What is causing the resurgence of the radiology job market?

[vm26]

At a certain volume of work, even the best radiologist will produce reports approaching a mid level quality

not sure if the recent imaging surge is short lived from Covid. But if this is here to stay, we need more radiologists trained

I think part of the surge is Covid related-easier/more desirable to triage a pt through the scanner than having to get up close and do a thorough physical exam.

Also more mid-levels, particularly in the ED which equals more imaging.

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[Taurus]

I read a lot slower than you, and would probably gain more from a midlevel than someone who has reached maximum reading efficiency. From people who have used the rad extenders (which I’m guessing would be similar to the theoretical midlevel) they are like senior residents or early fellows in report quality. And I generally do gain efficiency with that level of trainee

Lol. I think you just proved my point about economics. For you, you say you're a slow reader and having any kind of help is beneficial, whether resident/fellow/midlevel. It’s no secret that many radiologists in academic ivory towers never pick up a dictaphone. That's why they depend on residents and fellows to dictate the reports for them. They also type by pecking out each letter on the keyboard like a chicken so it takes them forever to put out a report themselves. It's funny stuff. So, maybe you're one of those academic types? If you’re that slow, you probably won’t do well outside of academia where you most often read independently without help. In private practice, you need to be a fast, efficient, and accurate reader with good general and procedural skills if you ever hope to make partner. Private practice is a very lean machine.

I'm not arguing about the abilities or skills of midlevels. For fun, let's just play devil's advocate and say that we could train a midlevel to the level of a senior resident or even attending, especially in one area such as plain films. No matter how skilled or knowledgeable the midlevel is, you cannot escape two things. 1) You still need to sit down with midlevel to review the images. 2) You still need to read through their reports for errors because the final report ultimately has your name on it and you're responsible for it medicolegally. You can't just sign off on their interpretations and reports blindly. Otherwise, that's fraud and you can go to prison like this radiologist did. Or, the midlevel will miss a critical finding, there will be a bad outcome, and you will be named in a lawsuit. Remember, images do not change and can be preserved indefinitely for the lawyers to comb through to look for mistakes. What will be your defense? "Your honor, I didn't look through the images. My midlevel did. I just signed off on his report." 😆 Let’s see how well that defense plays in court, state medical boards, with the annual credentialing committee at your hospital, and your insurance company. I have served as expert witness for several lawsuits. Losing or forced to settle a malpractice lawsuit can be detrimental to your career. Whenever you renew your state licenses or hospital privileges, they ask if you have been named in malpractice lawsuits and explain the outcomes.

Atlanta Radiologist Guilty of Fraudulently Passing Off Diagnoses Prepared by Non-Physician Employees

archives.fbi.gov

Does using residents/fellows/midlevels increase your RVU production compared to radiologists who read independently? Based on everything I've said, the answer is obviously no. I can put out final reports electronically for a normal chest plain film in 5 seconds and normal CT abdomen and pelvis in 5 minutes. Again I ask, where is the efficiency gain by using midlevels? Midlevels could only increase your RVU production if you don’t need to review the images and read their reports closely. Basically, blindly sign off their work. The radiologist in the above article ran such a scheme and is now in prison for fraud. Low end procedures can be performed competently and independently by a trained and experienced midlevel. If I trust a midlevel, I don’t need to micromanage a para or thora. This is where midlevels can increase your RVU production, assuming it covers the expense of keeping the midlevel on the payroll. The only other way midlevels could increase RVU production for the radiologist or group is if the government and insurance companies allow them to independently interpret imaging studies and finalize reports. I don’t see that happening anytime soon. Which radiology group would hire and risk the liability of midlevels interpreting and finalizing reports independently? Who would trust the report of a CT or MRI study put out by an independent NP? Lol. 🤣

I have worked in two private practice groups in my career so far and I have colleagues in other groups across the country. For the vast majority of private practice groups, RVU production is the most important metric they measure. Your group's individual partner take-home pay depends on it. Midlevels not only decrease your RVU production but they also require salaries and benefits. Where is that money coming from? How much lower in salary are you and your partners willing to accept so that you can afford to have the luxury of midlevels? How are you going to attract new radiologists to your group if your pay is significantly below the regional and national averages because you're slow and need midlevels to dictate reports for you? You know what happens to most radiologists in private practice who aren't productive enough? They get fired and wander the country looking for employment opportunities, usually as lowly paid locums.

As you saw during this pandemic, even huge tertiary medical centers are not immune from the laws of economics. Many hospitals and radiology departments saw large drops in volumes. Many hospitals had layoffs. My buddies in academia tell me how their radiology departments are starting to focus on RVU now too.

Because midlevels do not increase RVU production in image interpretations which is where the bulk of the profits in radiology come from, they will never be utilized widely in radiology. That's why the economics work against midlevels in radiology and why radiology is not in danger of midlevel encroachment. The business model for midlevels in radiology is very limited. Midlevels have a niche role in radiology, mostly low end procedures, IR consults, and scutwork. It makes no financial sense to use midlevels in image interpretations. Other fields such as primary care, anesthesia, and ED allowed their midlevels to be almost interchangeable with physicians, which was a huge mistake because you need a large moat separating the roles of midlevels and physicians. That's not the case with radiology. There are other forces that are more concerning in radiology. Specifically, corporate radiology and Wall $treet.

4. Triaging cases in rads is easy. Any screening exam, including mammo, ldct, hcc us, etc or outpatient spine or ppd+ chest radiographs, these are all relatively simple studies most of the time.

Lol. Are you still a resident? That multimillion dollar lawsuit may start off as a new 3 mm grouping of pleomorphic calcifications that your midlevel blows off on the screening mammogram. Anyways, I'm done with this inane discussion.

$16.7 Million Judgment in Boston Cancer Misdiagnosis Lawsuit - The Sanders Firm

A cancer misdiagnosis can mean the difference between life and death for affected patients. Misread test results, CAT scans, X-rays and blood work happen

thesandersfirm.com

https://www.thestate.com/news/local/article56055575.html

 

[GadRads]

I can put out final reports electronically for a normal chest plain film in 5 seconds and normal CT abdomen and pelvis in 5 minutes.

I think you must be in the very upper percentile in speed. I can read a normal chest xray in 15-20 secs (mainly checking for that small nodule or trace to small PTX, and checking bones for subtle lesions), sign a normal CT abd/pel in 7-10 mins, and a normal CT head in 3-4 mins. The fastest radiologist I met would sign a normal chest xray in 2-3 secs (he is a thoracic radiologist) and a CT abdomen pelvis in 5-6 minutes. But he would miss stuff on occasion that slower radiologists wouldn't miss. Aren't you worried about missing subtle abnormalities at that speed?

 

[Cognovi]

The point of midlevels is so that you can have more work signed under your name (with the added reimbursement and added medicolegal liability) without doing proportionately more actual work. People signing off midlevel reports do save time compared to dictating it themselves (this was the point of the retracted Penn-JACR paper), because you cut some corners such as the prior is all measured out already, you don't have to dig through the chart for history, you don't have to say as many words and proofread, etc. It's a slim margin to squeeze but you better believe people will try to squeeze it. It all comes down to whether that squeeze is worth the pay of a midlevel, or worth the satisfaction of not having to read studies you don't like to read (eg, the portable ICU chest radiographs).

