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IR call pay?
Putting out feelers for how other PRIVATE groups compensate their IRs for pay. Not looking for any discussion on merits of said pay and not looking for actual numbers. Percentage of partner base salary is the metric that may be helpful without giving out hard numbers or accounting for regional differences.
To be clear, my IRs are high level and are a huge asset to the group as far as hospital contracts and negotiations. They do all of the stroke and a majority of the leg/aorta work in our area. We are revisiting how we compensate our docs but can’t find any real good sources to compare. Call pay has been traditionally covered by a combo of hospital call pay and some contribution from the group. Are your IRs roughly 10%, 20%, 30% over partner base? what say you? -
59 Replies
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I have seen hospital stipends as low as 300/night and as high as 1000/night to hold the pager. You have to negotiate. The 300/night the managing partner was a ‘hospital pleaser’……that never works out very well for the group. It did however worked out great for him/her (got him/herself a good position in hospital admin).
Hospitals that desire high end IR but are unwilling to pay are delusional.-
As an aside——Over 20 years ago before med school I got an entry level job in IT at a hospital. I got 500$ / night of call. We were q5. It basically doubled my pay.
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Quote from Robotrad
I have seen hospital stipends as low as 300/night and as high as 1000/night to hold the pager. You have to negotiate. The 300/night the managing partner was a ‘hospital pleaser’……that never works out very well for the group. It did however worked out great for him/her (got him/herself a good position in hospital admin).
Hospitals that desire high end IR but are unwilling to pay are delusional.
My experience and perspective is similar to this. -
Quote from Robotrad
I have seen hospital stipends as low as 300/night and as high as 1000/night to hold the pager. You have to negotiate. The 300/night the managing partner was a ‘hospital pleaser’……that never works out very well for the group. It did however worked out great for him/her (got him/herself a good position in hospital admin).
Hospitals that desire high end IR but are unwilling to pay are delusional.
Can you clarify, does $300-$1000/night refer to hospital stipend or the amount PP actually pays their partner rads to take call? I have a hard time seeing a PP IR taking call for less than $1000/night unless they get extra when they actually go to do a procedure. Our IR rads (PP) regularly get inappropriate (non-emergent) phone calls during overnights that def disrupts sleep etc even though they don’t actually go in.
A bit off-topic but was wondering if most PP IR rads are being compensated significantly higher (20% or more) than non-IR partners? In my experience they are (mainly due to overnight call pay), but I suppose a group can justify overall equal compensation given that IR in general may have lower total RVUs.-
Bostonrad1 FTW. I would call you prescient but its already played out this way many places. Whats incredible is that any hospital admin still doesnt see this coming.
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Our IRs read Dx between cases and often equal Dx colleagues in overall RVU every day. They get $800 per call day
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We give ours a set amount of money per overnight call. We do not get a stipend from the hospital and leadership is hesitant to ask for it. It’s been brought up multiple times, but seems no one wants to rock the boat.
I would also be curious the workload expected of private practice IRs in the hospital setting. Our large practice is fairly subspecialized, but on frequent days when an IR might have one large case (bleed/TIPS/TACE etc), they might do 2 or three small cases (central lines or drains), and maybe read 10 CXR and call it a day (or more often they just do 3-5 light IR cases total). There is some grumbling from dx, who may also be doing 3-4 biopsies a day and reading 50-70 cross sectional. I don’t know what to think, but everyone is pretty defensive around here and no one wants to talk to each other about it.-
Sounds like your leadership has set up a deal that works great for them and not so much others. Not unusual tf.
If the hospital contract earns enough revenue to pay all of the after hours stipends at market rates then its not really a problem. If it doesnt you are probably not far from a shake up in your group, or the hospital having to start paying for call.-
Sounds about right. Radiologists are too afraid to talk to each other about their contracts let alone admins. Really pathetic tbh.
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Have experienced this is well. Unfortunately, IR wRVU’s are quite low now. so said IR doc might only bring in 30 wRVU’s per day. That will not support their partnership expenses and salary. Sorry.
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IR wRVU will never cover salaries for itself in a hospital setting. However, if the DR contracts earn enough a group can make the case it is their responsibility to subsidize IR to keep the contract. Its when the DR revenue is not enough that the hospital has to step up or it all falls apart. This happens in various ways. Very few figure it out before it has to be rebuilt.
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So my prediction: Groups used to need IR to keep/get hospital contracts. In many locales, given the expansion of teleradiology jobs and other factors, they no longer do. Groups will spin off their IR practices. IR docs will become hospital employees, much the way most surgeons are now. the hospitals will have to now subsidize the IR docs.
