War with Radiology?

[scared sh*tless]

---

Members do not see this ad.

From the AAN newletter

" Neuroimaging Under Threat

The AAN has joined forces with a number of prominent medical specialties to resist efforts by organized radiology that could drastically impede patient access to imaging by non-radiologists. We are also tracking and responding to new legislative and payer initiatives by radiologists at both the state and federal levels. For example, the AAN signed onto a letter to the Medicare Payment Advisory Commission (MedPAC) encouraging the commission to critically review reform proposals coming from radiologists. "

They further state that 'organized radiology' together with United Healthcare put enough pressure on Medicare to prevent non-radiologists from interpreting films.

The argument is that this decreses patient's access to a timely read, given that most specialists (i.e. neuro, cardio) are trained to read at least some imaging modality of their organ system.

What do people think about this?

IMHO, I think that in an era when health care costs are preventing a good number of people from seeking health care, it's a shame that radiologists are overpaid. This isn't a small issue, I think: most sick people will get billed by a radiologist. I know they are overpaid because they could get by nicely on half of their salary. Therefore, they are getting reimbursed twice what they need to be for reading films.

I think that the over-generous compensation for what is not that hard of a skill is what is drawing the neurolgists and cardiologists to want a crack at the reading room. If the reimbursement was $2 would we really care? We generally just read the films anyways and let that guide treatment.

How come radiologists get paid so much? Was it always this way, or are they just very well organized?

Educate me, people

Scared

 

[neurologist]

From the AAN newletter

" Neuroimaging Under Threat

The AAN has joined forces with a number of prominent medical specialties to resist efforts by organized radiology that could drastically impede patient access to imaging by non-radiologists. We are also tracking and responding to new legislative and payer initiatives by radiologists at both the state and federal levels. For example, the AAN signed onto a letter to the Medicare Payment Advisory Commission (MedPAC) encouraging the commission to critically review reform proposals coming from radiologists. "

They further state that 'organized radiology' together with United Healthcare put enough pressure on Medicare to prevent non-radiologists from interpreting films.

The argument is that this decreses patient's access to a timely read, given that most specialists (i.e. neuro, cardio) are trained to read at least some imaging modality of their organ system.

What do people think about this?

IMHO, I think that in an era when health care costs are preventing a good number of people from seeking health care, it's a shame that radiologists are overpaid. This isn't a small issue, I think: most sick people will get billed by a radiologist. I know they are overpaid because they could get by nicely on half of their salary. Therefore, they are getting reimbursed twice what they need to be for reading films.

I think that the over-generous compensation for what is not that hard of a skill is what is drawing the neurolgists and cardiologists to want a crack at the reading room. If the reimbursement was $2 would we really care? We generally just read the films anyways and let that guide treatment.

How come radiologists get paid so much? Was it always this way, or are they just very well organized?

Educate me, people

Scared

1. Hilarious how two-faced people can be when the shoe is on the other foot. For years the AAN has been lobbying all over the place to prevent physiatrists, physical therapists, chiropractors, and other non-neurologists from doing EMG. Hmmmmmmmm, sound familiar? Perhaps I am overly cynical, but yes, I really do think it's all about $$$$, and you're right, if the reimbursement for a cerebral angio (or EMG for that matter) was $2, nobody would give a s**t.

2. For some weird reason, rads seems to have always paid pretty well, although it's only recently gotten totally ridiculous. Chalk that up to the big push for primary care providers that was in effect when I was in med school in the early Clinton era. That churned out a whole bunch of family practice docs who just shotgun study after study to CYA. At the same time, fewer people were going into rads. So, you've had a big increase in rad volume and a steady or declining # of people to read them. Supply and demand works its magic. Also, the price of rads technology gets steeper and steeper, so someone has to pay for all those need new MRI machines, etc.

 

[Whisker Barrel Cortex]

Radiology has always has decent compensation due to the fact that it is considered procedural. Even though the majority of what we do is interpretive, it is still considered a procedure by medicare/medicaid and thus is well reimbursed. That being said, I think that the astronomical increase in salaries over the past few years have been due to an overall shortage of radiologists and a greatly increased volume of work per radiologist. The procedural fees keep falling, but the number of studies ordered keep increasing. I fully expect that within 5-10 years, medicare will substantially decrease reimbursement for imaging and salaries will fall to a more reasonable level.

Another thing that drives the salaries higher is ownership of equipment and imaging centers. Those radiologists make much more on average than those who do not own equipment due to collection of technical fees in addition to interpretive fees.

As for the "not that hard of skill" part, I find that extremely offensive. I geuss we are all idiots since 4 years of training in radiology is considered by most to be barely adequate to be proficient in all aspects of radiology and the majority do additional 1-2 year fellowship in subspecialties. I happen to think prescribing anticoagulation and physical therapy to stroke patients, doing trial and error seizure therapy, giving steroids to ms patients, etc seem very simple and straightforward compared to what a good radiologist does. Of course, I do not see the nuances that affect the every day practice of neurology as you do, so I am probably wrong.

Now for limitation of imaging to radiologists. The general gist of current efforts by the ACR are not necessarily to bar non-radiologists from interpreting imaging. The goal is to not allow people who are not the most proficient and knowledgable about imaging to perform imaging, to the detriment of patients. The idea is to get people somehow certified to read imaging studies in order prove they are good enough to interpret. It is very easy to do bad imaging and bad imaging interpretation (and this includes some radiologists). Unfortunately, currently the reimbursement is the same no matter how bad the imaging study is. This process took place in mammography. Back in the early eighties, FPs, medicine docs, OB/GYNs, surgeons were performing very poor mammographic studies in their offices. The governement stepped in and required accreditation. The quality of mammography has improved exponentially due to this action.

Self referral by clinicians to their own imaging center is a big issue as well. Many studies have shown that the amount of imaging performed increases 2-8 times when physicians refer patients to their own equipment. Insurance companies and Medicare have noticed this as well and are slowly beginning to take action.

 

[scared sh*tless]

Hey thanks to both for keeping this thread going, I am really interested in this subject and am getting some good perspectives on a complex issue.

