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Is it time to impose RVU and work hour limits for radiologists?
Hear me out. This is both a patient safety issue and a way to fight back against reimbursement cuts.
Patient safety perspective:
I thoroughly believe the vast majority of radiologists do their utmost to practice as carefully as possible and minimize errors. But, there is no doubt that reading huge volumes in a short time increases risk of errors. That is simply common sense. If the general public understood that a radiologist can easily read 120-150 cases in a day, many of which have hundreds of images and subtle findings, they would not be ok with it.
RVU limits as a way of fighting back against reimbursement cuts:
For decades the ACR has tried to fight reimbursement cuts to no avail. Radiology is a victim of its own success. The role of radiology is critical and image volume goes up and up at a rate unmatched by other medical specialties. The government treats medical reimbursement as a zero sum game. If imaging volumes go up, then reimbursement goes down. This devalues our profession and negatively impacts patient safety.
Consider say a 55 rvu limit per shift and a 9 hour shift limit. What would happen? Not all cases would get read. Nobody would pick up the slack because to do so would violate rvu and hour limits. Over utilization would no longer be the radiologists problem. It would become a problem for the government, hospitals and ordering physicians to solve. It would also drastically increase demand for radiologists. Hospitals and corporate entities would be in desperate need of radiologists.
Would salaries go down? It makes sense that if reimbursement per rvu is always going down and I am arguing to limit rvus, that this would bring down salaries, right? Not so fast. Reading huge rvu numbers has devalued our profession. While yes it leads to higher pay in a given year it leads to lower pay the next year when reimbursement gets cut. With rvu limits the onus shifts from radiologists to hospitals. If demand for radiologists shoots up 20% overnight due to rvu limits, do you really think salaries would go down? I doubt it. Hospitals would do what they had to do to hire rads.
My point is simple. Government has shirked its responsibility. It has a responsibility to not allow healthcare costs to bankrupt this country. It refuses to make the necessary decisions such as reigning in over utilization. It simply pays doctors less and less to do more and more. I am suggesting we break that cycle.
The ACR and ABR should be taking on this fight? I cannot think of many other professions where safety is more important. If this topic reaches public consumption I predict the rvu limits will be seen as a logical step.
Would radiologists then be replaced by AI or midlevels? I doubt it. I predict AI makes our jobs harder, not easier. As for midlevels I dont think that would happen either. Just argue radiologists are already overburdened. If they are reading 100+ cases themselves they do not have time to check the work of others safely.
If none of this happens, then at the very least the ACR should be fighting to limit radiologist legal liability in a way unheard of in other medical specialties. If I am being forced to work under unsafe conditions and am doing so to the best of my ability, then when a mistake happens should I really be at fault? Of course not!
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42 Replies
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I know you brought this up in the other thread and I responded there but the major issues are ones I brought up on that thread. Mainly,
– You assume the government would not still cut pay per exam which is not a given. What happens if we have RVU limits AND they still cut pay.
– RVU limits are not the same per person, per subspeciality, or per practice setting. How is that heterogeneity adjusted for?
– If limits are instituted, who reads the excess studies that will exist? There is already a shortage of radiologists.
I tend to agree with your premise that more studies = more government cuts but IMO it should be tackled from the other side – the inappropriate ordering of excessive studies by the clinicians. At the very least, we should be making it clear that the clinicians control the volume, not us.-
Agree with your points but I think you skimmed what I wrote too quickly since I addressed most of your questions. The way I presented it rvu limits are the same for everyone. Are all rvus equal? No. Whose fault is that? The people who developed the rvu system.
Who picks up the leftover work? Nobody. As I said it becomes no longer our problem. You say the problem should be tackled from the other side from the ordering physicians. I agree completely and that is the entire point of what I wrote. You say pay could still go down. As I wrote I think the demand for rads would make reimbursement per rvu irrelevant. Hospitals would pay whatever they had to in order to hire rads. If govt dropped reimbursement it would screw hospitals not rads. Supply and demand.