Problem is, right now hospital admins do not see this coming. They think they have all the cards…….
Any guesses on how much IR locums costs per week?-
Quote from bostonrad1
So my prediction: Groups used to need IR to keep/get hospital contracts. In many locales, given the expansion of teleradiology jobs and other factors, they no longer do. Groups will spin off their IR practices. IR docs will become hospital employees, much the way most surgeons are now. the hospitals will have to now subsidize the IR docs.
Problem is, right now hospital admins do not see this coming. They think they have all the cards…….
Any guesses on how much IR locums costs per week?
Anyone in a group with experience doing this? Our group is dealing with similar issues. I’m at a small to mid size hospital. Most of the guys in the IR (vascular) call pool are towards the end of their careers and want to drop out and just do general work. We’re not large enough to have dedicated IR only position everyday, and the younger guys productivity is less than a half of an average partner. We’ve talked about the possibility of trying to drop vascular IR during our next contract negotiation and letting the hospital try to employ the IR radiologists.-
Anyone know of an objective benchmark for IR call pay? Im an employed IR so our call comp is 100% from the hospital. When we used to be party of mixed IR/DR group, call comp used to come from the other radiologists pockets and it was always a struggle to negotiate anything reasonable with the diagnostic rads.
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Our IR docs also reach RVUs of DR. They do it by cherry picking the lists. Its infuriating and oddly humorous at the same time.
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So this is a real thing, no doubt. It’s happening.
As IR becomes more “specialized” with less DR skills, they have less in common with the rest of a group, and become more isolated.
If hospitals were smart, they would subsidize IR through a current group, and avoid the headaches of managing and paying for an IR team. Absolutely cheaper and better quality to give the DR some money, and leave it to them to figure out. But many administrators veer towards the employment model for control issues- at their peril. PP IR are much more productive than most employed.
Administrators have no interest in what costs they can avoid in the fuure, but are fixated on minimizing cost today. They clean up messes, they don’t avoid messes. So they tend to be very short sighted, no matter how many financial projections you present.
So if you can unload IR, it will probably benefit you, at least short term. Just don’t do it at the expense of current IR rads. Get them on board, to do DR, or maybe they are retiring. But if it comes to a segue of simply not recruiting, that may be an opening you can use.
Once you unload IR, of course you become more replaceable and move closer to DR employment, but you can fight that another day.
I think for some groups, mammo is moving into this territory if you can’t adequately recruit. Unfortunately, mammo is a cash cow and if you lose that, you probably can’t survive.
Strong groups control IR; but if there is something to let go, it makes the most sense. These days with recruiting, something has to give.
The next two areas in contention for negotiating stipends etc is off hours coverage and of course mammo; if you lose control of these, along with IR, then you really don’t have much a group left.
So pick your poison.
Quote from Radfive
Quote from bostonrad1
So my prediction: Groups used to need IR to keep/get hospital contracts. In many locales, given the expansion of teleradiology jobs and other factors, they no longer do. Groups will spin off their IR practices. IR docs will become hospital employees, much the way most surgeons are now. the hospitals will have to now subsidize the IR docs.
Problem is, right now hospital admins do not see this coming. They think they have all the cards…….
Any guesses on how much IR locums costs per week?Anyone in a group with experience doing this? Our group is dealing with similar issues. I’m at a small to mid size hospital. Most of the guys in the IR (vascular) call pool are towards the end of their careers and want to drop out and just do general work. We’re not large enough to have dedicated IR only position everyday, and the younger guys productivity is less than a half of an average partner. We’ve talked about the possibility of trying to drop vascular IR during our next contract negotiation and letting the hospital try to employ the IR radiologists.
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The future is separating IR from DR. Frankly, IRs dont earn their keep financially and its not even close.
The common IR refrain of you would lose the contract without us is tired and has now become a cliché.
I say let IR separate and they can tell hospital admin how they are important little creatures and deserving of medals, cakes and pizza parties.
Meanwhile become hospital employed and have your production scrutinized. Good luck making anywhere near DR salary. You might secure a good salary if you fall into the role of always saying yes to clinicians and admin. Oh, and hospital can actually function without IR. A hospital would grind to a halt without DR.
So personally if Im in this guys group, Id generously tell him keep whatever the hospital will give you but dont expect a dime out of the coffers of the group. We are already subsidizing your salary so doing call is the least you can do. This isnt a charity and quit begging.
