Switching From EM Into radiology?

[Splenda88]

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It's 2021. FM makes close to $300k working 4-4.5 days per week. It's been on the uptrend for the past decade.

I am amazed how easy it is for FM to get these M-Thur 250k+ job offers in big cities or nice suburbia.

Can't even find anything close to that in the hospitalist job market... In fact, it is hard to even find a hospitalist job in cities or suburbs at all. I am wondering if it's covid related.

I wonder how long it will take for the lifestyle crowd in medicine to realize that FM is truly a lifestyle specialty?

 

[skougess]

I am amazed how easy it is for FM to get these M-Thur 250k+ job offers in big cities or nice suburbia.

Can't even find anything close to that in the hospitalist job market... In fact, it is hard to even find a hospitalist job in cities or suburbs at all. I am wondering if it's covid related.

I wonder how long it will take for the lifestyle crowd in medicine to realize that FM is truly a lifestyle specialty?

It's a specialty in a true shortage (not an AAMC dictated shortage). My buddies in FM residencies have positions locked down in their PGY-2 years from urban/suburban places begging them to work for them.

 

[Rekt]

I am amazed how easy it is for FM to get these M-Thur 250k+ job offers in big cities or nice suburbia.

Can't even find anything close to that in the hospitalist job market... In fact, it is hard to even find a hospitalist job in cities or suburbs at all. I am wondering if it's covid related.

I wonder how long it will take for the lifestyle crowd in medicine to realize that FM is truly a lifestyle specialty?

I never thought it would happen at our hospital due to our volume and acuity, but we've had a few hospitalists leave and then our hospital let a bunch go after. Now they're hiring a bunch of NPs expecting left over hospitalists to supervise and didn't even talk to them about it. People are going to die on the floors.

 

[Splenda88]

I never thought it would happen at our hospital due to our volume and acuity, but we've had a few hospitalists leave and then our hospital let a bunch go after. Now they're hiring a bunch of NPs expecting left over hospitalists to supervise and didn't even talk to them about it. People are going to die on the floors.

Yeah.. I got a couple of job offers to be on call 24/7 to respond to NP calls... they offer to give $300/day on the 7 days off that I am on call. Hell no!

 

[skougess]

Yeah.. I got a couple of job offers to be on call 24/7 to respond to NP calls... they offer to give $300/day on the 7 days off that I am on call. Hell no!

That is an amazingly creative way for you to be a liability sponge. I can just imagine the pitch now:

“Our NPs are great and average only 1 call per day* to the supervising MD!

*NPs average 8 mistakes per day which they don’t call you about but your name will still be documented as supervising MD.”

 

[VA Hopeful Dr]

Enlighten me, how are you doing this? Direct primary care? Nice private practice, sole proprietorship, large corporate setting, rural, urban? So many questions…

People underestimate FM. The major part is that our starting salaries aren't all that impressive. If you joined with my hospital-employed group tomorrow as an FP its 200k/year. But, we're paid on productivity so very few of us aren't significantly above that amount within 12-18 months of work. Lots of jobs (non-PP hospital based specialties especially) are paid based on hours worked. Its a fairly static rate. FM starts low but has decent potential given time.

 

[Apollyon]

Agreed, same with me and I’m PM&R

So, now, it really is "Plenty of Money & Relaxation"!!

 

[VA Hopeful Dr]

It's great that there are at least some senior docs who are not out of touch.

I'm only 37...

 

[Splenda88]

I'm only 37...

Damn you old! 🙂 You've been an attending for 7+ yrs. You are a senior doc in my book.

 

[Frazier]

I'm FM and earning significantly more than 250k/year. My job is also way less stressful than even some of the best EM jobs out there.

So no, telling someone they should be grateful for 250k/year despite all the hardships that go with practicing emergency medicine really isn't the way to go.

Agreed! Make more than that in palliative too. Although it is a 5-day week (not FM's fabled 4 days).

The stress of my job pound-for-pound is in no way comparable to my experience in EM as resident or attending. I guess it could be stressful for some docs if the bread and butter of palliative medicine makes them uncomfortable, but that's another story.

Two of my old co-residents had shifts limited at already low rates (hired during pandemic). Effectively working 10x 10hr shifts at $180/hr. If they do that for the next 12 months they are pulling 216k. There are no locums available in that neck of the woods. 216k is their income. With 300k+ in student loan debt. Hardly the carrot they had in mind as medical students.

It is a shame and hopefully something changes for the better.

 

[Birdstrike]

I'm only 37...

Be careful, @Splenda88, you might actually be older than @VA Hopeful Dr, who I don't think is an EM doc. Here's how to calculate our real age:

Years lived + (EM-years worked x 1.25) = True EM physician age

 

[BoardingDoc]

I'm only 37...

Well I couldn't just call you "man."

 

[IRattending2021]

This forum is really just an echo chamber. Very little concept of what is going on in the outside world.

