[alex.nieto_484]

do i have to

[mohammedhosney99999_124]

i enjoyed this — thanks for sharing!

[bezalel72_205]

Very relevant. And I might need you all to come fix some stuff where I work…

[Patrick]

Good listen. Im starting to agree more on your view of subspecialization.

[gmail.com]

good stuff.
confirms what I thought, though difficult to see the future and how we pull out of this staffing “crisis” — is it appropriate to call it a crisis?
 

Quote from Daniel Corbett

I did a podcast with Daniel Arnold who runs The Radiology Report.  It was fun to do and we discuss a lot about the radiology job market and rad practice in general.  Give it a listen.

[link=https://theradiologyreport.podbean.com/e/navigating-the-challenges-of-hiring-and-recruiting-radiologists-with-daniel-corbett/]https://theradiologyreport.podbean.com/e/navigating-the-challenges-of-hiring-and-recruiting-radiologists-with-daniel-corbett/[/link]

[ljohnson_509]

^^ how is there a staffing crisis when there is no shortage of rads reading cases for 20-30/wRVU?

[btomba_77]

Quote from Drrad123

^^ how is there a staffing crisis when there is no shortage of rads reading cases for 20-30/wRVU?

There is a huge shortage of rads reading cases for 20-30/wRVU
 
Those companies have been shrinking … cutting off clients because they don’t have enough staff to cover all the work to be done.
 
_______
 
 
The issue (or one of the issues) is that they have been unwilling/ unable to increase compensation in a way that allows them to recruit and retain radiologists.
 

[ljohnson_509]

^^ ok, you would think that telerad rates would go up from 20-30/wRVU if they could not get enough rads? Supply/demand?
I guess this does not apply to telerad and corporate?

[toumeray]

Supply and demand apply in the long run but not necessarily in the short run. Badly run companies fail to adapt to market conditions fast enough and go bankrupt or lose business. Thats exactly whats happening with these PE telerad companies. Suits are still cashing in, cant hire radiologists, so they run up their debt until they go belly up, pay off the corporate debt and leave public common stock investors holding the back. Suits get their golden parachute after parasitizing the company for years. Change name/ start a new company from advanced radiologic imaging to superior radiologics imaging and rinse, repeat.

Its just corporate mismanagement which is happening all over the country in all fields.

[btomba_77]

Quote from Drrad123

^^ ok, you would think that telerad rates would go up from 20-30/wRVU if they could not get enough rads? Supply/demand?
I guess this does not apply to telerad and corporate?

 
Employer wages decisions always come slowly.
 
The same reason that Taco Bell decides to close at 10 pm rather than pay a kid the prevailing wage of $18/hr to work the late shift applies to telerads.
 
 

[ljohnson_509]

^^ yea, but radiology isnt Taco Bell right?

Youve got telerad companies failing to cover nights and breaking contracts forcing staff rads to do the work themselves. Endless job ads and spam recruitments to personal email.

What are they waiting for?

[btomba_77]

The labor/wage/supply/demand/employer/employee dynamics are similar

Dan- really enjoyed.

Were going to have to come up with some shift value in our group for on-site v remote

[gmail.com]

staff rads should get their own internal nighthawks and get control of their own destiny.  they just need to pay a competitive wage to stay up late, work alone and work very hard.
 

Quote from Drrad123

^^ yea, but radiology isnt Taco Bell right?

Youve got telerad companies failing to cover nights and breaking contracts forcing staff rads to do the work themselves. Endless job ads and spam recruitments to personal email.

What are they waiting for?

[jeevonbenning_648]

The $20-30/wRVU number doesn’t resonate with me. RVUs are all over the place.

What does this translate into:
$/chest x-ray
$/CT head
$/CT ab/pel

Thanks

[gmail.com]

I’m going off 2022 CMS RVU table for these numbers:
[not messing w/ PE or Malpractice RVUs OR GPCI]
 
CXR 2 views (CPT Code 71046) –  0.22 wRVU
 
CT head w/o contrast ( 70450) – 0.85 wRVU
 
CT Abd Pelvis w/ contrast (74177) – 1.82 wRVU
 
@$20/wRVU = $4.40/ 17.00/ 37.00
@$30/wRVU = $6.60/ 25.50/ 54.60
 
 

Quote from Re3iRtH

The $20-30/wRVU number doesn’t resonate with me. RVUs are all over the place.

What does this translate into:
$/chest x-ray
$/CT head
$/CT ab/pel

Thanks

[jeevonbenning_648]

Those numbers sound pretty good to me, blended that’s roughly 15 to $25 per study.

Especially if you are reading acute urgent Care ER tell the radiology type stuff where there’s a lot of normals.

[jeevonbenning_648]

For reference, I've been earning ~$48/RVU post tax (according to our data) in the military for a long time. Mostly bored at work because not busy enough, but have to deal with a lot of admin and military obligations which also take up time.
I'll gladly make half of that per study with a more flexible schedule and being able to read and live anywhere in the world.

Real estate passive income has paid me > $250K net of taxes annually, way more than I need to live a great life (3-5X of expenses), and this takes less than 100 hours per year, much less (like 10 hours per year) if you don't count attending webinars and podcasts which frankly is fun af to me.

So if life was strictly about $/RVU $/time there is zero reason to do radiology because passive LP in syndications destroys being a radiologist, earning like $10,000/hr and due to the tax code you legally owe $0 in tax year after year.

Life is not all about money, but reading this forum you sure as s* would think it is.

