Thoughts on SIR should IR leave DR talk

[HounsfieldUnit]

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Being isolated and structurally devoid enough to work unbathed in your PJ’s 100% of the time… uh… personally doesn’t sound great to me.

Hey now, I resemble that remark!

 

[shadowlightfox]

I don't know, man. I like the idea of continuing to associate IR with DR and being dual-certified. I can picture myself settling down doing mainly DR work close to my retirement years after all my years of hard IR work.

 

[SeisK]

I don't know, man. I like the idea of continuing to associate IR with DR and being dual-certified. I can picture myself settling down doing mainly DR work close to my retirement years after all my years of hard IR work.

If your group divorces as an IR and you’re salaried at DR level by the hospital for their IR services, in this market you could probably find a way to read studies paid per RVU in your downtime remotely for practices to supplement your income.

Divorcing may end up doing IRs a bigger favor than DRs.

 

[HounsfieldUnit]

Or the hospital decides to pay you at a general surgeon level or less. At some point a divorced IR field will be faced with the reality that RVUs are king in the end.

 

[SeisK]

Or the hospital decides to pay you at a general surgeon level or less. At some point a divorced IR field will be faced with the reality that RVUs are king in the end.

If the majority of community IRs retain a general diagnostic skillset, which most new graduates do, that simply won’t be the case. IRs will be able to leverage a higher market rate for themselves if they retain the ability to walk.

If that wouldn’t work in the future, it shouldn’t work now. And it does work now

 

[HounsfieldUnit]

I really don't see you being able to do 6000-7000 wRVUs a year and maintain $700-800k total comp as an independent IR. Economics don't make sense to me. MGMA 50th percentile for gen surgeons is 6700 wRVU a year at $70/wRVU which comes out to $470k. Sure if you're doing 10k wRVU (due to reading a bunch of DR) I can see it happening. No one is going to pay you $100/wRVU just so that you can keep up with the Jeffersons (DR) unless you live in someplace like Fairbanks.

 

[SeisK]

I really don't see you being able to do 6000-7000 wRVUs a year and maintain $700-800k total comp as an independent IR. Economics don't make sense to me. MGMA 50th percentile for gen surgeons is 6700 wRVU a year at $70/wRVU which comes out to $470k. Sure if you're doing 10k wRVU (due to reading a bunch of DR) I can see it happening. No one is going to pay you $100/wRVU just so that you can keep up with the Jeffersons (DR) unless you live in someplace like Fairbanks.

The difference comes from hospital subsidizing your work, which they are currently doing for newly employed IRs.

 

[HounsfieldUnit]

The difference comes from hospital subsidizing your work, which they are currently doing for newly employed IRs.

The general surgeon is getting subsidized in that $70wRVU figure by the hospital. Why should they pay you $100/wRVU? They don't have to do that right now. Independent IR getting paid $70/wRVU is including the subsidy. The problem is producing enough RVUs to get above 6-7k is going to be hard in most hospital settings unless you're reading 3-4k wRVU in diagnostic radiology a year and having significantly less than 14-17 weeks off as is normal in DR.

 

[SeisK]

The general surgeon is getting subsidized in that $70wRVU figure by the hospital. Why should they pay you $100/wRVU? They don't have to do that right now. Independent IR getting paid $70/wRVU is including the subsidy. The problem is producing enough RVUs to get above 6-7k is going to be hard in most hospital settings unless you're reading 3-4k wRVU in diagnostic radiology a year and having significantly less than 14-17 weeks off as is normal in DR.

Hospitals employing IRs directly now are paying them at existing near-DR marketplace rates, for 100% IR gigs. I don’t know what to tell you man. It exists already.

 

[HounsfieldUnit]

Then you're in effect saying hospitals are paying IR $100/wRVU for 6-7k wRVU a year of work at the 50th percentile. Most hospitals are still refusing to pay any form of subsidy for call stipends on IR services from IR/DR groups. It strains credulity that these hospitals playing hardball on moving IR from a pure pro fee billing model in IR/DR groups are fully conceding to paying $/wRVU rates far in excess of norms in any other field.

 

[SeisK]

Then you're in effect saying hospitals are paying IR $100/wRVU for 6-7k wRVU a year of work at the 50th percentile. Most hospitals are still refusing to pay any form of subsidy for call stipends on IR services from IR/DR groups. It strains credulity that these hospitals playing hardball on moving IR from a pure pro fee billing model in IR/DR groups are fully conceding to paying $/wRVU rates far in excess of norms in any other field.

Not all of them are, but some of them definitely are. I would link you the hospitals I personally know that do these, but it would probably be too identifying for me to do this. It’s not an impossible task to determine hospitals that have done this yourself.

 

[HounsfieldUnit]

Sure, I get the need for anonymity. However if anyone happens to find ACR or other public job posts I'd love to see them (even in DMs) showing pure IR pay pegged at DR rates (thus implying a rather large subsidy). I'd be happy to use them when arguing with my hospital admin that the market value of IR call time is real and we should be getting night and weekend call subsidies for our group's 24/7/365 IR coverage. 🙂

 

[robotvascular]

I am an IR with experience in PP IR/DR group, hospital employed, and an independent IR practice with an OBL.

My current gig is by far the most rewarding (both in job fulfillment and financially). Almost never do any work on the weekend (occasionally will take call for a local group who needs help---they pay well). Otherwise I rarely step foot in the hospital. Very busy but streamlined clinic. Surprisingly even biopsies pay well as an outpatient if you are collecting the technical component too. I actually kinda like biopsies now that I know I can profit 5-8 times what I got in the hospital for a 5-10 min case. Not all days need to be long PAD and embo cases.