The dumpster fire that we perceive to be EM, is really just a part of a much larger dumpster fire in medicine right now. It's completely faulty thinking that because EM has it bad that other specialties have it better. It's simply not true. We can talk about pediatrics, internal medicine, surgery (I have close friends in these circles that are all possibly unemployed next year), but since this topic is about radiology we can talk about that.

There is most definitely a push to increase teleradiology services due to cost savings. I agree that the threat of AI is really not a real and palpable one at this juncture. But when ED volumes are down, what do you think radiologists are doing when we aren't ordering pan scans? Ask the radiology residents at your home institution what happened to the number of reads that they were performing? Are Medicare cuts just going to hurt us in EM, but imaging studies are going to be reimbursed just as much if not more? Wrong. Also, the corporatization that is plaguing EM is projected to wreck radiology as well. Midlevels are already encroaching into IR, although I do agree nowhere close to the degree as EM. The list goes on and on...

Do you really think the market forces that have crippled EM have not affected other specialities? You think the people in the C-suite are sparing radiology at the expense of anyone else? Wrong. Everyone is fair game.

Radiology is a great specialty for a variety of reasons. I briefly flirted with doing IR at some point in medical school. That being said, the clinical medicine was and still is a draw to me to EM. If you are having doubts about EM, it's reasonable to contemplate radiology. But you could also just be getting cold feet now that the match is drawing near. That happened to me, as well as a lot of people.

Take your time over the next several months to mull it over. If you end up doing EM for a year and switching, it's not the end of the world. But just like you may end up regretting NOT doing radiology, you may be sitting in a reading room some day wishing you were the one who was clinically correlating.😉

mid level encroachment into IR is NOT a thing. One of my good friend did residency in a place where midlevel was doing procedures on their own in IR but that’s because they were short on docs and IR docs welcomed the mid levels.

when they were trying to ram new midlevels to do things like dialysis catheter and drain there were multiple bad, bad complications like accidental drain placement into the spleen, bowel and bladder. The midlevels are not capable of doing IR without supervisions.

currently I refuse to train midlevels even in paracentesis. They are helpful in floor work and consenting.

 

[southerndoc]

mid level encroachment into IR is NOT a thing. One of my good friend did residency in a place where midlevel was doing procedures on their own in IR but that’s because they were short on docs and IR docs welcomed the mid levels.

when they were trying to ram new midlevels to do things like dialysis catheter and drain there were multiple bad, bad complications like accidental drain placement into the spleen, bowel and bladder. The midlevels are not capable of doing IR without supervisions.

currently I refuse to train midlevels even in paracentesis. They are helpful in floor work and consenting.

That's not been my experience at several hospitals in different health systems. PA's/NP's do LP's, paracentesis, thoracentesis, CVL's, PICC's, Vascaths, and PD catheters. This is with IR as well as vascular surgery.

PA/NP's doing procedures is not unique to emergency medicine. It's in all specialties.

 

[IRattending2021]

That's not been my experience at several hospitals in different health systems. PA's/NP's do LP's, paracentesis, thoracentesis, CVL's, PICC's, Vascaths, and PD catheters. This is with IR as well as vascular surgery.

PA/NP's doing procedures is not unique to emergency medicine. It's in all specialties.

except LP, CVL, Piccs, para and thoras are not high RVU procedures. I remember one IR job specifically advertises “WE DONT DO PICCS” as a plus.

it’s like saying ed nursing is encroaching on EM because they are placing foleys when ED docs dont particularly want to place foley in the first place.

seriously, I don’t know any IR attendings who are dying to do paras and thoras in addition to the other stuff. Most are in different and some actively prefer to punt it to midlevels.

 

[southerndoc]

except LP, CVL, Piccs, para and thoras are not high RVU procedures. I remember one IR job specifically advertises “WE DONT DO PICCS” as a plus.

it’s like saying ed nursing is encroaching on EM because they are placing foleys when ED docs dont particularly want to place foley in the first place.

seriously, I don’t know any IR attendings who are dying to do paras and thoras in addition to the other stuff. Most are in different and some actively prefer to punt it to midlevels.

You say that midlevel encroachment doesn't exist in IR, and then when I give you specific examples, you state they aren't high RVU procedures and docs aren't wanting to do them (despite it being an encroachment on your specialty's procedures)... and then you completely ignore the part where I said they are frequently placing Vascaths, PD's, etc. What gives?

 

[cyanide12345678]

Enlighten me, how are you doing this? Direct primary care? Nice private practice, sole proprietorship, large corporate setting, rural, urban? So many questions…

It's easy making 250+ with family medicine.

The guaranteed income my wife is getting is 230, but with RVUs, if she generated 4800 rvus which is average for family medicine, she will hit 250k. We've seen exact numbers for her group. If she sees 24-25 patients a day for 4 clinical days and 12 patients on one half day, then she breaks 300k on rvus.

FM may truly be a better lifestyle specially than us.

 

[VA Hopeful Dr]

It's easy making 250+ with family medicine.

The guaranteed income my wife is getting is 230, but with RVUs, if she generated 4800 rvus which is average for family medicine, she will hit 250k. We've seen exact numbers for her group. If she sees 24-25 patients a day for 4 clinical days and 12 patients on one half day, then she breaks 300k on rvus.