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So you’re advocating for them to change the RVU system? I’m not sure what you’re offering as a solution to the RVU heterogeneity issue.
Also, I’m not sure there are enough rads to hire to cover the extra studies that will exist if limits are put in place.
I like the conversation and premise. I’m just not sure there is a good solution for us out there.
I have heard that some new ordering systems integrate ACR appropriateness criteria and several hospitals that use it have seen a decrease in volume so perhaps that is one of the solutions. -
Is there any precedent in medicine with regards to work limits? This would be extremely tough to do and enforce on a national level.
I suppose all the acr has to do is put out guidance. Then read more then suggested at your own risk. Lawsuit on a case over limits would be bad.
But I agree that this would stop the trend of reading more to maintain salaries with ever increasing cuts.
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Theres really no physician job like radiology where the work is literally lined up and refreshed at will. It would be like if there was a conveyer belt of patients for a surgeon to cut out their gallbladders over and over
Going to be impossible to fight clinicians about unindicated studies in this world of CYA medicine
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[font=”arial,helvetica,sans-serif”]
Quote from IR27
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[font=”arial,helvetica,sans-serif”] Theres really no physician job like radiology where the work is literally lined up and refreshed at will. It would be like if there was a conveyer belt of patients for a surgeon to cut out their gallbladders over and over [/font]
[font=”arial,helvetica,sans-serif”] Going to be impossible to fight clinicians about unindicated studies in this world of CYA medicine [/font]
[font=”arial,helvetica,sans-serif”][/font]
[font=”arial,helvetica,sans-serif”] This always reminded me of how we work in radiology:[/font]
[font=”arial,helvetica,sans-serif”]Neuman”[/font]
[font=”arial,helvetica,sans-serif”][b]Because the mail never stops! It just keeps coming and coming and coming, there’s never a let-up! It’s relentless! Every day it piles up more and more and more! And you gotta get it out! But the more you get it out the more it keeps coming in!”[/b][/font][/h2]-
I strongly oppose imposed regulation for what we should be doing ourselves. Let’s be real. We all know when we are overloaded, and when our colleagues are overloaded. It is painfully obvious when the list on PACS grows to 50 or 100 unread cases, and it doesn’t start to go down until late in the afternoon. We KNOW.
As I stated above, the main motivation to limit working staff is to maximize revenue and maximize time off while punishing the people on the line. There is no possible way that this practice doesn’t negatively affect patient care. I challenge anyone to deny that. But the hubris that we can read fast without any adverse impact will come back to bite us in the form of draconian regulations such as the OP proposes.-
Silly me. I made the original post. Lets stick with the current approach. It is working so well. Lets keep reading higher and higher volumes for less and less money.
I can read as fast as just about anybody. There is no jealousy here. Just concern for the future of the profession.
But I should be able to retire if I can squeeze in 5 more years.
My original post was primarily about ensuring that our jobs not be further devalued.
By the way if these cuts really do go through, an 11% global reimbursement cut is going to lead long term to salary cuts of more than 11%. Overhead will remain the same. Malpractice insurance, office staff, billing, Cme, retirement contributions will remain steady. So we are probably looking at 15-20% salary decrease over the next 2-3 years.
My guess is somebody will present the same ideas I presented in 3 years when things have gotten even worse. Hopefully by then I will have my fumoney and will not even waste my breath.
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Read my post. I don’t disagree with your premise; in fact I agree more than you might realize. If anything, I am trying to shame other rads into following at least some of your suggestions. I’m probably the silly one to think that this approach could work.
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No worries Dalai, I took more offense to somebody writing it was the least well thought out plan they ever saw and others implying that my proposal suggests I am slow and jealous of fast readers.
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Thanks, F.U.Money (fixed it for ya!)…
I’ll admit it… I [i]wish[/i] I could read faster but [i]only[/i] if I could do so with perfect accuracy, more than I manifest now reading at a slower pace.