[btomba_77]

Governance, leadership, operations.
 
 
yep.
 
 
(good talk, Dan)

[gmail.com]

There was something that caught my attention and made me think about the current situation.
 
If a telerad company drops 10 small/medium size hospitals b/c of staffing problems, then if/when those groups fall apart would a large group swallow them up?  And then if those rads in those rural hospitals quit to retire, do telerad or find another job, what happens – the big group is left holding the bag and potentially struggling to recruit to a rural location or they need to send their own partners/associates out to the rural area from the city/suburb to cover.  Maybe the night time coverage can be integrated into the big groups internal night hawk group (if possible), but it seems like the stress of covering the smaller hospitals in the rural is transferred to the bigger group.  Or do you think a big group of 100+ can digest these small groups and thrive/survive?
 
Would like to hear Daniel Corbett’s thoughts if possible.
 
Thanks
 

Quote from Daniel Corbett

I did a podcast with Daniel Arnold who runs The Radiology Report.  It was fun to do and we discuss a lot about the radiology job market and rad practice in general.  Give it a listen.

[link=https://theradiologyreport.podbean.com/e/navigating-the-challenges-of-hiring-and-recruiting-radiologists-with-daniel-corbett/]https://theradiologyreport.podbean.com/e/navigating-the-challenges-of-hiring-and-recruiting-radiologists-with-daniel-corbett/[/link]

[btomba_77]

Quote from PPRad

If a telerad company drops 10 small/medium size hospitals b/c of staffing problems, then if/when those groups fall apart would a large group swallow them up? 

 
yes.

And then if those rads in those rural hospitals quit to retire, do telerad or find another job, what happens

The sh*t hits the fan.  The bigger the group the more able to bumble their way through the surge of cases.
 
Worst case scenario for a megagroup: you pay top $$ for a locums or two “boots on the ground” at the now empty rural hospital, ship all the subspecialty work to your own radiologists, and use your own contracted telerads (whose contract you were able to keep because you’re such a large and valued client) to sweep up the excess.
 
 
 
been there done that multiple times as my group expanded over the years.

[tdetlie_105]

Quote from dergon

Quote from PPRad

If a telerad company drops 10 small/medium size hospitals b/c of staffing problems, then if/when those groups fall apart would a large group swallow them up? 

yes.

And then if those rads in those rural hospitals quit to retire, do telerad or find another job, what happens

The sh*t hits the fan.  The bigger the group the more able to bumble their way through the surge of cases.

Worst case scenario for a megagroup: you pay top $$ for a locums or two “boots on the ground” at the now empty rural hospital, ship all the subspecialty work to your own radiologists, and use your own contracted telerads (whose contract you were able to keep because you’re such a large and valued client) to sweep up the excess.

been there done that multiple times as my group expanded over the years.

 
Tricky part is when the cost of boots on the ground (Breast/IR/GI fluoroscopy) surpasses the net gain from the tele-diagnostic work.  Certain rural/semi-rural hospitals will simply be out of luck.  Have already heard of pts being transferred bc no IR to place temporary HD catheter
 
Also agree with Dan when its comes to the overshoot with respect to sub-specialization. Simply not doable unless mega-group or academics.  Next few years will be interesting/turbulent 

[Unknown Member]

Excellent podcast. 

I think history repeats itself and younger rads are falling into the same traps we did, but in much more complicated times. We frequently got away with it because there was much more room for error. No way we would today. 

Governance, leadership, operational management are the foundation of a practice. Too many groups simply worry about their next bonus and filling out the next quarterly schedule, until there is none. Again, we got away with it to some degree, no longer. 
 
Proactively leading a practice is more imperative now than ever. Staffing up with an engaged team can be expensive, but is the best security you can buy.  Running lean and decentralized is short sighted and will devolve quickly.
 
I think a lot of groups are caught in their own dysfunction and dont want to hear what people like Dan have to say. Outside advice may save a practice. You have to be willing to listen. If rads wont, its likely their short term interests dont coincide with the long term prospects of a practice. 
 

[Unknown Member]

Were going to have to come up with some shift value in our group for on-site v remote
 
if groups dont take this seriously they are in for a world of hurt. Of course remote rads will say it shouldnt matter. If your leadership works remote, you are doomed, their self interests are not conducive to a functional practice. 

Get it correct up front. Once you establish dysfunctional patterns of staffing its that much harder to fix. People fight for what we foolishly give them, as if theyve earned. 
 
Leadership requires dealing with conflict. Too many rads are afraid to address staffing issues openly. And so schedules devolve ito non-workable quagmires. There are points of no return, so the earlier you deal with it the better.  

[Robbro524_990]

The above information by boomer about dysfunctional groups is probably true, but with one big exception (especially compared to his age cohort): the radiologists just ARE NOT THERE in the ‘normal’ numbers that most administrators have in their own demographic mental model of how the world works.

Plus, a lot of the Boomers are exiting stage right as we type this – further exacerbating this ‘numbers’ conundrum.

Sure, administration may WANT to change groups, based on dysfunctional patterns of behavior or on-site conflicts, but, at least in this environment, they may not have any other options.

Also, from a COO’s perspective, if a change in radiology groups is made, and it doesn’t work out, then they really risk losing onsite coverage completely (and, hence, their own jobs). Because, this time around at least, radiologists and even radiology groups can and will leave (and possibly for a better job). These tele jobs keep getting better and better too, if one hasn’t noticed; just based on supply and demand.