FM may truly be a better lifestyle specially than us.

Depends how you look at it. Y'all get way more days off than we do. But, there's something to be said for regular hours.

 

[dadaddadaBATMAN]

Depends how you look at it. Y'all get way more days off than we do. But, there's something to be said for regular hours.

While technically true I would point out that the numbers are a little skewed. I typically work 17d a month.

At least two of my days off each month are post nights, which isn’t really a day off at all.

Overall at least 19 d of work, and honestly I am typically worthless for at least a day after any stretch of more than 3 d on.

I work two weekends each month.
I get no holidays.
Sick time is really not a thing.
Based on my compensation model, I don’t really have true vacation, just unpaid leave.

So you would presumably work 22d a month with 8 off for weekends on a typical month. I get 19 between days on and post nights alone.

If you get 4 weeks of vacation you’re pretty much already the same. And you sleep in your bed at night, see your family on weekends, and don’t deal with em bs.

I like em, and am better off here. But for someone looking for lifestyle the choice is probably pretty clear.

 

[namethatsmell]

While technically true I would point out that the numbers are a little skewed. I typically work 17d a month.

At least two of my days off each month are post nights, which isn’t really a day off at all.

Overall at least 19 d of work, and honestly I am typically worthless for at least a day after any stretch of more than 3 d on.

I work two weekends each month.
I get no holidays.
Sick time is really not a thing.
Based on my compensation model, I don’t really have true vacation, just unpaid leave.

So you would presumably work 22d a month with 8 off for weekends on a typical month. I get 19 between days on and post nights alone.

If you get 4 weeks of vacation you’re pretty much already the same. And you sleep in your bed at night, see your family on weekends, and don’t deal with em bs.

I like em, and am better off here. But for someone looking for lifestyle the choice is probably pretty clear.

Excellent points.

When EM rates were better and you'd make comfortable $ working 10-12 shifts/mo, the scheduling didn't matter quite as much since there were so many other days to make up for the DOMAs.

As rates decrease and people feel the need to work more I know a lot of folks doing +15 shifts/mo...which likely means five 1/2 DOMAs and another five full DOMAs each month. And this doesn't include any other unpaid meetings and "trainings" etc on non shift days to deal with...which many other fields have nicely *built in* to their schedule.

Do medical students still view EM as a "lifestyle" field?

 

[Dr Mantis Toboggan]

It's easy making 250+ with family medicine.

The guaranteed income my wife is getting is 230, but with RVUs, if she generated 4800 rvus which is average for family medicine, she will hit 250k. We've seen exact numbers for her group. If she sees 24-25 patients a day for 4 clinical days and 12 patients on one half day, then she breaks 300k on rvus.

FM may truly be a better lifestyle specially than us.

Are there any outpatient only FM residencies? Or do they all have some aspect of inpatient/call?

 

[namethatsmell]

And speaking of hours and scheduling...

I once came across a group that paid different rates for nights >>>> swings >> days and weekends >> weekdays and the major holidays all received a fixed shift bonus.

Was the smartest thing I've ever seen as it truly paid people appropriately for their time sacrifice and prevented common shenanigans like where certain docs seem to work only cush shifts while others perpetually get shafted. And proved to be a good surrogate of a place that treated their docs well.

Should any new grad come across a place that does this, stop what you're doing and beg/borrow/steal to get your foot in the door there.

 

[VA Hopeful Dr]

While technically true I would point out that the numbers are a little skewed. I typically work 17d a month.

At least two of my days off each month are post nights, which isn’t really a day off at all.

Overall at least 19 d of work, and honestly I am typically worthless for at least a day after any stretch of more than 3 d on.

I work two weekends each month.
I get no holidays.
Sick time is really not a thing.
Based on my compensation model, I don’t really have true vacation, just unpaid leave.

So you would presumably work 22d a month with 8 off for weekends on a typical month. I get 19 between days on and post nights alone.

If you get 4 weeks of vacation you’re pretty much already the same. And you sleep in your bed at night, see your family on weekends, and don’t deal with em bs.

I like em, and am better off here. But for someone looking for lifestyle the choice is probably pretty clear.

Is that a normal amount of shifts? Seems like I remember most people here talking about 13-15/month.

If you're working 17 then no question I've got it way better than you do, at least time wise. You likely still out earn me by a decent bit (and you absolutely should for the work y'all do).

 

[IRattending2021]

You say that midlevel encroachment doesn't exist in IR, and then when I give you specific examples, you state they aren't high RVU procedures and docs aren't wanting to do them (despite it being an encroachment on your specialty's procedures)... and then you completely ignore the part where I said they are frequently placing Vascaths, PD's, etc. What gives?

To me, encroachment is when others take the work IRs want to do and also typically belong to IR. It’s the physician attitude that is different.

How many EP wish they don’t have to sign mid level’s chart? How many anesthesiologist wish they don’t have to “supervise” CRNAs?

i can guarantee you almost every IR welcome nurses to do PICCs. It’s a nursing intervention....