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Quote from sartoriusBIG
The future is separating IR from DR. Frankly, IRs dont earn their keep financially and its not even close.
The common IR refrain of you would lose the contract without us is tired and has now become a cliché.
I say let IR separate and they can tell hospital admin how they are important little creatures and deserving of medals, cakes and pizza parties.
Meanwhile become hospital employed and have your production scrutinized. Good luck making anywhere near DR salary. You might secure a good salary if you fall into the role of always saying yes to clinicians and admin. Oh, and hospital can actually function without IR. A hospital would grind to a halt without DR.
So personally if Im in this guys group, Id generously tell him keep whatever the hospital will give you but dont expect a dime out of the coffers of the group. We are already subsidizing your salary so doing call is the least you can do. This isnt a charity and quit begging.
Hope you don’t do renal biopsies. -
Inpatient IR does not pay the bills and is not as professionally rewarding. It will be hard for even hospitals to hire a full IR team (financially or from a job satisfaction standpoint). VIR on its own can exist but really needs to be out of the hospital setting in the office based lab or ambulatory surgery center where they are doing embolizations (Prostate artery for BPH, uterine artery for abnormal uterine bleeding, genicular artery for osteoarthritis, Pelvic embolization for pelvic pain, rectal artery embolization for hemorrhoids etc. Or revascularization procedures (PAD, dialysis, venous reconstruction etc). The challenge is this is hard to grow without a clinic with initial consult and follow up (overhead of office space , time for VIR physician (opportunity cost to a group) to see patients and not reading films or doing procedures, office staff, billers, schedulers, medical assistants, physician extenders, marketing team etc.
The hospital coverage for IR is becoming more and more onerous (increasing need for biopsies for molecular targeting, vascular access at all hours of the day/night, fluid management (paracentesis, thoracentesis, abscess drains, nephrostomy, cholecystostomy etc). Not to mention bleeders (GI bleed, epistaxis, hemoptysis, trauma etc) , clotting (Acute limbs, PE/DVT , stroke etc).Not sure how the demands of the hospital will be fulfilled without subsidizing the VIR salaries. It is unfair for the DR /radiology department to be forced to subsidize the low RVU of inpatient IR and call stipend etc.
It would be best to negotiate that separately from the hospital contract. Ideally the radiology group would have all of these groups under their belt (diagnostic imaging , women’s health/breast imaging, Vascular Interventional, and radiation oncology) as this gives them ultimate leverage with the hospital systems and also a component of internal referrals of advanced imaging (MRI, PET scans, , but they need to effectively negotiate for these services with the hospital.-
Historically, certain studies subsidize others. It evened out collectively in the end. We all did most modalities, so no one was counting.
Now that so many have specialized skills, people start pointing at the others silos of rads unfairly stuck with low rvu procedures. Pretty short myopic. Like the rvu system is fair. I guess it seems so when it works in your favor.
Whether or not IR is a separate specialty from radiology down the line is a valid question. But while its still part, hammering them because of rvus is infuriating.
With that logic, mammographers should bail from radiology asap for all those rvus. A few full time mammographers could clean up.
The problem is as a divided group, we wont. stand a chance.
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This is a deeply ignorant but not a uncommon attitude among diagnostic rads in a mixed DR/IR group. Every hospital I know of that lost IR coverage ended up losing a boatload of money from patient transfers or having to pay locums for coverage. Other specialists in the hospital frankly rely on IR to bail them out of situations and you need IR on staff if your facility is a trauma center. If you lose DR, you just get a telerad operation to cover and some on the boots skeleton crew to cover the hospital scut work.
I do agree that splitting from a mixed group and going to a 100% employed IR model with the hospital is the way to go. My compensation is actually higher than when I was part of a mixed group but alot of it is subsidized by the hospital like other specialty surgical services. I would encourage any IR to seriously consider breaking off and just negotiating directly with hospital admin. I also do diagnostic reads for my hospital at per RVU click model to keep my skills up without having to do any diagnostic call or any scut work the diagnostic rads sometimes would try to punt at us.
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Quote from sartoriusBIG
The future is separating IR from DR. Frankly, IRs dont earn their keep financially and its not even close.
The common IR refrain of you would lose the contract without us is tired and has now become a cliché.
I say let IR separate and they can tell hospital admin how they are important little creatures and deserving of medals, cakes and pizza parties.
Meanwhile become hospital employed and have your production scrutinized. Good luck making anywhere near DR salary. You might secure a good salary if you fall into the role of always saying yes to clinicians and admin. Oh, and hospital can actually function without IR. A hospital would grind to a halt without DR.
