Radiology Future

[drtomkins]

To incoming/interviewing medical students:

Please consider this a public service announcement of sorts. It is shocking to me that many very intelligent medical students do not understand the economic undercurrents of the specialty into which they are applying. The field of radiology today is, without question, among the most financially unstable in all of healthcare.

The issue at hand is not what your salary will be in the future, but whether you will even have a job in the future. It pains me very much to admit that not a single one of the fellows in our program (which will remain anonymous) has been able to find a job, or even to secure an interview for a job. Some of these are trying, quite unsuccessfully at present, to obtain a second fellowship. The bottom line is that very few radiology groups are hiring. Numerous factors are coalescing to make the job situation so pernicious in radiology. These include: 1) capitated/diagnosis related groups payment systems that make radiologists parasites to the hospital, rather than generators of revenue like other physicians 2) ever decreasing reimbursements for imaging studies and 3) probably most important, a SEVERE glut of graduating residents and fellows. In fact, over the period 2000-2010, we trained about 50% more radiology residents PER YEAR than we trained over the period 1990-2000.

These three factors combined, will ensure that the radiology job market gets much, much worse before it gets better and in all likelihood will not get much better for more than a decade, and will ONLY get better if less medical students choose to go into the specialty.

The reason I felt the need to post this message is because I understand that many graduating medical students have quite a bit of loans to repay. While radiology very definitely is a wonderful field that is fun, exciting, rewarding and enjoyable; I do nevertheless feel that it would be nonsensical to say "pick what you love" when in all likelihood you will not be able to pay back your loans after graduating residency.

My advice: if you are independently wealthy and can afford to "do what you love" without worrying about paying back loans, then by all means, do radiology.

If, on the other hand, you are like the majority of medical students, and have significant loans to pay back, then please reconsider your choice. Find something else that you can tolerate with a much better economic outlook. Even if you have to suffer through a less than pleasant residency program. Believe you me: no one ever regretted later have a job or making more money. It goes back to the old adage: "It's not about the money, but it is about the money." Do not delude yourself into thinking that you are among those who can afford to "do what you love" when in all reality your financial situation may dictate otherwise.

So choose wisely in your quest for a specialty. And be very cautious about entering radiology if you have any significant loans to pay back. The fact that 1200 new radiology residents are being graduated every year in a climate where no one is hiring does not bode well for the job market in 6, 7, 8 or even 10 years time. The idea that radiologists will be retiring in droves over the next few years is utter nonsense. And the idea that interventional radiology is the way of the future and will save you is also utter nonsense. Many graduating residents did not match in the IR match of 2011, and it is only going to get worse. Moreover, the currently average (but by no means hot) job market in interventional radiology will eventually also be saturated.

The changing climate of healthcare is coming, and radiology is being hit the hardest. I would suggest the following specialties: internal medicine and subspecialties, surgical subspecialties (not general surgery), anesthesiology (also a shaky one, but better than radiology from a "paying back your loans" standpoint), ob/gyn (if you have the personality for it), dermatology, neurology and rehabilitation medicine. How do I presume to know all about these other specialties? Don't forget I'm a radiologist. I talk to all the other physicians in the hospital. Many of them are candid with me and are my friends. I make a point to understand the economics of healthcare. Please try to do the same before making an ill-informed decision to enter the profession of radiology unless your are independently wealthy and can afford to "do what you love".

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[officedepot]

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[PokerDoc]

. I make a point to understand the economics of healthcare. Please try to do the same before making an ill-informed decision to enter the profession of radiology unless your are independently wealthy and can afford to "do what you love".

And yet... here you are in Radiology. I find it troubling that you would make a post like this 4 days before our rank lists are locked in....

What do you seriously expect us to do, even if you are 100% right? We are not at a point where a forum post is going to have even the slightest impact in our decision process.

Furthermore, pretending this is a radiology problem is silly. Specialties across the board are experiencing problems and medicine as a whole is going to be a lot less rosy for new physicians than it was 10 years ago. We are all aware of this, and we are all going to deal with it one way or another.


Now that I am done pretending you are a real attending.... I think you're full of crap and a troll. /the end

 

[MRads]

You know, it might be a troll post but he probably has a point. Although no one can predict what's going to happen in 5-10 years, I've spoken to several fellows currently trying to find jobs, and they're all having no luck at all.

Any other fellows/attendings want to comment on this?

 

[PokerDoc]

cool, another new account with one post

 

[officedepot]

.

 

[Gryphes]

Hey Chopra/Chosen1. Haven't seen you for awhile. Good to see you back.

 

[drizzt3117]

Or nightflight?

Chosen1 lol, rads is harder than ob/gen surg, right? Lmao.

 

[colbgw02]

You know, it might be a troll post but he probably has a point. Although no one can predict what's going to happen in 5-10 years, I've spoken to several fellows currently trying to find jobs, and they're all having no luck at all.

Any other fellows/attendings want to comment on this?

Part of the problem, as I see it, is that the people finishing fellowship and residency this year applied to the field back in the fall 2004-2006 time range. Those were high times for radiology, and the applicants developed their expectations accordingly. There's no doubt that things have fallen off since then. The jobs are both fewer and less attractive (more years to partner, lower salary, etc.), but people claiming to not be able to find a job are either not trying hard enough or being too selective. The jobs are out there, just not necessarily in the desirable locations (cities, the coasts).

 

[MRads]

haha probably the same guy as the OP. Troll.

No, I'm an MS4.

 

[PokerDoc]

Part of the problem, as I see it, is that the people finishing fellowship and residency this year applied to the field back in the fall 2004-2006 time range. Those were high times for radiology, and the applicants developed their expectations accordingly. There's no doubt that things have fallen off since then. The jobs are both fewer and less attractive (more years to partner, lower salary, etc.), but people claiming to not be able to find a job are either not trying hard enough or being too selective. The jobs are out there, just not necessarily in the desirable locations (cities, the coasts).

Agree 100%. And like I said... we all are well aware that the picture isn't as rosy as it used to be. But I still am confident that hard work and loving my field will be enough. I may not be living in a mansion, nor do I want to, but I am still going to live comfortably, and my kids are going to have most of the things they want.

