the hospital systems to the detriment of their colleagues to support their own employment or to secure a cush admin job to wind down into retirement.

Reminds me of my own experience in corporate hell. UGH.

 

[Over9000]

Reminds me of my own experience in corporate hell. UGH.

I'm living it as a pathologist. No student should ever consider this field, not because the job market is bad, but because you have absolutely no autonomy in it.

I'd very much go back to residency to do something else, but it'd have to be something good, and frankly coming from path isn't exactly considered an asset.

 

[Silent Cool]

I'm living it as a pathologist. No student should ever consider this field, not because the job market is bad, but because you have absolutely no autonomy in it.

I'd very much go back to residency to do something else, but it'd have to be something good, and frankly coming from path isn't exactly considered an asset.

If you did that, what fields would you consider?

 

[shark2000]

I am not here to defend pathology. But the pathologists that I know in their 50s and 60s are some of the happiest doctors out there. Nice life style and decent money. No night and no weekends.

A pathologist told me once that he has never missed any social occasion and managed to go to all of his children's sports events at school.

Pathology job market is very very tight. But once you break into the market it is a relatively good gig. Definitely some fields are overrated and some are underrated. Pathology is one of the underrated ones.

 

[Over9000]

Pathology is underrated but its fundamentals make it prime prey for corporate-style interference.

My current work has such a problem, and its very difficult to tolerate.

But this road is so long and arduous, that aside from derm, which would never happen in a billion years, I can't see any practical reason why I'd trudge through residency again. Rads would have been a consideration, probably the most appropriate one, but the corporate issues that plague path are just starting to gain footholds in rads. But this is just an outsider's perspective. Maybe I'm wrong.

 

[shark2000]

Pathology is underrated but its fundamentals make it prime prey for corporate-style interference.

My current work has such a problem, and its very difficult to tolerate.

But this road is so long and arduous, that aside from derm, which would never happen in a billion years, I can't see any practical reason why I'd trudge through residency again. Rads would have been a consideration, probably the most appropriate one, but the corporate issues that plague path are just starting to gain footholds in rads. But this is just an outsider's perspective. Maybe I'm wrong.

You are right to some extent. Corporate-style interference is dominating most fields except for a few fields like derm. In my area, most jobs are hospital employee positions. Data shows that just 10 years ago only 10% of physicians were hospital employees and now it is about 60% and the trend is upward. Hospital employment appears a good deal at first esp when it is in competition with local private practice groups. Employee position usually has higher starting salaries and better perks with less work. Once all the local private practices dry up, then the hospital can dictate what they want. It happened to Dialysis centers in the last 5-10 years. The same is happening to cancer centers, cardiovascular centers, spine centers, ...

So if you ask me, I personally don't see a good trend in healthcare system for physicians. What happened to pathology about 20 years ago is rapidly happening to most other fields. Family doctor has been always the first patient-doctor encounter. In the last 60 years it was dominated by private outpatient offices. In the last 10 years, it has been rapidly replaced by hospitalist and hospital-owned outpatient centers.

Eventually, medicine will go the way that other major business like pharmacy, grocery, food industry, even eye-glass industry, book and magazine industry and ... have gone. Big corporates dominating the market with fine quality and very little room for competition.

And my last recommendation: Even if derm or radiology or any other fields seem great to you, don't think about a second residency. Just hang in there and do your best in your field.