Radiology job demand

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Radiology looks like a pretty good residency option......but I'm curious to know about the job demands. Is it really demanding?

Now since the "Radiologist Assistant" program is released, wont that hurt the job market for radiologists?

 

[ttumed]

Or it could double or triple your income like it did for many surgeons and PAs

 

[hans19]

Radiology looks like a pretty good residency option......but I'm curious to know about the job demands. Is it really demanding?[/QUOTE ]



Now since the "Radiologist Assistant" program is released, wont that hurt the job market for radiologists?

Is radiology demanding?

You bet. When you work you work, your tail off. However most radiologists get plenty of time to 'decompress'.

Will RPA's hurt the job market for radiologists?


No.

I think you ask some great questions, but I think you may be a little misinformed. Here are a few illustrative points:

PA's are NOT physicians. They are physician EXTENDERS-- they increase the productivity (and often the compensation) of existing physicians. They usually do not work without 'supervision' from another physician. Remember even with PA's there is still an overall shortage of primary care physicians.

Similarly, when CRNA's came along, anesthesiologist incomes went UP. An anesthesiologist oversaw 3-4 CRNA's and signed off on their work. Even with all the CRNA's, there is still a shortage of anesthesiologists.

It is a similar situation with RPA's. They can NOT interpret films but they assist with basic interventional procedures such as PICC and Central line placements. Nothing impressive about these procedures -- any intern in clinical medicine will learn how to them (albeit sans ultrasound/fluoro guidance). This frees up time for the interventionalist to do more interesting and better compensating 'high end' procedures. Thus RPA's will be an invaluable asset to the interventional radiologist. No matter how many RPAs are minted there will continue to be a huge demand for IR services.

 

[f_w]

> It is a similar situation with RPA's. They can NOT interpret films
> but they assist with basic interventional procedures such as PICC
> and Central line placements.

At least this is the idea. With the exception of PA's, most other midlevels have tried or succeeded to uncouple themselves from physician supervision.

CRNAs bill medicare directly and due to their large numbers, they often have a strong position in anesthesiology departments. Friends who just started out in GAS and have to 'supervise' a couple of CRNA's tell frightening stories (personally I like having the no-nonsense CRNAs to do cases, it keeps the MAFAT down. But I don't have sign off on their actions either.)

Paramedics are 'supervised' by some hired-gun 'medical director' whose supervison doesn't extend past putting his name under the standard operating procedures manual.

Optometrists expanding their scope of practice to systemic medications and even surgery.

So, gauging from this mixed past with midlevels, I am not so sure how much of a blessing the 'limited' practice of RAs will be in the long run. (I have worked and do work with PAs and NPs in radiology and find it very helpful. I don't really understand why we needed this new category.)

 

[Docxter]

> It is a similar situation with RPA's. They can NOT interpret films
> but they assist with basic interventional procedures such as PICC
> and Central line placements.

At least this is the idea. With the exception of PA's, most other midlevels have tried or succeeded to uncouple themselves from physician supervision.

CRNAs bill medicare directly and due to their large numbers, they often have a strong position in anesthesiology departments. Friends who just started out in GAS and have to 'supervise' a couple of CRNA's tell frightening stories (personally I like having the no-nonsense CRNAs to do cases, it keeps the MAFAT down. But I don't have sign off on their actions either.)

Paramedics are 'supervised' by some hired-gun 'medical director' whose supervison doesn't extend past putting his name under the standard operating procedures manual.

Optometrists expanding their scope of practice to systemic medications and even surgery.

So, gauging from this mixed past with midlevels, I am not so sure how much of a blessing the 'limited' practice of RAs will be in the long run. (I have worked and do work with PAs and NPs in radiology and find it very helpful. I don't really understand why we needed this new category.)

The reason for this new category was, essentially political, and to tackle unsupervised radiology practice of midlevels. There is this school in Utah, namely Weber State University in Ogden, Utah, that started to mass produce RPAs (radiology practitioner assistants) in 1997. These RPAs have their own national association and were pushing for independent practice and were even successful in convincing some state legislators. The ACR saw the problem and in 2002-2003 at the ACR annual meetings, there was some lobbying by the southeast caucus (represented by one of the the Georgia councilors) to create the RA (radiology assistant) midlevel designation, in an effort to oppose the RPA movement and create the RA position, give them recognized status within the ACR with representatives to the ACR council, and retain radiologist supervision. It was a successful move, since the RPA association has since backed down.