 

[Radology]

5 minutes for a normal belly CT is probably average to below average speed nationwide

a complicated metastatic workup should take easily 2-3x as long when you consider all the measurements, prior comparisons, dictating more than a blank template.

if it takes you 10 minutes to read a normal study, that means it takes 20-30 for a complicated one. That is unreasonably slow

 

[GadRads]

5 minutes for a normal belly CT is probably average to below average speed nationwide

a complicated metastatic workup should take easily 2-3x as long when you consider all the measurements, prior comparisons, dictating more than a blank template.

if it takes you 10 minutes to read a normal study, that means it takes 20-30 for a complicated one. That is unreasonably slow

10 mins is on the high end, which accounts for interruptions. Uninterrupted it takes me about 7 mins (some of this time includes looking at comparisons/chart/labs/history). I like to look at the history/chart. I have seen body-trained academic attendings spend 40 mins on complicated metastatic workups.

 

[Gadofosveset]

10 mins is on the high end, which accounts for interruptions. Uninterrupted it takes me about 7 mins (some of this time includes looking at comparisons/chart/labs/history). I like to look at the history/chart. I have seen body-trained academic attendings spend 40 mins on complicated metastatic workups.

Definitely takes longer in tertiary center academics to read a study, but it’s a different game, where the patients are at the end of the line with 3 different cancers, post multiple lines of therapy, and the referring clinicians want to hear each and every tiny detail. Totally ok that these cases take way more time.

 

[Gadofosveset]

Also, the “midlevel” question is interesting... it’s hard to know what it really means for the future.

First of all, from having worked with them there really is a knowledge gap. No question. And somewhat of a knowledge ceiling because they didn’t go to medical school BUT this true in every midlevel scenario. I imagine some EM docs probably said they could never be a threat because they can’t perform a complex resuscitation or whatever. Admin don’t care.

it’s also true that their relative value depends on the practice. They’re more valuable in academics so that they can offload some of the scut clinical work to focus on tougher cases, go to tumor boards, teach residents, etc. I’ve only ever seen “midlevels” negatively effect resident teaching in IR. On other services it’s actually been a plus because it can free up teaching time.

I agree that their utility would go way down in a high volume practice, but as someone pointed out, if you bring the volume up enough the quality goes lower and lower, so folks in these practices may be less protected than they think. If it’s clear that a high volume group’s reports are basically rapidly generated templates with little information, there will be no tears shed by outsiders if they are increasingly displaced by cheaper folks who can do same.

I’m not a big fan of the ACR and I’m not a member, but there is a kernel of truth to the idea that you can’t understaff and keep demand (and salary) for your services artificially high. If health system needs hit a critical point, it’s not that they will just pay more and more to the radiology department - they will start dismantling norms and conventions in the name of “progress.” Take US for instance. Training and leveraging sonographers did not really destroy the discipline by making an important part of the skill mobile. But it is really threatened by not being on demand, allowing POCUS to keep ramping up and other divisons to carve off bits of the service.

Workforce management over the heterogeneous practice patterns in the US is a tough problem with no easy solutions. Hopefully we as a whole can keep it in balance - and I agree with an earlier poster - the real imminent threat is corporate radiology. They will make long term considerations moot pretty stat.

 

[Cognovi]

IMO POCUS took off not because sonographers were not available, but because POCUSers are doing simpler, different, more rapid bedside evaluations than what they ever saw as possible in "formal" ultrasound in the radiology department. Radiologists don't even know how to interpret lung ultrasound, but that is bread and butter of POCUS.

Other divisions carved off bits of ultrasound service not because of radiology unavailability, in my perception. After hours and weekend vascular ultrasounds are still largely interpreted by radiology. At my place, after hours first trimester obstetric ultrasounds are interpreted by radiology while daytime emergency obstetric scans go to the ob-gyn MFM group. Both services use similarly credentialed sonographers. It was all turf gamesmanship that led to the current arrangement. You might say, well those are low-reimbursement, high-liability, unsatisfying-to-read studies so good riddance. But if you give it up you're not getting it back.

 

[Gadofosveset]

IMO POCUS took off not because sonographers were not available, but because POCUSers are doing simpler, different, more rapid bedside evaluations than what they ever saw as possible in "formal" ultrasound in the radiology department. Radiologists don't even know how to interpret lung ultrasound, but that is bread and butter of POCUS.

Other divisions carved off bits of ultrasound service not because of radiology unavailability, in my perception. After hours and weekend vascular ultrasounds are still largely interpreted by radiology. At my place, after hours first trimester obstetric ultrasounds are interpreted by radiology while daytime emergency obstetric scans go to the ob-gyn MFM group. Both services use similarly credentialed sonographers. It was all turf gamesmanship that led to the current arrangement. You might say, well those are low-reimbursement, high-liability, unsatisfying-to-read studies so good riddance. But if you give it up you're not getting it back.

I think much of what you’re saying is true, but, from having sat in on the meetings on this regarding ED POCUS, the official rationale - whether true or not — is radiologist availability and TAT. For vascular US it’s a little more complicated because it involves referral patterns and nebulous arguments about quality, but availability was also an issue and admins care more about that than nebulous quality. I do agree with you that once it’s gone it’s hard to get back except outside of normal business hours.

The main point is that in this age of health care you can sink yourself with oversupply, but you can’t protect yourself with undersupply because big health systems are absolutely motivated to “innovate” you right out of existence (to the sound of fanfare and with glossy brochures) - look at Kaiser advertising mammogram reads within minutes. TAT is only going to decrease until it’s instant. Volumes are probably going to go up too. If you try to stonewall systems with undersupply, they will find a way around you. It’s a tough balance.

 

[Cognovi]

I think much of what you’re saying is true, but, from having sat in on the meetings on this regarding ED POCUS, the official rationale - whether true or not — is radiologist availability and TAT. For vascular US it’s a little more complicated because it involves referral patterns and nebulous arguments about quality, but availability was also an issue and admins care more about that than nebulous quality. I do agree with you that once it’s gone it’s hard to get back except outside of normal business hours.

The main point is that in this age of health care you can sink yourself with oversupply, but you can’t protect yourself with undersupply because big health systems are absolutely motivated to “innovate” you right out of existence (to the sound of fanfare and with glossy brochures) - look at Kaiser advertising mammogram reads within minutes. If you try to stonewall them with undersupply, they will find a way around you. It’s a tough balance.

Hilarious since I've seen vascular ultrasounds are not signed off by the vascular surgeons for days or a week after the sonographer puts out the prelim report; and the POCUS images are not saved in a way available to anyone else in the hospital for review and comparison.

Agree with you that workforce is a tough balance of supply and demand. Making yourself scarce just gives justification for displacement.

 

[Gadofosveset]

Hilarious since I've seen vascular ultrasounds are not signed off by the vascular surgeons for days or a week after the sonographer puts out the prelim report; and the POCUS images are not saved in a way available to anyone else in the hospital for review and comparison.