So personally if Im in this guys group, Id generously tell him keep whatever the hospital will give you but dont expect a dime out of the coffers of the group. We are already subsidizing your salary so doing call is the least you can do. This isnt a charity and quit begging.
Just say no to IR exploitation of DR, just say no.
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When I started, IR was well compensated and sang the same song. What did DR do for them, except cost them money?
Now the tables have turned.
But for how long?
Remote DR is the easiest to replace, and technically made easier by the day. So I think being connected to boots on the ground will never get old.-
Also, once they figure out they bought the wrong service, what is to keep them from employing profitable areas.
I would think employing mammographers at a premium and skimming the inevitable surplus would be the logical play. Its best profit center in radiology.
Use that to pay for IR.
Then farm out DR to the lowest bidder. Could probably get a skim here too.Thats what disunity could get you, and will once groups fragment.
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Yes Boomer. Well said. Boots on the ground getting compensated with what they deserve due to the revenue they produce. Then IR being subsidized by the hospital, not the DR rads. This now the only way a hospital and group win together.
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So the guy/gal reading 250 X-rays should get 1/2 the guy who reads 50 mri?
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Quote from TurboEcho
So the guy/gal reading 250 X-rays should get 1/2 the guy who reads 50 mri?
That’s obviously a valid point but it seems different to me. IR is becoming and wants to become a completely different specialty these days. DR subsidizes IR and if that works for the group that is fine but if the IR docs aren’t happy with the arrangement and feel they could do better on their own DR won’t miss them (unless they start losing contracts but I don’t really think that would be a major issue with the poor service and poor recruitment for telerads these days). -
Quote from RadCog
Quote from TurboEcho
So the guy/gal reading 250 X-rays should get 1/2 the guy who reads 50 mri?
That’s obviously a valid point [b]but it seems different to me[/b]. IR is becoming and wants to become a completely different specialty these days. DR subsidizes IR and if that works for the group that is fine but if the IR docs aren’t happy with the arrangement and feel they could do better on their own DR won’t miss them (unless they start losing contracts but I don’t really think that would be a major issue with the poor service and poor recruitment for telerads these days).
Yes it is different. Let’s not conflate the two problems. One is an issue where a group can figure out how to come up with a fair method to weight actual work among a service that generates income that can afford to pay rads fairly. Daytime DR reads.
The other is the hospital’s responsibility to subsidize a service that cannot pay for itself. This goes for after hours DR coverage as well. -
Quote from Thread Enhancer
Quote from RadCog
Quote from TurboEcho
So the guy/gal reading 250 X-rays should get 1/2 the guy who reads 50 mri?
That’s obviously a valid point [b]but it seems different to me[/b]. IR is becoming and wants to become a completely different specialty these days. DR subsidizes IR and if that works for the group that is fine but if the IR docs aren’t happy with the arrangement and feel they could do better on their own DR won’t miss them (unless they start losing contracts but I don’t really think that would be a major issue with the poor service and poor recruitment for telerads these days).
Yes it is different. Let’s not conflate the two problems. One is an issue where a group can figure out how to come up with a fair method to weight actual work among a service that generates income that can afford to pay rads fairly. Daytime DR reads.
The other is the hospital’s responsibility to subsidize a service that cannot pay for itself. This goes for after hours DR coverage as well.
I just don’t follow the logic. In that case, why isn’t it the hospital’s problem to help subsidize the xray reader because Xrays generate garbage RVU? Neither entirely pays for itself. To go even further, someone reading straight 100 screening 3D Tomo’s is “out RVUing” most diagnostic rads, why are we allowing them to subsidize us?
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Lot of ignorance in this threat but some people get it. IR itself wants to break off. Why do you think they lopped off a year of diagnostic in residency and made it the new integrated IR pathway? They want to break off and they should.
This pervasive myth of we need IR to keep the contract is bonkers, especially in this market. Sure, youll have some groups implode if they separate for various reasons. One likely reason is you have ignorant hospital admin that dont have their finger on the pulse of this market so they play hardball and lose by winning. They cant find replacements. So the hospital suffers by losing money and patients suffer with whatever piecemeal third rate locums or tele the hospital cobbles together in short notice.
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Lets be frank- then next several years are the time to make your money and enjoy having leverage on hospital admin. Once the cycle flips, it doesnt matter all that you did to keep your precious contract by ignorantly subsidizing IR with DR earned money. The hospital or whatever remains of private equity and corporate radiology will still come for your jobs if the cycle flips.