In regards to hospital employed: The pay gets subsidized from the technical fees and higher reimbursement rates that hospitals receive. The going Pay usually starts the first couple years at a base pay 500ish, then transitions to Rvu based pay plus a call stipend. Generally 55-60$/RVU. RVUs start to rack up when you include clinic, consults, small procedures, vascular lab, etc. I was a go-getter and was able to get to 800ish range. The only reason I left was I thought I could do better on my own. This is how most cardiologists get paid now as 80% are hospital employed.

My PP IR/DR group was by far my worst experience. don't want to get my BP up thinking about it.

 

[irwarrior]

There are more and more people leaving hospital based VIR under DR group oversight as they are delegated to abscess drains , paracentesis, throacentesis and biopsies. The OBL/ASC success depends on can you get high end cases with insurance payments on your Endovascular table. This includes PAD, UFE, PAE, GAE, varicose veins, This requires some time to get a referral pattern that can support such a practice and depending on your area the competition can be stiff. But, you get to run your own practice run a clinic and book your own patients for procedures. check out oeisweb.com for more information.

 

[NDcienporciento100]

There are more and more people leaving hospital based VIR under DR group oversight as they are delegated to abscess drains , paracentesis, throacentesis and biopsies. The OBL/ASC success depends on can you get high end cases with insurance payments on your Endovascular table. This includes PAD, UFE, PAE, GAE, varicose veins, This requires some time to get a referral pattern that can support such a practice and depending on your area the competition can be stiff. But, you get to run your own practice run a clinic and book your own patients for procedures. check out oeisweb.com for more information.

Most successful OBLs have an edge. What do I mean by that? It means the vast majority are not on an island by themselves supporting themselves solely. Take Sunny Bagla. His group partners with Urology who will immediately start sending him patients and the IR and the Urologist will benefit from the large global fee. Docs doing high volume pad often partner with podiatrist etc. The vast majority of successful OBLs need strategic partners to be successful.

 

[irwarrior]

Most successful OBLs have an edge. What do I mean by that? It means the vast majority are not on an island by themselves supporting themselves solely. Take Sunny Bagla. His group partners with Urology who will immediately start sending him patients and the IR and the Urologist will benefit from the large global fee. Docs doing high volume pad often partner with podiatrist etc. The vast majority of successful OBLs need strategic partners to be successful.

 

[irwarrior]

Those are well known. But, there are countless others that are members of oeis who have built success in a more sustainable durable way which takes a lot more effort. Check out oeisweb.org and you can connect with many VIR with successful oil/asc practices and how they have accomplished it.

 

[nardini46]

Interesting thread. I want to share my perspective as an IR in private practice out in the community. I generate around 14k RVUs per year and have around 85th percentile MGMA compensation. I do around 60% IR 40% diagnostic with a substantial amount of hospitalist IR type work with the occasional PAD/IO/TIPS/embolization cases. I have a clinic that I host once per week to do outpatient evaluations for tumor ablations and PAE. I bring these patients to the hospital to do these cases as outpatients. I take q 2 IR call and work hard for my compensation. My DR partners do not complain about my RVUs.

I hold the opinion that its better to be part of a IR/DR group rather than an IR owning an OBL/ASC. Why? Every year compensation gets cut 2-5% thanks to medicare cuts. Commercial carriers follow suit. IMHO the long term outlook on these OBLs and ASCs doesn't look great when there are consistent cuts to reimbursement. The nice thing about being part of a hospital based IR/DR contract is that we get to negotiate for subsidies for DR overnight call and IR call. Reimbursement to hospitals go up consistently every year. Blame the government. The hospital sees the value our IRs and DRs bring and they help us out accordingly.

 

[irwarrior]

A hospital contract is nice as you can negotiate rates with the hospital with service line agreements for providing various levels of call depending on disease. ie a vascular access , bleeding, DVT/PE, stroke etc. The hospital lobbies are quite powerful and are able to negotiate much better rates with insurance companies and payors when compared to solo practitioners. Currently hospital lobbies are powerful. This may change as leadership in government changes.

Some IR/DR relationships are symbiotic, but many see IR as a loss leader and feel they have to carry the VIR physician. Often if you get large enough you can even negotiate rates with insurance companies .

The hospital contract often includes a large amount of fluid management (pleural effusions, paracentesis, lp, chest tubes , abscess drains) and a large amount of vascular access and biopsies. It can inundate your schedule.

To build the higher end cases (PAD, spine, pain, IO, prostates/fibroids etc) it takes a lot of effort by going out and giving talks and building referrals .

The hospital conflicts are often resolved by bending to the will of the surgical or procedural specialists (IC/VS/Neurosurg) as the radiology group is weary of losing the lucrative imaging contract.

Hospital administrators see you as a necessary hospital based service (ER/hospitalists/anesthesia) and not a group that is bringing in patients to the hospital system (ie neurosurgery/ortho/cardiac surgery/cardiology/GI/oncology etc). The hospital needs to fill their beds, icu, scanners , OR, labs with patients and the only way to do that is have patients and specialists and PCP who can bring patients to the hospital. In it's current state DR and VIR rarely do that.

A VIR physician who has a busy lab and clinic may be able to send patients to the hospital or refer to other physicians/ surgeons/ proceduralists/ order advanced imaging and that would be recognized by hospital administrators.