Ha - right? It’s painfully ironic when I get calls from the floor about why this vascular US was not done/read and I have to tell them that a different group handles it — but that’s the thing — it’s all bollocks. They made that argument - at least here - to take control of it, now it seems they often do a **** job, esp w “customer service,” but it will be hard to get back. This is exactly what would happen with midlevels, too, and the key to the door it seems to me in many cases is TAT/availability. It’s a really tough problem.

 

[Gadofosveset]

It kind of seems like a gentle undersupply would be the best way to go, but since the needs can shift quickly (based really on politics and health system competition) and since there’s a six year training lag, it’s impossible to really get it spot on.

A little bit of a tangent, but specialization is also a bit of a problem. I think Rich Duszak talks about this somewhere. For instance, for IR the majority of what’s needed in the US is basic light IR kind of stuff, ports, paras, etc, but IRs are now identifying more with high end procedures and DRs have less and less needle experience. It opens important gaps that midlevels fill. You also can’t have every knee MRI in the US read by a specialist. Multispecialists are anathema to academic centers (well , they make use of them but don’t value them), but given current pressures, these multispecialist rads are the ones who will keep the specialty viable, IMO. Back to the main topic, that’s part of why the demand is up. Systems need solid multispecialists to fill need gaps out there.

 

[Neopolymath]

It kind of seems like a gentle undersupply would be the best way to go, but since the needs can shift quickly (based really on politics and health system competition) and since there’s a six year training lag, it’s impossible to really get it spot on.

Specialization is also a bit of a problem. I think Rich Duszak talks about this somewhere. For instance, for IR the majority of what’s needed in the US is basic light IR kind of stuff, ports, paras, etc, but IRs are now identifying more with high end procedures and DRs have less and less needle experience. It opens important gaps that midlevels fill. Multispecialists are anathema to academic centers (well , they make use of them but don’t value them), but given current pressures, these multispecialist rads are the ones who will keep the specialty viable, IMO...

It seems like DR residents should prioritize learning these light IR skills so that they maximize their flexibility and marketability while job hunting. They shouldn't even be called light IR, IMO. They are just basic radiological procedures that all rads should be comfortable doing. I would be disappointed with myself if I didn't feel comfortable doing these things after training. It also causes the issue you mentioned in your post about the vacuum in that service line. As usual, physicians are their own worst enemy. We leave the door open by turning our noses up the blue collar work and fighting with each other.

 

[CallMeBigJeff]

I can put out final reports electronically for a normal chest plain film in 5 seconds and normal CT abdomen and pelvis in 5 minutes.

Damn... I wanna read as fast as you when I grow up, just matched DR

 

[GadRads]

Look at tables 1 and 2: DEFINE_ME " The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study". It's clear that the faster you read, the more you miss.

In principle, one could read a "normal" CT abdomen/pelvis without technical issues in about 3 mins, but the additional 3-4 mins is spent on subtle stuff, looking at labs, and checking a brief hx. On occasion doing these things have helped me avoid an important miss.

 

[vm26]

Look at tables 1 and 2: DEFINE_ME " The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study". It's clear that the faster you read, the more you miss.

In principle, one could read a "normal" CT abdomen/pelvis without technical issues in about 3 mins, but the additional 3-4 mins is spent on subtle stuff, looking at labs, and checking a brief hx. On occasion doing these things have helped me avoid an important miss.

Yea, problem is these "normal" exams are sometimes abnormal

 

[Taurus]

Look at tables 1 and 2: DEFINE_ME " The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpretation Errors: A Pilot Study". It's clear that the faster you read, the more you miss.

In principle, one could read a "normal" CT abdomen/pelvis without technical issues in about 3 mins, but the additional 3-4 mins is spent on subtle stuff, looking at labs, and checking a brief hx. On occasion doing these things have helped me avoid an important miss.

I don’t disagree that everyone in medicine is overworked. I wish I had more time to review the ED notes and lab work when I read a study. If I have a question, I call up the ED and get my clinical info before I finalize my report. If you take longer than 5 minutes to read a stone-cold normal CT abdomen and pelvis, then how long does it take you to read one with significant or incidental findings? As you spend time looking up the clinical notes and lab work or include in your report insignificant incidental findings like mild atherosclerosis of the aorta, your list grows longer and longer by the minute. Your phone is ringing off the hook because the ED is calling you constantly asking about that CT or ultrasound they ordered 30 minutes ago. Before you know it, you’re 1-2 hours behind but your group has contractually agreed to read stat ED studies in 30 minutes. Let’s see how your group likes that and whether you make partner or even keep your job. The group will expect you to get more efficient and faster each day til you are within 20% of the group average typically. I’m at best average speed reader in my group. Whenever the government cuts reimbursement, everyone tries to cram more in the same amount of time to maintain their current level of income. Like it or not, radiology is no different. You need to read more studies per hour to produce the same RVU compared to 10 years ago. Radiology is not alone. Speed and efficiency are paramount in most private practice settings in most medical fields. Most primary care doctors or other clinicians probably also wish they had more than 15 minutes for each patient encounter but that’s all the time that their groups or hospital systems will allow. It is what it is. I’m not saying I support what medicine has become and how screwed up it is in this country. “Hate the game and not the player.” You have to adapt to your position or be at risk of losing it. I wasn’t that fast when I finished training but I learned quickly that I had to improve my speed or I won’t have a job for long. The biggest timesavers are memorizing and executing your search pattern quickly and only once, using macros/templates, don’t include insignificant incidental findings, and developing your verbiage that you will repeatedly use.

 

[GadRads]

I don’t disagree that everyone in medicine is overworked. I wish I had more time to review the ED notes and lab work when I read a study. If I have a question, I call up the ED and get my clinical info before I finalize my report. If you take longer than 5 minutes to read a stone-cold normal CT abdomen and pelvis, then how long does it take you to read one with significant or incidental findings? As you spend time looking up the clinical notes and lab work or include in your report insignificant incidental findings like mild atherosclerosis of the aorta, your list grows longer and longer by the minute. Your phone is ringing off the hook because the ED is calling you constantly asking about that CT or ultrasound they ordered 30 minutes ago. Before you know it, you’re 1-2 hours behind but your group has contractually agreed to read stat ED studies in 30 minutes. Let’s see how your group likes that and whether you make partner or even keep your job. The group will expect you to get more efficient and faster each day til you are within 20% of the group average typically. I’m at best average speed reader in my group. Whenever the government cuts reimbursement, everyone tries to cram more in the same amount of time to maintain their current level of income. Like it or not, radiology is no different. You need to read more studies per hour to produce the same RVU compared to 10 years ago. Radiology is not alone. Speed and efficiency are paramount in most private practice settings in most medical fields. Most primary care doctors or other clinicians probably also wish they had more than 15 minutes for each patient encounter but that’s all the time that their groups or hospital systems will allow. It is what it is. I’m not saying I support what medicine has become and how screwed up it is in this country. “Hate the game and not the player.” You have to adapt to your position or be at risk of losing it. I wasn’t that fast when I finished training but I learned quickly that I had to improve my speed or I won’t have a job for long. The biggest timesavers are memorizing and executing your search pattern quickly and only once, using macros/templates, don’t include insignificant incidental findings, and developing your verbiage that you will repeatedly use.