While I dont think AI will replace us completely in our lifetimes, I think it does have the ability to make us more productive. Hard to say how much more productive but if its even twice as productive then you automatically have a glut of radiologists. And if its like some doomsayers predict, AI could 10x our productivity in the next 10-20 years. Regardless any productivity bump above 50% means we will have a glut and greedy admin and PE will most certainly have leverage that they will utilize to cut salaries across the board and outright terminate the low production slow rads.
So make your life better now and enjoy it for ten years, or just continue to live in your ignorant bliss. But sticking your head in the sand and living by some farcical notion that IR is the key to success. Good luck with that
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Once enough DRs turn against IR it will be over. No more handouts. We are getting there.
Rads, drop the diagnostic moniker, can pick up needle work again and other basic procedures like before.
IR can compete with surgeons and other specialists who do procedures that IR docs want to do. The money won’t be there for IR docs. -
Power to the people! Tired of being told that if it wasnt for IR, we wouldnt have keep the contract. Lets see how you replace us all in this market! DR is the engine of the hospital. Good luck getting tele to replace us in the next 10 years. Wont happen!
Haha but seriously, DR holds the true power- its just that most of the DRs are cowards unwilling to use their leverage. IRs tend to be more outspoken with a surgeon mentality. Someone start the DR revolution!
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The split is already well underway. Hospitals looking for coverage are being told flat out to just forget about IR coverage, its not going to happen. If they are lucky enough to find a group willing/able to take a contract it will be for DR only and the hospital will have to figure out IR on their own (pay crazy locums rates). It will accelerate if/when the big PE groups start dropping underperforming contracts and consolidate.
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Yeah. I just dont understand the ignorance on AM forums. You still hear the typical BS of IR needed to keep the contract. IR needs the AI revolution to happen. Otherwise they are just low rvu producing loudmouths
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Referring docs love IR. Referring docs can turf all after hours and no pay patients. Someone else pays IR salary. What’s not to like?
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Our IR are anything but loudmouths. They are physician leaders within the group and system. Highly respected by all. Eager to help clinicians. They all do DR as well. When not doing cases help with the Ed list. The last thing I would do is unload their service at their expense.
if ir wants to go it on their own, well thats a different story. No doubt its a lonely rvu road, and everyone will use them as a dumping ground. PP ir and employed ir are different beasts. The latter has to jump to the hospitals requests. It can become an adversary to DR, as they may want to increase revenue depending on their arrangement with the hospital. Vascular imaging may be up for grabs, and the ir low skill procedures may be dumped on DR. Thats what I would do.If this becomes an rvu thing, I would expect Mammo to do the same to DR. At this point, the are just a parasite using the proposed logic. Day work with high rvus; whats not to like.
Very short sighted overall. 5 to 10 years go fast. Before you know it you are fragmented into a corner. -
Our IR are anything but loudmouths. They are physician leaders within the group and system. Highly respected by all. Eager to help clinicians. They all do DR as well. When not doing cases help with the Ed list. The last thing I would do is unload their service at their expense.
if ir wants to go it on their own, well thats a different story. No doubt its a lonely rvu road, and everyone will use them as a dumping ground. PP ir and employed ir are different beasts. The latter has to jump to the hospitals requests. It can become an adversary to DR, as they may want to increase revenue depending on their arrangement with the hospital. Vascular imaging may be up for grabs, and the ir low skill procedures may be dumped on DR. Thats what I would do.If this becomes an rvu thing, I would expect Mammo to do the same to DR. At this point, DR ia a parasite using the proposed logic. Day work with high rvus; whats not to like about Mammo seceding from Dr.
Very short sighted overall. 5 to 10 years go fast. Before you know it you are fragmented into a corner. -
Our IR are anything but loudmouths. They are physician leaders within the group and system. Highly respected by all. Eager to help clinicians. They all do DR as well. When not doing cases help with the Ed list. The last thing I would do is unload their service at their expense.
if ir wants to go it on their own, well thats a different story. No doubt its a lonely rvu road, and everyone will use them as a dumping ground. PP ir and employed ir are different beasts. The latter has to jump to the hospitals requests. It can become an adversary to DR, as they may want to increase revenue depending on their arrangement with the hospital. Vascular imaging may be up for grabs, and the ir low skill procedures may be dumped on DR. Thats what I would do.If this becomes an rvu thing, I would expect Mammo to do the same to DR. At this point, DR is technically a parasite using the proposed logic. Day work with high rvus; whats not to like about Mammo seceding from DR.