 

[scootad.]

Don't listen to the trolls. I finished fellowship last year. While, yes its true the job market is quite bad overall, I had a couple of offers and accepted a private practice job in CA. I always dreamed of making out to CA (I'm an east coaster) and I'm loving the job. All of my co-fellows and people I graduated residency with found jobs 3 in D.C. The market forces you to be more proactive with the search but there are definitely jobs out there.

 

[MossPoh]

OMFG, THE SKY IS FALLING!!!!!!!!!

Seriously, every field I've rotated through or chatted with has some sky is falling scenario. I know multiple jobs right now with good pay and quick partnership that are out there...as an MS3. The big issue is that they aren't in the sexy locations.

 

[DrGregoryHouse]

I disagree, I have proof.

Radiology Resident Populations between 1980 and 2007. AJR 2010

 

[DrBowtie]

Just withdrew from the match. Thanks for the heads up.

 

[colbgw02]

Just withdrew from the match. Thanks for the heads up.

Haha. Well played.

 

[drtomkins]

Simply because people were able to find jobs after finishing fellowship last year, or that the job market last year had jobs which were neither desirable in income nor location, does not refute my thesis, in my humble opinion.

Last year, the job market was mediocre to below average, as the prior poster indicated. To paraphrase his comments, jobs were available, but with longer partnership tracks, less salary, and in undesirable locations.

This year, the job market is nearly nonexistent. I am positing that the job market is going to get worse before it gets better because we are training far too many residents today.

Medical students should be aware of the facts before choosing a specialty. The reason I posted my original post was that I personally know of a fellow who has a new baby, just born, with tons of loans, and no job lined up. I ask you: what possible incentive could I have to troll around on an online message board? I don't see what purpose it would serve to anyone unless I honestly believe what I am saying to be true. Believe me, I am not doing this for my own personal entertainment. I merely want medical students to understand the facts, and my experience has been that they by and large, have no concept of the business of medicine whatsoever.

I apologize if I am posting this information at an inopportune time. For those of you who are already in the match this year, I would advise you NOT to do a transitional year. Do your year in internal medicine. That way, you would still have the opportunity to switch over at a later date if you decide job security is more important than you realized as a medical student. If, on the other hand, you have an inkling to do surgery, do a gen surg year. Avoid a useless transitional year. But, by all means, take your radiology match if you have already applied.

Again, I am sorry for posting at an inopportune time. I was not aware that the match was 4 days away. Naturally, take my comments with a grain of salt if you wish. But I can assure you I have no ulterior motives whatsoever, nor can I conceive of any possible ulterior motives for posting comments such as these in a public message board frequented by medical students. My intention was not to frighten any of you, but to make you open your eyes to the realities that face our profession. I did not say to avoid radiology altogether, just to consider other alternatives if you have a great deal of loans to repay.

Personally, I love radiology. It is an amazing field. Those already well situated in groups will continue to do well. But the new guys will have difficulty finding decent jobs, and probably could do much better in other specialties. That is my point. Take it or leave it.

 

[PokerDoc]

Simply because people were able to find jobs after finishing fellowship last year, or that the job market last year had jobs which were neither desirable in income nor location, does not refute my thesis, in my humble opinion.

Last year, the job market was mediocre to below average, as the prior poster indicated. To paraphrase his comments, jobs were available, but with longer partnership tracks, less salary, and in undesirable locations.

This year, the job market is nearly nonexistent. I am positing that the job market is going to get worse before it gets better because we are training far too many residents today.

Medical students should be aware of the facts before choosing a specialty. The reason I posted my original post was that I personally know of a fellow who has a new baby, just born, with tons of loans, and no job lined up. I ask you: what possible incentive could I have to troll around on an online message board? I don't see what purpose it would serve to anyone unless I honestly believe what I am saying to be true. Believe me, I am not doing this for my own personal entertainment. I merely want medical students to understand the facts, and my experience has been that they by and large, have no concept of the business of medicine whatsoever.

I apologize if I am posting this information at an inopportune time. For those of you who are already in the match this year, I would advise you NOT to do a transitional year. Do your year in internal medicine. That way, you would still have the opportunity to switch over at a later date if you decide job security is more important than you realized as a medical student. If, on the other hand, you have an inkling to do surgery, do a gen surg year. Avoid a useless transitional year. But, by all means, take your radiology match if you have already applied.

Again, I am sorry for posting at an inopportune time. I was not aware that the match was 4 days away. Naturally, take my comments with a grain of salt if you wish. But I can assure you I have no ulterior motives whatsoever, nor can I conceive of any possible ulterior motives for posting comments such as these in a public message board frequented by medical students. My intention was not to frighten any of you, but to make you open your eyes to the realities that face our profession. I did not say to avoid radiology altogether, just to consider other alternatives if you have a great deal of loans to repay.

Personally, I love radiology. It is an amazing field. Those already well situated in groups will continue to do well. But the new guys will have difficulty finding decent jobs, and probably could do much better in other specialties. That is my point. Take it or leave it.

If its your opinion, thats fine, you're entitled to that much and I'll never be one to say people are not allowed to share their opinions. But you try a little too hard to make it sound like fact. And then you back up your 'thesis' with an anecdotal story. We all know anecdotes are not the way to sell your point in medicine.

If you mean well and are not simply trolling I don't mean to sound harsh, but you have to understand we have people who come on here with the sole purpose of trying to scare applicants away for reasons beyond my comprehension, so when someone else comes along with a new account and his first post is 'omg don't do radiology it's super bad because my friend can't find a job', you'll understand when no one takes you seriously on an anonymous forum.

 

[omarsaleh66]

In this economy it would be smart to work hard in your intern year so in case u cant find a job u can do some clinical moonlighting until jobs open up. Ive started looking for jobs but no one is really taking me seriously cuz I havent started my fellowship. I do know alot of young staff that would sign contracts even before they started their fellowship and get a sweet signing bonus. I still would go the rads route tho, its worth it.

 

[shark2000]

Last year out of 1200 graduates, only one person could find a job after finishing his 5th fellowship. Nobody else could find a job.