In residency, the referrers used to demand that all outside imaging be re-read by our subspecialty radiologists due to higher miss rates on outside studies and misdirections. But without a doubt private practice radiologists read at a faster pace, read a higher volume, and read across several subspecialties which is very challenging. If academic radiologists had to read at that pace and volume across several specialties, I believe they would miss just as much. But it's sad to see what medicine has become.

 

[Gadofosveset]

In residency, the referrers used to demand that all outside imaging be re-read by our subspecialty radiologists due to higher miss rates on outside studies and misdirections. But without a doubt private practice radiologists read at a faster pace, read a higher volume, and read across several subspecialties which is very challenging. If academic radiologists had to read at that pace and volume across several specialties, I believe they would miss just as much. But it's sad to see what medicine has become.

I think something that gets overlooked is that the two styles are complementary. You can’t read everything at academic detail pace for the general public. You can’t read a complicated cancer patient in 5 min. The right patients just have to be routed to the right readers and the right expectations in place.

Case in point: it took me 30 min to read a cancer follow up yesterday, which was frustrating, but in looking back at it, kind of unavoidable. I looked at the most recent oncology note to try to figure out what they wanted to know to try to focus my report. This revealed that the prior readers had kind of missed the point on the prior two scans, so it was necessary to sort of correct for this. Then just about every organ system (biliary, renal, vascular, pancreas, peritoneum) was becoming compromised in ways that needed intervention. There was a new metastasis (have to check priors to be sure). Have to make a couple of measurements of the primary but make sure they’re in the same plane as prior. Have to contact the oncologist about the actionable stuff. Total result: 30 min. Could I have read this in 10 min? Sure, but I would have missed at least some of the actionable stuff and I probably would have fallen into the trap of copying the misleading priors. Not the way I would want my mom’s scan to have been read (or mine!)

Then I read a LLQ pain case in <10 min.

It all depends on the kinds of cases you’re reading. The main mistake I think is to read them all at the same speed. It’s hard to argue that that’s good medicine.

 

[90sportsfan]

Or $16 million ...

$16.7 million award in cancer lawsuit - The Boston Globe

A jury has awarded $16.7 million to the daughter of a Boston woman who died of lung cancer after a Brigham and Women’s Hospital radiologist missed evidence of the cancer in a chest X-ray. The verdict is the largest this year in a medical malpractice case in Massachusetts.

www.bostonglobe.com

Scary! This is one of the things that scares me most about radiology. Dr. Clarke was trained and working at B&W, and still had a big miss like this, which cost him big time.

Looking online now, it doesn't look like Dr. Clarke is currently at B&W, as there is no listing for him on the institution website and other sites list that his Mass license expired in 2017.

His current affiliation can't be found, which makes you wonder if this one mistake tanked his career. This type of risk alone will prevent any substantial mid level encroachment. The $16 million verdict was the third largest in hospital history.

 

[radsresident-US]

Lol. I think you just proved my point about economics. For you, you say you're a slow reader and having any kind of help is beneficial, whether resident/fellow/midlevel. It’s no secret that many radiologists in academic ivory towers never pick up a dictaphone. That's why they depend on residents and fellows to dictate the reports for them. They also type by pecking out each letter on the keyboard like a chicken so it takes them forever to put out a report themselves. It's funny stuff. So, maybe you're one of those academic types? If you’re that slow, you probably won’t do well outside of academia where you most often read independently without help. In private practice, you need to be a fast, efficient, and accurate reader with good general and procedural skills if you ever hope to make partner. Private practice is a very lean machine.

I'm not arguing about the abilities or skills of midlevels. For fun, let's just play devil's advocate and say that we could train a midlevel to the level of a senior resident or even attending, especially in one area such as plain films. No matter how skilled or knowledgeable the midlevel is, you cannot escape two things. 1) You still need to sit down with midlevel to review the images. 2) You still need to read through their reports for errors because the final report ultimately has your name on it and you're responsible for it medicolegally. You can't just sign off on their interpretations and reports blindly. Otherwise, that's fraud and you can go to prison like this radiologist did. Or, the midlevel will miss a critical finding, there will be a bad outcome, and you will be named in a lawsuit. Remember, images do not change and can be preserved indefinitely for the lawyers to comb through to look for mistakes. What will be your defense? "Your honor, I didn't look through the images. My midlevel did. I just signed off on his report." 😆 Let’s see how well that defense plays in court, state medical boards, with the annual credentialing committee at your hospital, and your insurance company. I have served as expert witness for several lawsuits. Losing or forced to settle a malpractice lawsuit can be detrimental to your career. Whenever you renew your state licenses or hospital privileges, they ask if you have been named in malpractice lawsuits and explain the outcomes.

Atlanta Radiologist Guilty of Fraudulently Passing Off Diagnoses Prepared by Non-Physician Employees

archives.fbi.gov

Does using residents/fellows/midlevels increase your RVU production compared to radiologists who read independently? Based on everything I've said, the answer is obviously no. I can put out final reports electronically for a normal chest plain film in 5 seconds and normal CT abdomen and pelvis in 5 minutes. Again I ask, where is the efficiency gain by using midlevels? Midlevels could only increase your RVU production if you don’t need to review the images and read their reports closely. Basically, blindly sign off their work. The radiologist in the above article ran such a scheme and is now in prison for fraud. Low end procedures can be performed competently and independently by a trained and experienced midlevel. If I trust a midlevel, I don’t need to micromanage a para or thora. This is where midlevels can increase your RVU production, assuming it covers the expense of keeping the midlevel on the payroll. The only other way midlevels could increase RVU production for the radiologist or group is if the government and insurance companies allow them to independently interpret imaging studies and finalize reports. I don’t see that happening anytime soon. Which radiology group would hire and risk the liability of midlevels interpreting and finalizing reports independently? Who would trust the report of a CT or MRI study put out by an independent NP? Lol. 🤣

I have worked in two private practice groups in my career so far and I have colleagues in other groups across the country. For the vast majority of private practice groups, RVU production is the most important metric they measure. Your group's individual partner take-home pay depends on it. Midlevels not only decrease your RVU production but they also require salaries and benefits. Where is that money coming from? How much lower in salary are you and your partners willing to accept so that you can afford to have the luxury of midlevels? How are you going to attract new radiologists to your group if your pay is significantly below the regional and national averages because you're slow and need midlevels to dictate reports for you? You know what happens to most radiologists in private practice who aren't productive enough? They get fired and wander the country looking for employment opportunities, usually as lowly paid locums.

As you saw during this pandemic, even huge tertiary medical centers are not immune from the laws of economics. Many hospitals and radiology departments saw large drops in volumes. Many hospitals had layoffs. My buddies in academia tell me how their radiology departments are starting to focus on RVU now too.

Because midlevels do not increase RVU production in image interpretations which is where the bulk of the profits in radiology come from, they will never be utilized widely in radiology. That's why the economics work against midlevels in radiology and why radiology is not in danger of midlevel encroachment. The business model for midlevels in radiology is very limited. Midlevels have a niche role in radiology, mostly low end procedures, IR consults, and scutwork. It makes no financial sense to use midlevels in image interpretations. Other fields such as primary care, anesthesia, and ED allowed their midlevels to be almost interchangeable with physicians, which was a huge mistake because you need a large moat separating the roles of midlevels and physicians. That's not the case with radiology. There are other forces that are more concerning in radiology. Specifically, corporate radiology and Wall $treet.