This time, just based on the workforce numbers, it really is different.

I would actually argue that this healthcare workforce is actually closer to being ‘normal,’ since the boomer generation distorted ALL markets (workforce, financial, educational, etc), simply based on the sheer numbers of human beings that were born after WWII.

So, in my opinion at least, the current risk lies with hospitals and administration more than it ever has (rather than with existing radiologists and radiology groups) because you could show up half drunk to a job interview in this market and (ESPECIALLY if you can read 80 rvus a day), and they will still hire you.

And probably also give you a signing bonus.

The market has forever shifted, mainly due to demographics.

Likely never to ‘normalize.’ Unless, we start letting mid-levels read exams. I’m pretty sure most people on here (and especially our new graduates) have strongly held views there, though, so I’m not as worried about that threat….yet, at least.

Will AI help? We will see.

[Robbro524_990]

That was a great podcast btw.

Thanks for sharing!

[ljohnson_509]

Docdawg, perhaps I have been around too long but I have seen sharp reversals of the rad market multiple times over my career. There is a chance we turn again, not sure how but perhaps AI, extenders, big drop in volumes etc.

The current trend of reading non stop all day and then some is not sustainable and will lead to greater rad attrition over the long run.

This career aint fun for many/top 10 burnout specialty per surveys. But it pays well for now. Some pay with their mental health for the money.

[Unknown Member]

Just curious Dan

Who was you podcast partner?

Is he a radiologist?

[Unknown Member]

I agree many hospitals are stuck with their practices because of market conditions, and the risk of losing a contract is less than times past. But what I’m concerned about is the satisfactory function of the practice itself. Groups can muddle along overworked with “drunk” coworkers; who wants that? Successful management of a practice should be about patient care and radiologist job satisfaction. Hospitals don’t manage private practices, the radiologists do; that’s the point of a PP. The dysfunction ruins their work lives, how it relates to the contract is secondary. There is more flexibility to creatively manage a practice than ever. 
 

Quote from DOCDAWG

The above information by boomer about dysfunctional groups is probably true, but with one big exception (especially compared to his age cohort): the radiologists just ARE NOT THERE in the ‘normal’ numbers that most administrators have in their own demographic mental model of how the world works.

Plus, a lot of the Boomers are exiting stage right as we type this – further exacerbating this ‘numbers’ conundrum.

Sure, administration may WANT to change groups, based on dysfunctional patterns of behavior or on-site conflicts, but, at least in this environment, they may not have any other options.

Also, from a COO’s perspective, if a change in radiology groups is made, and it doesn’t work out, then they really risk losing onsite coverage completely (and, hence, their own jobs). Because, this time around at least, radiologists and even radiology groups can and will leave (and possibly for a better job). These tele jobs keep getting better and better too, if one hasn’t noticed; just based on supply and demand.

This time, just based on the workforce numbers, it really is different.

I would actually argue that this healthcare workforce is actually closer to being ‘normal,’ since the boomer generation distorted ALL markets (workforce, financial, educational, etc), simply based on the sheer numbers of human beings that were born after WWII.

So, in my opinion at least, the current risk lies with hospitals and administration more than it ever has (rather than with existing radiologists and radiology groups) because you could show up half drunk to a job interview in this market and (ESPECIALLY if you can read 80 rvus a day), and they will still hire you.

And probably also give you a signing bonus.

The market has forever shifted, mainly due to demographics.

Likely never to ‘normalize.’ Unless, we start letting mid-levels read exams. I’m pretty sure most people on here (and especially our new graduates) have strongly held views there, though, so I’m not as worried about that threat….yet, at least.

Will AI help? We will see.

[Robbro524_990]

That’s fair.

Maybe I’m more pessimistic now than I was in earlier days because I think that some amount of dysfunctional behavior amongst radiologists/MDs and medical groups is inherent; simply because human beings are so different in their values, views, personalities, and beliefs. The question is: how much dysfunction is an individual willing to accept, especially if the pay is really good. My guess, based on experience, is A LOT.

Surely, finding a group where that dysfunction is mitigated by good leadership would be ideal. They do exist, for sure.

But, finding a truly ‘utopian-ish’ group may come at a financial cost. And, then, that becomes a more personal / philosophical decision, in my opinion, at least. I think I’d rather just take some degree of group conflict, as long as the $$$ is good.

Plus, if a group implodes, then you will be hired tomorrow, anyway, if you are any good at all. So, why even worry about whether or not everyone gets along? I just don’t think it matters that much, as long as the work is getting done (in this market).

[Robbro524_990]

Oh great, this guy (Chirorad) is still alive.

The collective IQ of this thread just dropped precipitously.

[tom.claikens_334]

.

[lisbef3_453]

That was a good podcast.   What I’m not hearing either there or here is what the accepted ‘vig’ is for these remote ‘list crushers’ in either reduced pay or increased productivity.  20%?  50%?

[Robbro524_990]

I thought they/he mentioned a roughly 20% differential.

Maybe not, though

[Robbro524_990]

I was joking about Chirorad too btw.

He is sometimes a useful troll.

[btomba_77]

He did suggest 20%

But ideally it would be whatever differential keeps the group able to provide excellent on-site service.

I could easily picture a setting in which a 20% productivity expectation difference is too little.

Particularly in group settings in which productivity goals are fairly easily achievable and/or when the on-site environment is particularly frustrating with procedures/interruptions/ admin work and/or when the on-site setting takes a long time to get to.