 

[sylvanthus]

Thats always how it begins...

 

[VA Hopeful Dr]

Are there any outpatient only FM residencies? Or do they all have some aspect of inpatient/call?

I don't think there are any as inpatient OB/adult is a requirement. You can seek out programs that hit the absolute minimums in terms of inpatient/call. I would recommend against that 100% of new med school grads.

For someone wanting to go from EM/IM to FM, those inpatient months are almost certainly less important. Plus if you can credit for intern year you'll miss out on lots of them anyway.

 

[namethatsmell]

Thats always how it begins...

I wonder if we EM folks sounded like this IR guy/girl when anesthesia began sounding the alarm when their field was set ablaze with mid-level creep...

EM 20 years ago:
"No no no, midlevels will never be allowed into the ED because the stakes are too high with sick/undifferentiated patients....it's different in anesthesia because there's is such a controlled environment."

EM 10 years ago:
"OK OK OK, midlevels can see level 4-5s because they're easy and I hate seeing the sniffles...it's not 'real' doctor work anyway. And admin says this way they can increase my pay by an extra 0.25% if I just sign off on the midlevel charts. What a sweet deal, nothing can go wrong!"

EM 5 years ago:
"Hmmmm...admin now says that midlevels can see level 2-3s with 'appropriate oversight.' Is admin legally responsible for them since only they have credentialing/disciplinary/hiring/firing power over the midlevels...or am I stuck holding the bag? I may have to talk with them about thoh man look the regional medical director is in town and hosting a happy hour for us tonight at TGI Fridays!"

EM now:
"Sure, we'll hire you. Oh wait, you're not an NP or PA? While we're not looking for docs currently, let's definitely keep your CV on file as we're strongly considering expanding our footprint to upstate Siberia in the near future...and we think your unique attributes would be a great fit."

IR doc, I hate to be the bearer of bad news...but your field ain't special in regards to the risk of midlevel creep. It's clearly already happening, and the sooner you/your IR colleagues acknowledge this the better you guys may be able to defend against it.

 

[IRattending2021]

Thats always how it begins...

except as a field, I think we are quite effective in stopping this trend. Compared to EM or anesthesia, we have some advantages.

a lot of the mid level incursion started due to greed. Anesthesia groups wanted to make more or SDG wanted to make more etc. in general, there aren’t enough lucrative cases for most IRs to pack their schedule so most IRs are loss leader for the hospital doing procedures that’s gotta get done but arent reimbursed enough to be done by surgeons or GI. There really isn’t usually a monetary incentive for mid levels. I think some practices use them to do simple stuff so the IR/DR will keep reading imaging during that time, but there is an overall trend for IR to do more IRs.

basically, in anesthesia and EM hospital make more money with more mid levels. In many practice settings the hospital actually lose money if they hire IR midlevels since the procedures dont justify the reimbursement.

we have our unique challenges being the dumping ground of hospitals and always have our lucrative procedures taken away from us and that’s a very unique and disheartening issue, but this unique characteristic make us relatively (not completely) safe from total mid level encroachment that EM and gas have seen.

Just imagine the IR work list is like a pile of 15 procedures every day that pays like 0.5 rvu each and take an hour to do each time. They lose money for the hospital but it’s gotta get done. What makes it harder is that some of those trash cases actually take a lot of skills to do and beyond the ability of most if any mid levels.

what would a hospital or group do? Hire one ir person that do all those as a loss leader, or hire one ir person that do the easier stuff but lose even more money?

 

[IRattending2021]

I wonder if we EM folks sounded like this IR guy/girl when anesthesia began sounding the alarm when their field was set ablaze with mid-level creep...

EM 20 years ago:
"No no no, midlevels will never be allowed into the ED because the stakes are too high with sick/undifferentiated patients....it's different in anesthesia because there's is such a controlled environment."

EM 10 years ago:
"OK OK OK, midlevels can see level 4-5s because they're easy and I hate seeing the sniffles...it's not 'real' doctor work anyway. And admin says this way they can increase my pay by an extra 0.25% if I just sign off on the midlevel charts. What a sweet deal, nothing can go wrong!"

EM 5 years ago:
"Hmmmm...admin now says that midlevels can see level 2-3s with 'appropriate oversight.' Is admin legally responsible for them since only they have credentialing/disciplinary/hiring/firing power over the midlevels...or am I stuck holding the bag? I may have to talk with them about thoh man look the regional medical director is in town hosting and happy hour for us tonight at TGI Fridays!"

EM now:
"Sure, we'll hire you. Oh wait, you're not an NP or PA? While we're not looking for docs currently, let's definitely keep your CV on file as we're strongly considering expanding our footprint to upstate Siberia in the near future...and we think your unique attributes would be a great fit."

IR doc, I hate to be the bearer of bad news...but your field ain't special in regards to the risk of midlevel creep. It's clearly already happening, and the sooner you/your IR colleagues acknowledge this the better you guys may be able to defend against it.

except how much do SDG or hospital get paid for seeing sniffles? And then look up how much do people get paid doing a picc line or paracentesis.

the biggest differentiator is economics. It’s usually not worth it for there to be a mid level in IR.

in diagnostic rad, it’s even less attractive because to truly “supervise” you have to look at the imaging yourself. At this point might as well just dictate a full report.