Lol. Are you still a resident? That multimillion dollar lawsuit may start off as a new 3 mm grouping of pleomorphic calcifications that your midlevel blows off on the screening mammogram. Anyways, I'm done with this inane discussion.

$16.7 Million Judgment in Boston Cancer Misdiagnosis Lawsuit - The Sanders Firm

A cancer misdiagnosis can mean the difference between life and death for affected patients. Misread test results, CAT scans, X-rays and blood work happen

thesandersfirm.com

https://www.thestate.com/news/local/article56055575.html

1) I am an attending in a hybrid practice. I dictate and do not type with one finger or some ridiculous thing like that. I probably read a negative CTAP in about 10 minutes, with a range of 10-30 depending on complexity. A good trainee probably helps cut down the higher end (the complex cancer cases) and can bring a 30min cancer follow up to 10-15

2) As multiple people have mentioned, most radiologists are not spending 5min for a CTAP read. Regardless, instead of talking about vague anecdotal data "im about average for my group" lets talk numbers. Average radiologist makes 9000 RVUs per year nationwide. Divided by ~220 working days gives you about 42 RVUs a day / 9 hours = 4.67 RVUs per hour. Since a CTAP is ~1RVU thats about 13 minutes a study, on average, give or take. That's also about 2.5 minutes a chest x-ray (at 0.2 RVU), far higher than your claimed "5 seconds." I believe you are faster and that you are average for your group, however as you can see most of the country is not performing at that speed.

3) From a friend of mine who has worked with rad extenders "their reports are at about a senior resident or early fellow level." This is what he said about them verbatim. I have not worked with them personally. As I said I would generally gain from people at that level. I think many radiologists would agree, but if you disagree, that is fine. I believe at that speed you would not benefit from them. Many others would.

4) There is a huge gap between blindly signing drafted studies and reviewing them 100% the same as you would alone. This is what you fail to understand. A senior resident reviewing a study adds another set of eyes which reduces your malpractice risk, therefore you can speed up your own review a bit and are still practicing safely. Especially if its a complex case which has a lot of minor findings and measurements and comparisons, which the resident would have prefilled into the report. Malpractice risk is always present, and I would argue reading too fast is also a risk. We as radiologists balance the small, constant risk of missing something with the need to maintain efficiency. A senior resident/extender MAY help you read faster at an equivalent level of malpractice risk which is how I would argue they increase efficiency.

5) The articles you mentioned are basically irrelevant. The guy who went to jail hadn't even opened the studies at all, some were signed while he was on a flight. There is no rubber stamping going on, just pure fraud. Obviously malpractice settlements or judgements can be huge, I think everyone in the country is aware of this now. And yet, in the extender article they were reading at a rate of 100 Chest x-rays per hour - I consider that rubber stamping, but they were willing (or forced) to take the malpractice risk. Similar to the malpractice risk of spending 5 seconds on a chest xray. This practice is what I would call "rubber stamping" - and I am concerned we will be coerced into this practice - just as primary care docs sign off on a stack of notes from their PA/NP over the last 30 days as their form of "supervision."

6) Regarding the triage of cases: You completely ignored the salient point which is that the potential for a presumed "simple case" to turn out to be significant pathology with subtle findings can happen in primary care, and yet midlevels are still engaged in that care. Radiology can triage cases between those with a low pretest probability of pathology, and those with a high pretest probability, the same as urgent cares giving midlevels presumed "colds".

Obviously the low risk category could have a subtle abnormality such as pleomorphic calcs. The same could be said for a 40 year old with new cough who has subtle history/physical findings of malignancy, or autoimmune disorder that gets missed by a midlevel in urgent care. Yet, they are out there in urgent cares or ER's, discharging the presumed "colds" paradoxically with antibiotics, often with an MD signing off on their note. A midlevel missing a subtle finding on a usually straightforward radiology study is just the radiology version of the many midlevel clinical mistakes that are happening all over the country. It has not stopped them from infiltrating primary / urgent care and to think that it would stop them from interpreting images is quite naive

 

[Clean7795]

Obviously the low risk category could have a subtle abnormality such as pleomorphic calcs. The same could be said for a 40 year old with new cough who has subtle history/physical findings of malignancy, or autoimmune disorder that gets missed by a midlevel in urgent care. Yet, they are out there in urgent cares or ER's, discharging the presumed "colds" paradoxically with antibiotics, often with an MD signing off on their note. A midlevel missing a subtle finding on a usually straightforward radiology study is just the radiology version of the many midlevel clinical mistakes that are happening all over the country. It has not stopped them from infiltrating primary / urgent care and to think that it would stop them from interpreting images is quite naive

The difference is that the pertinent positive findings would not be documented by the midlevel; you would not be able to know that the midlevel even missed anything. In radiology any miss can be pulled up and examined, which is a part of the reason why diagnostic radiology has been shielded.

Overall I agree though that there is no specialty completely safe. Eventually corporations or mega-academic employers will gain enough power to force midlevels and their substandard reads/medicolegal liability onto you.

 

[maxxor]

1) I am an attending in a hybrid practice. I dictate and do not type with one finger or some ridiculous thing like that. I probably read a negative CTAP in about 10 minutes, with a range of 10-30 depending on complexity. A good trainee probably helps cut down the higher end (the complex cancer cases) and can bring a 30min cancer follow up to 10-15

2) As multiple people have mentioned, most radiologists are not spending 5min for a CTAP read. Regardless, instead of talking about vague anecdotal data "im about average for my group" lets talk numbers. Average radiologist makes 9000 RVUs per year nationwide. Divided by ~220 working days gives you about 42 RVUs a day / 9 hours = 4.67 RVUs per hour. Since a CTAP is ~1RVU thats about 13 minutes a study, on average, give or take. That's also about 2.5 minutes a chest x-ray (at 0.2 RVU), far higher than your claimed "5 seconds." I believe you are faster and that you are average for your group, however as you can see most of the country is not performing at that speed.

3) From a friend of mine who has worked with rad extenders "their reports are at about a senior resident or early fellow level." This is what he said about them verbatim. I have not worked with them personally. As I said I would generally gain from people at that level. I think many radiologists would agree, but if you disagree, that is fine. I believe at that speed you would not benefit from them. Many others would.

4) There is a huge gap between blindly signing drafted studies and reviewing them 100% the same as you would alone. This is what you fail to understand. A senior resident reviewing a study adds another set of eyes which reduces your malpractice risk, therefore you can speed up your own review a bit and are still practicing safely. Especially if its a complex case which has a lot of minor findings and measurements and comparisons, which the resident would have prefilled into the report. Malpractice risk is always present, and I would argue reading too fast is also a risk. We as radiologists balance the small, constant risk of missing something with the need to maintain efficiency. A senior resident/extender MAY help you read faster at an equivalent level of malpractice risk which is how I would argue they increase efficiency.

