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  • Death of small PP

    Posted by weetysimmi_194 on February 25, 2023 at 6:34 pm

    How are other small PP (less than 15 FTE) navigating the current job market, particularly in rural locations? Is it inevitable that we become hospital employees? My group has lost 5 of 15 rads in the last year and are faced with ever increasing teleradiology costs, difficulty recruiting and staring down 12 hour days with no solution in sight. We get woken up multiple times in the middle of the night to look at studies because our telerad provider has 2 hour TAT on studies despite paying 300% more than what we paid 5 years ago. We are now paying more money for a study than we collect and getting less service in return. We have gotten to the point of no return and recently approached the hospital about employing the remaining radiologists. We just can’t afford recruitment and locums in this market.

    It used to be that groups like mine would be absorbed by larger PP or corporate groups, but even these groups are short staffed and unable to service existing contracts. I’m very involved in the state ACR society and everyone in the state is describing the same situation. Many groups are on the brink of one group member leaving/getting sick and being in the same situation as my group.

    ACR job postings are more than 400 more than the number of graduating residents. I worry that areas like mine will be unable to have enough radiology coverage for the community. Unfortunately it’s not just radiology, but doctors in general. My mother in law had to go to the ER recently and after waiting 8 hours decided to leave without being seen, despite a proliferation of midlevels. We have daily emails from administration asking to discharge patients to reduce ER boarders, but it seems like there is always another patient to replace those leaving the hospital.

    Do we hope that AI can help improve efficiency? Should we be increasing radiology residemid-level. Am I being overly pessimistic? Are we starting to see the death of healthcare in the US?

    Signed,
    Tired radiologist who read 20k RVU last year out of necessity

    kiqbns_134 replied 1 year, 4 months ago 26 Members · 46 Replies
  • 46 Replies
  • ljohnson_509

    Member
    February 25, 2023 at 6:53 pm

    Sorry to hear. Its only going to get worse as those who can retire will, because it is so miserable these days.

  • satyanar

    Member
    February 25, 2023 at 6:55 pm

    It is inevitable that your hospital will have to subsidize radiologists to cover their imaging service, whether as employees or a PP group. Have you listened to Dans podcast?

  • 22002469

    Member
    February 25, 2023 at 7:57 pm

    Definitely need a subsidy.
     
    Why did 33% of the group leave in the last year? That seems extreme
     
    Did they all move? Take tele jobs?

    • weetysimmi_194

      Member
      February 25, 2023 at 8:02 pm

      Currently receiving 600k subsidy from the hospital. One person retired, 3 going full tele and another moving for family reasons. Every applicant so far wants 50% or more working from home. If we gave that to every new associate, the current partners would be st the hospital 90% of the time…

      • mario.mtz30_447

        Member
        February 25, 2023 at 8:09 pm

        Those 3 going full tele, why not keep them for your own full tele, 2nd and 3rd shifts?  That’s probably what they’re going to when they leave so why not keep them for your own group?  And new associates that want more tele, give them more 2nds and 3rds.
         
        At least you’ll be able to sleep, right?
         

        • 22002469

          Member
          February 25, 2023 at 8:31 pm

          Why do 3 out of 15 people already living rural want to leave a lucrative rural PP for tele rates? 
           
           

          • satyanar

            Member
            February 25, 2023 at 8:58 pm

            600k doesnt sound like enough.

          • ruszja

            Member
            February 25, 2023 at 9:29 pm

            Quote from Radsoxfan

            Why do 3 out of 15 people already living rural want to leave a lucrative rural PP for tele rates? 

            Because after 5 days in the hospital with the prospect of having to back up the tele company for a weekend night, the job the hospitals shuttle driver has starts to look attractive.

  • ruszja

    Member
    February 25, 2023 at 9:55 pm

    Quote from LivesinadarkRoom

    My group has lost 5 of 15 rads in the last year and are faced with ever increasing teleradiology costs, difficulty recruiting and staring down 12 hour days with no solution in sight.

    The question I have is ‘how did you get there?’*

    Did the 5 people leaving voice their unhappiness beforehand ? Was there an issue of real or perceived inequities they wanted addressed but leadership failed to do so ? Was there ever a ‘fix this or else’ situation ? How do you rate the leadership of your group, are they pulling their weight ?

    Being employed by the hospital won’t fix the staffing crisis. It just makes it someone else’s problem. Chances are the hospital won’t have any better luck hiring, they will just throw silly money at locums.