I will read what’s on the list for my slot, and I will help out on other lists if I possibly can. It is very disheartening to me to see those other lists explode in the middle of the day because there are not enough people assigned/available to read them. And THAT is something we can fix, but generally choose NOT to. -
Quote from fumoney
No worries Dalai, I took more offense to somebody writing it was the least well thought out plan they ever saw and others implying that my proposal suggests I am slow and jealous of fast readers.
You are obviously slow and jealous of fast readers.
You would have done well in east germany or the soviet union. -
With Imaging volumes going up and fewer people going into rads, this is just going to become more and more of an issue. At some point there will be some study linking speed to errors thatll make headlines and when that happens the ball may no longer be in our court.
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I think this is a great idea. No reimbursement after X hours worked.
Big tech Software engineers work 4 day weeks for 8 hours with ample breaks and make a bank. Dont see why we should be overworking our physicians to the point where its one of the most suicidal professions.
Allow people to go to medschool after high school, shorten residency, and get rid of fellowships while were at it.
Also expand scope for mid levels and make medical education free.
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I feel all Rads should listen to their internal clock when it comes to how fast we read. We all have one inside, which manifests as low-level unease or anxiety when we know we are going to fast to be happy with the quality of our work. I know exactly when I am reading too quickly because I feel it in my gut, and I dislike that feeling and thus will slow down even if it means I have to read some cases later from home during my off time. Its simply not worth sacrificing your mental peace or a potential bad outcome for a patient at the altar of MBA bean counters who could care less about us or patients. We must never forget their are real people on the other side of these images, with their own families, hopes and desires and we have a critically important role to play in their health care outcomes. It is sad how Rads as a field is slowly losing its way….
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Guacamole back yet again
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Quote from fw
Quote from fumoney
No worries Dalai, I took more offense to somebody writing it was the least well thought out plan they ever saw and others implying that my proposal suggests I am slow and jealous of fast readers.
You are obviously slow and jealous of fast readers.
You would have done well in east germany or the soviet union.
What kind of Bull-shiite (to quote an old friend) is THAT? -
Quote from DoctorDalai
Quote from fw
Quote from fumoney
No worries Dalai, I took more offense to somebody writing it was the least well thought out plan they ever saw and others implying that my proposal suggests I am slow and jealous of fast readers.
You are obviously slow and jealous of fast readers.
You would have done well in east germany or the soviet union.
What kind of Bull-shiite (to quote an old friend) is THAT?
Yes there are super-fast, accurate readers that can produce clean and meaningful reports but these are the outliers (maybe top 10-15%?). I guess a sports analogy would be yes there are big, strong, fast, and highly coordinated NCAA football players, but these are the outliers who make it to the NFL. The vast majority of NCAA players, who are also elite athletes, typically lack one or more of the above attributes.
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Quote from deicer
[font=”arial,helvetica,sans-serif”]
Quote from IR27
[/font]
[font=”arial,helvetica,sans-serif”] Theres really no physician job like radiology where the work is literally lined up and refreshed at will. It would be like if there was a conveyer belt of patients for a surgeon to cut out their gallbladders over and over [/font]
[font=”arial,helvetica,sans-serif”] Going to be impossible to fight clinicians about unindicated studies in this world of CYA medicine [/font]
[font=”arial,helvetica,sans-serif”][/font]
[font=”arial,helvetica,sans-serif”] This always reminded me of how we work in radiology:[/font][font=”arial,helvetica,sans-serif”]Neuman”[/font]
[font=”arial,helvetica,sans-serif”][b]Because the mail never stops! It just keeps coming and coming and coming, there’s never a let-up! It’s relentless! Every day it piles up more and more and more! And you gotta get it out! But the more you get it out the more it keeps coming in!”[/b][/font]LOL. good one.
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Cubsfan, I think we have similar viewpoints. I have put a lot of thought into this.
Your questions about rvu heterogeneity and what happens to leftover studies are great ones. I am saying it should not be our problem. If there are not enough rads to read all of the cases safely that is not our fault! That is due to overutilization and by us not continuing to suck it up it forces govt to address the real problem rather than us sweeping it under the rug for them. Rvu heterogeneity is real but again rads did not create the rvu system. The govt treats it as a perfect way to reimburse so it can also be seen as a perfect way to determine when a rad has reached their limit for the day.