5) The articles you mentioned are basically irrelevant. The guy who went to jail hadn't even opened the studies at all, some were signed while he was on a flight. There is no rubber stamping going on, just pure fraud. Obviously malpractice settlements or judgements can be huge, I think everyone in the country is aware of this now. And yet, in the extender article they were reading at a rate of 100 Chest x-rays per hour - I consider that rubber stamping, but they were willing (or forced) to take the malpractice risk. Similar to the malpractice risk of spending 5 seconds on a chest xray. This practice is what I would call "rubber stamping" - and I am concerned we will be coerced into this practice - just as primary care docs sign off on a stack of notes from their PA/NP over the last 30 days as their form of "supervision."

6) Regarding the triage of cases: You completely ignored the salient point which is that the potential for a presumed "simple case" to turn out to be significant pathology with subtle findings can happen in primary care, and yet midlevels are still engaged in that care. Radiology can triage cases between those with a low pretest probability of pathology, and those with a high pretest probability, the same as urgent cares giving midlevels presumed "colds".

Obviously the low risk category could have a subtle abnormality such as pleomorphic calcs. The same could be said for a 40 year old with new cough who has subtle history/physical findings of malignancy, or autoimmune disorder that gets missed by a midlevel in urgent care. Yet, they are out there in urgent cares or ER's, discharging the presumed "colds" paradoxically with antibiotics, often with an MD signing off on their note. A midlevel missing a subtle finding on a usually straightforward radiology study is just the radiology version of the many midlevel clinical mistakes that are happening all over the country. It has not stopped them from infiltrating primary / urgent care and to think that it would stop them from interpreting images is quite naive

The rvu numbers are a bit out of date. Looks like 10000 is closer to where people are these days.

Radiologist $alary Update 2020: Show Me The Money!

One of the most popular posts on The Reading Room is about radiologist compensation (FYI: it’s worth clicking on the link for the title of said blog post alone). Alas, as money still doesn’t grow on trees, it seemed like a good idea to give the post a facelift and update the numbers. Note: the […]

thereadingroom.mrionline.com

 

[Radology]

“Divided by ~220 working days gives you about 42 RVUs a day / 9 hours = 4.67 RVUs per hour. Since a CTAP is ~1RVU thats about 13 minutes a study, on average, give or take.”

do you get coffee? Eat lunch? Field phone calls? Give conference? Go to the bathroom? Consult with colleagues about cases? Respond to emails? Deal with technologists, contrast reactions, etc, etc? Do literally anything else during working hours from checking your mail to calling your spouse?

take 2 hours out of your denominator, add to the numerator as your numbers are dated. Then you’re in the 5-10 minute range per ct abdomen for the average radiologist

 

[GadRads]

According to this sample of 46 radiologists, the average radiologist spends just one 10 mins per CT AP.

Radiologists’ Variation of Time to Read Across Different Procedure Types
"Radiologists’ Variation of Time to Read Across Different Procedure Types"

 

[Taurus]

Obviously the low risk category could have a subtle abnormality such as pleomorphic calcs. The same could be said for a 40 year old with new cough who has subtle history/physical findings of malignancy, or autoimmune disorder that gets missed by a midlevel in urgent care. Yet, they are out there in urgent cares or ER's, discharging the presumed "colds" paradoxically with antibiotics, often with an MD signing off on their note. A midlevel missing a subtle finding on a usually straightforward radiology study is just the radiology version of the many midlevel clinical mistakes that are happening all over the country. It has not stopped them from infiltrating primary / urgent care and to think that it would stop them from interpreting images is quite naive

Lol. So says the first year attending in a hybrid practice/ivory tower. You learn a lot in your first year of practice. I guess I have more than half a decade of private practice experience on you then. You still have lots to learn, young grasshopper.

As I have repeatedly pointed out, midlevels have infiltrated many clinical specialties like primary care, ED, etc. As I have also repeatedly pointed out, there is a big difference between clinical specialties versus radiology or even pathology. Images do not change and images can be preserved indefiintely. In the ED, the midlevel who misses the ptosis can say later, "It wasn't there when I examined the patient!". If it wasn't documented in the clinical notes, it wasn't there or didn't happen. Without concrete evidence like videos, how do you prove otherwise? You can't. This is how clueless NP's are able to continue to practice. If you miss the hyperdense sign in the MCA on that head CT, it is preserved indefinitely unchanged (at least 7 years anyways) for the lawyers to review. You can't hide the fact that you missed and now the patient has permanent neurological damage because of your mistake. Majority of breast cancers have no family history or other known significant risk factors. I pray for your career if you (or your midlevel) miss early stage DCIS on the screening mammogram in a 40 year old woman with 2 preschoolers at home and now has stage IV breast cancer 3 years later. Like I said, I've been an expert witness for several lawsuits (@$500/hour, woohoo!). It's not that hard for me to figure out if you screwed up. Based on my evaluation, the lawyers will determine if they should settle or risk it in court.

Pathology is similar to radiology in this regard. Slides do not change (heck, they last decades unchanged). You can always go back to the original slide to see if the pathologist missed something. Have you heard of any midlevels putting out final reports in pathology? I think not.

Anyways, no private practice group that cares about RVU production will utilize midlevels for image interpretation, which is the vast majority of private practice groups in this country because there are two things that anybody loves most, 1) money 2) vacation time. Midlevels primarily reading imaging studies are a drag on your production. To be above board, you have to review the images again and look at their reports, both of which take time. It's faster for you to do it yourself and hence higher RVU. Or, you can be shady about it and sign off blindly on their work; problem is if they screw up the images are available for the lawyers to review.

 

[maxxor]

Lol. So says the first year attending in a hybrid practice/ivory tower. You learn a lot in your first year of practice. I guess I have more than half a decade of private practice experience on you then. You still have lots to learn, young grasshopper.

As I have repeatedly pointed out, midlevels have infiltrated many clinical specialties like primary care, ED, etc. As I have also repeatedly pointed out, there is a big difference between clinical specialties versus radiology or even pathology. Images do not change and images can be preserved indefiintely. In the ED, the midlevel who misses the ptosis can say later, "It wasn't there when I examined the patient!". If it wasn't documented in the clinical notes, it wasn't there or didn't happen. Without concrete evidence like videos, how do you prove otherwise? You can't. This is how clueless NP's are able to continue to practice. If you miss the hyperdense sign in the MCA on that head CT, it is preserved indefinitely unchanged (at least 7 years anyways) for the lawyers to review. You can't hide the fact that you missed and now the patient has permanent neurological damage because of your mistake. Majority of breast cancers have no family history or other known significant risk factors. I pray for your career if you (or your midlevel) miss early stage DCIS on the screening mammogram in a 40 year old woman with 2 preschoolers at home and now has stage IV breast cancer 3 years later. Like I said, I've been an expert witness for several lawsuits (@$500/hour, woohoo!). It's not that hard for me to figure out if you screwed up. Based on my evaluation, the lawyers will determine if they should settle or risk it in court.

Pathology is similar to radiology in this regard. Slides do not change (heck, they last decades unchanged). You can always go back to the original slide to see if the pathologist missed something. Have you heard of any midlevels putting out final reports in pathology? I think not.