I am truly sorry, WBC, for implying that what radiologists do is 'not that hard'. I mean to imply that with enough practice, it's not that hard of a skill. Of course, there are intricacies in anything (even making sandwiches for a living or being a Matire-D'). By the way, I think that what neurolgists doesn't take all that much skill when compared to what some other people do. I think that (and I may be wrong) transplant surgery, coiling aneurysms, etc... takes a lot of skill. I don't think that other people, such as neurologists, could just jump in on one of those two (but I could be wrong, especially about the latter). But no-one wants to jump in on the work of a ward neurolgist (except in the case of EMG's, and perhaps sleep studies -- as was well pointed out) because the pay is not that great.

I also think that radiologists' work differs greatly from that of a pathologist because not many people regularly look at their patients' cytology, histology etc.. (although perhaps they SHOULD ...) whereas most clinicians are used to interpreting their own films enough to guide treamtent (at least from what I have seen). This is probably why radiology gets a lot of heat (at least recently from the AAN) and that may be a little unfair.

What I think is especially hard about radiology is reading -- all modalities-- of study... that is a lot of organ systems and a lot of physics and a lot of different kinds of findings and 'signs'. Radioloigists are also the people who first develop the techniques and studies we clinicans need (as I understand it). And your point about mammography is well taken. I wonder if that applies to all imaging studies : i.e. what the difference is in the interpretation of all imaging studies between radiologists and the specialist who regularly reviews those films (i.e. plain roentograms of fractures and Orthos, Brain MRI's and neuros, etc...).

Basically, more than an opinion, I'm just stating my ignorance here... Hope not to offend anyone...

 

[neglect]

I have no problems with other fields doing NCS and EMGs. Except when they don't know their own limitations. Sometimes see EMGs with wildly off results. So it's a skill, like anything else. Being a neurologist doesn't give you automatic skills.

Not getting paid for reading films is a present wrong. Neurologists can read films within their area as well, and in many cases better than radiologists. Every time we get a scan, we automatically get a radiology consult, which is not necessary in many cases. Have there been any studies on this btw? Seems like a good project - how many times a radiology report (not the scan itself) changed mgmt.

Their reports not helping/being incorrect/or glaring misses are so common as to not even be commented on anymore by anyone in the department other than the newly arrived residents. Recent cases: yes, the temporal lobe is hypodense, that clivus looks funny because of a met, and no, the frontal T2 signal intensities could not be explained by trauma, unless trauma can affect the mesial frontal lobes in this weird pattern, which is also the place where the EEG sharps are shooting out of btw, and give you CSF full of pus; none of those patients have NPH.

Anyway, I'm all for an accrediting process. I'll just have to recall what PVWMD stands for again.

"I happen to think prescribing anticoagulation and physical therapy to stroke patients, doing trial and error seizure therapy, giving steroids to ms patients, etc seem very simple and straightforward compared to what a good radiologist does. Of course, I do not see the nuances that affect the every day practice of neurology as you do, so I am probably wrong."

Correct at the end. Not to defend it too much. We get very easy cases and very difficult cases of unknowns. Just like you do. BTW: anti-coagulate stroke? Surely you did an internship within the last 5 years?

 

[Whisker Barrel Cortex]

I have no problems with other fields doing NCS and EMGs. Except when they don't know their own limitations. Sometimes see EMGs with wildly off results. So it's a skill, like anything else. Being a neurologist doesn't give you automatic skills.

Not getting paid for reading films is a present wrong. Neurologists can read films within their area as well, and in many cases better than radiologists. Every time we get a scan, we automatically get a radiology consult, which is not necessary in many cases. Have there been any studies on this btw? Seems like a good project - how many times a radiology report (not the scan itself) changed mgmt.

Their reports not helping/being incorrect/or glaring misses are so common as to not even be commented on anymore by anyone in the department other than the newly arrived residents. Recent cases: yes, the temporal lobe is hypodense, that clivus looks funny because of a met, and no, the frontal T2 signal intensities could not be explained by trauma, unless trauma can affect the mesial frontal lobes in this weird pattern, which is also the place where the EEG sharps are shooting out of btw, and give you CSF full of pus; none of those patients have NPH.

Anyway, I'm all for an accrediting process. I'll just have to recall what PVWMD stands for again.

"I happen to think prescribing anticoagulation and physical therapy to stroke patients, doing trial and error seizure therapy, giving steroids to ms patients, etc seem very simple and straightforward compared to what a good radiologist does. Of course, I do not see the nuances that affect the every day practice of neurology as you do, so I am probably wrong."

Correct at the end. Not to defend it too much. We get very easy cases and very difficult cases of unknowns. Just like you do. BTW: anti-coagulate stroke? Surely you did an internship within the last 5 years?

What hospital are you at? It seems you have not so good radiologists in your hospital. They certainly don't sound fellowship trained. That's a pity. The view you have of radiologists in your facility is the view we have of neurologists in my facility. We usually have a few laughs after the neurology team leaves the room after reviewing a study. I could give you many many anecdotal stories of the limitations in knowledge of neuroimaging by our neurologists. Our neurorads department, on the other hand, is very strong.

Oh yea, and make sure you read the reports on the other imaging studies on your patients. That stroke patient who now has increasing oxygen demand does have pulmonary edema, despite the fact that you didn't see it on chest x-ray the past few days. Too bad that once you notice the report and check a troponin, the patient has lost a lot of myocardium (true story).

As for the anticoagulation thing, I was referring to thrombolysis for acute stroke. You would be surprised how much clinical medicine radiologists are required to know. Often residents on general services ask our advice on managment of patients. I usually respectfully decline to give them advice, but usually know the correct next step. Can't have people thinking I'm a clinician now, can I?

 

[sk678]

im not a radiologist or anything in anyway, but its hard to imagine that someone who has been in the hospital, read many reports, etc, can say you dont need to know a lot....even though i dont know the least of it, seems very very diffiuclt to me....not to mention, it must be hard not to make mistakes with the volume that is done...just my opinion

 

[neurologist]

. . . . Often residents on general services ask our advice on managment of patients. I usually respectfully decline to give them advice, but usually know the correct next step. Can't have people thinking I'm a clinician now, can I?

What hospital are YOU at? You must have some pretty lame clinicians if they are asking the radiologists for advice on clinical management. Yikes!