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^^ who says we have to make 4s-5s and not 2-3s and hire more people? Definitely not going to get sympathy there for a dropping salary.
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[b]Laughable – Boo Hoo for my RVU![/b]
Take care of yourselves and no one else. What about your techs and all the stress and fatigue they deal with? I haven’t seen one post expressing concern. Where is your concern for the techs that are on the front line w COVID while many of you are home hiding behind their monitors?
Where is your concern for the techs that get called in all hours of the night for cases that are not stat and ED won’t wait until the day shift comes in while many of you are home hiding behind your pillows?How many here screen cases in the middle of the night, weekends, holidays, to help prevent techs from being called out at 3:00 a.m for an unnecessary case? Oh wait you don’t because your group signed out to Teleradiology? How many of you require your techs to show up for their day shift regardless that they were up 4 hours after midnight left at 4:00 a.m and have to go home shower and you expect them to be back for 7:00 for the entire 8 hour shift? How many come on here and post how they possibly cannot do an overnight because it is so hard to recover from being up during the night but expect your techs to do it and at a more frequent occurrence then you will. Oh the inhumanity of working in healthcare.
How many of you keep your payroll down and hire tech aides that need supervision rather than a 2nd tech but come on here and b**itch PA and APRN are taking over? How many of you are supposedly on call until 10:00pm but text the tech at 9:00 and tell them send it all to Teleradiology, just adding to their work? Or how about texting a tech at one facility and tell the very busy tech to contact a tech at another facility and have them ……. because you possibly can’t do it. How many of you don’t know that the staff came in at 7:00 a.m., on a Saturday, should have left at 3:00, and at 9:00 pm they are still there trying to get all the unnecessary ED add ons done? Oh wait you don’t know because you signed off at 6:00 p.m. on weekend and on a holiday. How many of your groups book 45 minute and 1 hour cases in 30 minute time slots than yell at techs because they are behind and you want to go home?
Do you not think your techs are tired? Do you not think they are prone to mistakes? Is this also not a safety issue? Obvious you are more about the RVU and $$ then what you are doing to the staff.
Laughable – Boo Hoo for my RVU!-
Quote from Ixrayu
[b]Laughable – Boo Hoo for my RVU![/b]
Take care of yourselves and no one else. What about your techs and all the stress and fatigue they deal with? I haven’t seen one post expressing concern. Where is your concern for the techs that are on the front line w COVID while many of you are home hiding behind their monitors?
Where is your concern for the techs that get called in all hours of the night for cases that are not stat and ED won’t wait until the day shift comes in while many of you are home hiding behind your pillows?
How many here screen cases in the middle of the night, weekends, holidays, to help prevent techs from being called out at 3:00 a.m for an unnecessary case? Oh wait you don’t because your group signed out to Teleradiology? How many of you require your techs to show up for their day shift regardless that they were up 4 hours after midnight left at 4:00 a.m and have to go home shower and you expect them to be back for 7:00 for the entire 8 hour shift? How many come on here and post how they possibly cannot do an overnight because it is so hard to recover from being up during the night but expect your techs to do it and at a more frequent occurrence then you will. Oh the inhumanity of working in healthcare.
How many of you keep your payroll down and hire tech aides that need supervision rather than a 2nd tech but come on here and b**itch PA and APRN are taking over? How many of you are supposedly on call until 10:00pm but text the tech at 9:00 and tell them send it all to Teleradiology, just adding to their work? Or how about texting a tech at one facility and tell the very busy tech to contact a tech at another facility and have them ……. because you possibly can’t do it. How many of you don’t know that the staff came in at 7:00 a.m., on a Saturday, should have left at 3:00, and at 9:00 pm they are still there trying to get all the unnecessary ED add ons done? Oh wait you don’t know because you signed off at 6:00 p.m. on weekend and 4:00 pm on a holiday. How many of your groups book 45 minute and 1 hour cases in 30 minute time slots than yell at techs because they are behind and you want to go home?