A great option for current graduates is doing multiple fellowships. You have a fellowship income and many places give you internal moonlighting opportunities.
You can do 6 fellowships and then repeat it for 5 more cycles. By that time you will have worked for 30 years and it is the time to retire.

Last year there was only one job. This year there will not be any job.

 

[omarsaleh66]

Last year out of 1200 graduates, only one person could find a job after finishing his 5th fellowship. Nobody else could find a job.

A great option for current graduates is doing multiple fellowships. You have a fellowship income and many places give you internal moonlighting opportunities.
You can do 6 fellowships and then repeat it for 5 more cycles. By that time you will have worked for 30 years and it is the time to retire.

Last year there was only one job. This year there will not be any job.

hahah that is nonsense

out last year's class in my residency of 6 , 4 had jobs even before graduating. COME ON MAAAN!!!

 

[MrBurns10]

The job market does suck right now, probably the worst it's been in a very long time (ever?), but to say there are no jobs just isn't true. Many of the current fellows in my program have already locked down positions, and several others are interviewing with multiple practices. No one know what the job outlook is going to be like in 5 years for ANY field, so I wouldn't strike radiology off the list just because there are less jobs available now.

 

[DrBowtie]

My plan is to SOAP into an unfilled FP spot. They all have jobs.

 

[saftab]

Is there any kind of listing that has actual data about the types of jobs fellows are finding?

 

[rdrt]

Radiology 4 life.

 

[bronx43]

Just the fact that fellowships are more or less required for radiology speaks volumes about the job market. Obviously, no one can know for sure about the future, but graduating 1000+ radiologists per year doesn't bode well for the market. In reality, anesthesia is in the same boat, and they have CRNAs to worry about as well. The only thing that is keeping them afloat is the rapid increase in surgical volume in the past decade or so. Once that expansion hits a wall, the anesthesia market will be a disaster.

 

[davidjones]

A few things:

1) just because almost everyone does a fellowship says nothing about a job market, >90% of residents have been doing fellowships even in the good ol days.

2) radiologists, particularly DRs are whiners, they've had years of in opposed practice and high reimbursements
On the same topic as of 1/2012 to be able to get reimbursed for the technical fee facilities need some sort of accreditation now from Medicare, usually by the ACR, ill bet private insurers will follow, and I don't see the ACR accrediting orthopedic or cardiology facilities.
We take their stuff too. I know of a few groups that started doing echo, cause the PCPs got sick of cards doing thousands of dollars in testing after echos
Every IR that I know of that wants to do PAD or whatever else and who actually puts in the effort I.e marketing to PCPs etc has more than they need

3)job market sucks everywhere, on this website, there are neurologists, thats nephrologists ( the most miserable specialty if ever there was one, but with a high demand) having trouble finding desirable jobs.
Cards is in a similar state. Hospitalists are doing ok


4) jobs are out there, they may not be in NYC or LA, and might be in some Podunk town, but they pay well. I've seen the same jobs over periods of months go unfilled, even though these are partner tracks with >300k starting. People are just pissed because they feel they are entitled and unfortunately there is a large contingent of entitled people going into rads

5) not sure what the guy above meant about IR not being the wave of the future. It's not going to be your salvation if you think it will help you get a job, you'll definitely get a job doing an IR fellowship, but that job will be in...IR. that means going in at night, staying late and coming in early , unless you just want to be a needle jockey. If you want to do it b/c it's a great field then go for it. It's not going to get saturated, only 200 some IRs are trained every year, and roughly that number retire.

6) 1000 new docs is nothing, with a projected shortage of all physicians and an aging population decreasing the number of docs is a very dumb idea

7) it's strange that people post how crappy it is who actually aren't, in the field. Bronx has shown himself to be a very knowledgeable and rationale person, but you can't apply business or economic principles to medicine, if you could , then there wouldn't have been such a huge outcry about breast screening, I wouldn't be doing a 7000 dollar procedure for palliation in a patient with 3 months to live , ortho wouldn't be going hips in demented 98 year olds and every patient in the ER wouldn't be getting a head and chest CT. I'm not saying those are correct, but medicine is to complex for it.

 

[davidjones]

AND finally:

I spoke to one of my IR attendings about this, and he said when he finished the only job he could find paid 35000. This was maybe 15-20 years ago. I'm not going to tell you the ridiculous amount of money he makes now.

 

[deleted103644]

A few things:

1) just because almost everyone does a fellowship says nothing about a job market, >90% of residents have been doing fellowships even in the good ol days.

Yup, this says more about the complexity of the field - generalists should not be reading subspecialty studies and will probably stop getting insurance reimbursement for reads in the near future.

4) jobs are out there, they may not be in NYC or LA, and might be in some Podunk town, but they pay well. I've seen the same jobs over periods of months go unfilled, even though these are partner tracks with >300k starting. People are just pissed because they feel they are entitled and unfortunately there is a large contingent of entitled people going into rads

Yeah, have heard radiology fellows complain about jobs, but all that has meant is they need to move to Seattle instead of staying in NYC.

7) it's strange that people post how crappy it is who actually aren't, in the field. Bronx has shown himself to be a very knowledgeable and rationale person, but you can't apply business or economic principles to medicine, if you could , then there wouldn't have been such a huge outcry about breast screening, I wouldn't be doing a 7000 dollar procedure for palliation in a patient with 3 months to live , ortho wouldn't be going hips in demented 98 year olds and every patient in the ER wouldn't be getting a head and chest CT. I'm not saying those are correct, but medicine is to complex for it.

I would actually argue all of these have to do with the application of business principles to medicine (when probably they shouldn't be).

The controversy over breast screening was mainly political, but you could say there is significant demand for the procedures (even if they have been proven unnecessary before 50).

$7000 for a pointless procedure - sounds like a great economic move on the hospital's part. Same for unnecessary hip surgery and CT scans.

Medical decisions need to be insulated from economic ones, but I think your examples are the opposite of your point - these are cases where economics should have nothing to do with medicine, but it does.

 

[bronx43]

A few things:

1) just because almost everyone does a fellowship says nothing about a job market, >90% of residents have been doing fellowships even in the good ol days.