As for the post by "Neglect" asking about "how many times a radiology report changed management?" Well, it pretty much happens every time a radiologist puts some completely whacked out differential in their report and recommends some other study, and the clinician now has to go bark up a totally tangential pathway to cover their ass because the radiologist put something in writing as a possibility, despite the fact that there is no clinical evidence to support that possibility. It's called "defensive medicine."

 

[Whisker Barrel Cortex]

The radiology report changes management on a large number of patients in our ED. They will usually send home the patients that we call negative instead of calling a neurology or neurosurgery consult unless there is some other clinical factor that will cause them to consult anyway. We often call the neurology stroke service directly and go over the findings with them when there is a finding on CT or MRI that requires immediate attention. As for CT abd/pelvis/chest, our reads affect patient care in pretty much every case.

I can guarantee that on an average call night, we affect patient management in many more patients than any neurologist on call.

I am actually at a very good hospital (as opposed to the people whose post indicate they are likely at community hospital with poor radiology support). The residents that ask advice are usually FP residents rotating through or general medicine residents.

Neurologist, you obviously have a beef with radiologists, and that is unfortunate. You have no idea what the practice of radiology entails since you have not been through a rads residency or neuroradiology fellowship.

You continually insult my profession, despite my reluctance to do the same about yours. Trust me, it would be very easy.

 

[cliff]

http://www.outsource2india.com/services/teleradiology.asp

Patient contact specialties will never be out-sourced.
Non-patient specialties can.

Neurology is a contact specialty, most of radiology does not require patient contact. Proceed with caution.

The upsetting part of all of this - is that there are many more pompous radiologists than neurologists because it is more competitive to get into RADS these days than Neuro. In my opinion radiologists are screwing themselves. I figure if they gave a yard, in the long run, they would keep the rest of the field.

Let's wait and see what happens to imaging in the US under GW...


The link above is one of many unfortunately. I wish the market hadn't forced US healthcare to do this.

 

[neglect]

What hospital are you at? It seems you have not so good radiologists in your hospital. They certainly don't sound fellowship trained. That's a pity. The view you have of radiologists in your facility is the view we have of neurologists in my facility. We usually have a few laughs after the neurology team leaves the room after reviewing a study. I could give you many many anecdotal stories of the limitations in knowledge of neuroimaging by our neurologists. Our neurorads department, on the other hand, is very strong.

Trust me, if you're correct, then the laughter goes both ways. They have a neurorads fellowship program. Some of the fellows are good, some bad. I think the point from my perspective is that we have a patient, and we order an imaging study. We have to put that information into the context of the patient. To do this, we seldom need the radiology report, and sometimes we do. When I order a chem panel, I don't require a medicine consult. I don't require a cards consult for each EKG. These are tests that provide information that's just as vital, and given your example below, sometimes more vital, than the imaging tests we obtain.

Of course we frequently ask for a consult from another specialty. What bothers me is the waste of getting a report in every case, even the ones in which we don't need it at all. Like yes, I can see that this patient is herniating/stroked out/tumor has progressed (vs. post surgical change)/has TNTC lesions c/w MS. It is nice to read that the patient also has sinusitis. Oh yeah, those were enlarged VC spaces.

Oh yea, and make sure you read the reports on the other imaging studies on your patients. That stroke patient who now has increasing oxygen demand does have pulmonary edema, despite the fact that you didn't see it on chest x-ray the past few days. Too bad that once you notice the report and check a troponin, the patient has lost a lot of myocardium (true story).

System error. I've seen much worse.

As for the anticoagulation thing, I was referring to thrombolysis for acute stroke. You would be surprised how much clinical medicine radiologists are required to know.

Here is what you said:

"I happen to think prescribing anticoagulation and physical therapy to stroke patients, doing trial and error seizure therapy, giving steroids to ms patients, etc seem very simple and straightforward compared to what a good radiologist does."

OK then. Anticoagulation does NOT = thrombolysis, but that's OK. Given how much thrombolysis gets messed up, I'd say it's not as simple and straigtforward as it seems to be - from your view box of course. But your overall point is something I generally agree with: most of our cases are very easy, or they look that way to me after doing it day-in/day-out. So are most scans, EKGs, EEGs, NCVs, and lab tests I've seen, unless you're learning how to look at them for the first time. It's just a skill set. Riding a bicycle seems demanding until you learn how - then it seems simple.

 

[neglect]

As for the post by "Neglect" asking about "how many times a radiology report changed management?" Well, it pretty much happens every time a radiologist puts some completely whacked out differential in their report and recommends some other study, and the clinician now has to go bark up a totally tangential pathway to cover their ass because the radiologist put something in writing as a possibility, despite the fact that there is no clinical evidence to support that possibility. It's called "defensive medicine."

Oh man, I stand corrected. I see this every day. Usually in the 'I can't believe I'm on the floors away from my Important Research' attendings.

 

[Whisker Barrel Cortex]

I think the point from my perspective is that we have a patient, and we order an imaging study. We have to put that information into the context of the patient. To do this, we seldom need the radiology report, and sometimes we do. When I order a chem panel, I don't require a medicine consult. I don't require a cards consult for each EKG. These are tests that provide information that's just as vital, and given your example below, sometimes more vital, than the imaging tests we obtain.

You actually do get a cardiology consult with every EKG. A cardiologist is paid to put an official interpretation on each EKG since they are the experts in that field. Usually it doesn't happen until a couple of days later. Radiologists, preferably neuroradiologists, are experts in their field and will put the official interpretation in much quicker than that.

Of course we frequently ask for a consult from another specialty. What bothers me is the waste of getting a report in every case, even the ones in which we don't need it at all. Like yes, I can see that this patient is herniating/stroked out/tumor has progressed (vs. post surgical change)/has TNTC lesions c/w MS. It is nice to read that the patient also has sinusitis. Oh yeah, those were enlarged VC spaces.

You would be surprised how many of those things some of your neurology collegues would not pick up on a study and would not know what to call if they saw them.

OK then. Anticoagulation does NOT = thrombolysis, but that's OK. Given how much thrombolysis gets messed up, I'd say it's not as simple and straigtforward as it seems to be - from your view box of course. But your overall point is something I generally agree with: most of our cases are very easy, or they look that way to me after doing it day-in/day-out. So are most scans, EKGs, EEGs, NCVs, and lab tests I've seen, unless you're learning how to look at them for the first time. It's just a skill set. Riding a bicycle seems demanding until you learn how - then it seems simple.