Do you not think your techs are tired? Do you not think they are prone to mistakes? Is this also not a safety issue? Obvious you are more about the RVU and $$ then what you are doing to the staff.
Laughable – Boo Hoo for my RVU!
what a strange post. sorry your department is run poorly ( likely by the hospital), address it with them.
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RVU limit ? So any rad (or group of rads) has a say on how hard a boarded doctor across town works? Besides the overwrought nature of this suggestion, which is borne out of fear and envy, how is this not a direct attempt at monopolization through control of output and illegal under antitrust statutes.
Where should the desire to control doctors output stop? Could a NP or PA interpreting medical imaging then have a say on rate at which the typical rad reads? After all, if rads can ask for an RVU limit, NPs and PAs as clinicians dipping into the same large pot can then justly asked for the same deference. Therefore rads couldnt not exceed what NPs and PAs are comfortable with interpreting-perhaps limiting every clinician to lets say reading 5 xrays an hour. RVU limits are the same concept-reducing productivity to the lowest common dominator. Sorry not feasible, but worthy of a nice chuckle.
Because the slugger on the team across town hits 62 homers, and gets more fans, should all the fences be pushed back 50 feet? Or, like after 1968, the pitching mounds have to be changed? Live with it and adjust with the times please.
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Lxrsyu, please post your trolling disgruntled rants on a radiology tech message board.
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Who will read the extra, unread cases? Noctors chomping at the bit.
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Ixrayu
Single dumbest post I have ever seen on here. How many rads even employ techs or have any control over their work hours, etc? Isnt it usually the hospital that employs techs? So how do rads have any control over this? And if you had half of a brain you would see that part of the motivation for my post is to put downward pressure on over utilization which would help techs in addition to rads.
I treat techs well and with respect. But your rant is pure idiocy.
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Dumb? Not at all. There is absolutely complete truth to my post. Where I am there are large private groups that run services for several hospitals. They are partners with these hospitals providing services to multiple imaging centers. Their staff is employed by the group not the hospital. Their staff adheres to both group policy and hospital policy but the group NOT the hospital controls the staff.
Idiocy not at all. It happens.-
If I were a patient, I would want a minimum amount of time spent for everything – pcp visits, er visits, reading imaging studies, surgical procedures across the board. The governing boards should be able to come up with a minimum time and that time should be based on the fastest in the field who also are very good at what they do (fast without compromising quality).
Work hour limits should be imposed across all doctors across the board, which they already have and in my opinion are way too lenient with those hours.
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Ixrayu
Sounds like your issue is with a specific set of individuals, not radiologists as a whole. I have had multiple jobs in radiology and never have been the employer of techs. Furthermore I do not use telerads.
Lastly, it is the ordering docs who are responsible for techs being called in. In our litigious society there is little a rad can do to prevent ordering docs from abusing the system and calling in techs at odd hours.