6) 1000 new docs is nothing, with a projected shortage of all physicians and an aging population decreasing the number of docs is a very dumb idea

7) it's strange that people post how crappy it is who actually aren't, in the field. Bronx has shown himself to be a very knowledgeable and rationale person, but you can't apply business or economic principles to medicine, if you could , then there wouldn't have been such a huge outcry about breast screening, I wouldn't be doing a 7000 dollar procedure for palliation in a patient with 3 months to live , ortho wouldn't be going hips in demented 98 year olds and every patient in the ER wouldn't be getting a head and chest CT. I'm not saying those are correct, but medicine is to complex for it.

From what I understand, fellowships were not a practical requirement just 5 years ago. I may be wrong about this, but this is what I was told by multiple sources, many of whom were lamenting the fact that they now have to spend extra years training. There has been no legislation to spur this change, which essentially points to a tightening of the job market. When there is a glut of positions open for incoming graduates, employers do not have the luxury of demanding additional training in any of the sub-sub-specialties of radiology, especially when a general DR is able to and can be reimbursed for reading the same imaging. However, as the market tightens, and the relative number of positions shrink in comparison to the influx of graduates, then they are able to become more selective, as graduates attempt to distinguish themselves by way of fellowship training. This starts out in the large metropolitan areas of high competition, then with time, permeates to the outskirts of civilization. This is essentially how pathology started off their descent into job market hell. I'm not saying radiology is going to be pathology in a couple years, but similar principles apply. An infinite number of factors can stop this trajectory, but as of now, I see this fellowship requirement as an indication for tightness in the market.

As far as projected shortages or what have you, it's essentially meaningless in a vacuum. Purely looking at numbers 5-10 years ago, you could not predict that pathology was going to end up the way it is. You would have thought that the same reasons of increasing elderly population and shortage of all physicians would have meant that the gravy train rolled on for them. However, it didn't due to increased corportization of their field, which vastly increased productivity, and the decreased efflux of older pathologists. I don't think this scenario is directly applicable to radiology, but again, the principles are the same; changes in job market will depend on influx/efflux of providers (supply), changes in productivity and/or parameters which affect productivity, and demand. For radiology, I suspect that it's decrease in retiring radiologists which is the biggest contributor.

I'm not sure what you meant that business principles can't be applied to medicine. I mean, I can't explain with economics WHY all those medical services are performed in your examples, but I can draw economic and financial conclusions from them.

 

[davidjones]

This is sort of detracting from the thread, but I'll clarify point 7:

the $7000 procedure was a TAE in a patient with very agressive neuroendocrine tumor that would have tamponaded the heart if we didn't embolize, it prolonged his life by maybe 1-2 months, during which time he was able to spend with his family, and as I understand it, he died in his sleep and was comfortable, instead of from cardiogenic shock. The patient was discussed in tumor board by IR, surg onc and med onc, we all decided it was the best thing, even though technically it was a loss for the hospital (negative net). No way would a $7000 anything with a negative return would fly in business.

If you start applying practices that are best for a population instead of an individual in medicine, then you will have a really cost-effective system, but it will be the same for everyone, and procedures liek the one above will not be performed, or at least not as frequently. (I could be completely wrong as I have no business training)

CTs are gotten in the ER for CYA not necessarily for solid medical reasons, because if you miss that 1/1000 SAH you're SOL. Business practices could be applied to ER, where you only treat the truly emergent and send everyone else away, but where will the homeless guy with the UTI go?

 

[colbgw02]

From what I understand, fellowships were not a practical requirement just 5 years ago. I may be wrong about this, but this is what I was told by multiple sources, many of whom were lamenting the fact that they now have to spend extra years training. There has been no legislation to spur this change, which essentially points to a tightening of the job market. When there is a glut of positions open for incoming graduates, employers do not have the luxury of demanding additional training in any of the sub-sub-specialties of radiology, especially when a general DR is able to and can be reimbursed for reading the same imaging. However, as the market tightens, and the relative number of positions shrink in comparison to the influx of graduates, then they are able to become more selective, as graduates attempt to distinguish themselves by way of fellowship training. This starts out in the large metropolitan areas of high competition, then with time, permeates to the outskirts of civilization. This is essentially how pathology started off their descent into job market hell. I'm not saying radiology is going to be pathology in a couple years, but similar principles apply. An infinite number of factors can stop this trajectory, but as of now, I see this fellowship requirement as an indication for tightness in the market.

I disagree with those telling you a fellowship is now a practical requirement. Or, more correctly, I disagree that the current dip in the job market alone is responsible for it.

The truth is, as a function of consumer (i.e. ordering provider) demand, radiology was already well down the path of near-universal subspecialization long before the economic downturn. That trend has continued, meaning it has coincided with the economy's effect on radiology, so the lines between the those - and other - causes tend to get blurred. Are there some would-be general radiologists now doing fellowships who would not have otherwise? Absolutely. Are there some subspecialized radiologists doing a second fellowship? Yes, but in the context of a field where the overwhelming majority of residents were already pursuing subspecialization, I think it's appropriate to minimize the real impact of the downturn.

I italicized "real" because the operative question is not, "will I get my ideal job?". The question is, "will I get a [reasonable] job?". The answer to the former is almost certainly "no"; the answer to the latter is almost certainly "yes". Reasonable is, of course, a loaded term, which brings me back to my earlier post about expectations. Fellows (from 1 year programs) graduating this spring applied to radiology in the fall of 2005, when it was commonplace to have the job you wanted, in the city you wanted, with 1 year to partner, and they'd probably throw in some loan repayment or fellowship monthly stipend. There's no doubt that those opportunities are few and far between nowadays. And - for whatever reason - today's residents and fellows are choosing to forego the opportunities that are available by continuing there training. Evidently, they'd prefer to make $55K a year in San Francisco as a PGY-7 in hopes that they'll get a nearby job in a year rather than moving to eastern Washington and making $400K.