I agree that thrombolysis is likely more complex than I imagine. My point is that radiology is as well.

Also, part of radiology is steering other clinicians to the correct specialist or obviating the need for a specialist. This is something we do on a daily basis from the ED and general clinics.

You talk of the cost of paying the radiologist for the interpretation. Yet many studies have shown that the amount of imaging performed increases by anywhere from 2-8 times when a clinician is self-referring studies. Where are the clinicians that are outraged by this? Nowhere to be found.

 

[neglect]

You actually do get a cardiology consult with every EKG. A cardiologist is paid to put an official interpretation on each EKG since they are the experts in that field. Usually it doesn't happen until a couple of days later. Radiologists, preferably neuroradiologists, are experts in their field and will put the official interpretation in much quicker than that.

You would be surprised how many of those things some of your neurology collegues would not pick up on a study and would not know what to call if they saw them.

I agree that thrombolysis is likely more complex than I imagine. My point is that radiology is as well.

...You talk of the cost of paying the radiologist for the interpretation. Yet many studies have shown that the amount of imaging performed increases by anywhere from 2-8 times when a clinician is self-referring studies. Where are the clinicians that are outraged by this? Nowhere to be found.

Yeah, I actually knew the EKG stuff occured. Since I've never seen the reports, I assumed it stopped as a total waste of time. Like leeches, it persists.

I'm sure many things are missed by many people reading films. A good clinician asks a question with a study. The study may or may not answer that question and to do so one doesn't need to be as error-free as you imagine. For example, I've seen many early strokes missed on the early CT (sadly enough by both rads and neuro). What difference does it make? None. Our clinical question at that time was: bleed or bland? The answer was bland. The rest isn't usually important.

So yes, all of medicine is complex. ER doctors can, and (half shudder) do give tPA. They can master thromblysis. FPs can master and give botox. Most clinical scans can be read by clinicians who not only have enough skill, but know their own limitations.

I actally wasn't talking about cost. Did I? When we read a scan now, that time is subsumed as part of seeing the patient. As I said, that's wrong, especially when that read may have more clinical relevance to the patient. Not just neurology. Neurosurgery's spine films gives another instance where most radiology reports are probably never even glanced at.

These guys who self refer - unseemly. What really kills me are the VIPs who get various scans every other day for their migraines. We've gotta keep our own house clean, but we get rewarded for every mote of dirt. Troubling.

 

[neurologist]

Neurologist, you obviously have a beef with radiologists, and that is unfortunate. You have no idea what the practice of radiology entails since you have not been through a rads residency or neuroradiology fellowship.

You continually insult my profession, despite my reluctance to do the same about yours. Trust me, it would be very easy.

I really have no beef with radiologists, nor do I really mean to insult your profession. I just think that your specialty operates much too frequently completely divorced from clinical context. I've just had a few too many patients get freaked out because they got a hold of their radiology report and saw the words "multiple sclerosis." Then I have to spend about a million hours trying to convince them that's not what they have. Like it or not, for the most part, radiologists operate in a clinical vacuum which benefits nobody (except perhaps that subset of radiologists who went into the field specifically to avoid patient contact).

My gut feeling is that the solution to this is that all specialists (neuro, pulmonary, GI cards, etc) ought to be sufficiently trained and competent enough to read their own studies without relying on a radiologist. Of course, that would require a rather significant overhaul of medical education, so I doubt it will happen any time soon. And yes, if a neurologist needs to get a chest x-ray or barium enema or something on one of their patients, sure they should rely on a radiologist to interpret that . . . it's not something the average neurologist sees on a frequent enough basis. But head/spine CT, MRI, SPECT, PET? Come on. Maybe 20 years ago when the technology was new a rads interpretation was needed, but nowadays this should all be second nature to any neurologist. The role of the "neuroradiologist" should essentially be that of a consultant on particularly difficult cases, and I'm even willing to leave the interventional stuff to you (although it seems plenty of others on this board aren't! 😀 ).

 

[neglect]

Maybe 20 years ago when the technology was new a rads interpretation was needed, but nowadays this should all be second nature to any neurologist.

Actually, it's interesting. I met a graduate of my program who, as part of her on call duties, had to approve and read every head CT that came through. At the time there were less than 10 scanners or something like that. So historically this is something that grew up through neurology. Rads took it over, neuro let them, we've inherited the situation, but it's not static and it'll swing over to the other side.

 

[gmonavydoc]

Enjoy the $$$$$$$$$$$$$ 'cause in a few years all the studies will be zapped to Bombay and the reports zapped back at 1/100 the cost. The managed care MBA sharks are getting hard-ons just waiting to finally outsource rads.

Ask programmers and engineers where their jobs went...overseas.

 

[Whisker Barrel Cortex]

Enjoy the $$$$$$$$$$$$$ 'cause in a few years all the studies will be zapped to Bombay and the reports zapped back at 1/100 the cost. The managed care MBA sharks are getting hard-ons just waiting to finally outsource rads.

Ask programmers and engineers where their jobs went...overseas.

I love how people are so hate filled and spiteful when it comes to radiology. It really says a lot about you. Your actual knowledge of the situation is probably pretty minimal, so let me educate you. Here is some information for you:

It's a little different outsourcing a doctor's job than it is outsourcing programming job. The odds of this having a significant impact on radiology are very low. Each physician interpreting a study must be licensed in the state the study was performed and credentialed at the hospital it was performed. This limits the people reading to those who have passed the USMLE and have trained in the US. Not a huge number of those people wish to live in India (sure there are a few). There are also liability issues involved with a physician in another country reading studies. Who will the lawyers sue when there is a missed finding or misinterpretation? Additionally, Medicare currently does not reimburse for studies interpreted outside of the United States.

The total number of radiologists in india is about 3500. In comparison, the shortfall of radiologists in the United States is about 4500 and is projected by some to increase to as much as 15,000 in the next 15 years (of course projections are just speculation). The total number of US radiologists is 35,000 for comparison.