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I 100% agree with this proposal. And I know it would be extremely unpopular with some radiologists, but at the least the governing bodies should establish a guideline for a safe number of studies/RVU’s an hour/shift and if people want to go over that it is at their risk. And yes, there is definitely a difference in RVU’s and workload, but since that is the system that has been accepted, that is the system that has to be used. Don’t get me started about the worthlessness of the RVU methodology, but since everyone has accepted it, it’s only fair that is what we use. And I would argue there is a relatively accepted number of RVU’s the majority of radiologists read in a 9 hour shift which would be equivalent to around 60-70 RVU’s. Just because a radiologist can dictate more then that, it doesn’t mean its safe/should be accepted. As I stated earlier, pilots/truckers/nurses have limits to their work, and I am sure some of them can do more safely, but the whole point is to eliminate mistakes due to fatigue/speed/carelessness for the majority of radiologists. I also disagree most radiologists know their limits. In today’s environment, most radiologists are not in charge of their workload, and are forced to read more then they are comfortable/willing by upper management. I agree most specialties are not dealing with radiology’s dilemma of ever-increasing volumes with a relatively stagnant staffing model perpetuated by private equity. Most specialties have in-built limits to how much work they can do (OR turnover times/clinic patient turnover times/etc) but radiology departments keep expanding with no inbuilt release valve. Therefore just because other medical specialties are not doing it, it doesn’t mean radiology shouldn’t do it. And multiple professions have done this exact philosophy such as pilots/truck drivers/nurses, etc. to ensure safety of others. How to deal with excess studies will put a focus on eliminating overutilization of radiology and valuing radiologists work. It will also delay/eliminate the annual salary decreases from Medicare. If physicians want to earn more, then can definitely work more shifts (which is a much safer way to earn more money) then working unsafe hours/workloads. I think the ABR and ACR should both be involved if they really want to improve the field of radiology for the future, but as we know, they sit in their Ivory Towers and don’t really address the real problems most radiologists (especially younger radiologists) face. I do not know why the radiology tech issue is being brought up, radiology technologists are hourly employees who get paid overtime/holiday pay and pick up extra shifts at their discretion and even they have a limit to how many patients they image/scan an hour without the expectation of unlimited increasing work per year with yearly salary decreases.
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Try winning a malpractice case when you read 56 RVU on a shift after the ACR said 55 was the “safe limit.” Heck, try avoiding a malpractice suit once patients and lawyers find out.
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Quote from Film Jester
And I know it would be extremely unpopular with some radiologists, but at the least the governing bodies should establish a guideline for a safe number of studies/RVU’s an hour/shift and if people want to go over that it is at their risk. And yes, there is definitely a difference in RVU’s and workload, but since that is the system that has been accepted, that is the system that has to be used. Don’t get me started about the worthlessness of the RVU methodology, but since everyone has accepted it, it’s only fair that is what we use.
Just because this has been the methodology doesn’t mean it always has to be. Of course it can be improved. For now perhaps using the current RVU system is the only option, but it doesn’t have to be in perpetuity.
I hope your reports have more paragraphs than that post 🙂-
In another thread I pointed out the AORN has staffing metrics for nurses that must be met for for facility licensure approval. They justify these metrics under the guise of “patient saftey”. And how ACR could implement such metrics for radiology rvu limits before granting licensure because at some point it obviously becomes a patient saftey issue if a rad is pressured to read too many studies.
I commented that if there were RVU limits, it may have the unintended consequence of faster migration to AI. But the ability of AI may be overstated and the more I think about it, RVU limit might speed up the democratization of radiology across other specialties, i.e. increased midlevel, sub-specialty participation. Not sure…
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RNs don’t get paid more to see more patients though.
They basically negotiated the same pay for less work.-
Something like this will eventually happen if the keystroke lawsuit stuff continues. doctor how could you spend 15 seconds looking at the chest X-ray
They will find some academic rad at mgh or NYU to testify that says they spend 10 minutes on every chest X-ray and that is the standard of care
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This is one of the least well thought out ideas Ive ever heard. If you feel unsafe speak up. No need to restrict others in their practice. The only result would be kicking the need for radiology extenders into hyperdrive.
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Quote from Film Jester
…the governing bodies should establish a guideline for a safe number of studies/RVU’s an hour/shift and if people want to go over that it is at their risk.
Why is it an assumption that handling a higher volume of imaging interpretation translates into inferior or unsafe medicine? What is the outcome measurement: patient health outcomes; or, interpretation congruency with what a group of academics who tend to be picayune with reports (which most studies of quality seem to be based off of) ? To my knowledge, theres never been a study of merit linking imaging interpretation speed (or volume) with patient outcomes. I have seen studies firmly linking the superiority of breast imaging (beyond MQSA requirements) and body procedures to those who do it much more frequently than with those who do not. That doesn’t seem to resonate with most PP around the US. Should the rad governing bodies then think about prohibiting these procedures like they should total RVU tallies?