As far as projected shortages or what have you, it's essentially meaningless in a vacuum. Purely looking at numbers 5-10 years ago, you could not predict that pathology was going to end up the way it is. You would have thought that the same reasons of increasing elderly population and shortage of all physicians would have meant that the gravy train rolled on for them. However, it didn't due to increased corportization of their field, which vastly increased productivity, and the decreased efflux of older pathologists. I don't think this scenario is directly applicable to radiology, but again, the principles are the same; changes in job market will depend on influx/efflux of providers (supply), changes in productivity and/or parameters which affect productivity, and demand. For radiology, I suspect that it's decrease in retiring radiologists which is the biggest contributor.

If by "it", you're referring to efflux, then I think you're right. There are a lot of radiologists who would have been retired by now if the economy hadn't tanked. Teleradiology will keep some older radiologists in the workplace longer, but here I see the economy as the principle mover. As far as productivity, I think the radiology job market largely has already accounted for that change. Namely, PACS with CR/DR are now widespread. I just don't see a lot of room left to improve an individual radiologist's efficiency. But I concede that it is difficult to know what you don't know, as the saying is paraphrased.

In any case, I think we can both agree that the boom days of the first half of the last decade are long gone, never to return again. However, I think the situation isn't nearly as dire as some would purport, and I think the job market will loosen up in the coming years, albeit too slowly for most people's taste.

 

[PokerDoc]

also, most of us are six years out from having to deal with this. Things can and WILL change in that time.

 

[MossPoh]

Keep in mind that a "shortage" depends on demand and not just supply. I don't have any data to back it up, but it doesn't seem like the number of imaging studies being ordered/performed is exactly plateauing or declining.

 

[PokerDoc]

Keep in mind that a "shortage" depends on demand and not just supply. I don't have any data to back it up, but it doesn't seem like the number of imaging studies being ordered/performed is exactly plateauing or declining.

Back in November on my rotation I made some stupid comment that falsley assumed volume was down because of whatever the reason was and the radiologist showed me the hospital logs that showed that volume has never been higher.

 

[anbuitachi]

what OP says definitely makes sense to me... ive also heard the same from other people. I don't see how there can always be jobs for all graduates when almost all radiology spots are being filled, in this economy.

 

[Dr. USMLE]

Imaging Reimbursement Reduced in Proposed Federal Budget

Steven Fox

February 16, 2012 — The Obama administration debuted its proposed budget earlier this week, and part of the plan calls for cuts in Medicare reimbursement for advanced imaging tests.

The proposal has been met with a blistering attack from the American College of Radiology (ACR).

In a statement released shortly after the budget proposals were announced, the ACR called the cuts "unsupported" and said that they threaten patient access to care and may actually push up Medicare costs in the long run.

Two main provisions in the proposed budget would affect imaging.

One would increase to 95% the assumed utilization rate for advanced diagnostic equipment such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography.

The changes proposed in the budget would cut Medicare payments for advanced imaging procedures by about $820 million over the next 10 years, as reported by Medscape Medical News.

Some surveys suggest that imaging centers are using their MRIs and CTs more hours of the day than before. As the use of this type of expensive diagnostic equipment increases, the per treatment costs for purchasing, maintaining, and operating that equipment declines, making a reduction in payment appropriate. In other words, the higher the assumed utilization rate, the lower the Medicare reimbursement.

The other provision, aimed at reducing the number of unnecessary scans, would require physicians to get prior authorization before ordering expensive tests. The Medicare prior authorization program would be more or less modeled after programs that private insurers have increasingly plugged into their plans in recent years.

However, Bibb Allen Jr, MD, chairman of the ACR's Committee on Economics, told Medscape Medical News that cuts in reimbursement could block access to care and ultimately lead to higher costs.

"We think these proposals are a bad idea," said Dr. Allen, who is a diagnostic radiologist at Baptist Health System and Trinity Medical Center in Birmingham, Alabama. "We were able to show with data, back when a 75% utilization assumption was being considered, that even that was too high."

He said that surveys from imaging centers across the country, especially in rural areas, suggested that a 75% utilization assumption would lead to a curtailing of services, and therefore make it more difficult for seniors in those areas to get the scans they need. "And that could very well lead to missed diagnoses, complications in care, and expensive hospitalizations," he said.

Still, the Medicare Payment Advisory Commission (MedPAC) is pushing for higher utilization assumptions because of what it sees as the ballooning expenditures and unreasonably high pricing of imaging tests.

Uwe Reinhardt, PhD, an economist at Princeton University in New Jersey, shares that view. "By international standards, MRIs in the United States are extremely expensive," he told Medscape Medical News. "For example, Japan has many more MRI machines per capita than we have here in America. Yet an MRI there costs $200, whereas here they're $800 and up."

He added, "Imaging has been a thorn in the side of MedPAC for some time — at least a decade, I'd say. So I'm not surprised the administration would take this action." He did concede, however, that annual growth in imaging has abated somewhat since about 2004, a point that Dr. Allen emphasized several times.

Dr. Allen said that he thinks the claim that imaging is taking the lion's share of healthcare dollars "is way off base. As a percentage of total expenditures, Medicare is spending about the same amount on imaging as it spent as early as 2000," he said.

"Some of the impact of these reimbursements is not so easy to see just looking at the numbers," Dr. Allen said. "With reimbursements being reduced, a lot of imaging centers are having to postpone upgrades of their equipment, and that's very unfortunate."

He cited a national survey of 1000 voters conducted by the ACR. "We found that about 90% of Americans believe more cuts in imaging will cause medical problems to be missed. And 7 out of 10 people opposed further Medicare cuts in imaging."

Another economist, Stuart Altman, PhD, of Brandeis University in Waltham, Massachusetts, discounted the importance of the survey. "That's not science," he said. "There's no question that if you ask the average person in the street whether we should be using imaging to detect illness early, the answer's going to be yes," he said. "So I think the idea of conducting a poll of individual healthcare consumers isn't of much value."

He said that when it comes to Medicare issues, policymakers should be relying on informed opinions based on real data.

"These are complex issues, to be sure," said Dr. Altman. "There's no question that diagnostic imaging has its place. I think the general feeling is that we have created this really wonderful technology, but we're simply overusing it. We need to do these tests based on good evidence: whether the test is really needed, and whether the information we get will make a difference in how patients are managed," he said.