The companies that have non US trained, non US licenced radiologists do not provide a final interpretation, just a preliminary read. The final read is performed by the US radiologist. While I'm not too fond of this arrangement due to concerns about quality and liability, it in no way hurts American radiologists.

Although this may make you even more bitter, teleradiology will actually increase the variety of opportunities for American radiologists. I would consider taking a position in Australia or Switzerland (the two places which Nighthawk Radiology has opened) for a few years for an interesting experience. One practice owns a condo in Barcelona, Spain, and sends one of their partners there for a month every year to do the nighttime reads. I could definitely live with that.

Foreign radiology will likely be used (and is already being used) primarily for nightime reads. Is is something to keep an eye on? Sure. Will I lose sleep over it? No.

Again, thank you for your uniformed, spiteful response. Even though you wish ill on my profession, I truly hope that an NP or PA does not take your job in the future. Any non-procedural specialty is ripe for lower level providers to encroach on, and neurology is no exception.

 

[NRAI2001]

What is the avg salary of a radiologist?

 

[gmonavydoc]

Brush up on your Hindi and send me a postcard from Bombay....Denial ain't a river in Egypt.

 

[hans19]

Brush up on your Hindi and send me a postcard from Bombay....Denial ain't a river in Egypt.

Maybe you should brush up on your Hindi, Urdu, Gujarati, Tamil,Telugu, Kanada, Malayalam, and Arabic because there sure are a lot of FMGs in neurology.

They speak Marathi in Mumbai (Or 'Bombay' as you call it). If I ever go to Mumbai it will be as a tourist during my 8-10 weeks of vacation per year, flying first class on British Airways.

GMO, I'll be sure to send you a post card... please be sure to write from the Persian Gulf. Ma'ah Salaam!

 

[gmonavydoc]

Maybe you should brush up on your Hindi, Urdu, Gujarati, Tamil,Telugu, Kanada, Malayalam, and Arabic because there sure are a lot of FMGs in neurology.

They speak Marathi in Mumbai (Or 'Bombay' as you call it). If I ever go to Mumbai it will be as a tourist during my 8-10 weeks of vacation per year, flying first class on British Airways.

GMO, I'll be sure to send you a post card... please be sure to write from the Persian Gulf. Ma'ah Salaam!

you should feel right at home with all the FMG's they are your "peps"...

"Who needs the Quicky Mart" Slushy? "Thank you come again"

Apu- (future radiologist )

 

[magicman]

wait a minute. At my hospital, a stroke patient IS anticoagulated. If they came in on nothing, they add aspirin. If already aspirin, add plavix. If already both, then change to aggrenox.

 

[hans19]

you should feel right at home with all the FMG's they are your "peps"...

"Who needs the Quicky Mart" Slushy? "Thank you come again"

Apu- (future radiologist )

I think its 'peep' not 'pep'. I am neither Indian nor of any other South Asian ancestry, but I have friends and collegues of many ethnic backgrounds.

Your comments are xenophobic, and they border on bigotry.
We don't need that on this board, and we certainly don't need that in the military.

You are an officer, but not a gentleman.

 

[drusso]

1. Hilarious how two-faced people can be when the shoe is on the other foot. For years the AAN has been lobbying all over the place to prevent physiatrists, physical therapists, chiropractors, and other non-neurologists from doing EMG. Hmmmmmmmm, sound familiar? Perhaps I am overly cynical, but yes, I really do think it's all about $$$$, and you're right, if the reimbursement for a cerebral angio (or EMG for that matter) was $2, nobody would give a s**t.

I don't think that the AAN has been lobbying against having physiatrists do EMG. This would be impossible since formal EMG training in the ACGME core competencies of all PM&R residencies. Often, the AAN, AANEM, and the AAPM&R lobby on the same side of electrodiagnosis issues. Maybe you could clarify your sources?

 

[f_w]

******ed thread

 

[Mitogen79]

i agree f_w.... seriously, why can't everyone just put aside their own biases and work together in the best interest of patient care... i hate to sound like a 'premed' out to save the world, but face it, most of us got into medicine to make a positive difference in those that are ill; so let's stop this bickering... neurologists need radiologists, and radiologists rely on neurologists (and other referrals)...

 

[Whisker Barrel Cortex]

Brush up on your Hindi and send me a postcard from Bombay....Denial ain't a river in Egypt.

Ok, now I understand that you are a troll with no idea what he's talking about and no ideas to put forth. Good to know. I like knowing who to ignore.

 

[eddieberetta]

The problem with specialists reporting their own studies as has been suggested by two of the neurology people here is

1. when all you have are hammers, everything looks like a nail. Specialists deal with a certain range of pathology relevant to their own specialty and do not have experience with other lesions. How many cholesterol granulomas have you seen? How many traumatic ossicular disruptions? How many retropharyngeal abscesses? How many chondrosarcomas of the skull? How many meningoencephaloceles? These are picked up on head imaging all the time. Do you propose to send every study to a neurologist, neurosurgeon, ENT, orthopod? Or will a 2- week refresher course in Hawaii prepare you?

2. it is impossible to predict when lesions outside your scope of knowledge will arise. Since you have no training in dealing with them, it is not necessarily the case that you will even identify them, let alone diagnose / refer correctly.

3. it is incorrect to think that you have more experience with the imaging findings of diseases you treat regularly compared to a radiologist. your entire days clinic would flow through a single radiologist in the time of 1-2 of your clinical encounters. radiologists have orders of magnitude more image volume exposure than clinicians.

4 along the same lines, radiologists have more knowledge of imaging physics, artifacts, troubleshooting imaging problems etc. etc. that are everyday issues in the radiology department that you are completely shielded from when you drop by.

5 Yet a further issue is, by "cherry picking" cases as you propose to do, only referring when you have a question, you will reduce the case volume the radiologist sees, which would not allow him to maintain profiency. As a result you will not have specialist radiologists to turn to.

We can all list times our colleagues have made mistakes on both sides of the fence. But come on, it is simply not true that a freshly trained neurologist is safe to practice as a radiologist. The reason we have specialties is to better serve patients by training MDs to have special proficiencies in particular aspects of medicine. Like radiology. And clinical neurology.

 

[f_w]

Eddie, this is futile. You expend way too much energy on trying to convince people.