If you told me that instead of 10k RVUs I now need 12k per year and I never have to come into the hospital, touch another needle, or attend another meeting again Id jump for it.
 
 
 

[Unknown Member]

Not trying to troll

Just wondering was his podcast partner a radiologist actively recruiting or not

Thought the podcast was good and give a little historical perspective from before my time

[Robbro524_990]

Agree on the above 20% differential discussion.

I wonder what the financial tipping point is whereby your tele rads jump ship to another group, although it will probably vary based on your group dynamics and the pain of working onsite versus tele (and the difference in pay, of course).

To me, 20 to 30% pay differential feels about right, overall, but (again) I think there’s a great degree of variance there.

Plus, isn’t everyone (in medicine at least) trying to hire right now, Chirorad? Maybe less so in tech these days, though. Ouch. Most in that industry are taking it on the chin. For now.

[Unknown Member]

Thanks everyone.  Dan Arnold is the host of The Radiology Report and MRI online. He is a business guy who’s wife is a radiologist.  He knows his stuff.  There is a lot to absorb in the comments above.  Here is how I see it.  The current number of clinically practicing radiologists is somewhere around 33,000 nationwide.  The educational system is producing an average of 1,200 new providers every year.  My latest estimate is there are still 8,000+ radiologists past retirement age still working.  So how does the industry with an aging workforce and a static supply of new providers handle an average 6% increase in volume?  The numbers just don’t add up.
 
I believe the way imaging paradigm in the US will be drastically changing.  Referring physicians and hospital administrators have come to expect 15 minute stat cases and 24 hour outpatient turnaround times.  Hospitals have come to expect 24/7 diagnostic and IR services and the expectation the service is free and their contract has value. CMS has consistently driven down the cost of reimbursement for imaging because it is by far the largest expense in healthcare.
 
This of course leads us to the basic premise of capitalism which is supply and demand.  We all expect that if we work harder we can earn more but the system is set up against physicians, especially hospital based physicians.  What radiologists are paid is determined by the government and insurance companies.  This system only works as long as the radiologists stand for it.  I believe the coming years with the severe shortage will place monumental challenges on the system. As the shortage deepens, more groups will fail and hospitals will lose coverage and there will be NO one answering their RFPs.  Right now there are many entrepreneurial groups that will snatch up these hospital contracts and try to provide service.  They will be ultimately unsuccessful in hiring onsite radiologists to anchor the hospital unless they think completely outside the box in structuring the position.  So ultimately it ends up being a teleradiology solution with whatever onsite service they can scrape together.  What the hospital expects, hell no!
 
There will come a time when the radiologists in private practice will hit the limit of their productivity.  Many are hitting this right now and more many private radiology practices are one to two resignations away from total collapse.  We are early in the game and the hospital administrations are slow catching on about what is happening.  Many will not hear what their group is telling them and reject financial assistance offhand.  Financial assistance can help in the short term making the group more competitive but it won’t help in the long run. 
 
I am trying to get my mind around how the industry can adjust and provide the service needed.  I think it will ultimately be private practices providing a combination of dedicated onsite and remote coverage with a premium paid to those on the ground.  It will be interesting to see what groups can come up with the right model.  There will certainly be winners and losers in the coming imaging shakeup.
 
Sorry for the rambling post but I am trying to share my thoughts which are constantly evolving.
 

[lisbef3_453]

Perhaps a DRG payment model for the ED spearheaded by CMS (as it currently exists for admitted patients) will flip the incentives that drive the volume increases, not the least of which are the preponderance of noctors and the overall dumbing down of clinical medicine.

[g.giancaspro_108]

A DRG type system for ED and outpatients seem the most likely outcome, but there are other possibilities.  CMS will fight to continue to reduce payments.  Holding payments steady seems like a lofty goal and increasing payments at this point would essentially require an act of congress that legislators are unwilling to undertake.  With data showing midlevels drive up the cost of care and lower the quality perhaps some places like HMOs and ACOs will attempt to reduce midlevel usage, but in the FFS world hospital admins love them and therefore midlevels are only going to increase in numbers.  This means further reductions in pay with increases in volume to everyone else, including radiologists.
 
Nursing and technologists are striking for and receiving increased pay, so that is further reduction in pay for everyone else, including radiologists.
 
How the VA will survive this is anyone’s guess.  Their payment for physicians is already so far below market for so many specialties that recruiting is an overwhelming challenge as is. 
 
Boomer has been saying for years on these forums that good group leadership is essential to minimizing the damage and bad leadership is utterly destructive, and it has been years since we have seen his words played out before us in such great numbers across the country.
 
Dan mentioned he is trying to figure out how we can provide the service needed in the current times.  I feel that the people in charge (insurers, hospital administration, government) are not very interested in seeing that the service which is needed is provided.  If we look at the UK, the NHS has been far behind on imaging [i]for years.  [/i]The NHS leadership clearly has no intention of solving their shortfall apparently because that would require money.  They would rather have exams sit unread for months than pay radiologists (and non-radiologists which is standard of care in the UK system) to catch up on their unread studies.  Perhaps that system will become status quo here as well (including allowing non-physicians to interpret radiographs), because admin, insurers, CMS have made clear that they have no intention of doing what is best for the patient or for the taxpayer, they will do what is best for admin and insurers including letting them write the legislation.
 
Eventually, without government intervention this will likely crumble apart into a larger share of DPC private physician care and the standard insanely expensive and inefficient care for everyone else. 