What about reading interruptions; [link=https://www.radiologybusiness.com/topics/imaging-informatics/further-evidence-suggests-interruptions-radiology-reporting-rooms-are/]https://www.radiologybusiness.com/topics/imaging-informatics/further-evidence-suggests-interruptions-radiology-reporting-rooms-are//[/link] [link=https://www.radiologybusiness.com/topics/care-delivery/92-phone-calls-radiology-reporting-rooms-interrupt-workflow]https://www.radiologybusiness.com/topics/care-delivery/92-phone-calls-radiology-reporting-rooms-interrupt-workflow[/link]. Should a rad governing body require locks on reading room doors and call forwarding instead of ingratiating any and all hospital staff members 24/7/365? Some on these threads give the idea that if a hospital staff member walks into the reading room, the rad should immediate get up , turn away from the imaging, shake his/her hands (pre/post Covid), ask about their day, their kids, salute them, and curtsy (still might not be enough). Also, a rads brain is much more fried on the third day of holiday call than it would ever be reading over 90RVU in an efficient setting. Should the ACR then ban the practice of solo weekend/holiday coverage?
And how would a neuro and mammo reader (or practice with a higher volume of these RVU rich studies) fare with RVU speed limits up against a MSK group or a rad at a cancer center with comparisons each case? What if the personal rad and group profile changes frequently as to make different speed limits impossible to track?
The RVU speed limit chatter seems to be generated out of fear of what the new CMS cuts will bring along since these seem to be as deep and profound as the DRA in 2005. There is also an element of envy of those that read certain imaging quickly in a more efficient setting. These RVU speed limit concerns are not borne out of concerns for patient safety, as they are out of concerns of individuals future income or hold on power in their contracts with individual medical centers.
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Well said @ mrimadman. Too many variables to impose blanket restrictions
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We will not achieve agreement on this issue.
First off, ixrayu has a very valid point…techs are overworked and realize full well that their efforts make it possible for rads to make, well, significantly more than they do. Can YOU do their job? Can you operate the scanners, lift and position the patients, push the buttons, etc? No, you can’t.
On the RVU issue, I certainly chafe at the thought of anyone restricting practice. But I also resent the idea of being forced to read at a dangerous speed because corporate masters/partners insist on thinning the workforce to unsustainable levels so as to maximize vacation and revenue at the expense of those on the ground. This is a very poor way to deliver patient care and we all KNOW it. We can make excuses, and high-five each other about what incredibly good radiologists we are and WE can handle it, but we know, deep down, we can’t, at least not forever.
Sometimes greed gets in the way of doing the right thing.
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–The first obvious fix before considering an RVU limit would be making RVUs come close to reflecting the time and work spent. It’s a tough problem that no one will agree on 100%, but everyone can agree the current RVUs numbers are just not close to accurate. Some groups have made their own adjustments, that would be a good place to start.
–Then you have to figure out where to put in a hypothetical limit. Putting it in at 55 would be way too low, at least for private practice in my opinion. A more realistic limit would be something like 90th percentile volume in a day. 55 is closer to 50th percentile.
–It’s important to remember we actually are doctors and there are patients on the other side of these images. Saying from a business perspective we could create demand by suddenly maxing out at 55 RVUs is one thing, but we don’t work in retail.
–If there is suddenly a ton of excess work, it would increase the drive for non-radiologist interpretations. Not exactly the path we want to be going down.
–In truth, I think we all know slow rads that are still bad and fast rads the can read way more than 55 RVUs safely. If we are going to take a patient safety angle, it really should be addressing the true outliers, rads that just crush 100+ RVUs with little regard for their reports.
–Generally speaking, some people just want to work harder and longer than others and they shouldn’t be prevented from doing it as long as it’s safe for patients. I understand the idea that we can create demand for our work and therefore stop paycuts, but I just think it’s very hard to do in practice and potentially dangerous for the profession.
–If I supported anything, it would be a much higher limit to cut out the true unsafe outliers. Re-do the RVU system to make it fair, and then have some limit at like 90 or 95th percentile reading. 100+ RVU a day readers or something. If there is going to be a limit at all, it would have to start with that.
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