Looking at this 'neurology' forum, it is interesting to see that the only threads that elicit a number of replies >10 seem to be the ones dealing with the imaging issue. Isn't there anything else to talk about in neuro ?

 

[GopherBrain]

Eddie, this is futile. You expend way too much energy on trying to convince people.

Looking at this 'neurology' forum, it is interesting to see that the only threads that elicit a number of replies >10 seem to be the ones dealing with the imaging issue. Isn't there anything else to talk about in neuro ?

Nope, there isn't. We are all a month out of the match. Life is good, happiness washes over the land...

Things were different in this forum a couple of months ago... Cycles and all..

 

[eddieberetta]

Eddie, this is futile. You expend way too much energy on trying to convince people.

Looking at this 'neurology' forum, it is interesting to see that the only threads that elicit a number of replies >10 seem to be the ones dealing with the imaging issue. Isn't there anything else to talk about in neuro ?

You're right

Too bad hockey's cancelled. ;-)

 

[f_w]

> Too bad hockey's cancelled. ;-)

At times this 'discussion' does remind me of a couple of crude characters yelling at each other out of toothless mouths.

 

[neurologist]

You're right

Too bad hockey's cancelled. ;-)

Yeah, and NOBODY NOTICED!!!!!!

 

[Celiac Plexus]

as a pgy-2 surgery resident, i can already read CTs of the abd/pelvis, c-spine, and head somewhat well...CXRs are a piece of cake by now. Our neurosurg chief can read head CT in about 1.8 secs flat (slight exagerration).

but the idea that what radiologists do is "easy" and "simple" is frankly ******ed. i am pretty good friends with the whole radiology department since i review every CT with a resident or attending. i have learned 99% of my reading skills from the rads dept., and even though i think i am decent at reading some modalities, the rads folks have caught important things that i've missed many times. can i read a CT a/p? yeah. can a trained rads person read it better, hell yeah.

i think that the push by neurologists to be able to interpret their own studies is completely driven by ca$h. though i really don't give a rat's ass whether the family practice guy winds up winning the privilege of reading pet/ct scans of my left nut. i will always have my films read and interpreted by a u.s. trained radiologist.

i think as time marches by, there are always going to be turf wars. neurology is seeking to gain rights for reading of head studies? big surprise... pretty soon, they'll be wanting to set up fellowships in interventional neuroradiology and want to actually do the studies too... seem crazy? no way. if cardiologists can shoot all manner of angios, can place coronary stents, and now want to do carotid stenting on a grand scale... why not the neurologist? or for that matter, why not anyone with a medical degree? what's the driving force? ca$h.

whatever. i will always work with u.s. trained, board-certified radiologists. that's they're specialty, and they are the masters. if anyone out there has a problem with how much money they make, then that's their problem. if one really cares about money that much, don't pick neurology as a career.

i am pretty fed up with different fields attempting to poach other fields' turf, instead of innovating and coming up with their own new things... wouuldn't that be a better contribution to patient care? this turf thing is nothing but a thinly disguised grab for ca$h.

oh, and i would never ask a radiologist for clinical management advice for a patient. they're my little film biotches, and that's it.

 

[drgirl]

hey celiac plexus--how come you keep emphasizing that you're only going to work with U.S trained radiologists?......I mean, what other ones are you going to come across during residency and beyond? Even foreign trained ones have to repeat their residencies.

 

[hans19]

hey celiac plexus--how come you keep emphasizing that you're only going to work with U.S trained radiologists?......I mean, what other ones are you going to come across during residency and beyond? Even foreign trained ones have to repeat their residencies.

If you've been paying attention, remarks were made that radiology would soon be outsourced overseas to foreign-trained rads.

BTW
Consider this thread 'jacked. Come on... what were people expecting from a thread called 'War with Radiology?'. This is a self-fullfilling prophecy...

 

[drgirl]

If you've been paying attention, remarks were made that radiology would soon be outsourced overseas to foreign-trained rads.

BTW
Consider this thread 'jacked. Come on... what were people expecting from a thread called 'War with Radiology?'. This is a self-fullfilling prophecy...

Ah I see....my apologies, it's just been THAT hard to pay attention to this thread...

 

[Whodathunkit]

In comparison, the shortfall of radiologists in the United States is about 4500 and is projected by some to increase to as much as 15,000 in the next 15 years (of course projections are just speculation). The total number of US radiologists is 35,000 for comparison.

Much like how Derm keeps their #'s of graduates low on purpose...something tells me that despite Radiology programs being aware of this obvious "shortfall of radiologist", they have no intention of graduating more from their programs. More money for them...

You guys talk about how you work so very hard when you're on call. Nonstop is the word I hear alot. Wouldn't it be easier if you had more residents for all these studies that we order. At the very least, you wouldn't be so grumpy at 1AM when I need a read, since you're feeling overwhelmed and those annoying residents keep bothering you when you're on call. I mean...how dare us bother you when you're on call??

 

[Whisker Barrel Cortex]

Much like how Derm keeps their #'s of graduates low on purpose...something tells me that despite Radiology programs being aware of this obvious "shortfall of radiologist", they have no intention of graduating more from their programs. More money for them...

You guys talk about how you work so very hard when you're on call. Nonstop is the word I hear alot. Wouldn't it be easier if you had more residents for all these studies that we order. At the very least, you wouldn't be so grumpy at 1AM when I need a read, since you're feeling overwhelmed and those annoying residents keep bothering you when you're on call. I mean...how dare us bother you when you're on call??

Too bad you are misinformed. The number of radiology spots was decreased significantly due to a governement projection of a glut of radiologists in the early to mid nineties. Many smaller programs closed. The numbers have already gone up from about 900 spots to over a thousand in the past few years and continue to go up. I also suggest you read up on how residency spots are funded. Its through medicare/medicaid and there is a limited supply of money for residents at all programs. While our program asks for new spots, they don't get the funding for them. In fact, the hospital has considered cutting a radiology spot to add it somewhere else. See, its amazing what a little bit of knowledge of the actual background information will do for you.

After having been through a busy medicine internship and radiology call, it is definitely worse in radiology. As for the annoying residents calling us at 1 am, think of it as the same thing as when a nurse calls you for something. If it is something worthwhile, we don't mind. When its something that we feel is unnecessary, we can be kind of grumpy.