    * so my group can avoid this

    • mario.mtz30_447

      Member
      February 26, 2023 at 12:49 am

      OP I think telerad is your answer, hire your own telerads to cover after hours.  PP tele is more attractive to most rads than corporate tele so you have an advantage there.  
       
      Just make sure you dont treat them like second class citizens or theyll leave.  And hire enough of them, otherwise theyll leave.
       
      Group saved, problem solved, youre welcome.
       
      And if you dont think you can do this, why not?
       

      • Unknown Member

        Deleted User
        February 26, 2023 at 1:01 am

        Offer a part time track. Part-time associate, becomes part-time partner. True lifestyle job with the pro-rated income and full job security of a partnership job. I sense there’s a lot of demand for this. That will allow you to fill out your daytime rads.
         
        Yeah, and for afterhours use the same, internal telerads who are partners. 

        • weetysimmi_194

          Member
          February 26, 2023 at 4:54 am

          Thank you everyone for the replies. Unfortunately my group has passed the point of no return. I worry that groups like mine will continue to fold and eventually even groups in desirable areas are going to be forced into employment. This may even be the safe bet in the next 5-10 years with continued expected Medicare cuts leading to less favorable private insurance contracts. Volume can only make up for cuts for so long before wveryone breaks.

          • ljohnson_509

            Member
            February 26, 2023 at 5:31 am

            Because after 5 days in the hospital with the prospect of having to back up the tele company for a weekend night, the job the hospitals shuttle driver has starts to look attractive.

            Sometimes shuttle driver job seems more appealing than practicing radiology for hours on end, day after day these days.

            • gmail.com

              Member
              February 26, 2023 at 8:36 am

              lot more staycations and staying at home watching TV/Netflix as a shuttle driver, plus you may not be able to live/eat/play well with you time off.
               
              But is it worth it?  Is it worth the stress to be able to take a vacation w/ your family to some far off warm tropical climate a couple times per year and save up for a comfortable retirement earlier than the shuttle driver.

              Quote from Drrad123

              Because after 5 days in the hospital with the prospect of having to back up the tele company for a weekend night, the job the hospitals shuttle driver has starts to look attractive.

              Sometimes shuttle driver job seems more appealing than practicing radiology for hours on end, day after day these days.

          • btomba_77

            Member
            February 26, 2023 at 6:13 am

            Quote from LivesinadarkRoom

            Thank you everyone for the replies. Unfortunately my group has passed the point of no return. I worry that groups like mine will continue to fold and eventually even groups in desirable areas are going to be forced into employment. This may even be the safe bet in the next 5-10 years with continued expected Medicare cuts leading to less favorable private insurance contracts. Volume can only make up for cuts for so long before wveryone breaks.

            I’m sorry for your situation.
             
             
            But I also don’t see anything on the horizon that is going to make the consolidation in the radiology practice market slow.
             
             
            If you’re in a small – medium sized group within a drive a of a large corporate practice, pp mega-group, or major academic center looking to expand, you already have a target on your back.
             
            If you cant cover nights, cant expand services to the satisfaction of the system, can’t provide a $$/quality of life ratio good enough to recruit and retain, then it’s only a matter of time before it falls apart.
             
             
            There’s a tipping point with struggling groups. Once you lose too many FTEs it sets a vicious cycle of more work, more call etc for those remaining and it can destroy the practice.
             
             
            _________
             
            Interesting historical perspective to me—-
             
            In the previous tight job market of the early 2000s it was academic departments that went down the tubes like this.  It was mostly based on the huge compensation disparity between academics and private practice.  Once there were so many open position in local PP, huge numbers of radiologists left for greener pastures.
             
            It destroyed some big academic departments. 
             
            And the solutions to the problems of the last cycle are still echoing on today. Academics became less academic and more productive to keep salaries higher.  They got creative on labor force with alternative pathways and heavy reliance on ever-expanding fellowship programs.   They became reliant on teleradiology final reads for big volumes.
             
             
            Now it’s the small groups getting a good sweating.   
             
             
            I feel bad for you OP (and anyone else who has to go through this)  … I’ve been through some similar rough years and it’s not fun.
             