[btomba_77]

Quote from Daniel Corbett

 The numbers just don’t add up.

…
 
As the shortage deepens, more groups will fail and hospitals will lose coverage and there will be NO one answering their RFPs.  Right now there are many entrepreneurial groups that will snatch up these hospital contracts and try to provide service.  They will be ultimately unsuccessful in hiring onsite radiologists to anchor the hospital unless they think completely outside the box in structuring the position.  So ultimately it ends up being a teleradiology solution with whatever onsite service they can scrape together.  What the hospital expects, hell no!

agree with this take … with continued conglomeration

[lisbef3_453]

Quote from dergon

Quote from Daniel Corbett

The numbers just don’t add up.
…
As the shortage deepens, more groups will fail and hospitals will lose coverage and there will be NO one answering their RFPs.  Right now there are many entrepreneurial groups that will snatch up these hospital contracts and try to provide service.  They will be ultimately unsuccessful in hiring onsite radiologists to anchor the hospital unless they think completely outside the box in structuring the position.  So ultimately it ends up being a teleradiology solution with whatever onsite service they can scrape together.  What the hospital expects, hell no!

agree with this take … with continued conglomeration

 
I agree, but this will only work in the short term.  

[afazio.uk_887]

Rich Whitney did a pod cast where he said RP expected to make $500 million in profit 2023.   That’s impressive imo.  They must be extracting money from greedy hospital systems…. more power to them.   A lot of the Rads will benefit as well from this strategy as share holders in the company.  
 
 

[sriramjsrini_593]

Wouldnt trust much from RP

[g.giancaspro_108]

In December of 2021 RP employed over 3000 radiologists, it is probably higher in 2023.  Even using the 3000 radiologist number they can make that $500M by merely taking $167,000 from each rad, and based on the numbers I’ve seen they are making much more than that off each.
 
 

Quote from Waduh Dong

Rich Whitney did a pod cast where he said RP expected to make $500 million in profit 2023.   That’s impressive imo.  They must be extracting money from greedy hospital systems…. more power to them.   A lot of the Rads will benefit as well from this strategy as share holders in the company.  

[tdetlie_105]

Quote from sandeep panga

In December of 2021 RP employed over 3000 radiologists, it is probably higher in 2023.  Even using the 3000 radiologist number they can make that $500M by merely taking $167,000 from each rad, and based on the numbers I’ve seen they are making much more than that off each.

Quote from Waduh Dong

Rich Whitney did a pod cast where he said RP expected to make $500 million in profit 2023.   That’s impressive imo.  They must be extracting money from greedy hospital systems…. more power to them.   A lot of the Rads will benefit as well from this strategy as share holders in the company.  

 
Seems like RP is here to stay.  Don’t know anyone personally involved with them so most of my info comes from here.  Guess posts predicting their implosion are off.

[afazio.uk_887]

 
RP has figured out alternative revenue stream via hospital subsidies for coverage.  Smart play.  They have moved beyond simple professional fee skim model.  They also are largest teleradiology shop in the US.  
 
They can do this sort of business cause of the scale they have achieved.  Ultimately, it may payoff for Rad shareholders down the road. 
 
Personally, these massive greedy hospital systems have it coming to them.  Hospital CEOs and their private jets can spare some coin. 

[g.giancaspro_108]

There has been nothing to suggest it will pay off for RP “shareholders” or bondholders, or anyone other than their PE owners.  Have you seen their structure of ownership?  Has any RP physician sold their shares?  Is there any mechanism for them to sell their shares?  There has been nothing yet to suggest any rad that traded their business ownership for RP shares will receive anything at all for those shares.
 
Their bond rating was downgraded again a few months ago, I think it is Caa1 now.
 
But you know all this already.  I’m unclear why you support RP.  If you have some other knowledge that is not public then please share.
 

Quote from Waduh Dong

They can do this sort of business cause of the scale they have achieved.  Ultimately, it may payoff for Rad shareholders down the road. 

[afazio.uk_887]

The money in the health care system has only increased, it has just been shunted away from doctors to the health systems. RP may be able to siphon off some of this money from the hospitals by leveraging the Rad shortage and WFH to service contracts that are difficult to staff. Some of this money will make it to Rads who are shareholders when there is liquidity event.

To me, in my unbiased opinion, this is actually a good business strategy. Thats all bruh

[Patrick]

I agree that the attempt at achieving scale and market power is smart.  The questions I have:
-Will their leverage and the associated risk allow it to be realized effectively?
-Will their scale put a target on their back?  
-How much of the money will actually end-up in physician pockets after the debt, senior investors (some of whom are rads), managers are paid?  TBD…  A successful liquidity event actually seems quite distant to me?  Sale seems more likely than an IPO, but who will buy?
-Is it better for the dollars to go to “greedy” non-profit health systems OR “greedy” for-profit, non-provider investors?  
 
But, OK, if it helps you get through the day speculating on the future value of your shares, good for you.

[g.giancaspro_108]

Thank you for the explanation and I appreciate your line of thinking.
Nothing in their past makes me think that is what will happen.  Any increase in profits they see from hospital subsidies, etc will, based on their past actions, go directly to their owners (the real owners, not those who sold their businesses for “shares”) and to pay off the increasing interest rate on their debt.  I think their current notes are around 10%.
 
Just for fun, look at their shareholder structure and who gets paid what in the event of the possible liquidity event you mentioned.  Next, look at the likelihood of them being able to actually make that liquidity event happen.  The odds are unfavorable.
 
