Which subspecialty is most resistant to encroachment or expansion?

[osprey099]

Yeah, physicians screwing other physicians (by eliminating what used to be physician-designated jobs). That's what we're all about.

Why are we surprised? Again, we're the same ahole deuchy competitive pre-meds that we were 25 years ago. We screwed each other when we were trying to get into medical school, then into residency, why not now?! At least buy me dinner first.

That's right, become quadruple-boarded, so you can be the guy hiring NPs and eliminating physician jobs.

I mean, it’s just how society works, not just in medicine. Those people in corporate positions also grind and compete for those top positions. This is basically what a capitalist society/economy is about. It’s nothing particular about medicine. I think we often feel this way bc it’s all we’ve known but everyone has to compete to get to higher positions/better salary and any person’s gain is another person’s loss.

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[bronx43]

I mean, it’s just how society works, not just in medicine. Those people in corporate positions also grind and compete for those top positions. This is basically what a capitalist society/economy is about. It’s nothing particular about medicine. I think we often feel this way bc it’s all we’ve known but everyone has to compete to get to higher positions/better salary and any person’s gain is another person’s loss.

So you're supporting an exploitative model where the old and established eat the young for a quick buck?

 

[osprey099]

So you're supporting an exploitative model where the old and established eat the young for a quick buck?

Im not supporting it. I'm just saying that in general, it's just the way a capitalist society works (one individual/group succeeds at the expense of another individual/group).
Specifically to private practice oncology, would you support a scenario in which there are no mid-levels but oncologists making an average of 250k or a scenario in which mid-levels are employed by some oncologists and the oncologists make 400-500k? It's easy to say on an anonymous forum that we support a system with no mid levels and all oncologists doing everything, but how many of us are actually going to give up $100k+ of potential personal income every year to hold that up?

 

[DrMetal]

I mean, it’s just how society works, not just in medicine. Those people in corporate positions also grind and compete for those top positions. This is basically what a capitalist society/economy is about. It’s nothing particular about medicine. I think we often feel this way bc it’s all we’ve known but everyone has to compete to get to higher positions/better salary and any person’s gain is another person’s loss.

It's quite true. The only problem is, we spent 10-15 years of our good lives studying/working to get here, it's hard to quit this sh%$ show.

 

[bronx43]

Im not supporting it. I'm just saying that in general, it's just the way a capitalist society works (one individual/group succeeds at the expense of another individual/group).
Specifically to private practice oncology, would you support a scenario in which there are no mid-levels but oncologists making an average of 250k or a scenario in which mid-levels are employed by some oncologists and the oncologists make 400-500k? It's easy to say on an anonymous forum that we support a system with no mid levels and all oncologists doing everything, but how many of us are actually going to give up $100k+ of potential personal income every year to hold that up?

You’re basically saying “don’t hate the player, hate the game,” which is fine. I got no problem with the player. We got a problem with the game which is rigged. It’s rigged against all of us docs who all made similar sacrifices. It’s rigged because the government handed hospital systems a deck of aces and kings, while giving us 2s and 3s.

 

[blue.jay]

 

[whoknows2012]

Most comprehensive cancer centers are academic institutions and the only way those admins can get an erection is by horrendously low balling you. I've heard sub 200k for oncologists at some places, though that's only by word of mouth.

Probably true at places like dfci hopkins nih (know for sure it’s true at Hopkins, word of mouth at DFCI and assuming it’s true at NIH). Msk is 250 starting for junior faculty. NYC programs are all 220+ Now. There are also some nice incentive programs if you’re busy clinically (ie rvu based bonus) or busy academically (less clinic time, bonus for academic production. Etc)

 

[wamcp]

View attachment 340665

“White coat investors?”
Wow. I guess that exclusive investment club is also going to include your physical therapist, occupational therapist, case managers, social worker, nurse supervisor…everyone and their mother has a f**king white coat these days

 

[Sushirolls]

So you're supporting an exploitative model where the old and established eat the young for a quick buck?

If folks really want to make a change, a dent in the status quo, they need to do the following:

1) Open their own medical practices / groups
2) Advertise unabashedly they are physician only, always physician, only and will never have mid-levels.

Society won't be aware of the differences we witness daily until some one with a bull horn is blasting the message. Currently the only people with a megaphone are the ARNPs saying we're just as good...

 

[DoctorMD1]

You got it. Those poor anesthesiologists are barely making ends meet I'm sure despite the crna incursion. Only 250/hr now or so I hear. Might as well go work for taco bell right?