             
             
             

            • Jonnycool

              Member
              February 26, 2023 at 7:04 am

              It’s interesting, because literally every other industry simply increases prices in response to demand. I’m in the process of building out a center and everything from permits, contractors, attorneys, vendors/suppliers have increased their prices accordingly. Radiologists now have better bargaining positions for jobs, but the reimbursement at the center of everything for us is still out of our control. Pretty broken system for the majority of rads and docs.
               
              I would echo the sentiment to get a larger subsidy from the hospital, OP. This is the equivalent response our industry can demand. No one has the bandwidth to support more contracts. If they want to keep your group they need to increase the compensation, just like in every other industry.

              • gmail.com

                Member
                February 26, 2023 at 8:43 am

                I don’t think increasing reimbursement to the radiologist will lead to a substantial increase the overall hours radiologists will work.
                Young/new rads — a good number will continue to seek lifestyle jobs with good work/life balance.  Doubtful they will have the work ethic as the boomers (as outlined in the Dan Corbett podcast)
                The middle tier group of rads in 40s/50s –  maybe this will accelerate the decision to go part time (work a little less and make same amount or slightly more to preserve sanity) or may be this group will work more to get to early retirement;
                Late career rads – doubt you would be able to mobilize enough to leave their golden peaceful retirement
                 

                Quote from kyte

                It’s interesting, because literally every other industry simply increases prices in response to demand. I’m in the process of building out a center and everything from permits, contractors, attorneys, vendors/suppliers have increased their prices accordingly. Radiologists now have better bargaining positions for jobs, but the reimbursement at the center of everything for us is still out of our control. Pretty broken system for the majority of rads and docs.

                I would echo the sentiment to get a larger subsidy from the hospital, OP. This is the equivalent response our industry can demand. No one has the bandwidth to support more contracts. If they want to keep your group they need to increase the compensation, just like in every other industry.

                • smfst7_929

                  Member
                  February 26, 2023 at 8:46 am

                  You underestimate the power of the almighty $. Raise reimbursement rates 15% to account for inflation over past 3 years. Watch radiologists give up vacation and work harder. Capitalism baby. It works. Still wouldnt be enough to cover the shortage tho

                  • ljohnson_509

                    Member
                    February 26, 2023 at 8:56 am

                    ^^ as you get older (mid to late career) and have enough, money is much less motivating, especially given whats become of radiology practice and how miserable it is day to day.

                    • alvarezgga1

                      Member
                      February 26, 2023 at 9:13 am

                      To the OP,
                      As someone in a small PP group in a semirural region, recruiting is definitely painful. However, we have been successful in getting folks by curtailing partnership tracks to months instead of years and keeping things flexible in terms of how much they want to make. The future is going to be be minimal feet on the ground and rest tele. 
                      Also keep looking for better overnight coverage and tele groups.
                       

                • weetysimmi_194

                  Member
                  February 26, 2023 at 2:31 pm

                  As someone who has been out of training for 8 years now, it’s not completely clear to me that the younger guys don’t want to work. Most of our newer hires, some of whom have left in the last year were some of our most productive members. Many are getting burnt out with ever increasing workload for diminishing reimbursement. As others have alluded, it may be better to be hospital employees since hospital systems may be able to better negotiate with private payers. There is one group I know that is getting LESS than medicare rates for their main private insurance payer. They “solved” this issue by staying later and running leaner than my group. They are one person getting sick away from collapse.

                  If we were able to recruit we would have internalized our nights a long time ago. Unfortunately some members were against this idea since tele rates were so low. I think in this market it would be difficult to start an internal nighthawk service by ourselves. Funny enough that the same people against the idea were the same ones who don’t read MRI.

                  If my group becomes hospital employees I am going to recommend they hire 1 on 2 off for night coverage. Otherwise we will still have the same TAT issues with ever increasing costs.

                  • kiqbns_134

                    Member
                    February 26, 2023 at 2:47 pm

                    Being more recently out of training (2-3 years)… honestly i think a lot of trainees are just burn out from residency/fellowhship even these days. Volumes were high in training already too. With no end in sight it gets tough. I work in a small group and we’ll probably stick it out for a few years before we fold. Were already in a minimal on site with home work hybrid which works but maybe ill just go to full remote when the investments start filling out.

                    • dr.ahmed_alkamali_307

                      Member
                      February 26, 2023 at 3:32 pm

                      Agree with everything said about younger rads.  Easy to say boomers were willing work to more when they only had to read 20 CTs a day.  
                       
