radiology going down?

[PokerDoc]

---

Members do not see this ad.

I think the turf issue regarding PAD is overblown. Is it true that Vsurg and Cards have made huge inroads? Yes. But it was basically given away by the old school VIR docs that don't care to have clinic and have any pt care responsibilities. If you want PAD as a VIR, you can get it, as long as you take part in pt care. Obviously it is this would be hard if you aren't trained in PAD interventions, but as long as you know how to do it, the patient's are there.

Agreed. At my program, VIR does EVERYTHING.

 

[Radonkulous]

What about reclamation of coronary work? Any chance for ir to make inroads like cards and vs did to pad?

 

[T99]

Do it only if you love doing it. Dont trust these bean-counters in Washington to look out for your future.

Obama deficit plan includes $1.3B cuts to imaging
By Kate Madden Yee, AuntMinnie.com staff writer


September 21, 2011 -- President Barack Obama's plan to tame the U.S. budget deficit includes $320 billion in health savings over the next 10 years -- $1.3 billion of which would come from cuts to medical imaging, according to the proposal released September 19 by the White House.

"The plan [builds] on the Affordable Care Act to strengthen Medicare and Medicaid by reducing wasteful spending and erroneous payments, and supporting reforms that boost the quality of care," the White House said in a statement.

The cuts would come from updates to Medicare payments to "more appropriately account" for utilization of advanced imaging, as well as mandatory prior authorization. The president's proposal is part of ongoing negotiations on deficit reduction mandated by the Budget Control Act of 2011, which are to be handled by a special 12-member congressional "super committee." The committee must find an additional $1.5 trillion in federal savings to allow for another debt ceiling increase by December 23, or automatic cuts in both discretionary and mandatory programs will be triggered.

Medicare spending for advanced diagnostic imaging services paid for under the Medicare Physician Fee Schedule has grown dramatically in recent years due to an increase in the number and intensity of those services, the proposal stated. According to the Medicare Payment Advisory Commission (MedPAC), this volume growth may signify these services are mispriced.

What's the bottom line? Beginning in 2013, the president's proposal would implement a "payment adjustment" for advanced imaging equipment to account for higher levels of utilization, which will save $400 million over 10 years.
There's more: Also in 2013, the president's proposal would mandate prior authorization for the most expensive imaging services, to "ensure that these services are used as intended and protect the Medicare program and its beneficiaries from unwarranted use." Total savings would be $900 million over 10 years.

The proposal does not fix the sustainable growth rate (SGR) formula, which the U.S. Centers for Medicare and Medicaid Services (CMS) uses to set the conversion factor for the Medicare Physician Fee Schedule; the projected reduction to the fee schedule for 2012 is 29.5%, unless Congress manages to intervene.

In addition, the proposal would find $500 million in savings through penalties against those Medicare providers that fail to show meaningful use of electronic health records. The penalties would be credited to a special account beginning in 2020, and would be applied toward deficit reduction in 2021.

 

[DrBowtie]

Do it only if you love doing it. Dont trust these bean-counters in Washington to look out for your future.

Aren't you going into Rad/Onc? I wouldn't call your field safe either.

 

[T99]

Aren't you going into Rad/Onc? I wouldn't call your field safe either.

I am only MS3 - Dont HAVE to go into any field until next year.

I am not talking about anything being safe or not, god knows what future holds for everyone. I like both Rad/RadOnc from my shadowing and research experiences. All this Pay and entire speciality "going down" talks dont bother me and shouldnt bother you either if you think Imaging & Problem solving is fun.

 

[richse]

Do it only if you love doing it. Dont trust these bean-counters in Washington to look out for your future.

Maybe it's just me but cutting $1.3 billion from medical imaging over the next 10 years seems like a drop in the bucket compared to how much is spent on imaging. Anyone have concrete numbers to what what percentage this is?

 

[Quirk11]

Bronx:

Why wouldn't one become licensed in one of the last remaining OECD countries (ie Australia) to have a good financial outlook and open up shop? They would do well.

If I were a radiology resident and I saw trouble here, I would apply for work abroad...they will still do well..

MBA is an okay plan if you have those talents, but not all of us do...

As I've said numerous times, in contractionary markets and economies, everything trends downmarket in favor of reducing costs while preserving as much function and efficiency as possible. What this means for the medical industry is that that those offering expensive care with relatively low cost-effectiveness will get hit first and hardest. Therefore, I think certain super-specialized fields will feel the most pain, especially those fields offering this kind of care to Medicare beneficiaries. Elective surgeries will be reduced in favor of cheaper non-surgical alternatives, regardless of the efficacy of said alternatives.
Another point to keep in mind is that being a patient facing specialty inherently offers more security than those that don't. Here is where radiology comes into play. As I've said before, nothing is going to happen to the field itself. It's just that the market for imaging will be reduced in an effort to cut costs. And in the trend of the expansion of corporate medicine, decreased revenue will be directly displaced to the radiologist, given the glut of practitioners created by the previously larger market. When that happens, expect few jobs, and those that have jobs will have much less pay. Anesthesia faces a similar problem (on top of their self-created CRNA disaster) with the increasingly corporate structure of the health care system, as they overproduced as well, and aren't a patient-facing specialty.