Dr. Reinhardt said he thinks it is unreasonable for imaging centers to push for higher reimbursements based on their machines not being use during all available hours. "They're saying they only use their machines 30% or maybe 50% of the time, and that because of that they should get a higher reimbursement so they can amortize the cost of the machines," he said.

"But what I think the administration is now saying is, 'If you have an MRI machine and you can't utilize it fully, you shouldn't have it,' " he said.

Dr. Reinhardt doubts that changes in reimbursement would lead to widespread closings of MRI centers in rural and suburban areas. "My hunch is that when the dust settles, those centers will still be there and will still be profitable."

But will higher assumed utilization rates put an unfair burden on rural MRI centers?

"It's possible," he said. But he added, "There are all sorts of rural and other geographic cost adjusters built into [Medicare] fee schedules, so you can always make these adjustments if, say, a rural MRI center has a legitimate reason for low traffic."

As to the new proposal for requiring prior authorization for procedures, Dr. Reinhardt said, "Medicare has always been accused by everyone for lowering prices but doing nothing to control volume. And here they're trying to control volume, the same way private insurers have been doing for years," he said. "It makes sense."

Dr. Altman agreed, pointing out that private insurers have been using some form of prior authorization for 40 years. "It's admittedly a cumbersome tool that often ends up being very bureaucratic," he said. Given rising healthcare costs, however, he sees few options, at least as long as the medical community is based primarily on fee-for-service arrangements.

"The most feasible alternative, I think, is to move toward bundled payments and capitation, and move away from fee-for-service," Dr. Altman said. "That way, the doctors themselves will be taking a hard look at whether a procedure is needed or not."

Dr. Altman said bundled payments or episode-based payments are a logical option. "You tell the delivery system itself, 'Okay. Here's a condition. You're going to get a fixed amount of money to manage that condition. You decide when you need to do these tests and when you don't.' "

Dr. Reinhardt agrees that it might make sense to shift Medicare away from fee-for-service to bundled payments for all the care being devoted to treatment of defined episodes of illness, or to capitation for chronic illness. "That idea's been suggested by a number of policy analysts. It's also been suggested by Medicare itself. But it would take a decade or more to get it implemented," he said.

For now, Dr. Reinhardt said he thinks the chances of getting imaging reimbursement changes through Congress are "very decent." He cited a couple of reasons.

"When the administration is defending the prior authorization provision, they can simply say, 'The private insurers have done this for years. Why can't we?' "

The second reason, Dr. Reinhardt said, is one of urgency. "We're a lot more desperate now than we were 10 years ago," he said. "Frankly, we are terribly desperate."

Dr. Altman and Dr. Reinhardt have disclosed no relevant financial relationships.

Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to [email protected].

 

[drtomkins]

Many residents and medical students mistakenly believe that demographic trends will produce a commensurate increase in employment opportunities for graduating residents and fellows. I can tell you from first hand experience that this is not the case, and that this premise is probably the least true for radiology than any other medical specialty.

This is because many of the extra studies being ordered, we do not see a penny for reading them. In fact, many of our practices are doing a great deal of charity work. This is necessary to maintain our hospital contract priviledges. So, while volume indeed has never been higher, our services are being devalued to such an extent that we are expected to read many inpatient and emergency room studies for free, or for a small subsidy at the end of the year (usually not volume based) that comes with our hospital contract. Our real revenues are generated by outpatient hospital department studies, which are growing at a much slower pace, and which are already subjected to pre authorization problems. If primary care medical homes or accountable care organizations come into play (which looks likely), the reimbursement to us for reading and performing the outpatient studies will come not directly from the government, but from the primary care physician who receives a bundled payment for taking care of all of that patient's health care needs, volume is going to plummet at that point. No one is going to send their patients for expensive radiology studies when the cost of the study will be coming out of their own pocket! This is already happening in some places.

Academic types like the guy who showed you his long worklist don't understand how a private practice group is run.

Private practice radiologists such as myself have become used to making a decent living over the past several years. For this reason, we have increased and will continue to increase our productivity to absorb the ridiculous burden of non reimbursable care or minimally reimbursed care we are providing. I hope I am making myself clear here. Do not fall into the trap of believing that simply because volumes are up, revenues are also up. This does not follow in the real world, nor does it translate into more jobs or employment opportunities for new residents. There is no way our group is going to hire a new guy to read our "increased volume" of minimally reimbursed care. Where do you think his salary is going to come from? Out of our pockets! There is a lot more to it than meets the eye. Do not be fooled by high salary surveys for radiology. Yes, the partners in private practice groups will continue to make good money, but we will be less and less inclined to take on new hires, for the reasons discussed above.

Someome mentioned one of their attendings starting at 35,000 some years ago. I don't see how that is supposed to encourage medical students. In fact, I think we are heading back to something close to that in the mid to latter part of this decade.

Someone else mentioned what a "reasonable" job is. To me, if I were a medical student or resident, I would define a "reasonable" job not by comparing it to what I could have gotten in radiology a few years ago, but to comparing it to what my friends and colleagues are getting in other specialties. From that standpoint, there will be very few "reasonable" jobs in radiology, compared to other specialties.

The central thesis I want all of you to understand is: The sky is not falling in radiology. Our salaries in private groups are not plummeting. But there is almost no hope of a return to a decent job market in the next decade for new guys, for the reasons I discussed above. Sure, a few of the 1200 residents graduating every year will find their way into nice groups to take the place of a few retiring old guys like myself, but for the vast majority, don't expect a big change in the job market in radiology for at least another 10 years.

If you want "facts", that AJR article someone posted above is irrelevant. That just tells you how many residency positions were offered, not how many people actually went into radiology. Go find out the number of people who matched to radiology in the 90s versus today. You will find that a large number of the offered positions in the 90s went unfilled. So you can't say that just because 900-1000 positions were offered in the match in the 90s, means it is ok to graduate1200 new radiologists a year in the 2000s, because in reality only about 500 of those positions in the 90s were getting filled.

 

[cowme]

,

Private practice radiologists such as myself have become used to making a decent living over the past several years. For this reason, we have increased and will continue to increase our productivity to absorb the ridiculous burden of non reimbursable care or minimally reimbursed care we are providing.
.