I’m not certain if you believe the things you’re saying or you’re just having fun winding us up.
 

Quote from Waduh Dong

The money in the health care system has only increased, it has just been shunted away from doctors to the health systems. RP may be able to siphon off some of this money from the hospitals by leveraging the Rad shortage and WFH to service contracts that are difficult to staff. Some of this money will make it to Rads who are shareholders when there is liquidity event.

To me, in my unbiased opinion, this is actually a good business strategy. Thats all bruh

[afazio.uk_887]

 
My point really was just it could be a business model that works.  

[Robbro524_990]

It all depends on their company cash flow and debt structure.

However, in this market especially, I can’t imagine how both of those variables are actually improving, especially with this impending disaster of corporate debt markets (which haven’t yet imploded…but most likely WILL). We shall see.

If someone gave me 100k in RP stock, I’d sell it for cash. Quickly.

But that’s, like, just my opinion, man.

[kmh0667]

Be careful with your 20-25% cut to teleradiologists. They will leave to the better spot that values their call and expertise just as much as the on the ground rad. Remember, the in person consult died about 15 years ago. The pay differential is becoming less and less.
 
 

[farzadahmadimedrn710_43]

Quote from Waduh Dong

Rich Whitney did a pod cast where he said RP expected to make $500 million in profit 2023.   That’s impressive imo.  They must be extracting money from greedy hospital systems…. more power to them.   A lot of the Rads will benefit as well from this strategy as share holders in the company.  

You seriously take the words of the CEO of a predatory PE firm as truth? The statement is PR. Did Rich also comment upon why young non-buyout radiologists are fleeing RP groups in droves? Why can’t RP pay competitive wages to its employed “partner in name only” radiologists? Who’s going to read all these RP studies when there are no more young dumb fellows signing up to waste 2-3 years of their life in a dead end PE job?
 
*crickets*

[afazio.uk_887]

edit
 
 

[ipadfawazipad_778]

I wouldnt write RP off until they are gone. Maybe they can negotiate great rates with payers. So long as people keep signing up to work with them and they dont lose any contracts they can probably fumble along. If they succeed and eventually start radiology residencies that will be the end. The easy answer is any radiologist who hopes to have a longer than 7 year decent career should not work for RP. I dont fault the sell outs or those with a less than five year plan to retirement. I dont understand anybody else working for them though.

[gmail.com]

I don’t know the details of the No Surprises legislation, but if you are a payer dealing w/ RP and decide not to fall in line, then RP cannot come back w/ exorbitant rates for out-of-network patients coming through the ED.  I know this is a simplistic view of the No Surprises bill, but isn’t it supposed to prevent RP from going to payers with their vast network of rads and get really good rates?

Quote from AKOMAN

I wouldnt write RP off until they are gone. Maybe they can negotiate great rates with payers. So long as people keep signing up to work with them and they dont lose any contracts they can probably fumble along. If they succeed and eventually start radiology residencies that will be the end. The easy answer is any radiologist who hopes to have a longer than 7 year decent career should not work for RP. I dont fault the sell outs or those with a less than five year plan to retirement. I dont understand anybody else working for them though.

[Robbro524_990]

There are some really good points on here about RP.

I just hope that they didn’t lock in many long term, low interest rate, bonds or credit to make these acquisitions.

If the majority of their debt is short term and/or high interest, then they just have to be screwed.

Unless they have a huge PE firm or pension system backing them, which they may. Still, at some point, even firms like KKR will cut you lose if you aren’t cash flowing (ie. making money).

[tdetlie_105]

Quote from PPRad

I don’t know the details of the No Surprises legislation, but if you are a payer dealing w/ RP and decide not to fall in line, then RP cannot come back w/ exorbitant rates for out-of-network patients coming through the ED.  I know this is a simplistic view of the No Surprises bill, but isn’t it supposed to prevent RP from going to payers with their vast network of rads and get really good rates?

Quote from AKOMAN

I wouldnt write RP off until they are gone. Maybe they can negotiate great rates with payers. So long as people keep signing up to work with them and they dont lose any contracts they can probably fumble along. If they succeed and eventually start radiology residencies that will be the end. The easy answer is any radiologist who hopes to have a longer than 7 year decent career should not work for RP. I dont fault the sell outs or those with a less than five year plan to retirement. I dont understand anybody else working for them though.

 
Had the same thought.  RP (or any group) will never have enough clout to dictate rates with commercial payors given the alternative is going out-of-network (I’m not that savvy so may RP/PE has already figured out a work around)

[smfst7_929]

Keep in mind some posters on this forum are RP owned and have a vested interest in convincing people that RP is alive and well. They dont want their sellout shares to become even more worthless than they already are. Its easy to spot RP drones after months on this forum. Drrad is one for example.

[Robbro524_990]

Good point. I’m sure RP promised them to go public and that their increasingly diluted shares would be worth ‘millions.’

The problem is that a 20 multiple of zero is still zero, by my math at least. But, hey, I’m sure Rich Whitney explained all that to them in great detail (and explained all the risks involved too).