                      In his podcast Dan said millennials will b*** about their call shifts, but it feels justified these days.  The volumes are just brutal.   In my group, the boomers are the slowest rads and retiring or going part time because they can’t handle the volume. 
                       
                      Some of the younger rads are looking for work/life balance now so they can keep doing this another 10-20 years.  We didn’t have the luxury of the “golden days” of radiology.

                    • buckeyeguy

                      Member
                      February 26, 2023 at 4:52 pm

                      Just wait for the reality sinking in that we are in a recession that will likely get to a depression, and the markets will be for traders …
                       
                      At least you’ve been out a few years already.

                    • kiqbns_134

                      Member
                      February 26, 2023 at 5:31 pm

                      Ya im definitely hoping that depression happens, that would probably be the thing that keeps me working hard as i pick up deals in housing and market prices in the hopefully near future of a few years.

                    • consuldreugenio

                      Member
                      February 26, 2023 at 8:02 pm

                      Echo everything said. If you are in a small group and payer mix isnt competitive, hiring will be near impossible. We have lost some rads that cover multiple specialties. This is difficult to replace with new rads. Limited rads are also challenging to staff a small practice. Mammo can be re learned, but the rad has to commit 2-3+ days a week for a while to get back up to speed. Breast mri and breast mri biopsies have made things more painful for general rads to just back into. New mammo rads have less interest in doing other specialties and can get away with it. This all makes staffing a small practice a hot mess.

                      Generally throwing money at the problem is a decent band aid, but continuously high rvus and less time off has a breaking point. YMMV.

                    • ipadfawazipad_778

                      Member
                      February 26, 2023 at 8:26 pm

                      I personally think small PP with balls(no offense ladies) can make bank in the current market.  Hopsitals are figuring out they are royaly F’d if any radiology group leaves now in all but the most desireable locations.    Come up with a plan.  Tell the hospital what you need, (money, alternative scheduling ect.) and then give them the opportunity to say yes.  If they say no, just give notice.   The hospital will shop around and if your offer is remotely reasonable cave.  You have to be willing to walk, but in this job market, you really don’t have anything to lose except a terrible work environment.    I personally hope most radiologists choose to work lesss and then income/unit time goes way up.

                    • Unknown Member

                      Deleted User
                      February 27, 2023 at 6:51 am

                      Lol the title of this post sounded like someone mourning their micropenis. 

                    • Unknown Member

                      Deleted User
                      February 27, 2023 at 7:08 am

                      Lol !

                    • amotter

                      Member
                      February 27, 2023 at 11:40 am

                      Urology consult is recommended for that problem.

                    • consuldreugenio

                      Member
                      February 27, 2023 at 12:34 pm

                      @IGotKids2Feed

                      Lost some rads to retirement. These rads were the classic rads that could read MRI across specialties, do procedures and cover all sorts of call. Newer rads that do that type of thing are harder to find. We have found great rads though. Just not enough to keep up with retirements and transitions to part time.

                    • mario.mtz30_447

                      Member
                      February 27, 2023 at 11:07 am

                      Quote from Umichfan

                      We have lost some rads that cover multiple specialties. 

                       
                      How so?  

                    • pankajkaira1982_700

                      Member
                      February 27, 2023 at 8:37 am

                      doing the same thing. I am waiting for a market downturn/correction as well. 

                    • william.wang_997

                      Member
                      February 26, 2023 at 6:42 pm

                      ? Really
                       
                      The attending should burn out more.at least in some rotationsthere are 4 or 5 resident/fellows feeding one attending 20 studies each during the day. Residents and fellows have NO idea whats coming after.
                       

                      Quote from radrocker

                      Being more recently out of training (2-3 years)… honestly i think a lot of trainees are just burn out from residency/fellowhship even these days. Volumes were high in training already too. With no end in sight it gets tough. I work in a small group and we’ll probably stick it out for a few years before we fold. Were already in a minimal on site with home work hybrid which works but maybe ill just go to full remote when the investments start filling out.

                    • leonardogo

                      Member
                      February 27, 2023 at 11:19 am

                      Not sure what residency you went to, but I definitely read more than 20 studies a day as a resident. Maybe the 1st year residents read that much. Independent overnight call starting R2, we were pushing 100+ full reports with half of those cross sectionals. After becoming an attending, there wasn’t a huge jump in workload as you are implying. 
                       