Stop complaining About the burden of care you are now responsible for when you are clearly part of the problem

 

[fun8stuff]

Many residents and medical students mistakenly believe that demographic trends will produce a commensurate increase in employment opportunities for graduating residents and fellows. I can tell you from first hand experience that this is not the case, and that this premise is probably the least true for radiology than any other medical specialty.

This is because many of the extra studies being ordered, we do not see a penny for reading them. In fact, many of our practices are doing a great deal of charity work. This is necessary to maintain our hospital contract priviledges. So, while volume indeed has never been higher, our services are being devalued to such an extent that we are expected to read many inpatient and emergency room studies for free, or for a small subsidy at the end of the year (usually not volume based) that comes with our hospital contract. Our real revenues are generated by outpatient hospital department studies, which are growing at a much slower pace, and which are already subjected to pre authorization problems. If primary care medical homes or accountable care organizations come into play (which looks likely), the reimbursement to us for reading and performing the outpatient studies will come not directly from the government, but from the primary care physician who receives a bundled payment for taking care of all of that patient's health care needs, volume is going to plummet at that point. No one is going to send their patients for expensive radiology studies when the cost of the study will be coming out of their own pocket! This is already happening in some places.

Academic types like the guy who showed you his long worklist don't understand how a private practice group is run.

Private practice radiologists such as myself have become used to making a decent living over the past several years. For this reason, we have increased and will continue to increase our productivity to absorb the ridiculous burden of non reimbursable care or minimally reimbursed care we are providing. I hope I am making myself clear here. Do not fall into the trap of believing that simply because volumes are up, revenues are also up. This does not follow in the real world, nor does it translate into more jobs or employment opportunities for new residents. There is no way our group is going to hire a new guy to read our "increased volume" of minimally reimbursed care. Where do you think his salary is going to come from? Out of our pockets! There is a lot more to it than meets the eye. Do not be fooled by high salary surveys for radiology. Yes, the partners in private practice groups will continue to make good money, but we will be less and less inclined to take on new hires, for the reasons discussed above.

Someome mentioned one of their attendings starting at 35,000 some years ago. I don't see how that is supposed to encourage medical students. In fact, I think we are heading back to something close to that in the mid to latter part of this decade.

Someone else mentioned what a "reasonable" job is. To me, if I were a medical student or resident, I would define a "reasonable" job not by comparing it to what I could have gotten in radiology a few years ago, but to comparing it to what my friends and colleagues are getting in other specialties. From that standpoint, there will be very few "reasonable" jobs in radiology, compared to other specialties.

The central thesis I want all of you to understand is: The sky is not falling in radiology. Our salaries in private groups are not plummeting. But there is almost no hope of a return to a decent job market in the next decade for new guys, for the reasons I discussed above. Sure, a few of the 1200 residents graduating every year will find their way into nice groups to take the place of a few retiring old guys like myself, but for the vast majority, don't expect a big change in the job market in radiology for at least another 10 years.

If you want "facts", that AJR article someone posted above is irrelevant. That just tells you how many residency positions were offered, not how many people actually went into radiology. Go find out the number of people who matched to radiology in the 90s versus today. You will find that a large number of the offered positions in the 90s went unfilled. So you can't say that just because 900-1000 positions were offered in the match in the 90s, means it is ok to graduate1200 new radiologists a year in the 2000s, because in reality only about 500 of those positions in the 90s were getting filled.

the article doesn't mean anything. volume is much higher. CT and MRI are commonplace.... unlike the 1990s and 1980s. Imaging is medicine nowadays. Todays residents "physical exam" is CT trauma blunt series. Job security is good in radiology. The majority of ER docs/PCPs... and the future of primary care- NPs/PAs, will not be reading their own films and most specialists that can read their own studies don't have the time. Volumes are WAY< WAY up since the 1990s. While I would like less residents to go into radiology (up to a point), to decrease supply, it's not as simple as saying- "hey look at these numbers, they;re producing way too many radiologists!".

 

[Substance]

There's something awfully fishy about a new poster prophecizing doom for the field of radiology just around the time people make their rank lists.

I am extremely skeptical of this poster's credentials and of his intentions.

If the OP wishes to prove his good-naturedness, he must do two things:

1. Reveal his identity
2. Disclose that he has no ulterior motives in dissuading people from going into radiology(child who is applying etc.)

 

[bronx43]

There's something awfully fishy about a new poster prophecizing doom for the field of radiology just around the time people make their rank lists.

I am extremely skeptical of this poster's credentials and of his intentions.

If the OP wishes to prove his good-naturedness, he must do two things:

1. Reveal his identity
2. Disclose that he has no ulterior motives in dissuading people from going into radiology(child who is applying etc.)

It shouldn't matter, as all you're doing by the above is attacking his character - not his statement. He can be a genuine, good-natured attending radiologist, or he can be an idiotic lay person. The only thing that matters is the veracity of his posts. If you want to disregard his message, then you'd have to refute his arguments by demonstrating error in his logic or his supporting evidence.

 

[MRads]

Why don't you reveal your identity first? This forum is such bullsh sometimes.

 

[gooze]

to the op...what are your thoughts on urology? how do you think it will fare in the future in regards to supply/demand, compensation?

 

[shark2000]

You may be right that most people do not find their desirable job, though many think the only desirable job is a 9-5 job across the street with pays 500K a year.
You may be right that some people do second fellowship to stay in the desired location.
You may be right that many people can not find a job in their home town and have to move or have to compromise their salary. You may be right about many things.

But at the end of the day, there are not so many jobless radiologists. If the job market is that bad, there should be tons of jobless graduates in RSNA, ASHNR, Local radiology meetings, around your department or anywhere radiology related. However that is not what we see, at least for now. And consider that jobless people typically go to all these places in the hope to find a job or connection.
It is obvious that this may not be the case in 6-7 years. You may see a lot of jobless people or on the other hand you may see increased job openings.

Although people confronted him badly, there is more than a touch of truth in what he says. There are a good number of people in radiology who choose this specialty seeking lifestyle or money and they will be miserable.