 

[Mushdoc]

except as a field, I think we are quite effective in stopping this trend. Compared to EM or anesthesia, we have some advantages.

a lot of the mid level incursion started due to greed. Anesthesia groups wanted to make more or SDG wanted to make more etc. in general, there aren’t enough lucrative cases for most IRs to pack their schedule so most IRs are loss leader for the hospital doing procedures that’s gotta get done but arent reimbursed enough to be done by surgeons or GI. There really isn’t usually a monetary incentive for mid levels. I think some practices use them to do simple stuff so the IR/DR will keep reading imaging during that time, but there is an overall trend for IR to do more IRs.

basically, in anesthesia and EM hospital make more money with more mid levels. In many practice settings the hospital actually lose money if they hire IR midlevels since the procedures dont justify the reimbursement.

we have our unique challenges being the dumping ground of hospitals and always have our lucrative procedures taken away from us and that’s a very unique and disheartening issue, but this unique characteristic make us relatively (not completely) safe from total mid level encroachment that EM and gas have seen.

Just imagine the IR work list is like a pile of 15 procedures every day that pays like 0.5 rvu each and take an hour to do each time. They lose money for the hospital but it’s gotta get done. What makes it harder is that some of those trash cases actually take a lot of skills to do and beyond the ability of most if any mid levels.

what would a hospital or group do? Hire one ir person that do all those as a loss leader, or hire one ir person that do the easier stuff but lose even more money?

One IR attending overseeing multiple NPs will lose less money than multiple IR attendings

 

[namethatsmell]

except how much do SDG or hospital get paid for seeing sniffles? And then look up how much do people get paid doing a picc line or paracentesis.

the biggest differentiator is economics. It’s usually not worth it for there to be a mid level in IR.

in diagnostic rad, it’s even less attractive because to truly “supervise” you have to look at the imaging yourself. At this point might as well just dictate a full report.

You're talking about where things are now.

You may consider thinking about where things may be heading.

Imagine the MBA bean counter talking to a hospital CEO about the new IR physician position they're about to list..."look, nurses are already putting in PICCs and doing paras...why not just hire another IR midlevel and have the current IR docs teach them other procedures too since it's already been shown NPs can do IR? And we can take the cost savings and each get a new boat!"

 

[IRattending2021]

You're talking about where things are now.

You may consider thinking about where things may be heading.

Imagine the MBA bean counter talking to a hospital CEO about the new IR physician position they're about to list..."look, nurses are already putting in PICCs and doing paras...why not just hire another IR midlevel and have the current IR docs teach them other procedures too since it's already been shown NPs can do IR? And we can take the cost savings and each get a new boat!"

except PICC lines and para/thoras are not exactly...IR. It’s something we do but only because again it’s low reimbursement and no one else wants them.

b,but why don’t CEOs hire one IR and supervise a bunch of nurses?

Well, first of all, even in the most brain dead IR job where other specialty took literally everything else you must be able to do mesenteric angiogram and interventions / coiling for GI bleed. There are no mid levels capable of doing it period, just like mid levels cant actually solo a surgery. Having mid level encroach on high end ir procedural work is about as likely as urologist teaching nurses to do renal resection.

so either you hire ir to cover the whole gamut, or you hire ir to cover some and nurses to cover the rest (money losing as now you need two bodies instead of one to do procedures that pays 50 buck total), or you hire nurses only and transfer out whenever your pt need an angiography. Angiography and high end ir procedures, although money losing on the professional fee side, actually make insane technical fee for hospitals. Tell your ceo now that he/she will transfer the golden goose somewhere else because the nurse cant do angiography, see how far that flies.

b, but why don’t you hire one IR who can do all that and then have a bunch of nurses? Well, most Ir groups are from 3-10 docs, with a q3-10 call. When you hire someone who cant do the whole gamut, that person can’t take call. Unlike ER or rad onc or anesthesia, Ir did not expand like crazy (we did expand and I wasnt happy about it). This means that if you start introducing mid levels into the mix, you are going to run into issues with calls. And because there is a shortage, docs wont take crap jobs.

more over, most department is run by 1 or 2 IRs per day because our equipments are expensive and unlike an ed who can cheaply add new pt rooms or anesthesia where people are always building new ORs (new or make money), good luck justifying an additional 2 mil room to your ceo to do LP and paras. This mean we literally don’t have the room and space for actual mid levels. Sure, ceo why dont you hire someone to sit on their ass as do 3 paracentesis a day

 

[Birdstrike]

Well, first of all, even in the most brain dead IR job where other specialty took literally everything else you must be able to do mesenteric angiogram and interventions / coiling for GI bleed. There are no mid levels capable of doing it period, just like mid levels cant actually solo a surgery. Having mid level encroach on high end ir procedural work is about as likely as urologist teaching nurses to do renal resection.