Very short sighted overall. 5 to 10 years go fast. Before you know it you are fragmented into a corner. -
Boomer- This was 99% a satire from my commentary. Like all satires of course, there is a shred of truth. Mostly just wanted to make fun of the oft repeated idea that the contract is always lost without IR. Times are a changin my friend.
Of course I think IR is a valuable addition to the hospital and to patient care in general.
And funny you bring up mammodonnas. They would for sure sell us down the river for an extra dollar. But if AI enters radiology, mammodonnas are the first to feel the effects of AI. It may not replace them but it will 10x their productivity. With those kind of productivity gains, well need 1 out of every 10 breast imagers, maybe 2 to be generous because someone has to do the biopsies.
Also if AI makes breast imaging easy enough, you may see PAs or NPs get in the mix. Or maybe obgyns or breast surgeons will want a piece.
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Boomer- This was 99% a satire from my commentary. Like all satires of course, there is a shred of truth. Mostly just wanted to make fun of the oft repeated idea that the contract is always lost without IR. Times are a changin my friend.
Of course I think IR is a valuable addition to the hospital and to patient care in general.
And funny you bring up mammodonnas. They would for sure sell us down the river for an extra dollar. But if AI enters radiology, mammodonnas are the first to feel the effects of AI. It may not replace them but it will 10x their productivity. With those kind of productivity gains, well need 1 out of every 10 breast imagers, maybe 2 to be generous because someone has to do the biopsies.
Also if AI makes breast imaging easy enough, you may see PAs or NPs get in the mix. Or maybe obgyns or breast surgeons will want a piece.
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Quote from boomer
Our IR are anything but loudmouths. They are physician leaders within the group and system. Highly respected by all. Eager to help clinicians. They all do DR as well. When not doing cases help with the Ed list. The last thing I would do is unload their service at their expense.
if ir wants to go it on their own, well thats a different story. No doubt its a lonely rvu road, and everyone will use them as a dumping ground. PP ir and employed ir are different beasts. The latter has to jump to the hospitals requests. It can become an adversary to DR, as they may want to increase revenue depending on their arrangement with the hospital. Vascular imaging may be up for grabs, and the ir low skill procedures may be dumped on DR. Thats what I would do.If this becomes an rvu thing, I would expect Mammo to do the same to DR. At this point, DR is technically a parasite using the proposed logic. Day work with high rvus; whats not to like about Mammo seceding from DR.
Very short sighted overall. 5 to 10 years go fast. Before you know it you are fragmented into a corner.Mammo is already breaking off in many places, rads don’t want to do mammo? this is what happens- it goes away.
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What needs to go away is the all inclusive private radiology group- and they are disappearing at a rapid rate.
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Quote from boomer
If this becomes an rvu thing, I would expect Mammo to do the same to DR. At this point, DR is technically a parasite using the proposed logic. Day work with high rvus; whats not to like about Mammo seceding from DR.
Very short sighted overall. 5 to 10 years go fast. Before you know it you are fragmented into a corner.
5-10 years is all I would need if I was getting all the money I generate as a breast rad. -
Yeah my plan is to make as much money now for next ten years. Then coast the last half of my career eventually going part time.
So yes now is the time to jettison IR if your group can get away with it. Youll make more money for sure. And if the naysayers are correct, then maybe you have a target on your back to be replaced down the line. But I doubt it, not in this market. Not for at least ten years. In 10 years youll have made an extra mill.
If your IRs put up out good DR rvus then theyre worth keeping. Problem is the new grads have one less year of diag training so many dont feel comfortable reading high volume DR. Thats a hard sell for a group to pick up an IR who cant churn out DR volume between cases.
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Majority of DRs I know wet their pants if they have to touch a needle.
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Yes, in a majority of the community hospitals I’ve worked, we’re totally fine staffing with IRs who can both do procedures and read diagnostics as well.
Can’t staff that same community hospital with only DR, who can’t deal with all the IR stuff like port placements, angiograms, etc. -
Have those who hired any of the new integrated residents seen a decrease in speed and or ability to read imaging or even a decreased desire to read imaging. The current integrated IR residents get a couple of years less DR training PGY5/6 compared to their DR colleagues who do PGY5/6 in imaging and so wonder what the post training implications are . What modalities or organ based fields are they being asked to read?
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Have those who hired any of the new integrated residents seen a decrease in speed and or ability to read imaging or even a decreased desire to read imaging. The current integrated IR residents get a couple of years less DR training PGY5/6 compared to their DR colleagues who do PGY5/6 in imaging and so wonder what the post training implications are . What modalities or organ based fields are they being asked to read?