Overall, it's been a good move since PAs and NPs, while providing excellent clinical services, don't know much about radiology and it's technical details. The RA would be a "supertech" that would fill that void, knows a lot about imaging, and help out with procedures and even perform them with supervision.

 

[droliver]

Will RPA's hurt the job market for radiologists?

I disagree. Mid-level providers & physician extenders have uniformly affected the job markets of all areas they are involved in.

MDA's felt like they'd struck gold initially with CRNA's as cheap labor. Well, as their salaries have crept up there is decreasing cost-savings being realized on a systems basis & a direct increase in practice overhead for MDA's. Additionally each MDA replaced by a CRNA is one less position available in many lucrative and desiable locations. Also witness the likely unstopable expansion of independent CRNA practice.

Once you've trained these new breed of Radiology Assistants, you've ensured your future competition for some of the procedures they become competent in. Any comfort you take in supposed restrictions on their scope of practice can be reversed instantly by legislative means (witness the expansion of practices by Oral Surgeons, Optometrists, NP's, etc....)

 

[f_w]

> Overall, it's been a good move since PAs and NPs, while providing
> excellent clinical services, don't know much about radiology and
> it's technical details. The RA would be a "supertech" that would
> fill that void, knows a lot about imaging, and help out with
> procedures and even perform them with supervision.

I am not sure whether it was truly such a great move. Your PA will know exactly as much about radiology as you are willing to teach him/her. PA's are sort of 'raw material'. They come out of school with little depth of knowledge in any medical specialty. What this profession is lacking so far is a standardized training track, sort of a residency for them to become a 'sugery PA', 'ortho PA' and yes 'radiology PA'.


I do think it was a good idea to offer the RT's a path for advancement, there are many bright individuals in this profession who can perform at a far higher level than the associates degree most of them have does justice. Giving them a perspective for a higher functioning position is probably a good idea.

And yes, so far they are part of the ACR, they are very limited in their practice and bound to the supervision of a radiologist. 10 years down the line, they will form their own professional association, outnumber us in the ACR and get themselves reading priviledges via the wedge of 'providing care for rural areas that no radiologist wants to cover'. Once this legislation goes through in Kansas, and they haven't killed an undue number of patients in the first 2 years, they can use it as a wedge to get their priviledges in the areas where the meat is. 15 years from now, your friendly orthopedic colleague will just hire a RA to run and interpret is musculoskeletal MRI facility.

 

[Sinnman]

I do think it was a good idea to offer the RT's a path for advancement

Isn't that called medical school?

I do agree. Midlevels seem great to docs for a while because they can generate more $$. It doesn't take long for these people to say to themselves "I can do everything the doctor can and he makes more money." Then they generate a critical mass and convince some politicians of their "abilities."

Just look around. You obviously have the CRNAs but don't forget the steady increase of NP-only staffed clinics and the growing number of nurse midwives opening birthing centers sans a physician.

Just wait and see...

 

[lexrageorge]

Isn't that called medical school?

I do agree. Midlevels seem great to docs for a while because they can generate more $$. It doesn't take long for these people to say to themselves "I can do everything the doctor can and he makes more money." Then they generate a critical mass and convince some politicians of their "abilities."

Just look around. You obviously have the CRNAs but don't forget the steady increase of NP-only staffed clinics and the growing number of nurse midwives opening birthing centers sans a physician.

Just wait and see...

One problem with your assumption. Last I checked, the unemployment rate for practicing physicians was essentially nil. The economy is not a zero-sum game. A position opened for an NP or CRNA is not necessarily one less position for an MD.

 

[oncall]

RPAs...
A PA will never be able to interpret a radiograph...
They may be able the pretend to be a doctor (happens all the time and when I was in Internal Med I had to fix many a disaster from a PA's work) but even the most basic film such as a CXR has too many nuances for a non-MD to interpret. Consider that perhaps 20 percent of board certified radiologists may miss a lung nodule...do you think a PA can see it?
The threat will come from other specialties...but radiology changes too fast for most other people to take away the business.

Market.
It would be foolish to think that the market will stay good forever. Already there is much less demand for radiologists. There are people who sidetrack into the system by coming into the US as a foreign radiologist, getting a work visa and working as an attending without residency. As far as I know this is one of the few fields of medicine where it is acceptable. Plus people outsource to foreign contracts where a US doctor probably signs the reports of 50 nonlicensed people reading the films.