So, bottom line is that patient-facing specialties providing the most care (and more acute care) for the least amount of money will be the sturdiest in the coming decades. Within the medicine realm, I'm going with general internal medicine, who are the essential workhorses of the hospital. Medical subspecialties will likely get see their market share decrease a little bit, with certain subspecialties faring a bit better than others. Within the surgical fields, I see more security for general/trauma/vascular surgeons than orthopedic surgeons or plastic surgeons, due to the issue of acuity.

But, if you LOVE radiology, then I would probably advise that you try to get into interventional radiology, which can be seen as a downmarket alternative to pricey surgery. Or, if I was a radiologist, I would go back and get my MBA and try to get into administration. This is obviously not a plan of scale, as these positions are heavily limited, but as of now, there still seems to be a need for physician administrators. (who knows how hot that job will be in 5-10 years) And if you have any monetary assets, I would invest it well. Screw the big house or the BMW - I would put it in precious metals, farmland, or stocks with good fundamentals (mining stocks or foreign manufacturing companies). I personally don't like the equities market in the long term, but there is still money to be made in the interim, which can be siphoned into safer investments.

 

[HealingSenses]

please watch this, and maybe, chill?

http://www.youtube.com/watch?v=0C_oNMH0GTk

That's fair, but I don't understand what "evidence" you need for the future. That phrase "evidence of where the future is headed" is intrinsically oxymoronic, as evidence is the data of past occurrences. Any statement regarding the future is speculative by nature, despite how robust the logical inferences are. But, I have yet to see a single rebuttal from you or anyone else here that isn't entirely irrelevant.

 

[ncmd2005]

My advice to all of you trying to decide on a specialty is talk to actual practicing physicians out in the real world who are in THAT specialty.
Do NOT rely on limited academic perspectives. Most people in academic centers have no clue what's going on in the 'real' world.

I am in private practice (Radiology) in a large metropolitan area.
I can tell you that I heard all the same doomsday scenarios 7 years ago when I was applying.
I got news for you - it's mostly all just hype.
Radiology is still one of the most fascinating, rewarding specialties.
And yes.. we are way better off than most of the other specialties.
Most of the people in my group make 700k+
I am making 350k first year out of fellowship.
I have 10 weeks of vacation. Get a half day off each week.
My days are 7:30 - 5 unless I'm working a weekend or evening shift which is once/twice per month. Yes it is busy but you are compensated well and have more time off than any other MD. Radiologists are probably busier than most other physicians while they are at work because our work is nonstop from the time you walk in till you leave. Contrary to popular belief, we are not hanging out in the doctors lounge (I don't even know where our lounge is). We are busting our asses each second at work either reading the boatload of ER/inpatient cases or doing procedural work. Either way you are constantly busy. There is no downtime, which is fine because when its 5pm, you walk out and no one bothers you afterward. Unlike other clinical fields, we don't have 'lull's during the day - where you're just sitting around waiting for admissions or consults.

Trust me - I explored every specialty out there when I was in your shoes. There are pros/cons to each field. Do what you enjoy the most. You cannot predict the economic changes in medicine. It will affect all specialties more or less, so do not try to outsmart the system and pick the 'perfect' specialty. It does not exist.

Good luck!

 

[link2swim06]

My advice to all of you trying to decide on a specialty is talk to actual practicing physicians out in the real world who are in THAT specialty.
Do NOT rely on limited academic perspectives. Most people in academic centers have no clue what's going on in the 'real' world.

I am in private practice (Radiology) in a large metropolitan area.
I can tell you that I heard all the same doomsday scenarios 7 years ago when I was applying.
I got news for you - it's mostly all just hype.
Radiology is still one of the most fascinating, rewarding specialties.
And yes.. we are way better off than most of the other specialties.
Most of the people in my group make 700k+
I am making 350k first year out of fellowship.
I have 10 weeks of vacation. Get a half day off each week.
My days are 7:30 - 5 unless I'm working a weekend or evening shift which is once/twice per month. Yes it is busy but you are compensated well and have more time off than any other MD. Radiologists are probably busier than most other physicians while they are at work because our work is nonstop from the time you walk in till you leave. Contrary to popular belief, we are not hanging out in the doctors lounge (I don't even know where our lounge is). We are busting our asses each second at work either reading the boatload of ER/inpatient cases or doing procedural work. Either way you are constantly busy. There is no downtime, which is fine because when its 5pm, you walk out and no one bothers you afterward. Unlike other clinical fields, we don't have 'lull's during the day - where you're just sitting around waiting for admissions or consults.

Trust me - I explored every specialty out there when I was in your shoes. There are pros/cons to each field. Do what you enjoy the most. You cannot predict the economic changes in medicine. It will affect all specialties more or less, so do not try to outsmart the system and pick the 'perfect' specialty. It does not exist.