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Honestly I just assumed most pp groups would have the hospitals subsidize IR. We did it in my group for the last few years. Otherwise you can’t justify the higher salary.
Splitting off IR is incredibly short sited. Boots on the ground is very hard to find. You can easily leverage better subsidies for diagnostic AND IR if negotiated together. These last two years have been a blessing for us.
Get some balls and ask for better contracts. Be willing to walk if they don’t comply.
Wish the hospitals good luck for finding a different radiology provider.
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Quote from Thread Enhancer
Yes Boomer. Well said. Boots on the ground getting compensated with what they deserve due to the revenue they produce. Then IR being subsidized by the hospital, not the DR rads. This now the only way a hospital and group win together.
Hospital may benefit from IR, I get nothing from them. Let the hospital subsidize IR.
Also, rads who don’t read mammo shouldn’t benefit from mammo
Suum cuique- “to each his own” -
I think all forms of call should be compensated by the hospital.
Working overnight as DR should come at a premium, paid by the hospital. Using telerads or rads in group to cover overnights is a net $ loss for most groups.
Just thinking back to reading high volume studies at 4 AM as a resident makes me distressed. Surprised there are still enough overnight rads to cover so many hospitals.
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Quote from boomer
So this is a real thing, no doubt. It’s happening.
As IR becomes more “specialized” with less DR skills, they have less in common with the rest of a group, and become more isolated.If hospitals were smart, they would subsidize IR through a current group, and avoid the headaches of managing and paying for an IR team. Absolutely cheaper and better quality to give the DR some money, and leave it to them to figure out. But many administrators veer towards the employment model for control issues- at their peril. PP IR are much more productive than most employed.
Administrators have no interest in what costs they can avoid in the fuure, but are fixated on minimizing cost today. They clean up messes, they don’t avoid messes. So they tend to be very short sighted, no matter how many financial projections you present.
So if you can unload IR, it will probably benefit you, at least short term. Just don’t do it at the expense of current IR rads. Get them on board, to do DR, or maybe they are retiring. But if it comes to a segue of simply not recruiting, that may be an opening you can use.
Once you unload IR, of course you become more replaceable and move closer to DR employment, but you can fight that another day.
I think for some groups, mammo is moving into this territory if you can’t adequately recruit. Unfortunately, mammo is a cash cow and if you lose that, you probably can’t survive.
Strong groups control IR; but if there is something to let go, it makes the most sense. These days with recruiting, something has to give.
The next two areas in contention for negotiating stipends etc is off hours coverage and of course mammo; if you lose control of these, along with IR, then you really don’t have much a group left.
So pick your poison.
Quote from Radfive
Quote from bostonrad1
So my prediction: Groups used to need IR to keep/get hospital contracts. In many locales, given the expansion of teleradiology jobs and other factors, they no longer do. Groups will spin off their IR practices. IR docs will become hospital employees, much the way most surgeons are now. the hospitals will have to now subsidize the IR docs.
Problem is, right now hospital admins do not see this coming. They think they have all the cards…….
Any guesses on how much IR locums costs per week?Anyone in a group with experience doing this? Our group is dealing with similar issues. I’m at a small to mid size hospital. Most of the guys in the IR (vascular) call pool are towards the end of their careers and want to drop out and just do general work. We’re not large enough to have dedicated IR only position everyday, and the younger guys productivity is less than a half of an average partner. We’ve talked about the possibility of trying to drop vascular IR during our next contract negotiation and letting the hospital try to employ the IR radiologists.
Interesting story circulating in my regions about this. A group supposedly approached hospital admin about a procedure stipend and presented data showing they need around 0.5 radiologist salary to cover the revenue/productivity loss they suffer pulling people from DR to staff IR. Hospital refused to pay so they dropped all their procedure privileges. Hospital was forced to hire supposedly 3 dedicated IR docs to cover it. That’s been over a year ago and the that group still has a contract with the hospital covering diagnostic only which is telling of the current shortage.
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If only there was a Hospital Administrator forum like AM that they could learn from. But they don’t/won’t.
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Quote from dchapred
Putting out feelers for how other PRIVATE groups compensate their IRs for pay. Not looking for any discussion on merits of said pay and not looking for actual numbers. Percentage of partner base salary is the metric that may be helpful without giving out hard numbers or accounting for regional differences.