I wonder what is hourly rate for every specialty...hmm

 

[DoctorMD1]

Midlevels read radiology images... not sure why an echo wouldn’t be possible.

I am a rad and I've never heard of that...

 

[DrMetal]

I am a rad and I've never heard of that...

. . . said the Anesthesiologist, about CRNAs, in 1995!

 

[bronx43]

. . . said the Anesthesiologist, about CRNAs, in 1995!

Idk... I disagree with you here. Imaging simply doesn't lend itself to the same market pressures as clinical medicine (needing a warm body to do rote BS). I think docs would sooner just read and bill their own images before they would accept a midlevel interpretation. In my field, private practice docs are already doing this.

 

[DrMetal]

Idk... I disagree with you here. Imaging simply doesn't lend itself to the same market pressures as clinical medicine (needing a warm body to do rote BS). I think docs would sooner just read and bill their own images before they would accept a midlevel interpretation. In my field, private practice docs are already doing this.

I keep referring back to the CRNA model, b/c I think it really is telling. We allow mid-levels to intubate patients, to manage their Propofol and cross-titrate other drips. In that light, anything seems fair game in the new world of anti-physician medicine!

 

[bronx43]

I keep referring back to the CRNA model, b/c I think it really is telling. We allow mid-levels to intubate patients, to manage their Propofol and cross-titrate other drips. In that light, anything seems fair game in the new world of anti-physician medicine!

Just because it worked in anesthesia and other clinical specialties doesn't mean it works for radiology (or pathology for that matter). Even though we all went to medical school, their job is nothing like ours.
With that said, they have their own boogeymen - it just isn't the midlevel provider...

 

[DrMetal]

With that said, they have their own boogeymen - it just isn't the midlevel provider...

True. AI and Machine Learning!

 

[rokshana]

I am a rad and I've never heard of that...

Mid-Level Providers | Physicians & Staff | Premier Radiology

At Premier Radiology our Mid-Level Providers are formally trained to provide diagnostic, therapeutic, and preventive healthcare services, as delegated by a physician.

www.premierrad.com

 

[DoctorMD1]

Idk... I disagree with you here. Imaging simply doesn't lend itself to the same market pressures as clinical medicine (needing a warm body to do rote BS). I think docs would sooner just read and bill their own images before they would accept a midlevel interpretation. In my field, private practice docs are already doing this.

I agree. Cards read echo, most cardiac nucs, and some even cardiac MRI, OB can read gyn US etc etc.

 

[DoctorMD1]

Mid-Level Providers | Physicians & Staff | Premier Radiology

At Premier Radiology our Mid-Level Providers are formally trained to provide diagnostic, therapeutic, and preventive healthcare services, as delegated by a physician.

www.premierrad.com

They do simple image guided procedures and fluoroscopies, but don't interpret imaging

 

[Taurus]

Mid-Level Providers | Physicians & Staff | Premier Radiology

At Premier Radiology our Mid-Level Providers are formally trained to provide diagnostic, therapeutic, and preventive healthcare services, as delegated by a physician.

www.premierrad.com

Every radiology group with midlevels use similar boiler-plate language to describe their roles. We have midlevels in my group too. They work exclusively in IR to do consults, low-end procedures, and scut work. No radiology group would allow midlevels to read imaging exams independently. No private practice radiology would have a radiologist overread the imaging exams previewed by a midlevel because duplication of efforts and lack of efficiency gains. “Images do not change and they last forever” is the mantra I keep stressing. If the radiologist or midlevel screws up, the images are preserved in their original state for lawyers to later review. That’s why diagnostic fields like radiology and pathology are different from clinical fields. You can’t “fake it” in radiology or pathology.

 

[bronx43]

True. AI and Machine Learning!

I actually think it's elasticity of demand for imaging. Essentially every market force in the past decade that could have benefitted radiology has benefitted them - consolidation and corporatization of healthcare delivery, rise of midlevels, lack of transition from FFS reimbursement model, adoption of patient satisfaction metrics, lack of tort reform. All these factors heavily increase demand for imaging.

Half the imaging I order are useless diagnostically... yet I order it. Why? Because why not? The decision fork here is wildly asymmetric. If I don't order it, then my patient satisfaction scores go down and it would involve a 15 min argument with the patient about WHY imaging is unnecessary. Also, it covers my butt on the off chance that I was wrong. Given the FFS model, the hospital gets paid, so administrators won't send me emails about resource utilization.

However, the macroeconomics of healthcare and society in general are changing rapidly. It's likely that any of all of these forces will change in the upcoming decades.