                      It is true that as an attending, I read much more now…but it also takes much less brain power to read that many studies. And the type of studies are easier in general. Plus, I get paid 10x more than I did as a resident, which makes it feel more  justified. 
                       
                      I do agree that academic attendings do work hard and are not fairly compensated. Hence why many academics leave for PP and not the other way around. 
                       
                       

                    • kiqbns_134

                      Member
                      February 27, 2023 at 1:15 pm

                      Ya i trained at two very different places. One was resident run and we did a lot of call overnights where we did 100-150 cases overnight like any attending would. Daytime volumes would be like 50 cases but youre going over them twice so effectively 100. Not much time off, lots of overnights. Definitely burnt out at the end. My fellowship was at big time hospital where there was a glut of trainees and some of the residents dinked around for sure while the fellows kept the work going. My guess is most rads are pretty burnt already before they even get out to do real work.
                       
                      I had a co-resident leave after first year to go do pathology. He had to do like 100 msk plain films a day as a first year.. he wasnt like what he was seeing and rightly so.
                       
                       

            • smfst7_929

              Member
              February 26, 2023 at 7:10 am

              Small PP is only done if they try to keep 3 year to partner contracts or something equally as moronic in this market like tiered partnership. Nobody is putting up with that nonsense anymore. The OP didnt state what the partnership terms were. Would be interesting to know how much time to partner and if any hierarchy in the partnership or any unusual payout to those leaving the group. Believe it or not, I know of groups that give larger payouts to partners that have been with the group at least 20 years. You wouldnt believe what some groups have written into their bylaws. I think small PP is very viable but only if they adapt to the market appropriately.

              • Robbro524_990

                Member
                February 26, 2023 at 7:32 am

                Agree with the above. We are all facing the same market forces, so you have to innovate and pay good people for their work. You need to stress to hospital administration that they are about to go through a world of pain if they don’t financially back your group.

                Maybe you should also give Radiology Business Solutions a call and see how other groups your size are holding up in this market.

      • cieminsjohn

        Member
        February 27, 2023 at 8:07 am

        Quote from IGotKids2Feed

        OP I think telerad is your answer, hire your own telerads to cover after hours.  PP tele is more attractive to most rads than corporate tele so you have an advantage there.  

        [b]Just make sure you dont treat them like second class citizens or theyll leave.  And hire enough of them, otherwise theyll leave.[/b]

        Group saved, problem solved, youre welcome.

        And if you dont think you can do this, why not?

         
        Wish we had like buttons on here. 

    • aldoctc

      Member
      February 26, 2023 at 8:14 am

      “Being employed by the hospital won’t fix the staffing crisis. It just makes it someone else’s problem. Chances are the hospital won’t have any better luck hiring, they will just throw silly money at locums.”

      Yup!

      OP is where we were about 5 years ago.

      We “integrated” about 3 years ago.

      When we were PP, admin constantly complained about our inability to recruit. Now, after 3+ years of trying to recruit rads, they’re realizing we weren’t the problem.

      Integration didn’t “solve” any of our problems, just transferred them, but at least I don’t give a $hit anymore. I’m hoping for another 5 years; if I were younger, I’d be examining my options very seriously.

      • btomba_77

        Member
        February 26, 2023 at 9:11 am

        Quote from Dr. Joseph Mama

        “Being employed by the hospital won’t fix the staffing crisis. It just makes it someone else’s problem. Chances are the hospital won’t have any better luck hiring, they will just throw silly money at locums.”

        Yup!

        OP is where we were about 5 years ago.

        We “integrated” about 3 years ago.

        When we were PP, admin constantly complained about our inability to recruit. Now, after 3+ years of trying to recruit rads, they’re realizing we weren’t the problem.

        Integration didn’t “solve” any of our problems, just transferred them, but at least I don’t give a $hit anymore. I’m hoping for another 5 years; if I were younger, I’d be examining my options very seriously.

         
        Mostly agree… although economies of scale can mitigate some of the issues.   
         
        The big system/group may have better leverage on insurer payments.  They may have some rads who aren’t yet maxed out and can shift work from the small St. Elsewhere group to the big house.    They may have negotiated better rates for their teleradiology services because of their size and can shift some of the St. Elsewhere volume that way.  They may have internal night group that can easily satisfying the complaining ED docs at St. Elsewhere. They may have an existing relationship with a locums company who can find them a body to put on-site in a way the smaller couldn’t. They may have the backing of a hospital system willing to lose money on radiology in the short term in order to gain regional market share.
         