Good luck!

How many years ago did you get this job?

 

[Jack is Back]

My advice to all of you trying to decide on a specialty is talk to actual practicing physicians out in the real world who are in THAT specialty.
Do NOT rely on limited academic perspectives. Most people in academic centers have no clue what's going on in the 'real' world.

I am in private practice (Radiology) in a large metropolitan area.
I can tell you that I heard all the same doomsday scenarios 7 years ago when I was applying.
I got news for you - it's mostly all just hype.
Radiology is still one of the most fascinating, rewarding specialties.
And yes.. we are way better off than most of the other specialties.
Most of the people in my group make 700k+
I am making 350k first year out of fellowship.
I have 10 weeks of vacation. Get a half day off each week.
My days are 7:30 - 5 unless I'm working a weekend or evening shift which is once/twice per month. Yes it is busy but you are compensated well and have more time off than any other MD. Radiologists are probably busier than most other physicians while they are at work because our work is nonstop from the time you walk in till you leave. Contrary to popular belief, we are not hanging out in the doctors lounge (I don't even know where our lounge is). We are busting our asses each second at work either reading the boatload of ER/inpatient cases or doing procedural work. Either way you are constantly busy. There is no downtime, which is fine because when its 5pm, you walk out and no one bothers you afterward. Unlike other clinical fields, we don't have 'lull's during the day - where you're just sitting around waiting for admissions or consults.

Trust me - I explored every specialty out there when I was in your shoes. There are pros/cons to each field. Do what you enjoy the most. You cannot predict the economic changes in medicine. It will affect all specialties more or less, so do not try to outsmart the system and pick the 'perfect' specialty. It does not exist.

Good luck!

Yeah. I think all the talk about not being able to find a job won't be applicable for most. I mean, how many quality radiologists who worked hard, have pleasant personalities, and have networked will not be working? Very few.

And if you're willing to be paid less, you can always find a job.

 

[Laskpau]

If you can't find a job in the US, move to Canada:

"At present, the debate centers on what to do about the persistent shortage of radiologists; CAR estimates Canada is about 600 radiologists shy of the full capacity of 2500. That's a shortfall of more than 25%, and one that has an identifiable impact on the health care system. For example, in Ontario the average wait time for results from a CT scan is 70 days and the wait for MRI results is more than 90 days. At Montréal's Victoria Hospital wait times for certain x-ray examinations are reaching 3 months or more, while in PEI the shortage has forced them to abandon their mammography screening program." (http://www.cmaj.ca/content/176/1/21.full)

Also, Canadian radiologists make a very good living (same or above that of the US). Check out the data for the province of Quebec where salaries are the lowest in the country (in French, but I'm sure you can figure it out): http://veloptimum.net/photos/autres/6/salaireMoyenDrQc730H1270.jpg

 

[badasshairday]

If you can't find a job in the US, move to Canada:

"At present, the debate centers on what to do about the persistent shortage of radiologists; CAR estimates Canada is about 600 radiologists shy of the full capacity of 2500. That's a shortfall of more than 25%, and one that has an identifiable impact on the health care system. For example, in Ontario the average wait time for results from a CT scan is 70 days and the wait for MRI results is more than 90 days. At Montréal's Victoria Hospital wait times for certain x-ray examinations are reaching 3 months or more, while in PEI the shortage has forced them to abandon their mammography screening program." (http://www.cmaj.ca/content/176/1/21.full)

Also, Canadian radiologists make a very good living (same or above that of the US). Check out the data for the province of Quebec where salaries are the lowest in the country (in French, but I'm sure you can figure it out): http://veloptimum.net/photos/autres/6/salaireMoyenDrQc730H1270.jpg

What hoops need to be jumped through to practice radiology in Canada? I'm just curious, I probably won't end up moving up to our northern neighbour. I mean, Canadians take the USMLE's, etc. Do you need Canadian citizenship?

 

[Laskpau]

What hoops need to be jumped through to practice radiology in Canada? I'm just curious, I probably won't end up moving up to our northern neighbour. I mean, Canadians take the USMLE's, etc. Do you need Canadian citizenship?

If you graduated from a medschool in Canada or the US, you are not considered an IMG. If you want to practice in Ontario, I believe you would not need to take the MCC exams if you passed all steps of the USMLE. However, you would need to pass the Canadian boards (Comprehensive Objective Examination in Diagnostic Radiology), which I heard is more difficult that passing the ABR exams. I don't know much about the citizenship requirements but from what I gathered you would only need to be a permanent resident. This is much easier to get in Canada than in the US. If you have no criminal record, it's a matter of filling in some forms and waiting about a month.

 

[2012mdc]

What hoops need to be jumped through to practice radiology in Canada? I'm just curious, I probably won't end up moving up to our northern neighbour. I mean, Canadians take the USMLE's, etc. Do you need Canadian citizenship?

I've heard great things about Vancouver. I would consider it for Whistler alone 😀