 

[Taurus]

I actually think it's elasticity of demand for imaging. Essentially every market force in the past decade that could have benefitted radiology has benefitted them - consolidation and corporatization of healthcare delivery, rise of midlevels, lack of transition from FFS reimbursement model, adoption of patient satisfaction metrics, lack of tort reform. All these factors heavily increase demand for imaging.

Half the imaging I order are useless diagnostically... yet I order it. Why? Because why not? The decision fork here is wildly asymmetric. If I don't order it, then my patient satisfaction scores go down and it would involve a 15 min argument with the patient about WHY imaging is unnecessary. Also, it covers my butt on the off chance that I was wrong. Given the FFS model, the hospital gets paid, so administrators won't send me emails about resource utilization.

However, the macroeconomics of healthcare and society in general are changing rapidly. It's likely that any of all of these forces will change in the upcoming decades.

No matter what happens in the future, these things won’t change for radiology:

1. No to minimal patient interaction (difficult patients can be so draining mentally)
2. Don’t have to deal with social work (where does this pt go to dispo?)
3. Don’t have to deal with paperwork or insurance forms (our staff deals with it)

These reasons alone are enough to pick radiology over most the vast majority of clinical fields.

 

[bronx43]

No matter what happens in the future, these things won’t change for radiology:

1. No to minimal patient interaction (difficult patients can be so draining mentally)
2. Don’t have to deal with social work (where does this pt go to dispo?)
3. Don’t have to deal with paperwork or insurance forms (our staff deals with it)

These reasons alone are enough to pick radiology over most the vast majority of clinical fields.

Oh I totally agree with you. In fact, I kick myself for not going into rads back in the day.

However, my overarching point is that you don't get something for nothing in this world. Everything is give or take depending on external conditions. The lack of patient interface (all 3 points above) is a strength in the current environment, but may be a weakness when the system changes. Whether the system changes or if it's even in our lifetimes is yet to be determined. But from what I'm seeing now, big changes are becoming more likely by the day.

 

[Taurus]

Oh I totally agree with you. In fact, I kick myself for not going into rads back in the day.

However, my overarching point is that you don't get something for nothing in this world. Everything is give or take depending on external conditions. The lack of patient interface (all 3 points above) is a strength in the current environment, but may be a weakness when the system changes. Whether the system changes or if it's even in our lifetimes is yet to be determined. But from what I'm seeing now, big changes are becoming more likely by the day.

I would shoot myself if I had to do primary care and see patients all day, fight with insurance companies for preauthorization, and figure out where 80 yo grandma who lives by herself should go after breaking her hip. If you feel that way too, radiology is worth it no matter the future changes.

 

[CCM-MD]

If compensation was equal radiology competitiveness would be down the drain. I couldn’t do rads. Respect what you guys do but no thank you.

 

[bronx43]

I would shoot myself if I had to do primary care and see patients all day, fight with insurance companies for preauthorization, and figure out where 80 yo grandma who lives by herself should go after breaking her hip. If you feel that way too, radiology is worth it no matter the future changes.

Sure, I prob would too. But that's our subjective preferences. I was more talking about the nuts and bolts of specialties.

 

[rokshana]

I would shoot myself if I had to do primary care and see patients all day, fight with insurance companies for preauthorization, and figure out where 80 yo grandma who lives by herself should go after breaking her hip. If you feel that way too, radiology is worth it no matter the future changes.

and i'm sure there are those that would consider sitting in a dark cave with no one to talk to just as painful...as my sister says...dont yuck someone elses yum.

 

[hotsaws]

No matter what happens in the future, these things won’t change for radiology:

1. No to minimal patient interaction (difficult patients can be so draining mentally)
2. Don’t have to deal with social work (where does this pt go to dispo?)
3. Don’t have to deal with paperwork or insurance forms (our staff deals with it)

These reasons alone are enough to pick radiology over most the vast majority of clinical fields.

I wish more medical students understood the real value in this. I realized this early on in IM residency but I just couldn't conceptualize why these points would become so important. I chose A/I because it was my best hope at not burning out and maintaining a happy life. I think there is an intangible value to both rads and anesthesia beyond the hours and money for the above reasons.

 

[hotsaws]

yeah, A/I is a wonderful field. Excellent choice overall.

 

[DrMetal]

No matter what happens in the future, these things won’t change for radiology:

1. No to minimal patient interaction (difficult patients can be so draining mentally)
2. Don’t have to deal with social work (where does this pt go to dispo?)
3. Don’t have to deal with paperwork or insurance forms (our staff deals with it)

These reasons alone are enough to pick radiology over most the vast majority of clinical fields.