        __________
         
         
        Regardless of how true any of that above paragraph is …. it [b]is[/b] what is happening all over the US.     
         
        I’m not opposed to the small group model at all. In fact, the healthy smalll to medium egalitarian private practice is probably the best gig for a radiologist to have.    It’s just that in the current environment their numbers a dwindling and I don’t see anything on the horizon to alter that trend.
         
         
         
         

        • ruszja

          Member
          February 26, 2023 at 11:48 am

          Quote from dergon

          Mostly agree… although economies of scale can mitigate some of the issues.   

          The big system/group may have better leverage on insurer payments.  They may have some rads who aren’t yet maxed out and can shift work from the small St. Elsewhere group to the big house.    They may have negotiated better rates for their teleradiology services because of their size and can shift some of the St. Elsewhere volume that way. 

          But that’s a different model. Yes ‘health system practice’ as your employer and a number of large health systems do it has these opportunities. But that’s not what ‘hospital employment’ means in the setting of a small hospital. Unless there is a larger entity attached that already has a large rad practice, it just means the rads get a hospital paycheck like surgeons and intensivsts. It’s still a small town practice but the hospital can make promises like silly money, a 9-5 schedule or 1:3wk daytime schedules.

          • smfst7_929

            Member
            February 26, 2023 at 12:08 pm

            Medicare has economy of scale. Look at how well it is run, such an efficient machine with so much cost savings on medications, medical devices etc! Haha. Let that sink in. Just because youre big, doesnt mean you are cost effective. There is a benefit to being lean and nimble in the small to medium group setting. Being big could actually make it worse if poorly administered.

            • afazio.uk_887

              Member
              February 26, 2023 at 12:18 pm

              We are a small group, but fairly close to a city. We can offer better contracts to recruits with more WFH options and flexibility than the Corp city groups. Thus, we have been able to recruit ok. However – a true BFE group is gonna struggle a lot to recruit on-site.

              • Robbro524_990

                Member
                February 26, 2023 at 12:59 pm

                Agree with the above. The hybrid model minimizing onsite work while maximizing off site production will win out. That is, unless the payment model changes, which I highly doubt.

                If enough places/groups go to a true employee model, then productivity will fall off of a cliff, and patients/MDs will have to wait longer and longer for reports. There’s only so much efficiency that economies of scale can achieve, especially with this degree of a numerical physician/radiologist shortage.

                Also, most hospitals would rather NOT have physician employees, for the reasons discussedpreviously. Gonna be interesting.

  • william.wang_997

    Member
    February 26, 2023 at 12:59 am

    Yes,
     
    Hospital employment is the best solution looks like in the current scenarioit is happening nationwide. Less headache and they can hire telerads for you.
     
     

    Quote from LivesinadarkRoom

    How are other small PP (less than 15 FTE) navigating the current job market, particularly in rural locations? Is it inevitable that we become hospital employees? My group has lost 5 of 15 rads in the last year and are faced with ever increasing teleradiology costs, difficulty recruiting and staring down 12 hour days with no solution in sight. We get woken up multiple times in the middle of the night to look at studies because our telerad provider has 2 hour TAT on studies despite paying 300% more than what we paid 5 years ago. We are now paying more money for a study than we collect and getting less service in return. We have gotten to the point of no return and recently approached the hospital about employing the remaining radiologists. We just can’t afford recruitment and locums in this market.

    It used to be that groups like mine would be absorbed by larger PP or corporate groups, but even these groups are short staffed and unable to service existing contracts. I’m very involved in the state ACR society and everyone in the state is describing the same situation. Many groups are on the brink of one group member leaving/getting sick and being in the same situation as my group.

    ACR job postings are more than 400 more than the number of graduating residents. I worry that areas like mine will be unable to have enough radiology coverage for the community. Unfortunately it’s not just radiology, but doctors in general. My mother in law had to go to the ER recently and after waiting 8 hours decided to leave without being seen, despite a proliferation of midlevels. We have daily emails from administration asking to discharge patients to reduce ER boarders, but it seems like there is always another patient to replace those leaving the hospital.

    Do we hope that AI can help improve efficiency? Should we be increasing radiology residemid-level. Am I being overly pessimistic? Are we starting to see the death of healthcare in the US?

    Signed,
    Tired radiologist who read 20k RVU last year out of necessity