Anyways, no private practice group that cares about RVU production will utilize midlevels for image interpretation, which is the vast majority of private practice groups in this country because there are two things that anybody loves most, 1) money 2) vacation time. Midlevels primarily reading imaging studies are a drag on your production. To be above board, you have to review the images again and look at their reports, both of which take time. It's faster for you to do it yourself and hence higher RVU. Or, you can be shady about it and sign off blindly on their work; problem is if they screw up the images are available for the lawyers to review.

It's not the functional, well run, large private practice groups that have joint-ventures and such that I'm afraid will distort the market. As of now, most of those rads won't want to lower their clinical quality standards.

It's the private-equity-backed / HCA type hospitals taking Radiology-in-house, then deciding to do everything they can to force their labor costs down. Once some academic group shows the model works (glaring at Penn and Yale here), the HCA/RadPartners/USRS/Envision's will immediately move to adopt it. Suddenly their cost-basis is way lower for the "same productivity", and can start attacking the well run practices.

Then private practice will need to either adopt a similar model, or accept less pay / time off.

HCA has already started 2 radiology residencies in the past 2 years with plans to start more. The goal here is to drop quality (and cost) as LOW as they can get away with.

 

[scoopdaboop]

It's not the functional, well run, large private practice groups that have joint-ventures and such that I'm afraid will distort the market. As of now, most of those rads won't want to lower their clinical quality standards.

It's the private-equity-backed / HCA type hospitals taking Radiology-in-house, then deciding to do everything they can to force their labor costs down. Once some academic group shows the model works (glaring at Penn and Yale here), the HCA/RadPartners/USRS/Envision's will immediately move to adopt it. Suddenly their cost-basis is way lower for the "same productivity", and can start attacking the well run practices.

Then private practice will need to either adopt a similar model, or accept less pay / time off.

HCA has already started 2 radiology residencies in the past 2 years with plans to start more. The goal here is to drop quality (and cost) as LOW as they can get away with.

What's wrong with radiology residencies? As long as it's kept to a bare minimum increase every few years, no big deal. The population of the US doesn't stay stagnant, and neither should physician populations.

 

[maxxor]

What's wrong with radiology residencies? As long as it's kept to a bare minimum increase every few years, no big deal. The population of the US doesn't stay stagnant, and neither should physician populations.

Because it would be more productive and better training to expand the known excellent residencies versus creating new residencies in places that do not have a culture of medical education and are not referral centers.

In Radiology (and pathology), if you don’t know what to look for, you’ll never see it. It’s better to train at an area with a broad mix of interesting/uncommon pathology rather than a purely community place.

 

[scoopdaboop]

Because it would be more productive and better training to expand the known excellent residencies versus creating new residencies in places that do not have a culture of medical education and are not referral centers.

In Radiology (and pathology), if you don’t know what to look for, you’ll never see it. It’s better to train at an area with a broad mix of interesting/uncommon pathology rather than a purely community place.

Well I get that, but isn't the standards that can deem a radiology residency worthy done by ACR possibly or the NMRP etc?

 

[maxxor]

Well I get that, but isn't the standards that can deem a radiology residency worthy done by ACR possibly or the NMRP etc?

It’s the RRC and hasn’t been updated in ages. Requirements should be increased substantially.

I personally met all of them except IR and mammography my first year.

 

[guytakingboards]

Well I get that, but isn't the standards that can deem a radiology residency worthy done by ACR possibly or the NMRP etc?

As mentioned, its done by the ACGME Residency Review Committee (RRC). But the actual metrics used for graduation are numbers of particular studies. It makes no distinction in the degrees of difficulty of a particular studies.

A CT abdomen/pelvis with contrast of a 15 y/o girl for "abdominal pain" who in reality is just having her period (something you might see in the community) vs a ct abdomen/pelvis done on a patient in acute abdominal pain at a tertiary center who has cancer with multiple prior abdominal operations.... there's no substitute for learning from the tough cases.

Tertiary referral centers get a better spectrum of pathology: super rare stuff, common stuff presenting uncommonly, uncommon stuff presently like a common condition. That's the stuff that makes great doctors.

 

[radsresident-US]

“Divided by ~220 working days gives you about 42 RVUs a day / 9 hours = 4.67 RVUs per hour. Since a CTAP is ~1RVU thats about 13 minutes a study, on average, give or take.”

do you get coffee? Eat lunch? Field phone calls? Give conference? Go to the bathroom? Consult with colleagues about cases? Respond to emails? Deal with technologists, contrast reactions, etc, etc? Do literally anything else during working hours from checking your mail to calling your spouse?

take 2 hours out of your denominator, add to the numerator as your numbers are dated. Then you’re in the 5-10 minute range per ct abdomen for the average radiologist

I think your right on both points. 10k rays / 220 working days / 7 hours per day = 6.5 rvus per hour = 9.2 minutes/ rvu. That sounds about right based on my experience. Truthfully I was not looking for a precise calculation of rvu per minute and there are probably other small errors in the calculation - I just wanted a ballpark average.

the statistic I was responding to was the number put out by Taurus “I can read a CT ab/pel in 5 minutes”. In hindsight that number is meaningless. Anyone CAN read a ctap in 5 minutes but what’s that number mean? Is it the average, median, or lower 25%? Is it the lower limit, or the average on a subjectively assessed “simple study”? Ultimately I think an average of 9 minutes, which assumes a range ( for me, probably 7-30minutes with most in the lower end) is probably about right.

Regarding the midlevel clinical miss: I understand the logic of a physical exam / history finding not being documented therefore no evidence is there of the miss. Problem is, it doesn’t need to be. If you follow that logic to conclusion you would wonder why any primary care or nonprocedural doc would ever be sued for failure to diagnose at all. And yet, they commonly are.
The reasons are complex. They may have failed to include in their differential, based on documented clinical signs or symptoms, a rare but present disease that was not tested for. Or, they may have not documented pertinent negative findings and the patient claims they told the doctor about them ( ie the patient claims they mentioned night sweats, but there is no documentation in the chart about it - positive or negative). “If you don’t document it, it didn’t happen” is at play here. If they claim they mentioned it, and it doesn’t say in the chart “no night sweats” a jury may look on that negatively. Bottom line - midlevels can and do get sued and make mistakes in the clinical world. Again, admin doesn’t care cause of the $$.

I would ask those of you using that argument “their H and P is not recorded” for midlevels - why do MD PCPs get sued for failure to diagnose?

 

[Splenda88]

I wonder how much money the average radiologist generates for you guys/gals to be able to make that high salary(500k+/yr) plus 8-10 wks vacations.

The average IM doc generates ~ 2.7 mil/yr but yet salary is 240-280k/yr with very little vacation.