Even if you can find a job with high salary in your desirable location, this is no way a lifestyle specialty. Almost half of medical specialties provide better lifestyle. Forget about your rotation at med school. We are a round-the-clock service provider with coverage of almost all sections of the hospital. When I am on call, I do not have time to even go to the bathroom. Nevertheless I get a lot of calls from PAs to specialists nagging about delay in reports and asking for a "wet read" on the scan done 2 minutes ago because they want to go home or sleep. On the other hand my neurologist friend told me whenever he gets a consult, his plan is based on his mood. If he is in the mood he goes and sees the patient. If he is not in the mood, he asks for a brain MRI or head CT or spine MRI over the phone which takes almost 2-3 hours and if the results are not critical, he sleeps till morning.

As I said before most surgical sub-specialties, ophtho, ENT, , Ortho, Derm, rad onc, gas, urology, GI, neurology, IM subspecialties other than cards and Pul/critical care all provide better hours and lifestyle (better hours, no weekends, less stress, less studying) than radiology .I do not want to discourage you. This is a great field. But be aware what you are doing to your life. You will be one of the only doctors in the hospital who will not hang out in the doctor's lounge, does not have dedicated coffee break and does not have time to make a phone call even to your wife while at work.

 

[MRads]

Someone else mentioned what a "reasonable" job is. To me, if I were a medical student or resident, I would define a "reasonable" job not by comparing it to what I could have gotten in radiology a few years ago, but to comparing it to what my friends and colleagues are getting in other specialties. From that standpoint, there will be very few "reasonable" jobs in radiology, compared to other specialties.

That's not even the end of it. A "reasonable" job is what job you could have gotten had you not done medicine. I have plenty of friends who made 100k+ right out of college and now make 250-400k with no extra school, no debt, etc.

Someone above mentioned "hard work and loving my field will be enough." Really? Will liking your job be enough when CMS, hospitals, and insurance companies decide how much your skill, debt, and years of education are worth? I don't think so.

My point is this:

What I find disturbing about this whole thread is that some guy comes around to warn people about things he's noticed from his perspective and he gets attacked by a bunch of jokers who want to believe that saying that the future is rosy for their field on an online forum makes it a reality. Especially when it is CLEAR that radiology is facing some of its biggest challenges yet. The bottom line is, I think that the appropriate response to the OP's post is not personal attacks, but acknowledgement that radiology is facing some serious threats and bringing up what can actually be done about it (Donating/getting involved with RADPAC or your local state radiology PAC, etc.). That's time better spent then attacking someone on studentdoctor.

All of us going in to this field need to sack up and get involved instead of daydreaming that everything's going to be fine and dandy.

 

[yappy]

+1 MRADS!

I'm not a doctor, medstudent or premed; but, why let CMS devalue your skill and what you do? Rise up and shrug atlas. The price paid for an imagining study should be the highest possible amount of money that the market can adsorb. If someone is older and they have assets - ask for those assets. If somone is younger and has years ahead of them - tell them to get a loan. The idea that insurance and the Gov can dictate what physicians earn is crazy. The compensation should be increasing every year at least at pace with inflation.

Dont frame things in the context of "well 300-400k is a good salary". Then you'll be working harder and faster every year to maintain that. Frame this whole health care debate as "Images are important and an accurate DX is critical for positive patient out comes. It is a valuable service that should be $XXXX per case."I'm saying you should be fighting for every dime on every case.

Work on getting rid of the GSR and change medicare to a payment assist instead of a cap.

Good luck!

That's not even the end of it. A "reasonable" job is what job you could have gotten had you not done medicine. I have plenty of friends who made 100k+ right out of college and now make 250-400k with no extra school, no debt, etc.

Someone above mentioned "hard work and loving my field will be enough." Really? Will liking your job be enough when CMS, hospitals, and insurance companies decide how much your skill, debt, and years of education are worth? I don't think so.

My point is this:

What I find disturbing about this whole thread is that some guy comes around to warn people about things he's noticed from his perspective and he gets attacked by a bunch of jokers who want to believe that saying that the future is rosy for their field on an online forum makes it a reality. Especially when it is CLEAR that radiology is facing some of its biggest challenges yet. The bottom line is, I think that the appropriate response to the OP's post is not personal attacks, but acknowledgement that radiology is facing some serious threats and bringing up what can actually be done about it (Donating/getting involved with RADPAC or your local state radiology PAC, etc.). That's time better spent then attacking someone on studentdoctor.

All of us going in to this field need to sack up and get involved instead of daydreaming that everything's going to be fine and dandy.

 

[cowme]

That's not even the end of it. A "reasonable" job is what job you could have gotten had you not done medicine. I have plenty of friends who made 100k+ right out of college and now make 250-400k with no extra school, no debt, etc.

Unless your friends are all Ivy grads that work on wall street, and moved through the ranks very quickly in 4 years during the worst recession in 75 years....I find this hard to believe.

 

[Dr. USMLE]

Volumes are WAY< WAY up since the 1990s.

Ironically, increased volume is part of the problem. I am not sure if private insurers are the same way, but as far as Medicare is concerned, increased volume leads to lower rates because the national assumed utilization rate is much higher for the equipment, allowing Medicare to make much lower reimbursements. What should and will most likely happen is within the next 10 years another modality (perhaps hybrid imaging) will catch on. This will lead to new equipment needing to be purchased with new, far lower assumed utilization rates for the equipment amortization.

That is, innovation will resolve this issue. It is important to realize that typical "boom and bust" economics do not apply to innovative fields or companies. It goes back to shark's point about new products like the iPad selling at higher prices. Google was famous for saying they bucked all of the trends of the dot com bust. Apple is the most profitable company ever in history right now despite a huge decrease in discretionary spending across the nation. Since there is a huge incentive for companies like GE to innovate and they carry significant political clout, it is reasonable to assume further innovations within the next decade to keep radiology in diamonds and furs.

 

[MRads]

Unless your friends are all Ivy grads that work on wall street, and moved through the ranks very quickly in 4 years during the worst recession in 75 years....I find this hard to believe.

I found it hard to believe at first too