[JohnnyFever]

Seriously? RP squeezes the radiologist much more than it squeezes a hospital

[smfst7_929]

I think youve spotted another RP apologist/shill

[smfst7_929]

I still chuckle when I hear of stories of people that regretted selling out when they realized they actually end up losing money before 10 years. The word is out that selling out to RP is not even a good financial decision. Add to that the headaches of having an overlord metaphorically whipping you for RVUs, and the potential sellouts become fewer and fewer. If you cant even convince the small percentage of greedy rads, what do you have left? Backroom deals with hospital administrators? Even admin are skitting about RP. Someone I forget who posted here awhile back clearly stating that RP lost 5 chicago hospital contracts at Ascension because they had a backlog of thousands of cases and clinicians, patients and admin were all pulling their hair out.

Only RP shills can claim that RP is alive, well and rapidly taking over all of Radiology. It just isnt true. And with the near critical shortage of radiologists, more retiring than joining, increasing volumes RP is not long for this world. Sure they may hang in for another decade or evolve into a smaller company that existe in niche markets, but it you say they are taking over you are either naive or RP owned and employed

[mwakamiya]

Large corporate/PE backed groups are losing contracts left and right. Both in BFE and in big cities. 
As interests rates continue to go up, reimbursements payments go down, rads want to work less and cost of labor keep getting worse, the house of cards will crumble. 

[smfst7_929]

Yep you got it. Just a question of time. Im not naive enough to think they will dissolve in the next few years. Highly doubt they survive anywhere close to their current 3000 number in 10-20 years tho. This assumes nothing crazy happens in Radiology like allowing NPs/PAs to dictate cases nationwide. If we ever allow midlevels to dictate cases on a nationwide basis, all bets are off. The corporate and PE model does extremely well profit wise by compromising patient care with barebones physician staffing and filling out the rest with midlevels

[mwakamiya]

That other guy that shall remain nameless is a troll.
Either he is the most naive and clueless person in the world or he is an in the closet corporate sellout. 

[ipadfawazipad_778]

Can anybody make which contracts RP has lost? Would help me be more hopeful about their downfall.

[smfst7_929]

5 hospitals in chicago apparently.

[smfst7_929]

It was said they tried to common list these hospitals and still couldnt make it work. Apparently thousands of studies on the list at any one time. Imagine the morale at those sites. It was probably cherry picking nonstop with the worst cases going unread for days or weeks. This is mostly speculation and I cannot confirm it

[Unknown Member]

Quote from sartoriusBIG

It was probably cherry picking nonstop with the worst cases going unread for days or weeks. This is mostly speculation and I cannot confirm it

 
Yes this goes on at RP “subspecialized” practices.

[Melenas]

Hate to be debbie downer but I doubt much will change in the next 10 + years. The 33k or so radiologist arent ever gonna agree on how to change things. We will all keep coming back to the sweatshop as long as we keep making in the 400s. Even with all the changes, rads are still making way above the average physician. Sure we will complain but nothing drastic will change. CMS and other physicians/nurses/techs probably dont  have sympathy for us. They want their share of the pie and I dont know anything that is going to stop that train.
 
Radiologist have gotten used to having a certain level of income but we arent in charge. We gave that up when we decided we werent real doctors and hide in the dark room. Imagine if we did a real H and P, read the study and treated the patient. 
 
A quick solution is to do what the rest of medicine has done, use more PAs and NPs. There is really no reason they cant learn and dictate all the simple cases and have radiologist sign off. This is what is happening in primary care and the ED and even in some more complex cases. They learn and get better as the years passes. I for one do not want this but from economics and business point of view, it makes sense. A single radiologist could supervise a whole set of PAs to dictate all the basic ones and rad can handle all the harder cases. That solves many of the shortage of radiologist problem. Of course we should learn from other areas of medicine who flooded their field with mid levels.
 
In short, I think the cuts will keep coming, we will all have to dictate a little more each year, we will complain, there will be papers written about it, analyses will be done, but in the end I doubt drastic change will happen. 
 
 
 

[clickpenguin_460]

How do you know when a radiology study is hard?

[Melenas]

Quote from Cubsfan10

How do you know when a radiology study is hard?

Just like you know when a clinical case is hard or easy. The PAs and NPs screen patients all the time. 

[Melenas]

I for one would pick radiology again if I could start over as a medical student. 
 
I am very fortunate and thankful to be in a great specialty even with the battles we have to wage. I think it is a great field for someone who doesnt want to be at the center of attention of healthcare but still wants to contribute to it. 

[afazio.uk_887]

 
It is a great field and has done me right in life generally speaking. I will continue to do it until AI takes over some day [:D]

[ipadfawazipad_778]

Heck no on the midlevels in radiology!!!! Look what great things they have done to all the fields they are widely utilized in. NOT

[clickpenguin_460]

So you have a radiologist screen cases and say okay these are easy and these are hard?

You can’t screen rads cases like you can patient complaints.

The plain film foot could be harder than the brain mri on the list.

[Unknown Member]

Exactly,   it takes 4 years of training (plus medical school and internship) for a rad to train,  and none of us are perfect after that.
How are u gonna train a midlevel to do that job in a week,  or a month, or a decade?   

[clickpenguin_460]

The major thing here is that in clinical fields the midlevels mistakes and poor medical acumen are hidden in the chart or in a subjective patient visit.

Radiology results are forever plastered in the chart for everyone to see.

Imagine going through mid-level notes looking for mistakes and errors in care and you can imagine what rad reports would end up looking like. Radiology is hard enough for us to do and we will all make mistakes.

They can probably sling some barium and do some light needle work though.

[22002469]

Patient visits should all be videotaped. 
 
Not as good as the permanence of radiology images, but better than nothing. 
 