To be clear, my IRs are high level and are a huge asset to the group as far as hospital contracts and negotiations. They do all of the stroke and a majority of the leg/aorta work in our area. We are revisiting how we compensate our docs but can’t find any real good sources to compare. Call pay has been traditionally covered by a combo of hospital call pay and some contribution from the group. Are your IRs roughly 10%, 20%, 30% over partner base? what say you?
Getting back to the initial framing of the question, I think you need more info before you can talk about this in terms of % partner base pay.
How many IRs are in the call pool? Do they take any diagnostic call? How low are their wRVU’s compared to DX rads?
To pick a #, assuming 600k partner salary, you are asking are if the IR rads should be getting 660k, 720k, or 780k? That’s getting to be a pretty big premium if there is a decent # in the call pool, there is no diagnostic call, and their wRVUs are low. On the flip side, if they’re taking a lot of call and still reading a lot of cases, it might be reasonable or even low.
Basically, I just think its hard to generalize as % of partner base pay. That’s why you’re getting a lot of replies about how much a call shift is worth instead of what you asked for.
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Quote from Radsoxfan
Quote from dchapred
Putting out feelers for how other PRIVATE groups compensate their IRs for pay. Not looking for any discussion on merits of said pay and not looking for actual numbers. Percentage of partner base salary is the metric that may be helpful without giving out hard numbers or accounting for regional differences.
To be clear, my IRs are high level and are a huge asset to the group as far as hospital contracts and negotiations. They do all of the stroke and a majority of the leg/aorta work in our area. We are revisiting how we compensate our docs but can’t find any real good sources to compare. Call pay has been traditionally covered by a combo of hospital call pay and some contribution from the group. Are your IRs roughly 10%, 20%, 30% over partner base? what say you?
Getting back to the initial framing of the question, I think you need more info before you can talk about this in terms of % partner base pay.
How many IRs are in the call pool? Do they take any diagnostic call? How low are their wRVU’s compared to DX rads?
To pick a #, assuming 600k partner salary, you are asking are if the IR rads should be getting 660k, 720k, or 780k? That’s getting to be a pretty big premium if there is a decent # in the call pool, there is no diagnostic call, and their wRVUs are low. On the flip side, if they’re taking a lot of call and still reading a lot of cases, it might be reasonable or even low.
Basically, I just think its hard to generalize as % of partner base pay. That’s why you’re getting a lot of replies about how much a call shift is worth instead of what you asked for.
Well-put. Seems like there are several factors to consider and so no one size fits all answer.-
1. those numbers I cited was stipend (payment) from the hospital to provide the call coverage. Even though the professional fee we get in the hospital is not great per case, a well run IR dept makes good money on the technical fees that the hospital reaps. Many groups rightfully negotiate for a cut of this fee (ie the stipend). This is exactly the same as how ortho/NS get stipends to provide call coverage. This also encourages the docs to do high end/high reimbursing work (at least the tech fees) in the hospital.
2. Groups that have IR output labs can reap the tech fees and more than make up the revenue differences between IR and DR. Sometimes significantly so.
3. IR/DR groups have to run like a business. You have to negotiate. You have to market. You can’t just sit on your ass and expect the cases/studies to role in. Too many passive groups out there. Unfortunately I think our speciality selects out for the passive type.-
Quote from Robotrad
1. those numbers I cited was stipend (payment) from the hospital to provide the call coverage. Even though the professional fee we get in the hospital is not great per case, a well run IR dept makes good money on the technical fees that the hospital reaps. Many groups rightfully negotiate for a cut of this fee (ie the stipend). This is exactly the same as how ortho/NS get stipends to provide call coverage. This also encourages the docs to do high end/high reimbursing work (at least the tech fees) in the hospital.
2. Groups that have IR output labs can reap the tech fees and more than make up the revenue differences between IR and DR. Sometimes significantly so.
3. IR/DR groups have to run like a business. You have to negotiate. You have to market. You can’t just sit on your ass and expect the cases/studies to role in. Too many passive groups out there. Unfortunately I think our speciality selects out for the passive type.
Good points…part of the “problem” with our field is that even is a world of never-ending cuts/increasing volumes and burn-out, most PP groups are still doing pretty well. How long we can sustain this is a different story
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The real question is how do hospitals compensate practices to cover trauma/stroke/IR call. If you’re getting less than is traditional/customary, may be time to re look things and negotiate. No one is generating RVUs by taking home pager call, but its still work nonetheless and its required to maintain certain designations. I’ve been in two private groups now where IR is well subsidized by the hospital in order to maintain stroke and or trauma center designations (rad group gets the money).