 

[Bonobo]

It is mostly about money. But why is that so wrong? Why does radiology typically get the best medical students and fill with US grads every year when neurology does not? It is simply b/c radiologists want to monopolize on their turf and end up making more money b/c of it. Neurologists *must* fight to develop into an interventional/imaging field in order to preserve respect and attract good students back into the field. This is simple economics.

Also, if we want to discuss what's best for patients, simply look at cardiology. They are the kings when it comes to taking care of MIs. If I am a patient with an MI, I would want my imaging, intervention, everything done by a cardiology group. And b/c of their aggressiveness, cardiologists are all over the place and I *know* that I can get treated at a hospital properly for an MI. What about stroke? I have to find a center that has enough stroke neurologists, neuroradiologists and neurosurgeons (all who are in short supply) to be able to cover at least q3 call. The staffing simply isn't there b/c radiologists are not filling the INR slots, and their aren't enough fellowship programs opening up. This is why the cardiologists will be doing all the carotid stents....

I'm sick of turf issues also. Let every neuro-doc who is willing to spend a dedicated year read head CTs and MRIs. Let every neuro-doc who is willing to spend two years learning INR do it. Only then are we going to provide sufficient care for our patients. If we are not willing to work together on this, then the cardiologists are going to take over again (and I will join their camp instead).

B

 

[Whisker Barrel Cortex]

It is mostly about money. But why is that so wrong? Why does radiology typically get the best medical students and fill with US grads every year when neurology does not? It is simply b/c radiologists want to monopolize on their turf and end up making more money b/c of it. Neurologists *must* fight to develop into an interventional/imaging field in order to preserve respect and attract good students back into the field. This is simple economics.

Also, if we want to discuss what's best for patients, simply look at cardiology. They are the kings when it comes to taking care of MIs. If I am a patient with an MI, I would want my imaging, intervention, everything done by a cardiology group. And b/c of their aggressiveness, cardiologists are all over the place and I *know* that I can get treated at a hospital properly for an MI. What about stroke? I have to find a center that has enough stroke neurologists, neuroradiologists and neurosurgeons (all who are in short supply) to be able to cover at least q3 call. The staffing simply isn't there b/c radiologists are not filling the INR slots, and their aren't enough fellowship programs opening up. This is why the cardiologists will be doing all the carotid stents....

I'm sick of turf issues also. Let every neuro-doc who is willing to spend a dedicated year read head CTs and MRIs. Let every neuro-doc who is willing to spend two years learning INR do it. Only then are we going to provide sufficient care for our patients. If we are not willing to work together on this, then the cardiologists are going to take over again (and I will join their camp instead).

B

The cardiologists and vascular surgeons are doing peripheral work, to the detriment, not the benefit of patients at this point in time. They decided they wanted to do it, so they started. Ask any tech that has worked with them, and they'll tell you how painful these procedures are when performed by non-radiologists. They often take longer, have more radiation exposure, and use more catheters/equipment than interventional rads do. This doesn't sound like a benefit to patients. It actually hurts patient care. Making money is great, but when you barge into a procedure that someone else already does better just for the sake of TURF and patients suffer, its wrong in my opinion.

 

[Bonobo]

The cardiologists and vascular surgeons are doing peripheral work, to the detriment, not the benefit of patients at this point in time. They decided they wanted to do it, so they started. Ask any tech that has worked with them, and they'll tell you how painful these procedures are when performed by non-radiologists. They often take longer, have more radiation exposure, and use more catheters/equipment than interventional rads do. This doesn't sound like a benefit to patients. It actually hurts patient care. Making money is great, but when you barge into a procedure that someone else already does better just for the sake of TURF and patients suffer, its wrong in my opinion.

That was the argument made before cardiologists took over IR in the first place. The truth is that MI care wouldn't be nearly what it is today if cardiologists hadn't taken over their turf. Who is going to do all of the carotid stents? The 34 radiology residents each year who decide to leave their 50 hr/wk $300,000 lifestyles to enter IR? The US needs a system to help the 700,000 strokes a year. How are 400 INR folks going to take care of all these strokes? And prevent many more? And of course, even if we can train another 500 INR people (good luck with 20-something fellowship programs) they better be willing to distribute themselves as much as possible. Look, if there is a specially trained INR person available, then I would go for that any day over a cardiologist or a vasc surgeon. But most hospitals can't even find one, much less 3 to cover them 24/7.

This is not for the sake of turf. My own very large university hospital cannot get an INR doc. So the cardiologist and the vasc surgeon split the carotid stenting. Intracranial procedures? We tried letting the neuroradiologists do them, but with no real success. They are looking for INR people, but can't find even one without having to pay an obscene salary. So what do you think the hospital is going to do?

Are you sure money shouldn't matter? Where do you think the hospital finds funding to pay for its nursing, thousands of MRI's, plumbing etc?

B

 

[neglect]

The problem with specialists reporting their own studies as has been suggested by two of the neurology people here is

1. when all you have are hammers, everything looks like a nail. Specialists deal with a certain range of pathology relevant to their own specialty and do not have experience with other lesions. How many cholesterol granulomas have you seen? How many traumatic ossicular disruptions? How many retropharyngeal abscesses? How many chondrosarcomas of the skull? How many meningoencephaloceles? These are picked up on head imaging all the time. Do you propose to send every study to a neurologist, neurosurgeon, ENT, orthopod? Or will a 2- week refresher course in Hawaii prepare you?

2. it is impossible to predict when lesions outside your scope of knowledge will arise. Since you have no training in dealing with them, it is not necessarily the case that you will even identify them, let alone diagnose / refer correctly.

And yet you propose to continue to allow general radiology read any films at all?

3. it is incorrect to think that you have more experience with the imaging findings of diseases you treat regularly compared to a radiologist. your entire days clinic would flow through a single radiologist in the time of 1-2 of your clinical encounters. radiologists have orders of magnitude more image volume exposure than clinicians.

And yet you propose to continue to allow residents read films over night? And yet being a part time radiologist is OK?

4 along the same lines, radiologists have more knowledge of imaging physics, artifacts, troubleshooting imaging problems etc. etc. that are everyday issues in the radiology department that you are completely shielded from when you drop by.