Mid-levels fill in nonsense without even asking about potential pertinent issues.  

[Melenas]

Quote from kcrad

Exactly,   it takes 4 years of training (plus medical school and internship) for a rad to train,  and none of us are perfect after that.
How are u gonna train a midlevel to do that job in a week,  or a month, or a decade?   

 
I guess I dont think what I do is that hard, at least not the plain films and head CTs. It is like being in residency. 1st year you learn to dictate and the attending looks at it very carefully and by the 4th year, the attending is signing things off without even looking at them (for the most part). Why is that not possible with PAs or NPs? I think it is. They can be taught to learn all the danger zones and not miss lesions. None of us were born with this knowledge. They dont need to learn everything in radiology; they can be focused to specific areas of radiology, just like they are in other areas of medicine. 
 
Again, Im not advocating that we do this. I am simply saying, it isnt that hard to take that leap and let them do it. 

[ipadfawazipad_778]

Those who not learn from history are doomed to repeat it. Seriously in theory mid levels could do FM and ER, I n actuality they mostly cant and contribute to worse care and more wasteful healthcare spending. The answer is most definitely not opening up more specialties specifically radiology to mid levels. Can you imagine the increased image volumes for unnecessary further evaluation? Probably would result in an even greater shortage of radiologists.

[Melenas]

I think the regular doctors are also to blame for ordering stuff left and right. Look at any ED for example, the docs are no different in ordering than PAs/NPs. Ive seen one article someone that showed some increase radiology utilization, but it wasnt an astonishing amount. 

[Melenas]

And I dont think, it is necessarily unique to radiology. I bet other areas of medicine are having these dooms day conversations about their respective fields. 

[smfst7_929]

Sorry but diagnostic radiology is not the ED. A recent NP or PA grad can wing it in the ED setting etc by ordering imaging or other consults, but their severe lack or knowledge would become readily apparent within one day on the job in the radiology department reading easy ones. What exactly is an easy one anyway. Plain films? Those are harder than CT or MRI sometimes.

Another problem is they dont know what they dont know. Imagine yourself and your colleagues as R1s if you have a decent memory of what your knowledge base was at that time. You really going to cut loose a bunch of R1s to read solo on day 1? Hell, even after a year I wouldnt cut many R1 loose to read solo without overread. Most programs dont even allow R1 to submit prelims or take call. So in your mind R1s can take call and read solo on day 1? Because thats what youre assuming with PAs and NPs. Also keep in mind on the average an r1 is a standard deviation above the average PA/NP intelligence wise.

Frankly that has zero chance of happening unless they either overhaul tort reform completely and/or create medicare for all. Or if there is a dire critical shortage that starts compromising healthcare enough to make the news on a weekly basis

[xavierpanchana_510]

There are a lot of rads that dont read foot xrays and head ct’s well, so I’m not remotely worried about PAs and NPs.

[btomba_77]

Quote from Adahn

Quote from dergon

Quote from Daniel Corbett

The numbers just don’t add up.
…
As the shortage deepens, more groups will fail and hospitals will lose coverage and there will be NO one answering their RFPs.  Right now there are many entrepreneurial groups that will snatch up these hospital contracts and try to provide service.  They will be ultimately unsuccessful in hiring onsite radiologists to anchor the hospital unless they think completely outside the box in structuring the position.  So ultimately it ends up being a teleradiology solution with whatever onsite service they can scrape together.  What the hospital expects, hell no!

agree with this take … with continued conglomeration

I agree, but this will only work in the short term.  

I’m not sure how long the “short term” will be.  Nor am I sure how successful large PE, corporate, mega-system, mega-academic groups will be when they take over.
 
 
But for now, you can bet your a** that when that hospital RFP goes out they’re gonna try to get that contract and muddle through.
 
 
I’m not sure for how many years that will go on, but I do think it will cause the percentage of rads working in traditional private practices to continue to decrease.
 
 
 
 

[cbzagaceta]

Dan,

Agree with almost everything you have stated.

However, you are way off in saying that imaging is by far the largest expense in healthcare.

Among the fastest growing, sure.

[btomba_77]

Speaking of differential productivity:
 
 
 
Yesterday I was WFH. I read 30 MRIs, 12 CTs and 35 x-rays. Not a bad day at all.
 
 
Today I am on the ED plain film rotation with an R1 who has never read bone radiographs.
 
Since 7:30 am I have done 30 x-rays and one elbow arthrogram. That’s it.

[ipadfawazipad_778]

Maybe Im niave, but seems like PP should be able to undercut RP in terms of hospital subsidy because RP has so much corporate fat to support. Im biased against RP. Next will be them starting their own residencies and then our fate will
Be like ER.

[Patrick]

When one considers there are PPs running out there with between 12-17% non-physician overhead,  I think you are on to something.  That said, more private practices need to understand that sometimes, you have to invest to improve operations, etc.  PP sometimes get too penny-wise IMO, a problem that the Pound-focused PE and corporate groups dont have (other than the super cheap, unrealistic telerads groups operating). 

[aldoctc]

Interesting podcast discussion. Thanks for sharing.

By the end, it reminded me of my (rare) discussions with very religious types where my standard retort to their “proof” of their beliefs has come to be “IDK if there’s a God, an afterlife, nor why any of us are here. You don’t either. If there are answers, I’m willing to bet what you refer to as my “soul” that they aren’t the version you believe.”

At least DC has the honesty to discuss the topic of the future of radiology from a thoughtful position and not slide into dogma.