1. Cardiovascular surgery

• Average revenue: $3.7 million
• Average salary: $425,000

2. Cardiology (invasive)

• Average revenue: $3.48 million
• Average salary: $590,000

3. Neurosurgery

• Average revenue: $3.44 million
• Average salary: $687,000

4. Orthopedic surgery

• Average revenue: $3.29 million
• Average salary: $533,000

5. Gastroenterology

• Average revenue: $2.97 million
• Average salary: $487,000

6. Hematology/Oncology

• Average revenue: $2.86 million
• Average salary: $425,000

7. General surgery

• Average revenue: $2.71 million
• Average salary: $350,000

8. Internal medicine

• Average revenue: $2.68 million
• Average salary: $261,000

9. Pulmonology

• Average revenue: $2.36 million
• Average salary: $418,000

10. Cardiology (noninvasive)

• Average revenue: $2.31 million
• Average salary: $427,000

These 10 physician specialties generate the most revenue for hospitals - Becker's Hospital Review | Healthcare News & Analysis

The amount of revenue physicians generate for hospitals is typically considerably more than their annual salaries, according to a recent survey by physician staffing firm Merritt Hawkins.

www.beckershospitalreview.com

 

[sallyhasanidea]

It seems like DR residents should prioritize learning these light IR skills so that they maximize their flexibility and marketability while job hunting. They shouldn't even be called light IR, IMO. They are just basic radiological procedures that all rads should be comfortable doing. I would be disappointed with myself if I didn't feel comfortable doing these things after training. It also causes the issue you mentioned in your post about the vacuum in that service line. As usual, physicians are their own worst enemy. We leave the door open by turning our noses up the blue collar work and fighting with each other.

What exactly are the procedures you are referring to?

 

[Cognovi]

What exactly are the procedures you are referring to?

basic radiological procedures or light IR:

• procedures that entail removing or inserting fluid through a needle with or without a catheter in a body cavity or joint, except those involving blood vessels or the cranium
• procedures that entail biopsy of tissue through a core needle or fine needle from an organ or tissue, except those involving cutaneous, cardiac, neural, ocular, or most hollow viscus organs

borderline cases:

• cases involving veins (spectrum of complexity)

more advanced procedures:

• procedures involving arteries
• procedures that entail destroying tissue
• procedures that entail implanting devices or materials that are supposed to stay for a long time

 

[Fart Daddy Smooth]

I wonder how much money the average radiologist generates for you guys/gals to be able to make that high salary(500k+/yr) plus 8-10 wks vacations.

The average IM doc generates ~ 2.7 mil/yr but yet salary is 240-280k/yr with very little vacation.


1. Cardiovascular surgery

• Average revenue: $3.7 million
• Average salary: $425,000

2. Cardiology (invasive)

• Average revenue: $3.48 million
• Average salary: $590,000

3. Neurosurgery

• Average revenue: $3.44 million
• Average salary: $687,000

4. Orthopedic surgery

• Average revenue: $3.29 million
• Average salary: $533,000

5. Gastroenterology

• Average revenue: $2.97 million
• Average salary: $487,000

6. Hematology/Oncology

• Average revenue: $2.86 million
• Average salary: $425,000

7. General surgery

• Average revenue: $2.71 million
• Average salary: $350,000

8. Internal medicine

• Average revenue: $2.68 million
• Average salary: $261,000

9. Pulmonology

• Average revenue: $2.36 million
• Average salary: $418,000

10. Cardiology (noninvasive)

• Average revenue: $2.31 million
• Average salary: $427,000

These 10 physician specialties generate the most revenue for hospitals - Becker's Hospital Review | Healthcare News & Analysis

The amount of revenue physicians generate for hospitals is typically considerably more than their annual salaries, according to a recent survey by physician staffing firm Merritt Hawkins.

www.beckershospitalreview.com

Good Lord y'all are getting screwed

 

[Splenda88]

Good Lord y'all are getting screwed

Based on these numbers, no physicians should be making <500k/yr. We are being exploited.

 

[maxxor]

Good Lord y'all are getting screwed

You can't use these wobbly wobbly estimates of enterprise revenue and then justify you get a cut of the technical / hospital value as an independent entity, becomes it is very close to Stark violation (kickback for referrals). The USUAL ways around this are medical directors fees and other things, but you still hit "usual and customary" limits. This is also why MGMA et al survive because that's how compensation is justified as fair-market-value. There are lawsuits about this, most notably a hospital in West Virginia got in trouble for "overpaying a specialist" to keep a service line open based on downstream revenue.

Fundamentally, Radiologists produce a lot of RVUs. The average one reads 10k RVU a year. At 100% Medicare, that's 350,000. Nobody has 100% medicare rates in Radiology, so depending on payor mix, you can make more or less from a pure 100% professional fee practice.

Primary care RVUs are on average 4,847 per year .

More breakdown here (pg 17 and 18) http://www.medpac.gov/docs/default-...ciancompensationreport_cvr_contractor_sec.pdf

 

[Cognovi]

You can't use these wobbly wobbly estimates of enterprise revenue and then justify you get a cut of the technical / hospital value as an independent entity, becomes it is very close to Stark violation (kickback for referrals). The USUAL ways around this are medical directors fees and other things, but you still hit "usual and customary" limits. This is also why MGMA et al survive because that's how compensation is justified as fair-market-value. There are lawsuits about this, most notably a hospital in West Virginia got in trouble for "overpaying a specialist" to keep a service line open based on downstream revenue.

Fundamentally, Radiologists produce a lot of RVUs. The average one reads 10k RVU a year. At 100% Medicare, that's 350,000. Nobody has 100% medicare rates in Radiology, so depending on payor mix, you can make more or less from a pure 100% professional fee practice.

Primary care RVUs are on average 4,847 per year .

More breakdown here (pg 17 and 18) http://www.medpac.gov/docs/default-...ciancompensationreport_cvr_contractor_sec.pdf

Neat graph for reference

 

[Radology]

According to this sample of 46 radiologists, the average radiologist spends just one 10 mins per CT AP.

Radiologists’ Variation of Time to Read Across Different Procedure Types
"Radiologists’ Variation of Time to Read Across Different Procedure Types"

Noncontrast chest CT is the longest study to read in radiology, at 12 minutes average? With and without Mri spine takes 3 minutes?

I’m gonna assume this is a practice specific study with unreliable outcomes related to a very slow chest radiologist skewing the results

 

[maxxor]

Noncontrast chest CT is the longest study to read in radiology, at 12 minutes average? With and without Mri spine takes 3 minutes?

I’m gonna assume this is a practice specific study with unreliable outcomes related to a very slow chest radiologist skewing the results

Sounds like a normal L spine vs surveillance lung scan with a ton of slowly growing nodules.

 

[Radology]

It’s an average of a random selection of studies by type

so would include disaster post op spines and normal chest ct

 

[maxxor]

It’s an average of a random selection of studies by type

so would include disaster post op spines and normal chest ct

I read through that paper. Their methodology is so strange to the point where I'm not sure the data even makes sense after they massaged it so much. Just try and make your way through their selection/exclusion criteria.

Their assumptions and decision to use PACS event data for timekeeping rather than dictation data are very strange. They also excluded all cross sectional imaging cases that had "5 minute pauses between commands" assuming that it meant they were interrupted while reading with note that scrolling while looking at comparisons is not included in the logs, which to me means they likely had significant negative selection bias in their exclusion criteria for complex exams. If they'd used dictation "save as draft" commands, there would be no need to exclude those exams.

They also didn't do the obvious comparison of single-specialty reader reading times versus multi specialty readers.

I'm not sure this generalizes to anything at all.