About the zero unemployment assumption.
True, MDs have very low unemployment rates. If there were no PAs and NPs, doctors would likely make more money. Consider the reality...there is a FIXED amount of money going to pay providers...100 docs means it gets split 100 ways. Add a bunch of PAs it just means that the people without the PAs get less of the pie. It's all a gravy train anyhow. Most of the stuff doctors do is not really essential or medically necessary...but then you have to be a doctor a few years to begin to realize it.

Midlevels are a threat in general though...they pretend to know something they don't. They want to be a doctor without going to medical school. They are often the bottom of the barrel academically...sorry to say.

 

[trouta]

The RSNA just released an article on their website that indicated that the shortage of radiologists has almost completely resolved. I dont have the link off hand but Im sure you can find it by searching their web page.

 

[awdc]

The RSNA just released an article on their website that indicated that the shortage of radiologists has almost completely resolved. I dont have the link off hand but Im sure you can find it by searching their web page.

Radiologist Shortage Over?

 

[f_w]

Sunshine is the same guy who predicted a tremendous oversupply in 94. He also predicted a tremendous shortage for years to come in 03....

The data and predictions coming out of that office are for the birds.

 

[UnderDoc]

It seems to me that people place undue emphasis on the inputs (qualifications of the readers) rather than the outcomes (quality of the reads).... There is no reason why basic quality control principles can't be applied to the purchase of radiology reads -- whatever the source.

And how do you propose the quality of the reads should be assessed? Do we simply allow every Tom, Dick and Akbar with a teleradiology setup to plug in to the great global lightboard? The "product" here is the livelihood, and life itself, of American patients. Do we say, "Oh well, Muhammed, you missed that breast lesion and the patient died, guess the training at the U. of Karachi isn't what we had expected!"

Of course not! We're not about to turn active patient care into a proving-grounds for third-world radiologists. This is not in any way to denigrate the training or abilities of foreign physicians, but only to point out that the rigorous controls imposed on American training programs do not apply abroad, nor do we have the means to impose our standards on them. The same can be said for radiology para-professionals aspiring to do film reads. Quality patient care is our utmost priority, and diluting the pool of radiologists will only make it that much more difficult to guarantee this goal.

If a foreign-trained radiologist wants to practice on American patients, fine, he/she needs simply to complete the requisite training and board certification here and enter a US program. If a radiology para-professional has higher aspirations, then they may attempt the same. We can't blithely risk the lives of patients, treating them as so-called "outcomes" in a grand experiment -- that's what supervised residency training and board certification is for.

 

[UnderDoc]

...Your answer suggests that it is impossible to assess and monitor quality which is not true.

Sorry if I was unclear. I did certainly did not mean to suggest that it is impossible to assess and monitor quality, only that there is already a mechanism in place for this, otherwise known as board-certification. I don't think that the idea of interspersing "test reads" is prima facie a bad one for board certified radiologists. I am fully in favor of the current guidelines regarding board re-certification and would even insist that in a rapidly-developing field like radiology, such re-certification should perhaps occur with greater frequency than every ten years or utilize ongoing innovative strategies like the one that you are suggesting.

However, without successful completion of 4+ years of rigorous radiology training in an ABR approved program, I personally couldn't place all of my faith in even such quality control measures. Again, you are suggesting that these hypothetical radiologists are should be assessed while providing real film reads. Healthcare is just too risky an industry to allow us to loose such unknowns upon the public health. Drugs and medical devices in the US all undergo exorbitantly rigorous testing and re-testing in an effort to "primum non nocere", and still the papers are weekly plastered with class-action lawsuits against their manufacturers. In this era of shoot first, ask questions later litigiousness, anything other than the apotheosis of perfection won't hold up in court. You seem to be suggesting that we loosen the reins and just invite all comers into the global radiology love-fest as long as they can pass a test or two. Even if you could guarantee the safety of such an action, do you really think the American public would buy it when they're sitting in that jury box?

With few exceptions, when foreign-trained doctors come to the US to practice, they have to complete an American residency and take our board exams. This is the best way that I can imagine to guarantee that our societal and technological standards of state-of-the-art medicine are acquired. Just because radiology can be performed remotely doesn't mean that it should adhere to any different standard. Radiology, more than many fields, is intimately intertwined with technology. Can we be sure that everyone around the world is really getting sufficient experience with all the modalities currently employed in the US? I can guarantee you that this is a big "no". First-hand conversations with Pakistani and Indian colleagues have confirmed this for me.

I'm not saying that there is no place for foreign or para-professional radiologists. Perhaps they could complete some sort of accelerated radiology training program and take boards, or limited boards that would certify them in a certain spectrum of modalities. But just opening up the door to all comers is a really dangerous proposition.