Correct, that's why I'm on here constantly telling these guys to consider adding to their skill stack by doing fellowships or developing other talents, to make themselves less replaceable.

There was a day that being a GP was more than enough. Then, you had to do a residency in a specialty. Now, you've got to do a fellowship, or make yourself uniquely useful in some other way. 30 years from now, we'll probably have to do all that and learn how to code our AI-robot replacements (only half-joking). But for now, if you've got the "I-word" somewhere in your title, you're probably okay for a while.

Edit: ...and save money/pay off debt so you don't have to worry about any of it, anymore.

 

[namethatsmell]

except PICC lines and para/thoras are not exactly...IR. It’s something we do but only because again it’s low reimbursement and no one else wants them.

b,but why don’t CEOs hire one IR and supervise a bunch of nurses?

Well, first of all, even in the most brain dead IR job where other specialty took literally everything else you must be able to do mesenteric angiogram and interventions / coiling for GI bleed. There are no mid levels capable of doing it period, just like mid levels cant actually solo a surgery. Having mid level encroach on high end ir procedural work is about as likely as urologist teaching nurses to do renal resection.

so either you hire ir to cover the whole gamut, or you hire ir to cover some and nurses to cover the rest (money losing as now you need two bodies instead of one to do procedures that pays 50 buck total), or you hire nurses only and transfer out whenever your pt need an angiography. Angiography and high end ir procedures, although money losing on the professional fee side, actually make insane technical fee for hospitals. Tell your ceo now that he/she will transfer the golden goose somewhere else because the nurse cant do angiography, see how far that flies.

b, but why don’t you hire one IR who can do all that and then have a bunch of nurses? Well, most Ir groups are from 3-10 docs, with a q3-10 call. When you hire someone who cant do the whole gamut, that person can’t take call. Unlike ER or rad onc or anesthesia, Ir did not expand like crazy (we did expand and I wasnt happy about it). This means that if you start introducing mid levels into the mix, you are going to run into issues with calls. And because there is a shortage, docs wont take crap jobs.

more over, most department is run by 1 or 2 IRs per day because our equipments are expensive and unlike an ed who can cheaply add new pt rooms or anesthesia where people are always building new ORs (new or make money), good luck justifying an additional 2 mil room to your ceo to do LP and paras. This mean we literally don’t have the room and space for actual mid levels. Sure, ceo why dont you hire someone to sit on their ass as do 3 paracentesis a day

I sincerely hope you're right that you guys are safe forever. I truly do. I don't wish what's happening to EM on any other field.



However a 10 second google search may throw cold water on your confidence...

1) A 2019 Interventional Neuroradiology paper by folks at Columbia and Mt Sinai -- "Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners." In it, the authors comment:

"Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs."

Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners - PMC

Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse ...

www.ncbi.nlm.nih.gov

2) From the Journal of American College of Radiology in 2015, a paper by some authors from Emory cites studies showing no significant outcomes differences with chest port placement and liver biopsies done by midlevels vs docs:

DEFINE_ME

3) A 2019 paper in The British Journal of Cardiology "Safety, effectiveness and quality of nurse diagnostic coronary angiography" found the nurses outcomes to be "equivalent" to doctors

Safety, effectiveness and quality of nurse diagnostic coronary angiography - The British Journal of Cardiology

Introduction Coronary artery disease (CAD) remains among the leading causes of premature death in the UK, as well as the leading cause of death worldwide. In the UK, one in seven men and one in 11 women will die from CAD, which, on average, is one death every eight minutes.1 Despite advances in...

bjcardio.co.uk

I'm not trying to in any way devalue what you guys do nor suggest that these articles are "the truth." And nobody is saying that you guys have already been inundated by midlevels or that it's imminent. But if these quickly found (and by no means exhaustively searched) smattering of articles doesn't convince you that external forces are beginning to put a target on your guys back...I'm not sure what will. The CEO doesn't care about your call schedule or what you think is a "crap" job...he cares about being in the black. All it takes are enough of these "so there" crap articles like the above being passed on to your hospital CEO by his favorite NP or admin cronies and...what do you think could happen? Because that's what you guys should be now trying to defend against.

 

[Splenda88]

Anyone who thinks their specialty is safe from mid-level encroachment is IMO misguided...

 

[Birdstrike]

Anyone who thinks their specialty is safe from mid-level encroachment is IMO misguided...

Of course, none of us are "safe." We're all replaceable. The question is, to what degree.

 

[Birdstrike]

The gap between nursing and physician salaries has been large enough, for long enough, there was destined to be mid-level encroachment to fill that gap at some point, whether we liked it or not. The only thing that surprises me about it, is that it took the CEOs, business people and administrators this long to figure it out and implement this strategy to undercut us.

 

[Splenda88]

Of course, none of us are "safe." We're all replaceable. The question is, to what degree.

Even to 25%+... Handing 25%+ of tasks that were traditionally physician's tasks to mid-levels changes the job market completely. It's just the law of economics...