Here's what might change: As soon as we get comfortable with the idea of foreign radiologists (those in China, India, etc) reading our scans remotely, the medical industrial complex will find a way to make it happen if means cost savings.

Here's the fundamental problem with us physicians: our heads are often too buried in the sand. Not our fault, we can't help it. We're too busy with your educations/training, our BC/MOC, pick you next favorite set of letters to go after . . .that we can't see the crazy training coming. We don't have the business sense to see what the medical industrial machine is morphing into . . . and we definitely don't have the courage to stop it.

 

[DoctorMD1]

If compensation was equal radiology competitiveness would be down the drain. I couldn’t do rads. Respect what you guys do but no thank you.

I like radiology, but I totally understand how is definitely not for everyone.

 

[DoctorMD1]

and i'm sure there are those that would consider sitting in a dark cave with no one to talk to just as painful...as my sister says...dont yuck someone elses y

No matter what happens in the future, these things won’t change for radiology:

1. No to minimal patient interaction (difficult patients can be so draining mentally)
2. Don’t have to deal with social work (where does this pt go to dispo?)
3. Don’t have to deal with paperwork or insurance forms (our staff deals with it)

These reasons alone are enough to pick radiology over most the vast majority of clinical fields.

I agree with 2 & 3. But we have to deal with 1, especially breast imaging, procedures, fluoros and IR

 

[DoctorMD1]

Oh I totally agree with you. In fact, I kick myself for not going into rads back in the day.

However, my overarching point is that you don't get something for nothing in this world. Everything is give or take depending on external conditions. The lack of patient interface (all 3 points above) is a strength in the current environment, but may be a weakness when the system changes. Whether the system changes or if it's even in our lifetimes is yet to be determined. But from what I'm seeing now, big changes are becoming more likely by the day.

?. I thought Rheum is a cool specialty..

 

[Prehealth1011]

?. I thought Rheum is a cool specialty..

I was gonna say

We have multiple senior residents who couldn’t match rheum this year

 

[Taurus]

Here's what might change: As soon as we get comfortable with the idea of foreign radiologists (those in China, India, etc) reading our scans remotely, the medical industrial complex will find a way to make it happen if means cost savings.

Here's the fundamental problem with us physicians: our heads are often too buried in the sand. Not our fault, we can't help it. We're too busy with your educations/training, our BC/MOC, pick you next favorite set of letters to go after . . .that we can't see the crazy training coming. We don't have the business sense to see what the medical industrial machine is morphing into . . . and we definitely don't have the courage to stop it.

You mean foreign teleradiology? That was the boogie man 15 years ago and caused many to predict doom and gloom for radiology. You can only do that with prelim reads and not final reads. It never took off because CMS has a rule that you need to be on US soil to issue final reports, which is what the ordering wants. With the rise of telemedicine in most fields because of the pandemic, it’s highly unlikely that this rule will ever change. If it did, a health system could have most of their doctors in India and staff the boots on the ground with midlevels.

 

[bronx43]

?. I thought Rheum is a cool specialty..

If you practice in a city with low supply of rheumatologists then it’s a fantastic specialty. Real rheumatologic cases are some of the most rewarding things in medicine.
The big downside is that rheum diseases are incredibly rare and if you practice in a saturated city, then it can be absolutely terrible. Most of your referrals will be nonsense, and a good percent of these patients will be quite difficult to deal with.

 

[DrMetal]

a health system could have most of their doctors in India and staff the boots on the ground with midlevels.

FML! you're right. Now we're thinking more like MBAs.

 

[qwerty89]

If compensation was equal radiology competitiveness would be down the drain. I couldn’t do rads. Respect what you guys do but no thank you.

What competitiveness? Diagnostic Radiology has been slightly higher than middle of the road in competitiveness for a while now.

You underestimate the number of people in medicine like @Taurus and myself that can't stand the nonsense of clinical medicine and see rads as a fantastic way out, even if pay was at a hospitalist level.

 

[CCM-MD]

What competitiveness? Diagnostic Radiology has been slightly higher than middle of the road in competitiveness for a while now.

You underestimate the number of people in medicine like @Taurus and myself that can't stand the nonsense of clinical medicine and see rads as a fantastic way out, even if pay was at a hospitalist level.

If rads is slightly higher than middle of the road in competitiveness while paying the way it does, imagine where it would be if the compensation was worse. Lets be real here, derm isn't one of the most competitive specialties because there is a massive number of people interested in skin disease. You underestimate the number of people that wouldn't be interested in sitting in a room reading back to back scans after a 5 year residency if it didn't pay like it did.