Yeah, T2 recovery times are vital to reading images. No clinician could even grasp the concept of radio frequency applied across a stable magnetic field, much less it's importance.

The bottom line is that this skill set is just that, a skill set. It can be learned by anyone.

 

[eddieberetta]

And yet you propose to continue to allow general radiology read any films at all?

ummm..yes. Beacuse radiologists, unlike neurologists receive extensive training in intracranial, extracranial, osseous and soft tissue lesions that are seen on routine "neuro" exams, I propose that radiologists should read films. Do you think mere "general" neurologists should treat MS?

And yet you propose to continue to allow residents read films over night? And yet being a part time radiologist is OK?

do neurology residents make prelim diagnoses overnight? Do you prescribe meds? I guess we shouldn't allow that.

Yeah, T2 recovery times are vital to reading images. No clinician could even grasp the concept of radio frequency applied across a stable magnetic field, much less it's importance.

It's a different story when you have to supervise the department yourself, protocol studies, and make sure your dept and the imaging you sign on is up to par. The sad thing is that you don't even know what you don't know.

The bottom line is that this skill set is just that, a skill set. It can be learned by anyone.

Absolutely. Just do a radiology residency. (Obviously neurology is no different)

 

[Whodathunkit]

Too bad you are misinformed. The number of radiology spots was decreased significantly due to a governement projection of a glut of radiologists in the early to mid nineties. Many smaller programs closed. The numbers have already gone up from about 900 spots to over a thousand in the past few years and continue to go up. I also suggest you read up on how residency spots are funded. Its through medicare/medicaid and there is a limited supply of money for residents at all programs. While our program asks for new spots, they don't get the funding for them. In fact, the hospital has considered cutting a radiology spot to add it somewhere else. See, its amazing what a little bit of knowledge of the actual background information will do for you.

After having been through a busy medicine internship and radiology call, it is definitely worse in radiology. As for the annoying residents calling us at 1 am, think of it as the same thing as when a nurse calls you for something. If it is something worthwhile, we don't mind. When its something that we feel is unnecessary, we can be kind of grumpy.

In comparison, the shortfall of radiologists in the United States is about 4500 and is projected by some to increase to as much as 15,000 in the next 15 years (of course projections are just speculation). The total number of US radiologists is 35,000 for comparison.

So what you're saying is a short from the early to mid nineties(I'll give you 1990-1995) caused an exponential decrease in radiology spots....a SHORTFALL of 15,000?? Something doesn't quite seem right.

In fact, the hospital has considered cutting a radiology spot to add it somewhere else.

Maybe your hospital should spend one night on call with you(to see how hard you really are working)...or maybe they should just call you at 1AM for some advice...

 

[Whisker Barrel Cortex]

So what you're saying is a short from the early to mid nineties(I'll give you 1990-1995) caused an exponential decrease in radiology spots....a SHORTFALL of 15,000?? Something doesn't quite seem right.

Its really not that hard to understand, man. They PREDICTED a oversupply, causing many spots to close. At that point there WAS no shortage. In fact the job market was tight. Imaging has become the way to diagnose or rule out so many things that the volume of studies have increased greatly. This, combined with retiring rads, has led to a shortfall. Once this was realized, more spots are slowly being added. However, it will take many years to increase the spots enough to cover the shortage. Opening up a new program doesn't happen overnight.

 

[eddieberetta]

So what you're saying is a short from the early to mid nineties(I'll give you 1990-1995) caused an exponential decrease in radiology spots....a SHORTFALL of 15,000?? Something doesn't quite seem right.

Well the other factor is the marked rise in imaging utilization. The projections of the shortfall of radiologists vary so much because they factor in continued increasing utilization, but the rate if increase is uncertain. Some of the apparent shortfall in manpower has been made up for by increasing productivity per radiologist [i.e. radiologists are working faster, largely because of pacs, and longer hours than previously].

Addendum: Oops, did not see the previous post when I composed this one...

 

[Whodathunkit]

Imaging has become the way to diagnose or rule out so many things that the volume of studies have increased greatly.

OK. I can definitely see this as a cause. And unfortunately, I don't see this changing in the near future(thanks to lawyers) as physicians practice more and more defensive medicine.

Ah...long gone are the days when physicians used to diagnose pneumonias with a stethoscope.


Back to the topic, sort of:

At our institution,we are also having problems with recruiting a IR(and mostly for financial reasons as it seems we just can't seem to make a worthy offer).

Why are the asking salaries so high? Radiologists don't want people invading on their "turf", yet they don't want people who want to be properly trained to do those procedures to have the jobs. And those people I'm sure would accept a lower salary than the ones that radiologists feel are beneath them since they can get twice that much in private practice.

Sure the hospital is being cheap, and sure the CEO of the hospital makes alot so he should just fork it over if they truly need a IR, but the people that lose out the most are the patients.

 

[Celiac Plexus]

Back to the topic, sort of:

At our institution,we are also having problems with recruiting a IR(and mostly for financial reasons as it seems we just can't seem to make a worthy offer).

Why are the asking salaries so high? Radiologists don't want people invading on their "turf", yet they don't want people who want to be properly trained to do those procedures to have the jobs. And those people I'm sure would accept a lower salary than the ones that radiologists feel are beneath them since they can get twice that much in private practice.

Sure the hospital is being cheap, and sure the CEO of the hospital makes alot so he should just fork it over if they truly need a IR, but the people that lose out the most are the patients.

You seem to be saying, in a roundabout sort of way, that radiologists are greedy and don't care about patients. I disagree.

Radiologists are skilled workers that try to get compensated as much as possible for the work they do. There is nothing wrong with that, and in fact this dynamic is the cornerstone of our open market system.

Blaming radiologists for turning down subpar job offers as a reason for compromised patient care is ridiculous. What exactly do you propose they do? Take a below-market job offer just because your hospital needs them? America doesn't work like that. At the moment, hospitals need radiologists more than radiologists need hospitals. I'm sure the CEO of your hospital eeked out every penny he could get when he negotiated his contract. If your hospital really needs an interventional radiologist to avoid compromising patient care, by your logic the CEO should be the one to take a pay cut.