 

[IRattending2021]

I sincerely hope you're right that you guys are safe forever. I truly do. I don't wish what's happening to EM on any other field.



However a 10 second google search may throw cold water on your confidence...

1) A 2019 Interventional Neuroradiology paper by folks at Columbia and Mt Sinai -- "Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners." In it, the authors comment:

"Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs."

Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners - PMC

Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse ...

www.ncbi.nlm.nih.gov

2) From the Journal of American College of Radiology in 2015, a paper by some authors from Emory cites studies showing no significant outcomes differences with chest port placement and liver biopsies done by midlevels vs docs:

DEFINE_ME

3) A 2019 paper in The British Journal of Cardiology "Safety, effectiveness and quality of nurse diagnostic coronary angiography" found the nurses outcomes to be "equivalent" to doctors

Safety, effectiveness and quality of nurse diagnostic coronary angiography - The British Journal of Cardiology

Introduction Coronary artery disease (CAD) remains among the leading causes of premature death in the UK, as well as the leading cause of death worldwide. In the UK, one in seven men and one in 11 women will die from CAD, which, on average, is one death every eight minutes.1 Despite advances in...

bjcardio.co.uk

I'm not trying to in any way devalue what you guys do nor suggest that these articles are "the truth." And nobody is saying that you guys have already been inundated by midlevels or that it's imminent. But if these quickly found (and by no means exhaustively searched) smattering of articles doesn't convince you that external forces are beginning to put a target on your guys back...I'm not sure what will. The CEO doesn't care about your call schedule or what you think is a "crap" job...he cares about being in the black. All it takes are enough of these "so there" crap articles like the above being passed on to your hospital CEO by his favorite NP or admin cronies and...what do you think could happen? Because that's what you guys should be now trying to defend against.

I work in NYC and very familiar with the Columbia IR group. As far as I know there are no nurses or mid level doing cerebral angiography which is a laughable concept. They are also one of the group that refused to train midlevel to even do paracentesis (one of the mid level left because of this).

Disappointed by emory but not surprised. Some academic IR institutions actively sell out my field.

 

[dadaddadaBATMAN]

Is that a normal amount of shifts? Seems like I remember most people here talking about 13-15/month.

If you're working 17 then no question I've got it way better than you do, at least time wise. You likely still out earn me by a decent bit (and you absolutely should for the work y'all do).

In all fairness I meant to write 15-17 but must have been overzealous in one of my edits. I’ve been on the 17 end lately due to maternity leave stuff.

I also am a newer doc and paying off house and kid college funds, I can drop 20% without losing some benefits and I’m well compensated. I’ll probably do this next year or the year after. Pre(substantial) benefit income of 330 which will increase to 370 over a few years. If I did more nights I could clear 400 assuming the floor doesn’t drop on us (probably a poor assumption).

 

[Dr Mantis Toboggan]

I don't think there are any as inpatient OB/adult is a requirement. You can seek out programs that hit the absolute minimums in terms of inpatient/call. I would recommend against that 100% of new med school grads.

For someone wanting to go from EM/IM to FM, those inpatient months are almost certainly less important. Plus if you can credit for intern year you'll miss out on lots of them anyway.

I doubt I’d ever retrain but it’s interesting to think about.

 

[wamcp]

It's easy making 250+ with family medicine.

The guaranteed income my wife is getting is 230, but with RVUs, if she generated 4800 rvus which is average for family medicine, she will hit 250k. We've seen exact numbers for her group. If she sees 24-25 patients a day for 4 clinical days and 12 patients on one half day, then she breaks 300k on rvus.

FM may truly be a better lifestyle specially than us.

It’s kinda funny too that FM can moonlight in the ER but EM docs can’t moonlight in a FM clinic 🤔

Family Medicine Physician job in Iowa

Family Medicine Physician job in Iowa

www.practicelink.com

Potential Earnings of $438,000
$300,000 Guaranteed 1st Year

• Midwest Employed Family Practice Opportunity
• Guaranteed Annual Base Salary + Production
• Traditional Practice- 4.5 Day workweek
• Can moonlight in ED on days off to supplement income
• Quality of Life Opportunity - 12 Patients a day
• NO CALL
• Complete autonomy

 

[sylvanthus]

My hospital just hired a few NP “hospitalists” to function independently. Everyday I question why I entered medicine, so friggin depressing.

 

[Splenda88]

It’s kinda funny too that FM can moonlight in the ER but EM docs can’t moonlight in a FM clinic 🤔

Family Medicine Physician job in Iowa

Family Medicine Physician job in Iowa

www.practicelink.com

Potential Earnings of $438,000
$300,000 Guaranteed 1st Year

• Midwest Employed Family Practice Opportunity
• Guaranteed Annual Base Salary + Production
• Traditional Practice- 4.5 Day workweek
• Can moonlight in ED on days off to supplement income
• Quality of Life Opportunity - 12 Patients a day
• NO CALL
• Complete autonomy

I am starting to think FM docs are getting paid too much money 😛

 

[cyanide12345678]

I am starting to think FM docs are getting paid too much money 😛

Just as our reimbursements are declining, theirs is increasing. Plus they have ridiculous demand. Both my wife and i job hunted together. She was getting offers left and right, i was struggling to find openings. Had to stop looking in Texas to find opportunities. And i mean all of Texas including Lubbock, Amarillo, el paso. The worst staffing opportunities remain that I'm not that desperate to take.

Specialties i would pick over EM if i was a 3rd yr med student today: Derm, radiology, ophtho, pmnr, urology, ent, psych, FM, anesthesiology, ortho, and maybe even neurology -_-

 

[VA Hopeful Dr]

It’s kinda funny too that FM can moonlight in the ER but EM docs can’t moonlight in a FM clinic 🤔

Family Medicine Physician job in Iowa

Family Medicine Physician job in Iowa

www.practicelink.com

Potential Earnings of $438,000
$300,000 Guaranteed 1st Year

• Midwest Employed Family Practice Opportunity
• Guaranteed Annual Base Salary + Production
• Traditional Practice- 4.5 Day workweek
• Can moonlight in ED on days off to supplement income
• Quality of Life Opportunity - 12 Patients a day
• NO CALL
• Complete autonomy

Because moonlighting in a FM clinic isn't really a thing. I've never done nor ever even seen it as an option. All of the moonlighting I have done (urgent care, disability exams, weekend psych hospital coverage) are things EPs could do as well.

 

[curiousneuro]

Just as our reimbursements are declining, theirs is increasing. Plus they have ridiculous demand. Both my wife and i job hunted together. She was getting offers left and right, i was struggling to find openings. Had to stop looking in Texas to find opportunities. And i mean all of Texas including Lubbock, Amarillo, el paso. The worst staffing opportunities remain that I'm not that desperate to take.

Specialties i would pick over EM if i was a 3rd yr med student today: Derm, radiology, ophtho, pmnr, urology, ent, psych, FM, anesthesiology, ortho, and maybe even neurology -_-

Jobs are plentiful in neuro at the moment, but I'm worried about midlevel encroachment in this area as well...although I get the sense that no one really wants to deal with the nervous system, so that's a plus for hopeful job security...!

 

[Taurus]

I've seen the exact opposite where most people in radiology aren't worried about things like AI. It's mostly people outside of the field worrying.

As head of our AI initiative for my 100+ rad group, I can tell you that I've been very underwhelmed by the products I have seen. AI is more hype than reality. It's nowhere near replacing a rad if ever. If it is so good that it could replace a rad, I would be more worried about computers turning humans into slaves, ala Matrix. If I got a dollar for every time somebody says that AI is going to take over radiology, I would make another million. 🤪

Another misconception many have is that radiology is under the same threat from midlevels as primary care, ED, anesthesia, etc. It is not. Radiologists are not supervising midlevels while they read plain films, CT, MRI, etc. and then the rad just signs off on their reports. I have to still review the indication, history, and images. It’s faster for me to do all that and dictate the report myself than to have a midlevel do it and then to review their work. That’s why teaching a radiology resident is a huge drag on your RVU production. Sure, a few shady places may allow a midlevel to do all the work and just sign off on it blindly but that’s not the trend and will never be because of the litigation risks. An image can last forever and unchanged if it’s part of a lawsuit. Midlevels can be used to do low end procedures like paras, thoras, LPs, and consults but there is no real danger of them in replacing rads. The biggest money maker in radiology is the interpretation of images, not doing procedures. Yes, a guy who cranks through CT and MRI exams produces more RVU’s than an IR typically in a day. Actually, in my group, the biggest generators of RVU’s is mammo. In a well run mammo operation, they can produce 40% more RVU’s than any other section.

The biggest threat in radiology like most of medicine is corporate radiology and Wall Street.

 

[turkeyjerky]

The biggest threat in radiology like most of medicine is corporate radiology and Wall Street.

Wait, so there are actually places where midlevels are reading images?

That's honestly shocking to me. One of the things that's always impressed me about radiologists is their broad knowledge of pathology. You know, how every once in a while you get a report back with a diagnosis that you've never heard of before. I guess in the future I'll be seeing reports saying 'bilateral basal ganglia hemorrhages--correlate clinically" rather than Fahr syndrome.

If midlevels are reading images and PE is involved then it's just a matter of time...

 

[Taurus]

Wait, so there are actually places where midlevels are reading images?

The last place I know who did it the owner radiologist is in jail. That’s why I say only really shady places do it.

Atlanta Radiologist Sentenced to Prison

However, the evidence showed that from May 2007 through January 2008, REDDY signed and submitted thousands of reports in his name without even reviewing the films that were the subjects of the reports. Rather, he had non-physician technicians known as Radiology Practice Assistants (“RPA’s”) review the film and prepare the reports. In some cases, REDDY directed the RSI staff to simply sign for him, and transmit the report as it he had prepared it. In other cases, REDDY accessed the system for the purpose of signing and submitting the reports. Either way, the majority of the time he never looked at and analyzed the underlying films, and the reports signed by him therefore did not bear his medical conclusions or those of any other doctor.